Emergency Physicians Integrated Care v. Salt Lake County

2007 UT 72
This opinion is subject to revision before final
publication in the Pacific Reporter.
IN THE SUPREME COURT OF THE STATE OF UTAH
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Emergency Physicians Integrated No. 20060255
Care,
Plaintiff and Appellant,
v.
Salt Lake County, a political F I L E D
subdivision of the State of Utah,
Defendant and Appellee. September 7, 2007
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Third District, Salt Lake
The Honorable Paul G. Maughan
No. 030901884
Attorneys: Brian S. King, James L. Harris, Jr., Salt Lake City,
for plaintiff
David E. Yocom, Donald H. Hansen, Melanie F.
Mitchell, Salt Lake City, for defendant
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PARRISH, Justice:
INTRODUCTION
¶1 Emergency Physicians Integrated Care (“EPIC”) is a Utah
limited liability corporation formed for the purpose of providing
billing and collection services to various emergency physicians
around Utah. EPIC sued Salt Lake County (the “County”) under a
theory of quantum meruit, seeking compensation for medical
services its physicians provided to county inmates. The district
court entered summary judgment in favor of the County, holding
that EPIC’s services failed to “benefit” the County as required
by the first prong of a quantum meruit analysis. We reverse and
remand for further proceedings consistent with this opinion.
BACKGROUND
¶2 EPIC’s suit against the County sought compensation for
the value of the medical services provided by its physicians to

1 This section was renumbered in 2000 and subsequently
amended. The amended section is now found at Utah Code Ann.
§ 17-50-319 (2005).
No. 20060255 2
county inmates from February 2000 to November 2004. The County
denied any legal responsibility to pay for the services.
¶3 Prior to 2001, the County paid EPIC physicians for the
care they provided to convicted and pretrial inmates in
accordance with its own administrative guidelines and the
applicable provisions of the Utah Code. Utah Code Ann.
§ 17-15-17(3) (1999).1 In February 2001, the legislature amended
the provision of the Code that lists the charges for which a
county is statutorily responsible. Id. § 17-50-319 (2005). As
amended, Utah Code section 17-50-319 requires counties to pay
medical facilities for uncovered medical services provided to
convicted and pretrial inmates at noncapitated Medicaid rates,
absent a separately negotiated fee schedule between the county
and the facility. Id. § 17-50-319(1)(k), (2). Following the
amendment, the County began reimbursing EPIC physicians for
inmate care at the noncapitated state Medicaid rates.
¶4 EPIC contends that section 17-50-319, which covers
charges by “medical facilities,” is inapplicable to charges
provided by its physicians. EPIC argues that because the
noncapitated state Medicaid rate is substantially less than the
“usual and customary charges” for its physicians’ services, it is
entitled to additional compensation. EPIC further contends that
the County failed to make any payments for care provided to some
of the inmates.
¶5 In May 2005, EPIC moved for partial summary judgment,
arguing that the undisputed facts entitled it to judgment against
the County under the equitable theory of quantum meruit. The
County filed a cross-motion for summary judgment, arguing that
(1) payments to EPIC are covered under Utah Code section
17-50-319(2) and are therefore limited to the noncapitated state
Medicaid rates, (2) EPIC’s quantum meruit claim fails as a matter
of law, and (3) EPIC’s claims are barred by the notice of claim
provisions of the Utah Governmental Immunity Act.
¶6 The district court denied EPIC’s motion for partial
summary judgment and granted the County’s motion “to the extent
that [EPIC] has not shown that it is entitled to recover under a
claim of quantum meruit.” Reasoning that the inmates, rather
than the County, were the primary beneficiaries of the services
provided by EPIC physicians, the district court held that EPIC’s
quantum meruit claim failed as a matter of law because EPIC

3 No. 20060255
conferred only an incidental benefit on the County. In support
of this conclusion, the district court observed that the EPIC
physicians were required to bear the cost of inmate care because
they had a statutory duty to provide emergency care regardless of
a patient’s ability to pay under the Emergency Medical Treatment
and Active Labor Act (“EMTALA”), 42 U.S.C. § 1395dd (2000). The
district court also concluded that the County had no statutory
obligation to pay physicians for the medical care they provided
to inmates. While ostensibly considering whether EPIC was
entitled to the difference between the uncapitated Medicaid rate
and the rates charged by EPIC, the implication of the district
court’s ruling is that the County has no legal obligation to
reimburse EPIC physicians at all for medical services provided to
county inmates.
¶7 EPIC appealed to this court, arguing that (1) the
County has an obligation to pay EPIC physicians for emergency
medical services provided to inmates and (2) EPIC physicians are
entitled to be reimbursed by the County for the reasonable value
of these services. We have jurisdiction pursuant to Utah Code
section 78-2-2(3)(j).
STANDARD OF REVIEW
¶8 “Summary judgment is appropriate when there is no issue
as to any material fact and the moving party is entitled to
judgment as a matter of law.” Dairyland Ins. Co. v. State Farm
Mut. Auto. Ins. Co., 882 P.2d 1143, 1144 (Utah 1994) (citing Utah
R. Civ. P. 56(c)). When reviewing a ruling on summary judgment,
this court gives no deference to the lower court’s legal
conclusions and reviews the issues presented under a correctness
standard. Schaerrer v. Stewart’s Plaza Pharm., Inc., 2003 UT 43,
¶ 14, 79 P.3d 922. Factual disputes are viewed in the light most
favorable to the nonmoving party. Surety Underwriters v. E & C
Trucking, Inc., 2000 UT 71, ¶ 15, 10 P.3d 338.
ANALYSIS
¶9 We hold that the district court erred in entering
summary judgment in favor of the County. The basis for the
summary judgment was the district court’s holding that EPIC could
not establish the elements of its quantum meruit claim because
the services provided to county inmates by EPIC physicians did
not confer a benefit on the County. Because we disagree with
this holding, we vacate the summary judgment and remand the case
to the district court for further proceedings consistent with
this opinion.
I. QUANTUM MERUIT

No. 20060255 4
¶10 Quantum meruit is an equitable tool that allows a
plaintiff to receive restitution for the reasonable value of
services provided to the defendant. See J & M Constr., Inc. v.
Southam, 722 P.2d 779, 780 (Utah 1986) (per curiam); Christensen
v. Abbott, 671 P.2d 121, 123 (Utah 1983); Foulger v. McGrath, 95
P. 1004, 1007 (Utah 1908); Davies v. Olson, 746 P.2d 264, 269
(Utah Ct. App. 1987); Black’s Law Dictionary 1255 (7th ed. 1999)
(“A claim or right of action for the reasonable value of services
rendered.”). Quantum meruit has two branches, contract implied
in law (also referred to as unjust enrichment or quasi-contract)
and contract implied in fact, Davies, 746 P.2d at 269.
¶11 To prove the existence of a contract implied in law, a
plaintiff must establish the following: “(1) [T]he defendant
received a benefit; (2) an appreciation or knowledge by the
defendant of the benefit; (3) under circumstances that would make
it unjust for the defendant to retain the benefit without paying
for it.” Id. The district court entered summary judgment
against EPIC after it concluded that EPIC could not establish the
first element of a quantum meruit claim because the emergency
services its physicians provided to county inmates did not confer
a benefit on the County. We accordingly focus our discussion on
this element.
¶12 Although EPIC’s claim of quantum meruit is an equitable
one, the nature of the benefit conferred on the County by EPIC is
informed by the County’s constitutional duty and is governed by
statutory law. We consequently begin with an analysis of these
issues.
A. Constitutional Duty to Provide Care
¶13 As acknowledged by both parties, the County has a
constitutional obligation to provide medical care to those in its
custody. The Eighth Amendment imposes on governments a duty to
provide for the “‘serious medical needs of prisoners.’” City of
Revere v. Ma. Gen. Hosp., 463 U.S. 239, 243-44 (1983) (quoting
Estelle v. Gamble, 429 U.S. 97, 104 (1976)). To an equal degree,
the Fourteenth Amendment requires government entities to obtain
medical care for injured pretrial detainees. Id. at 244-46 (“The
Due Process Clause . . . does require the responsible government
or governmental agency to provide medical care to persons . . .
who have been injured while being apprehended by the police.”);
see Bell v. Wolfish, 441 U.S. 520, 535 (1979).
¶14 These constitutional duties, however, do not “dictate
how the cost of that care should be allocated as between the
[custodial government] entity and the provider of the care.”
Revere, 463 U.S. at 245. In the case that drew this distinction,

5 No. 20060255
City of Revere v. Massachusetts General Hospital, the Supreme
Court proposed several possible means by which a medical service
provider could be paid, but stated that “[i]f . . . the
governmental entity can obtain the medical care needed for a
detainee only by paying for it, then it must pay.” Id.
Ultimately, however, the allocation of costs is a matter of state
law. Id.
B. Statutory Duty to Pay for Medical Care
¶15 Because the County’s duty to pay for the medical care
of its inmates is a matter of state law, we consider whether Utah
law allocates the costs of convicted and pretrial inmates’
medical care to the County. EPIC contends that Utah Code section
17-50-319 renders the state liable for the cost of medical care
provided to inmates, while the County contends that it does not.
¶16 Section 17-50-319 enumerates the charges for which
counties are liable. Subsection (1)(c) of section 17-50-319
charges counties with the broad obligation to pay “expenses
necessarily incurred in the support of persons charged with or
convicted of a criminal offense and committed to the county
jail.” Utah Code Ann. § 17-50-319(1)(c) (2005). Subsection
(1)(k) specifically renders counties liable for “expenses
incurred by a health care facility in providing medical services”
to convicted and pretrial inmates, and subsection (2) provides
that reimbursement under subsection (1)(k) is limited to
noncapitated state Medicaid rates except where there is a
contract between a county jail and a health care facility
establishing a fee schedule for medical services rendered. Utah
Code Ann. § 17-50-319(1)(k), (2).
¶17 The County denies the applicability of the general
obligation contained in subsection (1)(c), claiming that it is
superseded by the more specific language of subsections (1)(k)
and (2). In an argument that defies internal consistency, the
County claims that it has no duty to pay for medical services
provided by emergency physicians because they are not
specifically included in the statutory scheme but then
acknowledges its attempt to pay EPIC physicians noncapitated
Medicaid rates based on that same statutory scheme.
¶18 The district court agreed with the County and found the
general provisions of subsection (1)(c) inapplicable, stating
that nothing in that section “specifically allocated the costs of
emergency physician services to counties.” We disagree. The
Constitution requires that the government provide medical care to
persons convicted or detained by a government entity. Revere,
520 U.S. at 243-44. Consequently, medical care is logically

2 We recognize that under an earlier incarnation of Utah
Code section 17-50-319(1)(c), we found no statutory duty to pay
an attorney for legal services rendered to a man accused of
murder. Pardee v. Salt Lake County, 118 P. 122, 124 (Utah 1911).
We held in that case that the term “support” did not encompass an
inmate’s criminal defense. Id. Pardee is distinguishable,
however, because unlike legal services, medical care does fall
within the commonly understood definition of “support” as
“[s]ustenance or maintenance.” See Black’s Law Dictionary 1453
(7th ed. 1999).
No. 20060255 6
included in subsection (1)(c)’s broad requirement that the County
pay the expenses “necessarily incurred in the support” of
pretrial or convicted inmates.2
¶19 Our conclusion in this regard is not changed by the
fact that subsection (1)(k) explicitly charges the County with
“expenses incurred by a health care facility in providing medical
services at the request of a county sheriff for existing
conditions of” convicted and pretrial inmates. Utah Code Ann.
§ 17-50-319(1)(k) (emphasis added). We acknowledge the well-
settled principle of statutory construction that “when two
provisions address the same subject matter and one provision is
general while the other is specific, the specific provision
controls.” Dairyland Ins. Co. v. State Farm Mut. Auto. Ins. Co.,
882 P.2d 1143, 1146 (Utah 1994); accord Lyon v. Burton, 2000 UT
19, ¶ 17, 5 P.3d 616. By their express terms, however,
subsections (1)(k) and (2) govern only services provided by
medical facilities, services that are distinct from medical care
provided by physicians.
¶20 A facility is defined as “something (as a hospital,
machinery, plumbing) that is built, constructed, installed, or
established to perform some particular function or to serve or
facilitate some particular end.” Webster’s Third New
International Dictionary 812-13 (1986). Thus, under the plain
language of the statute, the terms of subsections (1)(k) and (2)
apply exclusively to those costs incurred by the entity
associated with the physical structures in which the health care
needs of the inmates are provided, rather than the costs incurred
by individual health care providers. Because subsections (1)(k)
and (2) do not address the County’s obligation to compensate
medical doctors who provide care to inmates, the County’s
obligation in this regard is controlled by the more general
language of subsection (1)(c).
¶21 Although we conclude that the statute is clear on its
face, thereby rendering examination of legislative history

3 Because we find a statutory duty to remunerate EPIC, we
have no need to consider the possibility of a similar common law
duty.
7 No. 20060255
unnecessary, it is worth noting that the legislative history of
Senate Bill 152, which was codified as Utah Code section
17-50-319, is consistent with our conclusion that medical
services provided by physicians do not qualify under subsection
(1)(k) as “expenses incurred by a health care facility” (emphasis
added). The phrase “health care provider” was specifically
deleted from the bill, according to the bill’s statement of
intent, “because of the recognition and continued commitment of
counties and physicians to work out prisoner reimbursement issues
without legislation and because of the considerable difference in
Medicaid reimbursement rates for physicians as compared to
hospitals.” Utah House Journal, 54th Utah Leg., Gen. Sess., at
892-93 (Feb. 27, 2001). The legislature’s distinction between
health care providers and health care facilities is consistent
with the separate services (and consequently, separate billing)
that doctors and hospitals provide.
¶22 In sum, because subsections (1)(k) and (2) have no
application to individual health care providers, the general
provisions of subsection (1)(c) apply. Under this subsection,
the County has a statutorily mandated duty to pay the physicians
for the services provided.3 We now consider how the County’s
constitutional and statutory obligations fit into EPIC’s quantum
meruit claim.
C. The Benefit the County Received from EPIC
¶23 We hold that EPIC physicians conferred a benefit on the
County by providing the means by which it fulfilled its legal
obligation to provide inmate care. While the inmates also
benefitted from the services provided by EPIC physicians, it is
not an element of quantum meruit that the benefit run exclusively
to the party from which compensation is sought.
¶24 The district court acknowledged the County’s
constitutional duty, but held that the inmates were the true
beneficiaries of EPIC’s service and that any benefit to the
County was merely incidental. In support of this conclusion, the
district court relied on Myrtle Beach Hospital, Inc. v. City of
Myrtle Beach, 532 S.E.2d 868, 869 (S.C. 2000), in which the South
Carolina Supreme Court considered the city’s obligation to pay
for the medical treatment of pretrial detainees. The South
Carolina Supreme Court rejected the hospital’s quantum meruit
claim, finding that the “detainee rather than the City” received

4 Further, we find that the facts of Myrtle Beach are
distinguishable from those in this case. The City of Myrtle
Beach had no statutory obligation to pay for the medical care of
pretrial detainees because the statutes obligating payment
covered only convicted inmates. Myrtle Beach, 532 S.E.2d at 671.
As discussed above, however, Utah’s statute obligates the County
to pay for the medical care of pretrial and convicted inmates.
See supra ¶¶ 15-22.
No. 20060255 8
the benefit conferred by the hospital. Id. at 873. It held that
the city’s constitutional obligation under Revere was fulfilled
by “‘seeing that the detainees are taken promptly to a hospital’”
for treatment. Id. (brackets omitted) (quoting Revere, 463 U.S.
at 245). And it found that the services the hospital provided to
the inmates only incidentally benefitted the city by helping it
fulfill its constitutional obligation. Id. at 873 n.12.
¶25 We respectfully disagree with the South Carolina
Supreme Court’s conclusion that a government entity “receives
[only] an incidental benefit” from a medical service provider
treating inmates in its custody. Id.4
¶26 The first element of quantum meruit requires the court
to measure the benefit conferred on the defendant by the
plaintiff. Berrett v. Stevens, 690 P.2d 553, 557 (Utah 1984).
The benefit conferred satisfies this requirement if the
defendant’s retention of the benefit would be unjust without
providing compensation. 66 Am. Jur. 2d Restitution and Implied
Contracts § 13 (2001) (“It is not enough that a benefit was
conferred on the defendant, and rather, the enrichment to the
defendant must be unjust in that the defendant received a true
windfall or ‘something for nothing.’”); Berrett, 690 P.2d at 557
(“[T]he mere fact that a person benefits another is not by itself
sufficient to require the other to make restitution.”). While
unjust enrichment does not result if the defendant has received
only an incidental benefit from the plaintiff’s service, id.,
this court has found that a large variety of items fall under the
definition of “benefit,” including an “interest in money, land,
chattels, or choses in action; beneficial services conferred;
satisfaction of a debt or duty owed by [the defendant]; or
anything which adds to [the defendant’s] security or advantage.”
Baugh v. Darley, 184 P.2d 335, 337 (Utah 1947).
¶27 We acknowledge that EPIC provided a physical benefit to
the treated inmates, but the County also benefitted from EPIC’s

5 Under Utah Code section 17-50-319(2)(a), medical services
that a health care facility provides to inmates are the
responsibility of the state only to the extent that they are not
covered by private insurance. With this opinion, we do not
absolve inmates for potential liability for care, but merely hold
that EPIC provides a benefit to the County sufficient to fulfill
the first element of a claim for quantum meruit.
6 The Supreme Court’s Revere opinion contains dicta about
how the costs of inmate care might be allocated, which may have
formed some of the basis for the district court’s reasoning here.
Revere refers to federal grant money allocated to hospitals to
cover indigent care and state laws requiring treatment without
regard for a patient’s ability to pay. 463 U.S. at 245. It then
states that government entities might create their own hospitals
or impose “on the willingness of hospitals and physicians” to
treat inmates without consideration for payment. Id. The
existence of these options, however, does not necessarily excuse
government entities from paying for medical services provided to
inmates or dictate that the cost of treatment be born by
emergency physicians.
9 No. 20060255
service.5 In providing medical care to inmates, the County is
not acting as a passive third party to a primary relationship
between the physicians and inmates. Instead, the County has
complete control over when and where medical services are
provided and therefore dictates the means by which its
constitutional obligation is fulfilled. For practical purposes,
the County outsourced its constitutional duty to EPIC. Had it
not done so, it would have been required to employ more on-site
medical staff or bear increased liability for providing
inadequate care. These are real benefits that are sufficient to
establish the first prong of a quantum meruit claim.
¶28 In concluding that the County did not benefit from
emergency services provided to its inmates, the district court
reasoned that because EPIC has a duty to provide treatment to
county inmates under EMTALA, 42 U.S.C. § 1395dd, it is the
physicians who must bear the cost of treatment, after the
patients themselves.6 The language of the statute does not
support this conclusion. EMTALA requires hospital emergency
departments to treat individuals who have emergency medical
conditions without regard for their ability to pay. See 42
U.S.C. § 1395dd (2000). But it does not prohibit medical
providers from recovering payment from emergency patients or
their guardians after service has been provided.
II. REASONABLE VALUE OF CARE

No. 20060255 10
¶29 If EPIC proves its quantum meruit claim, it is entitled
to the “reasonable value” of the services it provided. Davies v.
Olson, 746 P.2d 264, 269 (Utah Ct. App. 1987); accord Baugh v.
Darley, 184 P.2d 335, 339 (Utah 1947) (“[I]n an action for unjust
enrichment, in those cases where there is a proper equitable
basis for the same, the measure of damages, by the great weight
of authority, is the reasonable value of the services
rendered.”). The parties spent considerable time in their
briefing and in oral argument debating the appropriate measure of
reasonable value, specifically, whether EPIC physicians should be
paid their billed charges or noncapitated state Medicaid rates.
Because the determination of what constitutes a “reasonable
value” for the physicians’ services is dependent on the specific
evidence presented and because the district court did not
consider whether the evidence on this issue raised a factual
dispute, we refrain from deciding this issue. Rather, we remand
the matter to the district court for consideration of this
argument and further proceedings consistent with this opinion.
CONCLUSION
¶30 We reverse the district court’s grant of summary
judgment to Salt Lake County. EPIC physicians provided a benefit
to the County when they provided medical services to pretrial and
convicted county inmates by allowing the County to discharge its
constitutional obligation to provide medical care to detainees
and inmates and its statutory obligation to pay for the expenses
necessarily incurred in support of county inmates. We therefore
remand this case for consideration of the other arguments and
defenses raised by the parties.
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¶31 Chief Justice Durham, Associate Chief Justice Wilkins,
Justice Durrant, and Justice Nehring concur in Justice Parrish’s
opinion.