Avera St. Mary's Hospital v. Sully County

#30152, #30167-a-SPM
2024 S.D. 25

IN THE SUPREME COURT
OF THE
STATE OF SOUTH DAKOTA

****

AVERA ST. MARY’S HOSPITAL, Plaintiff and Appellant,

v.

SULLY COUNTY, SOUTH DAKOTA, Defendant and Appellee.

****

APPEAL FROM THE CIRCUIT COURT OF
THE SIXTH JUDICIAL CIRCUIT
SULLY COUNTY, SOUTH DAKOTA

****

THE HONORABLE CHRISTINA L. KLINGER
Judge

****

ROBERT R. NELSON
Sioux Falls, South Dakota Attorney for plaintiff
and appellant.

JACK H. HIEB
ZACHARY W. PETERSON
RYAN S. VOGEL of
Richardson, Wyly, Wise, Sauck
& Hieb, LLP
Aberdeen, South Dakota Attorneys for defendant
and appellee.

****

ARGUED
OCTOBER 4, 2023
OPINION FILED 05/01/24
#30152, #30167

MYREN, Justice

[¶1.] Avera sought reimbursement from Sully County under county poor-

relief statutes for emergency medical treatment provided to J.R. The Sully County

Board of Commissioners denied the claim, and the circuit court affirmed that

decision. Avera appeals. Sully County filed a notice of review. We affirm.

Factual and Procedural History

[¶2.] J.R. is a Mexican national who worked on a seasonal visa for a few

months per year in Sully County. While working in Sully County in 2014, J.R.

suffered appendicitis and required emergency medical services. He was not

transported by ambulance, and it appears a friend took him to Avera St. Mary’s

Hospital (Avera) in Hughes County. After his treatment, J.R. returned to Mexico

without paying the medical bills totaling over $75,000. J.R. had no health

insurance, few assets, and earned $19,624.90 in 2014. Avera sought reimbursement

from Sully County under SDCL chapter 28-13—the chapter on county poor relief.

Avera made its application to Sully County while J.R. was still hospitalized.

[¶3.] The Sully County Board of Commissioners (Commission) denied

Avera’s application, citing J.R.’s status as a nonresident of Sully County. Avera

appealed the Commission’s decision to the circuit court under SDCL 28-13-40. The

circuit court remanded the case to the Commission to develop a more detailed

factual record. Following a hearing, the Commission determined J.R. was indigent

by design under SDCL 28-13-27(6)(d). The Commission also determined that “J.R.

was not lying sick or in distress in Sully County at the time Sully County was

notified 10 days later as shown by the Notice of Hospitalization[.]” Based on these

-1-
#30152, #30167

determinations, the Commission again denied Avera’s claim. Avera again appealed

to the circuit court.

[¶4.] The circuit court first reviewed the Commission’s decision that J.R.

was not indigent by design, then noted that “[t]he major question in this case comes

down to whether J.R. had to be lying sick in Sully County at the time that the

complaint was made or at the time of the illness or whether what temporary relief

was required to be provided.” The circuit court relied on Roane v. Hutchinson

County, 40 S.D. 297, 167 N.W. 168 (1918), and denied Avera’s claim for

reimbursement. Avera appeals the circuit court’s decision. The Commission filed a

notice of review regarding the standard of review utilized by the circuit court.

Standard of Review

[¶5.] Both parties stipulated that J.R. was indigent. The Commission

interpreted and applied the poor-relief statutes and denied Avera’s claim. The

circuit court reviewed the Commission’s statutory interpretation de novo and

affirmed. “This Court interprets statutes under a de novo standard of review

without deference to the decision of the trial court.” In re Est. of Laue, 2010 S.D. 80,

¶ 10, 790 N.W.2d 765, 768 (quoting In re Est. of Olson, 2008 S.D. 4, ¶ 8, 744 N.W.2d

555, 558). 1

1. Avera filed a notice of appeal from the circuit court’s order denying its claim
for assistance. In its briefing, Avera asserts this Court does not have
jurisdiction to consider the issues raised in the Commission’s notice of review.
Because of our resolution of Avera’s appeal, it is unnecessary to consider the
Commission’s notice of review or Avera’s jurisdictional challenge to the notice
of review.

-2-
#30152, #30167

Analysis

[¶6.] “The obligation to support poor persons results not from the common

law, but from statutes providing for their care from public funds.” State of North

Dakota ex rel. Strutz v. Perkins Cnty., 69 S.D. 270, 273, 9 N.W.2d 500, 501 (1943)

(citing Hamlin Cnty. v. Clark Cnty., 1 S.D. 131, 45 N.W. 329 (1890)).

In construing a statute, our purpose is to discover the true
intention of the law and that intention must be ascertained
primarily from the language expressed in the statute. The
intent of the law must be derived from the statute as a whole
and by giving the statutory language its plain, ordinary and
popular meaning.

Hauck v. Clay Cnty. Comm’n., 2023 S.D. 43, ¶ 6, 994 N.W.2d 707, 710 (quoting State

v. Ventling, 452 N.W.2d 123, 125 (S.D. 1990)).

[¶7.] South Dakota’s poor-relief statutes require every county to “relieve and

support all poor and indigent persons who have established residency therein[.]”

SDCL 28-13-1. The parties agree that J.R. was not a resident of Sully County.

SDCL 28-13-37 imposes a different obligation on counties regarding nonresident

indigent persons.

It shall be the duty of the county commissioners, on complaint
made to them that any person not an inhabitant of their county
is lying sick therein or in distress, without friends or money, so
that he is likely to suffer, to examine into the case of such person
and grant such temporary relief as the nature of the case may
require.

SDCL 28-13-37 (emphasis added).

-3-
#30152, #30167

[¶8.] Under SDCL 28-13-38 2, counties have discretionary authority to

provide a nonresident indigent person with the “same relief as is customary in cases

where persons have established residency in the state and county.” If a county

provides such discretionary assistance to a nonresident, SDCL 28-13-38 provides

that county is entitled to reimbursement from the county where the poor person

resides. While a county can provide nonresidents with the same relief as is

customary for residents, it is not statutorily obligated to do so. Instead, SDCL 28-

13-37 only requires that it “grant such temporary relief as the nature of the case

may require.”

[¶9.] J.R. became ill and received emergency medical assistance at Avera in

Hughes County. He was not transported to Avera by Sully County or at the

county’s direction. The Commission first became aware of J.R.’s circumstances after

he had already presented to Avera in Hughes County for emergency medical

treatment. The Commission considered the analysis in our Roane decision and

determined that the “nature of the case” did not require them to provide any

assistance under SDCL 28-13-37.

2. SDCL 28-13-38 provides:

Whenever any person entitled to temporary relief as a poor
person shall be in any county in which he has not established
residency, the commissioners thereof may, if the same is deemed
advisable, grant such relief by providing the same relief as is
customary in cases where persons have established residency in
the state and county. The county furnishing relief shall be
entitled to reimbursements from the county in which said poor
person has established residency.

(Emphasis added.)

-4-
#30152, #30167

[¶10.] In Roane, this Court addressed the Hutchinson County Commission’s

obligations under a previous iteration of this statute nearly a century ago in a

remarkably similar case. 167 N.W. at 168. In Roane, several nonresident indigents

were injured in Hutchinson County and required emergency surgery. Id. The

indigents were taken to a hospital in Yankton County, where they received surgery

from Dr. Roane. Id. A county commissioner in Hutchinson County became aware of

the incident, and that there was an expectation that Hutchinson County would pay

for the costs. Id. Sometime later, Roane made a claim to the Hutchinson County

board of county commissioners for the costs rendered in his services to the

nonresident indigents. Id. After the board rejected his claim, Roane sued

Hutchinson County for the costs of his services to the nonresident indigents. On

appeal, this Court recognized that “the obligation of a county to furnish care and

relief for poor and indigent persons found within such county is purely statutory[.]”

Id. Because the indigent persons who received assistance from Roane were not

lawfully settled in Hutchinson County, the statutes related to care for residents did

not apply. Id. at 168–69. Because the indigent persons were noninhabitants of

Hutchinson County, the Court instead focused on applying the 1913 Revised

Political Code of South Dakota § 2781. 3 The Roane Court emphasized how § 2781

3. Section 2781 is the predecessor of SDCL 28-13-37 and provided in pertinent
part:

It shall be the duty of the overseers of the poor, on complaint
made to them that any person not an inhabitant of their county
is lying sick therein or in distress, without friends or money, so
that he or she is likely to suffer, to examine into the case of such
(continued . . .)
-5-
#30152, #30167

placed the onus to act on the county—not any other entity, such as a hospital or

surgeon:

It must be observed from a reading of this section of the statute
that the only authority conferred upon any one to act for the
county in making examination and caring for and granting
temporary relief to persons sick or in distress, found in such
county, but who are not then inhabitants thereof, is placed in
the hands of the overseers of the poor.

Id. at 169. From this, the Roane Court concluded that no statute required

Hutchinson County to reimburse Roane:

There does not appear to be any provision in this statute for
exceptional urgent cases, or cases where the public officers failed
to act, as in Maine, where it is expressly provided by statute
that when officials fail to do their duty, any person may, after
giving due notice, render assistance, and the county shall be
liable therefor. We have no such statute; besides, there is no
showing in this case that the board of overseers of Hutchinson
county was ever notified or failed to render assistance to the
injured persons in question.

Id. The Roane Court emphasized that the statute authorized the board to provide

temporary relief but did not provide that others who undertook that task were

entitled to reimbursement:

From the provisions of section 2781 it is clear that it is only
temporary relief that is authorized to be furnished by the
overseers, upon complaint made to them, where persons are
found lying sick and in need of such temporary relief within
their county. It is only for temporary relief that the overseers
are authorized to charge the county in the case of nonresidents.
In this case it clearly appears that temporary relief was in fact

________________________
(. . . continued)
person and grant such temporary relief as the nature of the
same may require; . . .

1913 Revised Political Code of South Dakota § 2781, amended by 1915 S.D.
Sess. Laws ch. 256 § 2.

-6-
#30152, #30167

actually furnished by some good Samaritan, other than the
overseers of Hutchinson county, who in seeking such temporary
relief removed said injured persons to a hospital in Yankton
county, and, so far as shown by the record, without the
knowledge or consent of the said overseers. These injured
persons were so removed beyond and outside of the jurisdiction
of Hutchinson county and the overseers thereof. The decisions
herein cited sustain the proposition, under statutes like section
2781, that where some one else, other than the overseers,
furnishes the temporary relief that might have been furnished by
the overseers, but was not, the county cannot be charged for such
temporary relief voluntarily furnished by some other person,
however humane might have been the act of such other person;
that the county can only be charged by and through the acts of its
overseers amounting to express or implied authorization of the
temporary relief. No such authorization seems to have been
made in this case. There is no provision made for urgent cases
by section 2781, or any other provision of our statute law.

Id. at 170 (emphases added). 4 The Roane Court also remarked on the county’s lack

of an opportunity to provide relief to the indigents:

The allegation of the complaint is that one of the county
commissioners of Hutchinson county was informed that the
accident had occurred and that his county would be expected to
pay the expenses incurred in caring for said persons. There is
no showing that this notice was given at a time when said
injured persons were in Hutchinson county, or that the overseers
of that county failed to perform their duties of making
examination and granting relief. There is no showing that the
commissioners of Hutchinson county were ever given or had any
opportunity to make the examination or grant relief to said
injured persons or to perform their duties with reference to said
injured poor, as provided for by the statute. Also, it will be
observed that the said injured persons were actually lying sick
and in distress in Yankton county at the time respondent was

4. Avera notes that its care to J.R. was not voluntary because it was mandated
by federal law. Despite this change in federal law, the South Dakota
Legislature has not modified SDCL 28-13-37 to require reimbursement in
such circumstances. The public policy arguments submitted to this Court by
Avera and the amicus would be more appropriately presented to the
Legislature in support of a statutory amendment. This Court must apply the
statutes as they exist.

-7-
#30152, #30167

called upon to care for them. It nowhere appears that the
officials of Hutchinson county in any manner authorized or
caused the said injured persons to be removed to Yankton.
Id. at 169.

[¶11.] The amicus argues that the Legislature abrogated Roane by enacting

SDCL 28-13-33. 5 This premise is incorrect because that statute only applies to

indigent persons who have established residency in a county. The statute places no

responsibility on a county to reimburse emergency hospital services for an indigent

person who has not established residency in the county. Like this case, Roane

involved an indigent person who was not a resident of the county from which

reimbursement was sought.

[¶12.] Alternatively, the amicus asks this Court to overrule Roane. Its

principal argument is that the Roane Court misread § 2781 as conferring to the

county commission the authority to examine claims involving temporary relief for

persons sick or in distress rather than imposing upon the county commission a duty

5. SDCL 28-13-33 provides:

Subject to the provisions of this chapter and except as expressly
provided, if a hospital furnishes emergency hospital services to a
medically indigent person, the county where the medically
indigent person has established residency is liable to the hospital
for the reimbursement of the hospitalization. In the case of
nonemergency care, the county of residence is liable only to the
extent that the board of county commissioners, in good faith,
approves an application for assistance. If a county provides
payment for nonemergency services, the services shall be
approved by the county before the services are provided. To the
extent that the county provides payment to a hospital, the
county has the same remedies for the recovery of the expense as
are provided by chapter 28-14 for the recovery of money
expended for the relief and support of poor and indigent persons.

(Emphasis added.)

-8-
#30152, #30167

to do so. To the contrary, the Court in Roane did not fail to apply the statute

properly. Instead, it determined that no duty existed under the facts of the case. In

particular, the Roane Court explicitly found that there was “no showing that this

notice was given at a time when said injured persons were in Hutchinson County, or

that the overseers of that county failed to perform their duties of making

examination and granting relief.” Roane, 167 N.W. at 169. The analysis employed

by the Roane court is directly applicable to this case.

[¶13.] The poor-relief statutes relating to resident indigent persons have no

application to this case because J.R. was not a resident of Sully County. SDCL 28-

13-37 and -38 outline a county’s obligations and discretionary authority regarding

nonresident indigents. SDCL 28-13-37 imposes a duty on county commissioners to

investigate complaints concerning nonresident poor persons who are “lying sick

therein or in distress” and to provide “such temporary relief as the case shall

require.” SDCL 28-13-37 did not require the Commission to act with respect to an

indigent nonresident who had left Sully County before the Commission learned he

was in distress. Relying on the Roane analysis, the Commission determined it was

not responsible for reimbursing Avera for J.R.’s medical treatment.

[¶14.] J.R. was an indigent who was not a Sully County resident. He

received medical care at Avera St. Mary’s Hospital in Hughes County. Sully County

did not become aware of J.R.’s illness until the notice of hospitalization was sent

after J.R. had received emergency services and was hospitalized in Hughes County.

As in Roane, Sully County had no chance to investigate whether J.R., a nonresident,

was “lying sick” in its county or “in distress” and to provide “such temporary relief

-9-
#30152, #30167

as the nature of the case may require” before Avera provided emergency services to

J.R. In these circumstances, where temporary relief had already been administered

to the nonresident indigent by a third party in another county, Sully County had no

statutory obligation to reimburse Avera for J.R.’s emergency medical services. We

affirm.

[¶15.] JENSEN, Chief Justice, and KERN, SALTER, and DEVANEY,

Justices, concur.

-10-