Hostname: page-component-77c89778f8-rkxrd Total loading time: 0 Render date: 2024-07-20T12:23:55.991Z Has data issue: false hasContentIssue false

Subjecting Hospitals to Truth in Lending Disclosure Requirements: Bright v. Ball Memorial Hospital

Published online by Cambridge University Press:  24 February 2021

Abstract

The federal Truth in Lending Act requires creditors to comply with complex disclosure requirements whenever they engage in consumer credit transactions. In light of procedures adopted by hospitals and health care professionals which permit payment for services over time, there is some question as to whether these groups may be considered creditors within the meaning of the Act and therefore subject to the Act’s disclosure requirements. In Bright v. Ball Memorial Hospital, the Court of Appeals for the Seventh Circuit concluded that a hospital can be a creditor with respect to certain hospital-patient transactions. However, the court found that the defendant had not consummated consumer credit transactions with the plaintiffs and consequently had not violated the Act by failing to make disclosures.

This Case Comment contends that although the court correctly determined that a hospital, in certain circumstances, may be subject to the Act, it incorrectly held that Ball Memorial failed to consummate consumer credit transactions with the plaintiffs. This Case Comment also discusses the circumstances under which a hospital should be considered a creditor for purposes of the Truth in Lending Act and recommends that hospitals offering installment payment plans routinely comply with disclosure requirements of the Act.

Type
Notes and Comments
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 15 U.S.C. §§ 1601-1608, 1610 1613. 1661-1667 (1976 & Supp. Ill 1979. Supp. IV 1980). Congress adopted the Truth in Lending Act. Title I of the Federal Consumer Credit Protection Act. in 1968. The Act became effective July 1, 1969. The Act is primarily intended to require creditors to disclose the terms and costs of a loan to consumer borrowers. 15 U.S.C. § 1601(a) (1976). Creditors must disclosc both the total financc charge and the annual percentage rate of any finance charge imposed in consumer sales or loans for personal, family or household purposes, 15 U.S.C. § 1602(h) (1976). The Act also regulates the advertising of consumer credit costs and terms. 15 U-S.C. §§ 1661-1667 (1976 Supp. IV 1980).

2 15 U.S.C. § 1631(a) (Supp. IV 1980).

3 At least two cases have dealt with hospital coverage under state and federal con-sumer credit protection acts. See Bright v. Ball Mem. Hosp., 616 F.2d 328 (7th Cir. 1980); Anderson v. Houston County Hosp. Bd., 381 So. 2d 68 (Ala. Civ. App. 1980). In each ease, the hospital permitted patients to pay their hills in installments.

4 Rackman, Consumer Credit and the learned Professions of IMW and Medicine, 1976 B.Y.U. L. Rev. 783. 784. See also Ratner v. Drucker, 79 Misc. 2d 216, 369 N.Y.S.2d 859 (N.Y. Civ. Ct. 1974), where a privately practicing physician permitted payment over time for medical services rendered.

5 c Creditors must comply with disclosure requirements when a finance charge is im-posed on delinquent accounts or when payment is permitted in more than four installments. 15 U.S.C. § 1602(f) (Supp. IV 1980). See infra notes 95-125 and accompanying text.

6 15 U.S.C. §1640 (Supp. IV 1980).

7 616 F.2d 328 (7th Cir. 1980).

8 Id. at 333. See 15 US.C. §§ 1631*1646 (1976 fc Supp. IV 1980). requiring creditors lo make certain disclosures.

9 616 F.2d 328, 336 (7th Cir. 1980).

10 Id. at 335. See also infra note 44.

11 616 F.2d 328, 335 (7th Cir. 1980). See also infra note 49. The court thus affirmed the district court judgment in favor of Ball Memorial though it rejected the lower court's determination that hospital-patient transactions can never be subject to the Act. 616 F.2d 328, 336 (7th Cir. 1980).

12 Id. at 330.

13 Id.

14 Id.

15 Id.

16 Id.

17 Id.

18 Id.

19 Id.

20 Id. at 331.

21 Id.

22 Id.

23 Id. at 332.

24 Id.

25 Id.

26 Id.

27 Id.

28 Id. at 335.

29 This figure was subsequently modified to $20 per month. Id. at 332.

30 Susan Barber, another patient, had filed suit with Bright against the hospital, making similar allegations. However, most of the opinion considered the merits of Bright's case. Barber had received outpatient care on numerous occasions. She presumably had received an initial bill and the first three statements for each hospital visit, and at least one coupon book containing more than four coupons. No special arrangements were made for payment. At the time of suit, no payments had been made for the services rendered. Id. at 333. Handling charges were imposed and the hospital turned the account to a collection agency. Id, at 332.

31 Bright v. Ball Mem. Hosp., 463 F. Supp. 152, 155 (S.D. Ind. 1979).

32 Id.

33 Id, at 153-54. For a discussion of the creditor requirement, see infra notes 87-94 and accompanying text.

34 463 F. Supp. 152, 154 (S.D. Ind. 1979).

35 Id.

36 Id. See infra note 49.

37 463 F. Supp. 152, 154 (S.D. Ind. 1979).

38 Id.

39 15 UJ.C. § 1601 (1976), cited at 463 F. Supp. 152” 155 (S.D. Ind. 1979).

40 463 F. Supp. 152, 155 (S.D. Ind. 1979).

41 Id.

42 Bright v. Ball Mem. Hosp., 616 F.2d 328, 338-39 (7th Cir. 1980).

43 Id. at 335.

44 id. The Federal Reserve Board [hereinafter FRB] developed the concept of an informal workout agreement and hence it is neither statutory nor regulatory. For a discussion of the FRB’s role in interpreting and enforcing the Act, see infra note 45. The term creditor refers to a person who imposes a finance charge on a bill for services or, if pursuant to agreement, the bill is payable in more than four installments. 15 U.S.C. § 1602(f) (Supp. IV 1980). However, the fact that a bill is payable in more than four installments does not automatically bring the transaction within the scope of the Act, as the Act applies only to formal agreements between the consumer and the creditor. Thus, where a patient unilaterally decides to pay his bill in more than four installments, the Act does not apply. See FRB Letter No. 170 [1969-74 Transfer Binder] Consumer Cred. Guide (CCH) 30,498 (Oct. 24, 1969).

For further discussion of the concepts of formal and informal agreements, see infra notes 117-25 and accompanying text.

45 15 U.S.C. § 1604(a) delegates to the FRB the power to prescribe regulations to carry out the purposes of the Act. 15 U.S.C. § 1604(a) (Supp. IV 1980). To this end, the FRB has promulgated Regulation Z, 12 C.F.R, § 226 (1981). In addition, the FRB has from time to time issued many explanations and interpretations of Regulation Z, which include official Board interpretations focusing on significant policy questions, official staff interpretations clarifying technical ambiguities in Regulation Z, and unofficial staff interpretations issued as FRB letters.

46 A creditor who in good faith relies on any FRB rule, regulation or interpretation is absolved from liability for any violation of the Act. 15 U.S.C. § 1640(f) (Supp. IV 1980). Courts have construed this provision to permit good faith reliance on official Board or staff interpretations to qualify for the good faith defense, but courts are divided on the effect of the FRB letters. See, e,g., Ives v. W.T. Grant Co., 522 F.2d 749 (2d Cir. 1975); St. Germain v. Bank of Hawaii, 413 F. Supp. 587 (D.C. Hawaii), rev'd on other grounds, 573 F.2d 572 (9th Cir. 1976). The Bright court stated that FRB regulations and opinion letters are not binding on the courts, but are entitled to substantial deference “because of the important interpretive powers granted to the agency in this very complex field.** 616 F.2d 328, 333 n.l (7th Cir. 1980) (citing Croysdale v. Franklin Savings Ass’n, 601 F.2d 1340, 1344 n.4 (7th Cir. 1979)).

47 FRB Official Staff Interpretation FC-0I01, 42 Fed. Reg. 40,424, 40,425 (1977).

48 Bright v. Ball Mem. Hosp., 616 F.2d 328, 334 (7th Cir. 1980).

49 The standard terms for installment payments set forth on billing statements require a minimum monthly balance of 5% of the outstanding balance. Bright’s agreement with Ball Memorial called for payments of $15 or $20 per mpnth, substantially less than 5% of Bright's $933.35 bill. 616 F.2d 328, 335 (7th Cir. 1980).

Id. A late payment charge is a default or delinquency charge if imposed for actual unanticipated late payment. 12 C.F.R. § 226.4(c) (1981). A late payment “unanticipated” in fact refers to the unforeseeable failure of a customer to pay a bill in a timely manner. FRB Letter No. 1301, 5 CONSUMER CRED. GUIDE (CCH) [31,792 (May 23, 1978). While imposition of a late payment charge docs not, by itself, bring a transaction within the Act, 12 C.F.R. § 226.2(s) (1981) subjects any transaction containing a finance charge to the Act. Thus, characterizing a charge as a late payment or finance charge is significant in determining whether or not disclosures must be made in any consumer credit transaction.

A late payment charge should be contrasted with a finance charge, which is the sum of all charges incident to, or conditioned on, the extension of credit. A finance charge may include any of the following types of charges:

  • (1) Interest or any amounts payable under point, discount or other systems of addi-tional charges;

  • (2) Service or carrying charges;

  • (3) Loan fees, finder’s fees, or similar charges;

  • (4) Fees for investigation or credit reports;

  • (5) Charges or premiums or any insurance written in connection with any credit transaction, protecting the creditor against the obligor’s default. 15 U.S.C. § 1605(a) (1976 & Supp. IV 1980). See also 12 C.F.R. § 226.4(a) (1981).

12 C.F.R. § 226.401(b) (1981) sets forth three conditions to finding that a charge is a finance charge:

  • [1] When in the ordinary course of business a vendor’s billings are not paid in full within that stipulated period of time, and under such circumstances the vendor does not, in fact, regard the accounts in default, but

  • [2] continues or will continue to extend credit, and

  • [3] imposes charges periodically for delaying payment of such accounts from time to time until paid, the charge so imposed comes within the definitions of a “finance charge."

Whether or not a vendor considers an account in default depends upon the vendor’s actions. Relevant factors including whether the vendor continues to extend credit to customers after default, whether the vendor undertakes commercially reasonable efforts to correct the situation by promptly notifying the customer of the delinquency, and whether the vendor attempts to collect the delinquent account. See FRB Official Staff Interpretation No. FC-0060, 42 Fed. Reg. 25,489 (1977); FRB Letter No. 912 [1974-77 Transfer Binder] Consumer Cred. Guide (CCH) 31,246 (Aug. 13, 1975); FRB Letter No. 797 [1974-77 Transfer Binder] Consumer Cred. Guide (CCH) 31,119 (May 16, 1974); [1969-74 Transfer Binder] Consumer Cred. Guide (CCH) 30,088 (July 9, 1969).

50 15 U.S.C. § 1602(f) (Supp. IV 1980). Regulation Z, 12 C.F.R. § 226.2(s) defines a creditor similarly.

A recently enacted amendment to the Truth in Lending Act, which became effective March 31, 1982, simplifies the statutory definition by specifying that it applies to persons who regularly extend crcdit and to persons to whom a debt is, on its face, initially payable. This is intended to eliminate confusion regarding the responsibilities of assignees and arrangers of crcdit. S. REP. NO. 368, 96th Cong. 2d Sess. 3, 24 (1980), reprinted in 1980 U.S. Code CONG. & Ad. NEWS 836, 857. Hospitals are unaffected by the amendment since they are neither assignees nor credit arrangers.

51 616 F.2d 328, 336 (7th Cir. 1980).

52 Id.

53 463 F. Supp. 152, 154 (S.D. Ind. 1979).

54 616 F.2d 328, 336 (7th Cir. 1980).

55 Id.

56 Id. at 338. In reaching this ruling, the court relied on the facts that the hospital considered any account not settled within 48 days delinquent, and that it took commercially reasonable efforts to collect these accounts. See supra note 49.

57 616 F.2d 328, 338 (7th Cir. 1980).

58 id. The court refused to decide whether patients commencing payments from the coupon books consummate credit transactions with the hospital, since neither appellant had done so. Id.

59 Id. at 336.

60 For a related discussion of the disclosure requirements with which physicians must comply, should they fall within the Act, see Buckman, Consumer Credit and the Learned Professions of Law and Medicine, 1976 B.Y.U. L. Rev. 783, 788-89.

61 12 C.F.R. § 226.2(x) (1981).

62 12 C.F.R. § 226.8(a) (1981).

63 12 C.F.R. § 226.8(b)(1) (1981). FRB Letter No. 170 [1969-74 Transfer Binder] Consumer Cred. Guide (CCH) 30,498 (Oct. 24, 1969), states that in hospital-patient credit transactions, the hospital must make disclosures prior to consummation of the financing arrangements and not the physical act of performing the hospital services.

64 12 C.F.R. § 226.8(c)(1) (1981).

65 12 C.F.R. § 226.8(c)(2) (1981).

66 12 C.F.R. § 226.8(c)(7) (1981).

67 12 C.F.R. § 226.8(b)(2) (1981).

68 12 C.F.R. § 226.8(b)(1) (1981).

69 12 C.F.R. § 226.8(b)(3) (1981).

70 12 C.F.R. § 226.8(b)(4) (1981).

71 12 C.F.R. § 226.8(c)(4) (1981).

72 12 C.F.R. § 226.8(b)(4) (1981).

73 12 C.F.R. § 226.8(b)(5) (1981).

74 15 U.S.C. § 1640(a)(1) (Supp. IV 1980).

75 15 U.S.C. § 1640(a)(3) (Supp. IV 1980).

76 15 U.S.C. § 1640(a)(2)(A) (Supp. IV 1980).

77 15. U.S.C, § 1640(a)(2)(B) (Supp. IV 1980).

78 For example, the FRB could require hospitals permitting patients to pay for services under any type of installment payment plan to comply with the Act. The FRB could also detail other types of hospitaI*patient transactions which would mandate compliance with the Act. For example, any hospital routinely requiring patients to provide reimbursement for costs of extending credit would be required to comply with disclosure requirements. Thus, although a hospital could be found to be a creditor regarding some of its patient transactions, it would not be required to comply with disclosure requirements of the Act for all transactions. For instance, in Anderson v. Houston County Hosp. Bd.” 381 So. 2d 68 (Ala. Civ. App. 1980), the court recognized that a hospital could be a creditor under the state truth in lending act, but concluded that the defendant hospital was excused from compliance with the Act, since the hospital had not imposed a finance charge upon a patient’s account. 381 So. 2d at 70.

79 This analysis, adapted from Boyd, Consumer Law, 8 Tex. Tech. L. Rev. 1077, 1078 (1977), is based on statutory and regulatory provisions. See also Tom Benson Chevyway Rental & Leasing, Inc. v. Alien, 571 S.W.2d 348 (Tex. Civ. App. 1978), cert. denied, 442 U.S. 930 (1979).

80 15 U.S.C. § 1602(f) (Supp. IV 1980).

81 15 U.S.C. § 1602(h) (Supp. IV 1980).

82 15 U.S.C. § 1602(f) (Supp. IV 1980).

83 15 U.S.C. § 1602(0 (Supp. IV 1980).

84 15 U.S.C. §§ 1602(f), 1602(h) (Supp. IV 1980).

85 Under the Act and Regulation Z, the following credit transactions are exempt: business (non-consumer), commercial, agricultural, or governmental credit; transactions in securities or commodities; accounts with a broker-dealer registered with the Securities and Exchange Commission; transactions with governmentally regulated utilities; agricultural credit transactions exceeding $25,000; and certain lease transactions on personal property which are incident to the lease of real property. 15 U.S.C. § 1603 (1976 & Supp. IV 1980);

12 C.F.R. § 226.3 (1981).

86 See Bright v. Ball Mem. Hosp., 616 F.2d 328 (7th Cir. 1980); Anderson, 381 So. 2d 68 (Ala. Civ. App. 1980). C/. Rainer, 79 Misc. 2d 216, 359 N.Y.S.2d 859 (N.Y. Civ. Ct. 1974) (privately practicing physician held not subject to the state truth in lending act).

87 The term “creditor” is defined at 15 U.S.C. § 1602(f) (Supp. IV 1980). See supra note. 50 and accompanying text.

88 Legislative history indicates that the term “creditor” applies to those regularly engaging in credit transactions. A small retailer extending credit only in isolated instances would not be covered. H. REP. 1040, 90th Cong., 2d Sess. 3, 20 (1968), reprinted in 1968 U.S. Code CONG. & AD. NEWS 1962, 1974, 1980.

89 495 F.2d 646, 649 (9th Cir. 1974).

90 432 F. Supp. 887 (W.D.N.C. 1977).

91 495 F.2d 646, 649 (9th Cir. 1974).

92 James, 432 F. Supp. 887, 887 (W.D.N.C. 1977). See also Gerasta v. Hibernia Nat’l Bank, 411 F. Supp. 176, 185 (E.D. La. 1976), rev'd in part, aff’d in part, 575 F.2d 580, 583 (5th Cir. 1978). Gerasta followed the Eby mandate to exclude from the Act those persons extending credit only occasionally, in isolated circumstances, and where such extensions of credit comprised only incidental portions of their businesses.

93 Bright v. Ball Mem. Hosp. 616 F.2d 328, 336 (7th Cir. 1980).

94 This conclusion is not altered by the fact that Ball Memorial was a nonprofit hospital, since the FRB explicitly has recognized that a nonprofit Hospital can be a creditor. See, e.g., FRB Letter No. 960 [1974-77 Transfer Binder] CONSUMER CRED. GUIDE (CCH) 31,299 (Nov. 28, 1975); FRB Letter [1969-74 Transfer Binder] CONSUMER CRED. GUIDE (CCH) K 30,033 (April II, 1969).

95 95 A finance charge is:

the sum of all charges, payable directly or indirectly by the person to whom the credit is extended, and imposed directly or indirectly by the creditor as an incident to the extension of credit… . Examples of charges which are included in the finance charge include any of the following types of charges, which are applicable:

  • (1) Interest, time price differential, and any amount payable under a point, discount, or other system of additional charges.

  • (2) Service or carrying charge.

  • (3) Loan fee, finder’s fee, or similar charge.

  • (4) Fee for an investigation or crcdit report.

  • (5) Premium or other charge for any guarantee or insurance protecting the creditor against the obligor's default or other credit loss.

15 U.S.C. § 1605(a) (Supp. IV 1980).

The definition of a finance charge was amended effective March SI, 1982 to provide that a charge incurred in a similar cash transaction such as a sales tax or a license or registration fee is not equated with a finance charge. S. REP. NO. 368, 96th Cong., 2d Sess. 3, 26 (1980), reprinted in 1980 U.S. Code Cong. &: AD. News 236, 261. See also 12 C.F.R. § 226.4(a) (1981).

96 A finance charge brings the transaction within the Act, while a late payment charge does not. See supra note 49. Both types of charges must be disclosed, but finance charges are included in the computation of the annual percentage rate, while late payment charges are disclosed separately. See 12 C.F.R. § 226*5 (1981). See also Vega v. First Fed. Savings & Loan Ass’n, 622 F.2d 918, 922-23 (6th Cir. 1980) (various charges imposed on real estate loans held late payment charges because they were unanticipated, and were disclosed separately from finance charges).

97 352 F. Supp. 357 (N.D. 111. 1972).

98 id. at 362-63.

99 622 F.2d 918 (6th Cir. 1980).

100 Id. at 922.

101 Bright v. Ball Mem. Hosp., 616 F.2d 328, 338 (7th Cir. 1980).

102 id. at 330-31.

103 supra notes 12-24 and accompanying text.

104 See supra notes 19-24 and accompanying text.

105 See supra note 18. A y4% charge was levied on all accounts unpaid after 30 days.

616 F.2d 328, 330 (7th Cir. 1980). In some cases this same charge would clearly be a finance charge since the court explicitly recognized that the hospital was a creditor with respect to certain patients. Id. at 336. Yet, in Bright's case, the court characterized the standard y4% charge as a late payment charge, suggesting an inconsistent application of the requirement among hospital-patient transactions.

106 For example, several recent eases recognized that hospitals in the state of Arizona may not deny emergency care to any patient without cause. In Guerrero v. Copper Queen Hosp., 112 Ariz. 104, 537 P.2d 3129 (1975), the Arizona Supreme Court held that state public policy requires private hospitals to maintain facilities for emergency care. The court concluded that a licensed hospital may not deny emergency care to any patient without cause. In Hiser v. Randolph, 126 Ariz. 608, 617 P.2d 774 (Ariz. Ct. App. 1980), the court held that a hospital providing emergency room services must treat anyone needing such services.

See also 42 C.F.R. § 53.111 (1980), regulations promulgated under the Hill-Burton legislation, 42 U.S.C. §§ 291-291o (1976), 300o-300u (1976 8c Supp. IV 1980), stating that facilities providing emergency services are not in compliance with their assurance to make services available to residents of the community if they deny needed emergency services to any person unable to pay for them.

107 This was in fact the view advanced by the Bright court, 616 F.2d 328, 337 (7th Cir. 1980).

108 Mourning v. Family Publication Serv., Inc., 411 U.S. 356, 366 (1973).

109 id.

110 Id. at 369.

111 508 F. Supp. 116 (E.D. Mo. 1980).

112 386 F. Supp. 241 (S.D.N.Y. 1974).

113 12 C.F.R. § 226.2(s) (1981). See also Gilbert v. Atlantic Richfield Co., 448 F. Supp. 440, 443 (D. Conn. 1978). This rule was upheld by the United States Supreme Court in Mourning, 411 U.S. 356, 364-75 (1973), where plaintiff sought to recover a civil penalty for the defendant corporation's failure to make disclosures required by the Act. Defendant contended that the FRB exceeded its authority in promulgating the rule, arguing that the rule was inconsistent with the enabling statute, 15 U.S.C. §§ 1602(f). 1631, 1640(a) (1972). Under these sections, disclosure was required only in transactions involving imposition of a finance charge. The FRB rule, on the other hand, required disclosure in any transaction providing for payment in four or more installments, regardless of whether there is a finance charge. 12 C.F.R. § 226.2(k) (1972) (This section presently appears as 12 C.F.R. § 226.2(s) (1981)). Defendant argued that the statute's specificity implied that any transaction not subject to disclosure under the terms of the Act Was intended by Congress to remain unregulated.

The Mourning court rejected this argument as inconsistent with the FRB's broad rulemaking authority. Id. at 372-73. The court also noted that nothing in the Act suggested that Congress had made a comprehensive and exclusive list of transactions properly regulated under the enabling statute. Congress later amended the Act to conform to the regulation. 15 U.S.C. § 1602(f) (1976).

114 FRB Letter No. 909 [1974-77 Transfer Binder] CONSUMER CRED. GUIDE (CCH) 31,243 (Aug. 1, 1975). The FRB has also required hospitals with payment plans containing a finance charge or imposing a service charge on bills outstanding for six months to comply with the Act. FRB Letter No. 960 [1974-77 Transfer Binder] Consumer Cred. Guide (CCH) "[ 31,299 (Nov. 28, 1975); FRB Letter . No. 30 [1969-74 Transfer Binder] Consumer Cred. Guide (CCH) [ 30,086 (July 8, 1969); FRB Letter [1969-74 Transfer Binder] Consumer Cred. Guide (CCH) [30,033 (Apr. 11, 1969).

115 U.S. Dept, of Commerce, Statistical Abstract of the United States 105 (101st ed. 1980).

116 See supra note 29 and accompanying text.

117 15 U.S.C. § 1602(f) (Supp. IV 1980).

118 92 N.M. 691, 594 P.2d 351 (Ct. App. 1979).

119 92 N.M. at 693. 594 P.2d at 353.

120 FRB Official Staff Interpretation FC-0101, 42 Fed. Reg. 40,424 (1977); FRB Letter No. 1230 [1974-77 Transfer Binder] Consumer Cred. Guide (CCH) f 31,669 (Aug. 9, 1977).

121 15 U.S.C. § 1602(f) (Supp. IV 1980).

122 See supra note 44.

123 FRB Letter No. II [1969-74 Transfer Binder] Consumer Cred. Guide (CCH) K 30,037 (June 5, 1969).

124 See supra notes 12-24 and accompanying text.

125 The conclusion that the Bright court should have held Ball Memorial subject to the Act’s disclosure requirements in its transactions with Bright is mandated by FRB administration of the Act, federal court interpretations of the Act provisions, and two state court decisions concerning hospital liability under state truth in lending acts. Since state acts have been modeled after the federal act, the rationale for these decisions may be applicable to construing the federal act.

In Ratner v. Drucker, 79 Misc. 2d 216, 359 N.Y.S.2d 859 (Civ. Ct. 1974), the court held that a licensed physician rendering general medical services had not consummated a consumer credit transaction since the physician had not provided services to “consumers” or “purchasers,” but to “patients,” persons not deemed debtors engaging in consumer credit transactions. (This conclusion was not supported by fact or precedent.) Nonetheless, the court also observed that if a physician had entered into a special written agreement with a patient, specifically providing for the extension of credit, the transaction might be considered a consumer credit transaction. 79 Misc. 2d at 218, 359 N.Y.S.2d at 862.

In another case, Anderson v. Houston County Hosp. Bd" 381 So. 2d 68 (Ala. Civ. App. 1980), an Alabama court concluded that defendant hospital was not a creditor under the Alabama Consumer Credit Code, though the court stated that a hospital would be a creditor within the Code if it regularly extended credit for which payment of a finance charge was required. 381 So. 2d at 70.

126 See supra notes 87-94 and accompanying text.

127 See supra note 123 and accompanying text.

128 See sttpra notes 117-25 and accompanying text.

129 See supra note 123 and accompanying text.

130 See supra notes 95-107 and accompanying text.

131 See supra notes 108-16 and accompanying text.

132 See 15 U.S.C. § 1601(a) stating that the purpose of the Act is to assure “a meaningful disclosure of credit terms so that the consumer will be able to compare more readily the various credit terms available to him and avoid the uninformed use of credit, and to protect the consumer against inaccurate and unfair credit billing and credit card practices 15 U.S.C. § 1601(a) (1976). See also 12 C.F.R. § 226(a)(2) (1981). This dual purpose of the Act has also been rccognizcd by courts. See, e.g., White v. Arlen Realty & Dev. CoTp., 540 F.2d 645, 619 (4th Cir. 1975). As another court stated:

The Truth in Lending Act was enacted by Congress to serve two purposes: (1) to promote the full disclosure of credit terms in consumer credit transactions, and (2) to prescribe a uniform method for stating these terms better to enable the consumer to compare “the various credit terms available to him and avoid the uninformed use of credit.”

Barber v. Kimbrell's, Inc., 577 F.2d 216 (4th Cir.), cert, denied, 439 U.S. 934 (1978).

133 For this reason, the FRB explicitly has required charitable organizations, including hospitals, to comply with the Act. FRB Letter [1969-74 Transfer Binder] Consumer Cred. Guide (CCH) [30,027 (May 7, 1969).