Justia Health Law Opinion Summaries

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

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

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

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

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

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

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

In 2015, the California Governor issued a proclamation convening a special session of the Legislature for certain specified purposes, including to “[i]mprove the efficiency and efficacy of the health care system, reduce the cost of providing health care services, and improve the health of Californians.” Pertinent to this appeal, the Legislature enacted the End of Life Option act, which legalized physician-assisted suicide for the terminally ill. During a special session, the Legislature passed the Act. Plaintiffs were five individual physicians along with a professional organization that promoted ethical standards in the medical profession (collectively the Ahn parties), who asserted causes of action for violations of due process, of equal protection, and of California constitutional limitations on the power of the Legislature to act in special session. In February 2018, the Ahn parties filed a motion for judgment on the pleadings. After hearing argument, the trial court ruled that it would grant the motion, without leave to amend. On May 24, 2018, the trial court entered judgment in favor of the Ahn parties, and enjoined enforcement of the Act. Days later, three nonparties5 (collectively the Fairchild parties) filed an ex parte application to vacate the judgment, which was denied. The State filed a petition for writ of mandate to the Court of Appeal along with a request for an immediate stay. The Court granted a temporary stay, during which the Fairchild parties filed an appeal of the judgment, contending that, as a result of the denial of their ex parte application to vacate the judgment, they had standing to appeal and, in that appeal, to challenge the judgment on the merits. The Ahn parties disputed this. The issue this case presented for the Court of Appeal’s review was not whether the Fairchild parties are parties to the appeal, but only whether they were parties to this writ proceeding. Admittedly, the State’s writ petition did not name the Fairchild parties, nor did the Fairchild parties formally move to intervene. “However, a person can become a party to an action, even if not named in the complaint, by appearing and participating without any objection by the other parties. We see no reason why this principle should not also apply to a writ proceeding. This is not to say that they are necessarily proper parties.” The Court ultimately concluded the Ahn parties lacked standing on any of the theories they asserted in this appeal. The Court was unclear whether, on remand, they would be able to amend their complaint so as to allege standing, whether the trial court will grant them leave to do so, or whether they will be able to prove up their amended allegations. “It is possible (though by no means certain) that we will see this case again; if so, however, at least we will be sure that the constitutional issue is properly presented.” The Court issued a writ of mandate to direct the superior court to vacate its order granting the motion for judgment on the pleadings and to vacate the judgment. View "California v. Superior Court (Ahn)" on Justia Law

Harvey Cohoon was diagnosed with a treatable form of cancer and was residing at Victoria Healthcare Center while he underwent treatment and recovered from various injuries he had suffered. For 19 days, Cohoon did well at Victoria Center. On the 20th day, he was observed to have difficulty swallowing thin liquids, and after evaluation, his diet was changed. Plaintiff contended that change was not properly communicated to the kitchen, and that night he was served a dinner that did not comport with his new diet. Less than 20 minutes after being served dinner, a nurse found him in respiratory arrest. The paramedics had to remove large pieces of chicken from his throat before intubating him. More pieces of chicken were removed from his airway at the hospital. He died the following day due to complications from oxygen deprivation to his brain. Donna Cochrum, Cohoon’s niece, filed suit against Victoria Center, asserting causes of action for elder abuse and negligence. As personal representative of Cohoon’s estate, Cochrum asserted a wrongful death cause of action. A jury returned a verdict in favor of Cochrum on all causes of action. Subsequently, the trial court granted a motion for judgment notwithstanding the verdict (JNOV), finding insufficient evidence of recklessness to support the elder abuse cause of action. It also adjusted the remaining damages pursuant to Civil Code section 3333.2. Cochrum appealed the amended judgment, contending the evidence supported the elder abuse cause of action. Two of the defendants cross-appealed, contending the court improperly applied the Medical Injury Compensation Reform Act of 1975 cap. Finding no reversible error, the Court of Appeal affirmed the amended judgment. View "Cochrum v. Costa Victoria Healthcare, LLC" on Justia Law

The California Legislature reduced Medicaid hospital payments 10 percent between 2008-2011; the federal agency administering the Medicaid program approved the rate reductions. Hospitals alleged the reductions violated the Medicaid Act (42 U.S.C. 1396), which sets out procedural and substantive requirements the state must follow when establishing reimbursement rates. Hospitals unsuccessfully sought to have the rates declared void and almost $100 million in recalculated rates. The court of appeal affirmed, concluding that healthcare providers alleging a violation of section 1396a(a)(30)(A) may not obtain a writ of mandate against state officials to contest Medicaid rates approved by the federal agency that administers the program. Their recourse is an administrative action against the federal agency that approved the rates. While plaintiffs may obtain a writ of mandate for violations of the procedural requirements of section 13(A), no such violation occurred here. View "Santa Rosa Memorial Hospital v. Kent" on Justia Law