Justia Health Law Opinion Summaries

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

Nina’s was a residential care facility for the elderly (RCFE) licensed by the Community Care Licensing Division (CCL) of the State Department of Social Services. Plaintiff, an RN-certified legal nurse consultant, was hired to assist with the closure of Nina’s and agreed to assess each of the residents and recommend a new facility, as required by RCFE closing procedures, Health and Safety Code 1569.682(a)(1)(A).Caregivers from the new RCFE, Frye’s, came to transfer J.N. They immediately noticed that J.N. was in significant pain; multiple bandages “stuck to [J.N.’s] skin and her wounds,” which “all smelled really bad.” J.N.’s toes were black. Frye’s caregivers called 911. J.N. died weeks later. A CCL investigator contacted plaintiff, who confirmed that he had performed J.N.’s assessment. Plaintiff later denied performing J.N.’s physical assessment, stating that Mia “was the one in charge.” He denied guiding or instructing Mia during the assessment, stating he only acted as a “scribe.” The ALJ found clear and convincing evidence that plaintiff committed gross negligence in connection with J.N.'s appraisal, unprofessional conduct in carrying out nursing functions in connection with the appraisal, and unprofessional conduct by not being truthful with the Board investigator regarding J.N.'s care provided.The court of appeal upheld the revocation of plaintiff’s nursing license. Substantial evidence supports the finding that plaintiff engaged in a “usual nursing function” when he performed J.N.’s resident appraisal. Plaintiff’s dishonesty during the investigation constitutes unprofessional conduct. View "Clawson v. Board of Registered Nursing" on Justia Law

Plaintiff State Farm Mutual Automobile Insurance Company (State Farm) filed an Insurance Fraud Protection Act (IFPA) action alleging defendants Sonny Rubin, M.D., Sonny Rubin, M.D., Inc., and Newport Institute of Minimally Invasive Surgery (collectively, defendants) fraudulently billed insurers for various services performed in connection with epidural steroid injections. A month prior, however, another insurer, Allstate, filed a separate IFPA lawsuit against the same defendants, alleging they were perpetrating a similar fraud on Allstate. The trial court sustained defendants’ demurrer to State Farm’s complaint under the IFPA’s first-to-file rule, finding it alleged the same fraud as Allstate’s complaint. State Farm appealed, arguing its complaint alleged a distinct fraud. After review, the Court of Appeal agreed the demurrer was incorrectly sustained, but for another reason. The Court found the trial court and both parties only focused on whether the two complaints alleged the same fraudulent scheme, but in this matter of first impression, the Court found the IFPA’s first-to-file rule required an additional inquiry. "Courts must also review the specific insurer-victims underlying each complaint’s request for penalties. If each complaint seeks penalties for false insurance claims relating to different groups of insurer-victims, the first-to-file rule does not apply. A subsequent complaint is only barred under the first-to-file rule if the prior complaint alleges the same fraud and seeks penalties arising from the false claims, submitted to the same insurer-victims." Judgment was reversed and the matter remanded for further proceedings. View "California ex rel. State Farm Mutual Automobile Ins. Co. v. Rubin" on Justia Law

This appeal presented an issue of first impression for the Court of Appeals: does a commercial property insurance policy provide coverage for a business’s lost income due to the COVID-19 pandemic? After review of the specific insurance policy that California Mutual Insurance Company (California Mutual) issued to The Inns by the Sea (Inns) for its five lodging facilities, the Court determined Inns could not recover from California Mutual for its lost business income resulting from the COVID-19 pandemic. Further, Inns did not identify any manner in which it could amend its complaint to state a claim for coverage. Accordingly, the Court affirmed the trial court’s order sustaining California Mutual’s demurrer without leave to amend. View "The Inns by the Sea v. Cal. Mutual Ins. Co." on Justia Law

A hospital must provide “necessary stabilizing treatment” for any person in an “emergency medical condition,” 42 U.S.C. 1395dd(b), Health & Saf. Code 1317(a). California’s Knox-Keene Act (section 1340) requires that the patient's health insurance plan reimburse the hospital for providing “emergency services and care.” If the hospital and plan do not have an existing contract, the plan must pay the “reasonable and customary value." If a plan without a contract pays reimbursement that the hospital believes is below the “reasonable and customary value,” the hospital may sue the plan in quantum meruit for the shortfall.The court of appeal held that a hospital may not additionally sue for the tort of intentionally paying an amount that is less than what a jury might later determine is the “reasonable and customary value” of the services, and thereby obtain punitive damages, nor may the hospital sue for injunctive relief under California’s unfair competition law to enjoin the plan from paying too little in possible future claims. In the quantum meruit claim, a trial court properly instructs the jury that the “reasonable value” of emergency medical services is “the price that a hypothetical willing buyer would pay a hypothetical willing seller for the services, [when] neither [is] under compulsion to buy or sell, and both hav[e] full knowledge of all pertinent facts.” Rejecting challenges to several evidentiary rulings, the court affirmed the jury’s verdict finding that the plan paid the suing hospital the reasonable and customary value of its emergency medical services. View "Long Beach Memorial Medical Center v. Kaiser Foundation Health Plan, Inc." on Justia Law

Mitchell swallowed 60 Naproxen tablets. With her husband, she arrived at the Hospital emergency department on May 27, 2017, alert, oriented, and with no acute distress. The physician noted no motor deficits or sensory deficits. A nurse placed an IV catheter in Mitchell’s forearm. Nearly two hours later, Mitchell walked to the toilet with assistance from her husband, then walked back to her bed without assistance. On the way back, Mitchell fell, causing abrasions to her face and severely injuring her knee. The nursing staff had no reason to suspect Mitchell presented a high fall risk because she did not complain of dizziness; they had no observed balance problems. An x-ray and CT scan of Mitchell’s knee showed serious injuries. Mitchell was referred to physical therapy and was discharged from Hospital.Mitchell filed her complaint, alleging general negligence and premises liability on May 17, 2019. The hospital argued that the complaint alleged professional negligence, rather than general negligence or premises liability, and was barred under Code of Civil Procedure section 340.5’s one-year limitations period. Mitchell acknowledged that the condition of the floor did not contribute to her fall. The court of appeal affirmed the dismissal of the complaint. The nursing staff’s decision to not assist Mitchell in walking to the restroom was “integrally related” to her medical care. View "Mitchell v. Los Robles Regional Medical Center" on Justia Law

As part of a request to receive a higher reimbursement rate, plaintiff Family Health Centers of San Diego (Family Health) submitted a cost report detailing the reimbursable costs incurred by its clinics in providing covered services to Medi-Cal patients. Because the costs were not allowable Medi-Cal costs, Family Health eliminated them from its cost report. As part of an audit, however, defendant State Department of Health Care Services (the Department) determined the costs should not have been eliminated from the cost report. Instead, the Department reclassified the costs to a nonreimbursable cost center, which had the effect of disallowing a proportionate share of the clinics’ administrative overhead costs. Family Health filed an administrative appeal to dispute the audit adjustments, but, after a formal hearing, its appeal was denied. Family Health then filed a petition for a writ of mandate challenging the administrative decision, which also was denied. On appeal, Family Health contended the Department did not establish a proper basis for reclassifying the costs to a nonreimbursable cost center, and that the decision to reclassify the costs was not supported by substantial evidence. Family Health separately argued that a significant subset of the costs should not have been included in the nonreimbursable cost center because they were not costs at all. After review, the Court of Appeal found no reversible error and affirmed the judgment denying the petition. View "Family Health Centers of San Diego v. State Dept. of Health Care Service" on Justia Law

Smith’s hip resurfacing implant consists of a metal ball that covers the top of the femur and a cup that fits inside the hip socket. When a surgeon puts these ball-and-cup surfaces in the joint, the polished metal surfaces are supposed to allow smoother movement than the damaged bone or cartilage they replace. Gall, who had hip resurfacing surgery for his left hip, recovered and became physically active. Years later, convinced his implant was unsatisfactory, Gall sued Smith.Gall argued that Smith failed to properly warn Gall’s surgeon, Dr. Hernandez, about the risks of using Smith’s product. The trial court granted Smith summary judgment because Hernandez independently knew these risks and whether Smith gave Hernandez redundant warnings did not matter. Gall also argued that Smith’s product was defective. The trial court granted summary judgment because Gall did not show anything was wrong with his implant. Gall did show Smith’s quality control procedures once failed to satisfy regulatory authorities, but the court concluded this fact did not imply the parts Gall received were defective. The court of appeal affirmed. Gall’s claims share the same causation element and Gall did not establish causation. View "Gall v. Smith & Nephew, Inc." on Justia Law

Gray received emergency medical care at St. Mary Medical Center, owned and operated by Dignity Health. He received a bill that included an “ ‘ER LEVEL 2 W/PROCEDU’ ” charge. Gray claims Dignity’s failure to disclose, before providing emergency medical treatment, that its bill for emergency services would include such a charge—either by posting “signage in and around” the emergency department or “verbally during the patients’ registration process” —is an unfair business practice under the Unfair Competition Law (UCL) and unlawful under the Consumers Legal Remedies Act (CLRA).The court of appeal affirmed the dismissal of the suit. Gray does not claim that by including an ER Charge in its billing, Dignity violated any of the extensive state and federal statutory and regulatory laws governing the disclosure of hospital billing information and the treatment of persons presenting for treatment at an emergency department. Nor does he take issue with the hospital’s “chargemaster” amount for the Level 2 ER Charge, which his medical insurance largely covered. View "Gray v. Dignity Health" on Justia Law