Justia Health Law Opinion Summaries

Articles Posted in California Courts of Appeal
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In 2020, California and Santa Clara County issued public health orders intended to combat the Covid-19 pandemic, including orders restricting indoor gatherings and requiring face coverings, social distancing, and submission of a social distancing protocol by businesses, including churches. Calvary Chapel failed to comply with those orders. On November 2, 2020, the trial court issued a temporary restraining order, followed by a November 24 modified TRO, and a preliminary injunction that enjoined Calvary from holding indoor gatherings that did not comply with the restrictions on indoor gatherings and requirements that participants wear face coverings and social distance. Calvary was also enjoined from operating without submitting a social distancing protocol. Calvary violated the orders, failing to comply with any of the public health orders.The government sought an order of contempt, which the trial court issued on December 17, 2020, ordering Calvary and its pastors to pay monetary sanctions (Code of Civil Procedure sections 177.51 and 1218(a)). The court of appeal annulled the contempt orders and reversed the sanctions. The temporary restraining orders and preliminary injunctions are facially unconstitutional under the recent guidance of the U.S. Supreme Court regarding the First Amendment’s protection of the free exercise of religion in the context of public health orders that impact religious practice. View "People v. Calvary Chapel San Jose" on Justia Law

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The plaintiff alleged that after being treated at the defendant’s emergency room, he was billed an evaluation and management services (EMS) fee in addition to the charges for individual items of service and treatment. His total charges of $4,593 (before discounts) included the undisclosed EMS Fee of $2,811. He argued that the EMS Fee was charged to patients simply for being seen in the emergency room and is not visibly posted on signage in or around emergency rooms or at its registration windows/desks.The court of appeal affirmed the dismissal of his third amended complaint, alleging violation of the Consumers Legal Remedies Act (CLRA) (Civ. Code 1750). The court noted that another division of the court of appeals recently held that identical allegations do not state a cause of action under the CLRA. The plaintiff acknowledged the hospital’s compliance with California’s “Payers’ Bill of Rights,” Health and Safety Code 1339.50, by listing the EMS Fee in its chargemaster, which is published on defendant’s website. There is no duty to make an additional disclosure of the EMS Fee in light of the public policy reflected in federal and state statutes that emergency room care be provided to patients without delay or questioning about their ability to pay. View "Saini v. Sutter Health" on Justia Law

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Defendant-respondent Inland Empire Health Plan (IEHP) was a health care service plan subject to the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act). It contracted with certain medical groups and providers to provide medical care at reduced costs to eligible beneficiaries of the California Medical Assistance Program (Medi-Cal or Medicaid) who were enrolled with IEHP. Plaintiffs-appellants Allied Anesthesia Medical Group, Inc., and Upland Anesthesia Medical Group were groups of doctors who provided anesthesia services to IEHP’s enrollees for elective, nonemergency surgeries. Plaintiffs had no provider contract with IEHP; however, they had exclusive agreements with the hospitals. Plaintiffs were paid at the Medi-Cal fee schedule rate. In this case, plaintiffs claimed IEHP should have paid them at the reasonable and customary value rate for their services instead of the Medi-Cal fee schedule rate, and requested a declaratory judgment based solely upon the Knox-Keene Act and the Claims Settlement Practices regulation. IHEP demurred on several grounds, including: (1) the cause of action for breach of implied-in-fact contract fails to sufficiently plead “mutual assent” and “legal consideration”; and (2) the cause of action for breach of contract (third party beneficiary) failed to allege how plaintiffs were the express, intended third party beneficiaries of any contract between IEHP and the California Department of Health Care Services. The trial court agreed with IEHP, sustained its demurrer without leave to amend, and entered judgment. Plaintiffs appealed, maintaining IEHP was obligated to pay them the reasonable and customary value rate for their services to IEHP’s enrollees. To this the Court of Appeal disagreed and affirmed the trial court. View "Allied Anesthesia Medical Group v. Inland Empire Health Plan" on Justia Law

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The Court of Appeals affirmed the judgment of the trial court denying Defendant's petition for conditional release on the ground of restoration of sanity pursuant to Cal. Penal Code 1026.2, holding that the trial court did not abuse its discretion in denying the petition.Defendant was charged with homicide, found not guilty by reason of insanity, and committed to Napa State Hospital for a term of fifty years to life. Defendant later filed a petition for release into a conditional release program pursuant to section 1026.2. The trial court denied the petition, finding that Defendant had not carried his burden in showing by a preponderance of the evidence that he would not be a danger to the community if conditionally released. The Court of Appeals affirmed, holding that Defendant was not entitled to relief on his allegations of error. View "People v. Diggs" on Justia Law

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Appellant, a severely disabled child whose congenital abnormalities were undetected during his mother’s pregnancy, sued various medical providers for wrongful life. The California Department of Health Care Services (“DHCS”) asserted a lien on Appellant’s settlement to recover what DHCS paid for his medical care through the state’s Medi-Cal program, and the trial court awarded DHCS the full amount of the lien.   The Second Appellate District reversed, rejecting Appellant’s contentions that DHCS’s lien is preempted by federal law and that there is no substantial evidence that Appellant’s settlement included payments for past medical expenses. However, the court held that the trial court erred by failing to distinguish between past medical expenses and other damages.   The court concluded that the provisions of the Medi-Cal Act permitting DHCS to impose a lien on Appellant’s tort recovery are not preempted by federal law. Further, the court concluded that the trial court did not err by concluding that Appellant’s settlement included past medical expenses. The court reasoned that the Welfare and Institutions Code provides that DHCS “shall have a right to recover . . . the reasonable value of benefits” provided to a MediCal beneficiary, and it further provides that the court, not the Medi-Cal beneficiary, determines what portion of a settlement is fairly allocated to satisfy DHCS’s lien.  However, it does not appear that the trial court determined which portion of Appellant’s settlement was attributable to past medical expenses, thus the court remanded the trial court to apportion the settlement accordingly. View "Daniel C. v. White Memorial Medical Center" on Justia Law

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This putative class action against California and San Diego County officials challenged California Governor Gavin Newsom’s emergency orders and related public health directives restricting business operations during the COVID-19 pandemic. Plaintiffs, owners of affected restaurants and gyms (Owners), primarily contended the orders were procedurally invalid because they were adopted without complying with the Administrative Procedure Act (APA). Furthermore, Owners contended that the business restrictions were substantively invalid because they effected a taking without compensation, violating the Fifth Amendment to the United States Constitution. Rejecting these claims, the superior court sustained demurrers to the third amended complaint without leave to amend and dismissed the action. While the Court of Appeal sympathized with the position some Owners find themselves in and the significant financial losses they alleged, the unambiguous terms of the Emergency Services Act and controlling United States Supreme Court regulatory takings caselaw required that the judgment be affirmed. View "640 Tenth, LP v. Newsom" on Justia Law

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Hospitals provided emergency medical services to members of the county’s health plan, which is licensed and regulated by the state Department of Managed Health Care under the Knox-Keene Health Care Service Plan Act, Health & Saf. Code 1340. The county reimbursed the Hospitals for $28,500 of a claimed $144,000. The Hospitals sued, alleging breach of an implied-in-fact or implied-in-law contract. The trial court rejected the county’s argument that it is immune from the Hospitals’ suit under the Government Claims Act (Gov. Code 810).The court of appeal reversed. The county is immune from common law claims under the Government Claims Act and the Hospitals did not state a claim for breach of an implied-in-fact contract. The county does not contest its obligation to reimburse the Hospitals for the reasonable and customary value of the services; the issue is what remedies may be pursued against the county when the reasonableness of the reimbursement is disputed. The Knox-Keene Act provides alternative mechanisms to challenge the amount of emergency medical services reimbursements. A health care service plan has greater remedies against a private health care service plan than it does against a public entity health care service plan, a result driven by the Legislature broadly immunizing public entities from common law claims and electing not to abrogate that immunity in this context. View "County of Santa Clara v. Superior Court" on Justia Law

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Dual Diagnosis Treatment Center, Inc., d/b/a Sovereign Health of San Clemente, and its owner, Tonmoy Sharma, (collectively Sovereign) appealed the trial court's denial of Sovereign's motion to compel arbitration of claims asserted by Allen and Rose Nelson for themselves and on behalf of their deceased son, Brandon. The Nelsons alleged a cause of action for wrongful death, and on behalf of Brandon, negligence, negligence per se, dependent adult abuse or neglect, negligent misrepresentation, and fraud. According to the complaint, despite concluding that 26-year-old "Brandon requires 24 hour supervision ... at this time" after admitting him to its residential facility following his recent symptoms of psychosis, Sovereign personnel allowed him to go to his room alone, where he hung himself with the drawstring of his sweatpants. The trial court denied Sovereign's motion to compel arbitration because: (1) the court found Sovereign failed to meet its burden to authenticate an electronic signature as Brandon's on Sovereign's treatment center emollment agreement; and (2) even assuming Brandon signed the agreement, it was procedurally and substantively unconscionable, precluding enforcement against Brandon or, derivatively, his parents. Sovereign challenged the trial court's authentication and unconscionability findings. Finding no reversible error, the Court of Appeal affirmed the trial court's judgment. View "Nelson v. Dual Diagnosis Treatment Center" on Justia Law

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Plaintiff sued Adventist Health System/West and Hanford Community Hospital (collectively, Hospital), for a violation of the Consumer Legal Remedies Act (CLRA; Civ. Code, Sec. 1750 et seq.) and declaratory relief.Plaintiff received emergency treatment and services at Hospital’s emergency room in Hanford. The emergency room did not contain a posted notice or warning that a substantial EMS Fee would be added to Plaintiff’s bill on top of the individual charges for each item of treatment and services provided to her. Plaintiff alleged Hospital engaged in a deceptive practice when it did not disclose its intent to charge her a substantial emergency room EMS Fee.Hospital moved for judgment on the pleadings, which the trial court granted. The court found that although Plaintiff’s pleading adequately alleges Hospital failed to disclose facts that were known exclusively by Hospital and were not reasonably accessible to Plaintiff, the court concluded Plaintiff’s conclusory allegation that she relied on the failure to disclose the EMS Fee and thereafter received treatment at the Hospital does not plead the element of reliance with sufficient particularity.In an unpublished part of the opinion, the court concluded Plaintiff has not carried her burden of demonstrating the trial court erred when it denied her leave to file a third amended complaint. Thus, the court affirmed the judgment. View "Torres v. Adventist Health System/West" on Justia Law

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Johnson & Johnson, Ethicon, Inc., and Ethicon US, LLC (collectively, Ethicon) appealed after a trial court levied nearly $344 million in civil penalties against Ethicon for willfully circulating misleading medical device instructions and marketing communications that misstated, minimized, and/or omitted the health risks of Ethicon’s surgically-implantable transvaginal pelvic mesh products. The court found Ethicon committed 153,351 violations of the Unfair Competition Law (UCL), and 121,844 violations of the False Advertising Law (FAL). The court imposed a $1,250 civil penalty for each violation. The Court of Appeal concluded the trial court erred in just one respect: in addition to penalizing Ethicon for its medical device instructions and printed marketing communications, the court penalized Ethicon for its oral marketing communications, specifically, for deceptive statements Ethicon purportedly made during one-on-one conversations with doctors, at Ethicon-sponsored lunch events, and at health fair events. However, there was no evidence of what Ethicon’s employees and agents actually said in any of these oral marketing communications. Therefore, the Court of Appeal concluded substantial evidence did not support the trial court’s factual finding that Ethicon’s oral marketing communications were likely to deceive doctors. Judgment was amended to strike the nearly $42 million in civil penalties that were imposed for these communications. View "California v. Johnson & Johnson" on Justia Law