Hospital Collections: Can Hill-Burton Noncompliance Be Raised by Former Patients as an Affirmative Defense?

Abstract

The Hill-Burton Program was enacted in 1946 to provide federal assigtance to communities for the purpose of constructing and modernizing health care facilities. As a condition of Hill-Burton funding, the contracting hospital is required to assume obligations of “uncompensated care” and “community service.” Indigents eligible for Hill-Burton free care can, after exhausting administrative remedies, obtain injunctive relief to enforce compliance with the Program's regulations. However, it is unsettled today whether a hospital's noncompliance with these obligations to provide free care can be raised as an affirmative defense in a hospital collection action. Until recently, courts throughout the country have held that a patient could not raise the affirmative defense of Hill-Burton noncompliance. Yet, the 1979 Hill-Burton Regulations, as well as the recent decision in Hospital Center at Orange v. Cook, are indicators of the start of a contrary trend to allow the defense. This article examines the 1979 Regulations and court decisions on the affirmative defense and argues against allowing the defense.