Master Florida appellate decision recognizing restitution for medically necessary services provided when the patient was unable to consent. with this comprehensive case brief.
Nursing Care Services v. Dobos is a leading modern application of the emergency restitution doctrine in the medical-services context. It stands for the proposition—captured in the Restatement of Restitution § 116—that when a person is unable to consent and another unofficiously furnishes necessary services to prevent serious bodily harm, the law implies a promise to pay the reasonable value of those services. The decision reassures care providers that emergency assistance will not go uncompensated solely because no express contract could be formed in the moment of crisis.
For law students, the case is a clean illustration of implied-in-law obligation (quasi-contract) distinct from implied-in-fact contract. It shows how courts analyze “necessity,” incapacity, and officiousness; how a physician’s order informs the need for services; and how public policy prevents unjust enrichment without forcing caregivers to bear losses created by a patient’s temporary inability to assent.
380 So. 2d 516 (Fla. Dist. Ct. App. 3d Dist. 1980)
An elderly patient, Dobos, experienced an acute medical episode requiring hospitalization. While Dobos was in a compromised condition and unable to meaningfully consent to ancillary arrangements, her attending physician determined that continuous private-duty nursing was medically necessary to protect her health and safety in addition to routine hospital care. At the physician’s request, Nursing Care Services, Inc. provided round-the-clock nurses for a limited period. The agency supplied licensed personnel, kept time records, and intended to charge its standard rates. After Dobos recovered capacity and was discharged, she refused to pay for the private-duty nursing, asserting that she had not authorized it and that hospital staff could have sufficed or that any obligation belonged to others. Nursing Care Services sued Dobos in quantum meruit/unjust enrichment. The trial court ruled against the agency on the theory that no express contract existed. On appeal, the provider argued entitlement to restitution for necessaries rendered during an emergency to a person unable to consent.
Whether a provider of private-duty nursing services may recover in restitution from a patient for the reasonable value of medically necessary services furnished while the patient was unable to consent.
Under the Restatement of Restitution § 116 (and the common law of quasi-contract), a person who unofficiously supplies necessary services to another is entitled to restitution for their reasonable value if: (1) the services were necessary to prevent the other from suffering serious bodily harm or pain; (2) the supplier acted with intent to charge; (3) the recipient was unable to consent, and it was impossible or impracticable to obtain consent; and (4) the supplier had no reason to know the recipient would refuse the services if able to consent. Recovery is measured by the reasonable value of the services conferred, not by any express agreement.
Yes. The appellate court held that Nursing Care Services could pursue restitution for the reasonable value of the private-duty nursing furnished during the period when Dobos was unable to consent and the services were medically necessary, and it reversed the adverse judgment.
The court grounded its analysis in the doctrine of unjust enrichment and Restatement of Restitution § 116. First, it found the services were supplied unofficiously: the provider acted at the direction of the attending physician who determined continuous private nursing was necessary to safeguard the patient, rather than volunteering gratuitous or unwanted aid. Second, the services met the necessity requirement. The physician’s order provided strong, objective evidence that supplemental, continuous nursing was required to prevent serious harm and that the services were not merely optional comforts. Third, at the time arrangements were made, the patient was not in a condition to intelligibly assent; obtaining consent was impracticable in light of the medical emergency and the need for immediate care. Fourth, there was no indication the patient would have refused the services if competent; to the contrary, the record suggested reasonable people would accept such care in similar circumstances. The provider intended to charge, as evidenced by its business nature and invoicing. The court emphasized that emergency restitution avoids penalizing caregivers for the very circumstances that make consent impossible. It distinguished implied-in-law obligations from contract: the law imposes a duty to pay to prevent unjust enrichment even though no promise was made. Any lack of express authorization by relatives or the hospital did not defeat recovery against the ultimate beneficiary, the patient, because the benefit ran to her person and health. Finally, the appropriate measure of recovery was the reasonable value of the services actually provided; thus, the case was remanded for proceedings consistent with that measure if it had not already been established.
Nursing Care Services v. Dobos is a staple teaching case for the emergency exception in restitution. It shows courts are willing to imply an obligation to pay for medically necessary services provided without consent when consent is impossible, thereby preventing unjust enrichment and ensuring providers are compensated. The case also clarifies the elements that limit the doctrine—necessity, incapacity, lack of officiousness, and no reason to know of refusal—and demonstrates how a physician’s order can anchor the necessity finding. For students, the case helps differentiate implied-in-law restitution from true contract formation and illustrates the policy rationale that encourages prompt emergency care.
An implied-in-fact contract arises from conduct showing mutual assent; the parties’ behavior implies a promise even without words (e.g., requesting services and accepting them with knowledge of payment). Nursing Care Services v. Dobos proceeds on implied-in-law (quasi-contract) grounds: no mutual assent existed because the patient was incapacitated. The law imposes a duty to pay to prevent unjust enrichment when necessaries are furnished in an emergency.
The physician’s contemporaneous order for continuous private-duty nursing is strong evidence of medical necessity, satisfying the Restatement § 116 standard that the services were necessary to prevent serious bodily harm or pain. Courts look for objective indicia—medical judgment, the patient’s condition, and the immediacy of risk—rather than ex post claims that routine care might have sufficed.
Yes. Restitution under § 116 is unavailable if the provider had reason to know the recipient would refuse the services if able to consent. A prior competent refusal or a clear advance directive would generally preclude recovery because the provider cannot claim to have acted unofficiously or contrary to the patient’s known wishes.
The implied-in-law obligation runs against the recipient of the benefit—the patient. Family members or the hospital are generally not liable absent an independent contractual commitment or statutory duty. The court in Dobos allowed recovery from the patient because she directly received the medically necessary services.
The measure is the reasonable value of the services rendered (quantum meruit), not the provider’s list price per se and not any speculative measure of the benefit to the patient. Reasonableness can be established through customary rates, market evidence, and expert testimony.
Dobos aligns with Cotnam v. Wisdom’s classic rule permitting recovery by physicians for emergency surgery on an unconscious patient and anticipates modern cases like Credit Bureau v. Pelo allowing restitution for involuntary psychiatric care. Together, they reflect a consistent principle: necessary medical services supplied during incapacity are compensable to prevent unjust enrichment.
Nursing Care Services v. Dobos confirms that when a patient cannot consent and immediate medical needs require action, the law will imply an obligation to pay for necessary services reasonably supplied. By adopting the Restatement of Restitution § 116 framework, the court ensured that providers of emergency medical care are not penalized for acting promptly and unofficiously to protect patients from serious harm.
For practitioners and students, the case is a practical roadmap for pleading and proving unjust enrichment in the medical context. It highlights the importance of documenting medical necessity, incapacity, and the reasonableness of charges, and it showcases the boundary between contract doctrine and equitable restitution in emergencies.