NEW YORK STATI 
LAW RFVISION COMMISSION Legislative Document (1949) 
No. 65 (D) 
STATE OF NEW YORK 
LAW REVISION COMMISSION 
Act, Recommendation and Study relating to Deter- 
mination of the Validity and Extent of Hospital Liens 
in Advance of Judgment or Settlement in Personal 
Injury Action 
SUBMITTED WITH 
Senate Introductory No. 229, Printed Nos. 229, 2093 
Assembly Introductory No. 157, Printed Nos. 157, 2331 
YOUNG B. SMITH, Chairman 
JOHN R. BARTELS 
GLEN R. BEDENKAPP 
MILLARD H. ELLISON 
JOHN F. X. FINN 
PLINY W. WILLIAMSON, ex-officio 
HARRY A. REOUX, ex-officio 
MALCOLM WILSON, ex-officio 
FRED A. YOUNG, ex-officio (1948) 
JOHN D. BENNETT, ex-officio (1949) 
john w. McDonald 
Executive Secretary and 
Director of Research 
ALBANY 
WILLIAMS PRESS, INC. 
1949 Senate Introductory No. 229, Printed Nos. 229, 2093 
Assembly Introductory No. 157, Printed Nos. 157, 2331 
AN ACT 
To amend the lien law and the civil practice act, in relation to 
determination of the validity and extent of hospital liens in 
advance of judgment or settlement in personal injury actions 
The People of the State of New York, represented in Senate and 
Assembly, do enact as follows: 
Section 1. Subdivision one of section one hundred eighty-nine 
of the lien law, such section having been added by chapter five 
hundred thirty-four of the laws of nineteen hundred thirty-six and 
subdivision four thereof having been amended by chapter two 
hundred ninety of the laws of nineteen hundred thirty-nine, is 
hereby amended to read as follows; 
1. Every corporation incorporated under general law or special 
act as a charitable institution maintaining a hospital in the state 
supported in whole or in part by charity, and every county, city, 
town or village operating and maintaining a hospital shall to the 
extent hereinafter provided have a lien upon any and all rights of 
action, suits, claims, counterclaims or demands of any person 
admitted to any such hospital and receiving treatment, care and 
maintenance therein, on account of any personal injuries received 
within a period of one week prior to admission to the hospital and 
as the result of the negligence of any other person or persons or 
corporation, which any such injured person or *the legal repre- 
sentative of such injured person, in case of death as the result 
of such injuries, may or shall have, assert or maintain against 
any such other person or corporation for damages on account 
of such injuries, for the amount of the reasonable charges of 
such hospital, for such treatment, care and maintenance of such 
injured person at cost rates in such hospital. Charges for services 
rendered by any physician or surgeon shall not be included in cost 
rates except to the extent that the hospital has paid as a result of 
a legal obligation or is legally obligated to pay such charges. No 
such lien shall be effective, however, unless a written notice con- 
taining the name and address of the injured person, the date of 
the accident, the name and location of the hospital and the name 
of the person or persons, firm or firms, corporation or corporations 
alleged to be liable to the injured party for the injuries received, 
shall be filed in the office of the county clerk of the county in which 
such hospital is located, prior to the payment of any moneys to 
such injured person, his attorneys, or legal representatives as 
compensation for such injuries; nor unless the hospital shall also 
mail, registered and postage prepaid, a copy of such notice with a 
Explanation — Matter in italics is new; matter in brackets [ ] is old law to 
be omitted. 
3: 4 
statement of the date and place of filing thereof to the person or 
persons, firm or firms, corporation or corporations, alleged to be 
liable to the injured party for the injuries sustained prior to the 
payment to such injured person, his attorneys or legal representa- 
tives, as compensation for such injuries. Such hospital shall mail 
a copy of such notice to any insurance carrier which has insured 
such person, firm or corporation against such liability. Such filing 
and mailing shall be deemed to be effective notwithstanding any 
inaccuracy or omission therein if the information contained therein 
shall be sufficient to enable the person or persons or corporation 
alleged to be liable, by the exercise of reasonable diligence, to 
identify the injured person, the occurrence upon which the claim 
for damages is based and the name and address of the hospital 
asserting the lien. Any hospital claiming a lien hereunder shall, 
in addition to the foregoing, file in the said county clerk’s office 
within five days of the discharge of any injured person, an addi- 
tional notice of lien, duly verified, which shall show the total hos- 
pital charges which have accrued and no lien hereunder shall 
exceed this amount. 
§ 2. Such section one hundred eighty-nine of the lien law is 
hereby amended by inserting therein a new subdivision, to be 
subdivision six-a, to read as follows: 
6-a. At any time after the filing and mailing of the notices 
of lien as provided in subdivision one of this section, such injured 
person, or his legal representative in case of death, or such hospital, 
or any person, firm or corporation alleged to he liable to the 
injured person or to his legal representative, may apply for an 
order determining the validity of such lien and fixing the amount 
thereof. Such application shall be made to the court in which an 
action to recover damages for the injury or death hereinabove 
described brought by such injured person or his legal representa- 
tive is pending or to the surrogate of the county wherein letters 
have been issued to the executor or administrator of the injured 
person, or, if no such action is pending, to any court which woidd 
have jurisdiction of such an action or to the surrogate of the county 
wherein letters have been issued to the executor or administrator of 
the injured person. Such application shall be made upon not less 
than five nor more than ten days notice. Notice of the application 
shall be served upon the following persons, other than the applicant: 
(a) the person, firm or corporation alleged to be liable to the 
injured person or to his legal representative, (b) the hospital, (c) 
the injured person or his legal representative. If an action is 
pending, service upon any party thereto may be made upon his or 
its attorney. Upon the return of such application and the 
determination of the validity of such lien, an immediate hearing 
to determine the amount of the reasonable charges of such hospital 
for the treatment, care, and maintenance of such injured person at 
cost rates shall forthwith be ordered before the court and a jury, 
or, if a jury be waived, before the court or a referee. A copy 
of the order upon such application, with notice of entry, shall be 
served by the party making the application on every person, firm 
or corporation served with notice of the application, or upon his or 5 
its attorney appearing upon the application, and the sum fixed in 
said order shall constitute the extent of the lien provided in this 
section. 
§ 3. Subdivision nine of such section one hundred eighty-nine 
of the lien law is hereby amended to read as follows: 
9. Upon the order of any court of record having jurisdiction 
in the premises, any person, persons or corporation against whom 
a lien shall have been filed and served may deposit the amount of 
any settlement or judgment less the amount of any other liens or 
claims against such moneys superior to such hospital lien, with 
the county treasurer in the county in which the lien is filed, 
except, in a county within the city of New York where such deposit 
shall be made with the city [chamberlain] treasurer of such city, 
and the person, persons or corporation so depositing shall be dis- 
charged from all liability in connection with such lien which lien 
shall attach to the fund so deposited. 
§ 4. Subdivision ten of such section one hundred eighty-nine 
of the lien law is hereby amended to read as follows: 
10. Any such lien may be enforced by action [or law] against 
the person, persons or corporations claimed to be liable or against 
the fund deposited as hereinbefore provided in any court of record. 
§ 5. Section three hundred seventy-four-a of the civil practice 
act, as added by chapter five hundred thirty-two of the laws of 
nineteen hundred twenty-eight and amended by chapter five hun- 
dred twenty-three of the laws of nineteen hundred forty-seven, is 
hereby amended to read as follows: 
§ 374-a. Admissibility of certain written records. Any writing 
or record, whether in the form of an entry in a book or otherwise, 
made as a memorandum or record of any act, transaction, occur- 
rence or event, shall be admissible in evidence in proof of said 
act, transaction, occurrence or event, if the trial judge shall find 
that it was made in the regular course of any business, and that it 
was the regular course of such business to make such memorandum 
or record at the time of such act, transaction, occurrence or event, 
or within a reasonable time thereafter. All other circumstances 
of the making of such writing or record, including lack of personal 
knowledge by the entrant or maker, may be shown to affect its 
weight, but they shall not affect its admissibility. The term busi- 
ness shall include business, profession, occupation and calling of 
every kind. The terms “writing” and “record” as used herein 
shall include a hospital bill provided it bears a certification by the 
superintendent, acting superintendent or other head of the hos- 
pital that the bill is true and correct, that each of the items shown 
thereon was necessarily furnished or supplied and that the amount 
charged therefor is the fair and reasonable value thereof. A bill 
bearing such certification shall be admissible in evidence under 
this section and shall be prima facie evidence of the facts therein 
contained subject, however, to rebuttal by any party affected 
thereby. The provisions of this section governing the admissibility 
in evidence of certain hospital bills shall not apply to any action 
or proceeding in a surrogate’s court nor to any action or proceed- mg in any court instituted by or on behalf of or in the right of a 
hospital to recover payment for accommodations or supplies 
furnished or for services rendered by or in such hospital, or to an 
application pursuant to section one hundred eighty-nine of the lien 
law to determine the validity and extent of the lien of a hospital. 
§ 6. This act shall take effect immediately. 
(Note: These are amendments recommended by the Law Revision Com- 
mission. See Leg. Doc. (1949) No. 65 (D). Their purpose is to facilitate 
settlement of personal injury actions by providing a procedure to determine 
promptly the validity and extent of claimed liens of a hospital after filing 
and mailing notice of lien. They also provide that charges for personal 
services of physicians and surgeons are excluded from the lien of the hos- 
pital, except in a case where the hospital has paid such charges, as a result 
of a legal obligation, or is legally obligated to pay them. A conformity 
change is made in section 374-a of the Civil Practice Act.) RECOMMENDATION OF THE LAW REVISION COMMISSION 
TO THE LEGISLATURE 
Relating to Determination of the Validity and Extent of Hospital 
Liens in Advance of Judgment or Settlement in 
Personal Injury Action 
In 1936, Lien Law, section 189, was enacted, giving to hospitals 
supported in whole or in part by charity, and to municipal cor- 
porations operating and maintaining a hospital, a lien for the 
amount of the reasonable charges at “cost rates” for care of persons 
injured or who died as a result of the negligence of a third party, 
where such injuries were received within one week prior to the 
admission to the hospital. This lien attaches to any verdict, decision, 
decree, judgment or final order in any action brought against the 
third party, and to the proceeds of any settlement or compromise 
of such action and to the proceeds of ahy settlement or compromise 
of a claim or cause of action prior to action being brought. Elaborate 
procedural details are included relating to the filing of notice of 
lien, discharge thereof, stay of execution on the judgment, satis- 
faction of the lien, and enforcement thereof. There is, however, 
no provision relative to judicial determination of the validity of 
the lien itself or of the amount thereof prior to judgment, and the 
cases would seem to deny a remedy to fix the amount of the lien 
prior to judgment, although in some cases, an attempt to fix the 
amount has been made. (Cf. Finkel v. Kushner, 183 Misc. 64, 
aff’d. 268 App. Div. 912 (1944) ; Ferguson v. Ruppert, 166 Misc. 
427 and 530 (1938) ; David v. Billor, 188 Misc. 267 (1946). See 
also De Sola v. Farino, 172 Misc. 571 (1939) ; O’Connor v. Higgins, 
N. Y. L. J., July 13, 1948.) 
The absence of a means of determining promptly the validity 
of the lien or the amount thereof prior to judgment seriously 
impedes settlements of personal injury actions in any case where 
the injured person considers the amount of the claimed lien exces- 
sive. If he settles without regard to the amount of the hospital 
lien, he does so at the peril of not being able to maintain his 
position with respect to the excessiveness of the lien. In addition, 
the proceeds of any settlement or judgment are impounded for 
the time during which the hospital may sue to enforce its lien. 
The result is wholly unjust to the injured person. Furthermore, 
calendars are clogged with personal injury actions which might 
be avoided if some method to determine the amount and validity 
of hospital liens were provided. 
That the present law has resulted in a demand for legislative 
relief is indisputable. Since 1937, one year after the enactment 
of the statute, fourteen bills to provide this relief, many several 
times amended, have been introduced in the legislature. Since 1941, 8 
bills have been introduced annually.* Indeed in deciding that no 
remedy exists to test the validity and amount of the lien in ease 
of settlements, Mr. Justice Hooley wrote in Finkel v. Kushner, 
supra: 
This court is in full sympathy with the justice of the pro- 
cedure suggested in the two cases last cited. However, the 
view of that court in that respect was obiter dictum. In 
addition, the whole subject of hospital liens is a creation of 
the statute and the statute creating the lien has provided the 
machinery for testing its validity. This court may not create 
new methods for testing the lien’s validity and extent. This 
is a matter to which the Legislature of the State may well give 
its attention by adding suitable provisions to section 189 of 
the Lien Law which would enable a party interested, even 
before settlement of the action, to test expeditiously the validity 
and reasonableness of a hosital lien, a subject which has given 
the Bench and Bar some concern in recent years. 
The Commission has studied the subject in response to this 
demand, and is proposing herewith a means to test the validity and 
extent of the lien in advance of judgment or settlement. 
Most of the bills previously introduced fall into two categories. 
One group provided that the amount of the proposed settlement 
would be a determinant factor in arriving at a reasonable value 
of the hospital charge. The other group attempted to limit the 
amount of the lien to a fixed percentage of the amount of the 
recovery. The 1946 bill differed from both of these groups in that 
it attempted, in the case of ward patients, to fix the amount of cost 
rates by application of the rates settled by agreement between 
the hospitals of the state and workmen’s compensation insurance 
carriers. ’ 
The bill hereafter proposed differs from all of the bills heretofore 
before the legislature. Instead of attempting to lay down a formula 
for determining the amount of the hospital charge, it provides a 
method whereby the injured person, or his legal representative 
in the case of death of the injured person, or the hospital, or the 
person alleged to be liable, may apply to the court for an order 
determining the validity of the lien and fixing the amount thereof, 
whether or not an action is pending, at any time after the filing 
and mailing of notice of the hospital lien. This application is 
made on notice to all the other interested parties. An immediate 
hearing is to be provided, triable by court and jury, or by the 
* 1937: Sen. Int. No. 2091, Pr. No. S. 2625, A. Int. No. 2526, Pr. No. 
A. 3167; 1941: A. Int. No. 1789, Pr. No. 2129; A. Int. No. 1578, Pr. Nos. 
1850, 2268, 2740, 2907; A. Int. No. 505, Pr. No. 518; 1942: A. Int. No. 
1212, Pr. Nos. 1400, 2210, 2451; 1943; Sen. Int. No. 1475, Pr. No. 1731, 
A. Int. No. 1221, Pr. Nos. 1372, 2038, 2256; 1944; A. Int. No. 12, Pr. Nos. 
13, 337; 1945: A. Int. No. 373, Pr. No. 373 (recalled from the Governor), 
A. Int. No. 154, Pr. Nos. 154, 1289; A. Int. No. 1273, Pr. No. 1372; 1946: 
A. Int. No. 1811, Pr. No. 1966; Sen. Int. No. 556, Pr. No. S. 568, A. 
2231 (vetoed) ; 1947: A. Int. No. 895, Pr. No. 905; 1948: A. Int. No. 2148, 
Pr. No. A. 2287, Sen. Int. No. 2382, Pr. No. S. 2627. 9 
court if a jury is waived. The application results in an order fixing 
the amount of the lien. 
The Commission believes that the statutory lien, for the pro- 
tection of the hospital and the injured party alike, should be thus 
subject to judicial scrutiny as to its validity and amount. In the 
long run, delay in settlement of personal injury actions seriously 
hinders the collection of hospital charges, and puts a great burden 
on injured persons who are forced to trial because of the claimed 
excessiveness of the hospital charge. The statute, in its present 
form and as proposed to be amended, does not affect the amount or 
validity of the debt which the patient owes the hospital. All that 
is here proposed to be affected is the method for determining the 
validity and amount of the hospital lien. 
The Commission further believes that the amount of the lien 
should not include charges for personal services rendered by physi- 
cians and surgeons except in cases where the hospital has paid for 
such services or where it is under a legal obligation to pay for 
them. The statute was enacted to provide the hospital with security 
for “cost rates” for treatment, care and maintenance of the injured 
person in such hospital. It was not intended to define the amount 
the injured person owed, or to provide security for all charges in 
excess of “cost rates”. Unless the physicians’ or surgeons’ charges 
are actually part of the direct cost of treatment, care and mainte- 
nance, it is obvious that they should not be included in the amount 
of the lien. 
The statute proposed also corrects certain obvious errors (sub- 
divisions 9 and 10). Civil Practice Act, section 374-a should be 
clarified to exclude from its operation the proceeding under Lien 
Law, section 189. 
The Commission therefore recommends: 
I. That subdivision one of section 189 of the Lien Law be amended 
to read as follows: 
1. Every corporation incorporated under general law or 
special act as a charitable institution maintaining a hospital 
in the state supported in whole or in part by charity, and 
every county, city, town or village operating and maintaining 
a hospital shall to the extent hereinafter provided have a 
lien upon any and all rights of action, suits, claims, counter- 
claims or demands of any person admitted to any such hospital 
and receiving treatment, care and maintenance therein, on 
account of any personal injuries received within a period of 
one week prior to admission to the hospital and as the result 
of the negligence of any other person or persons or corporation, 
which any such injured person or the legal representative of 
such injured person, in case of death as the result of such 
injuries, may or shall have, assert or maintain against any 
such other person or corporation for damages on account of 
such injuries, for the amount of the reasonable charges of such 
hospital, for such treatment, care and maintenance of such 
injured person at cost rates in such hospital. Charges for 10 
services rendered by any physician or surgeon shall not he 
included in cost rates except to the extent that the hospital 
has paid as a result of a legal obligation or is legally obligated 
to pay such charges. No such lien shall be effective, how- 
ever, unless a written notice containing the name and address 
of the injured person, the date of the accident, the name and 
location of the hospital and the name of the person or per- 
sons, firm or firms, corporation or corporations alleged to be 
liable to the injured party for the injuries received, shall be 
filed in the office of the county clerk of the county in which 
such hospital is located, prior to the payment of any moneys 
to such injured person, his attorneys, or legal representatives 
as compensation for such injuries; nor unless the hospital 
shall also mail, registered and postage prepaid, a copy of 
such notice with a statement of the date and place of filing 
thereof to the person or persons, firm or firms, corporation 
or corporations, alleged to be liable to the injured party for 
the injuries sustained prior to the payment to such injured 
person, his attorneys or legal representatives, as compensation 
for such injuries. Such hospital shall mail a copy of such 
notice to any insurance carrier which has insured such person, 
firm or corporation against such liability. Such filing and 
mailing shall be deemed to be effective notwithstanding any 
inaccuracy or omission therein if the information contained 
therein shall be sufficient to enable the person or persons or 
corporation alleged to be liable, by the exercise of reasonable 
diligence, to identify the injured person, the occurrence upon 
which the claim for damages is based and the name and address 
of the hospital asserting the lien. Any hospital claiming a 
lien hereunder shall, in addition to the foregoing, file in the 
said county clerk’s office within five days of the discharge 
of any injured person, an additional notice of lien, duly 
verified, which shall show the total hospital charges which 
have accrued and no lien hereunder shall exceed this amount. 
II. That a new subdivision 6-a be added to section 189 of the 
Lien Law, to read as follows: 
6-a. At any time after the filing and mailing of the notices 
of lien as provided in subdivision one of this section, such 
injured person, or his legal representative in case of death, 
or such hospital, or any person, firm or corporation alleged 
to he liable to the injured person or to his legal representative, 
may apply for an order determining the validity of such lien 
and fixing the amount thereof. Such application shall be 
made to the court in which an action to recover damages for 
the injury or death hereinabove described brought by such 
injured person or his legal representative is pending or to 
the surrogate of the county wherein letters have been issued> 
to the executor or administrator of the injured person, or, if 
no such action is pending, to any court which would have juris- 
diction of such an action or to the surrogate of the county 11 
wherein letters have been issued to the executor or adminis- 
trator of the injured person. Such application shall he made 
upon not less than five nor more than ten days notice. Notice 
of the application shall he served upon the following persons, 
other than the applicant: (a) the person, firm or corporation 
alleged to he liable to the injured person or to his legal repre- 
sentative, (h) the hospital, (c) the injured person or his legal 
representative. If an action is pending, service upon any party 
thereto may he made upon his or its attorney. Upon the return 
of such application and the determination of the validity of such 
lien, an immediate hearing to determine the amount of the 
reasonable charges of such hospital for the treatment, care, 
and maintenance of such injured person at cost rates shall 
forthwith he ordered before the court and a jury, or, if a jury 
he waived, before the court or a referee. A copy of the order 
upon such application, with notice of entry, shall he served 
by the party making the application on every person, firm or 
corporation served with notice of the application, or upon his 
or its attorney appearing upon the application, and the sum 
fixed in said order shall constitute the extent of the lien pro- 
vided in this section. 
III. That subdivision nine of section 189 of the Lien Law be 
amended to read as follows: 
9. Upon the order of any court of record having jurisdiction 
in the premises, any person, persons or corporation against 
whom a lien shall have been filed and served may deposit the 
amount of any settlement or judgment less the amount of any 
other liens or claims against such moneys superior to such hos- 
pital lien, with the county treasurer in the county in which 
the lien is filed; except, in a county within the city of New 
York where such deposit shall be made with the city [chamber- 
lain] treasurer of such city, and the person, persons or corpora- 
tion so depositing shall be discharged from all liability in 
connection with such lien which lien shall attach to the fund 
so deposited. 
IV. That subdivision ten of section 189 of the Lien Law be 
amended to read as follows: 
10. Any such lien may be enforced by action [or law] 
against the person, persons or corporations claimed to be liable 
or against the fund deposited as hereinbefore provided in any 
court of record. 
V. That section 374-a of the Civil Practice Act be amended to read 
as follows: 
§ 374-a. Admissibility of certain written records. Any 
writing or record, whether in the form of an entry in a book or 
otherwise, made as a memorandum or record of any act, trans- 
action, occurrence or event, shall be admissible in evidence in 
proof of said act, transaction, occurrence or event, if the trial 12 
judge shall find that it was made in the regular course of any 
business, and that it was the regular course of such business 
to make such memorandum or record at the time of such act, 
transaction, occurrence or event, or within a reasonable time 
thereafter. All other circumstances of the making of such 
writing or record, including lack of personal knowledge by 
the entrant or maker, may be shown to affect its weight, but 
they shall not affect its admissibility. The term business shall 
include business, profession, occupation and calling of every 
kind. The terms “writing” and “record” as used herein 
shall include a hospital bill provided it bears a certification 
by the superintendent, acting superintendent or other head 
of the hospital that the bill is true and correct, that each of 
the items shown thereon was necessarily furnished or supplied 
and that the amount charged therefor is the fair and reasonable 
value thereof. A bill hearing such certification shall be admis- 
sible in evidence under this section and shall be prima facie 
evidence of the facts therein contained subject, however, to 
rebuttal by any party affected thereby. The provisions of this 
section governing the admissibility in evidence of certain hos- 
pital bills shall not apply to any action or proceeding in a 
surrogate’s court nor to any action or proceeding in any court 
instituted by or on behalf of or in the right of a hospital to 
recover payment for accommodations or supplies furnished or 
for services rendered by or in such hospital, or to an applica- 
tion pursuant to section one hundred eighty-nine of the lien law 
to determine the validity and extent of the lien of a hospital. 
Submitted herewith is a study made under the direction of the 
Commission. 
Dated, December 15, 1948. 
John W. MacDonald, 
Executive Secretary 
and Director of Research. 
THE LAW REVISION COMMISSION: TABLE OF CONTENTS 
I. The Problem 
PAGE 
II. Judicial Construction of Lien Law, Section 189 16 
A. Amount of lien 16 
B. Validity of lien lg 
III. History of Proposed Amendments 20 
IV. Statutes of Other States 24 
V. Other Problems Arising under Section 189 of the Lien Law 26 
A. Attachment of lien to cause of action of infant 27 
B. Section inapplicable to settlements of $300 or less ->q 
C. Ambiguity of provision as to reasonable charges 29 
D. Charges of physicians and surgeons 3q 
VI. Provisions of Civil Practice Act, Section 374-a 31 
Appendix: Hospital Lien Statutes 32 LIEN LAW, SECTION 189; PROCEDURE FOR DETERMINING 
REASONABLENESS OF HOSPITAL LIEN IN ADVANCE OF 
SETTLEMENT OF PERSONAL INJURY ACTION* 
I. The Problem 
Lien Law, section 189 was enacted by L. 1936, c. 5341 except 
for an amendment of subdivision 4 relating to filing fees (L. 1939, 
c. 290) it has remained unchanged since its enactment. Subdivision 
1 provides that every voluntary and municipal hospital has a lien 
upon all rights of action, suits, claims, counterclaims or demands 
of anyone receiving treatment, care and maintenance therein for 
personal injuries received as the result of the negligence of another 
within one week prior to admission to such hospital. The lien 
extends also to the rights of action, suits, claims, counterclaims or 
demands of the legal representative of the patient, in case of death 
as the result of such injuries. The lien is “for the amount of the 
reasonable charges of such hospital, for such treatment, care and 
maintenance of such injured person at cost rates in such hospital. ’ ’ 
Its effectiveness is conditioned upon the filing of a notice of lien in 
the office of the county clerk, and the mailing of such notice to those 
allegedly liable for the injuries, prior to the payment of any 
moneys as compensation to the injured person, his attorneys, or 
legal representatives. 
Under subdivision 2 of the statute, the lien attaches to any ver- 
dict, decision, decree, judgment or final order; to the proceeds of 
the settlement or compromise of any suit, action or proceeding 
effected before any verdict, decision, decree, judgment or final 
order is rendered; and to the proceeds of the settlement or com- 
promise of any claim, demand or cause of action effected before the 
commencement of a suit, action or proceeding thereon. 
Provision is made in subdivisions 3 and 10 for the enforcement 
of the lien by suit at law: the suit, under subdivision 3, may be 
brought within one year from the date of payment against one 
making payment to the injured person or his legal representative. 
Subdivisions 9 and 10 provide a means for avoidance of liability 
for a double payment of the hospital’s charges on the part of the 
defendant, by deposit of the amount of the settlement or judgment 
with the county treasurer or, in New York, with the city chamber- 
lain; the hospital may then enforce its lien by a suit at law against 
the person or corporation claimed to be liable or against the fund 
on deposit. 
The problem involved in this study is the lack of provision for 
testing the validity and extent of the claimed lien of the hospital, 
in advance of settlement. When an offer of settlement is made, 
* This study was made by the Law Revision Commission, under the direc- 
tion of the Executive Secretary and Director of Research, who was assisted 
by Mary A. Beck, Research Assistant. 
1 The statute is set forth in the Appendix, p. 32. 16 
there is no way by which counsel for either side can know whether 
the lien asserted by the hospital is (1) properly filed and therefore 
valid, or (2) correct in amount. The only proceeding provided in 
the statute for the determination of these questions is the action 
at law to be instituted by the hospital to enforce its lien, after 
payment by a third person to the injured person or after deposit 
of the amount of the settlement or judgment. 
II. Judicial Construction of Lien Law, Section 189 
A. Amount of Lien 
The courts have varied in their interpretation of the proceedings 
available under this statute to test the amount of the lien. In 
Finkel v. Kushner,2 an offer was made to settle a death action for 
$5000. The hospital which cared for decedent submitted a bill 
and filed a lien for $1,848.27, and plaintiff administrator refused 
to accept the offer of settlement because the amount left for the 
famity of the decedent would be insubstantial. He also objected 
that the items of the hospital bill were unreasonable, and sought 
unsuccessfully to arrange a compromise with the hospital. On a 
motion to set aside the lien, he prayed that a referee be appointed 
to determine the value of the hospital’s services. 
The motion and prayer for a referee were denied, on the ground 
that the statute did not authorize such a proceeding. Hooley, J. 
said: 
The affidavit in support of the motion asks that an order be 
made directing that a hearing be held before a referee to 
determine the fair and reasonable value of the services 
rendered by the hospital. The hospital submits that it has 
complied with section 189 of the Lien Law in the filing of its 
lien and that this court does not have authority to either fix 
the lien or to refer it to a referee to determine the value of the 
services. It asserts that the method of enforcing the lien in 
the event of a dispute as to the value of the services has been 
prescribed by subdivisions 9 and 10 of section 189 of the Lien 
Law, which provide that the money may be deposited with the 
City Chamberlain and that the hospital may enforce its lien 
by action against the person, persons or corporation claimed 
to be liable or against the fund deposited. 
The statute, however, deals only with the cases where a 
verdict, decision, decree, judgment or final order has been made 
or rendered in a suit, action or proceeding, or, with the proceeds 
of a settlement or compromise received either after or before 
a suit, action or proceeding has been begun. There is no pro- 
vision made for a situation where, as here, the settlement has 
not yet been consummated and where its acceptance will 
depend on what amount will be available to the family of the 
decedent after all proper claims are paid. The injured party 
or his representative is without a remedy to test the reasonable- 
2 183 Misc. 64 (1944) ajfd without opinion, 268 App. Div. 912. 17 
ness of the hospital’s lien in such a case and thus is deprived of 
an opportunity to properly evaluate the entire situation in 
advance of the settlement, being relegated to a defense in an 
action as, if and when brought by the hospital after the 
settlement has taken place. 
Under the present conditions settlements are impeded and 
the injured persons are often compelled to pay bills which they 
feel are unjust and exorbitant in order to avoid the delay and 
expense involved in the present awkward methods provided by 
the statute for determination of the reasonableness of the 
amount of the lien. Such procedure places an undue hardship 
upon the person injured or his representative. 
The Finkel case was cited and followed in O’Connor v, Higgins,3 
where the Special Term of New York County, McNally, J., denied 
a motion for the determination of the reasonableness of a lien, 
before settlement of the action. In T)e Sola v. Farino,4 an order 
of the Municipal Court of the City of New York, fixing the lien 
of a hospital over its objection on the motion of defendant, was 
reversed by the Appellate Term, Second Department, on the 
ground that subdivision 10 of the section requires that the lien be 
enforced by action and does not permit it to be determined by 
motion. On the other hand, in David v. Billor,5 a motion by the 
infant plaintiff to fix the amount of the hospital lien was granted by 
the Supreme Court, Special Term, New York County, and a referee 
was appointed to hear and report as to the amount of the lien. 
The lienor’s contention that the lien may be determined and fixed 
only by plenary suit was rejected. The court said at p. 267-268: 
. . . The only specific reference to actions at law con- 
tained in section 189 of the Lien Law appears in subdivision 3 
which provides that suits at law may be brought to enforce the 
lien by the lienor within the space of one year from payment, 
in the event such payment of proceeds of the claim has been 
made to the injured person without regard to the lien. Sub- 
division 10 further provides “Any such lien may be enforced 
by action or law against the person, persons or corporations 
claimed to be liable or against the fund deposited as herein- 
before provided in any court of record.” The use of the 
words “or law” have no meaning unless to reaffirm the 
availability of any remedy in law theretofore available. There 
is here no question of the enforcement of the lien. Its validity 
is not assailed but the injured person seeks to have its amount 
fixed. Clearly, the ancient power of equity in the protection 
of its infant wards and the remedies available to it to accom- 
plish that purpose are includable in that language. Were the 
provisions of subdivision 3 intended to be all-embracive, no 
need would arise for the inclusion of subdivision 10. Con- 
versely stated, the specific provision for a permissive suit at 
3 N. Y. L. J. July 13, 1948, p. 66. 
4 172 Misc. 571 (1939). 
5 188 Misc. 267 (1946). 18 
law in the specified situation implies, in addition to the per- 
missive character, that other situations remain necessarily 
subjected not alone to suits at law, but are enforcible broadly 
pursuant to law. . . . 
B. Validity of Lien 
Although there is no express provision in the statute for testing 
the validity of the lien except in a suit at law under subdivisions 3 
and 10, the following motions directed to that end have been 
entertained: application to vacate, cancel or discharge liens (1) 
because of hospital’s refusal to permit examination of records as 
provided in subdivision 5 of the statute,6 and (2) because the 
second filing provided for in subdivision 1 was not made7; motion 
for an order determining distribution of proceeds of settlement of 
a personal injury action, before release by plaintiff (apparently 
not an infant) was. executed, on which motion it was held that the 
lien did not attach since the settlement was for less than $300?; 
and motion by infant plaintiff and by the father of the infant, 
joined as party plaintiff, to have the alleged lien of a hospital 
determined and, if so determined, its extent fixed, on which motion 
only the validity of the lien teas established9. Only in the last case, 
Ferguson v. Buppert, did the hospital object to this procedure, sub- 
mitting proof by affidavit and exhibits as t.o the validity and extent 
of the lien but stating that it ‘ ‘ appears specially herein merely for 
the purpose of furnishing the court with the information herein 
before set forth and does not submit to jurisdiction of this Court on 
this application and in this manner to determine the validity of or to 
enforce its lien, by reason of the fact that said Section 189 of the 
Lien Law prescribes the manner in which such lien must be enforced 
if not satisfied” (p. 532). This motion followed a prior application 
of the infant plaintiff to compromise the action,10 on which the court 
withheld approval until the hospital was brought into court to 
prove the validity and extent of its lien, stating that the hospital 
is bound to show certain facts before its lien may attach, including 
the reasonableness of its charges and the cost rates in such hospital. 
In upholding the validity of the lien on this motion, the court after 
quoting subdivision 10, said (p. 533) : 
However, it seems to me that the lien is subject to an order 
of this court, upon due notice to all parties interested in a pro- 
ceeding to vacate the lien for want of compliance with the 
statutory requirements, even though there is no specific pro- 
vision in the statute suggesting or providing for that relief. If 
6 Matter of Larchmont Gables, Inc. et al., Petitioners, Mt. Vernon Hospital, 
Respondent, 188 Misc. 164 (1946). 
7 Groth v. City of New York, 183 Misc. 1026 (1944) ; Melichar v. Michelson, 
256 App. Div. 962 (1939), appeal dismissed because of settlement, 281 
N. Y. 665 (1939). 
8 Rookus v. Janowski, 177 Misc, 1075 (1942). 
9 Ferguson v. Ruppert, 166 Misc. 530 (1938). 
10 Ferguson v. Ruppert, 166 Miec. 427 (1938). the lienor does not comply with the provisions in the manner 
provided to perfect a lien, the parties to the action should not 
be relegated to a defense in an action to be brought within the 
time provided for the enforcement of the lien after deposit of 
the amount of the lien with the city chamberlain or the county 
treasurer, which for the purposes of subdivision 3 constitutes 
payment. 
In Finkel v. Kushner, supra, the Supreme Court, Special Term, 
Kings County, cited the Ferguson cases and said (p. 66) : 
This Court is in full sympathy with the justice of the pro- 
cedure suggested in the two cases last cited. However, the 
view of that court in that respect was obiter dictum. In addi- 
tion, the whole subject of hospital liens is a creation of the 
statute and the statute creating the lien has provided the 
machinery for testing its validity. This court may not create 
new methods for testing the lien’s validity and extent. This is 
a matter to which the Legislature of the State may well give 
its attention by adding suitable provisions to section 189 of 
the Lien Law which would enable a party interested, even 
before settlement of the action, to test expeditiously the validity 
and reasonableness of a hospital lien, a subject which has given 
the Bench and Bar some concern in recent years.11 
It may be noted that in all the reported cases where the validity 
of the lien is in question, the hospital does not object to adjudica- 
tion of that issue on motion, whereas where the extent of the lien 
is in question, it invariably contends that subdivisions 3 and 10 
of the statute prescribe an exclusive method for its determination, 
even though the statute is silent as to procedure in both cases. The 
only case in which the hospital objected to plaintiff’s motion to 
have the lien “determined” (Ferguson v. Ruppert) was one where 
the motion for “determination” of the lien was joined in a motion 
to fix the extent thereof. The reason for this seems apparent. It 
is convenient for the hospital to have its lien declared valid at 
any stage of plaintiff’s action, for it obviates the necessity for 
bringing a separate action. But the extent of the lien is another 
matter. When an offer of settlement is made in a personal injury 
or wrongful death action, and where the plaintiff considers the 
claimed lien excessive in amount, it is a rare plaintiff who prefers 
to have that amount tied up awaiting a possible action by the 
hospital, rather than to take the settlement offered and pay what 
ii The same court in Bogartz et al. v. Astor, 45 H. Y. S. (2d) 74 (1943), 
had cited Ferguson v. Ruppert in support of the proposition that where a 
lien has been created by statute and no remedy is provided for its enforce- 
ment, resort to a court of equity may he generally had, particularly in view 
of equity’s jurisdiction over the rights of property of an infant. The 
Bogartz case concerned jurisdiction of the Supreme Court to vacate a notice 
of lien filed by the employer and the carrier under Workmen’s Compensation 
Law, section 29, although no procedure for vacating is provided in that 
section. However, it was also held that the court had jurisdiction of the 
subject matter and that it had acquired jurisdiction of the parties since 
they had acquiesced in that procedure in prior proceedings. 20 
the hospital claims. While the hospital must prove both the valid- 
ity and extent of the lien in the action it may bring to enforce 
the lien, and any new procedure provided for a determination 
of these issues in advance of settlement would thus make no change 
in the proof required of the hospital, such new procedure would 
remove the undoubted advantage the hospital now enjoys of receiv- 
ing payment in full of its claim without being required to prove its 
reasonableness. 
In Finkel v. Kushner, supra, $5000 was offered in settlement of a 
death action. The hospital claimed $1,848.27. Two of the items 
objected to by plaintiff were the sums of $790 for surgeons’ fees 
and medical consultations, although decedent was a ward patient, 
and $262.60 for X-rays. It does not appear in the opinion how 
long decedent was in the hospital. After deduction of the requested 
attorney’s fee and the funeral bill, less than $700 would have been 
left for decedent’s family. In Ferguson v. Buppert, supra, the 
infant plaintiff was in the hospital 76 days. The settlement offered 
was $1500. The hospital filed a lien for $714.50. The bill is not 
itemized in the opinion. While these figures have no significance, 
without more information, as indicating that the charges were or 
were not reasonable in those cases, they do point up the plaintiff’s 
dilemma. 
III. History of Proposed Amendments 
The suggestion of the desirability of amending this statute is 
not a new one. Beginning with the year after the enactment of 
section 189, many bills have been introduced. These bills fall 
generally into three groups: those providing a procedure for test- 
ing the validity or reasonableness of the lien; those limiting the 
lien; and those proposing miscellaneous amendments or repeal of 
the statute. Only the first two groups have been investigated in 
detail. 
The first bill was introduced in 193712 Its chief amendment was 
the insertion of a new subdivision reading as follows: 
At any time after the filing of the lien as herein provided 
for in subdivision one of this section, the injured person, or 
his legal representative in case of death, or such hospital may 
serve a notice of motion, giving not less than five nor more 
than ten days notice thereof either upon the person or persons, 
firm or firms, corporation or corporations alleged to be liable 
to the injured party, or upon the attorney or attorneys thereof, 
if an action is pending, returnable in the court where such 
action is pending, or if no action has been brought, in any 
court of record in the county where the said hospital is situ- 
ated, requiring the court to determine and fix the reasonable- 
ness of the lien filed by such hospital. Upon the return of such 
motion the court may summarily fix the lien upon the papers 
submitted to it or, in its discretion, may take testimony or 
refer the matter to a referee, and the court or such referee 
12 Sen. Int. No. 2091, Pr. No. S. 2625 (A. Int. No. 2526). 21 
upon the hearing pursuant to such motion shall take into con- 
sideration the extent of the injury, the nature of the liability, 
if any, the amount actually recoverable, whether a judgment 
has been recovered or not, and all other relevant circumstances. 
Upon the entry of an order upon such motion fixing the lien, 
a copy of such order with notice of entry shall be served upon 
the hospital and also upon the person or persons, firm or firms, 
corporation or corporations liable for satisfaction of such lien 
hereunder, and the sum fixed in said order shall constitute the 
extent of the lien provided for in this section. 
This bill died in the Judiciary Committee. 
In 1941 three bills were introduced. One13 amended subdivision 
2 to provide that “the lien of any such hospital, subject to the 
approval of the reasonableness of the amount of such lien by the 
court, shall attach ...” Another14 was essentially the same as the 
1937 bill above, with more elaborate provisions for notice. The 
third15 added a new subdivision reading: 
9-a. A motion to vacate or modify a lien filed pursuant to 
this section may be made by or in behalf of any party interested 
therein in any court of competent jurisdiction and the court 
may grant the relief prayed for or other appropriate relief 
unless the hospital corporation filing such lien shall prove to 
the satisfaction of the court that the lien has been filed in 
accordance with the provisions of this section. 
This bill was approved by the Committee on State Legislation of 
the Association of the Bar of the City of New York,16 on the ground 
that relief is desirable from the present apparent necessity for 
deposit of any settlement or judgment before a lien may be vacated. 
All three bills were stricken from the Calendar after the third 
readings. 
In 1942 a bill was introduced17 which added a provision for a 
motion to determine and fix the reasonableness of the filed lien, 
identical to the proposal contained in 194118 which, as noted above, 
was essentially the same as the 1937 proposal. The 1942 bill, how- 
ever, applied only “in cities having a population of one million 
or more”; it also added a provision, applicable “in cities having a 
13 A. Int. No. 1789, Pr. No. 2129. 
1“ A. Int. No. 1578, Pr. Nos. 1850, 2268, 2740, 2907. 
!■» A. Int. No. 505, Pr. No. 518. 
le 1941 Bull. No. 5, Memo. No. 112, p. 317. 
17 A. Int. No. 1212, Pr. Nos. 1400, 2210, 2451. The Committee on State 
Legislation of the New York City Bar Association disapproved this bill on 
the grounds: (1) that there is no necessity for a new method of enforcing 
liens by motion since the hospital under the present law must prove the 
reasonableness of its charges, citing Ferguson v. Ruppert; (2) that the bill 
introduces irrelevant elements into the amount of the hospital’s recovery; 
(3) that even if the court should fix the amount of the lien at less than 
the reasonable cost, the right of the hospital to a deficiency judgment in 
another action for the balance due is not cut off, and the bill appears pro- 
ductive of unnecessary litigation and expense. (1942 Bull. No. 8, Memo. 
No. 182, p. 495.) 
is See note 14, supra. population of one million or more”, that no assignment of any 
portion of the amount recovered by settlement or after judgment 
for hospitalization, medical or surgical service shall be valid beyond 
the amount for which a lien may be filed under this section and 
that any such assignment shall be subject to the provisions of this 
section. The latter provision was probably directed toward a 
practice of hospitals in taking assignments for the total amount 
of the bill claimed and suing on the assignment, without invoking the 
provisions of Lien Law, section 189.19 The bill passed the Assembly 
but was lost and tabled in the Senate. 
From 1937 to 1942, all the bills seeking to amend Lien Law, 
section 189 as to the amount or validity of the lien followed a general 
pattern stemming from the original 1937 proposal: they all 
attempted to provide a procedure, by motion, by which the injured 
party or his legal representative, the person allegedly liable, or 
the hospital might have the lien “determined”, i.e. its validity estab- 
lished, and the amount of the lien fixed. These were all permissive, 
so that the hospital’s right of action after payment to the injured 
person or after deposit with the treasurer was not abrogated. The 
first type, proposed in 1937, quoted above and copied with elabora- 
tions in one bill of 1941,20 in the bill of 1942, and in one bill of 1945, 
adds elements to be considered in fixing the lien which are perhaps 
not relevant to the “reasonable charges at cost rates” of the hos- 
pital. “The extent of the injury” is ambiguous. If it relates 
to the severity of the injury, it is not necessarily related to the 
cost of hospitalization. The cost to the hospital of a patient who 
dies two hours after admission as the result of a fractured skull 
must be considerably less than the cost of maintenance and treat- 
ment of one who suffers a broken leg. Likewise, “the nature of 
the liability, if any”, and “the amount actually recoverable whether 
a judgment has been recovered or not”, constitute factors which 
counsel might consider in making, accepting, or rejecting an offer 
of settlement; the hospital could reasonably argue that the uncer- 
tainties of a personal injury action bear no relation to the fact that 
it has expended a certain sum in treating the injured person. 
It was of course the nuisance of obtaining and the difficulty experi- 
enced in satisfying a judgment against the injured person which 
led to the enactment of this section; it is likewise the parties’ uncer- 
tainty as to the enforceable extent of the lien and the difficulty 
experienced in compromising with the hospital which has led to 
the necessity for amending this section. 
See Reddy v. Zurich Gen. Acc. & Liability Ins. Co., Ltd., 171 Misc. 69 
(1939); Abbondola v. Kawecki, 177 Misc. 122 (1941). 
2o 1942 Bull. No. 8, Memo. No. 182, p. 495. Comparing this memorandum 
with the Committee’s memorandum on 1941 A. Int. 505, it appears that the 
Committee has taken the position that while a provision for vacating the 
lien by motion is desirable, one for fixing the amount of the lien is unneces- 
sary, in view of Ferguson v. Ruppert. The latter case, however, has since 
been questioned in Finkel v. Kushner, 183 Misc. 64 (1944), and the Appellate 
Term in De Sola v. Farino, 172 Misc. 571 (1939) had previously reached 
a contrary result. 23 
It should be noted here that there has been testimony in one 
case that the charge to a “liability patient”, that is, one admitted 
as the result of an accident, is always higher than the charge for 
the same services to other patients since there is the possibility that 
the “liability patient” might recover money in a law suit.21 This 
case concerned Kings County Hospital, owned and operated by the 
City of New York. The charges of a municipal hospital, however, 
under General Municipal Law section 130, may not in any case 
exceed actual cost of maintenance. Nothing has been learned of 
voluntary hospitals’ practice in this matter. 
The bill of 1941 quoted above22 contains no criteria for deter- 
mining the extent of the lien. The proof required of the hospital 
on such a motion to vacate or modify would be no different from 
that required in its present action at law, since no factors other 
than those already contained in the statute could enter the decision. 
The only difference this amendment would make would be to hasten 
the judicial determination of the amount of the lien, and thus 
deprive the hospital of the nuisance value of its subsequent suit 
at law. If the lien has been properly filed and the claimed amount 
can be proved, it should be as advantageous to the hospital as to 
the parties to have it quickly determined. The amount of the lien 
would then be a known element of the injured person’s damages, 
and each party would be in a better position to offer or accept a 
settlement. 
Except for one bill introduced in 1945, the proposed amendments 
after 1942 abandoned any attempt to provide a procedure for test- 
ing the validity and extent of the lien. All bills except one intro- 
duced since then have provided certain limitations on the lien 
instead. In 1943 identical bills were introduced in both houses.23 
These amended subdivision 1 to exclude “medical and surgical fees” 
from the lien of the hospital and added the following sentence after 
the first sentence of subdivision 1: 
Such cost rates shall not be in excess of the schedule of rates 
currently approved by the industrial commissioner and the 
superintendent of insurance for cases under the workmen’s 
compensation law. 
These bills were not reported out of the Judiciary Committees. 
In 1944, a proposed amendment24 excluded “personal services 
rendered by any physician or surgeon” from the lien of the hos- 
pital.25 This bill passed the Assembly but was not reported out 
of the Senate Judiciary Committee. 
21 Engels v. City of New York, 168 Misc. 753 (1938). 
22 See note 15, supra. 
23 s. Int. No. 1475, Pr. No. 1731; A, Int. No. 1221, Pr. Nos. 1372, 2038, 
2256. 
24 A. Int. No. 12, Pr. Nos. 13, 337. 
25 Approved by the Committee on State Legislation of the New York City 
Bar Association with the comment that the amendment was in conformity 
with public policy as expressed in the Workmen’s Compensation Law, which 
had been amended in 1935 {§ 13-f(l)) to provide that hospitals may not 
receive remuneration paid to physicians on their staffs for medical and 
surgical services. (1944, No. 93, p. 267.) 24 
In 1945 three bills were introduced. One, identical with the 
1944 bill described immediately above, passed the Legislature but 
was recalled from the Governor,20 
Another27 was identical with the 1942 bill discussed above,28 except 
that it applied generally instead of applying only to ‘ ‘ cities having 
a population of one million or more.” It was' lost and tabled. 
The third bill was the first of a series of annual proposals to limit 
the lien to 15 per cent of the amount recovered.29 It added the 
following words to the end of the first sentence in subdivision 1: 
“to the extent but not in excess of such sum as is equivalent 
to fifteen per centum of the amount ultimately recovered by 
or in behalf of such person upon any and all such rights of 
action, suits, claims, counterclaims or demands of such person; 
but such limitation with respect to such lien shall not be deemed 
or construed to prevent the recovery by such hospital, by appro- 
priate legal proceedings or otherwise, of that part of such 
charges as exceeds such sum.” 
This bill died in the Judiciary Committee. It has been introduced 
each year since then30 and it has died in Committee each year. 
In 1946 the only bill amending Lien Law, section 189 which has 
passed the Legislature (aside from the 1945 bill which was recalled 
from the Governor) was introduced.31 It excluded “personal serv- 
ices rendered by any physician or surgeon” from the lien and added 
the following sentence after the first sentence in subdivision 1 : 
“Where such injured person receives treatment, care and 
maintenance in a hospital ward, such cost rates shall for the 
purposes of this section be deemed equivalent to the rates cur- 
rently agreed upon between the hospitals of the state and com- 
pensation insurance carriers for payment in cases under the 
workmen’s compensation law.” 
This bill was vetoed without memorandum. 
IV. Statutes of Other States 
Of the twenty-four other American jurisdictions (including the 
District of Columbia and Hawaii) which have hospital lien laws, 
nine provide direct limitations on the lien, either by fixing a ceiling 
26 A. Int. No. 373, Pr. No. 373. 
27 A. Int. No. 154, Pr. Nos. 1154, 1280. 
28 See note 17, supra. 
29 A. Int. No. 1273, Pr. No. 1372. 
so 1946 A. Int. No. 1811, Pr. No. 1966; 1947 A. Int. No. 895, Pr. No. 905; 
1948 A. Int. No. 2148, Pr. No. A. 2287 and Sen. Int. No. 2382, Pr. No. S. 
2627. The Committee on State Legislation of the Bar Association of the 
City of New York (1947 Bull. No. 6, Memo. No. 98, p. 285) and the Hos- 
pital Association of New York State (Legislative Committee Bulletin No. 
46-2, Feb. 28, 1946, p. 3) disapproved this bill. 
si Sen. Int. No. 556, Pr. No. 568, Pr. No. A. 2231. The bill was intro- 
duced at the request of the Hospital Association of New York State as a 
“defensive measure to end the occasional padding of liens by the inclusion 
of doctors’ bills and inflation of hospital charges” (Hospital Association 
Legislative Bulletin No. 46-1, Jan. 31, 1946, p. 1). 25 
on charges or by fixing an amount or a percentage of the recovery 
to which the lien may attach, or by a combination of these limita- 
tions. In Texas3- and Missouri,33 the “reasonable rates” of the 
hospital may not exceed $5.00 per day. Texas limits the number 
of days to 100. Missouri allows in addition for “the reasonable 
cost of necessary X-ray, Laboratory, Operating Room and Medica- 
tion service. ’ ’ In Maryland34 the lien may not exceed such charges 
as may now or hereafter be allowed by the State Industrial Accident 
Commission for services rendered in the care and treatment of 
persons coming under the Workmen’s Compensation Act of that 
state. In Montana35 the lien may not exceed provisions of the 
schedule of fees as adopted by the Montana State Medical Associa- 
tion (the lien in Montana, as in several other states, is in favor of 
doctors and nurses as well as hospitals). In Kansas36 and Vir- 
ginia37 the lien may not exceed $200. In Maryland38, Missouri39 and 
North Carolina40 the lien attaches only to 50% of the amount paid 
to the injured person after deduction of the attorney’s fees. In 
Illinois41 the lien may not exceed one-third of the amount paid or 
due to the injured person. In Washington42 all liens for service 
rendered to any one person as a result of any one accident (includ- 
ing hospitals, licensed nurses, practitioners, physicians and sur- 
geons) may not exceed 25% of the amount of the judgment or 
settlement. 
In addition to these stated limitations, latent limitations appear 
in a few jurisdictions. In Indiana43 the lien applies only to judg- 
ments. This is also true in Hawaii.44 In Connecticut45 the lien 
applies only to the proceeds of accident and liability insurance 
policies which may be due to the patient. 
Several states provide a method for testing the reasonableness 
of the hospital charges. 
The North Dakota statute46 provides that if it appears at a trial 
for personal injuries that hospital services were rendered, a search 
of the records shall be made to ascertain whether a lien has been 
filed; if it has, mention of that fact and the amount claimed shall 
be made in the judgment. If the lien is contested, its amount is 
deposited after collection of the judgment to abide the final event 
of an action to enforce the lien, “which action must be brought by 
the hospital or the institution within sixty days after demand 
32 Appendix p. 65. 
33 Id. p. 54. 
34 Id. p. 51. 
33 Id. p. 55. 
3« Id. p. 49. 
87 Id. p. 67. 
33 Id. p. 51. 
39 Id. p. 54. 
Id. p. 58. 
41 Id. p. 45. 
*2 Id. p. 69. 
«Id. p. 47. 
44 Id. p. 70. 
45 Id. p. 40. 
46 Id. p. 60. 26 
therefor is made by any of the parties interested. ’ ’ This provision 
has the effect of a provision for motion, but it apparently applies 
only where judgment is rendered. 
The Connecticut statute47 provides that if the interested parties 
cannot agree as to the amount due the hospital, either party may 
bring an action of interpleader. This differs from subdivisions 3 
and 10 of the New York statute, for it gives the initiative to either 
party. 
The Arkansas statute48 provides that the lien may be filed in a 
pending action and that the court shall then embody in the judgment 
such an award with respect thereto as the evidence warrants. This 
makes the hospital a party, but is not mandatory. It also provides,49 
apparently where an action has not been begun, for determination 
and payment of the hospital lien on joint motion of the patient and 
the hospital. This assumes that the interests of the hospital and 
of the injured person are one. 
The Illinois statute50 provides that on petition filed by the injured 
person or the hospital, any court of competent jurisdiction shall 
on written notice to all interested parties adjudicate the rights of 
all interested parties and enforce their liens. The lien attaches 
to settlements. Since the lien is limited to a maximum of one-third 
of the sum paid or due to the patient, this statute leaves little room 
for delay or debate, especially in the light of an additional pro- 
vision51 that within ten days of the request of the defendant, the 
hospital must furnish a statement of the nature and extent of the 
injuries sustained, treatment given, and the history as given by 
the injured person as to the manner in which the injuries were 
received. 
The Virginia statute52 provides that the injured person may file 
a petition in the court that would have jurisdiction of the hospital’s 
claim if that claim were asserted against him by such hospital, and 
the court shall dispose of the reasonableness of the hospital’s claim 
in a summary way after five days’ notice to the hospital; the hos- 
pital likewise may have its claim summarily adjudicated in the 
same manner. 
Of these five provisions, three (Connecticut, Illinois and Vir- 
ginia) avoid the difficulty arising under the New York statute. 
Roughly half of the states having hospital lien laws avoid this 
difficulty, either by a quick procedure for adjudication of the 
amount of the lien or by limitations on the amount of the lien. 
V. Other Problems Arising Under Section 189 of the Lien Law 
Certain other substantive problems arising under Lien Law, 
section 189 became apparent in this study of the statute. They are 
briefly set forth below: 
47 Id. p. 40. 
48 Id. p. 35. 
49 Id. p. 38. 
60 Id. p. 46. 
si Id. p. 46. 
62 Id. p. 68. 27 
A. Attachment of Lien to Cause of Action of Infant 
There is confusion in the cases as to whether the lien attaches to 
an infant’s cause of action, or only to the cause of action of the 
infant’s father or guardian. It was said in Ferguson v. Ruppert53: 
The plaintiff insists that the infant is not liable for the 
hospital lien. It is true that at common law the parent or 
guardian would be primarily liable for necessaries where the 
infant has no separate estate, and as the infant has no cause of 
action for recovery of such hospital expenses, the amount 
thereof may not be taken from the infant’s share of the settle- 
ment. The injured person indicated in the statute is the person 
who has received hospitalization and not the parent who has 
been injured to the extent of loss of services. The plaintiff 
calls attention to Clarke v. Eighth Ave. R. R. Co. (238 N. Y. 
246), upon the theory that the infant may not recover for 
medical expenses and the like. Upon a trial of an action, in 
my opinion, the amount for which a lien for hospitalization has 
been filed in accordance with the statute may be recovered in 
an action by the infant. This fact does not preclude recovery 
in the loss of service action for any other expense for which 
the guardian or parent becomes liable. The guardian or parent 
not being liable for the amount of hospitalization could not, 
in any event, seek recovery as to such lien as a part of his 
cause of action. If the infant, the injured person, is liable 
to payment contingent upon recovery by settlement or other- 
wise, the amount of such lien must of necessity be a part of the 
damages receivable by such injured person. 
In Abbondola v. Kawecki,54 where the infant had recovered a 
judgment for personal injuries and where the father had recovered 
a judgment limited in amount to the hospital bill, the hospital 
claimed liens against both recoveries; a statutory lien based on 
section 189, and an equitable lien based on an assignment by the 
father prior to the service of the summons. After holding that 
where the hospital, by taking an assignment, has secured the pay- 
ment of its total bill, the necessity for the lien does not exist and 
section 189 does not apply, the court said (p. 123-124) : 
The respondent hospital cites certain cases in support of 
its contention that it has valid liens against both recoveries. 
The cases cited, however, are clearly distinguishable from the 
facts here. Ferguson v. Ruppert (166 Misc. 530) merely held 
that where a lien was filed the infant could properly include 
hospital expenses as part of his damage. However, it would 
seem that if the Legislature intended to change the rule that 
an infant may not recover for medical expenses and that such 
recovery is limited to the parent who is liable for the payment 
of the expense incurred, it could, and would plainly have so 
stated. 
53 166 Misc. 530 (1938) at p. 535. 
54 177 Misc. 122 (1941). 28 
Here the father recovered in his own action judgment for 
medical expenses incurred. Under the circumstances there 
could be no recovery by the infant as well, and the infant made 
no claim for the same. The judgment in favor of the infant 
having excluded any recovery for medical expense, no lien 
based on such medical expense may attach to the infant’s 
recovery. The extent of the defendant’s liability was fixed 
after trial and not by settlement or voluntary payment. 
The court then denied a motion to modify a prior order as to the 
disposition of the proceeds of the infant’s judgment. Since the 
attorney’s lien is prior to the hospital lien, the hospital lien attached 
to the father’s recovery (limited in this case to the amount of the 
hospital bill) only after the attorney’s fee had been deducted. 
No case has been found where the argument was advanced that 
the hospital lien attaches neither to the infant’s nor to the father’s 
cause of action (except in the case of death of the infant), but that 
argument might wTell be made. Subdivision 1 provides that the 
hospital shall have a lien “upon any and all rights of action, suits, 
claims, counterclaims or demands of any person admitted to any 
such hospital and receiving treatment, care and maintenance 
therein . . . which such injured person or the legal representa- 
tive of such injured person, in case of death as the result of such 
injuries, may or shall have, assert or maintain against any such 
other person . . . for damages on account of such injuries . . .” 
Since the injured infant has no common law right of action for 
hospital expenses incurred up to the time of the trial55, not being 
liable for them, this would exclude any lien against his recovery. 
Moreover, throughout the statute “such injured person” must refer 
to “any person admitted to any such hospital and receiving treat- 
ment, care and maintenance therein . . . ”, which definition 
would exclude the father or guardian of the injured infant. The 
injured person is one who suffers personal injuries, not one who 
suffers legal damage. 
A bill was introduced in 1937 to include the cases of guardian 
or husband in the lien56. It would have added a new paragraph 
(d) to subdivision 2, making the lien attach; 
To any verdict, decision, decree, judgment or final order 
made or rendered in any suit, action or proceeding brought in 
any court of this state by the husband or parent or guardian 
of such injured person for the recovery of expenses incurred or 
of any loss of services on account of such injuries, and to the 
proceeds of the settlement and compromise thereof or of any 
such claim, demand or cause of action effected before the com- 
mencement of any suit, action or proceeding thereon. 
45 The value of prospective medical treatment beyond the date of the trial, 
however, is an element of damage belonging to the infant, and not to the 
father. Clarke v. Eighth Avenue R. R. Co., 238 N. Y. 246 (1924). 
se A. Int. No. 1558, Pr. Nos. 1705, 2530 29 
The bill was recommitted to the General Laws Committee after the 
third reading. No subsequent similar amendment has been intro- 
duced. 
The only statute found which attempts to provide for infants’ 
eases is that of North Carolina57, which provides: 
Where damages are recovered for and in behalf of minors 
or persons non compos mentis, such liens shall attach to the 
sum recovered as fully and effectively as if the said person 
were sui juris. 
The lack of provision in the statutes for such cases indicates that 
the question, which has surely arisen in other states, is left for 
judicial interpretation. 
If hospital expenses are to be recovered only in the guardian’s 
own action, there is not much security for the hospital, for there 
is nothing to prevent a guardian from waiving his action; also, the 
guardian’s recovery would ordinarily consist largely or, as in 
Abbondola v. Kawecki, supra, entirely, of the hospital expenses 
incurred. After a substantial fee of the attorney is taken out of 
this, not much is left for either the hospital or the plaintiff. 
If these expenses are to be recovered in the infant’s action, the 
statute should perhaps be clarified, since the cases do not agree. 
While (as pointed out above) the hospital may insist on payment 
of its full claim and succeed because of the inconvenience to the 
plaintiff of waiting for an action at law in which to question the 
reasonableness of the charges, the plaintiff, on the other hand, 
may sometimes defeat the lien by settling a claim for $300 or less, 
in which case the lien does not attach (subdivision 6). It must 
often happen that a plaintiff would find himself with more in hand 
by the latter procedure than by making a larger settlement out of 
which the hospital’s claim is satisfied. 
B. Section Inapplicable to Settlements of $300 or less. 
The purpose of this provision of subdivision 6 is not clear. 
There is no doubt that it can be used to avoid the lien where the 
hospital’s claim is fairly large and the injured person’s other 
damage is fairly small. Since the statutory lien makes settlements 
more difficult58, this exception may have been designed to facilitate 
settlements in cases where the value of the claim is small. 
C. Ambiguity of Provision as to Reasonable Charges 
The provision that the lien shall be “for the amount of the 
reasonable charges of such hospital, for such treatment, care and 
maintenance of such injured person at cost rates in such hospital” 
seems ambiguous, although there has been no apparent difficulty 
with it, the parties and courts having assumed that “cost rates” 
govern. 
57 Appendix p. 46. 
58 Hayt and Hayt, Legal Aspects of Hospital Practices (Hospital Textbook 
Co., 1938) p. 74. 30 
D. Charges of Physicians and Surgeons 
The 1946 statute which was vetoed included a provision that the 
lien should be “exclusive of personal services rendered by any 
physician or surgeon.” In Goldwater v. Citizens Casualty Co. of 
New York59, a public hospital was permitted to collect a charge for 
surgical services as a part of the “treatment” given, even though 
the members of the medical staff of the city hospital were required 
under the New York City Charter to serve without compensation. 
This case was an action at law to recover for hospital services ren- 
dered to a policeman, the bill for which the insurance carrier had 
agreed to assume at the time it settled the policeman’s claim. 
Although the suit was not brought under the Lien Law, the opinion 
implies that the result would be the same (p. 249) : 
Section 130 of the General Municipal Law is still in effect 
to authorize charges for treatment; section 189 of the Lien 
Law gives emphasis to the right of such institutions to treat 
patients injured in accidents and to make a proper charge for 
such services. 
In Roosevelt Hospital v. Loewy60, however, a voluntary hospital’s 
charge for the services of a staff physician, rendered gratis to the 
hospital, was excluded from the hospital’s lien in an action brought 
under Lien Law, section 189. The Appellate Term, First Depart- 
ment, said per curiam (p. 114): 
It would appear that the reasonable charges of such hospital 
for which under subdivision 1 of section 189 of the Lien Law 
a lien is provided for “a charitable institution maintaining a 
hospital ’ * are such as are incurred by the hospital in operating 
and maintaining the hospital including any medical services 
such as those of resident physicians for which the hospital is 
under direct obligation to pay. The facts outlined distinguish 
this case from decisions involving either the Workmen’s Com- 
pensation Law requiring employers to pay for medical services 
rendered to their injured workmen or public hospitals sup- 
ported by public funds. The amounts collected by the latter 
are a part of the public funds used to maintain and support 
such public hospitals. 
In usual hospital practice the hospital does not pay fees as such 
even to resident physicians: their maintenance and their token 
salaries, like those of internes, are ordinary items of expense allo- 
cated to the various departments in which their services are 
rendered.61 In no sense are they paid for professional services, for 
their services are considered a part of their own education. A house 
physician, who serves not entirely for the purpose of education 
59 7 N. Y. S. (2d) 242 (1938). 
60 185 Misc. 113 (1945). 
61 Roswell, Accounting, Statistics and Business Office Procedures for Hos- 
pitals (United Hospital Fund of New York, 1946) p. 271. 31 
might be said to be working for a salary,62 but that is not on a fee 
basis. 
It would seem that charges for personal services of physicians 
and surgeons should be excluded from the lien, for fees for these 
personal services are not expenses incurred by the hospital. 
VI. Provisions of Civil Practice Act, Section 374-a 
Civil Practice Act, section 374-a, relating to the admissibility 
of certain written records, was amended by L. 1947, e. 523 by the 
addition of the following sentences: 
The terms “writing” and “record” as used herein shall 
include a hospital bill provided it bears a certification by the 
superintendent, acting superintendent or other head of the 
hospital that the bill is true and correct, that each of the items 
shown thereon was necessarily furnished or supplied and that 
the amount charged therefor is the fair and reasonable value 
thereof. A bill bearing such certification shall be admissible 
in evidence under this section and shall be prima facie evi- 
dence of the facts therein contained subject, however, to 
rebuttal by any party affected thereby. The provisions of this 
section governing the admissibility in evidence of certain 
hospital bills shall not apply to any action or proceeding in a 
surrogate’s court nor to any action or proceeding in any court 
instituted by or on behalf of or in the right of a hospital to 
recover payment for accommodations or supplies furnished 
or for services rendered by or in such hospital. 
If Lien Law, section 189 is amended to permit a motion by either 
party to vacate or to modify the lien filed by the hospital, the 
exception made in the last sentence of section 374-a would not seem 
to apply to that proceeding. A conformity change would be desir- 
able. 
62 Ponton, The Medical Staff in the Hospital (Physicians’ Record Co., 1939) 
p. 187 et seq. APPENDIX: HOSPITAL LIEN STATUTES 
New York Lien Law, § 189 
§ 189. Liens of hospitals. 1. Every corporation incorporated 
under general law or special act as a charitable institution main- 
taining a hospital in the state supported in whole or in part by 
charity, and every county, city, town or village operating and main- 
taining a hospital shall to the extent hereinafter provided have a 
lien upon any and all rights of action, suits, claims, counterclaims 
or demands of any person admitted to any such hospital and receiv- 
ing treatment, care and maintenance therein, on account of any 
personal injuries received within a period of one week prior to 
admission to the hospital and as the result of the negligence of any 
other person or persons or corporation, which any such injured 
person or the legal representative of such injured person, in ease 
of death as the result of such injuries, may or shall have, assert 
or maintain against any such other person or corporation for 
damages on account of such injuries, for the amount of the reason- 
able charges of such hospital, for such treatment, care and mainte- 
nance of such injured person at cost rates in such hospital. No 
such lien shall be effective, however, unless a written notice con- 
taining the name and address of the injured person, the date of 
the accident, the name and location of the hospital and the name of 
the person or persons, firm or firms, corporation or corporations 
alleged to be liable to the injured party for the injury received, 
shall be filed in the office of the county clerk of the county in which 
such hospital is located, prior to the payment of any moneys to 
such injured person, his attorneys, or legal representatives as 
compensation for such injuries; nor unless the hospital shall also 
mail, registered and postage prepaid, a copy of such notice with 
a statement of the date and place of filing thereof to the person 
or persons, firm or firms, corporation or corporations, alleged 
to be liable to the injured party for the injuries sustained prior 
to the payment to such injured person, his attorney or legal repre- 
sentatives, as compensation for such injuries. Such hospital shall 
mail a copy of such notice to any insurance carrier which has 
insured such person, firm or corporation against such liability. 
Such filing and mailing shall be deemed to be effective notwith- 
standing any inaccuracy or omission therein if the information 
contained therein shall be sufficient to enable the person or per- 
sons or corporation alleged to be liable, by the exercise of reasonable 
diligence, to identify the injured person, the occurrence upon which 
the claim for damages is based and the name and address of the 
hospital asserting the lien. Any hospital claiming a lien hereunder 
shall, in addition to the foregoing, file in the said county clerk’s 
office within five days of the discharge of any injured person, an 
additional notice of lien, duly verified, which shall show the total 
hospital charges which have accrued and no lien hereunder shall 
exceed this amount. 
2. The lien of any such hospital shall attach : (a) To any verdict, 
decision, decree, judgment or final order made or rendered in any 
suit, action or proceeding brought in any court of this state, by such 33 
injured person, or the legal representative of such injured person 
in case of death as the result of such injuries, against any other 
person or persons or corporation for the recovery of damages 
or compensation on account of injuries sustained through the negli- 
gence of any such person or persons or corporation or for the death 
of such person resulting therefrom, as well as to the proceeds of 
any settlement of any such verdict, decision, decree, judgment or 
final order made or rendered in any such suit, action or proceeding. 
(b) To the proceeds of the settlement or compromise of any 
such suit, action or proceeding, effected, before any verdict, decision, 
decree, judgment or final order is made or rendered therein, by 
any such injured person or his legal representative in case of death, 
with any other person, persons or corporation whose negligence is 
claimed or alleged to have been the cause of said injuries or death, 
or with any other person or persons or corporations on account 
thereof. 
(e) To the proceeds of the settlement or compromise of any 
such claim, demand, or cause of action, effected, before the com- 
mencement of any suit, action or proceeding thereon, by any such 
injured person or his legal representative in case of death, with 
any other person, or persons or corporation whose negligence is 
claimed or alleged to have been the cause of said injuries or death, 
or with any other person or persons or corporation on account 
thereof. 
3. After the filing of the notice and mailing of the copy and 
statement as herein provided, no release of any judgment, claim, 
or demand by such injured person shall be valid or effective against 
such lien, and the person or persons or corporation making any 
payment to such injured person or his legal representative for the 
injury sustained shall for a period of one year from the date of 
such payment as aforesaid remain liable to such hospital for the 
amount of its reasonable charges as aforesaid due at the time of 
such payment, to the extent of the full and true consideration paid 
or given to the injured person or his legal representative, less the 
amount of any other liens or claims against such moneys superior 
to such hospital lien, and any such corporation or other institu- 
tion or body maintaining such hospital may within such period 
enforce its lien by a suit at law against such person or persons or 
corporation making any such payment or gift. 
4. Every county clerk shall, at the expense of the county, provide 
a suitable, well-bound book, to be called the hospital lien docket, in 
which, upon the filing of any lien claim under the provisions of 
this section, he shall enter the name of the injured person, the date 
of the accident, the name of the hospital or other institution making 
the claim. The said clerk shall make a proper index of the same 
in the name of the injured person and shall be entitled to twelve 
cents for filing each claim, except in the counties comprised within 
the city of New York, where the filing fee shall be fifty cents in 
accordance with the provisions of subdivision fifty-six of section 
one thousand five hundred fifty-seven-a of the civil practice act, 
and at the rate of eight cents per folio for such entry made in the 
lien docket and six cents for every search in the office for such lien claim and twelve cents for filing and entering discharge of 
lien, except in the counties comprising the city of New York where 
the fee for filing and entering discharge of lien shall be one dollar 
in accordance with the provisions of subdivision twenty-three of 
section one thousand five hundred fifty-seven-a of the civil practice 
act. 
5. Any person or persons, firm or firms, corporation or corpora- 
tions legally liable for such lien or against whom a claim shall be 
asserted for compensation for such injuries, shall be permitted to 
examine the records of any such corporation, or other institution 
or body maintaining such hospital in reference to such treatment, 
care and maintenance of such injured person. 
6. The lien of any such hospital under the provisions of this 
section shall not apply to any award or settlement made pursuant 
to the workmen’s compensation law of this state, nor to the proceeds 
of any such award or settlement, in respect to the injury for which 
a lien is filed, nor in ease the amount paid to the injured person or 
his representative in the event of death in settlement or compromise 
is three hundred dollars or less. 
7. The provisions of this section to the contrary notwithstanding, 
the lien herein created shall be subject and subordinate to the lien 
of the amount recovered by verdict, report, decision, judgment or 
decree, settlement or compromise, or any attorney or attorneys 
retained by any such injured person or his legal representative in 
ease of death, to prosecute his claim for damages for personal 
injuries or for the death of the injured person, having or acquiring 
by virtue of such retainer a lien on the cause of action of any such 
injured person, or his legal representative in case of death, or on the 
verdict, report, decision, judgment, decree made in, or any settle- 
ment or compromise of, any such action or claim for damages for 
personal injuries or for the death of such injured person; and, 
notwithstanding the provisions of this section, the lien created 
hereunder in no case shall be operative so as to create a priority 
or a precedence therefor as against any other lien, debt or claim in 
the administration of the estate of a decedent or the distribution of 
damages recovered or obtained on account of a wrongful act, 
neglect or default causing a decedent’s death, and the amount of 
the debt or claim covered by such lien in such a case shall have the 
same position as to priority and be payable in the same manner and 
to the same extent as otherwise provided by law. 
8. Execution upon any judgment obtained in an action based 
upon injuries for which'a lien has been filed as herein provided 
shall be stayed until the lien has been satisfied or discharged in 
accordance with the provisions of this section. 
9. Upon the order of any court of record having jurisdiction in 
the premises, any person, persons or corporation against whom a 
lien shall have been filed and served may deposit the amount of 
any settlement or judgment less the amount of any other liens 
or claims against such moneys superior to such hospital lien, with 
the county treasurer in the county in which the lien is filed, except, 
in a county within the city of New York where such deposit shall 
be made with the city chamberlain of such city, and the person, 35 
persons or corporation so depositing shall be discharged from all 
liability in connection with such lien which lien shall attach to the 
fund so deposited. 
10. Any such lien may be enforced by action or law against the 
person, persons or corporations claimed to be liable or against the 
fund deposited as hereinbefore provided in any court of record. 
Digest of the Statutes of Arkansas (1937) 
§ 10819. Scope of lien. On compliance with the requirements 
of this Act, a practitioner, a nurse, and a hospital and each of them 
shall have a lien. 
(a) For the value of the service rendered and to be rendered by 
such practitioner, nurse, or hospital to a patient, at the express or 
implied request of that patient or of someone acting on his behalf, 
for the relief and cure of an injury suffered through the fault or 
neglect of someone other than the patient himself. 
(b) On any claim, right of action, and money to which the patient 
is entitled because of that injury, and to costs and attorneys’ fees 
incurred in enforcing that lien. 
§ 10820. How lien is established. In order to establish a lien 
under this Act, a practitioner, nurse, or hospital shall comply with 
the following conditions: 
(1) Notice required, (a) The practitioner, nurse, or hospital 
shall serve on the patient a written notice of his claim of lien and 
shall serve a copy of that notice on the tort feasor or on the insurer 
(if there be any), or, at the discretion of the practitioner, nurse, or 
hospital, or both; and he shall file in the office of the clerk of the 
Circuit Court in the county in which his professional, nursing, or 
hospital service has been or is being rendered, a copy of the notice 
so served, authenticated by an affidavit to show that the notice and 
copies of it have been served as required by this act. This notice 
may be served and recorded at any time while service is being 
rendered and at any time after the discontinuance of service so long 
as the claim of the practitioner, nurse, or hospital for compensation 
for service is not barred by the statute of limitations. 
(b) If to the knowledge of the practitioner, nurse, or hospital, 
the patient against whose claim or right of action it is desired to 
establish a lien has instituted an action in any court in Arkansas 
to enforce his claim against the tort feasor responsible for his 
injury, or against any insurer by which he was insured against loss 
through injury due to accident or accidental means, the practitioner, 
nurse, or hospital may, in his discretion, in lieu of or in addition 
to serving notice of his claim and recording such notice, as author- 
ized by the preceding paragraph, file a notice of his claim, duly 
authenticated under oath, in the court in which such action is 
pending; and the filing of the notice of such claim shall be notice 
thereof to all parties to the action, without the serving of further 
notice of the recording of the copy of any notice in the office of the 
clerk of the Circuit Court. 
(2) Contents of notice. The notice required by this section shall 
show so far as is known to the practitioner, nurse, or hospital on 
whose behalf it is filed or served. 36 
(a) the name and address of the tort feasor and, if a lien is 
claimed against an insurer, then the name and address of that 
insurer; 
(b) the name of the patient, his usual address, and his where- 
abouts when the notice is served, if elsewhere than at his usual 
address; 
(c) the name and address of the person claiming the lien, and 
whether he claims as a practitioner, nurse, or hospital; 
(d) the time when, place where, and circumstances under which 
the alleged fault or neglect of the tort feasor, occurred, and the 
nature of the injury; and 
(e) if the service of the practitioner, nurse or hospital has been 
completed the amount for which his lien is claimed. 
The notice shall be supported by an affidavit by the practitioner, 
nurse, or hospital, showing that the facts stated of affiant’s own 
knowledge are true and the facts stated on information and belief, 
he believes to be true. 
If the professional, nursing, or hospital service on which the 
claim of lien is based has not been completed when notice of the 
claim of lien is served and the amount for which a lien is claimed 
is not stated in the notice, then the practitioner, nurse, or hospital 
on whose behalf the notice has been served shall, within sixty (GO) 
days after the termination of his service, serve a supplementary 
notice on each person previously notified, and file a notice in the 
court in which the previous notice was filed, showdng the amount 
claimed under the lien. 
(3) Method of Service of Notice. Any notice required by this 
act to be served shall be deemed to have been served, 
(a) if delivered to the person on whom it is to be served, or left at 
his usual place of business or residence with some person of mature 
years employed or dwelling there; or 
(b) if delivered by registered mail at the last known address of 
the person to be notified, either within or without the State of 
Arkansas, as shown by the receipt returned by the Post Office 
Department and by an affidavit by an affiant having personal knowl- 
edge of the facts, showing that the notice herein required to be 
served was enclosed in the letter for which the receipt was returned, 
when that letter was deposited in the mail. 
(4) Amendatory and Supplementary Notices. The fact that a 
practitioner, nurse, or hospital has filed a notice of the lien as 
authorized by this act shall not prevent his filing amendatory or 
supplementary notices of liens subsequently; but every amendatory 
and supplementary notice shall be served and filed in the same 
manner as the original notice. 
§ 10821. Enforcement of Lien in Pending Action. If a patient 
has instituted an action in any court in Arkansas to enforce his 
claim against the tort feasor through wThose fault or neglect he was 
injured, or against any insurer by which he was insured against 
loss through accident or accidental means, and a practitioner, nurse, 
or hospital has filed in the court in which the action is pending a 
notice of his claim of lien, as authorized by this act, the court before 
which the action is pending shall have jurisdiction with respect to 37 
that claim of lien and shall embody in its judgment such an award 
with respect thereto as the evidence warrants. 
§ 10822. Settlement of patient’s claim without settlement of 
lien forbidden. A tort feasor and an insurer, and each of them, who 
has been notified, as authorized by this act, of a claim of lien against 
any claim or right of action that a patient has against such tort 
feasor or insurer by reason of an injury caused by the fault or 
neglect of a tort feasor, shall not, within sixty (60) days after the 
service of such notice, nor at any time after a copy of that notice 
has been recorded in the office of the clerk of the Circuit Court of 
the county in which the professional, nursing, or hospital service 
was rendered, pay to the patient, either directly or indirectly, any 
money, or deliver to him, either directly or indirectly, anything of 
value, in settlement or part settlement of the patient’s claim or 
right of action, without having previously 
(a) paid to the practitioner, nurse, or hospital that gave notice 
of such claim or lien, the amount claimed under it; or 
(b) received a written release of the claim of lien from the 
practitioner, nurse, or hospital that gave notice of it, except as 
otherwise authorized by this act. 
A tort feasor and an insurer, and either of them, that has been 
notified by a practitioner, nurse, or hospital of a claim of lien under 
this act, and who, directly or indirectly, otherwise than as is 
authorized »by this act, pays to the patient any money or delivers 
to him anything of value as a settlement or compromise of the 
patient’s claim arising out of the injury done to him, shall be 
liable to such practitioner, nurse, or hospital for the money value 
of the service rendered by such practitioner, nurse, or hospital, in 
an amount not in excess of the amount to which the patient was 
entitled from the tort feasor or insurer because of the injury. 
If the amount for which a tort feasor or an insurer is liable to 
the patient on account of his injury is not sufficient to pay in full 
the claims of all practitioners, nurses, and hospitals that rendered 
service in the case and who have given notice of liens, each such 
practitioner, nurse, and hospital shall share in the amount payable 
to the patient in the proportion that his claim bears to the total 
amount claimed by all other such practitioners, nurses, and hospitals. 
§ 10823. Payment of Damages or Insurance Into Court. (1) 
Any court having jurisdiction in an action by a patient injured 
through the fault or neglect of another person, against the person 
whose fault or neglect caused the injury or against an insurer- 
obligated by reason of that injury, and if an action has not been 
begun, then any court having authority to entertain an action under 
the circumstances stated above, if and when an action is brought, 
may, on petition or other procedure conformable to the rules of 
practice of the court, by the tort feasor or by the insurer who has 
been notified of a claim of lien under the provisions of this act, 
receive and impound 
(a) the amount claimed by any practitioner, nurse, or hospital 
under such lien, or 
(b) if no amount is named in the notice of the claim of lien 
that has been served, then the entire amount claimed by the patient 38 
from the tort feasor or from the insurer, or any less amount that 
the court deems sufficient to pay the amount claimed under such 
claims of lien or liens as have been served. 
(2) The Court may, 
(a) on joint motion or petition of the patient and the practitioner 
or practitioners, nurse or nurses, and hospital or hospitals claiming 
interest in the money so paid into court, or, 
(b) on judgment by any competent court, pay or distribute such 
money in accordance with that petition, motion, or judgment and 
pay any remaining balance to the person by whom the money was 
deposited. 
§ 10824. Default of Practitioner, Nurse, or Hospital in Enforc- 
ing Lien. If at the expiration of sixty days immediately following 
the day on which the most recent notice, amendatory notice, or 
supplementary notice of a claim of lien was filed in the office of 
the clerk of the Circuit Court, as authorized by this act, and 
If, in any event, immediately on the expiration of the period 
during which the practitioner, nurse, or hospital can enter action 
to enforce his claim against the patient for compensation for serv- 
ices rendered, the lien remains unsatisfied and unreleased, and no 
suit by the practitioner, nurse, or hospital by which notice of such 
lien was filed, to enforce that lien, is pending in any court, the 
lien shall be void and of no effect. 
Any patient against whose claim or right of action any such 
void lien exists may enforce that claim or rights of action dis- 
charged from that lien, on delivering to the tort feasor or insurer 
an affidavit showing that no action is pending against the affiant 
to enforce the lien claimed by the practitioner, nurse, or hospital; 
and on filing a copy of that affidavit with the clerk of the Circuit 
Court in whose office notice of the lien was originally filed, the 
clerk shall enter on his docket and file a notation to show that the 
lien has lapsed and is void. 
If the amount claimed under any lien has been paid into court 
as authorized by this act, and remains in the custody of the court 
after the lien has become void, on application by the tort feasor of 
[or] the insurer, by which the money was so paid, supported by a 
copy of the record of the Circuit Court showing that the lien has 
lapsed, the court may return the money to the person by whom it 
was deposited and give him judgment against the lienor for interest 
on the money during the time it was on deposit and for costs and 
a reasonable counsel fee. 
Any person who, in order to obtain the release of an alleged 
lapsed lien, makes a false affidavit and delivers a copy of it to 
any tort feasor or insurer or files a copy of any such affidavit in 
the office of the clerk of the Circuit Court shall be guilty of perjury 
and subject to the penalties prescribed for that offense. 
If at the expiration of the sixty (60) days period named above, 
an action is pending by the practitioner, nurse, or hospital to 
enforce a claim of lien filed by him, the lien shall continue in 
full force and effect during the pendency of that suit, unless 
released by the practitioner, nurse, or hospital by whom the claim 
was filed. 39 
§ 10825. Waiver or Release of Claim of Lien Void. A patient 
who has been notified by a practitioner, nurse, or hospital of a 
claim of lien on any claim or right of action that the patient has 
because of the injury for which service was rendered, shall not 
waive or release that claim, or any part of it unless 
(1) the amount claimed by the practitioner, nurse, or hospital, 
under the lien, has been paid; or 
(2) the practitioner, nurse, or hospital has in waiting released 
his lien. 
Any waiver or release given contrary to the provisions of this 
act shall be void and of no effect. 
§ 10826. Release to Be Given. When a lien has been satisfied 
or waived, the practitioner, nurse, or hospital that established or 
waived it shall, on written demand and at the expense of the patient, 
or the person by whom the patient was injured, or by the insurer 
obligated by reason of such injury, give a written released, duly 
acknowledged before a justice of the peace or notary public. Any 
such practitioner, nurse, or hospital that refuses or fails under the 
circumstances stated, for a period of five days or more after a 
written demand is made for a release, to execute and deliver it, 
shall be liable to the demandant for any injury or damage that 
results from such refusal or failure, and in any event he shall 
forfeit to the demandant the sum of $25 which may be recovered 
in any action for damages because of such failure, or in an action 
of debt before a justice of the peace, as the circumstances of the 
case require. 
§ 10827. Enforcement of Lien. A practitioner, nurse, or hos- 
pital that has perfected a lien under the provisions of this act, to 
secure the payment of a debt for service rendered, may enforce that 
lien by any proper action against the patient, the tort feasor, and 
the insurer, jointly or severally, in any court of competent juris- 
diction ; but no such action shall be begun after action on the debt 
itself is barred by the statute of limitations. The plaintiff in any 
such case shall make any and all persons having interests in the 
subject matter of the action, of whose interests he has knowledge, 
parties defendant. Any person having an interest in the subject 
matter of the action who is not made a party to it, may, with the 
consent of the court, become a party in order to protect his interest. 
Persons having interest in the subject matter of the action include, 
within the meaning of this Section, all persons authorized by this 
act to establish liens to secure their interests, those whose claims 
against the patients are not, as well as those whose claims against 
the patient are, due at the time of the commencement of the action. 
Any two or more persons having liens on the same or right of 
action of any patient may join in bringing action setting forth 
their respective rights in their pleading. An action to which any 
practitioner, nurse, or hospital having a lien on the subject matter 
is a party, shall not be dismissed without his consent. 
§ 10828. Liens assignable. All liens or claims of liens that 
accrue to any practitioner, nurse, or hospital under this act are 
assignable. Proceedings to enforce assigned liens or claims of 40 
liens may be maintained by and in the name of the assignee. The 
assignee shall have as full and complete power to enforce the lien 
or claim of lien assigned to him as if proceedings to that end were 
taken under this act, by and in the name of the assignor. 
§ 10829. Subrogation to right of lien. Any person who, with 
the consent of a patient injured through the fault or neglect of 
another person, pays to a practitioner, nurse, or hospital, the amount 
due for service to that patient, shall be subrogated to the rights 
of the payee with respect to the establishment and enforcement of 
a lien under this Act. 
§ 10830. Survival of liens, if any person, because of minority, 
hnental defect, death or other legal disability, cannot exercise any 
right conferred on him by this act or discharge any duty imposed 
on him by it, that right may be exercised, and that duty shall be 
discharged by his father, mother, guardian, executor, or administra- 
tor, as the circumstances of the case require. 
§ 10834. Attorney’s liens not affected. Provided the liens herein 
given shall in no way repeal or affect the statutory liens now pro- 
vided in favor of attorneys. 
Connecticut General Statutes (1941 Supp.) 
Sec. 699f. Liens on accident and liability insurance policies in 
favor of hospitals. Any hospital receiving state aid, or any hos- 
pital owned and operated by a municipality, which shall furnish 
medical or other service or materials to any patient injured by 
reason of any accident not covered by the workmen’s compensa- 
tion act shall have a first lien on the proceeds of any accident and 
liability insurance policy issued by any company authorized to do 
business in this state, which proceeds may be due to such patient, 
either directly or indirectly, to the extent of the actual cost of such 
service and materials, provided such hospital, after commencing to 
render such services or provide such materials and before payment 
by such insurance company, shall serve written notice upon such 
insurance company at its principal home office, if the company 
issuing such policy shall be located within this state, and upon the 
insurance commissioner of this state by registered mail if such 
insurance company shall be located without the state. Such notice 
shall be in duplicate and shall contain the name of the injured 
person, if known, the name of the company or companies issuing 
such policy and the amount expended and an estimate of the amount 
to be expended in the services rendered to or the materials pro- 
vided for such patient. Whenever the liability of such company 
or companies, either directly or indirectly, to the patient shall have 
been fixed, such insurance company shall pay directly to the hos- 
pital the amount due to it, provided such amount shall be agreed 
upon by all of the parties interested ; and a receipt by such hospital 
shall be evidence of payment of such amount by such company 
or companies on account of their liability to the insured. If the 
interested parties shall not agree concerning the amount due such 
hospital, either party may bring an action of interpleader to any 
court having jurisdiction. 41 
Delaware Laws 1931, Ch. 179 
Section 1. Every charitable association, corporation or other 
institution maintaining a hospital in the State of Delaware, sup- 
ported in whole or in part by private charity, shall have a lien 
upon any and all claims or demands, all rights of action, suits, 
counterclaims of any person admitted to any such hospital and 
receiving treatment, care and maintenance therein arising out of 
any personal injuries received in any such accident which any such 
injured person may or shall have, assert or maintain against any 
such other person or corporation for damages, compensation or 
other claim on account of such injuries, for the amount of the 
reasonable charges of such hospital for all medical treatment, care 
and nursing and maintenance of such injured person while in such 
hospital, to the extent of the full and true consideration paid or 
given to, or on behalf of such injured person or his legal repre- 
sentative. 
Section 2. Said charitable association, corporation or other insti- 
tution shall file in the office of the Prothonotary of the County in 
which such injuries shall have occurred notice in writing, contain- 
ing the names and addresses of the injured person, the date of the 
accident, the name and location of the hospital, and, if then known, 
the name of the person or persons, firm or firms, corporation or 
corporations alleged to be liable to such injured person by reason 
of the injuries received, prior to the payment of any moneys to 
such injured person or his or her legal representative by such 
person or persons, firm or firms, corporation or corporations to such 
injured person. Copies of said notice shall be sent by registered 
mail by the hospital to such injured person and all parties in 
interest, who may then be known. Thereafter an affidavit by a 
competent person, acting on behalf of such institution, setting forth 
such service, and all attempts to serve the same shall be filed in 
the office of the Prothonotary. 
Section 3. The lien of any such hospital shall attach to any 
verdict, report, decision, decree, award, judgment or final order 
made or rendered in any action or proceeding in any court of 
record of Delaware, or any public board or bureau, in any suit, 
action, or proceeding brought by such injured person, or by the 
estate of such injured person in case of deaths as the result of such 
injuries, against any other person or corporation for the recovery 
of damages or other compensation or payment in any way arising 
out of injuries received in any such accident, as well as to the 
proceeds of any settlement thereof, any claim or demand effected 
by any such injured person or on his behalf, with any other person 
or corporation in any way liable to said injured person, or his 
legal representative, in case of death, by reason of said injuries, 
effected with any other person or corporation on account thereof. 
Section 4. After the filing of the notice as herein provided, no 
release of any judgment, claim or demand by such injured person 
shall be valid or effectual as against such lien, and the person or 
persons, firm or firms, corporation or corporations making any 42 
payment to such injured person or his legal representative as com- 
pensation for the injuries sustained shall for a period of one year 
from the date of such payment as aforesaid remain liable to such 
hospital for the amount of its reasonable charges due at the time 
of such payment as aforesaid, to the extent of the full and true 
consideration paid or given to, or on behalf of such injured person 
or his legal representative, and any such charitable association, 
corporation or other institution or body maintaining such hospital 
may, within such period, enforce its lien by a suit at law against 
such person or persons, firm or firms, corporation or corporations 
making any such payment. 
Section 5. Every Prothonotary shall, at the expense of the 
county, provide a suitable, well-bound book, to be called the hos- 
pital lien docket, in which, upon the filing of any lien claim under 
the provisions of this act, he shall enter: 
The name of the injured person, the date of the accident, the 
name of the hospital or other institution making the claim, and 
the filing of an affidavit setting forth the service of, or attempts to 
serve, of all parties in interest. 
And the said clerk shall make a proper index of the same in the 
name of the injured person; and such clerk shall be entitled to 
One Dollar ($1.00) for filing each claim, and at the rate of 
twenty-five cents per folio for such entry made in the lien 
docket and twenty-five cents (25f0 for every search in the office 
for such lien claim. 
Section 6. Any person or persons, firm or firms, corporation or 
corporations legally liable or against whom a claim shall be asserted 
for compensation for such injuries, shall be permitted to examine 
the records of any such association, corporation or other institu- 
tion or body maintaining such hospital in reference to such treat- 
ment, care and maintenance of such injured person. 
Section 7. If any section, clause, sentence, paragraph or other 
part of this Act shall for any reason be adjudged by any court 
of competent jurisdiction to be invalid, such judgment shall not 
affect, impair or invalidate the remainder of this Act, or any part 
thereof, but shall be confined in its operation to the part thereof 
directly involved in the controversy in which such judgment shall 
be rendered. It being hereby declared the Legislature would have 
enacted the remainder of this Act without such part adjudged to 
be invalid. 
District of Columbia Code (Cum. Supp. V 1939) Tit. 24, 
§§ 22-26 
§ 22. Hospitals to have lien for services on recovery in accident 
cases.—Every association, corporation, or other institution main- 
taining a hospital in the District of Columbia, which shall furnish 
medical or other service to any patient injured by reason of an 
accident causing injuries not covered by the Employees’ Compen- 
sation Act or the Workmen’s Compensation Act, shall, if such 
injured party shall assert or maintain a claim against another for 43 
damages on account of such injuries, have a lien upon that part 
going or belonging to such patient, of any recovery or sum had 
or collected or to be collected by such patient, or by his heirs or 
personal representatives in the case of his death, whether by 
judgment or by settlement or compromise to the amount of the 
reasonable and necessary charges of such hospital for the treat- 
ment, care, and maintenance of such patient in such hospital up 
to the date of payment of such damages: Provided, That the lien 
herein set forth shall not be applied or considered valid against 
any one suffering injuries coming under the Employees’ Com- 
pensation Act or the Workmen’s Compensation Act in this District. 
§ 23. Same; notice to be filed.—No such lien shall be effective, 
however, unless a written notice containing the name and address 
of the injured person, the date of the accident, the name and loca- 
tion of the hospital, and the name of the person or persons, firm 
or firms, corporation or corporations alleged to be liable to the 
injured party for the injuries received, shall be filed in the office 
of the clerk of the District Court of the United States for the 
District of Columbia in a docket provided for such liens, prior to 
the payment of any moneys to such injured person, his attorneys, 
or legal representatives as compensation for such injuries; nor 
unless the hospital shall also mail, postage prepaid, a copy of such 
notice with a statement of the date of filing thereof to the person 
or persons, firm or firms, corporation or corporations alleged to 
be liable to the injured party for the injuries sustained prior to 
the payment of any moneys to such injured person, his attorneys, 
or legal representatives as compensation for such injuries. Such 
hospital shall mail a copy of such notice to any insurance carrier 
which has insured such person, firm, or corporation against such 
liability, where the name of such insurance carrier is ascertained. 
§ 24. Same; liability for not paying hospital amount of its lien, 
etc.—Any person or persons, firm or firms, corporation or cor- 
porations, including an insurance carrier, making any payment to 
such patient or to his attorneys or heirs or legal representatives as 
compensation for the injury sustained, after the filing and mailing 
of such notice without paying to such hospital the amount of its 
lien or so much thereof as can be satisfied out of the moneys due 
under any final judgment or compromise or settlement agreement 
after paying the amount of any prior liens, shall for a period of 
one year from the date of payment to such patient or his heirs, 
attorneys, or legal representatives, as aforesaid, be and remain 
liable to such hospital for the amount which such hospital was 
entitled to receive as aforesaid; and any such association, corpora- 
tion, or other institution maintaining such hospital may, within 
such period, enforce its lien by a suit at law against such person 
or persons, firm or firms, corporation or corporations making any 
such payment. 
§ 25. Same; permission to examine hospital records.—Any per- 
son or persons, firm or firms, corporation or corporations legally 
liable for such lien or against whom a claim shall be asserted for 
compensation for such injuries, shall be permitted to examine the 44 
ledger entries and similar records of any such association, corpora- 
tion, or other institution or body maintaining such hospital for the 
purpose of ascertaining the basis for such lien. 
§ 26. Same; clerk to provide lien docket.—The clerk of the Dis- 
trict Court of the United States for the District of Columbia shall 
provide a suitable bound book to be called the hospital lien docket, 
in which, upon the filing of any lien claim under the provisions 
of this Act, he shall enter the name of the injured person, the name 
of the person, firm or corporation alleged to be liable for the injuries, 
the date of the accident, and the name of the hospital or other insti- 
tution making the claim. Said clerk shall make a proper index 
of the same in the name of the injured person and the clerk shall 
charge such reasonable fees, not to exceed the sura of $1, as the 
court may by rule fix for the recording, indexing, and the releasing 
of the lien so filed. 
Idaho Laws 1941, Ch. 118 
Section 1. Every individual, partnership, firm, association, cor- 
poration, institution or any governmental unit or combination or 
parts thereof maintaining and operating a hospital in this state 
shall be entitled to a lien for the reasonable charges for hospital 
care, treatment and maintenance of an injured person upon any 
and all causes of action, suits, claims, counter claims, or demands 
accruing to the person to whom such care, treatment, or mainte- 
nance was furnished, or to the legal representatives of such person, 
on account of injuries giving rise to such causes of action and which 
necessitated such hospital care, treatment, and maintenance. 
Sec. 2. In order to perfect such lien, the executive officer or agent 
of such hospital, before, or within ten days after, such person 
shall have been discharged therefrom, shall file in the office of the 
recorder of the county in which such hospital shall be located 
a verified statement in writing setting forth the name and address 
of such patient, as it shall appear on the records of such hospital, 
the name and location of such hospital, and the name and address 
of the executive officer or agent of such hospital, the dates of 
admission to and discharge of such patient therefrom, the amount 
claimed to be due for such hospital care, and, to the best of the 
claimant’s knowledge, the names and addresses of all persons, 
firms, or corporations claimed by such injured person or the legal 
representative of such person, to be liable for damages arising 
from such injuries; such claimant shall also, within one day after 
the filing of such claim or lien, mail a copy thereof, postage prepaid, 
to each person, firm, or corporation so claimed to be liable for 
such damages, at the address so given in such statement. The 
filing of such claim or lien shall be notice thereof to all persons, 
firms or corporations liable for such damages, whether or not they 
are named in such claim or lien. 
Sec. 3. The recorder shall endorse thereon the date and hour 
of filing and, at the expense of the county, shall provide a hospital 
lien book with proper index in which he shall enter the date and 45 
hour of such filing, the name and address of such hospital and 
of such patient, the amount claimed and the names and addresses 
of those claimed to be liable for damage. Such recorder shall be 
paid the sum of fifty cents as his fee for such filing. 
Sec. 4. No release of such causes of action, or any of them, or 
of any judgment thereon, shall be valid or effectual as against such 
lien unless such lien holder shall join therein, or execute a release 
of such lien, and the claimant, or assignee of such lien may enforce 
such lien by an action against the person, firm, or corporation 
liable for such damage, which action shall be commenced and tried 
in the county in which such lien shall be filed, unless ordered 
removed to another county by the court for cause. If the claimant 
shall prevail in such action, the court may allow reasonable attor- 
ney’s fees and disbursements. Such action shall be commenced 
within two years after the filing of such lien. 
Sec. 5. The provisions of this Act shall not be applicable to 
accidents or injuries within the purview of the Workmen’s Com- 
pensation Law of this State. 
Sec. 6. An emergency existing therefor, which emergency is 
hereby declared to exist, this Act is declared to be in full force 
from and after its passage and approval. 
Illinois Stat. Ann. (Sniith-Hurd Cum. Supp. 1947) Ch. 82, 
§§ 97-101 
§ 97. Lien created—Notice of lien 
Every hospital organized for nonprofit, or hospital maintained 
and operated entirely by a county, rendering service in the treat- 
ment, care and maintenance, of such injured person shall have a 
lien upon all such claims and causes of action for the amount of 
its reasonable charges at ward rates in such hospital organized 
for nonprofit, or hospital maintained and operated entirely by a 
county up to the date of payment of such damages. 
Provided, however, that the total amount of all liens hereunder 
shall not exceed one-third of the sum paid or due to said injured 
person on said claim or right of action, and provided further, that 
said lien shall in addition include a notice in writing containing 
the name and address of the injured person, the date of the injury, 
the name and address of the hospital organized for nonprofit, or hos- 
pital maintained and operated entirely by a county, and the name 
of the party alleged to be liable to make compensation to such 
injured person for the injuries received, shall be served on both 
the injured person and the party against whom such claim or 
right of action exists. 
Service shall be made by registered mail or in person. 
§ 98. Lien to attach to verdict, judgment or decree, etc. 
The lien of any such nonprofit hospital, or hospital maintained 
and operated entirely by a county, shall, from and after the time 
of service of the aforesaid notice, attach to any verdict, judgment 46 
or decree secured in any suit or action by the injured party based 
on the negligent or wrongful act, and to any money or property 
which may be recovered by compromise settlement, or in any suit 
or action brought by such injured person on account of such 
claim or right of action. In case of death of the injured person, 
the lien shall attach to any money or property which may be 
recovered by compromise settlement, suit or action on account of 
injuries not resulting in the death of the injured person, or to 
any verdict, judgment or decree in any suit or action brought 
by the estate of the injured person against any other person for 
the recovery of damages on account of injuries not resulting in 
the death of the injured person. 
§ 99. Hospital records accessible to parties to personal injury suit 
—Hospital to furnish statement of injuries, etc. 
Any party to a cause pending in a court of record against whom 
a claim shall be therein asserted for damages resulting from said 
injuries shall, upon request in writing, be permitted to examine 
the records of such hospital in reference to such treatment, care 
and maintenance of such injured person. Any hospital claiming 
a lien under this Act shall, within ten (10) days of being so 
requested in writing by any such party, furnish to such party, or 
file with the clerk of the court in which said cause is pending, 
a written statement of the nature and extent of the injuries sus- 
tained by and the treatment given to or furnished for such injured 
person by such hospital and the history, if any, as given by the 
injured person, insofar as shown by the records of said hospital 
as to the manner in which said injuries were received. 
§ 99. Petition to enforce lien—Attorney’s lien not affected 
On petition filed by the injured person, or nonprofit hospital, 
or hospital maintained and operated entirely by a county, any 
court of competent jurisdiction shall, on written notice to all 
interested adverse parties, adjudicate the rights of all interested 
parties and enforce their liens: Provided, however, that nothing 
herein contained shall affect the priority of any attorney’s lien 
under “An Act creating attorney’s lien and for enforcement of 
same,” filed June 16, 1909, as amended. 
§ 100. Lien void on failure of hospital to furnish statement 
Should any hospital fail or refuse to give or file a written state- 
ment in conformity with and as required by Section 3 hereof after 
being so requested in writing in conformity with Section 3 hereof, 
the lien of such hospital shall immediately become null and void. 
§ 101. Petition to enforce lien—Attorney’s lien not affected 
On petition filed by the injured person, or non-profit hospital, 
any court of competent jurisdiction shall, on written notice to all 
interested adverse parties, adjudicate the rights of all interested 47 
parties and enforce their liens: Provided, however, that nothing 
herein contained shall affect the priority of any attorney’s lien 
under “An Act creating attorney’s lien and for enforcement of 
same,” filed June 16, 1909, as amended. 
Indiana Statutes Ann. (Burns 1940 Replacement) 
43-501. Lien on judgments for personal injury. Every person, 
firm, partnership, association, or corporation maintaining a hos- 
pital in the state, and every hospital owned, maintained or operated 
by the state or any political subdivision thereof, shall be entitled 
to hold a lien for the reasonable value of its services or expenses 
on any judgment for personal injuries rendered in favor of any 
person or persons, except persons covered by the provisions of the 
state or federal Workmen’s Compensation Act, or the federal 
Liability Act, admitted to any such hospital and receiving treat- 
ment, care, and maintenance therein on account of said personal 
injuries received as a result of the negligence of any person or 
corporation. In order to claim said lien said hospital shall, at 
the time or after said judgment shall have been rendered, enter, 
in writing, upon the judgment docket wherein the same is recorded, 
its intention to hold a lien thereon, together with the amount 
claimed. 
43-502. Junior lien. The lien as provided for in section one 
[§ 43-501] of this act shall be junior and inferior to all claims 
for attorney’s fees, court costs, and all other expenses contracted 
or incurred in the recovery of claims or damages for personal 
injuries as contemplated herein. 
Iowa Code (1946) 
582.1. Nature of lien. Every association, corporation, county, 
or other institution, including a municipal corporation, maintain- 
ing a hospital in the state, which shall furnish medical or other 
service to any patient injured by reason of an accident not covered 
by the workmen’s compensation act, shall, if such injured party 
shall assert or maintain a claim against another for damages on 
account of such injuries, have a lien upon that part going or 
belonging to such patient of any recovery or sum had or collected 
or to be collected by such patient, or by his heirs or personal rep- 
resentatives in the case of his death, whether by judgment or by 
settlement or compromise to the amount of the reasonable and 
necessary charges of such hospital for the treatment, care, and 
maintenance of such patient in such hospital up to the date of pay- 
ment of such damages; provided, however, that this lien shall not 
in any way prejudice or interfere with any lien or contract which 
may be made by such patient or his heirs or personal representa- 
tives with any attorney or attorneys for handling the claim on 
behalf of such patient, his heirs, or personal representatives; pro- 
vided, further, that the lien herein set forth shall not be applied 
or considered valid against anyone coming under the workmen’s 
compensation act in this state. 48 
582.2. Written notice of lien. No such lien shall be effective, 
however, unless a written notice containing the name and address 
of the injured person, the date of the accident, the name and loca- 
tion of the hospital, and the name of the person or persons, firm 
or firms, corporation or corporations alleged to be liable to the 
injured party for the injuries received, shall be filed in the office of 
the clerk of the district court of the county in which such hos- 
pital is located, prior to the payment of any moneys to such injured 
person, his attorneys or legal representative, as compensation for 
such injuries; nor unless the hospital shall also mail, postage pre- 
paid, a copy of such notice with a statement of the date of filing 
thereof to the person or persons, firm or firms, corporation or 
corporations alleged to be liable to the injured party for the 
injuries sustained prior to the payment of any moneys to such 
injured person, his attorneys or legal representative, as compensa- 
tion for such injuries. Such hospital shall mail a copy of such 
notice to any insurance carrier which has insured such person, 
firm or corporation against such liability, if the name and address 
shall be known. 
582.3. Duration and enforcement of lien. Any person or 
persons, firm or firms, corporation or corporations, including an 
insurance carrier, making any payment to such patient or to his 
attorneys or heirs or legal representatives as compensation for 
the injury sustained, after the filing and mailing of such notice 
without paying to such hospital the amount of its lien or so much 
thereof as can be satisfied out of the moneys due under any final 
judgment or compromise or settlement agreement, after paying 
the amount of any prior liens, shall, for a period of one year from 
the date of payment to such patient or his heirs, attorneys, or 
legal representatives, as aforesaid, be and remain liable to such 
hospital for the amount which such hospital was entitled to receive 
as aforesaid; any such association, corporation, or other institution 
maintaining such hospital may, within such period, enforce its 
lien by a suit at law against such person or persons, firm or firms, 
corporation or corporations making any such payment. 
582.4. Lien book—fees. Every clerk of the district court shall, 
at the expense of the county, provide a suitable well-bound book 
to be called the hospital lien docket in which, upon the filing of 
any lien claim under the provisions of this chapter, he shall enter 
the name of the injured person, the date of the accident, and the 
name of the hospital or other institution making the claim. Said 
clerk shall make a proper index of the same in the name of the 
injured person and such clerk shall be entitled to twelve cents for 
filing each claim, and at the rate of eight cents per folio for 
such entry made in the lien docket, and six cents for every search 
in the office for such lien claim. 
Kansas General Statutes (1945 Supp.) 
§ 65-406. Lien upon causes of action for damages accruing to 
patients. Every hospital in the state of Kansas, which shall fur- 
nish emergency medical or other service to any patient injured 49 
by reason of an accident not covered by the workmen’s compensa- 
tion act, shall, if such injured party shall assert or maintain a 
claim against another for damages on account of such injuries, have 
a lien not to exceed two hundred dollars upon that part going or 
belonging to such patient of any recovery or sum had or collected 
or to be collected by such patient, or by his heirs or personal 
representatives in the case of his death, whether by judgment or 
by settlement or compromise to the amount of the reasonable and 
necessary charges of such hospital for the emergency treatment, 
care and maintenance of such patient in such hospital up to the 
date of payment of such damages: Provided, however, That this 
lien shall not in any way prejudice or interfere with any lien or 
contract which may be made by such patient or his heirs or per- 
sonal representatives with any attorney or attorneys for handling 
the claim on behalf of such patient, his heirs or personal representa- 
tives: Provided further, That the lien herein set forth shall not be 
applied or considered valid against anyone coming under the 
workmen’s compensation act in this state. 
§ 65-407. Same; notice and itemized statement. No such lien 
shall be effective unless a written notice containing an itemized 
statement of all claims, endorsed and approved by the patient or 
his legal representative, the name and address of the injured 
person, the date of the accident, the name and location of the hos- 
pital, and the name of the person or persons, firm or firms, corpora- 
tion or corporations alleged to be liable to the injured party for 
the injuries received, shall be filed in the office of the clerk of the 
district court of the county in which such hospital is located, 
prior to the payment of any moneys to such injured person, his 
attorneys or legal representatives, as compensation for such 
injuries; nor unless the hospital shall also mail, postage prepaid, 
a copy of such notice with a statement of the date of filing thereof 
to the person or persons, firm or firms, corporation or corporations 
alleged to be liable to the injured party for the injuries sus- 
tained prior to the payment of any moneys to such injured per- 
son, his attorneys or legal representative, as compensation for 
such injuries. Such hospital shall mail a copy of such notice to 
any insurance carrier which has insured such person, firm or 
corporation against such liability, if the name and address shall 
be known. 
§ 65-408. Same; persons liable to hospital; limitation of actions. 
Any person or persons, firm or firms, corporation or corporations, 
including an insurance carrier, making any payment to such patient 
or to his attorneys or heirs or legal representatives as compensation 
for the injury sustained, after the filing and mailing of such 
notice without paying to such hospital the amount of its lien or 
so much thereof as can be satisfied out of the moneys due under 
any final judgment or compromise or settlement agreement, after 
paying the amount of any prior liens, shall, for a period of one 
year from the date of payment to such patient or his heirs, attor- 
neys or legal representatives, as aforesaid; be and remain liable 
to such hospital for the amount which such hospital was entitled 50 
to receive as aforesaid; any such association, corporation or other 
institution maintaining such hospital may, within such period, 
enforce its lien by a suit at law against such person or persons, 
firm or firms, corporation or corporations making any such payment. 
§ 65-409. Same; entering and filing lien; fee. The clerks of 
the district courts of the several counties of the state shall charge 
for their services for entering and filing lien statement under this 
act, a fee of fifty cents. Such fee shall when collected be paid 
into the county treasury and become a portion of the general fund 
of the county. 
Louisiana Gen. Slat. Ann. (Dart 1939) 
4390.5. State hospital—Subrogation to rights of employer against 
third person injuring employee.—Where a patient in any state 
supported hospital has been injured by the negligence of another 
person other than his employer, or by an employer in employment 
falling outside of the provisions of the Employer’s Liability Act, 
and has a right of action for the recovery of compensatory damages 
against such person, the board of administrators of such hospitals 
shall be subrogated to said right of action to the extent of reason- 
able charges for services rendered to such patient, in accordance 
with like charges in other hospitals of the first class, including physi- 
cians and surgeon’s fees. 
4390.6. Counsel for hospital—Appointment and fee.—The 
attorney-general shall designate counsel to represent the hospitals 
in all cases arising hereunder, and such counsel shall be allowed 
a fee of ten per cent (10%) of the amount of such charges, to be 
taxed as costs. 
1067.3. Copy of petition in suit for damages or compensation 
to be served on hospital. Any person who has received treatment 
in any of the charity hospitals of the state, for injuries which might 
entitle him to damages or compensation, and who files suit for the 
recovery of such damages or compensation, shall cause a copy of 
the petition in any such suit to be served on the hospital from 
which he received treatment, or on the attorney designated to 
represent said hospital, at least ten before the trial of such 
suit. 
1067.4. Duty of court. No court of this state shall proceed with 
the trial of any suit involving any claim referred to in section 1 
[§ 1067.3] hereof, unless a copy of the petition has been served as 
required in said section. 
1067.5. Effect of compromise. No compromise of any claim 
referred to in section 1 [§ 1067.3] hereof, whether made before or 
after the filing of suit, shall affect the right of any of the charity 
hospitals of this state to recover such fees and charges, if any, that 
may be due said hospital for treatment, from any party or parties, 
who may be liable for same under any law of this state. 
1067.6. Proceedings for recovery of charges. All proceedings 
for the recovery of any charges or fees due any charity hospital 
of this state may be presented in any court of this state, in term 51 
time or in vacation, by rule, in a direct action, or by intervention, 
or by third opposition, and all such proceedings shall be tried or 
heard summarily and by preference in all courts, after notice of 
not less than two days to adverse party or parties. 
1067.7. Pleadings of hospital prima facie true. Whenever the 
pleadings filed on behalf of any charity hospital of this state shall 
be accompanied by an affidavit of any officer of said hospital or 
of the attorney designated to represent said hospital, that the 
facts as alleged are true to the best of the affiant’s knowledge or 
belief, all of the facts alleged in said pleadings shall be accepted 
as prima facie true and as constituting a prime facie case, and 
the burden of proof to establish anything to the contrary shall 
rest wholly on the opposing party. 
Maryland Code Annotated (Flack 1940), Article 63 
46. Every association, corporation or other institution, including 
a municipal corporation, maintaining a hospital in the State of 
Maryland, which shall furnish medical or other service to any 
patient injured by reason of an accident not covered by the Work- 
men’s Compensation Act shall, if such injured party can assert 
or maintain a claim against another for damages on account of 
such injuries, have a lien upon fifty per cent, of that part going or 
belonging to such patient, of any recovery or sum had or collected 
or to be collected by such patient, or by his heirs or personal repre- 
sentatives in the case of his death, whether by judgment or by 
settlement or compromise to the amount of the reasonable and 
necessary charges of such hospital for the treatment, care and 
maintenance of such patient in such hospital up to the date of 
payment of such damages; provided, also that the lien shall not 
exceed the charges as may now or hereafter be allowed by the State 
Industrial Accident Commission of Maryland for services rendered 
in the care and treatment of persons coming under the Workmen’s 
Compensation Act of this State; and, provided, further, that the 
lien herein set forth shall not be applied or considered valid 
against any one coming under the Workmen’s Compensation Act in 
this State; and provided further, that said lien shall be subordinate 
only to the lien of any attorney or attorneys for his, her or their 
professoinal services in collecting or obtaining said damages. 
47. No such lien shall be effective, however, unless a written notice 
containing the name and address of the injured person, the date 
of the accident, the name and location of the hospital, the amount 
claimed, and the name of the person or persons, firm or firms, 
corporation or corporations alleged to be liable to the injured party 
for the injuries received, shall be filed in the office of the Clerk of 
the Circuit Court, if the services were rendered in the counties, 
or of the Circuit Court of Baltimore City, if rendered in Baltimore 
City, prior to the payment of any moneys to such injured person, 
his attorneys or legal representatives as compensation for such 
injuries; nor unless the hospital shall also mail, postage prepaid, 
by registered mail, a copy of such notice with a statement of the date of tiling thereof to the person or persons, firm or firms, corpora- 
tion or corporations, alleged to be liable to the injured party for 
the injuries sustained prior to the payment of any moneys to such 
injured person, his attorneys or legal representatives, as compensa- 
tion for such injuries. Such hospital shall mail a copy of such 
notice to any insurance carrier, if known, which has insured such 
person, firm or corporation against such liability. 
48. Any person or persons, firm or firms, corporation or corpora- 
tions, including an insurance carrier, making any payment to such 
patient or to his attorneys or heirs or legal representatives as 
compensation for the injury sustained, after the filing and mailing 
of such notice without paying to such hospital the amount of its 
lien as set out in Section 46 of this Article or so much thereof as 
can be satisfied out of the moneys due under any final judgment or 
compromise or settlement agreement after paying the amount of any 
prior liens, shall, for a period of one year from the date of payment 
to such patient or his heirs, attorneys or legal representatives, as 
aforesaid, be and remain liable to such hospital for the amount 
which such hospital was entitled to receive as aforesaid; and any 
such association, corporation or other institution maintaining such 
hospital may, within such period, enforce its lien by a suit at law 
against such person or persons, firm or firms, corporation or corpora- 
tions making any such payment. 
49. Any person or persons, firm or firms, corporation or coi'pora- 
tions, legally liable or against whom a claim shall be asserted for 
compensation for such injuries, shall be permitted to examine the 
records of any such association, corporation, or other institution 
or body maintaining such hospital in reference to such treatment, 
care and maintenance of such injured person. 
50. The Clerk of the proper court shall at the expense of the 
County or City, as the case may be, provide a suitable well-bound 
book, to be called the Hospital Lien Docket, in which, upon the 
filing of any lien claim under the provisions of this Act, he shall 
enter the name of the injured person, the name of the person, firm 
or corporation alleged to be liable for the injuries, the date of the 
accident, and the name of the hospital or other institution making 
the claim. Said Clerk shall make a proper index of the same in 
the name of the injured person. 
On presentation of a release of any lien, the Clerk of the proper 
Court in which said lien is filed and recorded, shall note in the 
record the date when such release was filed and he shall note on the 
release the fact that it has been so recorded. A release so noted, 
and the record in the Office of the Clerk, shall either of them be 
prima facie evidence of the release of the lien. 
The Clerk of the Court shall be entitled to collect not more than 
One Dollar for the filing, recording and indexing of each lien, and 
not more than One Dollar for the filing of the release of any lien 
and noting on the record and on the release the fact that the 
release has been so filed. 53 
Minnesota Stat. Ann. (West 1947) 
514.68. Lien for hospital charges. Any person, firm, or corpora- 
tion operating a hospital in this state shall have a lien for the 
reasonable charges for hospital care of an injured person upon 
any and all causes of action accruing to the person to whom such 
care was furnished, or to the legal representatives of such person, 
on account of injuries giving rise to such causes of action and 
which necessitated such hospital care, subject, however, to any 
attorney’s lien. 
514.69. File with clerk of the district court. In order to perfect 
such lien, the operator of such hospital, before, or within ten days 
after, such person shall have been discharged therefrom, shall file 
in the office of the clerk of the district court of the county in which 
such hospital shall be located a verified statement in writing setting 
forth the name and address of such patient, as it shall appear on 
the records of such hospital, the name and location of such hospital 
and the name and address of the operator thereof, the dates of 
admission to and discharge of such patient therefrom, the amount 
claimed to be due for such hospital care, and, to the best of 
claimant’s knowledge, the names and addresses of all persons, 
firms, or corporations claimed by such injured person, or the legal 
representatives of such person, to be liable for damages arising 
from such injuries; such claimant shall also, within one day after 
the filing of such claim or lien, mail a copy thereof, by registered 
mail, to each person, firm, or corporation so claimed to be liable for 
such damages to the address so given in such statement. The filing 
of such claim or lien shall be notice thereof to all persons, firms, or 
corporations liable for such damages whether or not they are 
named in such claim or lien. 
514.70. Clerk to provide record. The clerk of court shall endorse 
thereon the date and hour of filing and, at the expense of the 
county, shall provide a hospital lien book with proper index in 
which he shall enter the date and hour of such filing, the names 
and addresses of such hospital, the operators thereof and of such 
patient, the amount claimed and the names and addresses of those 
claimed to be liable for damages. He shall be paid $1.00 as his 
fee for such filing. 
514.71. Release. No release of such causes of action, or any of 
them, or of any judgment thereon shall be valid or effectual as 
against such lien unless such lienholder shall join therein, or execute 
a release of such lien, and the claimant, or assignee of such lien, 
may enforce such lien by action against the person, firm, or corpora- 
tion liable for such damages, which action shall be commenced and 
tried in the county in which such lien shall be filed, unless ordered 
removed to another county by the court for cause. If the claimant 
shall prevail in such action, the court may allow reasonable attor- 
neys’ fees and disbursements. Such action shall be commenced 
within two years after the filing of such lien. 
514.72. Not to apply to workmen’s compensation. The provisions 
of sections 514.68 to 514.71 shall not apply to any moneys becoming 
due under the workmen’s compensation act of this state. 54 
Missouri Rev. Stat. Ann. (West 1942) 
Every public hospital or clinic, and every privately maintained 
hospital, clinic or other institution for the care of the sick, which 
is supported in whole or in part by charity, located within the State 
of Missouri, or any such hospital duly incorporated under the 
laws of Missouri providing for the incorporation of eleemosynary 
institutions, shall have a lien upon any and all claims, counter- 
claims, demands, suits or rights of action of any person admitted 
to any hospital, clinic or other institution and receiving treatment, 
care or maintenance therein on account of any personal injury 
sustained by such person as the result of the negligence or wrong- 
ful act of another, which such injured person may have, assert 
or maintain against the person or persons causing such injury for 
damages on account of such injury, for the cost of such services, 
computed at reasonable rates not to exceed five dollars ($5.00) 
per day and the reasonable cost of necessary X-ray, Laboratory, 
Operating Room and Medication service, as such hospital, clinic, or 
other institution shall render such injured person on account of 
his injuries; provided, further, that the lien herein set forth shall 
not be applied or considered valid against anyone coming under 
the Workmen’s Compensation Act in this State. 
§ 3621.1. Hospitals to have lien on patient’s action for injuries 
§ 3621.2 Notice 
No such lien shall be effective, however, unless a written notice 
containing the name and address of the injured person, the date 
of the accident, the name and location of the hospital and the 
name of the person or persons, firm or firms, corporation or corpora- 
tions alleged to be liable to the injured party for the injuries 
received, shall be sent by registered mail with return receipt 
requested, to the person or persons, firm or firms, corporation or 
corporations, if known, alleged to be liable to the injured party, if 
known, for the injuries sustained prior to the payment of any 
moneys to such injured person, his attorneys or legal representa- 
tive, as compensation for such injuries. Such hospital shall send 
by registered mail with return receipt requested a copy of such 
notice to any insurance carrier, if known, which has insured such 
person, firm or corporation against such liability. 
§ 3621.3 Payments to patient after receiving notice of lien— 
liability to hospital 
Any person or persons, firm or firms, corporation or corporations, 
including an insurance carrier, making any payment to such 
patient or to his attorneys or heirs or legal representatives as com- 
pensation for the injury sustained, after the receipt of such notice 
in accordance with the requirements of Section 11, without pay- 
ing to such hospital the amount of its lien or so much thereof as 
can be satisfied out of 50% of the moneys due to such patient under 
any final judgment or compromise or settlement agreement after 55 
paying the amount of attorneys’ liens, federal and Missouri work- 
men’s compensation liens, and any prior liens, shall for a period 
of one year, after such settlement is made known to the hospital, 
from the date of payment to such patient or his heirs, attorneys or 
legal representatives, as aforesaid, be and remain liable to such 
hospital for the amount which such hospital was entitled to receive, 
as aforesaid, and any such association, corporation or other institu- 
tion maintaining such hospital may, within such period, enforce its 
lien by a suit at law against such person or persons, firm or firms, 
corporation or corporations making any such payment. 
Montana Rev. Codes (1936) 
8395.1. Lien of physicians, nurses and hospitals on causes of 
action and claims for injuries or death. Whenever a physician, 
nurse or hospital shall render services in the treatment or care of 
any person injured through the fault or neglect of another, such 
physician, nurse or hospital shall have a lien for the value of such 
services upon the claim and cause of action for such injury, or 
death resulting therefrom, and upon any judgment recovered on 
account thereof, and upon all moneys paid in satisfaction of such 
judgment or in settlement of such claim or cause of action, upon 
giving notice and complying with the requirements of this act. 
Such lien, however, shall be subject to any attorney’s lien provided 
for in section 8993. Provided, however, that no lien under this 
section shall exceed the provisions of the schedule of fees as adopted 
by the Montana State Medical Association. 
8395.2. Notice of claim of lien—service on party liable. Any 
physician, nurse or hospital claiming such lien shall serve a written 
notice upon the person or corporation against whom liability 
for such injury or death is asserted, stating therein the nature of 
the services and for whom and when rendered and the value thereof, 
and that a lien therefor is claimed as provided by this act. 
8395.3. Same—when filed with clerk of court. If an action is 
commenced to recover for such injury or death, a duplicate of such 
notice and claim of lien shall be filed in the office of the clerk of 
the court in which such action is pending, and such filing shall be 
notice to all parties to said action of such lien. 
8395.4. Failure to recognize claim—liability for. If any person 
or corporation, against whom a claim is made for damages for per- 
sonal injury or death, after receiving notice of lien as herein pro- 
vided, shall make payment to the claimant or claimants, on account 
of such injury or death, and the amount claimed by any physician, 
nurse, or hospital for services, as stated in the notice so given has 
not been paid, such person or corporation shall be liable to such 
physician, nurse or hospital for the reasonable value of such 
services. 
8395.5. Act not applicable when event covered by workmen’s 
compensation act. This act shall not apply to any injury or death 
for which compensation is awarded, under or pursuant to the 
workmen’s compensation law of Montana. 56 
Nebraska Rev. Stat. (1944) 
52-401. Physician’s, nurse’s, hospital liens; scope and operation; 
exception; claim of lien; notice. Whenever any person shall 
employ a physician, nurse or hospital to perform professional serv- 
ice or services of any nature, in the treatment of or in connection 
with an injury, and such injured person shall claim damages from 
the party causing the injury, such physician, nurse or hospital, 
as the case may be, shall have a lien upon any sum awarded the 
injured person in judgment or obtained by settlement or com- 
promise on the amount due for the reasonable value of services 
necessarily performed; Provided, that no such lien shall be valid 
against anyone coming under the Workmen’s Compensation Act. 
In order to prosecute such lien, it shall be necessary for such phy- 
sician, nurse or hospital to serve a written notice upon the person 
or corporation from whom damages are claimed that such physi- 
cian, nurse or hospital claims a lien for such services, and stating 
therein the amount due and the nature of such services; Provided, 
however, that whenever an action is pending in court for the 
recovery of such damages, it shall be sufficient to file the notice of 
such lien in the pending action. 
52-402. “Physician,” defined. The term “physician” shall 
include “surgeon,” and shall mean one legally authorized to 
practice his profession with the State of Nebraska and in good 
standing in his profession at the time. 
New Jersey Statutes Annotated (West 1939) 
2:60-36. Hospitals entitled to collect for services in accidents; 
lien upon claims and demands of injured person. Every charitable 
association, corporation or other institution maintaining a hospital 
in this state supported in whole or in part by private charity, or 
owned, operated or maintained by any municipal or county board 
or body, hereinafter in this article referred to as a “hospital”, shall 
have a lien upon any and all rights of action, suits, claims, counter- 
claims or demands of any person admitted to any such hospital and 
receiving treatment, care and maintenance therein, on account of 
any personal injuries received in any accident as the result of the 
negligence of any other person, which any such injured person may 
or shall have, assert or maintain against any such other person for 
damages because of such injuries, for the amount of the reasonable 
charges of such hospital for treatment, care and maintenance of 
such injured person at ward rates in such hospital up to the date of 
payment of such damages, upon compliance with the provisions of 
this article. 
2:60-37. Notice of lien; filing; contents. A notice in writing 
containing the name and address of the injured person, the date of 
the accident, the name and location of the hospital, and, if known, 
the names of the persons alleged to be liable to make compensation 
to such injured person for the injuries received, shall be filed in the 
office of the county clerk of the county in which such injuries shall 
have occurred, prior to the payment of any moneys to such injured 
person or his legal representative as compensation for such injuries. 57 
2:60-38. Notice mailed to person liable for payments; statement 
attached. After the filing of the notice mentioned in section 2:60-37 
of this title, the hospital shall mail, postage prepaid, a copy of such 
notice, with a statement of the date of the filing thereof to the 
persons alleged to be liable to make compensation for the injuries 
sustained by such injured person, if their names and addresses shall 
be known. 
2:60-43. To what lien attaches. The lien of any hospital under 
the provisions of this article shall attach to any verdict, report, 
decision, decree, award, judgment or final order made or rendered 
in any action or proceeding in a court of record of this state, or any 
public board or bureau, in any suit, action or proceeding brought 
by any such from the injuries, against any other person for the 
recovery of damages or compensation on account of injuries received 
in any such accident, as well as to the proceeds of a settlement 
thereof, or the settlement of any such claim or demand effected by 
any such injured person with another person whose negligence is 
claimed or alleged to have been the cause of the accident or effected 
with any other person on account thereof. 
2:60-44. Release of claims; enforcement of lien by action. After 
the filing of the notice as provided by section 2 :60-37 of this article, 
no release of any judgment, claim or demand by such injured 
person shall be valid or effectual as against such lien, and the 
person making any payment to such injured person or his legal 
representative as compensation for the injuries sustained shall for 
a period of one year from the date of such payment as aforesaid 
remain liable to such hospital for the amount of reasonable charges 
due at the time of such payment as aforesaid to the extent of the 
full and true consideration paid or given to the injured person, 
and any such hospital may, within such period, enforce its lien by 
an action at law against such person making any such payment. 
2:60-45. Hospital lien docket; entries in; fees. Every county 
clerk shall, at the expense of the county, provide a suitable, well- 
bound book, to be called the hospital lien docket, in which, upon 
the filing of any lien claim under the provisions of this article, he 
shall enter: 
a. The name of the injured person; 
b. The date of the accident; and 
c. The name of the hospital or other institution making the claim. 
The clerk shall make a proper index of the same in the name of 
the injured person. 
The county clerk shall, for filing each claim, for each entry made 
in the lien docket and for each search in the office for such lien 
claim, be entitled to the fees fixed by sections 22:2-19 and 22 :4r-10 
of the title Fees and Costs. 
2 ;60-46. Examination of hospital records. Any person, legally 
liable or against whom a claim is asserted for compensation for 
injuries sustained shall be permitted to examine the records of the 
hospital in reference to the treatment, care and maintenance of the 
injured person therein. 58 
North Carolina Gen. Stat. (Michie, 1944) 
§ 44-49. Lien created; applicable to persons non sui juris. From 
and after March 26, 1935, there is hereby created a lien upon any 
sums recovered as damages for personal injury in any civil action 
in this State, the said lien in favor of any person or corporaton to 
whom the person so recovering, or the person in whose behalf the 
recovery has been made, may be indebted for drugs, medical sup- 
plies, and medical services rendered by any physician, dentist, 
trained nurse, or hospitalization, or hospital attention and/or 
services rendered in connection with the injury in compensation for 
which the said damages have been recovered. Where damages are 
recovered for and in behalf of minors or persons non compos mentis, 
such liens shall attach to the sum recovered as fully and effectively 
as if the said person were sui juris. 
§ 44-50. Receiving person charged with duty of retaining funds 
for purpose stated; evidence; attorney’s fees; charges.—A like lien 
shall attach to all funds paid to any person in compensation for 
or settlement of the said injuries, whether in litigation or otherwise; 
and it shall be the duty of any person receiving the same before 
disbursement thereof to retain out of any recovery or any compensa- 
tion so received a sufficient amount to pay the just and bona fide 
claims for such drugs, medical supplies, and medical attention 
and/or hospital service, after having received and accepted notice 
thereof: Provided, that evidence as to the amount of such charges 
shall be competent in the trial of any such action: Provided further, 
that nothing herein contained shall be construed so as to interfere 
with any amount due for attorney’s services; Provided, further, 
that the lien hereinbefore provided for shall in no case, exclusive 
of attorneys’ fees, exceed fifty per cent of the amount of damages 
recovered. 
§ 44-51. Disputed claims to be settled before payments.—When- 
ever the sum or amount or amounts demanded for medical services 
or hospital fees shall be in dispute, nothing in this article shall 
have any effect of compelling payment thereof until the claim is 
fully established and determined, in the manner provided by law; 
Provided, however, that when any such sums are in dispute the 
amount of the lien shall in no case exceed the amount of the bills in 
dispute. 
North Dakota Rev. Code (1944) 
35-1801. Hospital Lien: For Services to Injured Persons; 
Attaches to Rights of Action, Insurance, and Other Claims. Any 
charitable association, corporation, or other institution maintaining 
a hospital in this state shall be entitled to a lien for the reasonable 
value of hospitalization services rendered to a person injured in any 
accident. The lien shall attach to all rights of action, claims, 
demands, and judgments recovered on account of the injuries 
against persons or corporations liable to the injured person in tort 
for damages occasioned by negligence causing the injuries, and shall 59 
attach to the proceeds of the settlement of such claims or demands, 
and to insurance of the tort feasor payable by reason of the liability 
occasioned by such injury, and to any insurance or indemnity pay- 
able to the injured person by any insurer. 
35-1802. Service of Notice of Intention to File Hospital Lien. 
A notice of intention to file a hospital lien shall be served upon the 
person or corporation claimed to be liable for the damages arising 
from the injury, by registered mail or by personal service in the 
manner provided for the service of a summons in a civil action. 
Proof of such service shall be filed with the lien statement. 
35-1803. Lien Statement: Contents; Verification; Filing. The 
lien claimant, at any time after the rendering of the hospital serv- 
ices, or some part thereof, or from time to time as the services are 
rendered, as the lien claimant may deem best, but not later than 
thirty days after the services have been rendered and terminated, 
shall file a lien statement in the office of the clerk of the district 
court of the county in which the services were rendered containing: 
1. The name of the injured person to whom the services were 
rendered; 
2. The address of the injured person as shown upon the records 
of the hospital or institution; 
3. The date upon which the injured person was admitted to the 
hospital and the date of his release, if he has been released from the 
hospital at the time of the filing of the statement; 
4. The name, if known, of the person or corporation alleged or 
claimed to be guilty of the negligence causing the injuries, and the 
address, if known, or ascertainable from the hospital records; 
5. The name and address of any person or corporation insuring 
the tort feasor against liability on account of ilegligence, if the 
same are known or ascertainable from the hospital records; 
6. The name of any insurer liable for insurance to the injured 
person, if known; and 
7. An itemized statement of the charges for hospital services and 
the total sum claimed to be due. 
Such statement shall be signed in the name of the hospital or 
institution claiming the lien and verified on behalf of the institution 
by some person authorized so to do and possessing knowledge of the 
facts. The verification shall show that the facts therein set forth 
are true to the best of the knowledge, information, and belief of 
the person making the same, that the charges for services are the 
reasonable and usual charges of the institution for such services, 
and that the sum claimed is due and unpaid. 
35-1804. Clerk of Court; Record; Fee. The clerk of the district 
court with whom the lien statement and proof of service are filed 
shall endorse thereon the date and hour of filing and shall make an 
abstract thereof in a book kept for that purpose to be known as 
“the hospital lien book”, which shall be indexed properly and shall 
contain the name of the hospital or institution filing the lien, the 
date and hour filed, the amount claimed, the name of the person 
or corporation against whom it is filed, the name of the person to 
whom such services are rendered and of any insurer of such injured 60 
person, and the number of the file where the original lien is kept. 
The clerk shall collect a fee of fifty cents for filing and indexing 
each lien. 
35-1805. Filing is Notice to Whom: Effect of Payment or Release 
of Claim. The filing of a hospital statement, from the time of filing 
thereof, shall be constructive notice to all persons of the claim of 
the hospital and of its right to a lien upon any claim or demand or 
cause of action against the tort feasors and the insurer or insurers 
of the tort feasors, or an insurer of the injured person, and no release 
of any judgment, claim, or demand by the injured person shall be 
valid or effective as against the lien. The person or corporation mak- 
ing any payment to the injured person, or to his legal representative, 
as compensation for injuries sustained, in settlement of a cause of 
action claimed to exist for negligence causing such injuries, or out 
of insurance carried by the tort-feasor, shall remain liable to the 
hospital for the amount of the reasonable charges due at the time 
of such payment to the extent of the full amount so paid or given 
to the injured person. 
35-1806. Hospital Lien Enforced by Action. Any hospital or 
institution securing a lien under this chapter may enforce its lien 
in a civil action against the tort feasor, the insurer of the tort feasor, 
or the insurer of the injured person. A judgment obtained against 
the tort feasor or any insurer shall not bar the hospital or institu- 
tion from collecting the amount of its account from the person for 
whom the services were rendered, or his insurer, unless payment 
has been made by the tort feasor or his insurer to the hospital, and 
then only to the extent that payment has been made. 
35-1807. Judgment for Damages to Contain Reference to Lien: 
Proceeds of Judgment Applied on Lien or Deposited. Upon the 
trial of any action for damages for personal injuries wherein it 
appears at the trial that services were rendered in hospitalization 
of the injured person, the court before whom the action is tried 
shall require the clerk of the district court to search the records for 
information as to whether a lien has been filed, and if a lien 
has been filed, mention of that fact and a statement of the amount 
claimed shall be made in the judgment. If the parties to the 
action admit the facts set forth in any lien described in the judg- 
ment, and the judgment is collected under execution, an amount 
equal to the amount claimed in the lien shall be deposited with the 
clerk of the district court for the payment of the lien wdien the 
execution is returned. If the lien is contested, the deposit shall be 
held to abide the final event of an action to enforce the lien, which 
action must be brought by the hospital or the institution within 
sixty days after a demand therefor is made by any of the parties 
interested. 
35-1808. Insurance: Payment to Holder of Lien; Deposit with 
Clerk. If an injured person receiving hospitalization has a contract 
providing for indemnity or compensation for the sum incurred for 
hospitalization, the hospital shall have a lien upon the amount pay- 
able under such contract, and the party obligated to make reim- 
bursement for the hospitalization under the contract may pay the 61 
sum due thereunder directly to the hospital, and such payment shall 
constitute a release of the party making the payment under such 
contract to the amount of the payment. If the amount of the claim 
is contested, payment shall be made to the clerk of the district court 
and shall be subject to all of the terms and conditions stated in 
section 35-1807. 
35-1809. Hospital Records Open to Inspection. Any person, 
firm or corporation legally liable under this chapter and against 
whom a claim is asserted for compensation for injuries shall be 
permitted to examine the records of any hospital which has filed a 
lien statement in reference to treatment, care, and maintenance of 
the injured person. 
35-1810. Workmen’s Compensation Bureau Excepted. The pro- 
visions of this chapter shall not apply to any money paid or pay- 
able under the title Workmen’s Compensation of this code. 
35-1811. Action on Lien; Limitations. An action to enforce a 
hospital lien shall be commenced within one year after the filing of 
the lien, except that when the cause of action against a tort feasor 
or insurer shall not have become barred or an action is pending 
involving the question of liability, the lien shall continue in effect 
until the final termination of such action and for a period of one 
year thereafter. 
Oregon Compiled Laws Annotated (1940) 
§ 67-1701, Lien on sum obtained for personal injury: Exception 
as to persons within Workmen’s Compensation Act: Notice of 
claim of lien. Whenever any person shall receive hospitalization 
on account of any injury and such injured person shall claim 
damages from the party causing the injury, such hospital shall have 
a lien upon any sum awarded the injured person in judgment or 
obtained by a settlement or compromise on the amount due for the 
reasonable value of such hospitalization rendered the injured person 
prior to the date of settlement or judgment; provided, that no such 
lien shall be valid against anyone coming under the workmen’s 
compensation act. 
In order to perfect and prosecute such lien it shall be necessary 
for such hospital to serve a written notice upon the person or 
corporation from whom damages are claimed that such hospital 
claims a lien for such hospitalization and stating therein the amount 
due and the nature of such hospitalization. 
§ 67-1702. Filing notice of lien with county clerk and in pend- 
ing action; When notice filed: Notice that injured person is receiv- 
ing hospitalization. In order to perfect such notice of lien as 
described in section 67-1701, it shall be necessary for such hospital 
or the owner or operator of such hospital, to file a notice of lien 
with the county clerk in the county where the said hospital is 
located. And in event that said injury was received in any other 
county of this state other than the county where such hospital is 
located, then in that event, a notice of lien shall also be filed in the 
county where the said injury occurred; said notice of lien to be 62 
filed within thirty (30) days after the completion of said hospital- 
ization and to contain an itemized statement of the amount claimed; 
provided, however, that such hospital shall give a written notice 
within seven (7) days after admission of the said injured party to 
the said hospital that such injured party is receiving hospitalization; 
said notice to be made by mailing a copy thereof by United States 
registered mail, addressed to the party alleged to have caused the 
injury and to the party being liable for damages on account of 
same. And in event that an action is instituted in court for the 
recovery of such damages, such hospital shall file a notice of such 
lien in the pending action. A copy of such notice shall be served 
upon each of the parties appearing in said action. 
§ 67-1703. Lien on amount payable under indemnity contract: 
Payment of amount due direct to hospital. In the event that such 
injured person receiving hospitalization shall have a contract pro- 
viding for indemnity or compensation for the sum incurred for 
hospitalization received by such injured person, such hospital shall 
have a lien upon the amount payable under said contract and the 
party obligated to make reimbursement for such hospitalization 
under such contract may pay the sum due thereunder directly to 
such hospital and such payment shall constitute a full release of 
the party making such payment under such contract to the amount 
of such payment. 
§ 67-1704. Effect of settlement by person causing injury: Lien 
not to apply to sum incurred for expenses incurred in securing 
settlement, compromise or damages. No rights or claims for lien 
under this act shall be allowed for hospitalization rendered an 
injured person after a settlement has been effected by or on behalf 
of the party causing the injury. No lien shall apply or be allowed 
against any sum incurred by the injured party for necessary attor- 
ney fees and costs and expenses incurred by the injured party in 
securing a settlement, compromise or recovering damages by an 
action at law. 
§ 67-1705. Examination of and copying hospital records. Any 
party legally liable or against whom a claim shall be asserted for 
compensation or damages for such injuries shall have a right to 
examine and make copies of all records of any hospital in reference 
to and connected with such hospitalization of such injured person. 
Rhode Island Acts and Resolves, 1939 Ch. 708 
Section 1. Every association, corporation or other institution, 
including a municipal corporation, maintaining a hospital in the 
state of Rhode Island, which shall furnish medical or other service 
to any patient injured by reason of an accident not covered by the 
workmen’s compensation act, shall, if such injured party shall 
assert or maintain a claim against another for damages on account 
of such injuries, have a lien upon that part going or belonging to 
such patient, of any recovery or sum had or collected or to be col- 
lected by such patient, or by his heirs or personal representatives in 
the case of his death, whether by judgment or by settlement or 63 
compromise to the amount of the reasonable and necessary charges 
of such hospital up to the date of payment of such damages; pro- 
vided, however, that the lien herein set forth shall not be applied 
or considered valid against anyone coming under the workmen’s 
compensation act in this state; and provided, further, that nothing 
herein enacted shall be so construed as to give the lien herein created 
precedence over the lien of an attorney. 
Sec. 2. No such lien shall be effective, however, unless a written 
notice containing the name and address of the injured person, 
the date of the accident, the name and location of the hospital, 
and the name of the person or persons, firm or firms, corporation 
or corporations alleged to be liable to the injured party for the 
injuries received, shall be filed in the office of the city or town clerk 
in which such hospital is located, prior to the payment of any 
moneys to such injured person, his attorneys or legal representa- 
tives as compensation for such injuries; nor unless the hospital shall 
also mail, postage prepaid, a copy of such notice with a statement 
of the date of filing thereof to such injured person, and to the 
person or persons, firm or firms, corporation or corporations, alleged 
to be liable to the injured party for the injuries sustained prior 
to the payment of any moneys to such injured person, his attorneys 
or legal representative, as compensation for such injuries. Such 
hospital shall mail a copy of such notice to any insurance carrier 
which has insured such person, firm or corporation against such 
liability. 
Sec. 3. Any person or persons, firm or firms, corporation or cor- 
porations, making any payment to such patient or to his attorneys 
or heirs or legal representatives as compensation for the injury 
sustained, after the filing and mailing of such notice without paying 
to such hospital the amount of its lien or so much thereof as can 
be satisfied out of the moneys due under any final judgment or com- 
promise or settlement agreement after paying the amount of any 
prior liens, shall, for a period of one year from the date of pay- 
ment to such patient or his heirs, attorneys or legal representatives, 
as aforesaid, be and remain liable to such hospital for the amount 
which such hospital was entitled to receive as aforesaid; and any 
such association, corporation or other institution maintaining such 
hospital may, within such period, enforce its lien by a suit at law 
against such person or persons, firm or firms, corporation or cor- 
porations, making any such payment. 
Sec. 4. Any person or persons, firm or firms, corporation or 
corporations, legally liable for such lien or against whom a claim 
shall be asserted for compensation for such injuries, shall be per- 
mitted to examine the records of any such association or other 
institution or body maintaining such hospital in reference to such 
treatment, care and maintenance of such injured person. 
See. 5. Every city or town clerk shall, at the expense of the city 
or town, provide a suitable well-bound book to be called the hos- 
pital lien docket in which, upon the filing of any lien claim under 
the provisions of this act, he shall enter the name of the injured 
person, the name of the person, firm or corporation alleged to he 64 
liable for the injuries, the name of an insurance carrier where the 
same is known at the time of filing of such notice, the date of the 
accident and the name of the hospital or other institution making 
the claim, and said clerk shall index the same in the name of such 
injured person and such hospital and in the name of such insurance 
carrier where the name of same is known at the time of filing such 
notice. 
Sec. 6. This act shall take effect upon its passage and shall con- 
tinue in effect notwithstanding any of the provisions of chapter 
2600 of the public laws of 1938, as amended, and of the general 
laws of 1938, and all acts and parts of acts inconsistent herewith 
are hereby repealed. 
Texas Rev. Civ. Stat. (Vernon 1941) 
Art. 5506a. Hospital or clinic’s lien for services on cause of action 
of persons injured 
Sec. 1. Every association, individual, corporation, or other institu- 
tion maintaining a hospital or clinic rendering hospital services 
in the State of Texas shall be entitled to a lien upon any and all 
rights of action, suits, claims, counterclaims, or demands of any 
persons admitted to any such hospital and receiving treatment, 
care, and maintenance therein, on account of any personal injuries 
received in any accident as the result of the alleged negligence 
of any other person or firm or corporation or joint stock associa- 
tion, his, its or their agent, servant or employee, which any such 
injured person may or shall have, assert, or maintain against any 
such other person or firm or corporation or joint stock association 
for damages on account of such injuries, for the amount of the 
charges of such hospital or clinic for such treatment, care and 
maintenance as may have been given to the injured persons. Pro- 
vided the lien provided for herein shall not exist or attach unless the 
injured person is received in such hospital within seventy-two (72) 
hours after the happening of the accident causing the injury. 
Lien to attach to judgment or orders in action or proceedings 
Sec. 2. The lien of any such hospital shall also attach to any 
verdict, report, decision, decree, award, judgment, or final order 
made or rendered in any action or proceeding, in any Court in 
Texas, or any public board or bureau in any suit, action or pro- 
ceeding brought by such injured persons, by any person entitled 
thereto in case of death of such injured person against any other 
person or corporation or joint stock association for the recovery 
of damages or compensation on account of injuries received in any 
such accident, as well as the proceeds of any settlement thereof, or 
the settlement of any such claim or demand effected by any such 
injured person or other person entitled thereto with any other per- 
son or firm or corporation or joint stock association whose negligence 
is claimed or alleged to have been the cause of the said accident. 65 
Section. 3. No release of any claim or demand on account of 
any such injuries, or in respect of any such verdict, report, decision, 
decree, award, judgment, or final order, made or rendered, as herein- 
before mentioned, executed by any such injured person, or by any 
person entitled thereto, shall be valid or effectual between the 
parties thereto or otherwise, unless prior to the execution and 
delivery thereof all such charges of any such hospital or institu- 
tion or clinic, furnishing hospital services, which has filed its, his, 
or their lien as hereinafter provided, shall have been paid in full, 
or to the extent of a full and true consideration paid and given to 
the injured person by the other party or parties to such release 
named therein, or paid and given by any other person or corpora- 
tion in behalf of such other party or parties, or unless such release 
shall also have been executed by the person, corporation, associa- 
tion, or institution maintaining such hospital; and every such 
verdict, report, decision, decree, award, judgment, or final order 
shall remain in force and effect until all such charges of any such 
hospital or institution shall have been paid in full or to the extent 
of any such verdict, report, decision, decree, award, judgment, or 
order; provided such hospital, institution or clinic furnishing said 
services does not charge more than a reasonable rate for such 
accommodations, in no event to exceed more than Five Dollars 
($5.00) per day for not longer than one hundred (100) days; pro- 
vided that a notice in writing containing the name and address of 
the injured person, the date of the accident, the name and location 
of the hospital or clinic rendering the service, and if known, the 
name of the person or persons, firm or firms, corporation or cor- 
porations, alleged to be liable to pay damages to such injured 
person for such injuries so received, shall be filed in the office of 
the County Clerk of the county in which such injury shall have 
occurred, prior to the payment of any moneys to such injured per- 
son or his legal representative or other person entitled thereto as 
damages for or on account of such injuries. Provided further that 
this lien shall not attach to any claim for amounts due the injured 
person under the Workmen’s Compensation Act of the State of 
Texas, or Federal Liability Act, or Federal Longshoremen’s or 
Harbor Workers’ Act or Workmen’s Compensation Act of Texas, 
nor to any insurance company, corporation, or joint stock associa- 
tion furnishing hospitalization under the Workmen’s Compensa- 
tion Act of the State of Texas. Provided further, that the lien 
provided for in this Act shall not attach to any claim for amounts 
due the injured person by any person, firm, association, corpora- 
tion, or the receiver, or receivers thereof, owning and/or operating 
a railroad in this State, where such person, firm, association, cor- 
poration, or receiver, or receivers, or his, its, or their employes, 
maintain a hospital, furnishing hospitalization to injured persons. 
Release ineffectual as against claims; exceptions as to liens 
County clerk to provide hospital lien docket 
Sec. 4. Every County Clerk shall at the expense of the county, 
provide a suitable, well bound book, to be called the “Hospital Lien Docket,” upon which, on the filing of lien claims under the 
provisions of this Act he shall enter the name of the injured per- 
son, the date of the accident, the name and address of the hospital 
or clinic or other institution making the claim, and the amount 
thereof. 
And the said Clerk shall make a proper index of the same in the 
name of the injured person, and such Clerk shall be entitled to 
twenty-five (25) cents for filing each claim and such fee shall be 
accountable as fees of office. 
The term “corporation,” as used in this Article shall include 
all municipal corporations, as well as all private, public and quasi- 
public corporations, except county and common and independent 
school districts. 
Hospital records subject to inspection. 
Sec. 4a. Any person or persons, firm or firms, corporation or 
corporations legally liable or against whom a claim shall be asserted 
for compensation for such injuries, shall be permitted to examine 
the records of any such association, corporation, or other institution 
or body maintaining such hospital in reference to such treatment, 
care and maintenance of such injured person, under such reason- 
able rules and regulations as such hospital may require; and the 
hospital record with respect to injured persons may be admitted 
in evidence in any proceeding with respect to the recovery of 
damages. 
Discharge of lien entered on hospital lien docket 
Sec. 4b. To discharge any notices filed under the provisions of 
this Act the hospital authorities or persons in charge of the finances 
of said hospital to whom said lien has been duly paid shall execute 
a certificate to the effect that the claim filed by such hospital for 
treatment, care and maintenance therein has been duly paid or 
released and authorizing the Clerk of the County in whose office 
said notice of hospital lien has been filed, to discharge the same; 
and thereupon such Clerk shall enter upon the margin of the hos- 
pital lien docket in which the said hospital lien notice has been 
entered, a memorandum of such filing and the date when such cer- 
tificate of payment or release was filed in his office, which certificate 
and entry shall constitute a discharge of lien, for which the Clerk 
shall receive the sum of twenty-five (25) cents and such fee shall 
be accountable as fees of office. 
Partial invalidity 
See. 4c. If any part of this Act is declared by the courts to be 
unconstitutional such decision shall not affect the validity of the 
remaining part of this Act, unless the part held unconstitutional 
is indispensable to the operation of the remaining part and the 
Legislature hereby declares that its would have passed those parts 
of this Act which are valid and omitted any parts which may be 
unconstitutional, if it had been advised of such unconstitutionality 
at the time of the passage of this Act. Insurance excepted from claim of lien. 
Sec. 4d. The provisions of this Act shall not give to any such 
hospital, or any person, firm or corporation claiming under it, any 
lien, claim, right, or demand upon the proceeds of any insurance 
policy in favor of the injured party, his beneficiaries, or legal 
representatives, and none of the provisions of this Act shall have 
application thereto. Provided, however, this section shall not 
include public liability insurance carried by the insured to protect 
him against loss or damage as a result of any accident or collision 
covered by said public liability insurance policy. 
Virginia Code Annotated (Michie 1942) 
§ 1560(1). Lien of hospital for charges.—Whenever any person 
sustains personal injuries caused by the alleged negligence of 
another and receives treatment in any hospital, public or private, 
or receives medical attention or treatment from any physician, or 
receives nursing service or care from any registered nurse in this 
State, such hospital, physician or nurse shall each have a lien for 
the amount of a just and reasonable charge for the service ren- 
dered, but not exceeding two hundred dollars in the case of a 
hospital, fifty dollars for all physicians and fifty dollars in the 
case of all nurses, on the claim of such injured person or of his 
personal representatives, against the person, firm or corporation 
whose negligence is alleged to have caused such injuries, unless 
the injured person, his personal representatives or members of 
his family, is paid under the provisions of the Workmen’s Com- 
pensation Act, but such lien shall be of inferior dignity to the 
claim or lien of the attorney or attorneys of such injured person or 
of his personal representatives for professional services for repre- 
senting such injured person or his personal representatives in 
his claim or suit for damages for such personal injuries. Any 
municipal corporation or any person, firm or corporation who may 
pay such charges, shall be subrogated to the lien provided for by 
this act. 
Provided, however, that in cases of personal injuries resulting 
in death and settlement therefor by compromise or suit under the 
provisions of sections fifty-seven hundred and eighty-six-fifty- 
seven hundred and ninety, inclusive of the Code, the liens herein 
provided for may be asserted against the recovery, or against 
the general estate of the decedent, but not both. If asserted against 
the recovery and paid, such liens shall attach pro rata to the 
amounts received respectively by such beneficiaries as are desig- 
nated to receive the moneys distributed and in their respective 
amounts; and such beneficiaries, or the personal representative for 
their benefit, shall be subrogated to the liens against the estate 
of such decedent provided for by section fifty-three hundred and 
ninety of the Code. 
§ 1560(2). Written notice required.—No such lien shall be 
created or become effective in favor of any such hospital, physician 
or nurse unless and until a written notice setting forth the name 68 
of the hospital, physician or nurse, as the case may be, the name 
of the injured person, and the date and place such person is alleged 
to have sustained injuries, shall have been served upon or given 
to the person, firm or corporation whose negligence is alleged to 
have caused such injuries or to the attorney for the injured party. 
Such notice when served upon or given to either shall have the 
effect of making such party liable for the reasonable charges for 
the services rendered the injured person to the extent of the amount 
paid to or received by such injured party or his personal repre- 
sentatives exclusive of attorney’s fees, but not in excess of the 
maximum amounts prescribed in section 1560(1). Nothing herein 
contained shall be construed as imposing liability on any person, 
firm or corporation whose negligence is alleged to have caused 
injuries to the person so receiving such service or on the attorney 
for the injured party where no settlement is made, or, in case of 
an attorney, where no funds come into his hands, or where no 
judgment is obtained in favor of such injured party or his per- 
sonal representatives, nor as imposing liability on anyone who has 
not received notice as required herein unless liability is imposed 
by a court as provided in section 1560(4), 
§ 1560(3). Hearing and disposal of claim of unreasonableness.— 
Should the person who received treatment in any such hospital, 
or services at the hands of any such physician or nurse or his 
personal representatives, question the reasonableness of the charges 
made therefor, he may file, in the court that would have juris- 
diction of such claim were the same asserted against him by such 
hospital, physician or nurse, a petition setting forth the facts and 
the court shall hear and dispose of the same in a summary way 
after five days’ notice to such claimant; and also in such case the 
claimant may file such petition in the court having jurisdiction 
were the claim asserted against the injured party or his personal 
representatives, and after five days’ notice the court shall hear and 
dispose of same in a summary way. 
§ 1560(4). Petition to enforce lien.—If a suit be instituted by 
such injured person or his personal representatives, the hospital, 
physician or nurse may, in lieu of proceeding according to sec- 
tions 1560(2) and 1560(3), file in the court -wherein such suit is 
pending a petition to enforce the lien given hereunder, which 
petition shall be heard and disposed of in a summary way. 
§ 5390. Order in which debts of decedents to be paid.—When the 
assets of the decedent in hands of his personal representative, 
after the payment of funeral expenses, not to exceed two hundred 
dollars, and charges of administration, are not sufficient for the 
satisfaction of all demands against him, they shall be applied; 
First: To debts due the United States; 
Second. To claims of physicians, not exceeding fifty dollars, for 
services rendered during the last illness of the decedent; and 
accounts of druggists, not exceeding the same amount, for articles 
furnished during the same period ; and claims of professional nurses, 69 
or other person rendering service as nurse to the decedent, at his 
request or the request of some member of his immediate family, 
not exceeding the same amount, for services rendered during the 
same period; and accounts of hospitals and sanitariums, not exceed- 
ing the same amount for articles furnished and services rendered 
during the same period; . . . 
Washington Rev. Stat. 1932 (Remington, 1940 Supp.) 
§ 1209-1. Persons entitled, services, and subjects. Every 
operator of a hospital and every duly licensed nurse, practitioner, 
physician and surgeon rendering service for any person who has 
received a traumatic injury shall have a lien upon any claim, 
right of action and/or money to which such person is entitled 
against any tort feasor and/or insurer of such tort feasor for the 
value of such service, together with costs and such reasonable 
attorney’s fees as the court may allow, incurred in enforcing such 
lien; Provided, however, That nothing in this act shall apply to any 
claim, right of action or money accruing under the Workmen’s 
Compensation Act of the State of Washington, and: Provided, 
further, That all the said liens for service rendered to any one per- 
son as a result of any one accident shall not exceed twenty-five (25) 
per centum of the amount of an award, verdict, report, decision, 
decree, judgment or settlement. 
§ 1209-2. Claim of lien, contents, and filing. No person shall be 
entitled to the lien given by the preceding section unless he shall, 
within twenty (20) days after the date of such injury, or, if 
settlement has not been a[e]ffected with and payment made to 
such injured person, then at any time before such settlement and 
payment, file for record with the county auditor of the county in 
which said service was performed, a notice of claim stating the 
name and address of the person claiming the lien and whether he 
claims as a practitioner, physician, nurse or hospital, the name and 
address of the patient and his place of domicile, if other than his 
actual address, the time when and place where the alleged fault 
or negligence of the tort feasor occurred, and the nature of the 
injury, the name and address of the tort feasor, if same or any 
thereof are known, which claim shall be subscribed by the claimant 
and verified before a person authorized to administer oaths. 
§ 1209-3. Recordation of lien claim. The county auditor shall 
record the claims mentioned in this chapter in a book to be kept 
by him for that purpose, which record must be indexed as deeds 
and other conveyances are required by law to be indexed. 
§ 1209-4. Waiver of lien by taking note. The taking of a 
promissory note or other evidence of indebtedness for any services 
performed, as provided in this act, shall not discharge the lien 
therefor unless expressly received as a payment for such services 
and so specified therein. 
§ 1209-5. Settlement and discharge of lien. No settlement made 
by and between the patient and tort feasor and/or insurer shall 70 
discharge the lien against any money due or owing by such tort 
feasor or insurer to the patient or relieve the tort feasor and/or 
insurer from liability by reason of such lien unless such settlement 
also provides for the payment and discharge of such lien or unless 
a written release or waiver of any such claim of lien, signed by 
the claimant, be filed in the court where any action has been com- 
menced on such claim, or in case no action has been commenced 
against the tort feasor and/or insurer, then such written release 
or waiver shall be delivered to the tort feasor and/or insurer. 
§ 1209-6. Enforcement by action—Payments as evidence. Such 
lien may be enforced by a suit at law brought by the claimant or 
his assignee within one (1) year after the filing of such lien 
against the said tort feasor and/or insurer. In the event that such 
tort feasor and/or insurer shall have made payment or settlement 
on account of such injury, the fact of such payment shall only for 
the purpose of such suit be prima facie evidence of the negligence 
of the tort feasor and of the liability of the payer to compensate 
for such negligence. 
Hawaii Revised Laws (1945) 
Sec. 8757. Liens for services in personal injury cases. When- 
ever any person recovers judgment for damages for personal 
injuries to himself or to another, any hospital which has furnished 
room, board, supplies, facilities or accommodations to the injured 
person in connection with the care, or treatment of such injuries, 
and any dentist, doctor, physician or surgeon who has treated 
the injured person for such injuries, shall have a lien, subject 
to any common law lien, on such judgment or the proceeds thereof 
for the agreed or reasonable value of the services performed or 
the agreed or reasonable value of the room, board, supplies, facili- 
ties or accommodations so furnished, as the case may be, if, before 
satisfaction of judgment is docketed, such dentist, doctor, physician, 
surgeon or hospital files in the office of the chief clerk of the cir- 
cuit court of the circuit in which judgment w*as recovered, or, in 
the case of a judgment recovered in a district court, in the office 
of the clerk of the district court of the district in which judgment 
was recovered, a notice setting forth the agreed or reasonable value 
of the services performed or the agreed or reasonable value of the 
room, board, supplies, facilities or accommodations furnished, as 
the case may be. In the event the available proceeds of the judg- 
ment are insufficient to satisfy in full the liens herein provided 
for, such proceeds shall, after all common law liens have been 
satisfied in full, be distributed pro rata between the lienors without 
any priority among them. 
§ 8758. Judgment debtor may pay money into court. If the 
judgment debtor so elects he may pay the amount of the judgment 
to the chief clerk of the circuit or clerk of the district court in 
which such judgment is rendered and thereby be released from 
any further obligation to the judgment creditor and to the lienor. 71 
In the event the judgment debtor pays the amount of the judgment 
to such clerk the lien shall attach to the sum so paid. 
§ 8759. Enforcement of lien. Such liens may be enforced upon 
the petition of the lienor to the circuit judge at chambers in the 
judicial circuit in which judgment was rendered, and jurisdiction 
is conferred upon the circuit judges at chambers to hear and 
determine all proceedings brought or instituted to enforce and 
foreclose such liens, and the proceedings had before the circuit 
judge at chambers shall be conducted in the same manner and form 
as ordinary foreclosure proceedings.