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Attempt to Force Children to Pay Father’s Hospital Bill Fails

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JUNE 2, 2003 VOLUME 10, NUMBER 48

Are adult children liable for the medical care of their parents? Several states (not including Arizona) have laws that attempt to impose what is sometimes called “family responsibility” or “filial responsibility” on children for the care of indigent parents. A recent South Dakota case provides a little insight into such laws.

Before James Nelson died at McKennan Hospital in Sioux Falls, he incurred a bill of almost $75,000. McKennan submitted the bill to Medicare, which paid $15,657.85 and required that the hospital make adjustments of most of the rest of its charges. When the adjustments were completed a $42.73 claim remained against Mr. Nelson’s estate; when that amount was paid the hospital signed a release of any further claims it might have made against Mr. Nelson or his estate.

Unfortunately for the hospital, Medicare audited the payments on behalf of Mr. Nelson and noted that his “lifetime days” had already expired before admission to the hospital. As a consequence McKennan was not entitled to any payment from Medicare, and the agency simply reduced its next payment accordingly.

Since McKennan had already agreed not to pursue Mr. Nelson’s estate, it decided to seek reimbursement from his children. South Dakota law includes a provision requiring children to pay for their parents’ care, and so the hospital filed suit against Mr. Nelson’s three children.

Unfortunately for the hospital, South Dakota’s law requires children to pay for their parents’ care only if the parents are unable to pay for care themselves. Just eight days before Mr. Nelson’s death a pending personal injury lawsuit was settled by payment of $1.2 million into a trust for Mr. Nelson’s benefit; on his death, the remaining trust assets were distributed to his estate and ultimately to his children. He was not indigent, and his estate was sufficient to pay for his care.

McKennan then argued that principles of “equity and social policy” should be applied to prevent Mr. Nelson’s children from receiving his estate without having to pay for his medical care. The South Dakota Supreme Court rejected that argument, noting that the hospital’s “equity” argument was unsupported by any citations to legal authority. Accounts Management, Inc., v. Nelson, May 21, 2003.

Though “filial responsibility” laws exist in over half of the states, they are seldom invoked because both Medicare and Medicaid rules prevent efforts to seek additional payments in most circumstances. The Nelson case provides some insight into how changes in health care financing might affect families.

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Robert B. Fleming


Robert Fleming is a Fellow of both the American College of Trust and Estate Counsel and the National Academy of Elder Law Attorneys. He has been certified as a Specialist in Estate and Trust Law by the State Bar of Arizona‘s Board of Legal Specialization, and he is also a Certified Elder Law Attorney by the National Elder Law Foundation. Robert has a long history of involvement in local, state and national organizations. He is most proud of his instrumental involvement in the Special Needs Alliance, the premier national organization for lawyers dealing with special needs trusts and planning.

Robert has two adult children, two young grandchildren and a wife of over fifty years. He is devoted to all of them. He is also very fond of Rosalind Franklin (his office companion corgi), and his homebound cat Muninn. He just likes people, their pets and their stories.

Elizabeth N.R. Friman


Elizabeth Noble Rollings Friman is a principal and licensed fiduciary at Fleming & Curti, PLC. Elizabeth enjoys estate planning and helping families navigate trust and probate administrations. She is passionate about the fiduciary work that she performs as a trustee, personal representative, guardian, and conservator. Elizabeth works with CPAs, financial professionals, case managers, and medical providers to tailor solutions to complex family challenges. Elizabeth is often called upon to serve as a neutral party so that families can avoid protracted legal conflict. Elizabeth relies on the expertise of her team at Fleming & Curti, and as the Firm approaches its third decade, she is proud of the culture of care and consideration that the Firm embodies. Finding workable solutions to sensitive and complex family challenges is something that Elizabeth and the Fleming & Curti team do well.

Amy F. Matheson


Amy Farrell Matheson has worked as an attorney at Fleming & Curti since 2006. A member of the Southern Arizona Estate Planning Council, she is primarily responsible for estate planning and probate matters.

Amy graduated from Wellesley College with a double major in political science and English. She is an honors graduate of Suffolk University Law School and has been admitted to practice in Arizona, Massachusetts, New York, and the District of Columbia.

Prior to joining Fleming & Curti, Amy worked for American Public Television in Boston, and with the international trade group at White & Case, LLP, in Washington, D.C.

Amy’s husband, Tom, is an astronomer at NOIRLab and the Head of Time Domain Services, whose main project is ANTARES. Sadly, this does not involve actual time travel. Amy’s twin daughters are high school students; Finn, her Irish Red and White Setter, remains a puppy at heart.

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Matthew M. Mansour


Matthew is a law clerk who recently earned his law degree from the University of Arizona James E. Rogers College of Law. His undergraduate degree is in psychology from the University of California, Santa Barbara. Matthew has had a passion for advocacy in the Tucson community since his time as a law student representative in the Workers’ Rights Clinic. He also has worked in both the Pima County Attorney’s Office and the Pima County Public Defender’s Office. He enjoys playing basketball, caring for his cat, and listening to audiobooks narrated by the authors.