Charlotte-Mecklenburg Hospital Authority v. Talford

ERVIN, Judge,

dissenting.

Although I concur in the Court’s determination that Defendant’s failure to challenge the trial court’s decision with respect to the issue of liability on appeal necessarily means that the only question before us is the appropriateness of the trial court’s decision to enter judgment in favor of Plaintiff on the issue of damages, I am unable to join that portion of the Court’s opinion that concludes that the trial court erred by granting summary judgment in favor of Plaintiff with respect to the damages issue. As a result, I join the Court in affirming the trial court’s decision to grant summary judgment in favor of Plaintiff with *212respect to the issue of liability, although I believe that Defendant’s liability is predicated on an express contract rather than on a quantum meruit theory. However, I respectfully dissent from that portion of the Court’s opinion that reverses the trial court’s decision concerning the damages issue and would affirm the damages-related portion of the trial court’s judgment as well.

I. Standard of Review

Summary judgment is proper “if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that- any party is entitled to a judgment as a matter of law.” N.C. Gen. Stat. § 1A-1, Rule 56(c). In reviewing an order granting summary judgment, our task is to “determine, on the basis of the materials presented to the trial court, whether there is a genuine issue as to any material fact and whether the moving party is entitled to judgment as a matter of law.” Coastal Plains Utils., Inc. v. New Hanover Cty., 166 N.C. App. 333, 340, 601 S.E.2d 915, 920 (2004) (citing Oliver v. Roberts, 49 N.C. App. 311, 314, 271 S.E.2d 399, 401 (1980), cert. denied, 276 S.E.2d 283 (1981)). “All inferences of fact from the proofs offered at the hearing must be drawn against the movant and in favor of the party opposing the motion.” Boudreau v. Baughman, 322 N.C. 331, 343, 368 S.E.2d 849, 858 (1988) (citing Page v. Sloan, 281 N.C. 697, 706, 190 S.E.2d 189, 194 (1972)).

Supporting and opposing affidavits shall be made on personal knowledge, shall set forth such facts as would be admissible in evidence, and shall show affirmatively that the affiant is competent to testify to the matters stated therein. Sworn or certified copies of all papers or parts thereof referred to in an affidavit shall be attached thereto or served therewith. . . . When a motion for summary judgment is made and supported as provided in this rule, an adverse party may not rest upon the mere allegations or denials of his pleading, but his response, by affidavits or as otherwise provided in this rule, must set forth specific facts showing that there is a genuine issue for trial. If he does not so respond, summary judgment, if appropriate, shall be entered against him.

N.C. Gen. Stat. § 1A-1, Rule 56(e). “ ‘A verified complaint may be treated as an affidavit if it (1) is made on personal knowledge, (2) sets forth such facts as would be admissible in evidence, and (3) shows affirmatively that the affiant is competent to testify to the matters stated therein.’ ” Merritt, Flebotte, Wilson, Webb & Caruso, PLLC v. *213Hemmings, 196 N.C. App. 600, 605, 676 S.E.2d 79, 83-84 (quoting Page, 281 N.C. at 705, 190 S.E.2d at 194), disc. review denied, 363 N.C. 655, 686 S.E.2d 518 (2009). A trial court’s decision to grant a summary judgment motion is reviewed on a de novo basis. Va. Electric & Power Co. v. Tillett, 80 N.C. App. 383, 385, 343 S.E.2d 188, 191, cert. denied, 317 N.C. 715, 347 S.E.2d 457 (1986).

II. Substantive Legal Issues

A. Basis of Liability

As an examination of the record and briefs clearly establishes, the parties agree that Plaintiff provided medical services to Defendant and billed Defendant $14,419.57 for those services. In reaching the conclusion that Defendant had failed to challenge the trial court’s liability decision on appeal and that the trial court’s decision concerning the liability issue should be upheld on appeal for that reason, the Court, with the apparent support of Plaintiff, appears to assume that the trial court relied on a quantum meruit theory in order to reach that result. Although I agree with the Court that Defendant has not challenged the trial court’s decision to find him liable to Plaintiff under any particular theory and that the trial court’s finding of liability should be upheld for that reason, I do not agree with the Court’s apparent understanding of the basis upon which the trial court decided the liability issue.

The Request for Treatment and Authorization Form that Plaintiff signed prior to receiving medical services from Plaintiff states, in pertinent part, that:

PAYMENT GUARANTY. I (patient and/or responsible party/ies) agree to pay all charges for services rendered by the Hospital and my physicians or other providers during my hospitalization or treatment. This guaranty includes charges for services not covered by my insurance, regardless of the reason that insurance coverage is denied. If I fail to pay all charges and the Hospital or my physicians use an attorney to collect unpaid charges, I agree to pay the reasonable cost of the attorney’s fees in addition to the unpaid charges.

In its order granting summary judgment in favor of Plaintiff, the trial court explicitly stated that:

THIS MATTER coming on before the undersigned Superior Court Judge presiding upon motion of the Plaintiff pursuant to Rule 56 of the North Carolina Rules of Civil Procedure for an *214Order granting Summary Judgment as to the Defendant. . . and it appearing to the Court that there is no genuine issue as to any material fact and that the Plaintiff is entitled to Judgment as a matter of law;
IT IS THEREFORE ORDERED that Plaintiffs Motion for Summary Judgment is granted and the Plaintiff is entitled to Judgment against the Defendant... as follows:
1. The principal amount of Fourteen Thousand Four-Hundred Nineteen Dollars and 57/100 ($14,419.57);
2. Interest at the legal rate from 2/8/2008, until paid in full;
3. Attorney fees in the amount of Two Thousand One Hundred Sixty Two Dollars and 94/100 ($2,162.94);
4. The costs in this action be taxed against the Defendant.

Although I can find no case holding that attorney’s fees are recoverable in an action brought solely on the basis of a quantum meruit theory, Plaintiff contends that such relief is available in cases brought pursuant to certain express contracts pursuant to N.C. Gen. Stat. § 6-21.2. As a result of the fact that the trial court awarded Plaintiff attorney’s fees in addition to compensatory damages, I believe that, instead of finding Defendant liable on the basis of a quantum meruit theory, the trial court made its liability determination in reliance on the language of the Payment Guaranty provision.1

In rejecting Plaintiff’s contention that the Payment Guaranty provision provides an alternative basis for holding Defendant liable for its bill, the Court concludes that the relevant contractual language does not create a valid guaranty because “Defendant himself signed the ‘Request for Treatment and Authorization Form’ that included a ‘Payment Guaranty’ section,” so that “no secondary obligation was ever created in a third party.” A careful reading of the Payment Guaranty provision demonstrates, however, that, notwithstanding the introductory heading that makes reference to a “Payment Guaranty,” this provision actually constitutes a direct promise made by Defendant to pay for the services that Plaintiff provided to him rather than a guaranty that Defendant would pay another person’s bill. See *215Forsyth Co. Hospital Authority, Inc., v. Sales, 82 N.C. App. 265, 268, 346 S.E.2d 212, 214 (stating that “the title is not necessarily controlling” and that “ [t]he substance of the transaction controls”), disc. review denied, 318 N.C. App. 415, 349 S.E.2d 594 (1986). The Court’s decision to treat the Payment Guaranty as an invalid guaranty provision, Cowan v. Roberts, 134 N.C. 415, 418, 46 S.E.2d 979, 980 (1904) (stating that “[a] guaranty is a promise to answer for some debt, or the performance of some duty, in the case of the failure of another person who is himself liable in the first instance [for] such payment or performance”) (citing Carpenter v. Wall, 20 N.C. 279, 280 (1838)), strikes me as inconsistent with the document’s literal language, which directly obligates Defendant to pay for the services which he received from Plaintiff rather than obligating Defendant to pay for services provided to another. As a result, I do not believe that the fact that the Payment Guaranty does not purport to render one person liable for the debt of another has any bearing on the extent, if any, to which Defendant is liable to Plaintiff on the basis of its provisions and cannot agree with the Court’s conclusion to the contrary. Thus, given that the Payment Guaranty expressly provides for an award of attorney’s fees, that the trial court awarded attorney’s fees to Plaintiff in its judgment, and that such attorney’s fees are not recoverable in an action brought on the basis of a quantum meruit theory,21 believe that the proper way to read the trial court’s judgment, is to understand it as resting on a decision to enforce the Payment Guaranty rather than on the doctrine of quantum meruit.

B: Measure of Damages

“It is a well[-]established principle that an express contract precludes an implied contract with reference to the same matter.” Concrete Co. v. Lumber Co., 256 N.C. 709, 713, 124 S.E.2d 905, 908 (1962) (citations omitted). However, “[w]here there is an express agreement to pay, but the amount is not specified, the person performing the services is entitled to recover on the theory of quantum meruit.” Duffell v. Weeks, 15 N.C. App. 569, 570-71, 190 S.E.2d 379, 381 *216(1972); see also Turner v. Marsh Furniture Co., 217 N.C. 695, 697, 9 S.E.2d 379, 380 (1940) (stating that, “when there is no agreement as to the amount of compensation to be paid for services, the person performing them is entitled to recover what they are reasonably worth____”). Although this Court has found that a contract for medical services between a hospital and a patient requiring the patient to pay “ ‘the regular rates and terms of the Hospital at the time of patient’s discharge’ ” constitutes a sufficiently definite price term to support an award of damages in reliance on an express contract, Shelton v. Duke Univ. Health Sys., 179 N.C. 120, 123-24, 633 S.E.2d 113, 115-16 (2006), disc. review denied, 361 N.C. 357, 643 S.E.2d 591 (2007), I am unable to conclude that a provision requiring Defendant to pay “all charges” is entitled to similar treatment. Thus, the ultimate issue before us on appeal is the correctness of the trial court’s decision that there was no genuine issue of material fact with respect to the reasonable value of the services that Plaintiff provided Defendant and that Plaintiff was entitled to judgment as a matter of law on that question.3

“In order to recover in quantum meruit, a party must prove, in addition to the contract, the reasonable value of his services rendered thereunder.” Paxton v. O.P.F., Inc., 64 N.C. App. 130, 133, 306 S.E.2d 527, 530 (1983) (citing Hood v. Faulkner, 47 N.C. App. 611, 616, 267 S.E. 2d 704, 706-07 (1980), and Harrell v. Construction Co., 41 N.C. App. 593, 595-96, 255 S.E.2d 280, 282 (1979), aff'd, 300 N.C. 353, 266 S.E.2d 626 (1980)).

The general rule is that when there is no agreement as to the amount of compensation to be paid for services, the person performing them is entitled to recover what they are reasonably worth, based on the time and labor expended, skill, knowledge and experience involved, and other attendant circumstances, rather than on the use to be made of the result or the benefit to the person for whom the services are rendered.

Turner, 217 N.C. at 697, 9 S.E.2d at 380 (citations omitted). In challenging the trial court’s decision to grant summary judgment in favor of Plaintiff on the issue of damages, Defendant attacks the sufficiency of the evidence that Plaintiff presented in an effort to establish the reasonableness of its charges for medical services.

*217In Harrell, 41 N.C. App. at 596, 255 S.E.2d at 282, this Court held that, where the “Plaintiff did not offer evidence as to the reasonable value or market value of its services, but merely stated what it was charging for these services as shown on plaintiffs [ledger sheets,]” the invoice, unaccompanied by any other evidence, did not suffice to establish that the plaintiff’s bill was reasonable. See also Paxton, 64 N.C. App. at 134, 306 S.E.2d at 530 (holding that “a plaintiff must do more than simply allege an amount and its reasonableness” in order “to recover more than nominal damages”); Hood, 47 N.C. App. at 617, 267 S.E.2d at 707 (holding that the plaintiff’s bill coupled with “the plaintiff’s opinion that the amount of his bill is reasonable [is not] sufficient to sustain an award for such sum”). On the other hand, in Environmental Landscape Design v. Shields, 75 N.C. App. 304, 330 S.E.2d 627 (1985), a case in which the plaintiff sought payment for landscaping work, we noted that, “[b]esides plaintiff’s bill, there was evidence in the present case that the landscaper who eventually landscaped defendants’ property also charged $30.00 per hour” and held that “this evidence was sufficient to go to the jury on the issue of damages.”4 Id. at 307, 330 S.E.2d 629; see also Booe v. Shadrick, 322 N.C. 567, 571, 369 S.E.2d 554, 556 (1988) (holding that the testimony of the plaintiff’s bookkeeper “as to what was billed for the materials and labor and the evidence of a payment for a part of it at the billed rate is evidence sufficient for the jury to find the reasonable value to the defendants of the remaining goods and services for which bills were submitted and no payment was made”).5 As a result, a critical *218distinction between the decisions in which the evidence has been held sufficient or insufficient to establish the reasonable value of goods and services provided to a defendant is the extent to which the record does or does not contain evidence tending to show that the amount the plaintiff charged was similar to that charged by at least one other market participant or had been previously paid by the defendant without objection.6

In overturning the trial court’s decision to grant summary judgment in favor of Plaintiff on the damages issue, the Court holds that “Plaintiff’s evidence concerning damages consisted entirely of a ‘bill’ stating that Plaintiff was owed $14,419.57, along with affidavits from its own employees stating that that amount was reasonable;” that “Defendant challenged the reasonableness of that amount;” and, that, “in his affidavit, [Defendant] provided specific challenges to [the] amounts Defendant claims he was charged by Plaintiff for services.” I do not read the Plaintiff’s showing before the trial court at the summary judgment hearing as consisting solely of a bill coupled with a conclusory claim of reasonableness.

In its complaint, Plaintiff alleged that “ [t]he fair and reasonable value of the goods and services referred to in paragraph 4 above, for which payment has not been received, is not less than Fourteen Thousand Four Hundred Nineteen Dollars and 57/100 ($14,419.57)” and that “[t]he charges listed for the services rendered as requested by the treating physician as medically necessary are reasonable given *219that they are standard charges rendered to all patients receiving similar types of services, they are within industry norms for similar facilities providing similar services at similar levels of care, and they are compliant with various published billing and charging regulations and guidelines, including those of the Center for Medicare and Medicaid Services.” Attached to Plaintiff’s complaint was an “Affidavit and Verification,” which stated that:

Before the undersigned Notary Public, personally appeared James D. Robinson, who being duly sworn, says: That he is the Manager of Patient Financial Services, Legal Accounts for The Charlotte-Mecklenburg Hospital Authority, Plaintiff in this action and that as such, he makes this affidavit:
He is personally familiar with the books, records and record-keeping system of Plaintiff and the entries were made in accordance with said systems; that the entries are part of the regular business records of the Plaintiff and represent the fair and reasonable value of the goods and services rendered; that the entries were made at or near the time of the transactions recorded; and that the account of [Defendant] is just and true as stated hereafter[.]
Further, he verifies that he has read the foregoing Complaint and knows the contents thereof, and that said contents are true of his own knowledge, save and except for those matters and things stated therein upon information and belief, and as to such matters and things, he believes them to be true.

In addition, Plaintiff submitted several affidavits to the trial court in support of its request for summary judgment, including the affidavit of Sunny Sain, Plaintiff’s Director of Revenue Management, in which Ms. Sain stated that:

The undersigned, Sunny Sain, Director, Revenue Management being first duly sworn, deposes and states that the charges listed for the services rendered as requested by the treating physician are reasonable given that they are standard charges rendered to all patients receiving similar types of services, they are within industry norms for similar facilities providing similar services at similar levels of care, and they are compliant with various published billing and charging regulations and guidelines, including those of the Center for Medicare and Medicaid Services.

*220Although Defendant argues that Ms. Sain’s affidavit “did not present any facts based upon personal knowledge that the fees charged were reasonable”, we need not decide whether Ms. Sain’s affidavit, taken in context, adequately establishes that the information contained in that document rested on her personal knowledge in light of her role as Plaintiff’s Director of Revenue Management, See Bird v. Bird, 193 N.C. App. 123, 130, 668 S.E.2d 39, 43 (2008), aff'd, 363 N.C. 774, 688 S.E.2d 420 (2010) (holding that a private investigator’s affidavit, when read in context, established that it was based on the requisite personal knowledge), Hospital v. Brown, 50 N.C. App. 526, 530, 274 S.E.2d 277, 280 (1981) (holding that an individual who “testified that he served as credit manager for plaintiff hospital for four years, was familiar with plaintiff’s schedule of charges, was familiar with schedules of charges for hospital services approved by Blue Cross-Blue Shield and the Federal government, and was familiar with the procedures used by plaintiff in determining the amount owed by patients” “was competent to give his opinion as to the reasonableness of the charges made by plaintiff for the treatment and care of” the patient),7 given that Mr. Robinson, in verifying the complaint, swore to essentially the same information as Ms. Sain and given that Defendant has not challenged the sufficiency of the evidence presented by Mr. Robinson. As a result, I believe that the record contains much more than a simple recitation of the amount of Plaintiff’s bill and a conclusory claim that the amount of Plaintiff’s bill was reasonable. Instead, I read the record as showing that Plaintiff has presented evidence to the effect that the amounts charged to Defendant were

1. Standard charges rendered to all patients receiving similar types of services.
2. Within industry norms for similar facilities providing similar services at similar levels of care.
*2213. Compliant with various published billing and charging regulations and guidelines, including those of the Center for Medicare and Medicaid Services.

Thus, unlike the Court,81 would hold that Plaintiff forecast sufficient evidence tending to show both the amount of the bill that it submitted to Defendant and that the amount of that bill was reasonable in light of prevailing market conditions,9 thereby obligating Defendant to produce evidence of “specific facts showing that there is a genuine issue for trial.”10

In attempting to respond to Plaintiffs evidence, Defendant submitted an affidavit upon which the Court relies, in part, to find that the record discloses the existence of a genuine issue of material fact sufficient to preclude an award of summary judgment with respect to the damages issue.11 In his affidavit, Defendant stated:

*2221. That I am the Defendant in the above-captioned matter;
2. That my hospital bill has a cost of $18.40 for one tablet of Diltiazem, and my prescription from CMC Pharmacy cost $23.00 for thirty (30) tablets;
3. That my hospital bill has a cost of $406.50 for one unit of Enoxaparin sodium, 120 mg syringe, and the cost for this item is $278.00 for ten units;
4. That my hospital bill has a cost of $1.45 per unit for a folic acid 1 mg tablet, and the cost at a local pharmacy is $4.00 for thirty 1 mg tablets;
5. That plaintiff's charges exceed the charges made and paid by other patients in the defendant's medical condition;
6. That the plaintiffs charges are not reasonable for the medical care necessary to control the defendant's medical condition.

The record provides absolutely no basis for inferring that the last two assertions contained in Defendant’s affidavit were based on his personal knowledge, so the statements in question were not properly before the trial court at the time that it ruled on Plaintiff’s summary judgment motion. Nugent v. Beckham, 37 N.C. App. 557, 560, 246 S.E.2d 541, 544 (1978) (noting that “[a]t no point does the affidavit in question affirmatively show that it was based on the personal knowledge of the affiant or that he was otherwise competent to testify to *223the matters stated therein”).12 An examination of the information about which Defendant appears to have personal knowledge set out in Defendant’s affidavit indicates that, in each instance, Defendant selected a medication that Plaintiff utilized in the course of providing medical services to him and compared the cost of purchasing that medication at retail to the amount that Plaintiff charged to Defendant relating to the same item.

On appeal, Defendant asserts, and the Court appears to agree, that these three cost differences demonstrate the existence of a genuine issue of material fact concerning the reasonable value of the services Defendant received from Plaintiff. I am unable to agree with this contention, since it rests upon a misapprehension of the relevant legal standard, which focuses upon the value of the services provided by Plaintiff rather than upon the cost of particular components of the services provided to Defendant if purchased under vastly different sets of circumstances. See, e.g., Doe v. HCA Health Services of Tennessee, Inc., 46 S.W.3d 191, 198-99 (2001) (stating that “ ‘reasonable value’ ” in cases involving “medical goods and services provided by a hospital to a patient” should be “determined by considering the hospital’s internal factors as well as the similar charges of other hospitals in the community”) (citing Galloway v. Methodist Hospital, Inc., 658 N.E.2d 611, 614 (Ind. Ct. App. 1995), Heartland Health System, Inc. v. Chamberlin, 871 S.W.2d 8, 11 (Mo. Ct. App. 1993), Victory Memorial Hospital v. Rice, 143 Ill App. 3d 621, 625, 493 N.E.2d 117, 120, 97 Ill. Dec. 635, _ (1986), and Ellis Hospital v. Little, 65 App. Div. 2d 644, 409 N.Y.S.2d 459, 461 (1978).

As the record clearly reflects, Plaintiff is not a retail establishment primarily engaged in the sale of medications, devices, or other supplies. Instead, Plaintiff is a provider of comprehensive medical services in a hospital environment. Simply put, Plaintiff did not merely sell Defendant specific medications; instead, Plaintiff provided these medications to Defendant as part of an overall package that also included nursing services, the use of hospital facilities, and similar items provided on a bundled rather than an unbundled basis. The fact that one could purchase certain medications in a retail estab*224lishment more cheaply than the amount associated with the provision of that medication as administered in the course of rendering inpatient treatment in a hospital, as reflected on Plaintiffs bill, has no bearing on the issue of whether Plaintiff charged a reasonable amount for the medical care that it provided to Defendant given the applicable legal standard. As a result, since the information contained in Defendant’s affidavit is simply not relevant to the issue of the reasonableness of the cost of the medical services that Defendant received from Plaintiff, I would hold that the information in question did not suffice to show the existence of a genuine issue of material fact concerning the reasonableness of Plaintiff’s bill and would affirm the trial court’s decision to grant summary judgment in favor of Plaintiff with respect to the damages issue as well.

III. Conclusion

Thus, for the reasons set forth above, I believe that Plaintiff forecast sufficient evidence concerning the reasonableness of the amount that it billed Defendant to require Defendant to show the existence of a genuine issue of material fact. In addition, I believe that the only factual information offered by Defendant in opposition to Plaintiff’s showing was simply irrelevant to the issue that is actually before the Court in light of the applicable measure of damages. As a result, although I concur in the Court’s decision to affirm the trial court’s determination that Defendant is liable to Plaintiff, I differ from the Court in believing that the trial court’s order should be affirmed in its entirety and respectfully dissent from the Court’s decision to overturn the trial court’s entry of summary judgment in favor of Defendant on the damages issue.13

. The Court concludes that the trial court lacked the authority to enter judgment in favor of Plaintiff on the basis of an express contract theory because Plaintiff never sought such relief in its complaint. I am unable to agree with this conclusion given that Plaintiff clearly alleged that it was entitled to recover damages on the basis of the Payment Guaranty provision in its complaint.

. Plaintiff contends in its brief that it is entitled to recover attorney’s fees pursuant to N.C. Gen. Stat. § 6-21.2, which authorizes a successful litigant to collect attorney’s fees in connection with the enforcement of “any note, conditional sale contract or other evidence of indebtedness.” We need not decide whether Plaintiff is actually entitled to recover attorney’s fees under the Payment Guaranty pursuant to N.C. Gen. Stat. § 6-21.2 in light of Defendant’s complete failure to challenge this aspect of the trial court’s judgment on appeal. Viar v. N.C. Dept. of Transp., 359 N.C. 400, 402, 610 S.E.2d 360, 361 (2005) (stating that “[i]t is not the role of the appellate courts ... to create an appeal for an appellant”).

. The distinction made in the text between an action brought under a quantum meruit theory and the use of quantum meruit principles to replace an indefinite price term in an express contract makes no practical difference for purposes of this case. In both instances, the measure of damages is the same: the reasonable value of the services provided to plaintiff by defendant.

. Although the Court attempts to distinguish this case from Environmental Landscaping on the grounds that the present case lacks “independent corroboration” evidence of prices charged by third parties for. similar services, I do not find this argument persuasive. At bottom, the fact that rendered the plaintiff’s evidence in Environmental Landscaping sufficient was the existence of evidence of what a service provider other than the plaintiff charged for similar services. Such evidence exists in this case in the form of testimony from Plaintiff’s affiants concerning the consistency of the prices charged by Plaintiff with the prices charged by other, similar facilities and the guidelines and billing regulations promulgated by various programs such as Medicare. I do not believe, for reasons that are stated in more detail below, that the fact that the evidence in question was presented in the form of affidavits executed by Plaintiff’s employees rather than in the form of evidence presented by a third party makes any material difference in the outcome given the absence of patent, as compared to latent, reasons for questioning the credibility of those affiants.

. Although the Court emphasizes the obvious factual differences between the present case and Booe, it also cites Booe for the proposition that a defendant is entitled to defend against efforts to collect a combined bill for materials and services by presenting evidence that the materials in question were overpriced. I do not, however, find this argument convincing given that the evidence before the Court in Booe uniformly included combined prices for both labor and materials rather than for materials alone.

. The Court questions the appropriateness of my reliance on certain of these cases because they were decided in a directed verdict, rather than in a summary judgment, context. However, this Court has clearly stated that “[t]he standard of review for a directed verdict is essentially the same as that for summary judgment.” Nelson v. Novant Health Triad Region, 159 N.C. App. 440, 442, 583 S.E.2d 415, 417 (2003). Although the Court notes that there are obvious differences between the inquiries that must be conducted in the two contexts and contends that the distinction between the summary judgment and directed verdict contexts is critical to a proper resolution of this case, I believe that these assertions do not undermine the usefulness of tbe decisions that I have discussed in the text for purposes of resolving the present case. According to well-established North Carolina law, in the event that a party with the burden of proof seeking the entry of summary judgment in its favor “properly supports all the essentials of that claim with evidence, it falls to the opposing party to present contradictory evidence or to show by facts that the movant’s evidence is insufficient or unreliable.” Blackwell v. Massey, 69 N.C. App. 240, 243, 315 S.E.2d 350, 352 (1984). As a result, the extent to which Plaintiff’s proof would be sufficient to avert the entry pf a directed verdict in favor of Defendant is clearly relevant to the issue of whether its evidentiary forecast sufficed to require Defendant to show the existence of a genuine issue of material fact or risk having summary judgment entered in favor of Plaintiff.

. The Court notes that “we have only affidavits from Plaintiffs employees stating that the amounts charged to Defendant were the same as would be charged by other hospitals” and that “Plaintiff’s own statements concerning the reasonableness of the charges [do not] carry the same weight as specific evidence that an independent third party did, in fact, charge the same rate.” Although I cannot quarrel with the accuracy of the Court’s statement that Plaintiff relied on information supplied by its own employees, I do not, for reasons to be discussed in more detail below, believe that the fact that Plaintiff employed these affiants provides any basis for overturning the trial court’s decision to grant summary judgment with respect to the issue of damages in favor of Plaintiff and am concerned that the Court’s reliance on this fact involves a credibility determination that is outside the scope of the issues that should be considered in ruling on a trial court order granting or denying a summary judgment motion.

. The difference of opinion that exists between the Court, on the one hand, and me, on the other, with respect to this issue is critical to a proper appreciation of our differing positions about the proper resolution of this case. Although both of us appear to understand the applicable standard as objective, rather than subjective, in nature, I believe that the additional references in Plaintiff’s affidavits to the charges assessed against other patients, the consistency of Plaintiff’s charges with those assessed for similar services in similar facilities, and the fact that Plaintiff’s charges are consistent with “various published billing and charging regulations and guidelines” are sufficient to convert Plaintiff’s evidence from a subjective claim of reasonableness to an objective description of applicable market conditions, thereby rendering this case distinguishable from decisions such as Austin v. Enterprises, Inc., 45 N.C. App. 709, 710-11, 264 S.E.2d 121, 122 (1980); Hood; and Paxton.

. Although the Court notes that the record does not contain an itemized bill detailing the services that Plaintiff provided to Defendant, it does not cite any authority for the proposition that the inclusion of such a bill in the record is a precondition for a finding of reasonableness, and I have not discovered any such authority in my own research. Thus, particularly given that the record clearly establishes that Defendant had access to such an itemized bill for use in preparing his defense, I do not believe that Plaintiff’s failure to submit such a bill for the trial court’s consideration at the time of the hearing on its summary judgment motion has any bearing on the proper resolution of this case.

. I do not, of course, believe that the fact that Plaintiff made a prima facie showing on the damages issue entitles it to summary judgment in its favor. Instead, I simply believe that Plaintiff’s success in making out such a case required Defendant to establish the existence of a genuine issue of material fact in order to preclude the entry of summary judgment in Plaintiff’s favor.

. The Court concludes, as I have previously indicated, that the fact that Plaintiff’s affidavits were executed by its own employees results in the existence of a genuine issue of material fact sufficient to preclude the entry of summary judgment in Plaintiff’s favor with respect to the damage issue for credibility-related reasons. I am not persuaded by this argument for two different reasons. First, since Defendant never *222made any such credibility-related argument in his brief, a decision to grant relief on this basis would be tantamount to “creating] an appeal for an appellant.” Viar, 359 N.C. at 402, 610 S.E.2d at 361. Secondly, the Supreme Court has clearly stated that “summary judgment may be granted for a party with the burden of proof on the basis of his own affidavits (1) when there are only latent doubts as to the affiant’s credibility; (2) when the opposing party has failed to introduce any materials supporting his opposition, failed to point to specific areas of impeachment or contradiction, and failed to utilize [N.C. Gen. Stat. § 1A-1,] Rule 56(f); and (3) when summary judgment is otherwise appropriate.” Kidd v. Early, 289 N.C. 343, 370, 222 S.E.2d 392, 412 (1976). As a result of the fact that the only doubts that the Court has expressed about the credibility of Plaintiff’s affiants arise from the identity of their employer, making these doubts latent, rather than patent, in nature; given the fact that the record is devoid of any reason to believe that the affiants have a personal stake in the outcome of this case; and given that the fact that I do not believe that the other bases for refusing to grant summary judgment in favor of the party with the burden of proof outlined in Kidd are present in this case, I do not believe that the trial court’s order is subject to reversal on credibility-related grounds even if the Court were to reach this issue and disagree with the Court’s apparent impression that granting summary judgment in favor of the party with the burden of proof in a case where the defendant has failed to forecast relevant evidence demonstrating the existence of a genuine issue of material fact is tantamount to making a determination that Plaintiff’s affiants are credible.

. Although the Court appears to assert, in reliance on Austin, that these generalized denials of reasonableness suffice to demonstrate the existence of a genuine issue of material fact, this argument overlooks the fact that the evidentiary forecast submitted on behalf of the plaintiff in Austin consisted of nothing more than a generalized assertion of reasonableness, 45 N.C. App. at 710-11, 264 S.E.2d 122, and the fact that, in order to avoid a grant of summary judgment, the defendant “must set forth specific facts showing there is a genuine issue for trial.” N.C. Gen. Stat. § 1A-1, Rule 56(e).

. The Court argues that the effect of the analytical approach that I have used in this case is that, in every case in which a trial judge grants a directed verdict, summary judgment should have been granted, and that, in the event that a trial court denies summary judgment in favor of one party, it should necessarily grant summary judgment in favor of the other party. I do not believe that such an outcome is inherent in the approach I have taken, which I believe to be the one required by applicable North Carolina law. The first of these two propositions is not necessarily valid because issues of credibility may appear to exist at the time a summary judgment motion is decided but do not ultimately materialize at trial. Similarly, in the event that a trial judge denies a summary judgment motion filed by one party on the grounds that the record discloses the existence of one or more genuine issues of material fact, it would be equally inappropriate for summary judgment to be .granted in favor of the other party. At bottom, as long as a party against whom summary judgment is sought presents or points to specific evidence in the record or specific patent difficulties with the credibility of the movant’s evidence, it is not defenseless against an exorbitant claim for monetary damages.