Denver Health & Hospital Authority v. City of Arvada Ex Rel. Arvada Police Department

JUDGE VOGT,

specially concurring.

¶ 50 I concur fully in the analysis and the result in the majority opinion. I write separately to highlight issues raised in this case that, in my view, cry out for resolution by the General Assembly.

¶ 51 As explained in the majority opinion, the constitutional requirement that governmental entities provide medical care to persons in their custody, codified in Colorado in section 16-3-401(2), C.R.S. 2015, includes an inherent obligation to pay for the costs of such care. I agree that the statutory definition of “custody” in section 16 — 1—104(9), C.R.S.2015 (“the restraint of a person’s freedom in any significant way”), applies to section 16-3-401(2) and, under the facts of this case, unambiguously requires that Arvada reimburse Denver Health for Terry Ross’s medical expenses.

¶ 52 While I believe the holding here gives effect to the plain language of the statutes, I also recognize that sections 16-3-401(2) and 16-1-104(9) as currently written can subject municipalities to potentially significant medical costs in a variety of situations. Arvada states that under the statutory definition of custody, its police department could be financially responsible for medical costs where, for example, officers restrain an intoxicated and injured teenager until an ambulance arrives; or where they come upon injured individuals following a shootout between rival gangs and do not allow the individuals to leave the scene until they can be transported to a hospital; or where a police officer shoots a suspect in self-defense; or where the police arrive on the scene of a domestic violence incident, take both individuals into custody, and both require medical attention. As Ar-vada correctly notes, even if the section 16-1-104(9) definition of custody applies to section 16-3^101(2), the statutes are silent as to the point in time at which custody is determined and as to whether it matters who caused the need for medical assistance.

¶ 53 Given these uncertainties, Arvada argues, the current statutory scheme has a potentially chilling effect on law enforcement’s willingness to be the first on the scene in response to a situation that might involve injured individuals.

¶ 54 Denver Health responds that there is no proof that the “chilling effect” Arvada describes has been felt over the life of section 16-3-401(2) or since Poudre Valley Health Care Inc. v. City of Loveland, 85 P.3d 558 (Colo.App.2003), was decided. That may be correct. However, more concrete examples of the reach of the statute are cited by CIRSA, appearing as amicus on behalf of its numerous member municipalities:

Denver Health has in the past sought reimbursement from CIRSA members for injuries such as dog bites occurring during the apprehension of a fleeing suspect, self-inflicted injuries occurring during a drunk driving episode before police even arrived, gunshot wounds sustained when a suspect ran at officers with a knife; among many other circumstances. These cases have ranged from the relatively insignificant (thousands of dollars) to the immense (half a million dollars). Additionally, time, effort, and resources of the members’ personnel is required to review, research, ¿nd determine the merit of claims submitted. The diversion of these resources has impacted the ability of CIRSA mémbers to effectively budget for and fund other valuable and necessary public projects.

¶ 55 CIRSA states that the current statutory scheme, as interpreted by the courts, has caused “ongoing uncertainty” for its members, and that “[i]f courts continue to determine that municipalities are responsible for paying the medical treatment of every *320suspect they arrest — regardless of whether the injury .was self-inflicted or .preexisting, and with no limit whatsoever on liability — all manner of government services will come under increased strain.”

¶ 66 In my view, these are valid concerns. However, relieving municipalities from responsibility for medical expenses raises equally legitimate concerns. As Denver Health explains, “[t]hese are zero sum circumstances where the intérests of the parties are inversely related.... Either the medical provider 'ór [the] governmental’agency must incur the costs of care if there are no other payors.” Citing Colorado’s “public policy favoring hospitals’ right to be paid for their life-saving work,” Amicus Colorado Hospital Association points out that hospitals, like municipalities, have operating budgets that are heavily impacted when they have to absorb large unreimbursed expenses, and that smaller rural hospitals in particular .can be adversely affected when'confronted with large costs of uncompensated emergency treatment.

¶ 57 Amicus, curiae City and County of Denver brings another perspective to the discussion. According to Denver’s brief, it “has contracted to pay more than $5,000,000 to Denver Health for care of persons Denver takes into custody and brings to Denver Health for treatment in 2015.” These funds are provided by Denver taxpayers. Thus, “any failure by a jurisdiction to pay for the medical care of its own detainees has the net effect of transferring at least a portion of the fiscal burden from taxpayers in that jurisdiction to the taxpayers of Denver.” This result, Denver argues, is not sound public policy, is unfair to Denver taxpayers, and was not the, legislature’s intent.

¶ 58 These are difficult issues, with compelling arguments on both sides. Resolution of the issues, in my view, is a quintessentially legislative function. ■ The General Assembly can receive input from all parties that have a stake in the issue, can .discuss and debate the competing policies, and can then enact legislation that will take into account the interests of all parties while protecting the rights of persons in the custody of the government to receive necessary medical care. I urge it to do so.