GIANETTI v. SIGLINGER, 279 Conn. 130 (2006)

900 A.2d 520

(SC 17586)Supreme Court of Connecticut

Borden, Norcott, Palmer, Vertefeuille and Sullivan, Js.

Argued April 18, 2006.

Officially released July 11, 2006.

Procedural History
Action to recover damages for, inter alia, the alleged breach of contract by the named defendant et al., and for other relief, brought to the Superior Court in the

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judicial district of Fairfield, where the named defendant et al. and the defendant Foster M. Young filed separate counterclaims; thereafter, the matter was tried to the court Rush, J.; judgment for the defendants on the complaint and on their counterclaims, from which the plaintiff appealed; subsequently, the court, Rush, J., denied the plaintiff’s motion for articulation; thereafter, the Appellate Court granted in part the plaintiff’s motion for review of the trial court’s denial of the plaintiff’s motion for articulation and ordered the trial court to articulate its findings concerning the plaintiff’s statute of limitations defense to the counterclaim filed by the defendant Foster M. Young, and the appeal was transferred to this court. Affirmed.

Charles D. Gianetti, pro se, the appellant (plaintiff).

Patrick D. Skuret, with whom, on the brief, wa Daniel D. Skuret, for the appellee (defendant Foster M. Young).

Elaine M. Skoronski, for the appellees (named defendant et al.).

Richard Blumenthal, attorney general, and Linda A. Russo, Richard M. Porter and Arnold I. Menchel, assistant attorneys general, filed a brief for the office of the attorney general as amicus curiae.

Opinion
PER CURIAM.

This appeal[1] arises out of an action brought by the plaintiff, Charles D. Gianetti, a physician, against the defendants, Glenn Siglinger and Laura Siglinger (Siglingers) and Foster M. Young, an attorney for the Siglingers, in which the plaintiff sought moneys that he claimed were due to him as compensation for medical services that he had provided to Allison Siglinger,

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the minor daughter of the Siglingers. The defendants filed counterclaims against the plaintiff alleging violations of General Statutes § 42-110b[2] of the Connecticut Unfair Trade Practices Act (CUTPA), General Statutes § 42-110a et seq. After trial to the court, the trial court rendered judgment for the defendants on both the plaintiff’s complaint and the defendants’ counterclaims. We affirm the judgment of the trial court.

The record reveals the following relevant facts and procedural history. On December 30, 1995, Allison Siglinger was involved in an automobile accident. As a result of this accident, the plaintiff, a plastic surgeon, provided services to Allison twice: at the emergency room of Bridgeport Hospital on the day of the accident; and during an office visit on January 9, 1996.

At the time that treatment was rendered, both the Siglingers and the plaintiff had a relationship with Physicians Health Services of Connecticut, Inc. (Physicians Health), a health maintenance organization.[3] The Siglingers were subscribers to the prepaid health care program issued by Physicians Health. Pursuant to their agreement, Physicians Health provided certain covered services in return for specified periodic payments. The

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agreement explicitly provided that it was “not anticipated that a [m]ember [would] make payments other than any applicable [c]opayment to any person or institution providing benefits under this [c]ontract.”

The plaintiff’s relationship with Physicians Health is more complicated. From 1977 through 1998, the plaintiff was a provider of Physicians Health services as a member of the Greater Bridgeport Individual Practice Association, Inc. (practice association), or its predecessors.[4] This relationship was reflected in a series of agreements between the plaintiff and the practice association, all of which contain certain basic tenets of the arrangement.[5] Under the agreements, the plaintiff, as a participating physician, was obligated to provide or arrange for the covered services designated by Physicians Health subscriber

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contracts and to submit bills for those services to Physicians Health. Physicians Health would then compensate the plaintiff for the medical services he provided to Physicians Health subscribers in accord with a fee schedule determined by Physicians Health. The plaintiff was not to bill Physicians Health subscribers for any amount above a nominal, predetermined co-payment. Specifically, under the agreement in effect at the time the plaintiff provided services to Allison Siglinger, the plaintiff “agree[d] that in no event . . . shall [p]hysician bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against [m]embers or persons . . . acting on their behalf for services provided pursuant to this [a]greement.” Thus, “balance billing,” which is an attempt by a physician to collect the balance due from a subscriber over and above the amount that Physicians Health determined to be reasonable for covered services, was clearly prohibited under the arrangement.

The parameters of this arrangement were a matter of some contention between the plaintiff and the practice association up to and during the time that the plaintiff provided services to Allison Siglinger. Specifically, on more than one occasion, the plaintiff had billed Physicians Health subscribers directly for certain services that he had provided to them. The plaintiff subsequently sought payment through litigation. See, e.g., Gianetti v. Fischetti, Superior Court, judicial district of Fairfield at Bridgeport, Docket No. CV-98-0352010S (February 3, 2000), aff’d, 64 Conn. App. 902, 777 A.2d 213 (2001); Gianetti v. Mulroney, Superior Court, judicial district of Fairfield at Bridgeport, Docket No. CV-91-0290495S (July 10, 1995). In a September 6, 1991 letter, the practice association informed the plaintiff that the board of directors had determined that the plaintiff had a pattern of not fulfilling his contractual obligations to the practice

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association with respect to billing issues. The letter warned that another occurrence of certain specified events, including balance billing of plan subscribers, would result in termination of his participation with Physicians Health. In letters dated February 14, 1995, and March 6, 1995, the practice association notified the plaintiff that it intended to terminate him as a Physicians Health provider due to his balance billing of a plan subscriber. The board eventually withdrew the termination notice after the plaintiff obtained legal representation and contested the action.

It is undisputed that the plaintiff did not inform the Siglingers at the time of treatment that he might claim compensation directly from them for his services, nor did he inform them of his disagreements with Physicians Health and other subscribers regarding compensation beyond that paid by Physicians Health. Indeed, the plaintiff submitted a request for payment to Physicians Health for the services that he performed for Allison Siglinger and received $1888.80 in July, 1996. The plaintiff requested a reconsideration of the amount paid to him, and by December, 1996, Physicians Health had adjusted his compensation for the care of Allison to $1980.80. The plaintiff has since filed an action against Physicians Health in small claims court, alleging “[i]ncorrect payment of medical services rendered” and seeking an additional $481.60 in compensation.

During this time frame, Glenn Siglinger, on behalf of Allison Siglinger, brought a personal injury action arising out of the automobile accident and Young acted as his attorney. In an effort to obtain records from the plaintiff pertaining to the treatment of Allison, Young sent the plaintiff a document entitled “authorization for record request and irrevocable lien.”[6] In October, 1996,

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the plaintiff sent Young two bills for the services provided: one detailing services provided and reflecting a total charge of $6385; and one reflecting a balance due of $4496.20. Young determined that the plaintiff, as a Physicians Health provider, was not permitted to bill the Physicians Health subscribers such as the Siglingers for the balance of his bill. Young, therefore, put the balance requested into escrow. The plaintiff sent Young another letter dated April 1, 1997, stating his position that the document entitled “authorization for record request and irrevocable lien” entitled him to payment of the balance that he had claimed due in his October, 1996 letter. Thereafter, in order to facilitate the settlement of the personal injury action, Glenn Siglinger sought appointment as guardian of Allison’s estate, and the plaintiff, in an effort to collect the moneys he claimed due, contested the appointment.

The plaintiff then filed the present action, seeking recovery from the Siglingers under the theories of breach of contract, quantum meruit and unjust enrichment, and from Young under an unjust enrichment theory. The Siglingers filed an answer denying the allegations and alleging the following six special defenses: breach of contract; waiver; satisfaction; negligent provision of services; duress; and violation of General Statutes § 20-7f.[7] They also filed a counterclaim alleging unfair trade practices in violation of § 42-110b. Similarly, Young filed an answer denying the allegation

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against him and alleging as special defenses that: any money due the plaintiff is owed by his codefendants; Physicians Health satisfied the debt; and the plaintiff violated General Statutes § 38a-193 (c).[8] Young also filed a counterclaim, alleging unfair trade practices in violation of § 42-110b, as well as an unfair insurance law practice in violation of § 20-7f and violation of § 38a-193 (c).

During a three day hearing, the trial court accepted evidence and heard testimony from the plaintiff, Young, Glenn Siglinger, and Michael Lee. Lee was a founding member of Physicians Health and, at various times, served as the chairman and vice chairman of the practice association. He testified regarding the operation of Physicians Health and the practice association, as well as the relationship of those organizations with the plaintiff.

The trial court rendered judgment in favor of the defendants on the complaint. The trial court also rendered judgment for the defendants on their counter-claims for CUTPA violations. In so holding, the trial court determined that the 1992 agreement between the

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plaintiff and the practice association was in force at the time that the plaintiff provided the relevant services. The court also concluded that this agreement prohibited the plaintiff from billing the Siglingers for the balance that he claimed was due after Physicians Health had paid him. Finally, the trial court noted other litigation arising out of the plaintiff’s practice of balance billing and concluded that the plaintiff was well aware that the practice was prohibited through court decisions and statutes. The court therefore ruled in favor of the defendants on their CUTPA counterclaims, awarding $25,656.30 to Young, and $39,970 to the Siglingers in actual and punitive damages. The trial court also ordered that its memorandum of decision be filed in all pending cases in which the plaintiff is a pro se plaintiff.

On appeal, the plaintiff raises fourteen issues.[9] After thoroughly examining the record and considering the

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briefs and oral arguments of the parties, we conclude that the plaintiff’s claims have no merit. The trial court’s findings are amply supported by the record and its legal conclusions are sound.

The judgment is affirmed.