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Bynum v. Magno11/18/2004
FOR PUBLICATION
ACOBA, J., CIRCUIT JUDGE POLLACK, IN PLACE OF NAKAYAMA, J., RECUSED, AND CIRCUIT JUDGE DEL ROSARIO, ASSIGNED BY REASON OF VACANCY; AND MOON, C.J., DISSENTING, WITH WHOM LEVINSON, J., JOINS
We have jurisdiction pursuant to Hawaii Revised Statutes (HRS) ยง 602-5(2) (1993) and Hawai`i Rules of Appellate Procedure (HRAP) Rule 13(a) (2000) to answer the following certified questions by the United States District Court for the District of Hawaii (the district court) to this court:
Where a plaintiff's healthcare expenses are paid by Medicare and/or Medical, does the discounted amount paid to a healthcare provider by [Medicare ] and Medi-Cal constitute the amount that should be awarded as medical special damages to a plaintiff in a negligence action? In this circumstance, is evidence of amounts billed in excess of the amount paid irrelevant and inadmissible?
For the reasons set forth herein, the answer to both questions is "no."
I.
The questions posed arise out of a medical malpractice action in which Plaintiffs-Appellees Joseph Bynum (Joseph) and his wife Lila Bynum (Lila) (collectively the Bynums), sued to recover damages for injuries Joseph allegedly suffered in connection with coronary artery bypass grafting surgery.
While vacationing on the Big Island of Hawaii in July of 1998, Joseph experienced chest pains. Initially, Joseph went to North Hawaii Community Hospital for treatment, and was later transferred to the Queen's Medical Center (Queen's) in Honolulu, for further treatment. Dr. Joana Magno (Magno), a cardiologist at Queen's, assumed responsibility for coordinating Joseph's care as his attending physician. Magno consulted with Dr. Michael Dang (Dang), a cardiovascular surgeon, and Dr. John Callan (Callan), a pulmonologist, and recommended that Joseph undergo bypass surgery on an urgent basis. Magno did not advise the Bynums that Joseph could try alternate treatments, such as medical therapy or angioplasty, but presented surgery as his only option. At the time Magno recommended bypass surgery, she knew Joseph had experienced respiratory failure two years earlier, and recognized that his history of lung disease was a "red flag" to bypass surgery.
During the bypass surgery performed by Dang, Joseph suffered respiratory distress, which required him to be placed on mechanical ventilation for the remainder of his life. After spending three months in Queen's, Joseph was transferred to six different intensive care facilities in California.
From the time of the surgery, Joseph was eligible for Medicare, which initially paid for his medical bills. However, to allow Joseph to become eligible for Medi-Cal, California's Medicaid program, and to protect their life savings from the costs of Joseph's ongoing hospitalization, the Bynums legally divorced on February 11, 1999.
Joseph lived in intensive care facilities for over 1,314 days after the surgery, and was dependent upon the ventilator for the rest of his life, passing away on February 21, 2002.
II.
The Bynums filed a lawsuit against Magno, Dang, Callan, and Queen's (hereinafter, collectively, Defendants), on December 30, 1999, prior to Joseph's death. During discovery, the Bynums produced medical bills, which reflected the "standard" or "customary" charges (hereinafter "standard rates") for the services provided by the medical facilities in which Joseph had resided. Prior to trial, the parties entered into a stipulation regarding those bills, in which they agreed, inter alia, that the medical bills "reflect medical treatment for [Joseph] that was necessary for medical conditions that existed
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