Date: Apr 17, 2026

Health Care Proxy Consent Not Required for Hospital Billing Claims When Patient Is Not Incapacitated; Patient May Be Bound by Representative-Signed Services Agreement and Ratification

Introduction

In Ellis Hosp. v Dalrymple (2026 NY Slip Op 02315 [248 AD3d 1541] [3d Dept Apr. 16, 2026]), the Appellate Division, Third Department affirmed a summary judgment awarding a hospital $5,048.55 (plus costs/disbursements) for unpaid charges arising from services rendered on May 31, 2023 and June 1, 2023.

The central dispute was not whether services were provided, but whether the hospital could collect when the defendant asserted (i) she did not receive bills at the proper address, (ii) some services were not medically necessary, and (iii) treatment required the consent of her husband as her health care proxy. Procedurally, the case also addressed summary judgment practice (including the limited role of surreply papers) and the trial court’s authority to hold summary judgment in abeyance to require additional proof.

The decision’s core practical rule is that a health care proxy’s consent does not control when the patient is not incapacitated and is actively participating in care; in that circumstance, the hospital may rely on the patient’s own capacity and the contractual/ratification framework to recover unpaid charges.

Summary of the Opinion

Affirmed summary judgment for the hospital on a claim to recover unpaid hospital bills.
The hospital satisfied its prima facie burden by showing: services rendered, an itemized bill, insurance billing/credits, and an outstanding balance equal to the patient’s deductible.
The hospital also submitted a written services agreement signed by the defendant’s husband as an “[a]uthorized [r]epresentative”, providing that the signatory or the patient would be financially responsible for charges not covered by insurance.
The defendant’s “health care proxy consent” defense failed because the record’s medical notes showed she was not incapacitated and played an active role in her care; thus, the husband did not assume the proxy role on the relevant dates, and the hospital was not required to obtain or follow his consent demands.
Even if the defendant did not sign the agreement herself, she ratified it by accepting services under it.
The court rejected claims of judicial bias and upheld procedural rulings: the trial court’s decision to hold summary judgment in abeyance for more documentation (CPLR 3212[f]) and its refusal to consider an unauthorized surreply.

Analysis

Precedents Cited

1) Judicial-bias and appellate review of the record

Steuhl v CRD Metalworks, LLC, 159 AD3d 1182 (3d Dept 2018) and Matter of Flanigan v Smyth, 148 AD3d 1249 (3d Dept 2017), lv dismissed 29 NY3d 1046 (2017): cited to dispose of the defendant’s judicial-bias assertions. The Third Department treated bias claims as requiring record support and, where “properly before” the court, rejected them “outright” when unsupported.

2) Summary judgment standards and burden shifting

White Knight Constr. Contrs., LLC v Haugh, 216 AD3d 1345 (3d Dept 2023): used for the governing summary judgment formulation—movant must show entitlement as a matter of law and absence of material fact issues; evidence is viewed in the light most favorable to the nonmovant.
Voss v Netherlands Ins. Co., 22 NY3d 728 (2014): cited as Court of Appeals authority for core summary judgment principles and the movant’s burden.
Durr v Capital Dist. Transp. Auth., 198 AD3d 1238 (3d Dept 2021) and Vickers v Parcells, 198 AD3d 1160 (3d Dept 2021): cited for the burden shifting once the movant meets its prima facie showing, and for the “every favorable inference” rule.

3) Hospital collection claims for services rendered

Albany Med. Ctr. Hosp. v Armlin, 146 AD2d 866 (3d Dept 1989) and Samaritan Hosp. v Chodikoff, 97 AD2d 937 (3d Dept 1983): invoked as Third Department authority supporting that itemized billing and proof of services/charges can establish a hospital’s prima facie entitlement to recover outstanding medical bills, shifting the burden to the patient to raise a triable dispute.

4) Contract formation through ratification by acceptance of services

Seton Health at Schuyler Ridge Residential Health Care v Dziuba, 127 AD3d 1297 (3d Dept 2015): cited for the principle that even if a party did not personally execute the written agreement, the party may ratify it by accepting services under the agreement—an especially relevant doctrine in healthcare billing where admission/registration paperwork is often signed by a representative.

5) Motion practice: surreply papers and court discretion to require more proof

HSBC Bank USA, N.A. v Roumiantseva, 130 AD3d 983 (2d Dept 2015): cited for the proposition that surreplies require leave; absent leave, a court may decline to consider them under CPLR 2214.
The court also referenced CPLR 3212 (f) to confirm the trial court’s authority to hold a summary judgment motion in abeyance to allow additional evidentiary submissions where appropriate.

Legal Reasoning

Hospital’s prima facie showing. The hospital presented competent proof of (i) services rendered over the specified dates, (ii) an itemized bill, (iii) insurance billing/credits, and (iv) a remaining balance of $5,048.55 (the deductible). This aligned with the hospital-collection precedents cited (Albany Med. Ctr. Hosp. v Armlin; Samaritan Hosp. v Chodikoff) and satisfied summary judgment standards (White Knight Constr. Contrs., LLC v Haugh; Voss v Netherlands Ins. Co.).
Contractual allocation of payment responsibility. The written services agreement signed by the husband expressly provided that the signatory “or the patient” would be financially responsible for charges not paid by insurance. This language mattered: it avoided a narrow “guarantor-only” framing and supported liability against the patient herself for the patient portion.
Health care proxy argument rejected because the patient was not incapacitated. The defendant framed the dispute as lack of proxy consent for treatment. The court treated the proxy’s authority as conditional: medical notes demonstrated she was not incapacitated and actively participated in decisions; therefore, the husband did not “assume the role” of proxy on those dates, and the hospital had no obligation to obtain or follow his consent demands.
Ratification by acceptance of services. Even if the defendant attempted to avoid payment because she did not personally sign the agreement, the court applied ratification: she accepted services under the agreement, thereby ratifying it (Seton Health at Schuyler Ridge Residential Health Care v Dziuba). This closes a common billing-defense gap where admission documents are executed by a family member or representative.
No triable issue of fact. After the hospital met its burden, the defendant needed admissible evidence raising a genuine dispute as to liability. Her objections—medical necessity, proxy consent, and execution of the agreement—did not, on this record, create a triable fact issue.

Impact

Limits “health care proxy” defenses in collection actions. The decision underscores a practical boundary: a proxy’s authority (and corresponding “consent required” argument) hinges on the patient’s incapacity. When the patient is competent and engaged, providers need not treat the proxy as the decision-maker for consent purposes.
Reinforces enforceability of representative-signed admission/service agreements. By relying both on the agreement’s text (“or the patient”) and on ratification-by-acceptance, the decision strengthens a hospital’s ability to obtain summary judgment where the patient later disputes signatures or authority.
Supports streamlined summary judgment proof in hospital-billing cases. Itemized billing plus proof of services and insurance credits remains the core evidentiary package, with the burden shifting to the patient to show a concrete factual dispute (not merely disagreement with treatment choices).
Procedural discipline for self-represented litigants and practitioners. The court’s handling of unauthorized surreply papers signals that standard CPLR motion-practice rules apply equally, while CPLR 3212(f) confirms the trial court’s discretion to require clarifying proof before granting judgment.

Complex Concepts Simplified

Summary judgment: A pretrial ruling where the court decides the case (or part of it) because there is no genuine dispute over important facts and the law clearly favors one side.
Prima facie burden / burden shifting: The moving party must first present enough evidence to win if unopposed. If it does, the other party must respond with evidence showing a real factual dispute.
Triable issue of fact: A genuine factual disagreement that requires a trial to resolve, not just speculation or conclusions.
Health care proxy and “incapacity”: A health care proxy typically acts only when the patient lacks capacity to make health care decisions. If the patient is not incapacitated, the proxy does not control consent decisions.
Ratification: Accepting benefits (here, medical services) under an agreement can bind a person to the agreement even if they did not personally sign it.
Account stated (as referenced by the trial court): A theory that a bill becomes binding if presented and not objected to within a reasonable time. Here, the trial court initially saw a fact issue about receipt of bills, but the final judgment rested on proof supporting recovery of unpaid medical bills under the contractual/services framework.
Surreply: An extra response after the reply papers. Courts generally require permission to file it; without leave, it may be ignored.
Deductible: The portion of covered medical costs the patient must pay before insurance pays according to the policy. The hospital proved the balance due matched the deductible.

Conclusion

Ellis Hosp. v Dalrymple reinforces that hospitals can obtain summary judgment for unpaid patient balances when they present competent proof of services, itemized charges, insurance credits, and an outstanding balance—particularly where admission/service documentation allocates responsibility to the patient and/or representative.

Most significantly, the decision clarifies that health care proxy consent is not a barrier to treatment (or later billing recovery) when the patient is not incapacitated. Where the patient remains competent and actively participates in care, a proxy does not “assume the role,” and the provider is not obligated to follow the proxy’s demands as a prerequisite to recovering charges. Combined with ratification by acceptance of services, the ruling narrows common defenses in healthcare collection actions and provides a clear roadmap for proof on summary judgment.