{ "id": 8234601, "name": "DENIECE SHELTON, individually and on behalf of a class of all persons similarly situated v. DUKE UNIVERSITY HEALTH SYSTEM, INC. d/b/a RALEIGH COMMUNITY HOSPITAL, d/b/a DUKE HEALTH RALEIGH HOSPITAL, d/b/a DUKE UNIVERSITY HOSPITAL, d/b/a DUKE UNIVERSITY MEDICAL CENTER and d/b/a DURHAM REGIONAL HOSPITAL", "name_abbreviation": "Shelton v. Duke University Health System, Inc.", "decision_date": "2006-08-01", "docket_number": "No. COA05-1113", "first_page": "120", "last_page": "126", "citations": [ { "type": "official", "cite": "179 N.C. App. 120" } ], "court": { "name_abbreviation": "N.C. Ct. App.", "id": 14983, "name": "North Carolina Court of Appeals" }, "jurisdiction": { "id": 5, "name_long": "North Carolina", "name": "N.C." }, "cites_to": [ { "cite": "293 S.E.2d 901", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 1982, "pin_cites": [ { "page": "921" } ], "opinion_index": 0 }, { "cite": "58 N.C. App. 414", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8525273 ], "year": 1982, "pin_cites": [ { "page": "447" } ], "opinion_index": 0, "case_paths": [ "/nc-app/58/0414-01" ] }, { "cite": "398 S.E.2d 331", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1990, "pin_cites": [ { "page": "334" } ], "opinion_index": 0 }, { "cite": "100 N.C. App. 718", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8527537 ], "year": 1990, "pin_cites": [ { "page": "722-23" } ], "opinion_index": 0, "case_paths": [ "/nc-app/100/0718-01" ] }, { "cite": "573 S.E.2d 600", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2002, "pin_cites": [ { "page": "604-05" } ], "opinion_index": 0 }, { "cite": "155 N.C. App. 372", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 9250282 ], "year": 2002, "pin_cites": [ { "page": "377-79" } ], "opinion_index": 0, "case_paths": [ "/nc-app/155/0372-01" ] }, { "cite": "534 S.E.2d 660", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 2000, "pin_cites": [ { "page": "664" } ], "opinion_index": 0 }, { "cite": "139 N.C. App. 778", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 9497849 ], "weight": 2, "year": 2000, "pin_cites": [ { "page": "784" } ], "opinion_index": 0, "case_paths": [ "/nc-app/139/0778-01" ] }, { "cite": "544 S.E.2d 4", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 2001, "pin_cites": [ { "page": "11" } ], "opinion_index": 0 }, { "cite": "142 N.C. App. 393", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 9441495 ], "weight": 2, "year": 2001, "pin_cites": [ { "page": "406" } ], "opinion_index": 0, "case_paths": [ "/nc-app/142/0393-01" ] }, { "cite": "N.C. Gen. Stat. \u00a7 75-1.1", "category": "laws:leg_statute", "reporter": "N.C. Gen. Stat.", "weight": 2, "pin_cites": [ { "page": "(b)" } ], "opinion_index": 0 }, { "cite": "200 S.E.2d 622", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1973, "pin_cites": [ { "page": "624-25" } ], "opinion_index": 0 }, { "cite": "284 N.C. 407", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8562175 ], "year": 1973, "pin_cites": [ { "page": "409-11" } ], "opinion_index": 0, "case_paths": [ "/nc/284/0407-01" ] }, { "cite": "311 S.E.2d 632", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 1984, "pin_cites": [ { "page": "636", "parenthetical": "\"[T]he terms of a contract must be definite and certain or capable of being made so; the minds of the parties must meet upon a definite proposition.\"" }, { "page": "636", "parenthetical": "emphasis added" } ], "opinion_index": 0 }, { "cite": "66 N.C. App. 590", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8525690 ], "weight": 2, "year": 1984, "pin_cites": [ { "page": "596", "parenthetical": "\"[T]he terms of a contract must be definite and certain or capable of being made so; the minds of the parties must meet upon a definite proposition.\"" }, { "page": "596" } ], "opinion_index": 0, "case_paths": [ "/nc-app/66/0590-01" ] }, { "cite": "553 S.E.2d 84", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2001, "pin_cites": [ { "page": "87" } ], "opinion_index": 0 }, { "cite": "146 N.C. App. 401", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 11358357 ], "year": 2001, "pin_cites": [ { "page": "405" } ], "opinion_index": 0, "case_paths": [ "/nc-app/146/0401-01" ] }, { "cite": "577 S.E.2d 411", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2003, "pin_cites": [ { "page": "414-15", "parenthetical": "citations omitted" } ], "opinion_index": 0 }, { "cite": "156 N.C. App. 503", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 9191271 ], "year": 2003, "pin_cites": [ { "page": "507", "parenthetical": "citations omitted" } ], "opinion_index": 0, "case_paths": [ "/nc-app/156/0503-01" ] } ], "analysis": { "cardinality": 674, "char_count": 15202, "ocr_confidence": 0.756, "pagerank": { "raw": 3.526392055988947e-07, "percentile": 0.8840781837087799 }, "sha256": "7455cff4e398e54a1ec981edadaa57cc954b22b75bbd3dd7ce8b5180e2852215", "simhash": "1:09b968e32ced947d", "word_count": 2442 }, "last_updated": "2023-07-14T22:27:33.869735+00:00", "provenance": { "date_added": "2019-08-29", "source": "Harvard", "batch": "2018" }, "casebody": { "judges": [ "Judges ELMORE and JACKSON concur." ], "parties": [ "DENIECE SHELTON, individually and on behalf of a class of all persons similarly situated v. DUKE UNIVERSITY HEALTH SYSTEM, INC. d/b/a RALEIGH COMMUNITY HOSPITAL, d/b/a DUKE HEALTH RALEIGH HOSPITAL, d/b/a DUKE UNIVERSITY HOSPITAL, d/b/a DUKE UNIVERSITY MEDICAL CENTER and d/b/a DURHAM REGIONAL HOSPITAL" ], "opinions": [ { "text": "STEELMAN, Judge.\nPlaintiff sought treatment at Raleigh Community Hospital, which is owned by Duke University Health System, in July of 2002. Plaintiff did not have health insurance sufficient to cover all her medical expenses. Prior to obtaining treatment, plaintiff signed a consent form entitled \u201cConsent and Conditions of Treatment.\u201d Under a section titled \u201cPayment Agreement,\u201d the consent form included the following language: \u201cThe undersigned individually obligates himself to the payment of the Hospital account incurred by the patient in accordance with the regular rates and terms of the Hospital at the time of patient\u2019s discharge.\u201d Plaintiff alleges that she was never provided with any information explaining or listing the \u201cregular rates\u201d of the hospital. Plaintiff further alleges that, unbeknownst to her at the time she signed the contract, defendant was charging greatly reduced rates to patients who had full insurance coverage through either government or private insurance programs.\nSubsequent to her discharge from the hospital, plaintiff received medical bills totaling $7891.00 for services rendered by defendant. Plaintiff paid these bills in full prior to filing suit in this matter.\nPlaintiff filed this action on 14 February 2005, on behalf of herself and a class of persons similarly situated. Plaintiffs complaint included causes of action for breach of contract; unjust enrichment; unfair and deceptive trade practices; and declaratory and injunctive relief. Defendant moved to dismiss the complaint pursuant to Rule 12(b)(6) of the North Carolina Rules of Civil Procedure on 15 April 2005. The trial court granted defendant\u2019s motion, and dismissed plaintiff\u2019s complaint with prejudice by order entered 11 July 2005. Plaintiff appeals.\nIn plaintiff\u2019s first argument, she contends that the trial court erred in dismissing her claims for breach of contract; unjust enrichment; and declaratory and injunctive relief. We disagree.\nWe review de novo the grant of a motion to dismiss. A motion to dismiss made pursuant to . . . Rule 12(b)(6) tests the legal sufficiency of the complaint. \u201cThe system of notice pleading affords a sufficiently liberal construction of complaints so that few fail to survive a motion to dismiss.\u201d Accordingly, when entertaining \u201ca motion to dismiss, the trial court must take the complaint\u2019s allegations as true and determine whether they are sufficient to state a claim upon which relief may be granted under some legal theory.\u201d\nLea v. Grier, 156 N.C. App. 503, 507, 577 S.E.2d 411, 414-15 (2003) (citations omitted).\nPlaintiff argues the following in support of her contract claim: 1) The Consent and Conditions of Treatment form which she signed failed to contain a definite price term; 2) because no definite price term was agreed upon, the law infers a \u201creasonable rate\u201d as the contract price for the services rendered; and 3) the rates defendant charged plaintiff for its services were unreasonable, and the charging of unreasonable rates constituted a breach of the contract. Plaintiff\u2019s contract claim fails if the relevant language of the consent form was sufficiently definite to inform plaintiff of the price term. Contract interpretation is a matter of law, and the standard of review for this Court is de novo. Internet East, Inc. v. Duro Communs., Inc., 146 N.C. App. 401, 405, 553 S.E.2d 84, 87 (2001).\nThe relevant language from the Consent and Conditions of Treatment form reads as follows: \u201cThe undersigned individually obligates himself to the payment of the Hospital account incurred by the patient in accordance with the regular rates and terms of the Hospital at the time of patient\u2019s discharge.\u201d We first note that nowhere in plaintiff\u2019s complaint does she contend that the rates she was charged were not the \u201cregular rates\u201d of the hospital, she merely contends that these rates were \u201cunreasonable\u201d. Therefore, the question of whether plaintiff was charged the \u201cregular rates\u201d is not before us on appeal.\nThe next question is whether the \u201cregular rates\u201d language in the agreement was sufficiently definite to allow a meeting of the minds on the price term. Elliott v. Duke University, Inc., 66 N.C. App. 590, 596, 311 S.E.2d 632, 636 (1984) (\u201c[T]he terms of a contract must be definite and certain or capable of being made so; the minds of the parties must meet upon a definite proposition.\u201d). Plaintiff contends that the hospital keeps a list of the rates it charges the uninsured (or under-insured) in a document called the \u201ccharge master\u201d. Plaintiff further alleges that she was not provided with this document before she signed the consent form. Plaintiff makes no allegation that she attempted to gain access to the \u201ccharge master\u201d to ascertain the regular rates and was denied access to this \u201ccharge master\u201d by defendant.\n\u201cThe heart of a contract is the intention of the parties, which is to be ascertained from the expressions used, the subject matter, the end in view, the purpose sought, and the situation of the parties at the time.\u201d When a contract is in writing and free from any ambiguity which would require resort to extrinsic evidence, or the consideration of disputed fact, the intention of the parties is a question of law. The court determines the effect of their agreement by declaring its legal meaning.\nA contract, however, encompasses not only its express provisions but also all such implied provisions as are necessary to effect the intention of the parties unless express terms prevent such inclusion. \u201cThe court will be prepared to imply a term if there arises from the language of the contract itself, and the circumstances under which it is entered into, an inference that the parties must have intended the stipulation in question.\u201d The doctrine of implication of unexpressed terms has been succinctly stated as follows:\n\u201cIntention or meaning in a contract may be manifested or conveyed either expressly or impliedly, and it is fundamental that that which is plainly or necessarily implied in the language of a contract is as much a part of it as that which is expressed. If it can be plainly seen from all the provisions of the instrument taken together that the obligation in question was within the contemplation of the parties when making their contract or is necessary to carry their intention into effect, the law will imply the obligation and enforce it. The policy of the law is to supply in contracts what is presumed to have been inadvertently omitted or to have been deemed perfectly obvious by the parties, the parties being supposed to have made those stipulations which as honest, fair, and just men they ought to have made.\u201d\nLane v. Scarborough, 284 N.C. 407, 409-11, 200 S.E.2d 622, 624-25 (1973).\nIn the instant case, the contested language is free from ambiguity. It is clear that plaintiff was agreeing by her signature to pay the \u201cregular\u201d rates charged by defendant for the services it was to render. Plaintiff makes no argument in her complaint that she was charged anything other than the \u201cregular\u201d rates. When we consider the \u201csituation of the parties at the time,\u201d the \u201csubject matter\u201d and the \u201cpurpose sought,\u201d we find the price term was sufficiently definite.\nPlaintiff sought medical services. Inherent in providing medical care and treatment is the element of the unforeseen. It is common, almost expected, that a course of treatment embarked upon will, through unforeseen circumstances, be amended, altered, enhanced, or terminated altogether, and a completely new course of treatment begun. In light of this, it would be impossible for a hospital to fully and accurately estimate all of the treatments and costs for every patient before treatment has begun. It would be cumbersome, and against patients\u2019 interests, to require hospitals to seek new authorization from a patient whenever some medical circumstance requires a new course of treatment. For this reason, it is entirely reasonable and predictable that patients would agree to pay the hospital\u2019s regular rates for whatever services might be necessary in treating their particular ailments or afflictions. None of this is to suggest that patients have no right to question hospitals concerning any particular treatment and the costs therefore, or that patients cannot refuse treatment for reasons of cost.\nAs previously stated, there is no evidence in the record that plaintiff attempted to ascertain the regular rates for the services to be provided to her. Plaintiffs complaint does allege that the \u201cregular\u201d rates existed on defendant\u2019s \u201ccharge master\u201d. Thus, the price term of \u201cthe regular rates and terms of the Hospital at the time of patient\u2019s discharge\u201d was \u201cdefinite and certain or capable of being made so.\u201d Elliott, 66 N.C. App. at 596, 311 S.E.2d at 636 (emphasis added). We hold that the rates of services contained in the \u201ccharge master\u201d were necessarily implied in the contract signed by plaintiff. Because there is no allegation that the rates contained in the \u201ccharge master\u201d were not sufficiently definite, and because there is no allegation that plaintiff was charged rates different than those \u201cregular\u201d rates contained in the \u201ccharge master\u201d, plaintiff\u2019s complaint does not allege a claim for breach of contract. The trial court properly dismissed this claim.\nPlaintiff argues in the alternative that if this Court finds the above contested language renders the contract unenforceable, she was entitled to recover under a theory of unjust enrichment, and the trial court erred in dismissing that claim. Because we have not held the contract to be unenforceable, we do not address this argument. Further, having held that plaintiff agreed to pay the \u201cregular rates\u201d; that the \u201cregular rates\u201d price term was sufficiently definite; and that plaintiff was, in fact, charged the \u201cregular rates\u201d; we need not address plaintiff\u2019s argument that the rates charged by defendant were \u201cunreasonable.\u201d\nNext plaintiff argues that the trial court erred in dismissing her claims for declaratory judgment and injunctive relief. Plaintiff makes no argument in her brief concerning her claim for injunctive relief, and it is deemed abandoned. N.C. R. App. P. Rule 28(b)(6) (2005). Plaintiff argues that she is entitled to a declaratory judgment to determine the actual price she should pay in light of the ambiguity of the price term in the contract. As we have already held that the price term is not ambiguous, plaintiff\u2019s argument fails. We again note that plaintiff paid the charges without objection when they were due. Plaintiffs first argument is without merit.\nIn plaintiff\u2019s second argument, she contends that the trial court erred in dismissing her claim for unfair and deceptive trade practices against defendant. We disagree.\nIn order to establish a claim [under N.C. Gen. Stat. \u00a7 75-1.1], plaintiffs must show (1) an unfair or deceptive act or practice, (2) in or affecting commerce, (3) which proximately caused actual injury to them. N.C. Gen. Stat. \u00a7 75-1.1(b) (1999) defines commerce as \u201call business activities however denominated, but does not include professional services rendered by a member of a learned profession.\u201d\nBurgess v. Busby, 142 N.C. App. 393, 406, 544 S.E.2d 4, 11 (2001). \u201cOur Court has made clear that unfair and deceptive acts committed by medical professionals are not included within the prohibition of N.C.G.S. \u00a7 75-1.1(a).\u201d Gaunt v. Pittaway, 139 N.C. App. 778, 784, 534 S.E.2d 660, 664 (2000). This exception for medical professionals has been broadly interpreted by this Court, see Phillips v. A Triangle Women\u2019s Health Clinic, 155 N.C. App. 372, 377-79, 573 S.E.2d 600, 604-05 (2002); Burgess, 142 N.C. App. 393, 544 S.E.2d 4 (2001); Gaunt, 139 N.C. App. 778, 534 S.E.2d 660 (2000); Abram v. Charter Medical Corp., 100 N.C. App. 718, 722-23, 398 S.E.2d 331, 334 (1990); Cameron v. New Hanover Memorial Hospital, Inc., 58 N.C. App. 414, 447, 293 S.E.2d 901, 921 (1982), and includes hospitals under the definition of \u201cmedical professionals.\u201d Id. We hold that the facts of this case do not justify a departure from this precedent. This argument is without merit.\nIn light of our holdings above, we do not reach plaintiff\u2019s third argument.\nAFFIRMED.\nJudges ELMORE and JACKSON concur.\n. Raleigh Community Hospital changed its name to Duke Health Raleigh Hospital effective June 1, 2004.", "type": "majority", "author": "STEELMAN, Judge." } ], "attorneys": [ "Wallace & Graham, P.A., by Mona Lisa Wallace, JohnS. Hughes, and Cathy A. Williams, and Shipman & Wright, L.L.P., by Gary K. Shipman and William G. Wright, for plaintiff-appellant.", "Fulbright & Jaworski L.L.P., by John M. Simpson, Frederick Robinson, and Stephen M. McNabb, for defendant-appellee." ], "corrections": "", "head_matter": "DENIECE SHELTON, individually and on behalf of a class of all persons similarly situated v. DUKE UNIVERSITY HEALTH SYSTEM, INC. d/b/a RALEIGH COMMUNITY HOSPITAL, d/b/a DUKE HEALTH RALEIGH HOSPITAL, d/b/a DUKE UNIVERSITY HOSPITAL, d/b/a DUKE UNIVERSITY MEDICAL CENTER and d/b/a DURHAM REGIONAL HOSPITAL\nNo. COA05-1113\n(Filed 1 August 2006)\n1. Contracts; Hospitals and Other Medical Facilities\u2014 medical expenses \u2014 agreement to pay \u201cregular rates\u201d \u2014 no breach of contract by hospital\nPlaintiff patient who did not have health insurance sufficient to cover all of her medical expenses did not state a claim for breach by defendant hospital of a contract in which she agreed to pay \u201cthe regular rates and terms of the hospital at the time of the patient\u2019s discharge\u201d where plaintiff alleged that defendant hospital was charging reduced rates to patients who had full insurance coverage and that the rates defendant charged plaintiff were not stated in the contract and were unreasonable because (1) plaintiff did not allege that she was not charged the \u201cregular rates\u201d of defendant hospital; (2) plaintiff alleges that the \u201cregular rates\u201d were shown on defendant\u2019s \u201ccharge master,\u201d and plaintiff made no allegation that she attempted to gain access to the \u201ccharge master\u201d to ascertain the regular rates and was denied access to this document by defendant; (3) the rates of services contained in the \u201ccharge master\u201d were necessarily implied in the contract signed by plaintiff; and (4) the price term of the hospital\u2019s \u201cregular rates\u201d was thus definite and certain or capable of being made so.\n2. Declaratory Judgments\u2014 price term \u2014 ambiguity\nThe trial court did not err by dismissing plaintiffs claim for declaratory judgment to determine the actual price she should pay for hospital service in light of the alleged ambiguity of the price term in the contract, because: (1) the Court of Appeals has already held that the price term was not ambiguous; and (2) plaintiff paid the charges without objection when they were due.\n3. Unfair Trade Practices\u2014 dismissal of claim \u2014 medical professionals not included\nThe trial court did not err by dismissing plaintiff\u2019s claim for unfair and deceptive trade practices, because: (1) unfair and deceptive acts committed by medical professionals are not included within the prohibition of N.C.G.S. \u00a7 75-1.1(a); and (2) the facts of this case do not justify a departure from this precedent.\nAppeal by plaintiff from judgment entered 11 July 2005 by Judge Ronald L: Stephens in Wake County Superior Court. Heard in the Court of Appeals 22 March 2006.\nWallace & Graham, P.A., by Mona Lisa Wallace, JohnS. Hughes, and Cathy A. Williams, and Shipman & Wright, L.L.P., by Gary K. Shipman and William G. Wright, for plaintiff-appellant.\nFulbright & Jaworski L.L.P., by John M. Simpson, Frederick Robinson, and Stephen M. McNabb, for defendant-appellee." }, "file_name": "0120-01", "first_page_order": 152, "last_page_order": 158 }