About 15 years ago, I recall chatting with a colleague from Bucks County who practiced family law but also maintained a general practice. She informed me that she was starting to sue adult children on behalf of nursing homes which provided their parents with care. I was familiar from reading the Support Act that it had some language allowing suits on behalf of indigent persons. In fact, it said that a child of an indigent person could be held liable even if the person was a “public charge” (e.g., welfare recipient). The law dates back to 1937 and is found at 23 Pa.C.S. 4603.

Over the past 15 years I have occasionally heard about this kind of case being brought but a decision in 1700 Pine Street Operations LLC v. Berger is the first case I have encountered since Presbyterian Medical Center v. Budd, 832 A.2d 1066 (Pa.S. 2003).

The plaintiff operates a nursing and rehabilitation center in Norristown, PA. In October, 2015 the facility admitted Stephen Howard as a patient. His daughter, Caroline Berger filled out the paperwork at the time of the admission. Ms. Berger signed an admission agreement on October 30, 2015 even though she told the facility that her father was fully competent to sign the agreement. The facility (1700 Pine) said his signature was not required. Mr. Berger also applied for Medicaid on his behalf. That request was denied and while the opinion does not make clear whether that denial resulted in his discharge the ruling indicates that Mr. Howard died on November 30, 2015, the date he was discharged.

1700 Pine then issued an invoice for Mr. Howard’s care. When it was not paid in October, 2017 the facility sued Ms. Berger for just under $13,000 with a request for 18% interest on the balance. The claim was in contract and under Section 4603 of the Support Act. The precise defenses posed in the defendant’s answer are not set forth in the opinion of Judge Thomas Rogers of Montgomery County but the defenses referenced in the opinion included:

1.       The facility said they would help with the Medicaid application but gave no assistance.

2.      Mr. Howard left no estate and had no assets at the time he was admitted for care.

3.      Ms. Berger did everything she was required to secure Medicaid support for her dad.

The Court found Ms. Berger’s testimony to be “extremely credible.” The Plaintiff

showed while there were technically no estate assets Mr. Howard died with three life insurance policies which paid $25,500 to Ms. Berger by reason of her father’s death.

Without specification, the trial court found that although she signed the agreement, she did so for her father and that there was contractual privity between her and the nursing home. Moving onto the claim under the Support Act, the court cites the applicable statute. It then relied upon the defendant’s testimony that her dad was indigent when admitted for care. Although the insurance proceeds were not referenced as the basis for its finding, the court found that Ms. Berger had the financial ability pay the facility the amount invoiced.

On the claims for attorneys fees and 18% interest, both of which arose from the contract signed at admission, the court declined to award either as Ms. Berger was not a party to the agreement. The implication was that she signed as her father’s agent although agency is not discussed.

The case is not precedent setting but does demonstrate issues that commonly arise in what might be termed “last placement admissions.” The author has been down this road when he admitted his mother to hospice in 2009. There are dozens of documents to sign and needless to say, the people executing them are non thinking like lawyers even if they have that license. In one sense, this case was easy. The defendant had $25,500 “found” dollars arising from her father’s passing. The court held that half of those proceeds were going to pay dad’s final bill. It’s a much tighter case if there was no insurance policy to collect and the defendant was, herself in some financial distress. Judge’s are not insensitive to these matters. They have discretion but they also have a responsibility to enforce laws that have been on the books for four generations.

For the layperson reading this, one defense posed here was problematic. When Ms. Berger showed up with her father, of course the facility said they would be happy to assist with the Medicaid paperwork. It appears to have been the only source of payment known to the facility when the admission was made. But an offer to help should not be taken as some kind of warranty that Medicaid will be granted or that the facility can or will do more than hand you the forms and suggest what needs to be completed. They are in the business of providing care for the infirm. They are not financial investigators or family historians. The other takeaway is that unless the hand of the patient cannot make a “mark” the patient should be signing the contract so there is no indication that the child is co-signing, guarantying or acting as surety for the person getting the care. Signing as witness to a parent is one thing. It is not the same as signing as the party forming the contract for another person’s care.

The duty to support a minor child has long been termed by the courts as “well nigh absolute.” The duty to support an indigent parent does not fall into that category but the statute adopted long ago does make clear that care providers for an indigent person can look to that person’s children to contribute if not entirely pay for medical services reasonably necessary for the indigent person’s care.

For further research 37 Pa. Law Encyclopedia Chapter 3, Section 61 (LexisNexis 2012).