Justia Health Law Opinion Summaries

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

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

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

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

The issue this case presented for the Court of Appeal's review centered on whether a pause in a criminal jury trial due to the coronavirus disease 2019 (COVID-19) pandemic violated an accused’s due process right to a fair trial. Here, the prosecution nearly completed its case-in-chief against Defendant-appellant John Breceda when the trial court paused proceedings on March 16, 2020, because three of the 14 jurors were ill. Breceda refused to waive time and refused to proceed with 11 jurors. The trial court denied his motion for a mistrial and continued the case. Beginning that day, and for months after, the COVID-19 pandemic caused California officials to issue a series of orders to continue to provide essential government services, safeguard constitutional rights, and protect people from a "mysterious, contagious, and deadly virus." The effect of some of those orders was jury trials could not proceed. Seventy-two days after the trial court paused proceedings, the court denied Breceda’s second motion for a mistrial. Trial resumed the following day. The prosecution completed its case-in-chief, and Breceda testified. The jury acquitted Breceda of first degree murder but convicted him of second degree murder and arson of another’s property. Breceda argued on appeal that the trial court erred by denying his mistrial motions because the pause in his jury trial due to the COVID-19 pandemic violated his due process right to a fair trial. The Court of Appeal disagreed: "Although the pause in the trial was lengthy, 10 weeks, Breceda’s constitutional rights were not set aside and forgotten. ... the record demonstrates the court remained appropriately focused on Breceda’s constitutional rights during the onset of an unprecedented global health crisis." Judgment was thus affirmed. View "California v. Breceda" on Justia Law

Appellant Dameron Hospital Association (Dameron) required patients or their family members to sign Conditions of Admissions (COAs) when Dameron provided the patients’ medical care. The COAs at issue in this case contained language that assigned to Dameron direct payment of uninsured and underinsured motorist (UM) benefits and medical payment (MP) benefits that would otherwise be payable to those patients under their automobile insurance policies. Dameron treated five of California State Automobile Association Inter-Insurance Bureau's ("CSAA") insureds for injuries following automobile accidents. Those patients had UM and/or MP coverage as part of their CSAA coverage, and Dameron sought to collect payment for those services from the patients’ UM and/or MP benefits at Dameron’s full rates. Instead of paying to Dameron the lesser of either all benefits due to the patients under their UM and MP coverage, or Dameron’s full charges, CSAA paid portions of those benefits directly to the patients which left balances owing on some of Dameron’s bills. Dameron sued CSAA to collect UM and MP benefits it contended CSAA owed Dameron under the assignments contained in the COAs. The trial court concluded that Dameron could not enforce any of the assignments contained in the COAs and entered judgment in CSAA’s favor following CSAA’s successful motion for summary judgment. The Court of Appeal held Dameron could not collect payment for emergency services from the UM or MP benefits due to patients that were covered under health insurance policies. Further, the Court held: (1) the COA forms were contracts of adhesion; (2) it was not within the reasonable possible expectations of patients that a hospital would collect payments for emergency care directly out of their UM benefits; and (3) a trier of fact might find it was within the reasonable expectations of patients that a hospital would collect payments for emergency care directly out of their MP benefits. Accordingly, the Court concluded Dameron could not maintain causes of action to collect MP or UM benefits due to four of the five patients directly from CSAA. However, consistent with this opinion, the trial court could consider whether an enforceable assignment of MP benefits was made by one adult patient. View "Dameron Hospital Assn. v. AAA Northern Cal. etc." on Justia Law

Prior to her death, Eyvon Ambrose (decedent) had become entirely dependent upon others for her basic care needs. Defendants Oroville Hospital d/b/a Golden Valley Home Health and Oroville Hospital, agreed to provide decedent in-home nursing services for wound care for a pressure injury to her left ischium or buttock. Defendants provided such in-home wound care on six occasions in July 2015 and four additional occasions in October 2015. According to real parties in interest (plaintiffs), decedent’s wound worsened, she sustained additional wounds, she was hospitalized, and she ultimately died from her wound and complications. Plaintiffs filed the underlying actions against defendants alleging a number of causes of action. Defendant’s writ petition and arguments related solely to plaintiff’s cause of action to recover under the Elder Abuse and Dependent Adult Civil Protection Act for defendants’ alleged neglect which, they asserted, was committed with recklessness, oppression, fraud, or malice. Therefore, plaintiffs asserted entitlement to enhanced remedies under the Elder Abuse Act. They sought no other relief in their petition. Defendants moved for summary judgment or, in the alternative, summary adjudication, asserting they did not have a substantial caretaking or custodial relationship with the decedent, a prerequisite for recovery for neglect under the Elder Abuse Act. They further asserted that a reasonable jury could not find them guilty of forms of abuse or neglect rising to the level of recklessness. The trial court denied defendants’ motion. To the Court of Appeal, Defendants sought a preemptory writ of mandate directing the trial court to vacate its denial of their motion for summary adjudication and to grant the motion. The Court concluded that, in opposition to defendants’ prima facie showing of entitlement to summary adjudication on plaintiffs’ Elder Abuse Cause of action based on the absence of a substantial caretaking or custodial relationship, plaintiffs failed to raise a triable issue of material fact. The Court therefore issued the requested writ. View "Oroville Hospital v. Superior Court" on Justia Law

In a suit challenging the emergency temporary standards (ETS) promulgated by the California Occupational Safety and Health Standards Board in response to the COVID-19 pandemic, the trial court denied a request for a preliminary injunction suspending enforcement of the ETS. The trial court concluded that the plaintiffs had not shown a likelihood of prevailing on the merits and found the public interest in curbing the spread of COVID-19 weighed “heavily” in favor of ongoing enforcement of the ETS.The court of appeal affirmed, rejecting arguments that the trial court erroneously applied a deferential standard of review, the findings of emergency lacked necessary findings, and the ETS exceeded the Board’s statutory authority. The administrative record demonstrated the Board did not abuse its discretion in adopting prescriptive standards in the ETS; the Board considered performance standards during the rulemaking process, including existing regulations, and concluded certain prescriptive standards were necessary to assure “to the extent feasible, that no employee will suffer material impairment of health or functional capacity.” The Board did not abuse its discretion in establishing regulations excluding workers exposed to COVID-19 cases from the workplace and mandating a continuation of pay, benefits, and seniority during such periods of exclusion. View "Western Growers Association v. Occupational Safety & Health Standards Board" on Justia Law

The Acting Warden of the California Institute for Men petitioned a Superior Court for authorization to perform electroconvulsive therapy (ECT) on inmate Rudy Terraza. Convicted of first-degree murder at age 17, Terraza was a 44-year-old with a history of mental illness. According to a prison psychiatrist, Terraza has a “schizoaffective disorder, bipolar type . . . characterized by auditory hallucinations, delusions, and impairment in thought processing, volition and motivation, and social functioning, as well as significant mood swings, depression, and mania.” Despite medication and psychiatric treatment, his mental health had grown worse over time, and he had resided in a psychiatric hospital since September 2019. He had been “consumed” by voices, with no desire to socialize or “practice self-care.” He occupied a single hospital room and was unable to function in standard prison housing. A psychiatrist averred that ECT was the “gold standard” treatment for patients like Terraza; seizures produced by the treatment would "help the brain return to normal functioning." The trial court authorized ECT after making several findings required by the Penal Code, including that ECT would be beneficial and that there was a compelling justification for it. In this habeas proceeding, the inmate argued the state constitutional right to privacy required the appointment of a surrogate to make a consent determination for him, beyond trial court findings of ECT’s suitability. Upon consideration of precedent, the Court of Appeal concluded the state constitutional right to refuse medical treatment did not require appointment of a surrogate decisionmaker. Nevertheless, the Court concluded that a court’s authorization of ECT therapy had to include a consideration of whether the inmate, when he or she was competent, expressed any preferences, views, or beliefs that would operate to preclude consent to the procedure. "By statute, such consideration is required for most medical procedures performed on incarcerated persons lacking capacity to consent." Because the statutory balancing test for ECT did not do so, the Court granted the writ to allow further consideration. View "In re Terraza" on Justia Law

Joanne R., a conservatee subject to a conservatorship under the Lanterman-Petris-Short (LPS) Act, contends that the trial court provided her an inadequate jury trial waiver advisement and improperly induced her to waive her right to a jury trial by stating she could either have a court trial that day or a jury trial nine months later.The Court of Appeal concluded that, although it is concerned by the delay in providing conservatees jury trials during the COVID-19 pandemic, there was no violation of Joanne's statutory right to a jury trial. However, the court cautioned the superior court that a nine-month delay for a conservatee to have a jury trial where the conservatorship would otherwise end in a year, absent a health emergency, raises serious constitutional concerns in light of the significant liberty interests at stake. The court urged the superior court to dedicate the necessary additional resources to LPS jury trials so that conservatees may exercise their right to a jury trial in a timely manner. The court noted that failure to do so likely violates a conservatee's constitutional right to due process. View "Stusser v. Joanne R." on Justia Law