Justia California Court of Appeals Opinion Summaries

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

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

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

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

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

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

Under Health and Safety Code 101850, Alameda, a hospital authority was created as “a public agency for purposes of eligibility with respect to grants and other funding and loan guarantee programs.” The plaintiffs worked for Alameda and claim Alamed “automatically deducted ½ hour from each workday” to account for a meal period, although employees “were not allowed or discouraged from clocking out for meal periods.” The trial court dismissed their sis class action Labor Code claims, reasoning that Alameda was a “statutorily created public agency” beyond the reach of the Labor Code and Industrial Welfare Commission (IWC) Wage Order invoked in the complaint. The court held that a Private Attorneys General Act (PAGA) claim would not lie because Alameda is not a “person” within the meaning of section 18, there was no underlying statutory violation from which the PAGA claim could derive, and Alameda’s “public agency” status exempted it from punitive damages.The court of appeal affirmed the dismissal of the fourth claim but otherwise reversed. Alameda lacks many of the hallmarks of sovereignty. Subjecting Alameda to liability would not infringe upon any sovereign governmental powers. Alameda is not a “municipal corporation.” but is not excluded from the category of “governmental entit[ies].” There are at least some Labor Code violations for which a PAGA suit against Alameda may proceed. View "Stone v. Alameda Health System" on Justia Law

This case arose out of a qui tam action against Prime Healthcare Services—Encino Hospital, LLC (Encino Hospital) and others to impose civil penalties for violation of the Insurance Fraud Prevention Act (IFPA), Insurance Code section 1871 et seq. The State of California and relator (Plaintiffs) appealed from a judgment entered after a bench trial in which the court found insufficient evidence to support their allegations that Defendants engaged in insurance fraud by billing insurers for services performed in a detox center for which they had no appropriate license, and by employing a referral agency to steer patients to the center.   The Second Appellate District affirmed the judgment. The court explained that, CDI alleged that Encino Hospital misrepresented to insurers that it was properly licensed to provide detox services when it was not. The trial court found no evidence suggesting that Defendants presented a false claim to any insurer. The court agreed, reasoning that no authority of which it is aware or to which it has been directed obligates Encino Hospital to hold any license other than its license as a general acute care hospital. Because Encino Hospital needed no separate license or approval, and no evidence showed it concealed any provider, the CDI’s cause of action for false claims failed for lack of a predicate. View "State of Cal. v. Encino Hospital Medical Center" on Justia Law

In November 2015, while hospitalized at Fremont, an acute psychiatric facility, McGovern was assaulted by another patient. In March 2016, McGovern’s attorney sent Fremont a letter, requesting that Fremont preserve evidence, and stating that counsel would be gathering more information and would present Fremont’s insurance carrier with a pre-litigation demand. It requested that Fremont place its carrier on notice. On October 27, 2016, McGovern’s counsel sent Fremont a Notice of Intent to Commence Action For Medical Negligence Pursuant to Code of Civil Procedure 364, which requires that a plaintiff give a healthcare provider 90 days’ notice before commencing an action for professional negligence. Subsection (d) tolls the limitations period for 90 days if the notice is served on the defendant within the last 90 days of the applicable statute of limitations. which expired on November 7, 2016, in McGovern's case.McGovern filed suit on January 20, 2017. The trial court granted Fremont summary adjudication, finding that the March letter constituted a section 364 notice. so the complaint was not timely filed, and McGovern failed to establish a triable issue of fact as to neglect under Welfare & Institutions Code 15610.57. The court of appeal reversed. The March letter lacked the requisite elements for section 364 compliance and was not a notice of intent. McGovern’s professional negligence causes of action are not time-barred, The court also reversed an order quashing a subpoena for the assailant’s mental health records. View "McGovern v. BHC Fremont Hospital, Inc." on Justia Law

The California Legislature has required school children to be vaccinated for 10 diseases; COVID-19 was not yet among them. The issue here was whether a school district could require students to be vaccinated for COVID-19 as a condition for both: (1) attending in-person class; and (2) participating in extracurricular activities. The superior court determined there was a “statewide standard for school vaccination,” leaving “no room for each of the over 1,000 individual school districts to impose a patchwork of additional vaccine mandates.” On independent review, the Court of Appeal reached the same conclusion and affirmed the judgment. View "Let Them Choose v. San Diego Unified School Dist." on Justia Law