Justia Health Law Opinion Summaries

Plaintiff Anna Sandoval-Ryan signed admission documents on behalf of her brother, Jesus Sandoval, following his admission to Sacramento Post-Acute (Post- Acute), a skilled nursing facility owned by Oleander Holdings, LLC (Oleander) and Plum Healthcare Group, LLC (Plum Healthcare). Among the documents plaintiff signed were two agreements to arbitrate claims arising out of the facility’s care for Sandoval. Sandoval’s condition deteriorated while being cared for at the facility, and he was transferred to a hospital where he later died. Plaintiff sued defendants Post-Acute, Oleander, and Plum Healthcare in superior court; she brought claims on her own behalf and on behalf of Sandoval. Defendants moved to compel arbitration of plaintiff’s claims. The trial court denied the motion on the basis the agreements were invalid because they were secured by fraud, undue influence, and duress. Defendants appealed the trial court’s ruling, contending the parties agreed to allow the arbitrator to decide threshold questions of arbitrability, and the trial court erred by deciding the issue instead. Absent clear and unmistakable language delegating threshold arbitrability issues to the arbitrator, the Court of Appeal concluded defendants’ claim lacked merit. View "Sandoval-Ryan v. Oleander Holdings" on Justia Law

The Court of Appeal affirmed the reappointment of S.A.'s conservator under the Lanterman-Petris-Short Act and the trial court's order that she can be medicated against her will. The court held that substantial evidence showed that S.A. was gravely disabled where S.A. had schizophrenia and lacked insight about her mental illness, S.A. would not take medication without the support of a conservator, and S.A. cannot provide for herself without a conservatorship and without medication. The court also held that the involuntary medication order was proper because substantial evidence established S.A. was unable to make informed treatment decisions. View "Y.A. v. S.A." on Justia Law

Von Staich is incarcerated at San Quentin State Prison, based on 1986 second-degree murder and attempted murder convictions. In May 2020, he sought habeas corpus relief, citing the COVID-19 pandemic. Shortly thereafter, San Quentin suffered a COVID-19 outbreak that infected approximately 75 percent of the inmate population and dozens of prison staff in just weeks. Von Staich is 64 years old and suffers respiratory problems resulting from bullet fragments lodged in his lung; he claimed that he and a 65-year-old cellmate, both of whom had tested positive for COVID-19 (Van Staich was asymptomatic), were in an extremely small open cell and that there is no opportunity for social distancing.The court directed the Warden to transfer Von Staich to a suitable quarantine location, finding that the Warden and the California Department of Corrections and Rehabilitation (CDCR) have acted with deliberate indifference. There is ongoing federal litigation concerning inadequate medical care due to severe overcrowding in the California correctional system and San Quentin has particular risk factors, caused by the age and architecture of the facility. The court acknowledged that the existing Eighth Amendment violation will continue until the population at San Quentin can be reduced to the 50 percent level. Unless CDCR’s existing expedited release programs are sufficient to promptly achieve this population reduction—which, the sheer numbers indicate they cannot be—CDCR will have to find additional means of releasing or transferring prisoners out of San Quentin. View "In re Von Staich" on Justia Law

Plaintiffs filed suit alleging that defendants entered into an illegal referral and kickback scheme in which USC paid below-market rates for hospitalist services from Concord, and Concord self-referred patients to Elevate, which shared ownership with Concord. Plaintiffs further alleged that when Plaintiff Alborzi complained to management at Verdugo Hills Hospital about the illegal scheme, the hospital stopped referring patients to him and eventually dissolved the on-call panel in retaliation.The Court of Appeal held that the trial court erred by sustaining the demurrer because plaintiffs were not required to exhaust judicial remedies before asserting the causes of action they have alleged here. The court also found that plaintiffs' complaint alleged sufficient facts to support causes of action for violations of Health and Safety Code section 1278.5 and Business and Professions Code section 17200, et seq., and therefore the demurrer should have been overruled as to those claims. The court further found that plaintiffs' cause of action for violation of Government Code section 12653 failed to allege sufficient facts to state a cause of action, but leave to amend was warranted. Finally, the court found that plaintiffs have abandoned the three causes of action they did not address on appeal. Accordingly, the court reversed the judgment and remanded the action with directions. View "Alborzi v. University of Southern California" on Justia Law

In 2014, plaintiff-respondent Keith Burchell underwent what was supposed to be a simple, outpatient procedure to remove a small mass in his scrotum for testing. His surgeon, Dr. Gary Barker, discovered that the mass was more extensive than expected, believing the mass was malignant. Without consulting either Burchell (who was under anesthesia) or the person Burchell had designated as his medical proxy, Barker removed the mass from both the scrotum and the penis, a different and substantially more invasive procedure than had been contemplated. Burchell suffered serious side effects, some of which are permanent and irreversible. The mass turned out to be benign. Burchell brought suit, alleging professional negligence and medical battery. A jury returned a verdict for Burchell on both causes of action, awarding him $4 million in past noneconomic damages and $5.25 million in future noneconomic damages against Dr. Barker and defendant-appellant Faculty Physicians & Surgeons of the Loma Linda University School of Medicine (FPS). On appeal, FPS argued the award of noneconomic damages should have been reduced to the $250,000 limit on such damages in “any action for injury against a health care provider based on professional negligence” provided by Civil Code section 3333.2(a), part of the Medical Injury Compensation Reform Act of 1975 (MICRA). In the alternative, FPS argued the award of noneconomic damages was excessive and the product of improper argument by Burchell’s counsel, so the Court of Appeal should reverse and remand for new trial unless Burchell accepts a reduction of the award to an amount we deem reasonable. Finally, FPS argued Burchell’s offer to compromise pursuant to Code of Civil Procedure section 998 was invalid, so the award of expert witness fees and prejudgment interest should also be reversed. After review, the Court of Appeal rejected FPS' first two arguments, but concurred that Burchell’s section 998 offer was invalid, and therefore reversed the award of expert witness fees and prejudgment interest. View "Burchell v. Faculty Physicians & Surgeons etc." on Justia Law

Four consolidated appeals presented a question of whether medical providers who provided services under California’s Medi-Cal program were entitled to reimbursement for the costs of providing in-house medical services for their own employees through “nonqualifying” self-insurance programs. Even for nonqualifying self-insurance programs, however, the Provider Reimbursement Manual allowed providers to claim reimbursement for reasonable costs on a “claim-paid” basis. Oak Valley Hospital District (Oak Valley) and Ridgecrest Regional Hospital (Ridgecrest) had self-insurance programs providing health benefits to their employees. Claims for in-house medical services to their employees were included in cost reports submitted to the State Department of Health Care Services (DHS). DHS allowed the costs when Oak Valley and Ridgecrest employees received medical services from outside providers but denied costs when the medical services were provided in-house. DHS determined claims paid to Oak Valley and Ridgecrest out of their self-insurance plan for in-house medical services rendered to their employees were not allowable costs. The trial court granted Oak Valley and Ridgecrest's the writ petitions on grounds that costs of in-house medical services were reimbursable so long as they were “ ‘reasonable’ ” as defined by the Provider Reimbursement Manual. DHS appealed in each case. After review, the Court of Appeal concluded Oak Valley’s and Ridgecrest’s self-insurance programs did not meet the requirements of a qualified plan under CMS guidelines and Provider Reimbursement Manual. The Court of Appeal rejected DHS’s contention that Oak Valley and Ridgecrest costs relating to in-house medical services for their employees were inherently unreasonable. To the extent DHS argued the cost reports were not per se unreasonable, but unreasonable under the circumstances of the actual treatments of Oak Valley and Ridgecrest employees, the Court determined the evidence in the record supports the trial court’s findings that expert testimony established Oak Valley and Ridgecrest incurred actual expenses in providing in-house medical services for their employees that were not otherwise reimbursed. Accordingly, the Court affirmed the trial court’s granting of the petitions for writs of administrative mandate. View "Oak Valley Hospital Dist. v. Cal. Dept. of Health Care Services" on Justia Law

Plaintiffs Rafi Ghazarian and Edna Betgovargez had a son, A.G., with autism. A.G. received applied behavior analysis (ABA) therapy for his autism under a health insurance policy (the policy) plaintiffs had with defendant California Physicians’ Service dba Blue Shield of California (Blue Shield). Mental health benefits under this policy are administered by defendants Magellan Health, Inc. and Human Affairs International of California (collectively Magellan). By law, the policy had to provide A.G. with all medically necessary ABA therapy. Before A.G. turned seven years old, defendants Blue Shield and Magellan approved him for 157 hours of medically necessary ABA therapy per month. But shortly after he turned seven, defendants denied plaintiffs’ request for 157 hours of therapy on grounds only 81 hours per month were medically necessary. Plaintiffs requested the Department of Managed Health Care conduct an independent review of the denial. Two of the three independent physician reviewers disagreed with the denial, while the other agreed. As a result, the Department ordered Blue Shield to reverse the denial and authorize the requested care. Plaintiffs then filed this lawsuit against defendants, asserting breach of the implied covenant of good faith and fair dealing against Blue Shield, and claims for intentional interference with contract and violations of Business and Professions Code section 17200 (the UCL) against defendants. Defendants each successfully moved for summary judgment. As to the bad faith claim, the trial court found that since one of the independent physicians agreed with the denial, Blue Shield acted reasonably as a matter of law. As to the intentional interference with contract claim, the court found no contract existed between plaintiffs and A.G.’s treatment provider with which defendants could interfere. Finally, the court found the UCL claim was based on the same allegations as the other claims and thus also failed. After its review, the Court of Appeal concluded summary judgment was improperly granted as to the bad faith and UCL claims. "[I]t is well established that an insurer may be liable for bad faith if it unfairly evaluates a claim. Here, there are factual disputes as to the fairness of defendants’ evaluation. . . .There are questions of fact as to the reasonability of these standards. If defendants used unfair criteria to evaluate plaintiffs’ claim, they did not fairly evaluate it and may be liable for bad faith." Conversely, the Court found summary judgment proper as to the intentional interference with contract claim because plaintiffs failed to show any contract with which defendants interfered. View "Ghazarian v. Magellan Health" on Justia Law

Defendants Silverado Senior Living Management, Inc., and Subtenant 350 W. Bay Street, LLC dba Silverado Senior Living – Newport Mesa appealed a trial court's denial of its petition to compel arbitration of the complaint filed by plaintiffs Diane Holley, both individually and as successor in interest to Elizabeth S. Holley, and James Holley. Plaintiffs filed suit against defendants, who operated a senior living facility, for elder abuse and neglect, negligence, and wrongful death, based on defendants’ alleged substandard treatment of Elizabeth. More than eight months after the complaint was filed, defendants moved to arbitrate based on an arbitration agreement Diane had signed upon Elizabeth’s admission. At the time, Diane and James were temporary conservators of Elizabeth’s person. The court denied the motion, finding that at the time Diane signed the document, there was insufficient evidence to demonstrate she had the authority to bind Elizabeth to the arbitration agreement. Defendants argued the court erred in this ruling as a matter of law, and that pursuant to the Probate Code, the agreement to arbitrate was a “health care decision” to which a conservator had the authority to bind a conservatee. Defendants relied on a case from the Third District Court of Appeal, Hutcheson v. Eskaton FountainWood Lodge, 17 Cal.App.5th 937 (2017). After review, the Court of Appeal concluded that Hutcheson and other cases on which defendants relied are distinguishable on the facts and relevant legal principles. "When the Holleys signed the arbitration agreement, they were temporary conservators of Elizabeth’s person, and therefore, they lacked the power to bind Elizabeth to an agreement giving up substantial rights without her consent or a prior adjudication of her lack of capacity. Further, as merely temporary conservators, the Holleys were constrained, as a general matter, from making long-term decisions without prior court approval." Accordingly, the trial court was correct that the arbitration agreement was unenforceable as to Elizabeth. Furthermore, because there was no substantial evidence that the Holleys intended to sign the arbitration agreement on their own behalf, it could not be enforced against their individual claims. The Courttherefore affirmed the trial court’s order denial to compel arbitration. View "Holley v. Silverado Senior Living Management" on Justia Law

A juvenile court has the authority to order vaccinations for dependent children under its jurisdiction. Recently enacted Health and Safety Code section 120372, subdivision (d)(3)(C) provides that a state public health officer (SPHO) or a doctor designated by a SPHO "may revoke the medical exemption." The Court of Appeal held that section 120372, subdivision (d)(3)(C) does not deprive the juvenile court of that authority.After determining that this case was not moot, the court rejected father's contention that the juvenile court had no legal authority to revoke the vaccination exemptions from a past treating physician and to order that the children be vaccinated. The court held that evidence in the record supported the juvenile court's finding that the children needed vaccinations. The court also held that there is no statutory bar to preclude the juvenile court from ordering dependent children to receive medically necessary vaccinations. Finally, the court held that the juvenile court could reasonably find that the past treating physician did not know the children's current need for vaccinations and father's remaining contentions do not show grounds for reversal. View "In re S.P." on Justia Law

Objector, a conservatee subject to conservatorship under the Lanterman-Petris-Short Act, contested the petition to reappoint a public guardian as his conservator. On appeal, objector contends the trial court violated Welfare and Institutions Code section 5350, subdivision (d)(2), and denied him due process by failing to commence the jury trial within 10 days of his demand for trial.The Court of Appeal was deeply troubled by the significant delay of over four months in holding a trial on objector's petition, especially given the lack of any justification by the court for most of the delay. The court emphasized the statutory obligation of trial courts to hold a jury trial within 10 days, with only a limited exception for a 15-day continuance if requested by the proposed conservatee. However, the court held that the trial court's failure to commence trial within 10 days of the jury trial demand did not support dismissal of the petition. Rather, the time limit in section 5350, subdivision (d)(2), is directory, not mandatory, because the Legislature has not expressly provided for dismissal of the conservatorship petition if a trial is not held within 10 days. Furthermore, objector was not prejudiced and denied due process. Accordingly, the court affirmed the judgment. View "Conservatorship of Jose B." on Justia Law