Justia Health Law Opinion Summaries

Artur Hefczyc appealed an order denying his motion for class certification in his lawsuit against Rady Children's Hospital-San Diego (Rady). On behalf of a proposed class, Hefczyc sought declaratory relief to establish that Rady's form contract, signed by patients or guarantors of patients who receive emergency room care, authorized Rady to charge only for the reasonable value of its services, and that Rady therefore was not authorized to bill self-pay patients based on its master list of itemized charge rates, commonly referred to as the "Chargemaster" schedule of rates, which Hefczyc alleged was "artificial" and "grossly inflated." The trial court denied Hefczyc's motion for class certification, concluding that the class was not ascertainable, that common issues did not predominate, and that class action litigation was not a superior means of proceeding. Hefczyc contends that the trial court erred in denying class certification because, as the complaint sought only declaratory relief, the motion for class certification was brought under the equivalent of Federal Rules of Civil Procedure, rule 23(b)(1)(A) or (b)(2) (28 U.S.C.), for which he was not required to establish the ascertainability of the class, that common issues predominated and that class action litigation was a superior means of proceeding. Hefczyc also contended that even if the trial court properly imposed those three requirements in this action, the trial court abused its discretion in concluding that those requirements were not met. After review, the Court of Appeal concluded that Hefczyc's arguments lacked merit, and accordingly affirmed the order denying class certification. View "Hefczyz v. Rady Children's Hosp." on Justia Law

The State of California prevailed in a representative public nuisance action against ConAgra, NL, and Sherwin-Williams. The trial court ordered the defendants to pay $1.15 billion into a fund to be used to abate the public nuisance created by interior residential lead paint in the ten counties represented by the state. The court of appeal affirmed in part, noting that the absence of a regulation or statute declaring interior residential lead paint to be unlawful does not bar a court from declaring it to be a public nuisance. The court reversed in part, holding that substantial evidence did not support causation as to residences built after 1950, and remanded to the trial court with directions to recalculate the amount of the abatement fund to limit it to the amount necessary to cover the cost of remediating pre-1951 homes, and hold an evidentiary hearing regarding the appointment of a suitable receiver. View "People v. ConAgra Grocery Products Co." on Justia Law

To seek redress for an opioid epidemic, characterized by the Court of Appeal as having placed a financial strain on state and local governments dealing with the epidemic’s health and safety consequences, two California counties sued (the California Action) various pharmaceutical manufacturers and distributors, including the appellants in this matter, Actavis, Inc., Actavis LLC, Actavis Pharma, Inc., Watson Pharmaceuticals, Inc., Watson Laboratories, Inc., and Watson Pharma, Inc. (collectively, “Watson”). The California Action alleged Watson engaged in a “common, sophisticated, and highly deceptive marketing campaign” designed to expand the market and increase sales of opioid products by promoting them for treating long-term chronic, nonacute, and noncancer pain - a purpose for which Watson allegedly knew its opioid products were not suited. The City of Chicago brought a lawsuit in Illinois (the Chicago Action) making essentially the same allegations. The issue presented by this appeal was whether there was insurance coverage for Watson based on the allegations made in the California Action and the Chicago Action. Specifically, the issue was whether the Travelers Property Casualty Company of America (Travelers Insurance) and St. Paul Fire and Marine Insurance Company (St. Paul) owe Watson a duty to defend those lawsuits pursuant to commercial general liability (CGL) insurance policies issued to Watson. Travelers denied Watson’s demand for a defense and brought this lawsuit to obtain a declaration that Travelers had no duty to defend or indemnify. The trial court, following a bench trial based on stipulated facts, found that Travelers had no duty to defend because the injuries alleged were not the result of an accident within the meaning of the insurance policies and the claims alleged fell within a policy exclusion for the insured’s products and for warranties and representations made about those products. The California Court of Appeal concluded Travelers had no duty to defend Watson under the policies and affirmed. View "The Traveler's Property Casualty Company of America v. Actavis, Inc." on Justia Law

Plaintiff YDM Management Company, Inc. (YDM) appeals from a judgment of the trial court in favor of defendant Sharp Community Medical Group, Inc. (Sharp), after Sharp successfully moved for summary judgment of YDM's operative complaint. YDM purchased accounts receivable from Doctors Express, a company that operated urgent care facilities in San Diego, for services rendered to Sharp managed care members. In its role as an Independent Practice Association (IPA), Sharp provided health insurance to its managed care members, and paid claims for services provided to its members. At the time that it provided the services at issue to Sharp members, Doctors Express did not have a preferred provider contract with Sharp. Providers without a contract with an IPA were reimbursed for nonemergency medical services provided to the IPA's members at amounts significantly less than the "reasonable and customary value for the health care services rendered." However, an IPA such as Sharp was required by regulation to reimburse out of network providers for the full "reasonable and customary value" for any emergency medical services provided to its members. As the assignee of Doctors Express, YDM filed this lawsuit seeking additional reimbursement from Sharp for services provided by Doctors Express to members of Sharp's health plan, beyond the amount that Sharp had already reimbursed Doctors Express for those services. The trial court granted summary judgment in favor of Sharp. On appeal, YDM contended the trial court erred in granting summary judgment in Sharp's favor based on the declaration of a Sharp employee, and that the court erred in failing to give adequate consideration to the declaration of YDM's expert in concluding that there was no triable issue of material fact. The Court of Appeal concluded the trial court did not err in granting summary judgment in favor of Sharp. View "YDM Management Co., Inc. v. Sharp Community Med. etc." on Justia Law

Plaintiff-appellant Paul Kendall's second amended complaint made several types of class-wide claims that challenged the billing and collection practices of the health facility operating an emergency room where he received care, defendant and respondent Scripps Health (Scripps). Kendall contended that "selfpay" patients, who signed a form during the reception process at the emergency room (an "Agreement for Services at a Scripps Facility"), were being unfairly billed under that contractual agreement at prescribed rates that are listed on a publicly available "charge description master" (Charge Master). This appeal arose out of the trial court's order denying Kendall's motion to certify a proposed class of self-pay patients for the pursuit of two overriding legal theories that applied to both the declaratory relief and statutory claims. Scripps opposed the motion, arguing a class action was not shown to be an appropriate method to pursue the case because of a lack of predominant common issues and of any convincing showing of an ability to ascertain the identity of all the proposed class members. The trial court denied the motion for class certification, concluding that Kendall had not presented any substantial evidence showing there were predominant common issues of law and fact among the putative class members. On appeal, Kendall contends the trial court's order denying class certification of his statutory claims reflects the use of improper criteria and an incorrect legal analysis. Finding no abuse of discretion or lack of substantial evidence, the Court of Appeal affirmed the order denying class certification. View "Kendall v. Scripps Health" on Justia Law

The petition underlying this appeal challenged a trial court order summarily adjudicating a cause of action under the Elder Abuse and Dependent Adult Civil Protection Act (the Act), a cause of action for fraud by concealment, and another for medical battery, while allowing other claims, including one for medical negligence, to proceed to trial. Petitioner Maxine Stewart was the representative of Anthony Carter, a man who died after admission to a hospital owned by real parties in interest, St. Joseph’s Health (et al.). She alleged the hospital “denied and withheld from Mr. Carter the right to refuse an unnecessary surgery, denied and withheld from Mr. Carter the right to be involved in secret hospital meetings to invalidate his designated consent, and denied and withheld from Mr. Carter his right to a second opinion prior to proceeding with an unwarranted surgery that resulted in a hypoxic injury, brain damage, cardiac arrest and his untimely death.” Having concluded the petition might have merit, the Court of Appeal stayed the action in the trial court and requested an informal response. Having received and read the “return by verified answer” that was filed by real parties in interest, the Court then set an order to show cause and requested further briefing on a specific issue. Real parties in interest decided to stand on their informal response in lieu of filing another brief, and Stewart declined to file a traverse. After review, the Court then granted the petition: in the published portion of this opinion, the Court discussed the cause of action for elder abuse to explain how, in its view, a substantial impairment of this right can constitute actionable “neglect” of an elder within the meaning of both the little-invoked catchall definition contained in Welfare and Institutions Code section 15610.57(a)(1), and two of the types of neglect set forth in section 15610.57(a)(2). View "Stewart v. Superior Court" on Justia Law

Marlene Baker LaBerge, a 73-year-old woman, was a resident and patient of a 24- hour skilled nursing facility owned by Italian Maple Holdings, LLC dba La Paloma Healthcare Center (La Paloma). LaBerge's heirs, Paul LaBerge, Suzanne Marx, and Talmadge Baker (collectively Plaintiffs) sued La Paloma and Plum Healthcare, LLC (together Defendants) for elder abuse, violations of the Patient's Bill of Rights as codified at Health and Safety Code section 1430, negligence, and wrongful death. In response, Defendants filed a petition to compel arbitration based on the two arbitration agreements that LaBerge had executed. The two arbitration agreements included language required by Code of Civil Procedure section 1295, subdivision (c), requiring such agreements to include a 30-day "cooling off" period, during which the parties to the agreement may rescind it. Ten days after LaBerge signed the agreements (and therefore, prior to the expiration of the statutorily-required 30- day rescission period), LaBerge passed away. The superior court denied the petition to compel arbitration, relying on Rodriguez v. Superior Court, 176 Cal.App.4th 1461 (2009) to conclude that the agreements were not effective until the 30-day rescission period passed without either party rescinding the agreements; because LaBerge died before the expiration of the 30-day rescission period, the agreements could not be given effect. On appeal, Defendants contended the trial court’s interpretation was wrong, and the Court of Appeal should decline to follow Rodriguez because that case was factually distinguishable from this case. The Court of Appeal concluded the trial court erred in interpreting section 1295, subdivision (c), and that the arbitration agreements were valid and enforceable. Pursuant to the plain language of section 1295, subdivision (c), the terms of those agreements governed the parties' relationship upon their execution; the fact that one signatory died before the expiration of the statutory 30-day rescission period does not render the terms of the parties' agreements unenforceable in the absence of other grounds for not enforcing them. View "Baker v. Italian Maple Holdings" on Justia Law

This case turned on whether an attorney-in-fact who admitted her principal to a residential care facility for the elderly made a “health care” decision. If she did, as the trial court found, she acted outside the scope of her authority under the power of attorney, and the admission agreement she signed, and its arbitration clause this appeal sought to enforce, were void. On these facts the Court of Appeal concluded the decision was health care decision, and the attorney-in-fact who admitted her, acting under the PAL, was not authorized to make those kinds of decisions on behalf of the principal. As a result of this conclusion, the Court affirmed the trial court’s denial of a motion by the residential care facility to compel arbitration. Because the attorney-in-fact acting under the PAL did not have authority to admit the principal to the residential care facility for the elderly, her execution of the admission agreement and its arbitration clause were void. View "Hutcheson v. Eskaton Fountainwood Lodge" on Justia Law

Pacific Bay treated an individual who was a subscriber to a Blue Shield health plan. It submitted invoices to Blue Shield for payment for the services rendered to the subscriber. Pacific Bay contends it was underpaid and brought suit against Blue Shield to recover the additional amount it claimed to be owed. The court sustained Blue Shield's demurrer to the first amended complaint (FAC) without leave to amend, finding that Pacific Bay had not shown that it was entitled to any payment from Blue Shield. As an out-of-network, nonemergency service provider, Pacific Bay was entitled to payment for treating Blue Shield's subscriber under the terms of the applicable evidence of coverage (EOC). Pacific Bay did not allege Blue Shield paid it improperly under the EOC, nor did it argue that it could allege additional facts to support such a claim. Pacific Bay claimed it was underpaid. Against this backdrop, Pacific Bay's other allegations did not give rise to any valid cause of action. View "Pacific Bay Recovery v. Cal. Physicians' Services" on Justia Law

At issue was whether the trial court employed the correct legal standard in determining the reasonable value of appellant's emergency treatment of four patients as an interventional cardiologist. The Court of Appeal agreed with the parties that the court in Children's Hospital Central California v. Blue Cross of California, (2014) 226 Cal.App.4th 1260, correctly applied the governing standard. The Court of Appeal declined to adopt appellant's narrow reading of the case and, instead, held that Children's Hospital supports the decision that the trial court made here to consider a variety of evidence to determine the "reasonable market value" of the services that appellant provided under quantum meruit principles. Accordingly, the court affirmed the judgment of the trial court. View "Sanjiv Goel, M.D., Inc. v. Regal Medical Group" on Justia Law