Colorow Health Care, LLC; QP Health Care Services, LLC, d/b/a Vivage; Travis Young; Beverly Cole; and Michael Reinhardt, Petitioners
Amy Fischer and Roger Fischer. Respondents Strictly Compliant Text Noncompliant Text
Certiorari to the Colorado Court of Appeals Court of Appeals
Case No. 15CA1252
Attorneys for Petitioners Colorow Health Care, LLC; QP Health
Care Services, LLC, d/b/a Vivage; Beverly Cole, and Michael
Reinhardt: Hall & Evans, L.L.C. David Gelman Alan Epstein
Attorneys for Petitioner Travis Young: Senter Goldfarb &
Rice, LLC Tiffaney Norton Denver, Colorado
Attorneys for Respondents: Laszlolaw Theodore E Laszlo, Jr.
Michael J. Laszlo Boulder, Colorado The Meyer Law Firm, P.C.
William R. Meyer Boulder, Colorado.
Attorneys for Amicus Curiae Colorado Health Care Association:
Kittredge LLC Daniel D. Domenico Denver, Colorado MRDLaw
Michael Francisco Colorado Springs, Colorado.
Attorneys for Amicus Curiae Colorado Trial Lawyers
Association: The Viorst Law Offices, P.C. Anthony Viorst
¶1 When Charlotte Fischer moved into a nursing home, she
received an admissions packet full of forms. Among them was
an agreement that compelled arbitration of certain legal
disputes. The Health Care Availability Act ("HCAA"
or "Act") requires that such agreements contain a
four-paragraph notice in a certain font size and in
bold-faced type. Charlotte's agreement included the
required language in a statutorily permissible font size, but
it was not printed in bold. Charlotte's daughter signed
the agreement on Charlotte's behalf.
After Charlotte died, her family initiated a wrongful death
action against the health care facility in court. Citing the
agreement, the health care facility moved to compel
arbitration out of court. The trial court denied the motion,
and the court of appeals affirmed, determining the
arbitration agreement was void because it did not strictly
comply with the HCAA.
In this opinion, we consider whether section 13-64-403,
C.R.S. (2017), of the HCAA, the provision governing
arbitration agreements, requires strict or substantial
compliance. We hold it demands only substantial compliance.
We further conclude the agreement here substantially complied
with the formatting requirements of section 13-64-403,
notwithstanding its lack of bold-faced type.
Accordingly, we reverse the judgment of the court of appeals
and remand for further proceedings consistent with this
Facts and Procedural History
At eighty-nine years of age, Charlotte Fischer was admitted
to a long-term health care facility operated by Colorow
Health Care, LLC ("Facility") and its management
company, QP Health Care Services, LLC. When Charlotte entered
the Facility, her daughter Judith, acting as Charlotte's
attorney-in-fact, filled out the admissions paperwork. As
part of the entry packet, Judith signed an arbitration
agreement ("Agreement"),  compelling arbitration for any claim
arising from or relating to Charlotte's relationship with
the Facility. The parties do not dispute that Judith signed
it voluntarily on Charlotte's behalf.
Such arbitration agreements are governed by section 13-64-403
of the HCAA. This section instructs health care facilities to
include certain language in these agreements, stating that
patients need not sign them, and that care will not be
withheld from those who refuse to do so. § 13-64-403(4).
The HCAA also obliges health care facilities to print the
language in at least ten-point, bold-faced type. Id.
The Agreement included the HCAA-required language (albeit
with some typos), in twelve-point type and all capital
letters. But the Facility failed to print the language in
Two years later, Charlotte died. According to Charlotte's
granddaughter and grandson-in-law, Amy and Roger Fischer
("Fischers"), Charlotte died as a result of an
assault committed by a Facility employee. The Facility
disputes this. Despite the Agreement, the Fischers filed this
wrongful death action against the Facility, its management
company, and three of the Facility's employees in state
court. The Facility filed a motion to compel arbitration.
Because the Facility did not print the required language in
bold-faced type, the Fischers claimed the Agreement was
invalid. Agreeing with the Fischers, the trial court denied
the motion. The Facility filed an interlocutory appeal.
The court of appeals affirmed, concluding (1) the HCAA
demands strict compliance, and (2) the failure to include the
necessary bold-faced type invalidated the arbitration
agreement. The Facility appealed both conclusions, and we
We begin by discussing the standard of review and general
principles of statutory interpretation. Next, we describe the
relevant portions of the HCAA. We then evaluate whether
section 13-64-403 of that Act requires strict or substantial
compliance with its terms. After considering the
statute's text and purpose, we conclude it demands only
substantial compliance. Last, we assess whether the Agreement
substantially complies with the HCAA's formatting
requirements. We conclude that it does.
Standard of Review
Whether a statute requires strict or substantial compliance
is a question of statutory construction, see, e.g.,
Finnie v. Jefferson Cty. Sch. Dist. R-1, 79 P.3d
1253, 1255-58 (Colo. 2003), which we review de novo.
Lewis v. Taylor, 2016 CO 48, ¶ 14, 375 P.3d
In interpreting statutes, we endeavor to give effect to the
intent of the General Assembly. Coloradans for a Better
Future v. Campaign Integrity Watchdog, 2018 CO 6, ¶
16, 409 P.3d 350, 353. To determine that intent, we begin
with a statute's plain language. Id. We apply
the text as written, reading words in context, §
2-4-101, C.R.S. (2017), and according them their ordinary
meanings. Coloradans for a Better Future, ¶ 16,
409 P.3d at 353.
The Health Care Availability Act
The General Assembly enacted the HCAA, §§ 13-64-101
to -503, C.R.S. (2017), to "assure the continued
availability of adequate health care services . . . by
containing the significantly increasing costs of malpractice
insurance for medical care institutions." §
13-64-102(1). In harmony with that stated intent, section
13-64-403 of the HCAA provides patients and health care
facilities "an option to settle their claims in a timely
fashion through arbitration." Moffett v. Life Care
Ctrs. of Am., 219 P.3d 1068, 1074 (Colo. 2009) (quoting
Colo. Permanente Med. Grp., P.C. v. Evans, 926 P.2d
1218, 1227 n.17 (Colo. 1996) (citing S. Floor Deb. on S.B.
143, 56th Gen. Assemb., 2d Sess. (Feb. 25, 1988) (statement
of Sen. Ted Strickland))). By permitting parties to select
arbitration, the HCAA allows them to curb litigation
expenses, which in turn limits the price of malpractice
insurance. Id. Because arbitration is efficient and
cost effective, Colorado has long recognized it as a
preferred method to settle disputes. See, e.g.,
Lane v. Urgitus, 145 P.3d 672, 678 (Colo. 2006)
("In Colorado, arbitration is a favored method of
While "allow[ing] arbitration of disputes, [the HCAA]
also contains protective provisions curbing abusive practices
in obtaining agreements to arbitrate." Moffett,
219 P.3d at 1073. The General Assembly's stated goal for
section 13-64-403 is to ensure "that an arbitration
agreement be a voluntary agreement between a patient
and a health care provider." § 13-64-403(1)
(emphasis added). To that end, the HCAA imposes certain
requirements on arbitration agreements. Two are relevant to
the case before us now. First, the Act requires health care
companies to include particular language explaining that
these agreements are voluntary. §
Second, it requires that language be printed just above the
signature line in at least ten-point font and bold-faced
Of course, health care companies have to fulfill their
obligations under the HCAA. But how perfectly must they
conform to these requirements? That is, does this law require
strict or substantial compliance? We turn to that question
Does the HCAA Require Strict or Substantial
"Not all directives and requirements declared in statute
law should be understood to have equal force." 3 Norman
Singer & Shambie Singer, Sutherland Statutory
Construction § 57:1 (7th ed. 2017). To be sure, all
statutes demand compliance, but the term
"'[c]ompliance' . . . without further
modification, connotes an element of degree."
Woodsmall v. Reg'l Transp. Dist., 800 P.2d 63,
67 (Colo. 1990) (citations omitted). While some statutes
require strict compliance, others demand only substantial
compliance. Id. "Strict compliance leaves no
margin for error and even technical deficiencies may be
unacceptable. Substantial compliance is less than absolute,
but still requires a significant level of conformity."
The Grp., Inc. v. Spanier, 940 P.2d 1120, 1122
In this case, we find no easy answer from the General
Assembly or from our prior decisions. The General Assembly
often specifies the level of compliance it envisions,
see, e.g., § 8-47-104, C.R.S. (2017)
(substantial compliance); § 10-3-302, C.R.S. (2017)
(strict compliance), but it did not do so anywhere in the
HCAA. And although this court has touched on the HCAA in the
past, see generally Moffett, 219 P.3d 1068
(considering whether the HCAA allows a person possessing a
power of attorney ...