Justia Health Law Opinion Summaries

Salvatore Baglione, insured under Health Net of California Inc. through his employer, the County of Santa Clara, brought a lawsuit against Health Net alleging breach of contract and bad faith. This followed Health Net's inconsistent authorization of a medication prescribed for Baglione's chronic condition. Health Net moved to compel arbitration of Baglione's claims based on an arbitration provision in the enrollment form Baglione had signed. The Superior Court of Los Angeles County denied Health Net's motion, finding that the agreement between Health Net and the County did not satisfy the disclosure requirements of Health and Safety Code section 1363.1, and therefore, the arbitration provision was unenforceable. Health Net appealed the decision.The Court of Appeal of the State of California, Second Appellate District, Division Eight, affirmed the trial court's order. The appellate court ruled that the enrollment form did not comply with the requirements of section 1363.1. It found that the form was not clear in its disclosure of which disputes were subject to arbitration, particularly with references to additional documents and laws that did not pertain to the arbitration agreement. Furthermore, the form did not place the arbitration provision immediately before the signature line, as required by the statute. The court also agreed with the lower court that the agreement between Health Net and the County was non-compliant. It ruled that an arbitration agreement, which is part of a health plan, is not enforceable unless both the enrollment form and the County agreement are compliant. Therefore, the court affirmed the trial court's order denying Health Net's motion to compel arbitration. View "Baglione v. Health Net of Cal." on Justia Law

In the Court of Appeal of the State of California Sixth Appellate District, Francisco Gutierrez appealed a judgment granting summary judgment to Uriel Tostado and ProTransport-1, LLC, in a personal injury case. Gutierrez was injured when his vehicle was hit by an ambulance driven by Tostado, an emergency medical technician employed by ProTransport-1, during a patient transport. Nearly two years after the accident, Gutierrez filed a complaint against Tostado and ProTransport-1. The defendants moved for summary judgment, arguing that Gutierrez's claims were time-barred under the Medical Injury Compensation Reform Act's (MICRA) one-year statute of limitations for professional negligence. The trial court agreed and granted the motion, a decision Gutierrez appealed.In considering Gutierrez's appeal, the appellate court held that because Tostado was providing professional medical services at the time of the incident, MICRA's one-year statute of limitations applied, despite Gutierrez not being the recipient of those services. The court reasoned that the act of driving the ambulance was an integral part of the provision of medical care, and it was foreseeable that third parties could be injured during the provision of such care. The court rejected Gutierrez's argument that MICRA only applied where the defendant owed a professional duty to the plaintiff, holding instead that MICRA applied as long as the plaintiff was injured due to negligence in the rendering of professional services, and their injuries were foreseeable. The court affirmed the trial court's judgment. View "Gutierrez v. Tostado" on Justia Law

The insurer, in this case, had notice of the hospital’s lien for treatment provided to the patient and, pursuant to a settlement agreement with the patient, gave him a check for the lien amount made payable to both him and the hospital. The hospital, Long Beach Memorial Medical Center, claims this action did not comply with the Hospital Lien Act (HLA) and sued the insurer who wrote the check, Allstate Insurance Company, for violating the HLA. The trial court granted Allstate’s motion for summary judgment, ruling Allstate’s two-payee check, which was never cashed, satisfied its obligation under the HLA.   The Second Appellate District reversed. The court concluded that merely delivering to the patient (or, in this case, his attorney) a check for the lien amount, made payable to both the patient and the hospital, is not a payment in satisfaction of the hospital’s lien under the HLA. The court explained Allstate maintains that it made this payment to the Medical Center concurrent with payment to the patient and that, therefore, the Medical Center cannot establish Allstate made a settlement payment to the patient without paying the Medical Center the amount of its lien. The court explained that Allstate declined to specify which check made payable to the Medical Center as copayee—the February 2020 check or the March 2021 check— Allstate claims satisfied its payment obligation to the Medical Center. However, neither check was a payment to the Medical Center. Moreover, Allstate does not invoke the exception to the general rule here. View "Long Beach Memorial Medical Center v. Allstate Ins. Co." on Justia Law

Plaintiffs-Appellants Santa Paula Animal Rescue Center, Inc. (SPARC) and Lucky Pup Dog Rescue (Lucky Pup) (collectively Appellants) appealed a judgment of dismissal following the trial court’s order sustaining, without leave to amend, Defendant County of Los Angeles’s (the County) demurrer to Appellants’ petition for writ of mandate. Appellants contend that the Hayden Act and, more specifically, Food and Agriculture Code section 31108 and similar provisions impose on the County a ministerial duty to (1) release a dog or other shelter animal to a requesting animal adoption or rescue organization with Internal Revenue Code section 501(c)(3) status prior to euthanasia without first determining whether the animal has behavioral problems or is adoptable or treatable, and (2) release the aforementioned animal to the requesting animal rescue or adoption organization without requiring the organization to meet qualifications additional to having Internal Revenue Code section 501(c)(3) status.   The Second Appellate District reversed the trial court’s judgment and directed the trial court to vacate its order sustaining the demurrer without leave to amend. The court concluded that the demurrer was improperly granted because the County lacks discretion to withhold and euthanize a dog based upon its determination that the animal has a behavioral problem or is not adoptable or treatable. However, the County has discretion to determine whether and how a nonprofit organization qualifies as an animal adoption or rescue organization. View "Santa Paula Animal Rescue Center, Inc. v. County of L.A." on Justia Law

Plaintiff was placed on unpaid administrative leave and then terminated from her employment with defendant Sequoia Union Elementary School District (the School District) after refusing to either provide verification of her COVID-19 vaccination status or undergo weekly testing as required by a then-operative order of the State Public Health Officer.Plaintiff brought suit under the Confidentiality of Medical Information Act against defendants the School District; Sequoia Union Elementary School (the School); and the School principal and superintendent, alleging (1) discrimination due to her refusal to authorize release of her medical information and (2) unauthorized use of her medical information.The trial court sustained defendants’ demurrer without leave to amend, finding each claim failed as a matter of law due to certain statutory exceptions.Without any factual allegations that defendants received any “medical information,” such as medical records, a medical certification, or other information in “electronic or physical form... derived from a provider of health care” (section 56.05, subd.(i)), the Fifth Appellate District found that the complaint fails to state a cause of action for unauthorized use of such information under section 56.20(c). View "Rossi v. Sequoia Union Elementary School" on Justia Law

Plaintiff and appellant Rhonda S. is the conservator, appointed pursuant to section 5350 of the Lanterman-Petris Short Act (LPS), of her adult son David S. Plaintiff sued Defendants and respondents Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals for a declaration of their obligations, under LPS and the terms of David’s health plan, to transport and accept for “assessment and evaluation” (each as defined in LPS) conservatees like David upon their conservators’ demand. The trial court sustained Kaiser’s demurrer.
The Second Appellate District affirmed. The court explained that it rejects Plaintiff’s implication that an LPS conservatee is per se suffering from an “Emergency Medical Condition” at all times following the judicial determination of grave disability. The purposes of LPS conservatorship include providing treatment to the conservatee. (Section 5350.1.) To assume a conservatee’s condition remains static following the conservatorship order is to assume treatment is always ineffectual. We are offered no basis for such an assumption. For a mental health condition to be an “Emergency Medical Condition” under the plan, “acute symptoms of sufficient severity” must result in an “immediate” specified danger or mental health disorder-induced disability. Second, even if conservatees were in a state of perpetual “Emergency Medical Condition” within the meaning of the plan, Plaintiff’s requested declaration would eliminate the coverage requirement that a “reasonable person would have believed that the medical condition was an Emergency Medical Condition which required ambulance services.” View "Rhonda S. v. Kaiser Foundation Health Plan" on Justia Law

Genentech manufactures and sells Rituxan, a drug used to treat leukemia and lymphoma. Rituxan is sold in single-use vials. Williamson was diagnosed with follicular lymphoma and was treated with Rituxan. Williamson later sued Genentech, on behalf of himself and a putative class of similarly situated individuals. He claims that Genentech violates the unfair competition law by selling Rituxan (and three other medications) in excessively large single-use vials; because the appropriate dosage varies based on a patient’s body size, Genentech’s vial sizes are too large for most patients. He argues Genentech should be required to offer smaller vials to reduce the waste of expensive medicine. In addition to injunctive relief, Williamson seeks to recover the amount the class spent on wasted Rituxan (and three other medications). Williamson took only Rituxan, not the other three medications, and paid a $231.15 deductible– the rest of the payments were made by his health insurer.The court of appeal affirmed the dismissal of the case for lack of standing under California’s unfair competition law (Bus. & Prof. Code 17200). Williamson suffered no economic injury caused by the alleged unfair practices and cannot establish standing by borrowing an economic injury from his insurer. The collateral source rule, under which a tortfeasor must fully compensate a victim and cannot subtract compensation the victim may have received from their insurer or another collateral source, does not apply. View "Williamson v. Genentech, Inc." on Justia Law

Plaintiff Gene Moran, who was a patient at Huntington Beach Hospital (the Hospital) three times in 2013, sued defendants Prime Healthcare Management, Inc., Prime Healthcare Huntington Beach, LLC, Prime Healthcare Services, Inc., and Prime Healthcare Foundation, Inc. (collectively defendants) under various theories in 2013. In a prior opinion, the Court of Appeal found that while most of Moran’s claims lacked merit, he had sufficiently alleged facts supporting standing to claim the amount that self-pay patients were charged was unconscionable, and reversed the trial court’s dismissal of the case. Moran’s sixth amended complaint included both the allegations regarding unconscionability and a new theory of the case: defendants had violated the Unfair Competition Law (UCL), and the Consumer Legal Remedies Act (CLRA) by failing to disclose Evaluation and Management (EMS) fees charged in the emergency room through signage or other methods. The complaint sought relief under both the old and new theories for violations of the UCL, CLRA, and for declaratory relief. Defendants moved to strike the allegations regarding EMS fees, arguing their disclosure obligations were defined by statute. The trial court agreed and struck the allegations from the sixth amended complaint. Finding no reversible error in that decision, the Court of Appeal affirmed. View "Moran v. Prime Healthcare Management, Inc." on Justia Law

Petitioner sued directors and staff of a structured sober living facility, including a real party in interest Peter Schuster, for dependent adult abuse. The trial court found Petitioner failed to comply with Code of Civil Procedure section 2031.210 because his statement of compliance in response to Schuster’s document requests failed to identify which documents would relate to which specific requests. The court imposed sanctions against Petitioner and his attorney in the amount of $910 for misusing the discovery process. Petitioner filed the instant petition for a writ of mandate directing the court to reverse the sanctions order. He argued that a statement of compliance in response to a production demand need not identify which document pertains to which request; such identification need only occur when the documents are produced.   The Second Appellate District granted Petitioner’s petition. The court explained that based on the plain language of section 2031.210, a statement of compliance need not identify the specific request to which each document will pertain. Because Petitioner substantially complied with his discovery responsibilities in this regard, the court’s imposition of sanctions was an abuse of discretion. View "Pollock v. Superior Court" on Justia Law

Vilches, the father and guardian of Doe (age 7), took her to Leao for treatment. Vilches later sued Leao to compel the release of Doe’s therapy records. Under Health and Safety Code 123110, the personal representative of a minor is entitled to access the minor’s patient records unless “[t]he health care provider determines that access to the patient records ... would have a detrimental effect on the provider’s professional relationship with the minor patient or the minor's physical safety or psychological well-being. The decision of the health care provider ... shall not attach any liability to the provider unless the decision is found to be in bad faith. Leao indicated she had determined that it would have a detrimental impact on Doe’s ability to trust in general, and would negatively impact the patient-counselor relationship. She was also concerned that Vilches would use the records to coach his daughter's responses in a court evaluation in an upcoming custody proceeding.The court of appeal affirmed summary judgment in favor of Leao, rejecting an argument that the absence of bad faith does not immunize a therapist’s determination from judicial review and that section 123110 creates a presumption of entitlement to disclosure. The statute does not require separate determinations for each type of patient record. When the provider makes the detriment determination, a plaintiff must show bad faith to compel disclosure. View "Vilches v. Leao" on Justia Law