Justia Health Law Opinion Summaries

Articles Posted in California Courts of Appeal

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This case presented a narrow issue of whether respondent Michelle Rouillard in her capacity as director of California’s Department of Managed Health Care (Department) violated the California Administrative Procedure Act (APA) when she sent letters to seven health care service plans directing them to comply with California law in their coverage of abortion services. The issue reduced to whether a “voluntary” abortion was a “medically necessary” procedure that health care service plans were required to cover. The letters told the recipients that health care plans could not limit or exclude coverage for termination of pregnancies. Petitioner Missionary Guadalupanas of the Holy Spirit, Inc., claimed that by sending out the letters interpreting “basic health care services” to include abortions, respondent ignored the APA rulemaking process. The Court of Appeal concluded petitioner’s argument set forth a false dichotomy between a “voluntary” service and a “medically necessary” health care service, which health care plans were required to cover under California Code of Regulations, title 28, section 1300.67."This false assumption led petitioner to the flawed conclusion that the Department’s letters were for the purpose of clarifying an ambiguity in the statute, and that compliance with the rulemaking procedures of the APA was necessary." The Court determined the application of the regulation to the facts of this case was unambiguous, and the Department was not required to comply with the APA. View "Missionary Guadalupanas of the Holy Spirit v. Rouillard" on Justia Law

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The owners and operators of a skilled nursing facility contended the trial court erred when it denied their petition to compel arbitration. They attempted to enforce arbitration in this action for elder abuse and wrongful death brought by a decedent through her husband as successor in interest, her husband individually, and their children. Appellants claimed the successor had signed the arbitration agreements as the decedent’s authorized agent. The trial court determined that although the successor did not sign the agreements as the decedent’s agent, he expressly bound himself to arbitrate all claims he held individually and as the successor in interest. As a result, the decedent’s claim for elder abuse and the husband’s individual claim for wrongful death were subject to arbitration. However, the court denied the petition because the children’s claims were not subject to arbitration, and allowing the arbitration and the litigation to proceed concurrently could result in inconsistent findings of fact and law. Finding no reversible error in the trial court’s judgment, the Court of Appeal affirmed. View "Valentine v. Plum Healthcare Group, LLC" on Justia Law

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Health and Safety Code section 1418.8 concerns nursing home residents who lack the capacity to make their own health care decisions and are without family members or other legal surrogates. The superior court held that the statute, on its face, violates due process under the California Constitution by failing to require notice to residents of a physician’s predicate determinations that the patient lacks capacity, has no surrogate decision-maker, needs a recommended medical intervention, and has a right to judicial review; was never intended to authorize interdisciplinary team (IDT) decision-making for administration of antipsychotic medication, and violates due process, as applied, when used to authorize such drugs; and violates the patient’s privacy rights and is unconstitutional as applied to decisions regarding end of life withdrawal of care. The court of appeal reversed, construing the statute to uphold its constitutionality rather than enjoining its use, and directing the superior court to enter a modified judgment, requiring nursing homes to adopt additional procedures. Written and oral notice must be provided to every resident for whom section 1418.8 is invoked, of any determination of the resident’s incapacity; any determination that no surrogate decision-maker is available; any proposed medical intervention; the fact that a decision will be made by the IDT; the resident’s right to have a patient representative participate in IDT decision-making; and the resident’s right to judicial review of IDT decisions. Except in emergency circumstances, no medical treatment decision by an IDT on behalf of a resident may be implemented until the resident has been given a reasonable opportunity to seek judicial review. Except in emergency circumstances, every IDT must include a patient representative, and where the resident has no family or friend willing to serve, someone unaffiliated with the nursing home must serve as the patient representative. The IDT process may be used to authorize the administration of antipsychotic medications and for decisions to create or change physician orders for life-sustaining treatment, DNRs or comfort care orders, and to transfer patients to hospice care. View "California Advocates for Nursing Home Reform v. Smith" on Justia Law

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Medi–Cal, California’s program under the joint federal-state Medicaid program (Welf. & Inst. Code 14000), provides health care services to certain low-income individuals and families, including the aged, blind, disabled, pregnant women, and others. (42 U.S.C. 1396). Beginning in 2013-2014, there were delays in the determination of applications for Medi-Cal benefits, sometimes with severe consequences for applicants who did not obtain needed medical care. Applicants and an advocacy organization sued the California Department of Health Care Services (DHCS). The court ordered DHCS to make Medi-Cal eligibility determinations within 45 days unless certain exceptions applied. The court of appeal reversed. The trial court did not abuse its discretion by declining to abstain but California law does not impose on DHCS a duty to make all Medi-Cal eligibility determinations within 45 days. There is an obligation to determine Medi-Cal eligibility within 45 days under federal regulation 32 CFR 435.912(c)(3)(ii), but that obligation is subject to exceptions so that the underlying obligation is not sufficiently clear and plain to be enforceable in mandate. It was not clear whether DHCS was out of compliance with an overall performance benchmark of processing 90% of applications within 45 days; absent such evidence, it was error to issue writ relief applicable across-the-board. View "Rivera v. Kent" on Justia Law

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Hoag, a Newport Beach acute care hospital whose patients include beneficiaries of California’s Medi-Cal program, was audited by the California Department of Health Care Services. Hoag’s cost report for fiscal year 2009 included $2,413,623 in audit reimbursement reductions mandated by Assembly Bill (AB) 5 and AB 1183. Hoag filed an administrative appeal that was a blanket challenge to the legality of those assembly bills and the legality of the reimbursement reductions based upon them. Over 18 months later, Hoag submitted a second administrative appeal regarding an alleged $620,903 calculation error that it requested be “incorporated” into the open administrative appeal. Hoag alleged that if its global challenge failed, the $2,413,623 reduction should not include $620,903 stemming from an erroneous calculation of Medi-Cal days subject to the reductions required by the assembly bills. The Department’s Office of Administrative Hearings and Appeals dismissed the administrative appeal of the alleged calculation error as untimely. The court of appeal affirmed. Hoag’s legal challenge to the Medi-Cal audit reduction is a separate issue from its challenge to the alleged calculation error and was, therefore, untimely. View "Hoag Memorial Hospital Presbyterian v. Kent" on Justia Law

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The Medical Board of California sought the medical records of three minors for whom Dr. Kennedy provided vaccination exemptions. After Kennedy refused to produce the records, the Director superior court granted a petition under Government Code section 11187 and ordered Kennedy to produce the records. The court denied Kennedy’s request to stay the order while he pursued appellate review. The court of appeal denied Kennedy’s petition for a writ of supersedeas, rejecting Kennedy’s argument under Code of Civil Procedure section 917.2, which operates automatically to stay an order directing “the assignment or delivery of personal property, including documents,” if the appellant posts an undertaking. The automatic stay provisions apply to civil actions but do not ordinarily apply to a special proceeding. The underlying petition to enforce an administrative subpoena is a special proceeding because it is “established by statute” and commenced independently of a pending action by petition. The court noted that its interpretation is consistent with federal law. An automatic stay would impede the Board’s discharge of its duty to “protect the public against incompetent, impaired, or negligent physicians.” Kennedy has not shown a discretionary stay is warranted; it is likely that the court acted within its discretion in finding the Board’s interest in obtaining records of vaccination exemptions outweighed the patients’ privacy rights, given that the Board must keep the records confidential during its investigation. View "Kennedy v. Super. Court" on Justia Law

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An employer's decision to deny or modify a physician's request for specific medical services for an injured employee is subject to review under the "utilization review" process; utilization review is handled by medical experts. Petitioners sought issuance of a writ of review following a decision by the appeals board concerning an employee and her request for heavy housework assistance. The Court of Appeal granted the employer's petition for review because the appeals board acted in excess of its jurisdiction in addressing, on the merits, the issue of home assessment for housekeeping services. The court explained that the Legislature has expressly stated that it was its intent to have medical professionals ultimately determine the necessity of requested treatment. Therefore, the court annulled the decision of the appeals board and remanded with directions for further proceedings. View "Allied Signal Aerospace v. Workers' Compensation Appeals Board" on Justia Law

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This case arose out of an allegedly negligent surgery performed on real party in interest Jamie Harper at the Modoc Medical Center. Harper did not present a claim to petitioner Last Frontier Healthcare District, doing business as the Modoc Medical Center (Last Frontier), within a year of her surgery. Respondent superior court originally granted Harper’s petition for relief from the claim presentation requirement based in part on its erroneous conclusion that Harper’s giving notice of her intent to sue extended the time to file her application for leave to present a late claim with Last Frontier. Last Frontier filed a petition for writ of mandate and/or prohibition with the Court of Appeal to challenge the superior court's order. The Court of Appeal issued an alternative writ and the trial court responded by issuing a new order properly denying Harper’s petition for relief from the claim presentation requirement: "Giving notice of an intent to file a medical malpractice action under Code of Civil Procedure section 364 does not alter the jurisdictional deadlines underlying an application for relief from the Government Claims Act requirement of presenting a timely claim to a public entity before bringing an action for damages against it." The Court of Appeal denied Last Frontier's petition for mandamus relief because the relief requested was no longer needed. View "Last Frontier Healthcare Dist. v. Superior Ct." on Justia Law

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Plaintiff worked as an anesthesiologist at the hospital, beginning in 1991. In 2011, the California Department of Public Health conducted an unannounced “medication error reduction plan” survey at the hospital, found that Plaintiff was responsible for numerous deficiencies regarding the use of the drug droperidol and that the deficiencies “placed patients at risk for undue adverse medical consequences,” and declared that the hospital was in “immediate jeopardy.” The medical group that is responsible for providing the hospital with physicians agreed to remove Plaintiff from the anesthesia schedule pending further investigation. Plaintiff went through required remediation, returned to work, and continued to improperly use the drug. The practice group terminated his “staff privileges, membership, or employment” with the hospital “based on a medical disciplinary cause or reason” without giving prior notice and a hearing under Business and Professions Code section 809. The trial court awarded Plaintiff damages. The court of appeal affirmed. A hospital may not avoid its obligation to provide notice and a hearing before terminating a doctor’s ability to practice in the hospital for jeopardizing the quality of patient care, by directing the medical group employing the doctor to refuse to assign the doctor to the hospital View "Economy v. Sutter East Bay Hospitals" on Justia Law

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Plaintiffs are four parents and their children residing throughout California and a California nonprofit corporation, A Voice for Choice, Inc. This case rose constitutional challenges to Senate Bill No. 277, which repealed the personal belief exemption to California’s immunization requirements for children attending public and private educational and child care facilities. Plaintiffs sued claiming Senate Bill No. 277 violated their rights under California’s Constitution to substantive due process, privacy, and a public education. The trial court sustained the defendants’ demurrer to plaintiffs’ complaint without leave to amend and plaintiffs appealed. On appeal, plaintiffs also raised an additional argument that Senate Bill No. 277 violated their constitutional right to free exercise of religion, although they did not allege a separate cause of action on that basis in their complaint. The Court of Appeal found "[p]laintiffs' arguments are strong on hyperbole and scant on authority." Finding no violation of plaintiffs' constitutional rights, the Court of Appeal affirmed the trial court. View "Love v. California Dept. of Education" on Justia Law