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IN THE CIRCUIT COURT OF THE TWELFTH JUDICIAL CIRCUIT
IN AND FOR SARASOTA COUNTY, FLORIDA
SARASOTA DOCTORS HOSPITAL, INC.
and ENGLEWOOD COMMUNITY
HOSPITAL, INC.,
Plaintiffs,
Vv. CASE NO: 2011 CA 001588 NC
SARASOTA COUNTY and SARASOTA
COUNTY PUBLIC HOSPITAL DISTRICT,
Defendants.
/
SARASOTA COUNTY PUBLIC HOSPITAL DISTRICT’S
ANSWER TO COMPLAINT AND AFFIRMATIVE DEFENSES
Defendant, Sarasota County Public Hospital District (“SCPHD”) hereby files its Answer
and Affirmative Defenses and states:
1. Admitted for jurisdictional purposes only.
2. Admitted for jurisdictional purposes only.
3. Admitted.
4. Admitted.
5. Admitted.
6. The Special Act speaks for itself. To the extent that any allegations contained
within paragraph 6 of the Complaint vary or differ from the Special Act, said allegations are
denied. Any further allegations are denied.
f. The Special Act speaks for itself. To the extent that any allegations contained
within paragraph 7 of the Complaint vary or differ from the Special Act, said allegations are
denied. Any further allegations are denied.
8. Admitted.
9. Without knowledge and therefore denied.
Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 1 of 2110. The Special Act speaks for itself. To the extent that any allegations contained
within paragraph 10 of the Complaint vary or differ from the Special Act, said allegations are
denied. Any further allegations are denied.
11. The Special Act speaks for itself. To the extent that any allegations contained
within paragraph 11 of the Complaint vary or differ from the Special Act, said allegations are
denied. Any further allegations are denied.
12. The Special Act speaks for itself. To the extent that any allegations contained
within paragraph 12 of the Complaint vary or differ from the Special Act, said allegations are
denied. Any further allegations are denied.
13. Admitted that the District owns and operates Sarasota Memorial Hospital in
Sarasota County, Florida. Denied that Sarasota Memorial is a competitor of Doctors Hospital
and Englewood for hospital services within the County.
14. The Special Act speaks for itself. To the extent that any allegations contained
within paragraph 14 of the Complaint vary or differ from the Special Act, said allegations are
denied. Any further allegations are denied.
15. The Special Act speaks for itself. To the extent that any allegations contained
within paragraph 15 of the Complaint vary or differ from the Special Act, said allegations are
denied. Any further allegations are denied.
16. The Special Act speaks for itself. To the extent that any allegations contained
within paragraph 16 of the Complaint vary or differ from the Special Act, said allegations are
denied. Any further allegations are denied.
17. The Special Act speaks for itself. To the extent that any allegations contained
within paragraph 17 of the Complaint vary or differ from the Special Act, said allegations are
denied. Any further allegations are denied.
Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 2 of 2118. The Special Act speaks for itself. To the extent that any allegations contained
within paragraph 18 of the Complaint vary or differ from the Special Act, said allegations are
denied. Any further allegations are denied.
19. Denied.
20. Denied.
21. Denied.
Count |
Although Plaintiffs purportedly direct Count | of the Complaint to both Sarasota County
and SCPHD, it is unclear from the language of the allegations whether the particular allegations
relate to Sarasota County or SCPHD. SCPHD has responded to the allegations as if they were
directed toward SCPHD. To the extent that they apply to both Sarasota County, or only to
sarasota County, SCPHD adopts Sarasota County’s responses to said allegations as if fully set
forth herein.
22. Defendant realleges and reasserts its responses to paragraphs 1 through 21 as if
fully set forth herein.
23. Admitted for jurisdictional purposes only.
24. Denied.
25. Without knowledge and therefore denied.
26. Denied.
2/. Denied.
28. Denied.
Count Il
Although Plaintiffs purportedly direct Count II of the Complaint to both Sarasota County
and SCPHD, it is unclear from the language of the allegations whether the particular allegations
relate to Sarasota County or SCPHD. SCPHD has responded to the allegations as if they were
directed toward SCPHD. To the extent that they apply to both Sarasota County, or only to
Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 3 of 21Sarasota County, SCPHD adopts Sarasota County’s responses to said allegations as if fully set
forth herein.
29. Defendant realleges and reasserts its responses to paragraphs 1 through 21 as if
fully set forth herein.
30. Admitted for jurisdictional purposes only.
31. The Special Act speaks for itself. To the extent that any allegations contained
within paragraph 31 of the Complaint vary or differ from the Special Act, said allegations are
denied. Any further allegations are denied.
32. The Special Act speaks for itself. To the extent that any allegations contained
within paragraph 32 of the Complaint vary or differ from the Special Act, said allegations are
denied. Any further allegations are denied.
33. Denied.
34. Denied.
35. Denied.
36. Denied.
3/. Without knowledge and therefore denied.
38. Denied.
39. Denied.
40. Without knowledge and therefore denied.
AFFIRMATIVE DEFENSES
SCPHD adopts and incorporates all affirmative defenses raised by co-Defendant
Sarasota County as if fully set forth herein.
First Affirmative Defense
Plaintiffs have failed to perform a condition precedent in filing this action. To the extent
that SCPHD is responsible for reimbursing Plaintiffs for monies spent in connection with hospital
Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 4 of 21services provided to indigents (which SCPHD denies), Plaintiffs have failed to submit invoices in
accordance with the provisions of the Special Act.
Second Affirmative Defense
Plaintiffs have failed to state a cause of action as there is no common law, statutory or
Constitutional obligation for the SCPHD to pay for hospital care for indigents.
Third Affirmative Defense
The allegations of the Complaint are contradicted by the documents attached to the
Complaint and the documents referenced therein. The Special Act contains no provisions which
specifically mandate that the SCPHD provide indigent care and does not expressly provide for
taxation to pay for indigent care.
Fourth Affirmative Defense
Plaintiffs have failed to state a cause of action since the provision on which Plaintiffs rely
was made void/ineffective by the 1968 revision to the Florida Constitution.
Fifth Affirmative Defense
Plaintiffs are not entitled to the relief being sought as the relief sought is against public
policy and unconstitutional.
Counterclaim for Declaratory Relief
Defendant/Counter-Plaintiff, Sarasota County Public Hospital District (“SCPHD”), brings
this action for declaratory judgment pursuant to § 86.011, Florida Statutes, and names as
Defendants the following parties wno may have an interest in the outcome of this action:
Plaintiff/Counter-Defendant Sarasota Doctors Hospital, Inc., and Plaintiff/Counter-Defendant
Englewood Community Hospital, Inc. Additionally, Sarasota County, a political subdivision of the
State of Florida (“County” or “Sarasota County”), which already been named a defendant in the
underlying action, also has an interest in the outcome of this action.
Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 5 of 21Introduction, Parties and Jurisdiction
41. This is an action for declaratory relief to determine the enforceability under the
laws and constitution of State of Florida of a portion of a special law applicable within Sarasota
County, Chapter 2003-359, Laws of Florida (the “Special Act’), relative to the purported right of
hospitals in Sarasota County to obtain reimbursement from the County for costs expended in
providing medical care to indigent County residents.
42. SCPHD and the County are in doubt as to the enforceability of a portion of the
Special Act under the laws and constitution of State of Florida. Accordingly, SCPHD, in good
faith, and pursuant to Florida law, seeks judicial review of the legal enforceability of a portion of
section 8(9) of the Special Act. Should the Court determine the subject portion of Section 8(9)
of the Special Act is unlawful either under the laws or constitution of the State of Florida,
SCPHD respectfully requests the Court declare that neither the County nor SCPHD is required
to reimburse hospitals for costs associated with providing hospital services and care to indigent
County residents.
43. Defendant/Counter-Plaintiff, Sarasota County, is a political subdivision of the
State of Florida.
44. Plaintiff/Counter-Defendant, Sarasota Doctors Hospital, Inc. (“Doctors Hospital”)
is a corporation organized and existing under the laws of the State of Florida.
45. Plaintiff/Counter-Defendant, Englewood Community Hospital, Inc. (“Englewood
Hospital”) is a corporation organized and existing under the laws of the State of Florida.
46. This Court has jurisdiction of this action pursuant to §§ 26.012 and 86.011,
Florida Statutes.
The Special Act and Its History
47. The Special Act, which established the Sarasota County Hospital District
(“Hospital District’) originated with Chapter 26468 (1949), Laws of Florida (the “Original Special
Act”), approved by Sarasota County electors in a referendum, held on January 10, 1950.
Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 6 of 2148. section 8(9) of the Special Act, at issue in this action, was first enacted by
Chapter 59-1839, Laws of Florida (1959), an amendment to the Original Special Act. Chapter
59-1839 was never been submitted to Sarasota County electors for approval.
49. Both the Original Special Act and the 1959 amendment that introduced the
subject language of Section 8(9) were enacted under the authority of the 1885 Florida
Constitution.
50. Article XIll, Section 3 of the 1885 Florida Constitution included the following
Obligation on the counties with respect to providing hospital services and care for the indigent,
“[t]he respective counties of the State shall provide in the manner prescribed by law, for those of
the inhabitants who by reason of age, infirmity or misfortune, may have claims upon the aid and
sympathy of society.”
51. In response to this mandate from the 1885 Florida Constitution, Section 8(9) of
the Special Act delineated the manner in which hospitals in Sarasota County could seek
reimbursement from Sarasota County for certain hospital services and care provided to indigent
citizens:
(9) To certify to the Board of County Commissioners of Sarasota County, on or
before the 15th day of each month commencing with the month of November
1959, a list of all the medically indigent persons who have been hospitalized in
any of the hospitals which are operated by the Hospital Board during the
preceding month, together with the itemized charges for the hospital services and
care for each of said medically indigent persons which have been rendered in
such preceding month by the said hospital. The Board of County Commissioners
of Sarasota County shall, within 45 days after the receipt of such certified list of
medically indigent patients with the hospital charges, make remittance to the
treasurer of the Hospital Board of the sum total of the amount shown on the
certified list to be the amount owing to the Hospital Board for the hospital
services and care rendered to the medically indigent persons during the month
embraced in said certification.
The Hospital Board shall give written notice to the Welfare Department of
Sarasota County of the proposed admission of each medically indigent person to
hospitals operated by said Hospital Board, prior to the actual admission of each
such medically indigent person, provided, however, that notice to said Welfare
Department prior to the admission of a medically indigent person shall not be
required in emergency cases.
Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 7 of 21The said Board of County Commissioners shall in like manner reimburse any
other hospital in Sarasota County, approved by the State Board of Health, for
hospital services rendered to medically indigent persons as herein defined, upon
like certification by such hospital and at such rates as shall not exceed those
prescribed for such patients by hospitals owned and operated by said Hospital
Board.
The term “medically indigent person” as used in this act, shall be deemed to
mean an inhabitant of Sarasota County who is ill or injured and who requires
treatment in a hospital as prescribed and ordered by a physician and who is
unable to provide himself or herself with such necessary hospital services.
52. The 1968 Florida Constitution eliminated the mandate for counties to provide
hospital services and care for the indigent. Instead, Article XII, Section 10 of the 1968 Florida
Constitution provided that Article XIll, Section 3 of the 1885 Florida Constitution was relegated
to statutory status, subject to modification or repeal.
53. Subsequently, Article XIll of the 1885 Florida Constitution was repealed by
section 11.2422, Florida Statutes (1985), which provided:
Every statute of a general and permanent nature enacted by the State or by the
Territory of Florida at or prior to the regular and special 1983 legislative sessions,
and every part of such statute, not included in the Florida Statutes 1985, as
adopted by § 11.2421, as amended, or recognized and continued in force by
reference therein or in §§ 11.2423 and 11.2424, as amended, is repealed.
The Florida Supreme Court, in Dade County v. American Hospital of Miami, Inc., 502 So. 2d
1230, 1232 (Fla. 1987), held that, pursuant to Section 11.2422, Florida Statutes (1985) and
subsequent revisor bills, Article XIII, Section 3 of the 1885 Florida Constitution was repealed.
54. Since the adoption of the 1968 Florida Constitution, Florida’s statutory framework
for addressing hospital care, generally, and hospital services and care for indigents, specifically,
has evolved to provide mechanisms for such things as funding options for counties to provide
for indigent patient care costs within a county (Chapters 155, 212 and 409, Florida Statutes); a
reimbursement requirement for counties whose indigent patients receive hospital care in
another county (Section 154.301 et seq., Florida Statutes); and requirements for hospitals,
public and private, to accept and treat indigent patients in emergency situations (Section
395.1041, Florida Statutes).
Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 8 of 2155. Additionally, the federal Emergency Medical Treatment and Active Labor Act
(“EMTALA”), 42 U.S.C. § 1395dd, requires all hospitals that receive federal funds from the
Medicare or Medicaid programs and have an emergency department to provide for any
individual who comes to the emergency department and a request is made on that individual's
behalf for examination or treatment for a medical condition, “an appropriate medical screening
examination within the capability of the hospital's emergency department, including ancillary
services routinely available to the emergency department to determine whether or not an
emergency medical condition” exists. EMTALA further provides that if the patient does have an
emergency medical condition which has not been stabilized, the hospital may not transfer that
patient unless certain conditions are met. EMTALA does not include the patient's ability to pay
for medical treatment as a consideration in providing treatment or permitting transfers.
56. With respect to the Special Act, the Florida Legislature enacted Section 189.429,
Florida Statutes, in 1998, which required all special districts to submit a draft codified charter to
the Florida Legislature by December 1, 2004, “so that its special acts may be codified into a
single act for reenactment by the Legislature, if there is more than one special act for the
district.” The legislative history for Section 189.429 provides that codification process may
include substantive changes, but such substantive changes “must be advertised clearly and
concisely” in the codifying local bill.
5/. Accordingly, in June 2003, the Florida Legislature enacted Chapter 2003-359,
Laws of Florida (the “Codified Special Act’), which amended, codified and reenacted the
Original Special Act creating the Hospital District.
58. The legislative history of the Codified Special Act states that the codification and
reenactment process constituted “the process of bringing a special act up-to-date” in order to
“ascertain the current status of a special district's charter,” rather than a detailed and
comprehensive review of the substance of the preceding special acts. The legislative history
Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 9 of 21further indicates that the only substantive change in the Codified Special Act provided for an
implied power to sell or exchange real estate or any interest in real estate.
59. The following, earlier quoted paragraph of Section 8(9) of the Special Act
constitutes the subject matter of the instant action:
The said Board of County Commissioners shall in like manner reimburse any
other hospital in Sarasota County, approved by the State Board of Health, for
hospital services rendered to medically indigent persons as herein defined, upon
like certification by such hospital and at such rates as shall not exceed those
prescribed for such patients by hospitals owned and operated by said Hospital
Board.
This provision has been cited in correspondence submitted to the County since January 2008
from Doctors Hospital and Englewood Hospital, (collectively the “Private Hospitals”), as
requiring the County to reimburse the Private Hospitals for expenses in excess of
$59,000,000.00 that the Private Hospitals attribute to the provision of hospital services and care
to indigent persons.
60. For the nearly fifty years since the Original Special Act was amended to add
section 8(9), up to January 2008, neither of the Private Hospitals has submitted any pre-
admission notices to the County before admitting any medically indigent persons; a condition
precedent to receiving reimbursement for the provision of hospital services and care to
medically indigent persons under Section 8(9).
61. Based on the foregoing facts and governing law, SCPHD doubts whether it or the
County has any obligation to reimburse the Private Hospitals under the Codified Special Acct.
62. Because this counterclaim alleges the unconstitutionality of a portion of the
Codified Special Act, pursuant to Section 86.091, Florida Statutes, a copy of this counterclaim
has been served upon the State Attorney of the Twelfth Judicial Circuit of the State of Florida.
Count | — Unconstitutional Privilege
63. The SCPHD re-alleges and incorporates paragraphs 41 through 62, supra, as if
fully set out herein.
10
Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 10 of 2164. This is an action for declaratory relief pursuant to Chapter 86, Florida Statutes.
65. Article Ill, Section 11(12) of the Florida Constitution provides that there shall be
no special law or general law of local application pertaining to a “private incorporation or grant of
privilege to a private corporation.”
66. The Private Hospitals are “private corporations.”
67. It is established under Florida law that the term “privilege” in Article Ill, Section
11(12) means a financial right or benefit granted to a private corporation.
68. The Private Hospitals assert that they have a financial right to reimbursement for
hospital services and care to the medically indigent, which reimbursement would constitute a
benefit in violation of Article Ill, Section 11(12) of the Florida Constitution.
69. The SCPHD’s rights, status, and other equitable or legal relations are affected by
a question of construction or validity arising under the Codified Special Act, specifically whether
reimbursement to private hospitals pursuant to Section 8(9) of the Codified Special Act grants a
privilege to the Private Hospitals in violation of Article Ill, Section 11(12) of the Florida
Constitution. Accordingly, the SCPHD has the right to obtain a declaration of its rights, status, or
other equitable or legal relations thereunder.
10. There is a bona fide, actual, present and practical need for a declaration
because, through the instant action, the SCPHD may be compelled to take measures, including
the levy of additional ad valorem taxes or reallocation of its ad valorem taxes, in order to provide
significant public funds to cover the costs sought by the Private Hospitals.
71. The declaration sought deals with a present state of ascertainable facts or
present controversy as to the state of facts, as set forth, supra.
12. All persons having an actual, present, adverse and antagonistic interest in the
subject matter have been joined in this action, and all adverse interests are before the court.
WHEREFORE, the SCPHD requests this Court issue a declaratory judgment that:
11
Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 11 of 21a) Determines and declares the parties’ rights, status or other equitable or legal
relations under the Codified Special Act, finding that the portion of Section 8(9) of the Codified
Special Act providing for the payment or reimbursement of private hospitals by the County for
costs expended in providing medical care to indigent County residents is unconstitutional under
Article Ill, Section 11(12) of the Florida Constitution;
b) Determines and declares that neither the County nor the SCPHD is required to
make payment or reimbursement to Doctors Hospital, Englewood Hospital, or any other private
hospital in Sarasota County pursuant to said portion of Section 8(9) of the Codified Special Act;
and
C) Grants any other such relief as the Court may deem just and appropriate,
including, but not limited to, costs and attorney's fees.
Count Il — Unconstitutional Pledge of Credit
13. The SCPHD re-alleges and incorporates paragraphs 41 through 62, supra, as if
fully set out herein.
14. This is an action for declaratory relief pursuant to Chapter 86, Florida Statutes.
15. Article VII, Section 10 of the Florida Constitution provides that no special district
shall “become a joint owner with, or stockholder of, or give, lend or use its taxing power or credit
to aid any corporation, association or person.”
16. The term “credit” implies the imposition of some new financial liability on the
special district, which effectively results in the creation of a debt for the benefit of private
enterprises. In order to have a use of public credit, the special district must be either directly or
contingently liable to pay something to somebody.
Tf. The Private Hospitals’ reliance on the portion of Section 8(9) of the Codified
Special Act providing for the SCPHD to pay or reimburse private hospitals for hospital services
provided to indigent County residents, not previously relied on by private hospital for nearly 50
years, would necessarily impose a new financial liability on the County that would result in the
12
Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 12 of 21creation of a debt for the benefit of private enterprises, i.e., the Private Hospitals or the indigent
County residents.
18. Thus, meeting the obligation to reimburse the Private Hospitals for the cost of
providing hospital services and care to medically indigent persons would require use of the
SCPHD taxing power or a pledge of public credit.
19. Under Florida law, the SCPHD, as a special district, may not use either its taxing
power or pledge of credit unless the purpose of the obligation is to serve a paramount public
purpose. Any benefits to a private party must be incidental only.
80. Reimbursing private hospitals for hospital services and care they are legally
required to provide does not serve a public purpose. The only purpose such reimbursement
serves is to bolster the profits of the private hospitals.
81. The federal mandate for private hospitals to provide hospital services and care to
the indigent serves the public purpose. As history has demonstrated, that public purpose has
been served without reimbursement from the SCPHD at the expense of taxpayers who have not
approved a referendum to do so. Thus, reimbursement from the SCPHD to the coffers of the
private hospitals does not serve an additional public purpose.
82. The SCPHD’s rights, status, or other equitable or legal relations are affected by a
question of construction or validity arising under Section 8(9) of the Codified Special Act,
specifically whether reimbursement to private hospitals pursuant to Section 8(9) of the Codified
Special Act would require the SCPHD to give, lend or use its taxing power or credit to aid the
private hospitals in violation of Article VII, Section 10 of the Florida Constitution. Accordingly, the
SCPHD has the right to obtain a declaration of its rights, status, or other equitable or legal
relations thereunder.
83. There is a bona fide, actual, present and practical need for a declaration because
the SCPHD may be compelled to take measures, including increases in ad valorem taxes, in
13
Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 13 of 21order to provide significant public funds to cover the costs sought by the Private Hospitals, and
the SCPHD doubts the constitutionality of such funding measures.
84. The declaration sought deals with a present state of ascertainable facts or
present controversy as to the state of facts, as set forth, supra.
85. All persons having an actual, present, adverse and antagonistic interest in the
subject matter have been joined in this action, and all adverse interests are before the court.
WHEREFORE, the SCPHD requests this Court issue a declaratory judgment that:
a) Determines and declares the parties’ rights, status or other equitable or legal
relations under the Codified Special Act, finding that the portion of Section 8(9) of the Codified
Special Act providing for the payment or reimbursement of private hospitals by the County for
costs expended in providing medical care to indigent County residents is unconstitutional under
Article Vil, Section 10 of the Florida Constitution;
b) Determines and declares that the SCPHD is not required to allocate any of its ad
valorem tax revenue to make payment or reimbursement to Doctors Hospital, Englewood
Hospital, or any other private hospital in Sarasota County pursuant to said portion of Section
8(9) of the Codified Special Act; and
C) Grants any other such relief as the Court may deem just and appropriate,
including, but not limited to, costs and attorney's fees.
Count Ill — Equal Protection Violation
86. The SCPHD re-alleges and incorporates paragraphs 41 through 62, supra, as if
fully set out herein.
87. This is an action for declaratory relief pursuant to Chapter 86, Florida Statutes.
88. The Equal Protection Clause of the Florida Constitution provides that “[a]ll natural
persons are equal before the law.” Art. |, § 2, Fla. Const.
89. It is established that a statutory classification violates equal protection if it treats
similarly situated entities in a different manner based upon an illogical and arbitrary basis.
14
Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 14 of 2190. The Florida Legislature, in Chapters 154 and 212, Florida Statutes, has provided
counties with the mechanisms to provide funding for the provision of indigent medical care;
mechanisms that must first be submitted to referendum for approval before they may be utilized.
91. In this case, requiring the County to reimburse the private hospitals or the
SCPHD to allocate its ad valorem revenue pursuant to Section 8(9) of the Codified Special Act
would violate the Equal Protection Clause of Article |, Section 2 of the Florida Constitution by
making the private hospitals in Sarasota County the only hospitals in the state with a statutory
right to be reimbursed for hospital services and care to indigents without such reimbursement
first being approved by referendum.
92. Allowing reimbursements to the private hospitals pursuant to Section 8(9) of the
Codified Special Act would have a direct effect on the legally protected fiscal interests of the
SCPHD.
93. The SCPHD’s rights, status, or other equitable or legal relations are affected by a
question of construction or validity arising under Section 8(9) of the Codified Special Act,
specifically whether reimbursement to private hospitals pursuant to Section 8(9) of the Codified
Special Act would arbitrarily create a separate class of hospitals; private hospitals located in
Sarasota County having a right to receive reimbursement for indigent care costs from Sarasota
County, without such right to reimbursement having first been approved by referendum.
Accordingly, the SCPHD has the right to obtain a declaration of its rights, status, or other
equitable or legal relations thereunder.
94. There is a bona fide, actual, present and practical need for a declaration because
the SCPHD may be compelled to take measures, including increases in ad valorem taxes or
allocation of ad valorem revenue away from the operation of the District, in order to provide
significant public funds to cover the costs sought by the Private Hospitals.
95. The declaration sought deals with a present state of ascertainable facts or
present controversy as to the state of facts, as set forth, supra.
15
Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 15 of 2196. All persons having an actual, present, adverse and antagonistic interest in the
subject matter have been joined in this action, and all adverse interests are before the court.
WHEREFORE, the SCPHD requests this Court issue a declaratory judgment that:
a) Determines and declares the parties’ rights, status or other equitable or legal
relations under the Codified Special Act, finding that the portion of Section 8(9) of the Codified
Special Act providing for the reimbursement of private hospitals by the County for costs
expended in providing medical care to indigent County residents is in violation of the Equal
Protection Clauses of the Florida Constitution by arbitrarily creating a separate class of
hospitals, and, therefore, unconstitutional;
b) Determines and declares that the SCPHD is not required to make payment or
allocate ad valorem revenues for reimbursement to Doctors Hospital, Englewood Hospital, or
any other private hospital in Sarasota County pursuant to said portion of Section 8(9) of the
Codified Special Act
C) Grants any other such relief as the Court may deem just and appropriate,
including, but not limited to, costs and attorney’s fees.
Count IV — Repeal by General Law
97. The SCPHD re-alleges and incorporates paragraphs 41 through 62, supra, as if
fully set out herein.
98. This is an action for declaratory relief pursuant to Chapter 86, Florida Statutes.
99. A general act of the Florida Legislature will be deemed to have repealed or
modified a special act embraced within its general terms, where either the general act is a
general revision of the whole subject or the two acts are so irreconcilable as to indicate a
legislative intent to this effect.
100. When the Original Special Act was enacted, the 1885 Florida Constitution
required counties to provide hospital care and services to indigents. The 1968 Florida
16
Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 16 of 21Constitution eliminated this requirement, and proceeded to address hospital services and care
to indigents through statutes of general statewide application.
101. Accordingly, the Florida Legislature has enacted multiple statutes of general
statewide application that afford counties and their citizens options to provide for funding
indigent medical care, including, but not limited to:
a. Chapter 154, Florida Statutes, the Florida Health Care Responsibility Act,
which addresses the financial responsibility of counties for the costs of indigent residents
receiving medical care in other counties, authorizes counties to establish special districts
to “provide funding for indigent and other health and mental health care services”
through a vote of the electorate. See § 154.331, Fla. Stat. (2010).
b. Chapter 212, Florida Statutes, authorizes counties to levy an “indigent
care surtax pursuant to an ordinance conditioned to take effect only upon” referendum,
and upon approval of such surtax, requires development of a plan for providing health
care services to indigent residents. See § 212.055(7), Fla. Stat. (2010).
C. section 409.2673, Florida Statutes, authorizes a shared county and state
program for “low-income persons who do not meet the criteria for Medicaid” or other
governmentally funded program that includes hospital care.
d. section 409.915, Florida Statutes, establishes a county contribution
system to Medicaid, which has set limits and can be funded through monies generated
through a surtax approved under Section 212.055(7).
102. The above-described statutes are statutes of general statewide application that
provide funding mechanisms for indigent care costs. They do not require such mechanisms be
put in place, but leave the decision to implement such mechanisms to the counties and their
voters. Section 8(9) of the Codified Special Act bypasses this legislative intent and provides the
County and its voters no input and no alternative in whether to have an indigent care funding
mechanism, and if so, how to structure and administer that funding mechanism.
17
Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 17 of 21103. When combined together, the general acts of the Florida Legislature, see {J 6/7,
supra, constitute a general revision of the whole subject of providing counties with the choice to
adopt funding mechanisms for the provision of indigent care.
104. SCPHD’s rights, status, or other equitable or legal relations are affected by a
question of construction or validity arising under the Codified Special Act, specifically, whether
general Florida law enacted since the passage of the Original Special Act has repealed Section
8(9) of the Special Act by implication because the Florida Legislature has intended to create a
system wherein counties have options in providing for funding indigent medical care, including
the option of putting to voters whether to have such funding at all.
105. There is a bona fide, actual, present and practical need for a declaration because
of the questions presented by the instant lawsuit which apparently seeks to require that SCPHD
allocate its ad valorem revenue to provide reimbursement to the Private Hospitals for care
provided by such Hospitals.
106. The declaration sought deals with a present state of ascertainable facts or
present controversy as to the state of facts, as set forth, supra.
107. All persons having an actual, present, adverse and antagonistic interest in the
subject matter have been joined in this action, and all adverse interests are before the court.
WHEREFORE, the SCPHD requests this Court issue a declaratory judgment that:
a) Determines and declares the parties’ rights, status or other equitable or legal
relations under the Codified Special Act, finding that the portion of Section 8(9) of the Codified
Special Act providing for the payment or reimbursement of private hospitals by the County for
costs expended in providing medical care to indigent County residents has been repealed by
implication through the enactment of general statutes offering counties the authority to
determine, through its voters, whether to provide for indigent medical care funding;
b) Determines and declares that neither the County nor SCPHD is required to make
payment or reimbursement to Doctors Hospital, Englewood Hospital, or any other private
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and
C) Grants any other such relief as the Court may deem just and appropriate,
including, but not limited to, costs and attorney's fees.
Count V — Vagueness
108. The SCPHD re-alleges and incorporates paragraphs 41 through 62, supra, as if
fully set out herein.
109. This is an action for declaratory relief pursuant to Chapter 86, Florida Statutes.
110. The Codified Special Act is vague, indefinite and uncertain in its terms in that the
term “medically indigent person” is defined as “an inhabitant of Sarasota County who is ill or
injured and who requires treatment in a hospital as prescribed and ordered by a physician and
who is unable to provide himself or herself with such necessary hospital services,” but includes
no objective standards to determine when an individual is “unable to provide himself or herself
with such necessary hospital services.” The Codified Special Act also fails to identify any
individual or entity responsible for making such a determination.
111. The Codified Special Act is vague, indefinite and uncertain in its terms in that the
terms “hospitalized” and “hospital services and care” are undefined in the Codified Special Act.
Absent definitions to those terms, the SCPHD is unable to determine what costs are authorized
for reimbursement under the Codified Special Act. The Codified Special Act also fails to identify
any individual or entity responsible for making such a determination.
112. The Codified Special Act is vague, indefinite and uncertain in its terms in that the
pre-admission notice required in Section 8(9) of the Codified Special Act does not identify what
is required to be included in the notice, whether there is any party that has the right to review
and approve such notices, and the “Welfare Department’ where notice is to be submitted no
longer exists. Absent further clarification, it is impossible to determine how pre-admission
notices are to be received, who is to received them and whether there is any right given to any
19
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responsible for making such determinations.
113. Accordingly, the lack of definite and certain definitions for the terms “medically
indigent person,” “hospitalized” and “hospital services and care,’ as well as the lack of
definiteness in the pre-admission notice procedure described in Section 8(9) of the Codified
Special Act fails to provide a definite warning of what conduct or action is required or prohibited,
measured by common understanding and practice, thus rendering Section 8(9) of the Codified
Special Act void.
114. SCPHD’s rights, status, or other equitable or legal relations are affected by a
question of construction or validity arising under the Codified Special Act, specifically, whether
section 8(9) of the Codified Special Act is enforceable for the purposes of requiring SCPHD to
allocate its ad valorem revenue to reimburse private hospitals for costs expended in providing
“hospital services and care” to “medically indigent persons” when the Codified Special Act lacks
any objective standards for determining indigency, what costs may be reimbursed, how and to
whom to provide pre-admission notice, and fails to designate a party or entity as responsible for
making those determinations.
115. There is a bona fide, actual, present and practical need for a declaration because
of the questions presented by the instant lawsuit which apparently seeks to require that SCPHD
allocate its ad valorem revenue to provide reimbursement to the Private Hospitals for care
provided by such Hospitals.
116. The declaration sought deals with a present state of ascertainable facts or
present controversy as to the state of facts, as set forth, supra.
117. All persons having an actual, present, adverse and antagonistic interest in the
subject matter have been joined in this action, and all adverse interests are before the court.
WHEREFORE, the SCPHD requests this Court issue a declaratory judgment that:
20
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relations under the Codified Special Act, finding the portion of Section 8(9) of the Codified
Special Act providing for the payment or reimbursement of private hospitals for costs expended
in providing medical care to indigent County residents is void because Section 8(9) of the
Codified Special Act is vague as it lacks any objective standards for determining indigency or
what constitutes payable hospital services, and fails to designate a party or entity as responsible
for making those determinations;
b) Determines and declares that neither SCPHD nor the County is required to make
payment or reimbursement to Doctors Hospital, Englewood Hospital, or any other private
hospital in Sarasota County pursuant to said portion of Section 8(9) of the Codified Special Act:
C) Grants any other such relief as the Court may deem just and appropriate,
including, but not limited to, costs and attorney's fees.
CERTIFICATE OF SERVICE
| HEREBY CERTIFY that a true copy of the foregoing has been sent by U.S. Mail to
Stephen A. Ecenia and J. Stephen Menton, Rutledge, Ecenia & Purnell, P.A., 119 South Monroe
Street, Suite 202, Tallahassee, FL 32301, and Frederick J. Elbrecht, Deputy County Attorney,
Office of the County Attorney, 1660 Ringling Boulevard, Second Floor, Sarasota, Florida 34236 on
April 5, 2011.
WIYQJAMS PARKER HARRISON
Pst Pa
Carol Ann Kalish
Florida Bar No: 0992755
Jennifer L. Grosso
Florida Bar No: 0637815
200 South Orange Avenue
Sarasota, Florida 34236
Telephone: (941) 366-4800
Facsimile: (941) 954-3172
Attorneys for Defendant
Sarasota County Public Hospital District
1422301_1.docx
21
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Preview
IN THE CIRCUIT COURT OF THE TWELFTH JUDICIAL CIRCUIT IN AND FOR SARASOTA COUNTY, FLORIDA SARASOTA DOCTORS HOSPITAL, INC. and ENGLEWOOD COMMUNITY HOSPITAL, INC., Plaintiffs, Vv. CASE NO: 2011 CA 001588 NC SARASOTA COUNTY and SARASOTA COUNTY PUBLIC HOSPITAL DISTRICT, Defendants. / SARASOTA COUNTY PUBLIC HOSPITAL DISTRICT’S ANSWER TO COMPLAINT AND AFFIRMATIVE DEFENSES Defendant, Sarasota County Public Hospital District (“SCPHD”) hereby files its Answer and Affirmative Defenses and states: 1. Admitted for jurisdictional purposes only. 2. Admitted for jurisdictional purposes only. 3. Admitted. 4. Admitted. 5. Admitted. 6. The Special Act speaks for itself. To the extent that any allegations contained within paragraph 6 of the Complaint vary or differ from the Special Act, said allegations are denied. Any further allegations are denied. f. The Special Act speaks for itself. To the extent that any allegations contained within paragraph 7 of the Complaint vary or differ from the Special Act, said allegations are denied. Any further allegations are denied. 8. Admitted. 9. Without knowledge and therefore denied. Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 1 of 2110. The Special Act speaks for itself. To the extent that any allegations contained within paragraph 10 of the Complaint vary or differ from the Special Act, said allegations are denied. Any further allegations are denied. 11. The Special Act speaks for itself. To the extent that any allegations contained within paragraph 11 of the Complaint vary or differ from the Special Act, said allegations are denied. Any further allegations are denied. 12. The Special Act speaks for itself. To the extent that any allegations contained within paragraph 12 of the Complaint vary or differ from the Special Act, said allegations are denied. Any further allegations are denied. 13. Admitted that the District owns and operates Sarasota Memorial Hospital in Sarasota County, Florida. Denied that Sarasota Memorial is a competitor of Doctors Hospital and Englewood for hospital services within the County. 14. The Special Act speaks for itself. To the extent that any allegations contained within paragraph 14 of the Complaint vary or differ from the Special Act, said allegations are denied. Any further allegations are denied. 15. The Special Act speaks for itself. To the extent that any allegations contained within paragraph 15 of the Complaint vary or differ from the Special Act, said allegations are denied. Any further allegations are denied. 16. The Special Act speaks for itself. To the extent that any allegations contained within paragraph 16 of the Complaint vary or differ from the Special Act, said allegations are denied. Any further allegations are denied. 17. The Special Act speaks for itself. To the extent that any allegations contained within paragraph 17 of the Complaint vary or differ from the Special Act, said allegations are denied. Any further allegations are denied. Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 2 of 2118. The Special Act speaks for itself. To the extent that any allegations contained within paragraph 18 of the Complaint vary or differ from the Special Act, said allegations are denied. Any further allegations are denied. 19. Denied. 20. Denied. 21. Denied. Count | Although Plaintiffs purportedly direct Count | of the Complaint to both Sarasota County and SCPHD, it is unclear from the language of the allegations whether the particular allegations relate to Sarasota County or SCPHD. SCPHD has responded to the allegations as if they were directed toward SCPHD. To the extent that they apply to both Sarasota County, or only to sarasota County, SCPHD adopts Sarasota County’s responses to said allegations as if fully set forth herein. 22. Defendant realleges and reasserts its responses to paragraphs 1 through 21 as if fully set forth herein. 23. Admitted for jurisdictional purposes only. 24. Denied. 25. Without knowledge and therefore denied. 26. Denied. 2/. Denied. 28. Denied. Count Il Although Plaintiffs purportedly direct Count II of the Complaint to both Sarasota County and SCPHD, it is unclear from the language of the allegations whether the particular allegations relate to Sarasota County or SCPHD. SCPHD has responded to the allegations as if they were directed toward SCPHD. To the extent that they apply to both Sarasota County, or only to Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 3 of 21Sarasota County, SCPHD adopts Sarasota County’s responses to said allegations as if fully set forth herein. 29. Defendant realleges and reasserts its responses to paragraphs 1 through 21 as if fully set forth herein. 30. Admitted for jurisdictional purposes only. 31. The Special Act speaks for itself. To the extent that any allegations contained within paragraph 31 of the Complaint vary or differ from the Special Act, said allegations are denied. Any further allegations are denied. 32. The Special Act speaks for itself. To the extent that any allegations contained within paragraph 32 of the Complaint vary or differ from the Special Act, said allegations are denied. Any further allegations are denied. 33. Denied. 34. Denied. 35. Denied. 36. Denied. 3/. Without knowledge and therefore denied. 38. Denied. 39. Denied. 40. Without knowledge and therefore denied. AFFIRMATIVE DEFENSES SCPHD adopts and incorporates all affirmative defenses raised by co-Defendant Sarasota County as if fully set forth herein. First Affirmative Defense Plaintiffs have failed to perform a condition precedent in filing this action. To the extent that SCPHD is responsible for reimbursing Plaintiffs for monies spent in connection with hospital Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 4 of 21services provided to indigents (which SCPHD denies), Plaintiffs have failed to submit invoices in accordance with the provisions of the Special Act. Second Affirmative Defense Plaintiffs have failed to state a cause of action as there is no common law, statutory or Constitutional obligation for the SCPHD to pay for hospital care for indigents. Third Affirmative Defense The allegations of the Complaint are contradicted by the documents attached to the Complaint and the documents referenced therein. The Special Act contains no provisions which specifically mandate that the SCPHD provide indigent care and does not expressly provide for taxation to pay for indigent care. Fourth Affirmative Defense Plaintiffs have failed to state a cause of action since the provision on which Plaintiffs rely was made void/ineffective by the 1968 revision to the Florida Constitution. Fifth Affirmative Defense Plaintiffs are not entitled to the relief being sought as the relief sought is against public policy and unconstitutional. Counterclaim for Declaratory Relief Defendant/Counter-Plaintiff, Sarasota County Public Hospital District (“SCPHD”), brings this action for declaratory judgment pursuant to § 86.011, Florida Statutes, and names as Defendants the following parties wno may have an interest in the outcome of this action: Plaintiff/Counter-Defendant Sarasota Doctors Hospital, Inc., and Plaintiff/Counter-Defendant Englewood Community Hospital, Inc. Additionally, Sarasota County, a political subdivision of the State of Florida (“County” or “Sarasota County”), which already been named a defendant in the underlying action, also has an interest in the outcome of this action. Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 5 of 21Introduction, Parties and Jurisdiction 41. This is an action for declaratory relief to determine the enforceability under the laws and constitution of State of Florida of a portion of a special law applicable within Sarasota County, Chapter 2003-359, Laws of Florida (the “Special Act’), relative to the purported right of hospitals in Sarasota County to obtain reimbursement from the County for costs expended in providing medical care to indigent County residents. 42. SCPHD and the County are in doubt as to the enforceability of a portion of the Special Act under the laws and constitution of State of Florida. Accordingly, SCPHD, in good faith, and pursuant to Florida law, seeks judicial review of the legal enforceability of a portion of section 8(9) of the Special Act. Should the Court determine the subject portion of Section 8(9) of the Special Act is unlawful either under the laws or constitution of the State of Florida, SCPHD respectfully requests the Court declare that neither the County nor SCPHD is required to reimburse hospitals for costs associated with providing hospital services and care to indigent County residents. 43. Defendant/Counter-Plaintiff, Sarasota County, is a political subdivision of the State of Florida. 44. Plaintiff/Counter-Defendant, Sarasota Doctors Hospital, Inc. (“Doctors Hospital”) is a corporation organized and existing under the laws of the State of Florida. 45. Plaintiff/Counter-Defendant, Englewood Community Hospital, Inc. (“Englewood Hospital”) is a corporation organized and existing under the laws of the State of Florida. 46. This Court has jurisdiction of this action pursuant to §§ 26.012 and 86.011, Florida Statutes. The Special Act and Its History 47. The Special Act, which established the Sarasota County Hospital District (“Hospital District’) originated with Chapter 26468 (1949), Laws of Florida (the “Original Special Act”), approved by Sarasota County electors in a referendum, held on January 10, 1950. Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 6 of 2148. section 8(9) of the Special Act, at issue in this action, was first enacted by Chapter 59-1839, Laws of Florida (1959), an amendment to the Original Special Act. Chapter 59-1839 was never been submitted to Sarasota County electors for approval. 49. Both the Original Special Act and the 1959 amendment that introduced the subject language of Section 8(9) were enacted under the authority of the 1885 Florida Constitution. 50. Article XIll, Section 3 of the 1885 Florida Constitution included the following Obligation on the counties with respect to providing hospital services and care for the indigent, “[t]he respective counties of the State shall provide in the manner prescribed by law, for those of the inhabitants who by reason of age, infirmity or misfortune, may have claims upon the aid and sympathy of society.” 51. In response to this mandate from the 1885 Florida Constitution, Section 8(9) of the Special Act delineated the manner in which hospitals in Sarasota County could seek reimbursement from Sarasota County for certain hospital services and care provided to indigent citizens: (9) To certify to the Board of County Commissioners of Sarasota County, on or before the 15th day of each month commencing with the month of November 1959, a list of all the medically indigent persons who have been hospitalized in any of the hospitals which are operated by the Hospital Board during the preceding month, together with the itemized charges for the hospital services and care for each of said medically indigent persons which have been rendered in such preceding month by the said hospital. The Board of County Commissioners of Sarasota County shall, within 45 days after the receipt of such certified list of medically indigent patients with the hospital charges, make remittance to the treasurer of the Hospital Board of the sum total of the amount shown on the certified list to be the amount owing to the Hospital Board for the hospital services and care rendered to the medically indigent persons during the month embraced in said certification. The Hospital Board shall give written notice to the Welfare Department of Sarasota County of the proposed admission of each medically indigent person to hospitals operated by said Hospital Board, prior to the actual admission of each such medically indigent person, provided, however, that notice to said Welfare Department prior to the admission of a medically indigent person shall not be required in emergency cases. Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 7 of 21The said Board of County Commissioners shall in like manner reimburse any other hospital in Sarasota County, approved by the State Board of Health, for hospital services rendered to medically indigent persons as herein defined, upon like certification by such hospital and at such rates as shall not exceed those prescribed for such patients by hospitals owned and operated by said Hospital Board. The term “medically indigent person” as used in this act, shall be deemed to mean an inhabitant of Sarasota County who is ill or injured and who requires treatment in a hospital as prescribed and ordered by a physician and who is unable to provide himself or herself with such necessary hospital services. 52. The 1968 Florida Constitution eliminated the mandate for counties to provide hospital services and care for the indigent. Instead, Article XII, Section 10 of the 1968 Florida Constitution provided that Article XIll, Section 3 of the 1885 Florida Constitution was relegated to statutory status, subject to modification or repeal. 53. Subsequently, Article XIll of the 1885 Florida Constitution was repealed by section 11.2422, Florida Statutes (1985), which provided: Every statute of a general and permanent nature enacted by the State or by the Territory of Florida at or prior to the regular and special 1983 legislative sessions, and every part of such statute, not included in the Florida Statutes 1985, as adopted by § 11.2421, as amended, or recognized and continued in force by reference therein or in §§ 11.2423 and 11.2424, as amended, is repealed. The Florida Supreme Court, in Dade County v. American Hospital of Miami, Inc., 502 So. 2d 1230, 1232 (Fla. 1987), held that, pursuant to Section 11.2422, Florida Statutes (1985) and subsequent revisor bills, Article XIII, Section 3 of the 1885 Florida Constitution was repealed. 54. Since the adoption of the 1968 Florida Constitution, Florida’s statutory framework for addressing hospital care, generally, and hospital services and care for indigents, specifically, has evolved to provide mechanisms for such things as funding options for counties to provide for indigent patient care costs within a county (Chapters 155, 212 and 409, Florida Statutes); a reimbursement requirement for counties whose indigent patients receive hospital care in another county (Section 154.301 et seq., Florida Statutes); and requirements for hospitals, public and private, to accept and treat indigent patients in emergency situations (Section 395.1041, Florida Statutes). Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 8 of 2155. Additionally, the federal Emergency Medical Treatment and Active Labor Act (“EMTALA”), 42 U.S.C. § 1395dd, requires all hospitals that receive federal funds from the Medicare or Medicaid programs and have an emergency department to provide for any individual who comes to the emergency department and a request is made on that individual's behalf for examination or treatment for a medical condition, “an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department to determine whether or not an emergency medical condition” exists. EMTALA further provides that if the patient does have an emergency medical condition which has not been stabilized, the hospital may not transfer that patient unless certain conditions are met. EMTALA does not include the patient's ability to pay for medical treatment as a consideration in providing treatment or permitting transfers. 56. With respect to the Special Act, the Florida Legislature enacted Section 189.429, Florida Statutes, in 1998, which required all special districts to submit a draft codified charter to the Florida Legislature by December 1, 2004, “so that its special acts may be codified into a single act for reenactment by the Legislature, if there is more than one special act for the district.” The legislative history for Section 189.429 provides that codification process may include substantive changes, but such substantive changes “must be advertised clearly and concisely” in the codifying local bill. 5/. Accordingly, in June 2003, the Florida Legislature enacted Chapter 2003-359, Laws of Florida (the “Codified Special Act’), which amended, codified and reenacted the Original Special Act creating the Hospital District. 58. The legislative history of the Codified Special Act states that the codification and reenactment process constituted “the process of bringing a special act up-to-date” in order to “ascertain the current status of a special district's charter,” rather than a detailed and comprehensive review of the substance of the preceding special acts. The legislative history Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 9 of 21further indicates that the only substantive change in the Codified Special Act provided for an implied power to sell or exchange real estate or any interest in real estate. 59. The following, earlier quoted paragraph of Section 8(9) of the Special Act constitutes the subject matter of the instant action: The said Board of County Commissioners shall in like manner reimburse any other hospital in Sarasota County, approved by the State Board of Health, for hospital services rendered to medically indigent persons as herein defined, upon like certification by such hospital and at such rates as shall not exceed those prescribed for such patients by hospitals owned and operated by said Hospital Board. This provision has been cited in correspondence submitted to the County since January 2008 from Doctors Hospital and Englewood Hospital, (collectively the “Private Hospitals”), as requiring the County to reimburse the Private Hospitals for expenses in excess of $59,000,000.00 that the Private Hospitals attribute to the provision of hospital services and care to indigent persons. 60. For the nearly fifty years since the Original Special Act was amended to add section 8(9), up to January 2008, neither of the Private Hospitals has submitted any pre- admission notices to the County before admitting any medically indigent persons; a condition precedent to receiving reimbursement for the provision of hospital services and care to medically indigent persons under Section 8(9). 61. Based on the foregoing facts and governing law, SCPHD doubts whether it or the County has any obligation to reimburse the Private Hospitals under the Codified Special Acct. 62. Because this counterclaim alleges the unconstitutionality of a portion of the Codified Special Act, pursuant to Section 86.091, Florida Statutes, a copy of this counterclaim has been served upon the State Attorney of the Twelfth Judicial Circuit of the State of Florida. Count | — Unconstitutional Privilege 63. The SCPHD re-alleges and incorporates paragraphs 41 through 62, supra, as if fully set out herein. 10 Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 10 of 2164. This is an action for declaratory relief pursuant to Chapter 86, Florida Statutes. 65. Article Ill, Section 11(12) of the Florida Constitution provides that there shall be no special law or general law of local application pertaining to a “private incorporation or grant of privilege to a private corporation.” 66. The Private Hospitals are “private corporations.” 67. It is established under Florida law that the term “privilege” in Article Ill, Section 11(12) means a financial right or benefit granted to a private corporation. 68. The Private Hospitals assert that they have a financial right to reimbursement for hospital services and care to the medically indigent, which reimbursement would constitute a benefit in violation of Article Ill, Section 11(12) of the Florida Constitution. 69. The SCPHD’s rights, status, and other equitable or legal relations are affected by a question of construction or validity arising under the Codified Special Act, specifically whether reimbursement to private hospitals pursuant to Section 8(9) of the Codified Special Act grants a privilege to the Private Hospitals in violation of Article Ill, Section 11(12) of the Florida Constitution. Accordingly, the SCPHD has the right to obtain a declaration of its rights, status, or other equitable or legal relations thereunder. 10. There is a bona fide, actual, present and practical need for a declaration because, through the instant action, the SCPHD may be compelled to take measures, including the levy of additional ad valorem taxes or reallocation of its ad valorem taxes, in order to provide significant public funds to cover the costs sought by the Private Hospitals. 71. The declaration sought deals with a present state of ascertainable facts or present controversy as to the state of facts, as set forth, supra. 12. All persons having an actual, present, adverse and antagonistic interest in the subject matter have been joined in this action, and all adverse interests are before the court. WHEREFORE, the SCPHD requests this Court issue a declaratory judgment that: 11 Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 11 of 21a) Determines and declares the parties’ rights, status or other equitable or legal relations under the Codified Special Act, finding that the portion of Section 8(9) of the Codified Special Act providing for the payment or reimbursement of private hospitals by the County for costs expended in providing medical care to indigent County residents is unconstitutional under Article Ill, Section 11(12) of the Florida Constitution; b) Determines and declares that neither the County nor the SCPHD is required to make payment or reimbursement to Doctors Hospital, Englewood Hospital, or any other private hospital in Sarasota County pursuant to said portion of Section 8(9) of the Codified Special Act; and C) Grants any other such relief as the Court may deem just and appropriate, including, but not limited to, costs and attorney's fees. Count Il — Unconstitutional Pledge of Credit 13. The SCPHD re-alleges and incorporates paragraphs 41 through 62, supra, as if fully set out herein. 14. This is an action for declaratory relief pursuant to Chapter 86, Florida Statutes. 15. Article VII, Section 10 of the Florida Constitution provides that no special district shall “become a joint owner with, or stockholder of, or give, lend or use its taxing power or credit to aid any corporation, association or person.” 16. The term “credit” implies the imposition of some new financial liability on the special district, which effectively results in the creation of a debt for the benefit of private enterprises. In order to have a use of public credit, the special district must be either directly or contingently liable to pay something to somebody. Tf. The Private Hospitals’ reliance on the portion of Section 8(9) of the Codified Special Act providing for the SCPHD to pay or reimburse private hospitals for hospital services provided to indigent County residents, not previously relied on by private hospital for nearly 50 years, would necessarily impose a new financial liability on the County that would result in the 12 Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 12 of 21creation of a debt for the benefit of private enterprises, i.e., the Private Hospitals or the indigent County residents. 18. Thus, meeting the obligation to reimburse the Private Hospitals for the cost of providing hospital services and care to medically indigent persons would require use of the SCPHD taxing power or a pledge of public credit. 19. Under Florida law, the SCPHD, as a special district, may not use either its taxing power or pledge of credit unless the purpose of the obligation is to serve a paramount public purpose. Any benefits to a private party must be incidental only. 80. Reimbursing private hospitals for hospital services and care they are legally required to provide does not serve a public purpose. The only purpose such reimbursement serves is to bolster the profits of the private hospitals. 81. The federal mandate for private hospitals to provide hospital services and care to the indigent serves the public purpose. As history has demonstrated, that public purpose has been served without reimbursement from the SCPHD at the expense of taxpayers who have not approved a referendum to do so. Thus, reimbursement from the SCPHD to the coffers of the private hospitals does not serve an additional public purpose. 82. The SCPHD’s rights, status, or other equitable or legal relations are affected by a question of construction or validity arising under Section 8(9) of the Codified Special Act, specifically whether reimbursement to private hospitals pursuant to Section 8(9) of the Codified Special Act would require the SCPHD to give, lend or use its taxing power or credit to aid the private hospitals in violation of Article VII, Section 10 of the Florida Constitution. Accordingly, the SCPHD has the right to obtain a declaration of its rights, status, or other equitable or legal relations thereunder. 83. There is a bona fide, actual, present and practical need for a declaration because the SCPHD may be compelled to take measures, including increases in ad valorem taxes, in 13 Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 13 of 21order to provide significant public funds to cover the costs sought by the Private Hospitals, and the SCPHD doubts the constitutionality of such funding measures. 84. The declaration sought deals with a present state of ascertainable facts or present controversy as to the state of facts, as set forth, supra. 85. All persons having an actual, present, adverse and antagonistic interest in the subject matter have been joined in this action, and all adverse interests are before the court. WHEREFORE, the SCPHD requests this Court issue a declaratory judgment that: a) Determines and declares the parties’ rights, status or other equitable or legal relations under the Codified Special Act, finding that the portion of Section 8(9) of the Codified Special Act providing for the payment or reimbursement of private hospitals by the County for costs expended in providing medical care to indigent County residents is unconstitutional under Article Vil, Section 10 of the Florida Constitution; b) Determines and declares that the SCPHD is not required to allocate any of its ad valorem tax revenue to make payment or reimbursement to Doctors Hospital, Englewood Hospital, or any other private hospital in Sarasota County pursuant to said portion of Section 8(9) of the Codified Special Act; and C) Grants any other such relief as the Court may deem just and appropriate, including, but not limited to, costs and attorney's fees. Count Ill — Equal Protection Violation 86. The SCPHD re-alleges and incorporates paragraphs 41 through 62, supra, as if fully set out herein. 87. This is an action for declaratory relief pursuant to Chapter 86, Florida Statutes. 88. The Equal Protection Clause of the Florida Constitution provides that “[a]ll natural persons are equal before the law.” Art. |, § 2, Fla. Const. 89. It is established that a statutory classification violates equal protection if it treats similarly situated entities in a different manner based upon an illogical and arbitrary basis. 14 Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 14 of 2190. The Florida Legislature, in Chapters 154 and 212, Florida Statutes, has provided counties with the mechanisms to provide funding for the provision of indigent medical care; mechanisms that must first be submitted to referendum for approval before they may be utilized. 91. In this case, requiring the County to reimburse the private hospitals or the SCPHD to allocate its ad valorem revenue pursuant to Section 8(9) of the Codified Special Act would violate the Equal Protection Clause of Article |, Section 2 of the Florida Constitution by making the private hospitals in Sarasota County the only hospitals in the state with a statutory right to be reimbursed for hospital services and care to indigents without such reimbursement first being approved by referendum. 92. Allowing reimbursements to the private hospitals pursuant to Section 8(9) of the Codified Special Act would have a direct effect on the legally protected fiscal interests of the SCPHD. 93. The SCPHD’s rights, status, or other equitable or legal relations are affected by a question of construction or validity arising under Section 8(9) of the Codified Special Act, specifically whether reimbursement to private hospitals pursuant to Section 8(9) of the Codified Special Act would arbitrarily create a separate class of hospitals; private hospitals located in Sarasota County having a right to receive reimbursement for indigent care costs from Sarasota County, without such right to reimbursement having first been approved by referendum. Accordingly, the SCPHD has the right to obtain a declaration of its rights, status, or other equitable or legal relations thereunder. 94. There is a bona fide, actual, present and practical need for a declaration because the SCPHD may be compelled to take measures, including increases in ad valorem taxes or allocation of ad valorem revenue away from the operation of the District, in order to provide significant public funds to cover the costs sought by the Private Hospitals. 95. The declaration sought deals with a present state of ascertainable facts or present controversy as to the state of facts, as set forth, supra. 15 Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 15 of 2196. All persons having an actual, present, adverse and antagonistic interest in the subject matter have been joined in this action, and all adverse interests are before the court. WHEREFORE, the SCPHD requests this Court issue a declaratory judgment that: a) Determines and declares the parties’ rights, status or other equitable or legal relations under the Codified Special Act, finding that the portion of Section 8(9) of the Codified Special Act providing for the reimbursement of private hospitals by the County for costs expended in providing medical care to indigent County residents is in violation of the Equal Protection Clauses of the Florida Constitution by arbitrarily creating a separate class of hospitals, and, therefore, unconstitutional; b) Determines and declares that the SCPHD is not required to make payment or allocate ad valorem revenues for reimbursement to Doctors Hospital, Englewood Hospital, or any other private hospital in Sarasota County pursuant to said portion of Section 8(9) of the Codified Special Act C) Grants any other such relief as the Court may deem just and appropriate, including, but not limited to, costs and attorney’s fees. Count IV — Repeal by General Law 97. The SCPHD re-alleges and incorporates paragraphs 41 through 62, supra, as if fully set out herein. 98. This is an action for declaratory relief pursuant to Chapter 86, Florida Statutes. 99. A general act of the Florida Legislature will be deemed to have repealed or modified a special act embraced within its general terms, where either the general act is a general revision of the whole subject or the two acts are so irreconcilable as to indicate a legislative intent to this effect. 100. When the Original Special Act was enacted, the 1885 Florida Constitution required counties to provide hospital care and services to indigents. The 1968 Florida 16 Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 16 of 21Constitution eliminated this requirement, and proceeded to address hospital services and care to indigents through statutes of general statewide application. 101. Accordingly, the Florida Legislature has enacted multiple statutes of general statewide application that afford counties and their citizens options to provide for funding indigent medical care, including, but not limited to: a. Chapter 154, Florida Statutes, the Florida Health Care Responsibility Act, which addresses the financial responsibility of counties for the costs of indigent residents receiving medical care in other counties, authorizes counties to establish special districts to “provide funding for indigent and other health and mental health care services” through a vote of the electorate. See § 154.331, Fla. Stat. (2010). b. Chapter 212, Florida Statutes, authorizes counties to levy an “indigent care surtax pursuant to an ordinance conditioned to take effect only upon” referendum, and upon approval of such surtax, requires development of a plan for providing health care services to indigent residents. See § 212.055(7), Fla. Stat. (2010). C. section 409.2673, Florida Statutes, authorizes a shared county and state program for “low-income persons who do not meet the criteria for Medicaid” or other governmentally funded program that includes hospital care. d. section 409.915, Florida Statutes, establishes a county contribution system to Medicaid, which has set limits and can be funded through monies generated through a surtax approved under Section 212.055(7). 102. The above-described statutes are statutes of general statewide application that provide funding mechanisms for indigent care costs. They do not require such mechanisms be put in place, but leave the decision to implement such mechanisms to the counties and their voters. Section 8(9) of the Codified Special Act bypasses this legislative intent and provides the County and its voters no input and no alternative in whether to have an indigent care funding mechanism, and if so, how to structure and administer that funding mechanism. 17 Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 17 of 21103. When combined together, the general acts of the Florida Legislature, see {J 6/7, supra, constitute a general revision of the whole subject of providing counties with the choice to adopt funding mechanisms for the provision of indigent care. 104. SCPHD’s rights, status, or other equitable or legal relations are affected by a question of construction or validity arising under the Codified Special Act, specifically, whether general Florida law enacted since the passage of the Original Special Act has repealed Section 8(9) of the Special Act by implication because the Florida Legislature has intended to create a system wherein counties have options in providing for funding indigent medical care, including the option of putting to voters whether to have such funding at all. 105. There is a bona fide, actual, present and practical need for a declaration because of the questions presented by the instant lawsuit which apparently seeks to require that SCPHD allocate its ad valorem revenue to provide reimbursement to the Private Hospitals for care provided by such Hospitals. 106. The declaration sought deals with a present state of ascertainable facts or present controversy as to the state of facts, as set forth, supra. 107. All persons having an actual, present, adverse and antagonistic interest in the subject matter have been joined in this action, and all adverse interests are before the court. WHEREFORE, the SCPHD requests this Court issue a declaratory judgment that: a) Determines and declares the parties’ rights, status or other equitable or legal relations under the Codified Special Act, finding that the portion of Section 8(9) of the Codified Special Act providing for the payment or reimbursement of private hospitals by the County for costs expended in providing medical care to indigent County residents has been repealed by implication through the enactment of general statutes offering counties the authority to determine, through its voters, whether to provide for indigent medical care funding; b) Determines and declares that neither the County nor SCPHD is required to make payment or reimbursement to Doctors Hospital, Englewood Hospital, or any other private 18 Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 18 of 21hospital in Sarasota County pursuant to said portion of Section 8(9) of the Codified Special Act: and C) Grants any other such relief as the Court may deem just and appropriate, including, but not limited to, costs and attorney's fees. Count V — Vagueness 108. The SCPHD re-alleges and incorporates paragraphs 41 through 62, supra, as if fully set out herein. 109. This is an action for declaratory relief pursuant to Chapter 86, Florida Statutes. 110. The Codified Special Act is vague, indefinite and uncertain in its terms in that the term “medically indigent person” is defined as “an inhabitant of Sarasota County who is ill or injured and who requires treatment in a hospital as prescribed and ordered by a physician and who is unable to provide himself or herself with such necessary hospital services,” but includes no objective standards to determine when an individual is “unable to provide himself or herself with such necessary hospital services.” The Codified Special Act also fails to identify any individual or entity responsible for making such a determination. 111. The Codified Special Act is vague, indefinite and uncertain in its terms in that the terms “hospitalized” and “hospital services and care” are undefined in the Codified Special Act. Absent definitions to those terms, the SCPHD is unable to determine what costs are authorized for reimbursement under the Codified Special Act. The Codified Special Act also fails to identify any individual or entity responsible for making such a determination. 112. The Codified Special Act is vague, indefinite and uncertain in its terms in that the pre-admission notice required in Section 8(9) of the Codified Special Act does not identify what is required to be included in the notice, whether there is any party that has the right to review and approve such notices, and the “Welfare Department’ where notice is to be submitted no longer exists. Absent further clarification, it is impossible to determine how pre-admission notices are to be received, who is to received them and whether there is any right given to any 19 Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 19 of 21party to review them The Codified Special Act also fails to identify any individual or entity responsible for making such determinations. 113. Accordingly, the lack of definite and certain definitions for the terms “medically indigent person,” “hospitalized” and “hospital services and care,’ as well as the lack of definiteness in the pre-admission notice procedure described in Section 8(9) of the Codified Special Act fails to provide a definite warning of what conduct or action is required or prohibited, measured by common understanding and practice, thus rendering Section 8(9) of the Codified Special Act void. 114. SCPHD’s rights, status, or other equitable or legal relations are affected by a question of construction or validity arising under the Codified Special Act, specifically, whether section 8(9) of the Codified Special Act is enforceable for the purposes of requiring SCPHD to allocate its ad valorem revenue to reimburse private hospitals for costs expended in providing “hospital services and care” to “medically indigent persons” when the Codified Special Act lacks any objective standards for determining indigency, what costs may be reimbursed, how and to whom to provide pre-admission notice, and fails to designate a party or entity as responsible for making those determinations. 115. There is a bona fide, actual, present and practical need for a declaration because of the questions presented by the instant lawsuit which apparently seeks to require that SCPHD allocate its ad valorem revenue to provide reimbursement to the Private Hospitals for care provided by such Hospitals. 116. The declaration sought deals with a present state of ascertainable facts or present controversy as to the state of facts, as set forth, supra. 117. All persons having an actual, present, adverse and antagonistic interest in the subject matter have been joined in this action, and all adverse interests are before the court. WHEREFORE, the SCPHD requests this Court issue a declaratory judgment that: 20 Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 20 of 21a) Determines and declares the parties’ rights, status or other equitable or legal relations under the Codified Special Act, finding the portion of Section 8(9) of the Codified Special Act providing for the payment or reimbursement of private hospitals for costs expended in providing medical care to indigent County residents is void because Section 8(9) of the Codified Special Act is vague as it lacks any objective standards for determining indigency or what constitutes payable hospital services, and fails to designate a party or entity as responsible for making those determinations; b) Determines and declares that neither SCPHD nor the County is required to make payment or reimbursement to Doctors Hospital, Englewood Hospital, or any other private hospital in Sarasota County pursuant to said portion of Section 8(9) of the Codified Special Act: C) Grants any other such relief as the Court may deem just and appropriate, including, but not limited to, costs and attorney's fees. CERTIFICATE OF SERVICE | HEREBY CERTIFY that a true copy of the foregoing has been sent by U.S. Mail to Stephen A. Ecenia and J. Stephen Menton, Rutledge, Ecenia & Purnell, P.A., 119 South Monroe Street, Suite 202, Tallahassee, FL 32301, and Frederick J. Elbrecht, Deputy County Attorney, Office of the County Attorney, 1660 Ringling Boulevard, Second Floor, Sarasota, Florida 34236 on April 5, 2011. WIYQJAMS PARKER HARRISON Pst Pa Carol Ann Kalish Florida Bar No: 0992755 Jennifer L. Grosso Florida Bar No: 0637815 200 South Orange Avenue Sarasota, Florida 34236 Telephone: (941) 366-4800 Facsimile: (941) 954-3172 Attorneys for Defendant Sarasota County Public Hospital District 1422301_1.docx 21 Filed for Record 04/05/2011 05:26 PM - Karen E. Rushing, Clerk of the Circuit Court - Sarasota County, FL - 2011 CA 001588 NC Dkt-79392115 Page 21 of 21