‘Till Debt Do Us Part (Or Bring Us Together)

Hospitals….nobody wants to go but sometimes we need to go.  Often visits are unexpected and come at inopportune times.  Other times hospital trips are planned but all trips are longer than we really would like.  Many of you are reading this blog post today due to the services you received at a hospital.   Like any institution or entity, hospitals do some good things and some bad things.  In the end, hospitals serve an important and vital role in our society. 

Hospitals need money to operate.  Think of the electricity they use….the waste they generate….the food they must prepare and provide…the equipment and supplies needed to save and enhance lives…the staff needed to care for patients, process paperwork, etc.  None of these items is free. 

Insurance helps to provide a good chunk of the money needed to run hospitals.  Claims filed under patient insurance plans serves as a key source of operating capital. Under most insurance plans, however, the patient is responsible for payment of a portion of the hospital bill.  And in cases of serious illnesses, injuries, and/or lengthy stays the monetary amount of the patient portion can be quite overwhelming.  Those without insurance face an even more daunting proposition of trying to figure out how to pay the bill with no help.   

Medical bills will lead many Americans to file bankruptcy or otherwise change their financial picture for years to come.  And in North Carolina there is an added source of concern:  a little concept called the doctrine of necessaries.  The doctrine of necessaries says where a married patient receives medical treatment and incurs a bill for services rendered, the patient’s spouse can be held liable also for payment of the bill.  The fact that the spouse did not sign any patient agreement or application for services is irrelevant.  Automatic spousal liability attaches under the doctrine.

For the provider of the necessary services or goods to utilize the doctrine of necessaries and establish a legal right to payment it must show the following:  that (1) services or goods were provided to the spouse; (2) the services or goods were necessary for the health and well-being of the receiving spouse; (3) the person against whom the action is brought was married to the person to whom the necessary services or goods were provided at the time such services were provided; and (4) the payment for the necessaries has not been made.  Possibly the doctrine could be applied to create spousal liability for other items such as funeral expenses, food, clothing, shelter, and transportation but these waters have not yet been tested in North Carolina’s appellate courts.  The doctrine has been asserted primarily for the purpose of collecting on hospital and medical debts.  The lone exception to the doctrine of necessaries is where the patient and the spouse were separated at the time the goods or services were provided.  However this only applies if the provider of the goods or services had knowledge, actual or constructive, of the separation.

The doctrine, which is based on a long-standing common law tradition of rights and obligations between spouses, has been upheld in North Carolina’s Court of Appeals and Supreme Court and is thus the law of the state.  In Greensboro, Moses Cone Operating System routinely files lawsuits against both spouses when seeking to collect on a hospital debt incurred by one spouse.  One can anticipate other hospitals and medical providers do the same.  Nothing illegal about this but sometimes it seems unfair.  If you are contacted by a hospital, medical provider, or collector on a medical debt incurred by you or your spouse and would like a free consultation contact Attorney John O’Neal today.


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