Justia Health Law Opinion Summaries

The Board of Directors (the Board) of Bear Valley Community Hospital (Bear Valley) refused to promote Dr. Robert O. Powell from provisional to active staff membership and reappointment to Bear Valley's medical staff. Dr. Powell appealed the superior court judgment denying his petition for writ of mandate to void the Board's decision and for reinstatement of his medical staff privileges. Dr. Powell practiced medicine in both Texas and California as a general surgeon. In 2000, the medical executive committee of Brownwood Regional Medical Center (Brownwood), in Texas, found that Dr. Powell failed to advise a young boy's parents that he severed the boy's vas deferens during a hernia procedure or of the ensuing implications. Further, the committee found that Dr. Powell falsely represented to Brownwood's medical staff, on at least two occasions, that he fully disclosed the circumstances to the parents, behavior which the committee considered to be dishonest, obstructive, and which prevented appropriate follow-up care. Based on the committee's findings, Brownwood terminated Dr. Powell's staff membership and clinical privileges. In subsequent years, Dr. Powell obtained staff privileges at other medical facilities. In October 2011, Dr. Powell applied for appointment to the medical staff at Bear Valley. On his initial application form, Dr. Powell was given an opportunity to disclose whether his clinical privileges had ever been revoked by any medical facility. In administrative hearings generated by the Bear Valley Board’s decision, there was a revelation that Dr. Powell had not been completely forthcoming about the Brownwood termination, and alleged the doctor mislead the judicial review committee (“JRC”) about the circumstances leading to that termination. Under Bear Valley's bylaws, Dr. Powell had the right to an administrative appeal of the JRC's decision; he chose, however, to bypass an administrative appeal and directly petition the superior court for a writ of mandamus. In superior court, Dr. Powell filed a petition for writ of mandate under Code of Civil Procedure sections 1094.5 and 1094.6, seeking to void the JRC's/Board's decision and to have his medical privileges reinstated. The trial court denied the petition, and this appeal followed. On appeal of the superior court’s denial, Dr. Powell argued he was entitled to a hearing before the lapse of his provisional staff privileges: that the Board surreptitiously terminated his staff privileges, presumably for a medical disciplinary cause, by allowing his privileges to lapse and failing to act. The Court of Appeal determined the Bear Valley Board had little to no insight into the true circumstances of Dr. Powell’s termination at Brownwood or the extent of his misrepresentations, thus the Board properly exercised independent judgment based on the information presented. In summary, the Court of Appeal concluded Bear Valley provided Dr. Powell a fair procedure in denying his request for active staff privileges and reappointment to the medical staff. View "Powell v. Bear Valley Community Hospital" on Justia Law

The Court of Appeal affirmed the trial court's order appointing the Public Guardian of the County of Ventura as the conservator of objector's person and estate after the jury found beyond a reasonable doubt that he was gravely disabled as a result of mental disorder. The court held that the trial court committed harmless error by giving instructions concerning possible consequences should a party prevail. In this case, the trial court's instruction informed the jury about the duration and types of treatment that may be ordered if a conservatorship was established. View "Conservatorship of P.D." on Justia Law

Al-Shaikh, an orthopedic surgeon, moved his Fremont practice and sought approval by the Department of Health Care Services (DHCS), under Medi-Cal regulations. He had been an approved Medi-Cal provider in Fremont for six years. DHCS denied his application, claiming that Al-Shaikh’s fee arrangement with his billing service was unlawful. Al-Shaikh appealed. DHCS agreed the provisions it had cited were inapplicable but cited another state law, incorporating a federal Medicaid regulation. Al-Shaikh filed suit, then relocated his Auburn practice, for which he used the same billing service; the relocation was approved by a different DHCS regional office. Al-Shaikh cited an Office of the Inspector General publication that expressly states his fee arrangement does not violate federal law. DHCS approved the Fremont office after three years. The court dismissed the case as moot. Al-Shaikh moved for fees under Code of Civil Procedure 1028.5, which allows a small business or a licensee that prevails in an action against a state regulatory agency to recover a maximum of $7,500 in fees if the agency acted without substantial justification. The court of appeal directed the superior court to award Al-Shaikh the full amount recoverable under section 1028.5. DHCS has an obligation to be knowledgeable about the law it is charged with implementing and was unable to cite a case or regulatory decision supporting its position; it acted without substantial justification. View "Al-Shaikh v. State Department of Health Care Services" on Justia Law

Dr. Erdle was arrested for possession of cocaine. He successfully completed drug treatment under a deferred entry of judgment program. Before completion of his drug program and dismissal of his criminal matter, the Medical Board filed an accusation. Erdle argued that he could not be disciplined because the action was based entirely on information obtained from his arrest record. Penal Code 1000.4 provides that “[a] record pertaining to an arrest resulting in successful completion of a pretrial diversion program shall not ... be used in any way that could result in the denial of any employment, benefit, license, or certificate.” Business and Professions Code section 492, however, states: “Notwithstanding any other provision of law, successful completion of any diversion program under the Penal Code . . . shall not prohibit" disciplinary action by specific agencies, "notwithstanding that evidence of that misconduct may be" in an arrest record. The ALJ concluded that section 492 permits discipline but that arrest records should not be permitted at the hearing; that testimony by the arresting officer was allowable; and that cause for discipline existed. The court of appeal held that section 492 creates a blanket exemption from the restrictions contained in section 1000.4 for licensing decisions made by the specified healing arts agencies. View "Medical Board of California v. Superior Court" on Justia Law

This case turned on whether an attorney-in-fact made a “health care decision” by admitting her principal to a residential care facility for the elderly and, in the process, agreeing to an arbitration clause. The trial court found she acted outside the scope of her authority under the power of attorney, and the arbitration clause this appeal seeks to enforce was void. The issue this case presented for the Court of Appeal’s review centered on the scope of two statutes, the Power of Attorney Law (Prob. Code, sec. 4000 et seq. (PAL)), and the Health Care Decisions Law (Prob. Code, sec. 4600 et seq. (HCDL)), in light of the care a residential care facility for the elderly agreed to provide, and actually provided, in this instance (Health & Saf. Code, sec. 1569 et seq.). For resolution, the Court had to parse the authority of two of the principal’s relatives, one holding a power of attorney under the PAL and one holding a power of attorney under the HCDL. The Court concluded admission of decedent to the residential care facility for the elderly in this instance was a health care decision, and the attorney-in-fact who admitted her, acting under the PAL, was not authorized to make health care 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 make health care decisions for her principal, her execution of the admission agreement and its arbitration clause are void. View "Hutcheson v. Eskaton Fountainwood Lodge" on Justia Law

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