Empire Health Found. v. CHS/Community Health Sys. Inc.
Opinion of the Court
Plaintiff Empire Health Foundation sues Defendants CHS/Community Health Systems Inc., Spokane Washington Hospital Company LLC, and Spokane Valley Washington Hospital Company LLC (collectively "CHS") for breach of contract, alleging it failed to fulfill the charity care commitments *1256it made in its 2008 acquisition of two Spokane area hospitals. ECF No. 1.
The Foundation moves for partial summary judgment solely on the issue of whether CHS provided the amount of charity care contemplated by a condition in a state agency certificate, which the Court previously ruled is enforceable under the parties' contract. ECF Nos. 22, 36, 50. CHS moves for summary judgment, arguing the charity care condition is too indefinite and uncertain to enforce or, alternatively, CHS did not breach the charity care condition and the Foundation is not entitled to any remedy. ECF No. 59. The parties oppose each other's motions. ECF Nos. 58, 62. The Court held a hearing on both motions on February 26, 2019. After reviewing the record and relevant legal authorities, the Court denies both motions because genuine disputes over material facts abound, the contract is enforceable, and an equitable remedy is available.
BACKGROUND
In 2007, Empire Health Services and CHS entered an Asset Purchase Agreement under which Empire Health Services sold Deaconess Medical Center and Valley Hospital and Medical Center to CHS. ECF No. 14-1. The Foundation is a nonprofit community health foundation formed from the proceeds of the sale. ECF No. 1 at 1. The Foundation received all of Empire Health Services' rights and obligations when it dissolved following the sale. Id.
Section 10.14 of the contract concerns "Indigent Care Policies." ECF No. 14-1 at 53-54. Section 10.14 provides,
As of the Closing Date, Buyers shall adopt the indigent care policies of CHS attached as Exhibit D hereto, including the relevant provisions of the billing and collections policy with respect to the indigent, which are at least as favorable to the indigent and uninsured as Seller's indigent care policy, including the relevant provisions of the billing and collections policy with respect to the indigent, for the Hospitals as Buyers' indigent care policy. No patient will be turned away because of age, race, gender or inability to pay. Buyers shall use best efforts to cause the Hospitals to continue to provide services to patients covered by the Medicare and Medicaid programs and those unable to pay for emergent or medically necessary care at levels similar to the historic levels of indigent care previously provided by the Hospitals. For a period of at least ten (10) years following the Closing Date, Buyers will provide the Board of Trustees with an annual report of their compliance with this Section 10.14. Buyers will also continue to provide care through community-based health programs, including cooperation with local organizations that sponsor healthcare initiatives to address identified community needs and improve the health status of the elderly, poor, and at-risk populations in the community. This covenant shall be subject in all respects to changes in legal requirements or governmental guidelines or policies (such as implementation of universal healthcare coverage).
Id.
Exhibit D's charity care policies, which section 10.14 cross-references, provide, "[i]n order to serve the health care needs of our community, and in accordance with RCW [Revised Code of Washington] 70.170 and WAC [Washington Administrative Code] 246-453, [each hospital] will provide 'Charity Care' to patients or the 'Responsible Party' without financial means to pay for 'Appropriate hospital-based medical services.' " ECF No. 14-2 at 14, 27. Exhibit D's charity care policies define *1257eligibility and processes for identifying charity cases and providing or denying charity care. Id. at 14-19, 27-32.
Pursuant to the contract, CHS applied for Certificates of Need from the Washington State Department of Health. ECF No. 18-1 at 2. The Department granted CHS's applications "pending agreement to the following conditions":
[Each hospital] will provide charity care in compliance with the charity care policies provided in this Certificate of Need application, or any subsequent policies reviewed and approved by the Department of Health. [Each hospital] will use reasonable efforts to provide charity care in an amount comparable to or exceeding the average amount of charity care provided by hospitals in the Eastern Washington Region. Currently, this amount is 3.35% of the adjusted revenue. [Each hospital] will maintain records documenting the amount of charity care it provides and demonstrating its compliance with its charity care policies.
Id. at 2-3; accord id. at 5. The Department elsewhere described this condition as "requir[ing] CHS to increase the level of charity care to the regional average." ECF No. 63-7 at 41. CHS agreed to this condition. ECF No. 18-2 at 2, 4. Then, in 2008, the Department issued the Certificates of Need and approved the purchase of each hospital, subject to this condition. ECF No. 61-1 at 2; ECF No. 61-2 at 2.
The 3.35% figure was the average of the three most recent years of available data, from 2004 to 2006. ECF No. 63-1 at 93-94; ECF No. 63-5 at 4, 7; ECF No. 63-6 at 4, 7; ECF No. 63-7 at 6. While the 3.35% figure established the initial benchmark for providing charity care, the benchmark was subject to change based on subsequent years' data. ECF No. 63-1 at 94. The Foundation claims that, between 2011 and 2016, CHS failed to meet the benchmark. ECF No. 50. CHS disputes how the Foundation calculated the benchmark, provides an alternative calculation, and claims it approximated or exceeded the benchmark. ECF No. 59.
Section 12.23 of the contract, entitled "No Third Party Beneficiaries," provides, "[t]he terms and provisions of this Agreement are intended solely for the benefit of Buyers and Seller and their respective permitted successors or assigns, and it is not the intention of the parties to confer, and this Agreement shall not confer, third-party beneficiary rights upon any other person." ECF No. 14-1 at 65.
Section 12.24 of the contract, entitled "Enforcement of Agreement," provides,
The parties hereto agree that irreparable damage would occur in the event that any of the provisions of this Agreement was not performed in accordance with its specific terms or was otherwise breached. It is accordingly agreed that the parties shall be entitled to an injunction or injunctions to prevent breaches of this Agreement and to enforce specifically the terms and provisions hereof in any court of competent jurisdiction, this being in addition to any other remedy to which they are entitled at law or in equity.
Id.
In its complaint, the Foundation explains,
This lawsuit seeks (1) injunctive relief and/or specific performance to require Defendants to fully comply with the requirements of Agreements, which incorporate the ... Certificate of Need Conditions ...; (2) disgorgement of all excess profits retained by Defendants as a result of its failure to comply with the requirements of the Agreements, as modified by state law, including but not limited to, its failure to provide at *1258least the regional average of charity care to Spokane area indigent patients; and (3) all other contractual and equitable relief available to Plaintiff for Defendants' failure to provide charity care as required by the Agreements.
ECF No. 1 at 8. For its breach of contract cause of action, the Foundation alleges it is entitled to damages "including, without limitation, declaratory and injunctive relief, specific performance, and restitution/disgorgement." Id. at 10. Finally, in its demand for relief, the Foundation asks the Court to "[e]njoin Defendants from current and future breaches of ... contract"; "[o]rder disgorgement of all funds retained by Defendants that should have been provided as charity care and/or community benefits under the Agreement, the ... Certificate of Need conditions and consistent with Washington law"; "[e]nter judgment in favor of the Foundation in an amount to be proven at trial due to Defendants' breach of contract"; and "[a]ward such other relief as is just and proper." Id. at 11.
LEGAL STANDARD
A party is entitled to summary judgment where the documentary evidence produced by the parties permits only one conclusion. Anderson v. Liberty Lobby, Inc. ,
The moving party has the initial burden of showing no reasonable trier of fact could find other than for the moving party. Celotex Corp. v. Catrett ,
"[A] mere 'scintilla' of evidence will be insufficient to defeat a properly supported motion for summary judgment; instead, the nonmoving party must introduce some 'significant probative evidence tending to support the complaint.' " Fazio v. City & County of San Francisco ,
The Court must view the facts and draw inferences in the manner most favorable to the nonmoving party. Anderson , 477 U.S. at 255,
DISCUSSION
"A breach of contract is actionable only if the contract imposes a duty, the duty is breached, and the breach proximately causes damage to the claimant." Nw. Indep. Forest Mfrs. v. Dep't of Labor & Indus. ,
A. The contract's essential terms are reasonably definite and certain.
CHS argues the Certificate of Need's charity care condition is too indefinite and uncertain to enforce. If correct, this would relieve CHS of its duty under that provision.
"[F]or a contract to form, the parties must objectively manifest their mutual assent ... [and] the terms assented to must be sufficiently definite." Keystone Land & Dev. Co. v. Xerox Corp. ,
"Where the parties have intended to finalize a bargain, any uncertainty as to incidental or collateral matters is generally not harmful to the validity of the contract." 25 David K. DeWolf et al., Washington Practice Series § 2:27 (3d ed. rev. 2018) (citing Restatement, supra , § 33 cmt. a). "Washington courts do not lightly declare a contract void for lack of certainty but will instead endeavor to discover the true meaning and intent of the parties." Id.
Here, section 10.14 provides that "[n]o patient will be turned away because of ... inability to pay" and CHS "shall use best efforts to cause the Hospitals to continue to provide services to patients covered by the Medicare and Medicaid programs and those unable to pay for emergent or medically necessary care at levels similar to the historic levels of indigent care previously provided by the Hospitals." ECF No. 14-1 at 53. Meanwhile, the Certificate of Need's charity care condition says each hospital "will use reasonable efforts to provide charity care in an amount comparable to or exceeding the average amount of charity care provided by hospitals in the Eastern Washington Region." ECF No. 18-1 at 2-3, 5; ECF No. 61-1 at 2; ECF No. 61-2 at 2. Section 12.24 then provides specific remedies to ameliorate the "irreparable damage [that] would occur in the event that any of the provisions of this Agreement was not performed in accordance with its specific terms or was otherwise breached." ECF No. 14-1 at 65.
The Court must interpret these provisions together. See City of Union Gap v. Printing Press Props., L.L.C. ,
Reading these provisions as an average person would read them, the Court discerns a core of common meaning sufficient to both determine CHS's performance with reasonable certainty and give the Foundation a reasonably certain basis for an appropriate remedy. See generally
Considering all, the Court concludes the contract's essential terms are reasonably definite and certain.
B. The Certificate of Need's charity care condition and section 10.14's change-of-law provision are ambiguous.
The parties dispute whether, between 2011 and 2016, CHS provided a level of charity care comparable to the regional average. The dispute centers on the appropriate benchmark for measuring whether CHS fulfilled its charity care obligations. First, the parties dispute how to calculate the regional average. The Foundation uses available data from the immediately preceding year. CHS uses available data from a trailing three-year period. Each party provides some evidence that its own calculation is the correct one under the contract and possibly represents the original intent. Second, the parties dispute whether the Patient Protection and Affordable Care Act, Pub. L. No. 111-148,
"The touchstone of contract interpretation is the parties' intent." Tanner Elec. Co-op. v. Puget Sound Power & Light Co. ,
If, after considering the context described above, a contract provision is subject to two or more reasonable interpretations, it is ambiguous and presents a question of fact as to its meaning. See *1261Viking Bank v. Firgrove Commons 3, LLC ,
Here, the Certificate of Need's charity care condition says each hospital "will use reasonable efforts to provide charity care in an amount comparable to or exceeding the average amount of charity care provided by hospitals in the Eastern Washington Region." ECF No. 18-1 at 2-3, 5; ECF No. 61-1 at 2; ECF No. 61-2 at 2. After considering the entire context, including the extrinsic evidence the parties have provided, the second half of this provision is subject to two or more reasonable interpretations. Specifically, "comparable to" could reasonably require either approximation or a close match. Either way, the degree of deviation to be tolerated is not conclusively established. Further, and perhaps more importantly, "average amount" could reasonably require using available data from either the immediately preceding year or a trailing three-year period. Again, each party provides some evidence that its own calculation is the correct one under the contract and possibly represents the original intent. Thus, the Certificate of Need's charity care condition is ambiguous and presents a question of fact as to its meaning.
Additionally, section 10.14's change-of-law provision says "[t]his covenant [regarding charity care] shall be subject in all respects to changes in legal requirements or governmental guidelines or policies (such as implementation of universal healthcare coverage)." ECF No. 14-1 at 54. After considering the entire context, including the extrinsic evidence the parties have provided, this provision is subject to two or more reasonable interpretations. Specifically, in the event this provision is triggered-a question of fact the parties dispute-this provision could reasonably be interpreted as either absolving CHS of its charity care obligations or reducing its obligations to reflect new charity care needs. Again, each party provides some evidence that its own interpretation is the correct one under the contract and possibly represents the original intent. Thus, section 10.14's change-of-law provision is ambiguous and presents a question of fact as to its meaning.
Summary judgment is inappropriate where, as here, "the contract terms are ambiguous so that it is necessary to determine the intent of the parties to the contract," "evidence of the custom and usage of the trade is required in order to interpret an agreement," and "there is a factual dispute regarding ... the scope of an agreement" as well as "whether a contract has been ... subsequently altered." 10B Charles Alan Wright et al., Federal Practice and Procedure § 2730.1 (4th ed. rev. 2018). Moreover, "factual disputes concerning the occurrence ... of the alleged breach itself may prevent summary judgment from being entered."
C. The Foundation may seek an equitable remedy.
CHS argues the Foundation is entitled to no relief. The contract provides "the parties shall be entitled ... to enforce specifically the terms and provisions hereof ... in addition to any other remedy to which they are entitled at law or in equity." ECF No. 14-1 at 65.
1. The Foundation may not recover under a traditional damages theory.
The purpose of damages in a breach of contract action is "the awarding of a sum which is the equivalent of performance of the bargain-the attempt to *1262place the plaintiff in the position he would be in if the contract had been fulfilled." Rathke v. Roberts ,
Here, despite its arguments to the contrary, the Foundation does not actually seek damages based on any traditional expectation interest, as defined above. See ECF No. 1 at 8, 10-11. While the Foundation bargained for CHS to provide a certain level of charity care to the Spokane community, the Foundation developed no economic interest in that benefit. See Restatement, supra , § 307 cmts. b, d; 12 Arthur L. Corbin, Corbin on Contracts § 63.17 (rev. ed. 2018). Therefore, the Foundation may not recover under a traditional damages theory.
2. The Foundation may not recover under an unjust enrichment theory.
"[T]he terms 'restitution' and 'unjust enrichment' are the modern designation for the older doctrine of 'quasi contracts,' " which are "obligations created by the law when money or property has been placed in one person's possession, under such circumstances that in equity and good conscience, he ought not to retain it." Bill v. Gattavara ,
CHS argues the Foundation cannot meet the elements of unjust enrichment. The Court disagrees. The Foundation conferred the benefit of the hospitals, and the revenue they would generate, upon CHS in exchange for its promise to provide a certain level of charity care, measured by a percentage of that revenue, to the Spokane community. See Chandler v. Wash. Toll Bridge Auth. ,
However, parties to a valid, binding contract may not claim unjust enrichment *1263on the same matters governed by that contract. See Chandler ,
3. The Foundation may obtain equitable monetary relief in lieu of specific performance.
CHS argues that, although the contract provides for specific performance, the Foundation is not entitled to this remedy because some form of damages is adequate. Generally, "[s]pecific performance ... will not be ordered if damages would be adequate to protect the expectation interest of the injured party." Restatement, supra , § 359. And, as CHS notes, "the parties cannot vary by agreement the requirement of inadequacy of damages." Id. § 359 cmt. a. Therefore, the Court must analyze whether damages are adequate.
"When a court's legal powers cannot adequately compensate a party's loss with money damages, then a court may use its broad equitable powers to compel a party to specifically perform its promise." Crafts v. Pitts ,
"Where the promisee intends to make a gift of the promised performance to the beneficiary, the beneficiary ordinarily has an economic interest in the performance but the promisee does not." Id. § 307 cmt. d. If so, "the promisee's remedy in damages is not an adequate remedy ... and specific performance may be appropriate."
As discussed above, while the Foundation bargained for CHS to provide a certain level of charity care to the Spokane community, the Foundation developed no economic interest in that benefit. Moreover, the Foundation's consequential damages, including how CHS's alleged breach of contract impacted the Foundation's grantmaking, is exceedingly difficult to prove with reasonable certainty. See *1264ECF No. 61-9 at 11-12. Indeed, "[t]he precise way in which the grantmaking would have been different or the different dollar amounts spent cannot be determined in hindsight."Id. at 12. For these reasons, damages are not an adequate remedy.
"[T]he trial court has broad discretionary authority to fashion equitable remedies...." Cornish Coll. of the Arts v. 1000 Va. Ltd. P'ship ,
Here, the Foundation seeks specific performance and restitution or disgorgement of all excess profits CHS retained as a result of its failure to comply with the charity care condition. ECF No. 1 at 8, 10-11. But because CHS sold the hospitals to MultiCare Health System after the Foundation filed this action, specific performance is no longer available against CHS.
D. The Foundation has constitutional standing.
The Court previously granted the Washington State Attorney General's Office leave to file an amicus curiae brief addressing whether the Foundation has "standing." ECF No. 75. As CHS notes, the Attorney General did not address whether the Foundation has constitutional standing. Instead, the Attorney General discussed the Foundation's statutory right *1265to enforce CHS's charity care commitments, an issue which neither party raised. CHS disputes this analysis and argues the Foundation would lack constitutional standing on any statutory basis. But CHS does not dispute that the Foundation has constitutional standing to claim a breach of a contract to which it is a party. And indeed, the Court assures itself that the Foundation does, in fact, have constitutional standing on this basis. See generally Spokeo, Inc. v. Robins , --- U.S. ----,
Accordingly, IT IS HEREBY ORDERED :
1. Plaintiff's motion for partial summary judgment, ECF No. 50 , is DENIED.
2. Defendants' motion for summary judgment, ECF No. 59 , is DENIED .
IT IS SO ORDERED.
This is not to say that restitution and disgorgement are not helpful concepts in crafting some other form of equitable relief. On the contrary, these concepts could prove to be of paramount importance.
"Where specific performance is otherwise an appropriate remedy, ... the promisee ... may maintain a suit for specific enforcement of a duty owed to an intended beneficiary." Restatement, supra , § 307. "Even though a contract creates a duty to a beneficiary, the promisee has a right to performance." Id. § 307 cmt. b. "The promisee cannot recover damages suffered by the beneficiary, but the promisee is a proper party to sue for specific performance if that remedy is otherwise appropriate...." Id. This is so because "[a] party to a contract is entitled to enforce it and to sue in his own name." Kim v. Moffett ,
A showing that the promisor wrongfully caused the impossibility is not required, see Corbin, supra , § 63.24, though it certainly tips the scales of equity in the promisee's favor, see Zastrow ,
CHS argues the Foundation cannot obtain equitable monetary relief because, by the time it filed this action, it already knew specific performance was impossible. See Corbin, supra , § 63.24. But when the Foundation filed the complaint, all it knew was that "CHS ha[d] announced a sale of the hospitals to Multicare Health System." ECF No. 1 at 9 (emphasis added). The sale was not yet finalized. See ECF No. 51-3 at 3; ECF No. 63-16 at 19; ECF No. 69-8 at 6. Surely, these facts did not deprive the Court of the equitable jurisdiction it would otherwise have.
"There are cases in which justice requires the payment of damages, even though the promised performance is impossible...." Corbin, supra , § 64.10. This might be such a case because, while "[i]t is a general rule that the promisee, as well as the beneficiary, has a right against the promisor," DeWolf, supra , § 12:6 (citing Plese-Graham, LLC v. Loshbaugh ,
Case-law data current through December 31, 2025. Source: CourtListener bulk data.