Justia Health Law Opinion Summaries

Articles Posted in California Courts of Appeal
by
A healthcare provider contended it was underpaid for substance abuse treatment that it rendered to 29 patients. Seeking to recover the difference directly from the insurance company, the provider filed suit alleging the insurer entered into binding payment agreements during verification of benefits and authorization calls with the provider and otherwise misrepresented or concealed the amounts it would pay for treatment. The trial court entered summary judgment against the provider. After review, the Court of Appeal concluded the court did not err in determining one or more elements of the provider’s causes of action could not be established. View "Aton Center v. United Healthcare Ins. Co." on Justia Law

by
As four medically comprised inmates who required skilled nursing care were approaching their parole dates, the California Department of Corrections and Rehabilitation (CDCR) unsuccessfully attempted to locate post-parole skilled nursing facilities. When their parole dates arrived, the CDCR paroled them to Kern County and transported them to the emergency department at Kern Medical Center (KMC), a licensed general acute care hospital. Kern County Hospital Authority (Hospital Authority), which operates KMC, sought a peremptory writ of mandate and injunction against the CDCR and its Secretary.The trial court granted the Writ, and the CDCR appealed, arguing it does not have a ministerial duty to obtain Hospital Authority’s express consent before transporting parolees to KMC’s emergency department.The Fifth Appellate District reversed, holding that the Department failed to comply with regulation 79789 when transferring the parolees to KMC, and therefore abused its discretion. However, finding that the injunction was overbroad, the Fifth Appellate District remanded to the trial court for issuance of a new peremptory writ. View "Kern County Hospital Auth. v. Dept. of Corrections & Rehabilitation" on Justia Law

by
Plaintiff was employed by Defendant and, as a condition of employment, was required to get a flu vaccine. Plaintiff sought an exemption based on a medically recognized contraindication, presenting a doctor's note that recommended she avoid the vaccine based on her history of cancer and general allergies. However, neither of these was a medically recognized contraindication, and Defendant terminated her employment.Plaintiff filed suit under the FEHA for disability discrimination. The trial court granted summary judgment in Defendnat's favor, plaintiff appealed.The Second Appellate District affirmed, finding that Defendant did not engage in disability discrimination and that Defendant's reason for terminating Plaintiff's employment was legitimate and lacked pretext. Further, the court rejected Plaintifff's retaliation claim. View "Hodges v. Cedars-Sinai Medical Center" on Justia Law

by
The Plan is a nonprofit health care service plan subject to Health & Safety Code 1340, including the Parity Act, under which: “Every health care service plan contract . . . that provides hospital, medical, or surgical coverage shall provide coverage for the diagnosis and medically necessary treatment of severe mental illness of a person of any age, and of serious emotional disturbances of a child . . . under the same terms and conditions applied to other medical conditions.”Plaintiffs alleged that the Plan violates the Parity Act by “deterring members from obtaining one-on-one mental health therapy without making individualized determinations … encouraging ‘group’ therapy, without making individualized determinations" where similar practices are not followed in the treatment of physical health conditions. An Unruh Civil Rights Act claim alleged that the Plan intentionally discriminated against persons with mental disabilities or conditions. The court granted the Plan summary judgment.The court of appeal affirmed the rejection of one plaintiff’s individual claims; the Plan is not liable for the acts of its subsidiary by whom the plaintiff’s coverage was issued. The court otherwise reversed. On an Unfair Competition Law claim, the court failed to consider how the Plan’s conduct undermines its contractual promises of covered treatment in violation of the Parity Act. On the Unruh claim, triable issues of fact exist as to whether the plaintiffs were denied medically necessary treatment as a result of intentional discrimination. View "Futterman v. Kaiser Foundation Health Plan, Inc." on Justia Law

by
Appellants Crestwood Behavior Health, Inc. (Crestwood), West Anaheim Extended Care and Extended Care Hospital of Westminster (West Anaheim), and Royale Health Care Center dba South Coast Post Acute (South Coast) (together, appellants) operated skilled nursing facilities serving beneficiaries of the California Medical Assistance Program (Medi-Cal). Respondent Department of Health Care Services (the Department) administered Medi-Cal. As relevant here, the Department also administered the “Skilled Nursing Facility Quality and Accountability Supplemental Payment System” (QASP), which authorized supplemental payments, over and above Medi-Cal reimbursement rates, to skilled nursing facilities meeting certain performance standards. Consolidated appeals challenged the Department’s method for calculating QASP payments. Appellants argued they did not receive all the QASP payments to which they were entitled and blame the alleged underpayment to the Department’s practice of excluding certain Medi-Cal days—known as “special treatment program days” or “STP days”—from its calculations. They sought writs of mandate directing the Department to include STP days in the calculation of QASP payments. The Court of Appeal concurred with the trial court that appellants failed to identify an appropriate basis for writ relief. Appellants sued under Welf. & Inst. Code Section 14170 (a)(1), which did not impose a mandatory or ministerial duty on the Department that could support the issuance of a writ of mandate. And the Court found appellants did not show any abuse of discretion by the Department. Accordingly, the trial court judgment was affirmed. View "Crestwood Behavioral Health, Inc. v. Baass" on Justia Law

by
Moss Gropen brought suit against, among other defendants, Cyrus Shabrang and Michael Noud (together, Real Parties in Interest) arising out of Gropen’s treatment at a hospital. Gropen appeared at the noticed deposition with his wife Laura Gropen. Defense counsel objected to Laura’s presence at the deposition because she was a percipient witness in the action and could be deposed in the future. Gropen’s deposition did not proceed beyond the parties stating their objections on the record. Real Parties in Interest subsequently filed a motion for protective order and sanctions, asking the court to exclude Laura from Gropen’s deposition. At the hearing on the motion, for the first time, Gropen’s counsel explicitly requested under California Rules of Court, rule 1.100, that accommodations be provided to Gropen because he was suffering from Post-Traumatic Stress Disorder (PTSD), a recognized disability under the Americans with Disabilities Act of 1990 (ADA). The court acknowledged that PTSD fell under the ADA but found Gropen’s request for an accommodation untimely. It thus granted the protective order and sanctioned Gropen. Gropen petitioned for a writ of mandate, arguing that the superior court abused its discretion in granting the protective order and erred by not considering the evidence that Gropen was diagnosed with PTSD. Gropen also maintained that his request that Laura attend his deposition was a reasonable accommodation. The Court of Appeal concluded Gropen’s request for accommodation was timely, the district court abused its discretion by failing to remand the matter to the superior court with instructions to deny the motion for a protective order and sanctions, and to properly consider Gropen’s request under Rule 1.100. View "Gropen v. Super. Ct." on Justia Law

by
On August 28, 2017, while the plaintiffs were being transported in an ambulance operated by AMR employees, the ambulance collided with another vehicle. The plaintiffs’ suit, filed on November 8, 2018, and alleging motor vehicle negligence and medical malpractice, was rejected on summary judgment based upon the one-year statute of limitations applicable to actions for professional negligence by health care providers under the Medical Injury Compensation Reform Act (MICRA) (Code Civil Procedure 340.5).The court of appeal affirmed. MICRA applies when ambulance passengers are injured during a collision. The limitations period was not extended under section 364(d) because the plaintiffs sent AMR a notice of intent to sue on August 23, 2018. The plaintiffs’ prior March 2018 letter to AMR’s third-party claims administrator constituted a section 364(a) notice of intent to sue. The March letter listed the plaintiffs’ names, AMR as the insured, the date of the accident, and the claim number. It detailed the injuries, treatment, and other damages sustained by each plaintiff and referenced the enclosed supporting documentation. It concluded with settlement demands for each plaintiff and requested a response within 15 days. View "Lopez v. American Medical Response West" on Justia Law

by
A patient filed a complaint concerning Dr. Dore, a Board-certified psychiatrist. The Board discovered suspected irregularities in Dore's prescription of controlled substances. Dore declined to answer questions. The Board served her with an investigative subpoena seeking medical records supporting the prescription of the controlled substances to a family member and with investigative interrogatories requesting information about the family member's treatment and employment with Dore. Dore refused to produce the records and objected to the interrogatories. Her family member objected to the subpoena.The Board sought an order compelling compliance and provided reports from the Controlled Substance Utilization Review and Evaluation System (CURES) database. A Board-certified psychiatrist opined it was necessary to obtain the family member’s medical records to evaluate whether Dore complied with the standard of care, noting an AMA ethics opinion counseling physicians against treating family members except in emergencies. Dore's expert, a psychiatrist and licensed California attorney, disagreed with the assertion that prescribing controlled substances to family members presumptively violates the standard of care. The family member explained his reason for seeking treatment from Dore, identifying the medications she prescribed, and describing the treatment she provided.The court of appeal affirmed the trial court, which ordered compliance, impliedly concluding the Board established good cause to justify the production of the family member’s private medical information. The Board had a compelling interest in investigating Dore’s allegedly improper conduct. View "Kirchmeyer v. Helios Psychiatry Inc." on Justia Law

by
In May 2020, the state transferred 194 inmates from CIM to San Quentin. The transferees were at risk of developing serious symptoms of COVID-19 (persons over the age of 65 and/or with underlying medical conditions); although they had tested negative two weeks prior, several had COVID-19 at the time of the transfer. Some exhibited symptoms before exiting the transfer bus. San Quentin then had no COVID-19 cases among its prisoner population. A month later, at least 1,400 inmates, including Malear, were diagnosed with COVID-19. Several inmates have died from it. Malear filed a putative class action, alleging failure to take reasonable action to summon medical care for prisoners who were in immediate need. The trial court dismissed, holding that Malear had not complied with the Government Claims Act, having filed suit before the rejection of his government claim.The court of appeal reversed, Although Malear filed suit before the denial of his government claim, he filed an amended complaint as of right after the denial and before the defendants were served with the original complaint or appeared in the action. The amended complaint alleged denial of his claim. Malear has established substantial compliance with the statutory requirement. Assuming the truth of the material allegations in the amended complaint, Malear has stated facts sufficient to constitute a cause of action; the complaint does not disclose the existence of a statutory immunity defense as a matter of law. View "Malear v. State of California" on Justia Law

by
This appeal from summary judgment in favor of Sequoia Insurance Company (Sequoia) was one of thousands of cases nationwide involving a claim for business interruption coverage arising out of the COVID-19 pandemic. The outcome here turned on whether there was evidence creating a triable issue that the insured, Best Rest Motel, Inc. (Best Rest), sustained lost business income “due to the necessary ‘suspension’ ” of its operations “caused by direct physical loss of or damage” to the insured property. Best Rest contended its case fell directly within the exception discussed by the Court of Appeal in Inns-by-the-Sea v. California Mut. Ins. Co., 71 Cal.App.5th 688 (2021). Though the Court found Inns might undermine, if not entirely foreclose Best Rest’s case, the Court limited its holding by positing in dicta a “hypothetical scenario” where “an invisible airborne agent would cause a policyholder to suspend operations because of direct physical damage to property.” Here, the Court determined Best Rest's argument failed because the record contained no evidence creating a triable issue that the hotel “could have otherwise been operating” but for the presence of COVID-19 on the premises. Best Rest’s own evidence established the exact opposite was true: its vice president and operating partner testified that the phones were “ringing off the hook[ ]” with cancellations—not because of COVID-19 in the hotel, but because of government shut down orders and travel restrictions that shuttered tourism. Accordingly, the Court affirmed summary judgment in the insurance company's favor because there was no evidence creating a triable issue that COVID-19 in the hotel caused the claimed lost income. View "Best Rest Motel, Inc. v. Sequoia Insurance Co." on Justia Law