Justia California Court of Appeals Opinion Summaries

In this case, Gardena Hospital in California appealed a decision regarding its reporting of patient days for the purpose of calculating Medi-Cal reimbursement. The controversy centered around whether "bed hold" days — days when a patient is not physically in the hospital's subacute section but is expected to return — should be included in the reported patient days. If these days were included, it would result in a smaller per diem reimbursement to the hospital by the state. The hospital argued that bed hold days should be excluded, pointing to the Accounting and Reporting Manual for California Hospitals (the "Hospital Manual"), which does not specifically mention bed holds. The state, on the other hand, referred to the Accounting and Reporting Manual for California Long-Term Care Facilities (the "Long-Term Manual"), which specifically states that bed hold days should be included in total patient days.The Court of Appeal of the State of California, Second Appellate District, Division Eight ruled in favor of the state, affirming the lower court's decision. The court held that where two state manuals guide health care facility accounting, the one that specifically addresses the issue at hand — in this case, the Long-Term Manual's explicit reference to bed holds — governs. The court reasoned that the specific provision controls the general one and can be regarded as a correction to it. Thus, according to this holding, Gardena Hospital must include bed hold days in its reported patient days for the calculation of Medi-Cal reimbursement. View "Gardena Hospital, L.P. v. Baass" on Justia Law

In the case before the Court of Appeal of the State of California First Appellate District Division Four, the plaintiffs, thousands of individuals who suffered adverse effects from the use of a prescription drug, TDF, made by Gilead Life Sciences, Inc., brought a claim of negligence and fraudulent concealment against Gilead. The plaintiffs alleged that while Gilead was developing TDF, it discovered a similar, but chemically distinct and safer potential drug, TAF. However, Gilead allegedly decided to defer development of TAF because it was concerned that the immediate development of TAF would reduce its financial return from TDF. Gilead sought summary judgment on the ground that in order to recover for harm caused by a manufactured product, the plaintiff must prove that the product was defective. The trial court denied Gilead's motion for summary judgment in its entirety.In reviewing this case, the appellate court held that the trial court was correct to deny Gilead's motion for summary judgment on the negligence claim. The court reasoned that a manufacturer's duty of reasonable care can extend beyond the duty not to market a defective product. The court found that the factual basis of the plaintiffs' claim was that Gilead knew TAF was safer than TDF, but decided to defer development of TAF to maximize its profits. The court held that if Gilead's decision to postpone development of TAF indeed breached its duty of reasonable care to users of TDF, then Gilead could potentially be held liable.However, the appellate court reversed the trial court's decision regarding plaintiffs' claim for fraudulent concealment. The court concluded that Gilead's duty to plaintiffs did not extend to the disclosure of information about TAF, as it was not available as an alternative treatment for HIV/AIDS at the time the alleged concealment occurred. Consequently, the court granted in part and denied in part Gilead's petition for a writ of mandate, directing the superior court to vacate its order denying Gilead's motion for summary judgment and to enter a new order denying summary adjudication of the negligence claim but granting summary adjudication of the fraudulent concealment claim. View "Gilead Tenofovir Cases" on Justia Law

In the case before the Court of Appeal of the State of California, Second Appellate District, Division Two, the plaintiff, Ali Shalghoun, appealed a judgment from the Superior Court of Los Angeles County in favor of the defendant, North Los Angeles County Regional Center, Inc. Shalghoun, an administrator of a residential facility for developmentally disabled persons, sued the regional center after he was attacked by a resident at the facility. The resident, known as J.C., was a client of the regional center, which had arranged for his placement at the facility.The central issue in the case was whether the regional center had a legal duty to protect the employees of a residential facility from a developmentally disabled person who had been placed there. The plaintiff argued that the regional center was negligent in failing to immediately move J.C. to another facility after being informed that the facility could no longer provide the level of care he required.However, the appellate court affirmed the lower court's decision, finding that the regional center did not owe a duty of care to the facility's employees. The court reasoned that the regional center's duty, as mandated by the Lanterman Developmental Disabilities Services Act, was to provide services and support to the developmentally disabled person (the "consumer"), not to protect third-party employees at a residential facility. The court also noted that the regional center did not have the unilateral power to relocate a consumer; it depended on the acceptance of the consumer by another residential facility.According to the court, the imposition of liability on regional centers for injuries inflicted by consumers could potentially drive the centers out of business, disrupt the entire system of services and support for developmentally disabled individuals, and contradict the Act's mandate to place consumers in the least restrictive environment. The court therefore concluded that public policy factors weighed against recognizing a duty of care running from the regional center to the employees of the residential facility. View "Shalghoun v. North Los Angeles County Regional Center, Inc." on Justia Law

This case concerns a defendant, Jeanette Sarmiento, who requested mental health diversion after being charged with attempted robbery. Sarmiento suffers from posttraumatic stress disorder (PTSD), major depressive disorder, and stimulant use disorder, all of which have never been treated. Despite meeting many of the requirements for diversion, her request was denied by the Superior Court of San Diego County due to her history of drug abuse and the court's conclusion that she posed an unreasonable risk of danger to the public.Sarmiento sought a writ of mandate from the Court of Appeal, Fourth Appellate District Division One, State of California. The court determined that her past failures in drug treatment did not predict her response to mental health treatment, since her underlying mental health conditions, which were the core of her substance abuse issues, were never previously addressed. The court also found that the trial court's concern about Sarmiento's lack of success in past attempts at substance abuse treatment did not support the finding that the recommended treatment would not meet her specialized needs. Further, the court found that the trial court misapplied the statutory criteria in determining that residual concerns for public safety could justify the denial of diversion.Given these findings, the Court of Appeal granted the writ and directed the Superior Court to approve Sarmiento's request for mental health diversion. The court emphasized that the purpose of mental health diversion is to treat individuals with mental disorders in order to prevent them from entering and reentering the criminal justice system, and to protect public safety. The court concluded that the trial court's decision failed to follow the Legislature's direction to focus less on Sarmiento's past and more on the promise of her future and that of her community. View "Sarmiento v. Super. Ct." on Justia Law

This case involves a pharmaceutical manufacturer, Gilead Life Sciences, Inc., and its development and sale of a drug, tenofovir disoproxil fumarate (TDF), to treat HIV/AIDS. The approximately 24,000 plaintiffs allege that they suffered adverse effects from TDF, including skeletal and kidney damage. Gilead developed a similar but chemically distinct drug, tenofovir alafenamide fumarate (TAF), which could potentially treat HIV/AIDS with fewer side effects. The plaintiffs claim that Gilead delayed the development of TAF to maximize profits from TDF.The plaintiffs do not claim that TDF is defective. Instead, they assert a claim for ordinary negligence, arguing that Gilead's decision to delay the development of TAF breached its duty of reasonable care to users of TDF. They also assert a claim for fraudulent concealment, arguing that Gilead had a duty to disclose information about TAF to users of TDF.The Court of Appeal of the State of California, First Appellate District, Division Four, partially granted Gilead's petition for a writ of mandate and held that the plaintiffs could proceed with their negligence claim. The court concluded that a manufacturer's legal duty of reasonable care can extend beyond the duty not to market a defective product. However, the court reversed the trial court's decision denying Gilead's motion for summary adjudication of the plaintiffs' claim for fraudulent concealment. The court held that Gilead had no duty to disclose information about TAF to users of TDF, as TAF was not available as an alternative treatment at the time. View "Gilead Tenofovir Cases" on Justia Law

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