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Payment dispute between Avera, Sully County reaches SD Supreme Court

This room serves as the court for South Dakota Supreme Court justices when they hold deliberations on the campus of USD in Vermillion. Cameras are not allowed in the courtroom during oral arguments.
Zadya Abbott
The Supreme Court met this week at the USD School of Law in Vermillion

South Dakota law requires counties to help with medical bills for residents who can’t afford it. But what happens when the patient only lives there for part of the year?

That’s a question now in front of the state Supreme Court in the case Avera Health V. Sully County. It involves a patient suffering appendicitis - identified only as “J.R.” - a semi-permanent resident of the county who was transported to an emergency facility for a lifesaving procedure.

Avera is seeking payment from Sully County for the treatment J.R. received. The individual lives in Sully County as a temporary worker for six months of the year, thus the county argues he is a nonresident.

A lower court ruled in favor of the county. Avera appealed, and the case went to the state Supreme Court this week.

Robert Nelson, counsel for Avera, argues the county does owe payments to the health system for services delivered.

“Section 37 places absolutely no legal duty or legislative mandate on Avera St. Mary’s, but on the county," Nelson said. "In fact, the entire chapter of (South Dakota Common Law) 28-13 dealing with medical indigent care places no duty or obligation on any hospital. It’s all upon the county.”

The law cited by Nelson, SDCL 28-13, obligates counties to support impoverished and indigent persons who have established residency within their borders. Further, the law describes a medically indigent person as one who has no or limited ability to pay debts following a hospitalization.

Jack Heib, representing Sully County, said the county shouldn’t be on the hook for a non-permanent resident.

“Under these facts, not having been there, I think it’s reasonable to say ‘okay, the county needs to get him to a hospital potentially – the county needs to get him out of that situation,’" Heib argues. "But it doesn’t say they need to pay whoever it is that they ultimately take them to.”

The court is expected to return a decision in the coming months.

C.J. Keene is a Rapid City-based journalist covering the legal system, education, and culture