Amendment to hospital lien law held unconstitutional.

COURTS ARE RELUCTANT TO DECLARE STATE LAWS UNCONSTITUTIONAL. Every effort is made to interpret a statute consistent with the Constitution. Most laws contain clauses that provide that if any one section is declared null and void, the validity of other sections of the law in question shall not be affected. Hospitals generally have liens on proceeds of all patient claims against third party for payment for all services provided by the hospital. In Missouri, the law provides that nonprofit hospitals can be reimbursed for up to 50 percent of the total amount of any settlement or judgment that any patient receives. An attempt was made to amend the law to include "other health care providers" in the same category as hospitals. Several hospitals in the St. Louis area brought suit challenging the constitutionality of the amendment to the hospital lien law.

MISSOURI'S HOSPITAL LIEN LAW WAS ENACTED TO ALLOW HOSPITALS TO FILE LIENS AGAINST THE PROCEEDS OF PATIENTS' SETTLEMENTS. Hospitals were entitled to collect on the liens for up to 50 percent of the amount due to their patients under any final judgment, compromise or settlement agreement. During the 1999 legislative session, several bills were introduced into the legislature for the purpose of creating a new hospital lien law. All of these bills sought to expand the scope of the hospital lien to allow certain defined clinics, health practitioners, and other institutions the same lien rights as hospitals. After numerous amendments, the Missouri legislature enacted a law which was entitled "An Act To Repeal [160] Sections ... Relating To Professional Licensing, in lieu thereof 160-9 new sections relating to the same subject, with penalty provisions, an expiration date for certain sections, and an emergency clause for a certain section." The record indicated that over the objection of State Senator Marvin Singleton, M.D., the bill was passed into law. Three hospitals, each of which is a privately maintained hospital supported in whole or part by charity, filed claims for relief under the hospital lien law both before and after the passage of the legislation in question. The hospitals concluded that the amendment to the hospital lien law threatened to reduce the amounts that might otherwise be available to hospitals. The Circuit Court of Cole County, upheld the constitutionality of the law. The hospitals appealed.

THE SUPREME COURT OF MISSOURI HELD THE LAW UNCONSTITUTIONAL AND REVERSED THE JUDGMENT OF THE LOWER COURT. The court held, inter alia, that statutes maintain a presumption of constitutionality. The court further noted that the constitutionality of a statute will be upheld unless it "clearly and undoubtedly" violates the constitutional limitation. The test for determining whether a law has multiple subjects is not whether the individual provisions of the law itself relate to each other, but focuses on the subject of the law as expressed in the title of the bill introduced in the legislature. If the individual provisions "fairly relate" to the subject described in the title of the bill, having a "natural connection" to the subject, or are a means to accomplish the law's purpose, then the law has a single subject and withstands a constitutional challenge. If the purpose of the law is clearly expressed in the title of the bill introduced in the legislature, then the court need not look beyond the title to determine the bill's subject. The state legislature passed the law in question as a bill proclaimed as "relating to professional licensing." "Professional licensing" is a gerund, the noun form of the verb referring to the act of obtaining, maintaining, or revoking the state's authority for a person to engage in professional activity. The court concluded that this was the sole subject described in the title in question. The court concluded that it was difficult to discern how the hospital lien law might relate to or have a natural connection with the bill titled "Relating to Professional Licensing."

THE STATED SUBJECT OF THE BILL WAS "PROFESSIONAL LICENSING," THE ACT OF LICENSING, NOT "PROFESSIONAL LICENSEES." The single subject limitation required the contents of the bill, not the entities affected by the bill, fairly relate to the subject expressed in the title of the act. The court noted that the hospitals, previously the sole beneficiary of the hospital lien law are adversely affected by the law in question. Hospitals are subject to licensing under their own specific provisions mandated by the Department of Health. The court found that even under the state's argument in favor of the constitutionality of the bill, there is no relationship between professional licensing and the hospital lien law. SSM Cardinal Glennon Childern's Hospital v. State, 2002 WL 356700 S.W.3d - MO

A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for nearly 40 years, he concentrates in health care law with the Providence, R.I., firm of A. David Tammelleo & Associates. He has presented seminars on medical, nursing and hospital law throughout the United States. In addition to his writings as Editor of Medical Law's, Nursing Law's & Hospital Law's Reagan Reports, his legal articles have been published in the most prestigious health law journals. A prolific writer, his thousands of articles, as well its his achievements as an attorney and lecturer, have won him recognition in Martindale-Hubbell's Bar Register of Preeminent Lawyers and Marquis Who's Who in American Law.