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Horvitz & Levy MICRA Manual
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8/20/2012
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2012 edition of Horvitz & Levy MICRA Manual now available
HORVITZ & LEVY LLP 15760 VENTURA BOULEVARD 18TH FLOOR ENCINO, CALIFORNIA 91436-3000 T 818.995.0800 WWW.HORVITZLEVY.COM More than 50 years of specializing in civil appeals COPYRIGHT © 2012 HORVITZ & LEVY LLP. ALL RIGHTS RESERVED MICRA MANUAL 2012 Edition H O R V I T Z & L E V Y L L P M I C R A M A N U A L i Copyright © 2012 Horvitz & Levy LLP TABLE OF CONTENTS Page A. THE LEGISLATIVE INTENT BEHIND MICRA . . . . . . . . . . . . . . . . . . . . . . 1 1. The importance of legislative intent . . . . . . . . . . . . . . . . . . . . . . . . . 1 2. The overall purpose of MICRA . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 3. The specific purpose of each MICRA statute . . . . . . . . . . . . . . . . . 2 a. Business and Professions Code section 6146 (limiting contingent attorney fees) . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 b. Civil Code section 3333.1, subdivision (a) (allowing evidence of collateral source payments) . . . . . . . . . . . . . . . 2 c. Civil Code section 3333.1, subdivision (b) (precluding subrogation by collateral source) . . . . . . . . . . . . . . . . . . . . . 2 d. Civil Code section 3333.2 (limiting recovery of noneconomic damages to $250,000) . . . . . . . . . . . . . . . . . . 3 e. Code of Civil Procedure section 340.5 (shortening the statute of limitations) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 f. Code of Civil Procedure section 364 (requiring 90 days’ notice of intent to sue) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 g. Code of Civil Procedure section 667.7 (allowing periodic payment of future damages) . . . . . . . . . . . . . . . . . . . . . . . . 4 h. Code of Civil Procedure section 1295 (encouraging and facilitating arbitration) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 4. MICRA should be liberally construed . . . . . . . . . . . . . . . . . . . . . . . 5H O R V I T Z & L E V Y L L P M I C R A M A N U A L ii Copyright © 2012 Horvitz & Levy LLP B. DEFINITIONS COMMON TO ALL MICRA STATUTES . . . . . . . . . . . . . . . 6 1. In general . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2. “Health care provider” defined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 a. Statutory definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 b. An emergency medical technician is a “heath care provider” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 c. An unlicensed social worker, registered with the Board of Behavioral Sciences and working toward licensure, is a “health care provider” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 d. A medical student lawfully practicing under a statutory exemption to the licensing requirement is a “health care provider” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 e. A blood bank is a “health care provider” . . . . . . . . . . . . . . . . 8 f. A sperm bank is a “health care provider.” So is a tissue bank” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 g. A skilled nursing facility is a “health care provider” . . . . . . . . 9 h. A residential care facility is not a “health care provider” . . . . 9 i. There are conflicting decisions on whether a medical group is a “health care provider” . . . . . . . . . . . . . . . . . . . . . 9 j. An HMO is not a “health care provider” . . . . . . . . . . . . . . . 13 k. A federally employed doctor or a federal hospital is a “health care provider” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 l. Vicarious liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1) For the professional negligence of a health care provider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2) For the negligence of an unlicensed employee of a health care provider . . . . . . . . . . . . . . . . . . . . . . . 14H O R V I T Z & L E V Y L L P M I C R A M A N U A L iii Copyright © 2012 Horvitz & Levy LLP m. The phrase “legal representatives” in the definition of “health care provider” has been construed to mean a health care provider’s estate . . . . . . . . . . . . . . . . . . . . . . . 15 n. The law in other states . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3. “Based upon professional negligence” defined . . . . . . . . . . . . . . . 16 a. Statutory definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 b. “Professional negligence” defined . . . . . . . . . . . . . . . . . . . 17 1) Broadly construed . . . . . . . . . . . . . . . . . . . . . . . . . . 17 a) Murillo v. Good Samaritan Hospital (1979) 99 Cal.App.3d 50 . . . . . . . . . . . . . . . . . . . . . 17 b) Williams v. Superior Court (1994) 30 Cal.App.4th 318 . . . . . . . . . . . . . . . . . . . . . . 18 c) Bellamy v. Appellate Department (1996) 50 Cal.App.4th 797 . . . . . . . . . . . . . . . . . . . . . . 18 d) Taylor v. United States (9th Cir. 1987) 821 F.2d 1428 . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 e) Hedlund v. Superior Court (1983) 34 Cal.3d 695 . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 f) Canister v. Emergency Ambulance Service, Inc. (2008) 160 Cal.App.4th 388 . . . . . . . . . . 20 g) David M. v. Beverly Hospital (2005) 131 Cal.App.4th 1272 . . . . . . . . . . . . . . . . . . . . . 21 h) Bell v. Sharp Cabrillo Hospital (1989) 212 Cal.App.3d 1034 . . . . . . . . . . . . . . . . . . . . . . 21 i) Palmer v. Superior Court (2002) 103 Cal.App.4th 953 . . . . . . . . . . . . . . . . . . . . . . 22 j) Scripps Clinic v. Superior Court (2003) 108 Cal.App.4th 917 . . . . . . . . . . . . . . . . . . . . . . 23H O R V I T Z & L E V Y L L P M I C R A M A N U A L iv Copyright © 2012 Horvitz & Levy LLP k) Osborn v. Irwin Memorial Blood Bank (1992) 5 Cal.App.4th 234 . . . . . . . . . . . . . . . 24 l) Johnson v. Superior Court (2002) 101 Cal.App.4th 869 . . . . . . . . . . . . . . . . . . . . . . 24 m) Cryolife, Inc. v. Superior Court (2003) 110 Cal.App.4th 1145 . . . . . . . . . . . . . . . . . . . . . 24 n) Rose v. Fife (1989) 207 Cal.App.3d 760 . . . . 24 o) Mero v. Sadoff (1995) 31 Cal.App.4th 1466 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 p) Francies v. Kapla (2005) 127 Cal.App.4th 1381 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 q) Titolo v. Cano (2007) 157 Cal.App.4th 310 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 2) Some unusual circumstances . . . . . . . . . . . . . . . . . 25 a) Flores v. Natividad Medical Center (1987) 192 Cal.App.3d 1106 . . . . . . . . . . . . . . . . . . 25 b) Ellis v. City of San Diego (9th Cir. 1999) 176 F.3d 1183 . . . . . . . . . . . . . . . . . . . . . . . . 26 c) Vazquez de Mercado v. Superior Court (2007) 148 Cal.App.4th 711 . . . . . . . . . . . . . 26 3) A statutory proviso . . . . . . . . . . . . . . . . . . . . . . . . . . 27 c. “Based upon” professional negligence defined . . . . . . . . . 27 1) Intentional torts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 a) Nelson v. Gaunt (1981) 125 Cal.App.3d 623 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 b) Brown v. Bleiberg (1982) 32 Cal.3d 426 . . . 28 c) Waters v. Bourhis (1985) 40 Cal.3d 424 . . . 28H O R V I T Z & L E V Y L L P M I C R A M A N U A L v Copyright © 2012 Horvitz & Levy LLP d) Noble v. Superior Court (1987) 191 Cal.App.3d 1189 . . . . . . . . . . . . . . . . . . . . . 28 e) Central Pathology Service Medical Clinic, Inc. v. Superior Court (1992) 3 Cal.4th 181 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 f) Delaney v. Baker (1999) 20 Cal.4th 23 . . . . . 29 g) Barris v. County of Los Angeles (1999) 20 Cal.4th 101 . . . . . . . . . . . . . . . . . . . . . . . . . . 30 h) Perry v. Shaw (2001) 88 Cal.App.4th 658 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 i) Guardian North Bay, Inc. v. Superior Court (2001) 94 Cal.App.4th 963 . . . . . . . . . . . . . . 31 j) Covenant Care, Inc. v. Superior Court (2004) 32 Cal.4th 771 . . . . . . . . . . . . . . . . . 31 k) David M. v. Beverly Hospital (2005) 131 Cal.App.4th 1272 . . . . . . . . . . . . . . . . . . . . . 32 l) Smith v. Ben Bennett, Inc. (2005) 133 Cal.App.4th 1507 . . . . . . . . . . . . . . . . . . . . . 33 m) Unruh-Haxton v. Regents of University of California (2008) 162 Cal.App.4th 343 . . . . . 33 n) Arguing that MICRA should apply to intentional torts . . . . . . . . . . . . . . . . . . . . . . . 34 2) Equitable indemnity action . . . . . . . . . . . . . . . . . . . . 36 a) Western Steamship Lines, Inc. v. San Pedro Peninsula Hospital (1994) 8 Cal.4th 100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 b) Preferred Risk Mutual Ins. Co. v. Reiswig (1999) 21 Cal.4th 208 . . . . . . . . . . . . . . . . . . 36 c) County of Contra Costa v. Kaiser Foundation Health Plan, Inc. (1996) 47 Cal.App.4th 237 . . . . . . . . . . . . . . . . . . . . . . 37H O R V I T Z & L E V Y L L P M I C R A M A N U A L vi Copyright © 2012 Horvitz & Levy LLP d) SeaRiver Maritime v. Industrial Medical Services (N.D.Cal. 1997) 983 F.Supp. 1287 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 3) EMTALA action . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 4) Elder abuse action . . . . . . . . . . . . . . . . . . . . . . . . . . 39 d. The law in other states . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41H O R V I T Z & L E V Y L L P M I C R A M A N U A L vii Copyright © 2012 Horvitz & Levy LLP C. BUSINESS AND PROFESSIONS CODE SECTION 6146: LIMITING CONTINGENT ATTORNEY FEES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 1. Text of section 6146 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 2. Summary of section 6146 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 3. Section 6146 is constitutional . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 4. Section 6146 cannot be waived . . . . . . . . . . . . . . . . . . . . . . . . . . 43 5. Other contexts in which section 6146 may apply . . . . . . . . . . . . . 44 a. Wrongful death action . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 b. Action against public entity or employee . . . . . . . . . . . . . . 44 c. EMTALA action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 d. Elder abuse action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 e. Equitable indemnity action . . . . . . . . . . . . . . . . . . . . . . . . . 44 f. Action under Federal Tort Claims Act . . . . . . . . . . . . . . . . . 44 6. Statutory definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 a. Definition of “health care provider” . . . . . . . . . . . . . . . . . . . 45 b. Definition of “based upon professional negligence” . . . . . . 45 c. Definition of “recovered” . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 1) Deduction of costs . . . . . . . . . . . . . . . . . . . . . . . . . . 45 2) Recovery by multiple plaintiffs . . . . . . . . . . . . . . . . . 45 3) Recovery against multiple defendants . . . . . . . . . . . 45 7. The fee limit includes the hourly fee paid to an associate counsel to handle an appeal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 8. The fee limit includes the contingent fee paid to a medical-legal consultant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47H O R V I T Z & L E V Y L L P M I C R A M A N U A L viii Copyright © 2012 Horvitz & Levy LLP 9. The fee limit applies to the contingent fee paid by a minor or incompetent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 a. The usual pre-MICRA fee was 25% . . . . . . . . . . . . . . . . . . 47 b. If the MICRA fee was less than 25%, the court had to award the MICRA amount . . . . . . . . . . . . . . . . . . . . . . . . . 47 c. If the MICRA fee was greater than 25%, the court could award 25% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 d. Now, courts must use the reasonable fee standard . . . . . . 48 10. Factoring periodic payments into the fee calculation . . . . . . . . . . 48 a. The fee on periodic payments is based on the present value of the payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 b. Present value is based on the jury’s present value verdict. In the absence of a jury determination of present value, the cost of an annuity should be used . . . . . . . . . . . 49 11. Ensuring compliance with the fee limit . . . . . . . . . . . . . . . . . . . . . 49 a. It matters to the defendant . . . . . . . . . . . . . . . . . . . . . . . . . 49 b. An excessive fee can be exposed by anyone . . . . . . . . . . 49H O R V I T Z & L E V Y L L P M I C R A M A N U A L ix Copyright © 2012 Horvitz & Levy LLP D. CIVIL CODE SECTION 3333.1: ALLOWING EVIDENCE OF COLLATERAL SOURCE BENEFITS AND PRECLUDING SUBROGATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 1. Text of section 3333.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 2. Summary of section 3333.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 a. Collateral source rule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 b. Section 3333.1, subdivision (a) . . . . . . . . . . . . . . . . . . . . . 52 c. Section 3333.1, subdivision (b) . . . . . . . . . . . . . . . . . . . . . 53 3. Section 3333.1 is constitutional . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 a. Subdivision (a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 b. Subdivision (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 4. Other contexts in which section 3333.1 may apply . . . . . . . . . . . . 54 a. Wrongful death action . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 b. Action against public entity or employee . . . . . . . . . . . . . . 54 c. EMTALA action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 d. Elder abuse action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 e. Equitable indemnity action . . . . . . . . . . . . . . . . . . . . . . . . . 54 f. Action under Federal Tort Claims Act . . . . . . . . . . . . . . . . . 54 5. Statutory definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 a. Definition of “health care provider” . . . . . . . . . . . . . . . . . . . 54 b. Definition of “based upon professional negligence” . . . . . . 54 6. Meaning of other statutory terms . . . . . . . . . . . . . . . . . . . . . . . . . 55 a. “. . . any amount payable as a benefit to the plaintiff . . . . ” 55H O R V I T Z & L E V Y L L P M I C R A M A N U A L x Copyright © 2012 Horvitz & Levy LLP b. “. . . pursuant to the United States Social Security Act . . . .” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 c. “. . . any contract or agreement of any group, organization . . . . ” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 d. “. . . source of collateral benefits introduced pursuant to subdivision (a) . . . . ” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 7. Federal statutes authorizing reimbursement from a tort recovery prevail over section 3333.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 a. If a federal right to reimbursement exists, subdivision (b) of section 3333.1 is preempted . . . . . . . . . . . . . . . . . . . . . 59 b. If subdivision (b) is preempted, subdivision (a) should be unenforceable as well . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 c. Collateral sources with a federal right to reimbursement . . 59 1) Federal government . . . . . . . . . . . . . . . . . . . . . . . . . 59 a) Medi-Cal . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 b) Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 2) ERISA plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 8. State statutes authorizing reimbursement of public benefits from a tort recovery prevail over section 3333.1 . . . . . . . . . . . . . . . . . . 63 a. Medi-Cal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 b. County hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 c. California Children’s Services (CCS) . . . . . . . . . . . . . . . . . 64 9. Section 3333.1 prevails over state statutes allowing reimbursement of, or a credit against, workers’ compensation benefits from a tort recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 a. An employer has no right to reimbursement . . . . . . . . . . . . 64 b. An employer has no right to a credit . . . . . . . . . . . . . . . . . . 64H O R V I T Z & L E V Y L L P M I C R A M A N U A L xi Copyright © 2012 Horvitz & Levy LLP 10. Summary: list of collateral sources encompassed by section 3333.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 a. Private health, sickness, accident, or disability benefits . . . 65 b. Medicare Part C (Medicare Advantage) . . . . . . . . . . . . . . . 65 c. State disability insurance (SDI) . . . . . . . . . . . . . . . . . . . . . 65 d. Workers’ compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 e. Social Security survivors benefits . . . . . . . . . . . . . . . . . . . . 65 f. Social Security Disability Insurance (SSDI) . . . . . . . . . . . . 66 g. Supplemental Security Income (SSI) . . . . . . . . . . . . . . . . . 66 11. Summary: list of collateral sources not encompassed by section 3333.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 a. Private life insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 b. Private gratuitous benefits . . . . . . . . . . . . . . . . . . . . . . . . . 67 c. Medicare Parts A and B . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 d. Medi-Cal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 e. County hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 f. California Children’s Services (CCS) . . . . . . . . . . . . . . . . . 67 g. In-Home Supportive Services (IHSS) . . . . . . . . . . . . . . . . . 67 h. Rehabilitation services . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 i. Regional centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 j. Special education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 12. Benefits that are not collateral sources in the first place, evidence of which should be admissible without regard to section 3333.1: regional centers and special education . . . . . . . . 69H O R V I T Z & L E V Y L L P M I C R A M A N U A L xii Copyright © 2012 Horvitz & Levy LLP a. Whether the collateral source rule applies is an open question . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 b. Regional centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 c. Special education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 d. Public policy considerations underlying the collateral source rule do not apply . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 1) The Helfend case . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 2) The Arambula case . . . . . . . . . . . . . . . . . . . . . . . . . 70 e. The law in other states . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 1) Washington v. Barnes Hospital (Mo. 1995) 897 S.W.2d 611 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 2) Fla. Physicians Ins. Reciprocal v. Stanley (Fla. 1984) 452 So.2d 514 . . . . . . . . . . . . . . . . . . . . . . . . 73 13. Litigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 a. Section 3333.1 should be pled as an affirmative defense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 b. The collateral source provider has no right to intervene . . . 73 c. Consider retaining a defense rehabilitation expert . . . . . . . 74 d. Proffer special jury instructions . . . . . . . . . . . . . . . . . . . . . . 74 1) Instruction if evidence of past collateral source benefits is admitted . . . . . . . . . . . . . . . . . . . . . . . . . 74 2) Instruction if evidence of future collateral source benefits is admitted . . . . . . . . . . . . . . . . . . . . . . . . . 74 3) Instruction if evidence of regional center or special education benefits is admitted . . . . . . . . . . . . . . . . . 74 e. Consider proposing a special verdict or special interrogatories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75H O R V I T Z & L E V Y L L P M I C R A M A N U A L xiii Copyright © 2012 Horvitz & Levy LLP E. CIVIL CODE SECTION 3333.2: LIMITING RECOVERY OF NONECONOMIC DAMAGES TO $250,000 . . . . . . . . . . . . . . . . . . . . . . 76 1. Text of section 3333.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 2. Summary of section 3333.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 3. Section 3333.2 is constitutional . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 4. Other contexts in which section 3333.2 may apply . . . . . . . . . . . 80 a. Wrongful death action . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 b. Action against public entity or employee . . . . . . . . . . . . . . 80 c. EMTALA action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 d. Elder abuse action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 e. Equitable indemnity action . . . . . . . . . . . . . . . . . . . . . . . . . 81 f. Action under Federal Tort Claims Act . . . . . . . . . . . . . . . . . 81 5. Statutory definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 a. Definition of “health care provider” . . . . . . . . . . . . . . . . . . . 81 b. Definition of “based upon professional negligence” . . . . . . 81 6. A single plaintiff is limited to $250,000 for a single injury, regardless of the number of actors or acts that caused the injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 7. A single plaintiff may be limited to $250,000 even for multiple injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 8. The heirs in a wrongful death action are limited to an aggregate of $250,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 9. A spouse suing for loss of consortium is entitled to a separate $250,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 a. The $250,000 limit applies to the spouse . . . . . . . . . . . . . . 83 b. The spouse’s $250,000 limit is separate . . . . . . . . . . . . . . 84H O R V I T Z & L E V Y L L P M I C R A M A N U A L xiv Copyright © 2012 Horvitz & Levy LLP c. If the injured patient dies, the spouse’s loss-ofconsortium claim merges into the spouse’s wrongful death claim. A single $250,000 limit applies . . . . . . . . . . . 84 10. A relative suing for negligent infliction of emotional distress is entitled to a separate $250,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 a. The $250,000 limit applies to the relative . . . . . . . . . . . . . . 85 b. The relative’s $250,000 limit is separate . . . . . . . . . . . . . . 85 11. The noneconomic damages are reduced to $250,000 after applying the plaintiff’s comparative fault percentage . . . . . . . . . . . 85 12. The noneconomic damages are reduced to $250,000 before applying the defendant’s comparative fault percentage under Proposition 51 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 13. A hypothetical combining the $250,000 limit and comparative fault by both the plaintiff and the defendant . . . . . . . . . . . . . . . . . 87 14. The noneconomic damages should be reduced to $250,000 before calculating the percentage of noneconomic damages in the verdict and using that percentage to allocate a settlement between noneconomic and economic damages . . . . . . . . . . . . . . 87 a. The noneconomic damages in a settlement are not subject to setoff. To determine how much of the settlement is noneconomic damages, calculate the percentage of noneconomic damages in the verdict . . . . . 87 b. The noneconomic damages should be reduced to $250,000 before the percentage of noneconomic damages in the verdict is calculated . . . . . . . . . . . . . . . . . . 88 15. The noneconomic damages owed by a nonsettling defendant should not exceed $250,000 minus the noneconomic damages paid by a settling codefendant . . . . . . . . . . . . . . . . . . . . . . . . . . 90 16. Litigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 a. Section 3333.2 should be pled as an affirmative defense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 b. The jury should not be told about the $250,000 limit . . . . . 92H O R V I T Z & L E V Y L L P M I C R A M A N U A L xv Copyright © 2012 Horvitz & Levy LLP c. The verdict must separate noneconomic from economic damages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 d. If the verdict for noneconomic damages exceeds $250,000, immediately move to reduce it to $250,000 . . . . 97 17. The law in other states . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98H O R V I T Z & L E V Y L L P M I C R A M A N U A L xvi Copyright © 2012 Horvitz & Levy LLP F. CODE OF CIVIL PROCEDURE SECTION 340.5: SHORTENING THE STATUTE OF LIMITATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 1. Text of section 340.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 2. Summary of section 340.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 a. Limitations period for an adult . . . . . . . . . . . . . . . . . . . . . 100 1) The one-year “discovery” limitations period . . . . . . 100 2) The three-year “outside” limitations period . . . . . . 100 b. Limitations period for a minor . . . . . . . . . . . . . . . . . . . . . . 101 3. Section 340.5 is constitutional . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 4. Other contexts in which section 340.5 may apply . . . . . . . . . . . . 102 a. Wrongful death action . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 b. Action against public entity or employee . . . . . . . . . . . . . 102 c. EMTALA action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 d. Elder abuse action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 e. Equitable indemnity action . . . . . . . . . . . . . . . . . . . . . . . . 103 f. Action under Federal Tort Claims Act . . . . . . . . . . . . . . . . 103 5. Statutory definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 a. Definition of “health care provider” . . . . . . . . . . . . . . . . . . 103 b. Definition of “based upon professional negligence” . . . . . 103 6. An action by an adult must be brought within one year after the plaintiff first suffered appreciable harm and suspected, or should have suspected, that someone had done something wrong . . . . 103H O R V I T Z & L E V Y L L P M I C R A M A N U A L xvii Copyright © 2012 Horvitz & Levy LLP a. The one-year “discovery” limitations period is triggered when the plaintiff actually suspects wrongdoing (the subjective test) or when a reasonable person would have suspected wrongdoing (the objective test), whichever occurs first . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 b. The plaintiff need not be aware of the specific facts necessary to establish the elements of the cause of action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 c. The plaintiff need not be aware of the defendant’s identity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 d. The plaintiff need not be aware of the applicable law . . . . 105 e. Cases applying the one-year “discovery” limitations period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 1) Cases holding the plaintiff’s action is time-barred as a matter of law . . . . . . . . . . . . . . . . . . . . . . . . . 106 a) Sanchez v. South Hoover Hospital (1976) 18 Cal.3d 93 . . . . . . . . . . . . . . . . . . . . . . . . 106 b) Gutierrez v. Mofid (1985) 39 Cal.3d 892 . . . 107 c) Rose v. Fife (1989) 207 Cal.App.3d 760, 768-770 . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 d) Kleefeld v. Superior Court (1994) 25 Cal.App.4th 1680 . . . . . . . . . . . . . . . . . . . 108 e) Other cases . . . . . . . . . . . . . . . . . . . . . . . . . 108 2) Cases holding the plaintiff’s action is not timebarred, or at least not time-barred as a matter of law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 a) Brown v. Bleiberg (1982) 32 Cal.3d 426, 433-436 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 b) Unjian v. Berman (1989) 208 Cal.App.3d 881, 884-889 . . . . . . . . . . . . . . . . . . . . . . . 110H O R V I T Z & L E V Y L L P M I C R A M A N U A L xviii Copyright © 2012 Horvitz & Levy LLP c) Kitzig v. Nordquist (2000) 81 Cal.App.4th 1384, 1391-1396 . . . . . . . . . . . . . . . . . . . . 110 d) Artal v. Allen (2003) 111 Cal.App.4th 273 . 111 e) Zambrano v. Dorough (1986) 179 Cal.App.3d 169 . . . . . . . . . . . . . . . . . . . . . . 112 f) Other cases . . . . . . . . . . . . . . . . . . . . . . . . . 113 7. The one-year “discovery” limitations period can be tolled by service of a 90-day notice of intent to sue during the last 90 days of the one-year period, and by non-MICRA tolling provisions, but not by section 340.5’s internal tolling provisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 a. Section 340.5’s internal tolling provisions do not apply . . 114 b. The 90-day notice tolling provision applies . . . . . . . . . . . . 114 c. Non-MICRA tolling provisions apply . . . . . . . . . . . . . . . . . 114 8. An action by an adult must be brought within three years after the plaintiff first suffered appreciable harm . . . . . . . . . . . . . . . . . 115 a. The three-year period is an outside limit on the time for bringing an action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 b. Cases applying the three-year “outside” limitations period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 1) Cases holding the plaintiff’s action is time-barred as a matter of law . . . . . . . . . . . . . . . . . . . . . . . . . 116 a) Hills v. Aronsohn (1984) 152 Cal.App.3d 753, 760-763 . . . . . . . . . . . . . . . . . . . . . . . 116 b) Marriage & Family Center v. Superior Court (1991) 228 Cal.App.3d 1647 . . . . . . . . . . . . 116 c) McNall v. Summers (1994) 25 Cal.App.4th 1300 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 d) Garabet v. Superior Court (2007) 151 Cal.App.4th 1538 . . . . . . . . . . . . . . . . . . . . 117H O R V I T Z & L E V Y L L P M I C R A M A N U A L xix Copyright © 2012 Horvitz & Levy LLP e) Other cases . . . . . . . . . . . . . . . . . . . . . . . . . 118 2) Cases holding the plaintiff’s action is not timebarred, or at least not time-barred as a matter of law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 a) Steingart v. White (1988) 198 Cal.App.3d 406 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 b) Warren v. Schecter (1997) 57 Cal.App.4th 1189 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 c) Mason v. Marriage & Family Center (1991) 228 Cal.App.3d 537 . . . . . . . . . . . . . . . . . . 119 d) Other cases . . . . . . . . . . . . . . . . . . . . . . . . . 120 9. The three-year “outside” limitations period can be tolled by MICRA’s tolling provisions, but not by non-MICRA tolling provisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 a. Non-MICRA tolling provisions do not apply . . . . . . . . . . . 120 b. MICRA’s tolling provisions . . . . . . . . . . . . . . . . . . . . . . . . 120 1) Service of a 90-day notice of intent to sue during the last 90 days of the three-year limitations period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 2) Fraudulent concealment of the defendant’s negligence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 3) Presence of a medically inserted foreign body inadvertently left in the plaintiff’s body . . . . . . . . . . 122 10. An action brought by a minor who was less than six years old when appreciable harm was first suffered must be brought within three years after the harm or prior to the minor’s eighth birthday, whichever is longer. If the minor was at least six years old when appreciable harm was first suffered, the action must be brought within three years after the harm . . . . . . . . . . . . . . . . 123H O R V I T Z & L E V Y L L P M I C R A M A N U A L xx Copyright © 2012 Horvitz & Levy LLP a. Section 340.5 says a minor’s action accrues on the date of the “wrongful act”; nevertheless, the courts have held the action accrues on the date of “injury,” just like it does for an adult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 b. It is the plaintiff’s age on the date of injury, not on the date of filing, that counts . . . . . . . . . . . . . . . . . . . . . . . . . 123 c. The one-year “discovery” limitations period in section 340.5 does not apply . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 d. The rule of discovery does not apply . . . . . . . . . . . . . . . . 124 e. The six-year limitations period for prenatal injury specified in Code of Civil Procedure section 340.4 does not apply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 f. Cases applying the minor’s limitations period . . . . . . . . . . 124 1) Aronson v. Superior Court (1987) 191 Cal.App.3d 294 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 2) Tran v. Fountain Valley Community Hospital (1997) 51 Cal.App.4th 1464 . . . . . . . . . . . . . . . . . . 125 3) Other cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 11. The minor’s limitations period can be tolled by MICRA’s tolling provisions, but not by non-MICRA tolling provisions . . . . . . . . . . 125 a. Non-MICRA tolling provisions do not apply . . . . . . . . . . . 125 b. MICRA’s tolling provisions apply . . . . . . . . . . . . . . . . . . . 126 12. Litigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 a. Section 340.5 must be raised by demurrer or as an affirmative defense or both . . . . . . . . . . . . . . . . . . . . . . . . 126 b. The defendant bears the burden of proving the limitations defense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 c. Consider invoking the right to a bifurcated trial . . . . . . . . . 126H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxi Copyright © 2012 Horvitz & Levy LLP d. There is a right to a jury trial on the issue of the date of accrual of the plaintiff’s cause of action . . . . . . . . . . . . . . 126H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxii Copyright © 2012 Horvitz & Levy LLP G. CODE OF CIVIL PROCEDURE SECTION 364: REQUIRING 90 DAYS’ NOTICE OF INTENT TO SUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 1. Text of section 364 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 2. Text of related statute: Code of Civil Procedure section 365 . . . 128 3. Summary of sections 364 and 365 . . . . . . . . . . . . . . . . . . . . . . . 128 4. Section 364 is constitutional . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 5. Other contexts in which section 364 may apply . . . . . . . . . . . . . 129 a. Wrongful death action . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 b. Action against public entity or employee . . . . . . . . . . . . . 129 c. EMTALA action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 d. Elder abuse action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 e. Equitable indemnity action . . . . . . . . . . . . . . . . . . . . . . . . 130 f. Action under Federal Tort Claims Act . . . . . . . . . . . . . . . . 130 6. Statutory definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 a. Definition of “health care provider” . . . . . . . . . . . . . . . . . . 130 b. Definition of “based upon professional negligence” . . . . . 130 7. The notice of intent to sue must specify the alleged injury . . . . . 130 8. The notice of intent to sue must be served in a manner likely to result in actual notice to the defendant . . . . . . . . . . . . . . . . . . . . 131 a. Service of notice by mail, in strict compliance with statutory requirements, is effective immediately upon deposit in the mail, even if the defendant does not actually receive it . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 b. Service of notice by fax, without complying with the statutory requirement of an advance written agreement permitting service by fax, is effective if based on pastH O R V I T Z & L E V Y L L P M I C R A M A N U A L xxiii Copyright © 2012 Horvitz & Levy LLP experience that documents sent by fax were received by the person being served . . . . . . . . . . . . . . . . . . . . . . . . . . 131 c. Service of notice on a hospital is insufficient notice to a doctor if the plaintiff knows the doctor’s identity . . . . . . . . 131 d. Service of notice on a billing service with no direct connection to a doctor is insufficient notice to the doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 9. Notice of intent to sue need not be given to Doe defendants before amending the complaint to name them . . . . . . . . . . . . . . 132 10. The statute of limitations is tolled for 90 days when the notice of intent to sue is served within the last 90 days of the limitations period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 a. Woods v. Young (1991) 53 Cal.3d 315 . . . . . . . . . . . . . . 133 b. Russell v. Stanford University Hospital (1997) 15 Cal.4th 783 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 c. Newman v. Burnett (1997) 54 Cal.App.4th 722 . . . . . . . . 133 d. Preferred Risk Mutual Ins. Co. v. Reiswig (1999) 21 Cal.4th 208 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 e. Impact on tolling of inadequate notice of intent to sue . . . 133H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxiv Copyright © 2012 Horvitz & Levy LLP H. CODE OF CIVIL PROCEDURE SECTION 667.7: ALLOWING PERIODIC PAYMENT OF FUTURE DAMAGES . . . . . . . . . . . . . . . . . . 135 1. Text of section 667.7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 2. Summary of section 667.7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 a. Periodic payments are mandatory if requested . . . . . . . . 137 b. The jury determines the gross amount of future damages. The trial court structures the periodic-payment schedule to match future losses with compensation as the losses occur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 c. Periodic payments usually end upon death . . . . . . . . . . . 137 d. The defendant usually purchases an annuity to fund the periodic payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 e. Purchasing an annuity does not entitle the defendant to an acknowledgment of satisfaction of judgment . . . . . . . . 138 3. Section 667.7 and annuities: how periodic payments save money . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 4. Section 667.7 is constitutional . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 5. Other contexts in which section 667.7 may apply . . . . . . . . . . . . 140 a. Wrongful death action . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 b. Action against public entity or employee . . . . . . . . . . . . . 140 c. EMTALA action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 d. Elder abuse action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 e. Equitable indemnity action . . . . . . . . . . . . . . . . . . . . . . . . 141 f. Action under Federal Tort Claims Act . . . . . . . . . . . . . . . . 141 6. Statutory definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 a. Definition of “health care provider” . . . . . . . . . . . . . . . . . . 141H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxv Copyright © 2012 Horvitz & Levy LLP b. Definition of “based upon professional negligence” . . . . . 141 7. Impact of section 667.7 on settlement . . . . . . . . . . . . . . . . . . . . 141 8. Impact of section 667.7 on the trial . . . . . . . . . . . . . . . . . . . . . . . 141 a. Steps must be taken to preserve the right to a periodicpayment judgment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 1) Invoke the right to a periodic-payment judgment in the answer to the complaint and in a trial brief . . . 141 2) Request BAJI No. 16.01, the special verdict form for medical malpractice cases . . . . . . . . . . . . . . . . 142 3) In a “lost years” case, request that BAJI No. 16.01 be amended with questions that apportion future lost earnings between the earnings subject to lump-sum payment and the earnings subject to periodic payments . . . . . . . . . . . . . . . . . . . . . . . . . 143 a) Lost years earnings are not subject to periodic payments . . . . . . . . . . . . . . . . . . . . 143 b) Earnings during the plaintiff’s remaining lifetime are subject to periodic payments. Apportionment is required . . . . . . . . . . . . . . 144 c) Request that BAJI No. 16.01 be amended so the jury can apportion . . . . . . . . . . . . . . . 145 4) Immediately after the verdict, request a stay of entry of judgment . . . . . . . . . . . . . . . . . . . . . . . . . . 145 b. Defense counsel should vigorously defend against both aspects of plaintiff’s future economic damages claim: gross value and present value . . . . . . . . . . . . . . . . . . . . . 146 1) A defense economist should be used on the issue of future inflation rates for gross value, and on the issue of future interest rates for present value . . . . 146 a) The need for a defense economist is much more apparent where periodic payments are concerned . . . . . . . . . . . . . . . . . . . . . . . 146H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxvi Copyright © 2012 Horvitz & Levy LLP b) The defense economist should scrutinize the plaintiff’s economist’s projection of future inflation . . . . . . . . . . . . . . . . . . . . . . . 146 c) The defense economist should scrutinize the plaintiff’s economist’s projection of future interest rates . . . . . . . . . . . . . . . . . . . 147 2) A defense annuitist should be used on the issue of present value whenever a life insurance company’s assessment of the plaintiff’s life expectancy is likely to be significantly shorter than the jury’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 a) Annuity testimony is like getting two bites at the apple on periodic payments . . . . . . . . . 148 b) Annuity testimony should be admitted . . . . 149 3) Steps should be taken to minimize jury confusion over the difference between gross value and present value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 a) Confusion is likely . . . . . . . . . . . . . . . . . . . . 154 b) The BAJI present value table is no help . . . 154 c) Use proportions . . . . . . . . . . . . . . . . . . . . . . 154 d) Another approach: have the jury render findings on the essential components of gross and present value, but have the court perform the calculations . . . . . . . . . . . . . . . 154 c. If the plaintiff’s life expectancy is disputed, defense counsel should request a special finding on this issue . . . 155 d. The existence of the periodic-payment statute should not be disclosed to the jury . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 e. If a lump-sum judgment is entered, request periodic payments in post-trial motions . . . . . . . . . . . . . . . . . . . . . 156 1) Motion to vacate judgment . . . . . . . . . . . . . . . . . . . 156H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxvii Copyright © 2012 Horvitz & Levy LLP 2) Motion to correct clerical error . . . . . . . . . . . . . . . . 156 3) Section 473 motion . . . . . . . . . . . . . . . . . . . . . . . . 157 4) Motion under section 667.7 itself . . . . . . . . . . . . . . 158 9. Converting the verdict to a periodic-payment judgment . . . . . . . 158 a. Determine whether the defendant has adequate medical malpractice insurance to be entitled to a periodicpayment judgment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 b. Submit a proposed periodic-payment judgment that is complete in every regard . . . . . . . . . . . . . . . . . . . . . . . . . 159 c. Keep in mind the fundamental goal of periodic payments: to pay damages for future losses as those losses are incurred . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 d. Periodic payments for future economic losses should be spread over the full period of time the losses will be incurred. The payments should be progressive to account for inflation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 1) Holt v. Regents of University of California (1999) 73 Cal.App.4th 871 . . . . . . . . . . . . . . . . . . . . . . . . 159 2) Hrimnak v. Watkins (1995) 38 Cal.App.4th 964 . . . 161 3) Atkins v. Strayhorn (1990) 223 Cal.App.3d 1380 . 162 4) Deocampo v. Ahn (2002) 101 Cal.App.4th 758 . . 163 e. Never request periodic payment of damages for future noneconomic losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 1) Too much uncertainty exists regarding the total of the periodic payments . . . . . . . . . . . . . . . . . . . . . . 166 2) Too much uncertainty exists regarding the length of the periodic-payment schedule . . . . . . . . . . . . . 167H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxviii Copyright © 2012 Horvitz & Levy LLP 3) Avoid these potentially costly uncertainties. Use the future noneconomic damages as a source of upfront cash needed to pay the attorney fee and litigation expenses . . . . . . . . . . . . . . . . . . . . . . . . . 168 f. Consider whether to forego the right to periodic payment of future lost earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 1) The periodic payments may not end upon death . . 168 2) The uncertainty about whether periodic payments for future lost earnings will end upon death impacts the defendant’s insurer’s ability to close its claim file . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 g. An ordered, step-by-step approach should be followed when converting the verdict to a periodic-payment judgment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 1) Step one: reduce the noneconomic damages to $250,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 2) Step two: set off a settlement by a codefendant . . 170 a) Determine the present value of any portion of the settlement that was structured . . . . . 170 b) Determine the impact of Proposition 51 on the setoff . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 c) Subtract the cash portion of the setoff from the past economic damages in the verdict. Subtract any structured portion of the setoff from the present value of the future economic damages in the verdict . . . . . . . . 171 3) Step three: calculate any prejudgment interest . . . 173 a) Decide whether the periodic-payment judgment is more favorable than the plaintiff’s Code of Civil Procedure section 998 offer . . 173 b) Calculate the prejudgment interest . . . . . . . 173H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxix Copyright © 2012 Horvitz & Levy LLP c) If the amount of prejudgment interest is specified in the judgment, make sure that postjudgment interest does not accrue on the prejudgment interest . . . . . . . . . . . . . . . 174 4) Step four: calculate the statutory maximum attorney fee, estimate the plaintiff’s nonrecoverable costs, and allow for their payment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 a) Calculate the attorney fee and estimate the nonrecoverable costs . . . . . . . . . . . . . . . . . 174 b) If there is a settlement setoff, take into account that some or all of the higher percentages on the sliding fee scale already have been paid . . . . . . . . . . . . . . . . 175 c) Determine whether some of the damages subject to periodic payments must be paid as upfront cash to help cover the attorney fee and nonrecoverable costs . . . . . . . . . . . 175 5) Step five: fashion a payment schedule . . . . . . . . . 176 a) Work directly off the plaintiff’s evidence of future damages . . . . . . . . . . . . . . . . . . . . . . 177 b) If information is missing from the plaintiff’s evidence, extrapolate . . . . . . . . . . . . . . . . . 178 c) Avoid level periodic payments . . . . . . . . . . . 178 6) Step six: adjust the payment schedule if the damages subject to periodic payments have been reduced because of a settlement setoff or because money was moved to upfront cash to help pay the attorney fee and nonrecoverable costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 7) Step seven: attach a schedule of annual amounts to the defendant’s proposed judgment, but specify that the periodic payments are monthly . . . . . . . . 179H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxx Copyright © 2012 Horvitz & Levy LLP 8) Step eight: specify the manner in which postjudgment interest accrues on the judgment . . . . . 179 h. A sample periodic-payment judgment . . . . . . . . . . . . . . . 180 10. Bonding a periodic-payment judgment on appeal . . . . . . . . . . . . 181 11. The defendant is not entitled to an acknowledgment of satisfaction of judgment until the last periodic payment is made. This should not present a problem, however, because the case most likely will end in a structured settlement . . . . . . . . . . . . . . . 182 a. Purchasing an annuity will not entitle the defendant to an acknowledgment of satisfaction of judgment . . . . . . . . . . 182 b. The inability to obtain an acknowledgment of satisfaction of judgment is not a reason to forego periodic payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 c. If the defendant objects to a periodic-payment judgment, defense counsel must comply . . . . . . . . . . . . . . . . . . . . . 184H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxxi Copyright © 2012 Horvitz & Levy LLP I. CODE OF CIVIL PROCEDURE SECTION 1295: ENCOURAGING AND FACILITATING ARBITRATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 1. Text of section 1295 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 2. Summary of section 1295 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 3. Section 1295 is constitutional . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 4. Statutory definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 a. Definition of “health care provider” . . . . . . . . . . . . . . . . . . 188 b. Definition of “based upon professional negligence” . . . . . 188 5. Meaning of other statutory terms . . . . . . . . . . . . . . . . . . . . . . . . 188 a. “Any contract for medical services . . . ” . . . . . . . . . . . . . . 188 b. “. . . any dispute as to medical malpractice . . . ” . . . . . . . 189 c. “. . . all subsequent open-book account transactions for medical services . . . ” . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 6. An arbitration agreement that fails to comply with section 1295 is automatically unenforceable . . . . . . . . . . . . . . . . . . . . . . . . . . 191 7. An arbitration agreement that complies with section 1295 is not automatically enforceable. Consent to arbitrate must be knowing and voluntary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 8. A section 1295 arbitration agreement covers a claim by a nonsignatory if an agency or similar relationship exists between the nonsignatory and one of the parties to the arbitration agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 a. The section 1295 cases holding that a nonsignatory must arbitrate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 b. The contrary, minority view . . . . . . . . . . . . . . . . . . . . . . . . 193 c. Analogous cases holding that a nonsignatory must arbitrate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 d. Equiable indemnity claims are an exception . . . . . . . . . . 195H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxxii Copyright © 2012 Horvitz & Levy LLP 9. A minor cannot disaffirm an arbitration agreement if the medical services contract was signed by a parent, or if the medical care related to pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 10. Presumably, a section 1295 arbitration agreement will specify that MICRA applies. If so, an arbitrator’s failure to apply MICRA should be judicially reviewable as an act in excess of the arbitrator’s powers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 11. The law in other states . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198H O R V I T Z & L E V Y L L P M I C R A M A N U A L i Copyright © 2012 Horvitz & Levy LLP TABLE OF AUTHORITIES Page Cases Adams v. Murakami (1990) 268 Cal.Rptr. 467 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Adams v. Murakami (1991) 54 Cal.3d 105 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Albrecht v. Broughton (1970) 6 Cal.App.3d 173 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Alcott Rehabilitation Hospital v. Superior Court (2001) 93 Cal.App.4th 94 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9, 114 American Bank & Trust Co. v. Community Hospital (1984) 36 Cal.3d 359 . . . . . . . . . . . . . . . . . . . . . . . 1, 4, 75, 138, 139, 142 American Casualty Co. v. O’Flaherty (1997) 57 Cal.App.4th 1070 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 Anson v. County of Merced (1988) 202 Cal.App.3d 1195 . . . . . . . . . . . . . . . . . . . . . 102, 128, 129, 130 Arambula v. Wells (1999) 72 Cal.App.4th 1006 . . . . . . . . . . . . . . . . . . . . . . . . . . 52, 69, 70, 72 Aronson v. Superior Court (1987) 191 Cal.App.3d 294 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124, 125 Arredondo v. Regents of University of California (2005) 131 Cal.App.4th 614 . . . . . . . . . . . . . . . . . . 101, 102, 123, 124, 125 Artal v. Allen (2003) 111 Cal.App.4th 273 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111, 112 Ashworth v. Memorial Hospital (1988) 206 Cal.App.3d 1046 . . . . . . . . . . . . . . . . . . . . . . . . . 100, 122, 123 Association for Retarded Citizens v. Department of Developmental Services (1985) 38 Cal.3d 384 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68, 69H O R V I T Z & L E V Y L L P M I C R A M A N U A L ii Copyright © 2012 Horvitz & Levy LLP Atkins v. Strayhorn (1990) 223 Cal.App.3d 1380 . . . . . . 76, 82, 84, 85, 86, 162, 163, 167, 173 Auto Equity Sales, Inc. v. Superior Court (1962) 57 Cal.2d 450 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Baker v. Birnbaum (1988) 202 Cal.App.3d 288 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Baker v. Sadick (1984) 162 Cal.App.3d 618 . . . . . . . . . . . . . . . . . . . . . . . . . . 187, 189, 196 Barber v. Superior Court (1991) 234 Cal.App.3d 1076 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108, 121 Barme v. Wood (1984) 37 Cal.3d 174 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1, 2, 3, 53, 59, 65 Barris v. County of Los Angeles (1999) 20 Cal.4th 101 . . . . . . . . . . . . . . . . . . . . . 2, 30, 34, 38, 44, 80, 129 Bartleson v. United States (9th Cir. 1996) 96 F.3d 1270 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Bell v. Sharp Cabrillo Hospital (1989) 212 Cal.App.3d 1034 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Bellah v. Greenson (1978) 81 Cal.App.3d 614 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Bellamy v. Appellate Department (1996) 50 Cal.App.4th 797 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18, 19 Belton v. Bowers Ambulance Service (1999) 20 Cal.4th 928 . . . . . . . . . . . . . . 100, 101, 113, 114, 115, 120, 125 Bennett v. Hospital Corp. of America (9th Cir., Aug. 14, 1990, No. 89-35059) 1990 WL 119096 . . . . . . . . . . 152 Bennett v. Shahhal (1999) 75 Cal.App.4th 384 . . . . . . . . . . . . . . . . . . . 113, 114, 128, 131, 133 Benun v. Superior Court (2004) 123 Cal.App.4th 113 . . . . . . . . . . . . . . . . . . . . . . . . . 35, 40, 41, 103H O R V I T Z & L E V Y L L P M I C R A M A N U A L iii Copyright © 2012 Horvitz & Levy LLP Bernson v. Browning-Ferris Industries (1994) 7 Cal.4th 926 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105, 120 Bispo v. Burton (1978) 82 Cal.App.3d 824 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115, 120 Bolanos v. Khalatian (1991) 231 Cal.App.3d 1586 . . . . . . . . . . . . . . . . . . . . . . . . . 187, 192, 193 Bowden v. Green (1982) 128 Cal.App.3d 65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Bristol-Myers Squibb Co. v. Superior Court (1995) 32 Cal.App.4th 959 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Brown v. Bleiberg (1982) 32 Cal.3d 426 . . . . . . . . . . . . . . . . . . . . 28, 106, 109, 115, 120, 121 Brown v. Stewart (1982) 129 Cal.App.3d 331 . . . . . . . . . . . . . . . . . . . . 56, 57, 59, 63, 64, 67 Bryant v. New York City Health & Hosps. Corp. (1999) 93 N.Y.2d 592 [716 N.E.2d 1084] . . . . . . . . . . . . . . . . . . . 65, 66, 67 Buckner v. Tamarin (2002) 98 Cal.App.4th 140 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193, 194 Budavari v. Barry (1986) 176 Cal.App.3d 849 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Budd v. Nixen (1971) 6 Cal.3d 195 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Budinger v. McGann (C.D.Cal. 1987, CV 86-7499 MRP) 1987 WL 268934 . . . . . . . . . . . . . . . 62 Bunnell v. Department of Corrections (1998) 64 Cal.App.4th 1360 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103, 130 Burgess v. Superior Court (1992) 2 Cal.4th 1064 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1, 35, 83 Burgon v. Kaiser Foundation Hospitals (1979) 93 Cal.App.3d 813 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108H O R V I T Z & L E V Y L L P M I C R A M A N U A L iv Copyright © 2012 Horvitz & Levy LLP Burrows v. Redbud Community Hosp. Dist. (N.D.Cal. 1997) 188 F.R.D. 356 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Cable Connection, Inc. v. DIRECTV, Inc. (2008) 44 Cal.4th 1334 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 California Physicians’ Service v. Superior Court (1980) 102 Cal.App.3d 91 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3, 73 California Teachers Assn. v. Governing Bd. of Rialto Unified School Dist. (1997) 14 Cal.4th 627 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Camarillo v. Vaage (2003) 105 Cal.App.4th 552 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Campanano v. California Medical Center (1995) 38 Cal.App.4th 1322 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Canister v. Emergency Ambulance Service, Inc. (2008) 160 Cal.App.4th 388 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6, 7, 14, 21 Carter v. Prime Healthcare Paradise Valley LLC (2011) 198 Cal.App.4th 396 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Cedar Rapids Community School Dist. v. Garret F. (1999) 526 U.S. 66 [119 S.Ct. 992, 143 L.Ed.2d 154] . . . . . . . . . . . . . . . 70 Central Pathology Service Medical Clinic, Inc. v. Superior Court (1992) 3 Cal.4th 181 . . . . . . . . . . . . . . . . . 1, 28, 29, 30, 31, 32, 34, 36, 37 Chosak v. Alameda County Medical Center (2007) 153 Cal.App.4th 549 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7, 12, 15 Christ v. Lipsitz (1979) 99 Cal.App.3d 894 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Clark v. Baxter Healthcare Corp. (2000) 83 Cal.App.4th 1048 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Clay v. Permanente Med. Group, Inc. (N.D.Cal. 2007) 540 F.Supp.2d 1101 . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Clemente v. Amundson (1998) 60 Cal.App.4th 1094 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69H O R V I T Z & L E V Y L L P M I C R A M A N U A L v Copyright © 2012 Horvitz & Levy LLP Clemmer v. Hartford Insurance Co. (1978) 22 Cal.3d 865 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Cochran v. Rubens (1996) 42 Cal.App.4th 481 . . . . . . . . . . . . . . . . . . . . . . . . . . . 187, 190, 191 Coe v. Superior Court (1990) 220 Cal.App.3d 48 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Colburn v. United States (S.D.Cal. 1998) 45 F.Supp.2d 787 . . . . . . . . . . . . . . . . . . . . . . . . 46, 82, 83 Conrad v. Ball Corp. (1994) 24 Cal.App.4th 439 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Coon v. Nicola (1993) 17 Cal.App.4th 1225 . . . . . . . . . . . . . . . . . . . . . . . . . 187, 191, 192 Cornejo v. State (1990) 57 Wash.App. 314 [788 P.2d 554] . . . . . . . . . . . . . . . 151, 152, 153 Country Villa Claremont Healthcare Center, Inc. v. Superior Court (2004) 120 Cal.App.4th 426 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 County of Contra Costa v. Kaiser Foundation Health Plan, Inc. (1996) 47 Cal.App.4th 237 . . . . . . . . . . . . . . . . . . . . . . . 5, 37, 38, 192, 195 County of Los Angeles v. Smith (1999) 74 Cal.App.4th 500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68, 70 County of Sacramento v. State of California (1982) 134 Cal.App.3d 428 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Covenant Care, Inc. v. Superior Court (2004) 32 Cal.4th 771 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31, 32, 39, 40 Cox v. Superior Court (2002) 98 Cal.App.4th 670 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Craven v. Crout (1985) 163 Cal.App.3d 779 . . . . . . . . . . . . . . . . . . . . . . . 97, 142, 145, 158 Cryolife, Inc. v. Superior Court (2003) 110 Cal.App.4th 1145 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8, 9, 24H O R V I T Z & L E V Y L L P M I C R A M A N U A L vi Copyright © 2012 Horvitz & Levy LLP Curtis T. v. County of Los Angeles (2004) 123 Cal.App.4th 1405 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 David M. v. Beverly Hospital (2005) 131 Cal.App.4th 1272 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3, 21, 32 Davis v. Marin (2000) 80 Cal.App.4th 380 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128, 132 DeRose v. Carswell (1987) 196 Cal.App.3d 1011 . . . . . . . . . . . . . . . . . . . . . . . . . 112, 113, 115 Delaney v. Baker (1999) 20 Cal.4th 23 . . . . . . . . . . . . . . . . . . . . 1, 29, 30, 34, 39, 40, 41, 81 Deocampo v. Ahn (2002) 101 Cal.App.4th 758 . . . . . . . . . . . . 4, 163, 172, 173, 174, 176, 180 Derderian v. Dietrick (1997) 56 Cal.App.4th 892 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131, 132 DiMarco v. Chaney (1995) 31 Cal.App.4th 1809 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Dinong v. Superior Court (1980) 102 Cal.App.3d 845 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186, 188 Disabled & Blind Action Committee of Cal. v. Jenkins (1974) 44 Cal.App.3d 74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Dolan v. Borelli (1993) 13 Cal.App.4th 816 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104, 108 Donabedian v. Manzer (1986) 187 Cal.App.3d 1021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Downey Venture v. LMI Ins. Co. (1998) 66 Cal.App.4th 478 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Drissi v. Kaiser Found. Hosps., Inc. (N.D.Cal. 2008) 543 F.Supp.2d 1076 . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Dujardin v. Ventura County Gen. Hosp. (1977) 69 Cal.App.3d 350 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113H O R V I T Z & L E V Y L L P M I C R A M A N U A L vii Copyright © 2012 Horvitz & Levy LLP Edwards v. Superior Court (2001) 93 Cal.App.4th 172 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Elam v. College Park Hospital (1982) 132 Cal.App.3d 332 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Ellis v. City of San Diego (9th Cir. 1999) 176 F.3d 1183 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Emery v. Southern Cal. Gas Co. (1946) 72 Cal.App.2d 821 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Enfield v. Hunt (1979) 91 Cal.App.3d 417 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Engalla v. Permanente Medical Group, Inc. (1997) 15 Cal.4th 951 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85, 191 Espinoza v. Machonga (1992) 9 Cal.App.4th 268 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87, 88 Estate of Horman (1971) 5 Cal.3d 62 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 FMC Corp. v. Holliday (1990) 498 U.S. 52 [111 S.Ct. 403, 112 L.Ed.2d 356] . . . . . . . . . . . . . . . 62 FMC Corp. Employee Welfare Benefits Plan Committee v. Good Samaritan Hosp. (N.D.Cal. 1988, C-88-3092-FMS) 1988 WL 424459 . . . . . . . . . . . . . . . . 62 Fein v. Permanente Medical Group (1985) 38 Cal.3d 137 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1, 2, 3, 53, 54, 55, 56, 58, 59, 74, 77, 142, 143, 167, 170 Ferguson v. Dragul (1986) 187 Cal.App.3d 702 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Fetter v. United States (S.D.Cal. 1986) 649 F.Supp. 1097 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Fineberg v. Harney & Moore (1989) 207 Cal.App.3d 1049 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Fla. Physicians Ins. Reciprocal v. Stanley (Fla. 1984) 452 So.2d 514 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73H O R V I T Z & L E V Y L L P M I C R A M A N U A L viii Copyright © 2012 Horvitz & Levy LLP Flores v. Natividad Medical Center (1987) 192 Cal.App.3d 1106 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15, 25 Flowers v. Torrance Memorial Hospital Medical Center (1994) 8 Cal.4th 992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17, 18 Fox v. Ethicon Endo-Surgery, Inc. (2005) 35 Cal.4th 797 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104, 105, 109 Francies v. Kapla (2005) 127 Cal.App.4th 1381 . . . . . . . . . . . . . . . . . . . . . . 25, 46, 82, 86, 89 Francis v. Sauve (1963) 222 Cal.App.2d 102 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Franck v. Polaris E-Z Go Div. of Textron, Inc. (1984) 157 Cal.App.3d 1107 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Frerks v. Shalala (2d Cir. 1995) 52 F.3d 412 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Gallegos v. Dick Simon Trucking, Inc. (Utah Ct.App. 2004) 110 P.3d 710 . . . . . . . . . . . . . . . . . . . . . . . . 151, 153 Garabet v. Superior Court (2007) 151 Cal.App.4th 1538 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Garcia v. County of Sacramento (2002) 103 Cal.App.4th 67 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Garcia v. Hejmadi (1997) 58 Cal.App.4th 674 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Garhart v. Columbia/Healthone, L.L.C. (Colo. 2004) 95 P.3d 571 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Garoian v. Blaine (Jan. 9, 2004, B158721) 2004 WL 42903 2004 Cal.App. Unpub. Lexis 185 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Generale Bank Nederland v. Eyes of the Beholder Ltd. (1998) 61 Cal.App.4th 1384 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Gilbertson v. Osman (1986) 185 Cal.App.3d 308 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113H O R V I T Z & L E V Y L L P M I C R A M A N U A L ix Copyright © 2012 Horvitz & Levy LLP Gilman v. Beverly California Corp. (1991) 231 Cal.App.3d 121 . . . . . . . . . . . . . . . . . . . . . . . 46, 77, 82, 86, 87 Gluckman v. Gaines (1968) 266 Cal.App.2d 52 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Godwin v. City of Bellflower (1992) 5 Cal.App.4th 1625 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131, 132 Goliger v. AMS Properties, Inc. (2004) 123 Cal.App.4th 374 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 Gonzalez v. Chen (2011) 197 Cal.App.4th 881 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Gordon v. J & L Machinery Service Co. (1963) 213 Cal.App.2d 711 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Gorman v. Leftwich (1990) 218 Cal.App.3d 141 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175, 191 Graham v. Hansen (1982) 128 Cal.App.3d 965 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106, 108 Graham v. Workers’ Comp. Appeals Bd. (1989) 210 Cal.App.3d 499 . . . . . . . . . . . . . . . . . . . 55, 56, 57, 58, 64, 65 Granberry v. Islay Investments (1995) 9 Cal.4th 738 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Gray v. Reeves (1977) 76 Cal.App.3d 567 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Green v. Franklin (1987) 235 Cal.Rptr. 312 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Griffin v. Southeastern Pennsylvania Transp. Authority (Pa.Commw.Ct. 2000) 757 A.2d 448 . . . . . . . . . . . . . . . . . . . . . . . . . 79, 80 Grimm v. Thayer (1987) 188 Cal.App.3d 866 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Gross v. Recabaran (1988) 206 Cal.App.3d 771 . . . . . . . . . . . . . . . . . . . . . . . . 5, 187, 190, 192H O R V I T Z & L E V Y L L P M I C R A M A N U A L x Copyright © 2012 Horvitz & Levy LLP Guardian North Bay, Inc. v. Superior Court (2001) 94 Cal.App.4th 963 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9, 31 Gutierrez v. Mofid (1985) 39 Cal.3d 892 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105, 107 Hanif v. Housing Authority (1988) 200 Cal.App.3d 635 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52, 69 Hanooka v. Pivko (1994) 22 Cal.App.4th 1553 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131, 132 Harris v. Superior Court (1986) 188 Cal.App.3d 475 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Hathaway v. Baldwin Park Community Hospital (1986) 186 Cal.App.3d 1247 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Hawkins v. Superior Court (1979) 89 Cal.App.3d 413 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Hazel v. Hewlett (1988) 201 Cal.App.3d 1458 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 HBE Leasing Corp. v. Frank (2d Cir. 1994) 22 F.3d 41 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Hedlund v. Superior Court (1983) 34 Cal.3d 695 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20, 22 Helfend v. Southern Cal. Rapid Transit Dist. (1970) 2 Cal.3d 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52, 70, 71, 72 Henry v. Clifford (1995) 32 Cal.App.4th 315 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Herbert v. Superior Court (1985) 169 Cal.App.3d 718 . . . . . . . . . . . . . . . . . . . . . . 187, 188, 194, 195 Hernandez v. California Hospital Medical Center (2000) 78 Cal.App.4th 498 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53, 63 Herrera v. Superior Court (1984) 158 Cal.App.3d 255 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187, 189H O R V I T Z & L E V Y L L P M I C R A M A N U A L xi Copyright © 2012 Horvitz & Levy LLP Hilleary v. Garvin (1987) 193 Cal.App.3d 322 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188, 189 Hillman v. Britton (1980) 111 Cal.App.3d 810 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Hills v. Aronsohn (1984) 152 Cal.App.3d 753 . . . . . . . . . . . . . . . . . . . . . . 113. 115, 116, 123 Hodson v. Woods (1984) 160 Cal.App.3d 1227 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Hoffman v. United States (9th Cir. 1985) 767 F.2d 1431 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Hollingshead v. Matsen (1995) 34 Cal.App.4th 525 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Hollingsworth v. Kofoed (1996) 45 Cal.App.4th 423 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Hollister v. Benzl (1999) 71 Cal.App.4th 582 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188, 189 Holt v. Regents of University of California (1999) 73 Cal.App.4th 871 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4, 48, 49, 138, 141, 147, 148, 155, 159, 163, 165, 168, 174, 176, 182 Hooper v. Capobianco (May 25, 2004, C040072) 2004 WL 1167395, 2004 Cal.App. Unpub. Lexis 5001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Horwich v. Superior Court (1999) 21 Cal.4th 272 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Howell v. Hamilton Meats & Provisions, Inc. (2011) 52 Cal.4th 541 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Hrimnak v. Watkins (1995) 38 Cal.App.4th 964 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49, 137, 138, 141, 142, 148, 150, 161, 173, 182, 183 Hurlbut v. Sonora Community Hospital (1989) 207 Cal.App.3d 388 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144H O R V I T Z & L E V Y L L P M I C R A M A N U A L xii Copyright © 2012 Horvitz & Levy LLP In re Air Crash Disaster Near Cerritos, Cal. (9th Cir. 1992) 982 F.2d 1271 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 In re Exxon Valdez (9th Cir. 2000) 229 F.3d 790 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Inter Valley Health Plan v. Blue Cross/Blue Shield (1993) 16 Cal.App.4th 60 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 International Engine Parts, Inc. v. Feddersen & Co. (1995) 9 Cal.4th 606 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Jackson v. East Bay Hosp. (N.D.Cal. 1997) 980 F.Supp. 1341 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Jackson v. United States (9th Cir. 1989) 881 F.2d 707 . . . . . . . . . . . . . . . . . . . . . . . . 44, 45, 49, 130 Jefferson v. County of Kern (2002) 98 Cal.App.4th 606 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Johnson v. Superior Court (2002) 101 Cal.App.4th 869 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8, 9, 24 Jolly v. Eli Lilly & Co. (1988) 44 Cal.3d 1103 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104, 105 Jones v. Caillouette (Oct. 31, 2011, G044382) 2011 WL 5146024, 2011 Cal.App. Unpub. Lexis 8317 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Jones v. Catholic Healthcare West (2007) 147 Cal.App.4th 300 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Jones v. Queen of the Valley Hospital (1979) 90 Cal.App.3d 700 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Jordan v. Department of Motor Vehicles (2002) 100 Cal.App.4th 431 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Jordan v. Long Beach Community Hosp. (1988) 248 Cal.Rptr. 651 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60, 82, 84 Kaplan v. Mamelak (2008) 162 Cal.App.4th 637 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115H O R V I T Z & L E V Y L L P M I C R A M A N U A L xiii Copyright © 2012 Horvitz & Levy LLP Katz v. Children’s Hosp. of Orange County (9th Cir. 1994) 28 F.3d 1520 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Kelemen v. Superior Court (1982) 136 Cal.App.3d 861 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Keller Construction Co. v. Kashani (1990) 220 Cal.App.3d 222 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 Kilburn v. Pineda (1982) 137 Cal.App.3d 1046 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Kite v. Campbell (1983) 142 Cal.App.3d 793 . . . . . . . . . . . . . . . . . . . . . . . . . . 101, 125, 126 Kitzig v. Nordquist (2000) 81 Cal.App.4th 1384 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105, 110 Kleefeld v. Superior Court (1994) 25 Cal.App.4th 1680 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Knowles v. Superior Court (2004) 118 Cal.App.4th 1290 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104, 105 Kotler v. Alma Lodge (1998) 63 Cal.App.4th 1381 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Lamont v. Wolfe (1983) 142 Cal.App.3d 375 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Larcher v. Wanless (1976) 18 Cal.3d 646 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Larsson v. Cedars of Lebanon Hospital (1950) 97 Cal.App.2d 704 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Lathrop v. HealthCare Partners Medical Group (2004) 114 Cal.App.4th 1412 . . . . . . . . . . . . . . . . . . . . 3, 10, 11, 12, 13, 14 Lebrilla v. Farmers Group, Inc. (2004) 119 Cal.App.4th 1070 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Leung v. Verdugo Hills Hospital (2008) 168 Cal.App.4th 205 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181, 182H O R V I T Z & L E V Y L L P M I C R A M A N U A L xiv Copyright © 2012 Horvitz & Levy LLP Li v. Yellow Cab Co. (1975) 13 Cal.3d 804 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Lima v. Vouis (2009) 174 Cal.App.4th 242 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Limon v. College Hospital (Aug.17, 2011, B230179) 2011 WL 3612229, 2011 Cal.App. Unpub. Lexis 6227 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Lofty v. Richardson (1971) 440 F.2d 1144 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Mandjik v. Eden Township Hospital Dist. (1992) 4 Cal.App.4th 1488 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Mark K. v. Roman Catholic Archbishop (1998) 67 Cal.App.4th 603 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Marriage & Family Center v. Superior Court (1991) 228 Cal.App.3d 1647 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100, 115 Marshall v. Bankers Life & Casualty Co. (1992) 2 Cal.4th 1045 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Marshall v. Brown (1983) 141 Cal.App.3d 408 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92, 97 Marshall v. McMahon (1993) 17 Cal.App.4th 1841 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Martell v. Antelope Valley Hospital Medical Center (1998) 67 Cal.App.4th 978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102, 103 Martinez-Ferrer v. Richardson-Merrell, Inc. (1980) 105 Cal.App.3d 316 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Mason v. Marriage & Family Center (1991) 228 Cal.App.3d 537 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Mayes v. Bryan (2006) 139 Cal.App.4th 1075 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86, 89 McAdory v. Rogers (1989) 215 Cal.App.3d 1273 . . . . . . . . . . . . . . . . . . . . . . . . . 76, 85, 86, 87H O R V I T Z & L E V Y L L P M I C R A M A N U A L xv Copyright © 2012 Horvitz & Levy LLP McComber v. Wells (1999) 72 Cal.App.4th 512 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87, 171 McKinney v. California Portland Cement Co. (2002) 96 Cal.App.4th 1214 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52, 70 McNall v. Summers (1994) 25 Cal.App.4th 1300 . . . . . . . . . . . . . . . . . . . . . . 100, 116, 117, 121 Medical Mutual of Ohio v. deSoto (6th Cir. 2001) 245 F.3d 561 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Mero v. Sadoff (1995) 31 Cal.App.4th 1466 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Michaelis v. Schori (1993) 20 Cal.App.4th 133 . . . . . . . . . . . . . . . . . . . . . . . . . . . 187, 192, 196 Miller v. Bechtel Corp. (1983) 33 Cal.3d 868 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Miller v. Lakeside Village Condo-minium Assn. (1991) 1 Cal.App.4th 1611 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Miller v. Sciaroni (1985) 172 Cal.App.3d 306 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57, 64 Moncharsh v. Heily & Blase (1992) 3 Cal.4th 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47, 48, 170, 196 Moore v. First Bank of San Luis Obispo (2000) 22 Cal.4th 782 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Moore v. Preventive Medicine Medical Group, Inc. (1986) 178 Cal.App.3d 728 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Mormile v. Sinclair (1994) 21 Cal.App.4th 1508 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192, 193 Moshonov v. Walsh (2000) 22 Cal.4th 771 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Murillo v. Good Samaritan Hospital (1979) 99 Cal.App.3d 50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18, 19, 113H O R V I T Z & L E V Y L L P M I C R A M A N U A L xvi Copyright © 2012 Horvitz & Levy LLP Nelson v. Gaunt (1981) 125 Cal.App.3d 623 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Newman v. Burnett (1997) 54 Cal.App.4th 722 . . . . . . . . . . . . . . . . . . . . . . . 101, 126, 128, 133 Newton v. Clemons (2003) 110 Cal.App.4th 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Nguyen v. Los Angeles County Harbor/UCLA Medical Center (1995) 40 Cal.App.4th 1433 . . . 44, 49, 138, 148, 150, 151, 170, 174, 176 Noble v. Superior Court (1987) 191 Cal.App.3d 1189 . . . . . . . . . . . . . . . . . . . . . . . . 28, 30, 32, 189 Nogueiro v. Kaiser Foundation Hospitals (1988) 203 Cal.App.3d 1192 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 NORCAL Mutual Ins. Co. v. Newton (2000) 84 Cal.App.4th 64 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187, 192, 193 Norgart v. Upjohn Co. (1999) 21 Cal.4th 383 . . . . . . . . . . . . . . . . . . 100, 102, 104, 105, 106, 109 O’Flaherty v. Belgum (2004) 115 Cal.App.4th 1044 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Ojeda v. Sharp Cabrillo Hospital (1992) 8 Cal.App.4th 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45, 47 Orellana v. Mejia (1988) 249 Cal.Rptr. 828 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Osborn v. Irwin Memorial Blood Bank (1992) 5 Cal.App.4th 234 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Padilla v. Greater El Monte Community Hospital (2005) 129 Cal.App.4th 667 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Palmer v. Superior Court (2002) 103 Cal.App.4th 953 . . . . . . . . . . . . . . . . . . . 8, 9, 10, 12, 13, 22, 23 People v. Birkett (1999) 21 Cal.4th 226 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70H O R V I T Z & L E V Y L L P M I C R A M A N U A L xvii Copyright © 2012 Horvitz & Levy LLP People v. Dee (1990) 222 Cal.App.3d 760 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 People v. Heitzman (1994) 9 Cal.4th 189 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 Perry v. Medina (1987) 192 Cal.App.3d 603 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Perry v. Shaw (2001) 88 Cal.App.4th 658 . . . . . . . . . . . . . . . . . . . . . . . . . . 2, 3, 30, 31, 33 Pettigrew v. Grand Rent-A-Car (1984) 154 Cal.App.3d 204 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Phillips v. Desert Hospital Dist. (1989) 49 Cal.3d 699 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128, 129 Photias v. Doerfler (1996) 45 Cal.App.4th 1014 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3, 116, 124 Piedra v. Dugan (2004) 123 Cal.App.4th 1483 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140, 143 Pietrelli v. Peacock (1993) 13 Cal.App.4th 943 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192, 193 Pollock & Riley, Inc. v. Pearl Brewing Company (5th Cir. 1974) 498 F.2d 1240 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Potter v. Firestone Tire & Rubber Co. (1993) 6 Cal.4th 965 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Power v. Arlington Hosp. Ass’n (4th Cir. 1994) 42 F.3d 851 . . . . . . . . . . . . . . . . . . . . . . . . . . . 44, 103, 129 Preferred Risk Mutual Ins. Co. v. Reiswig (1999) 21 Cal.4th 208 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2, 4, 5, 12, 36, 37, 38, 55, 103, 128, 129, 130, 133 Pressler v. Irvine Drugs, Inc. (1985) 169 Cal.App.3d 1244 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Prince v. Sutter Health Care (2008) 161 Cal.App.4th 971 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7H O R V I T Z & L E V Y L L P M I C R A M A N U A L xviii Copyright © 2012 Horvitz & Levy LLP Purdy v. Pacific Automobile Ins. Co. (1984) 157 Cal.App.3d 59 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 Ramirez v. Superior Court (1980) 103 Cal.App.3d 746 . . . . . . . . . . . . . . . . . . . . . . . . . . 186, 187, 191 Reichle v. Hazie (1937) 22 Cal.App.2d 543 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Reigelsperger v. Siller (2007) 40 Cal.4th 574 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2, 4, 5, 187, 191 Reyes v. County of Los Angeles (1988) 197 Cal.App.3d 584 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107, 121 Rhodes v. California Hospital Medical Center (1978) 76 Cal.App.3d 606 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Richardson v. Belcher (1971) 404 U.S. 78 [92 S.Ct. 254, 30 L.Ed.2d 231] . . . . . . . . . . . . . . . . . 66 Roa v. Lodi Medical Group, Inc. (1985) 37 Cal.3d 920 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1, 2, 43 Roberts v. County of Los Angeles (2009) 175 Cal.App.4th 474 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102, 103 Rodriguez v. Superior Court (2009) 176 Cal.App.4th 1461 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187, 191 Romar v. Fresno Community Hosp. and Medical Center (E.D.Cal. 2008) 583 F.Supp.2d 1179 . . . . . . . . . . . . . . . . . . . . . . . . . 39, 80 Rose v. Fife (1989) 207 Cal.App.3d 760 . . . . . . . . . . . 24, 100, 104, 105, 107, 111, 115 Rosenfield v. Superior Court (1983) 143 Cal.App.3d 198 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186, 191 Roskind v. Morgan Stanley Dean Witter & Co. (2000) 80 Cal.App.4th 345 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Rotolo Chevrolet v. Superior Court (2003) 105 Cal.App.4th 242 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52H O R V I T Z & L E V Y L L P M I C R A M A N U A L xix Copyright © 2012 Horvitz & Levy LLP Ruiz v. Podolsky (2010) 50 Cal.4th 838 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5, 188, 192 Russell v. Stanford University Hospital (1997) 15 Cal.4th 783 . . . . . . . . . . . . . . . . . . . . . . . . 1, 100, 120, 126, 133 Rutledge v. Stewart (Jan. 16, 1996, D022567) [unpub. opn.] . . . . . . . . . . . . . . . . . . . . . . . . . 91 Saika v. Gold (1996) 49 Cal.App.4th 1074 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Salgado v. County of Los Angeles (1998) 19 Cal.4th 629 . . . . . . . . . . . . . . . . . . . . . . . . 49, 76, 80, 137, 138, 139, 140, 141, 142, 143, 148, 156, 166, 167, 168, 170, 174, 176, 177, 182 Samuels v. Mix (1999) 22 Cal.4th 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Sanchez v. South Hoover Hospital (1976) 18 Cal.3d 93 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104, 106, 120, 121 Scharer v. San Luis Rey Equine Hospital, Inc. (2012) 204 Cal.App.4th 421 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Schiernbeck v. Haight (1992) 7 Cal.App.4th 869 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92, 168 Schneider v. Friedman, Collard, Poswall & Virga (1991) 232 Cal.App.3d 1276 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Schneider v. Kaiser Foundation Hospitals (1989) 215 Cal.App.3d 1311 . . . . . . . . . . . . . . . . . . . . . . . 47, 49, 170, 196 Scholz v. Metropolitan Pathologists, P.C. (Colo. 1993) 851 P.2d 901 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14, 15 Schultz v. Harney (1994) 27 Cal.App.4th 1611 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43, 45, 47 Schwarder v. United States (9th Cir. 1992) 974 F.2d 1118 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Scott v. United States (9th Cir. 1989) 884 F.2d 1280 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152H O R V I T Z & L E V Y L L P M I C R A M A N U A L xx Copyright © 2012 Horvitz & Levy LLP Scripps Clinic v. Superior Court (2003) 108 Cal.App.4th 917 . . . . . . . . . . . . . . . . . . . . . . . . . . 10, 12, 23, 24 SeaRiver Maritime v. Industrial Medical Services (N.D.Cal. 1997) 983 F.Supp. 1287 . . . . . . . . . . . . . . . . . . . . . . . . . . 38, 54 Semsch v. Henry Mayo Newhall Memorial Hospital (1985) 171 Cal.App.3d 162 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85, 86, 97 Silver v. McNamee (1999) 69 Cal.App.4th 269 . . . . . . . . . . . . . . . . . . . . . . . . . . . 128, 131, 132 Smith v. Ben Bennett, Inc. (2005) 133 Cal.App.4th 1507 . . . . . . . . . . . . . . . . . . . . . . . . . . 33, 41, 130 Smock v. State of California (2006) 138 Cal.App.4th 883 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Southlake Limousine & Coach, Inc. v. Brock (Ind.App. 1991) 578 N.E.2d 677 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 State Comp. Ins. Fund v. Workers’ Comp. Appeals Bd. (1997) 53 Cal.App.4th 579 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Steinfeld v. Foote-Goldman Proctologic Medical Group, Inc. (1996) 50 Cal.App.4th 1542 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Steinfeld v. Foote-Goldman Proctologic Medical Group, Inc. (1997) 60 Cal.App.4th 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 Steingart v. White (1988) 198 Cal.App.3d 406 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113, 118 Steketee v. Lintz, Williams & Rothberg (1985) 38 Cal.3d 46 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101, 124, 125 Stinnett v. Tam (2011) 198 Cal.App.4th 1412 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77, 78 Stuart v. UNUM Life Ins. Co. of America (9th Cir. 2000) 217 F.3d 1145 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Swoap v. Superior Court (1973) 10 Cal.3d 490 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxi Copyright © 2012 Horvitz & Levy LLP Syverson v. Heitmann (1985) 171 Cal.App.3d 106 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Tapia v. Pohlmann (1998) 68 Cal.App.4th 1126 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Taylor v. United States (9th Cir. 1987) 821 F.2d 1428 . . . . . . . . 13, 14, 19, 81, 83, 85, 91, 97, 141 Timmel v. Moss (9th Cir. 1986) 803 F.2d 519 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Titolo v. Cano (2007) 157 Cal.App.4th 310 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25, 189 Toigo v. Hayashida (1980) 103 Cal.App.3d 267 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Toland v. Vana (1990) 271 Cal.Rptr. 457 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Torres v. County of Los Angeles (1989) 209 Cal.App.3d 325 . . . . . . . . . . . . . . . . . . . . . . 101, 102, 107, 124 Torres v. Xomox Corp. (1996) 49 Cal.App.4th 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88, 89, 90, 171 Tran v. Fountain Valley Community Hospital (1997) 51 Cal.App.4th 1464 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Trantafello v. Medical Center of Tarzana (1986) 182 Cal.App.3d 315 . . . . . . . . . . . . . . . . . . . . . . . . . . 118, 121, 123 Tresemer v. Barke (1978) 86 Cal.App.3d 656 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Tzolov v. International Jet Leasing, Inc. (1991) 232 Cal.App.3d 117 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 United Food & Commercial Workers v. Pacyga (9th Cir. 1986) 801 F.2d 1157 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Unjian v. Berman (1989) 208 Cal.App.3d 881 . . . . . . . . . . . . . . . . . . . . . . . . . . 105, 106, 110H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxii Copyright © 2012 Horvitz & Levy LLP Unruh-Haxton v. Regents of University of California (2008) 162 Cal.App.4th 343 . . . . . . . . . . . . . . . . . . . . . . . . . . . 33, 34, 113 Van Buren v. Evans (May 20, 2009, F054227) 2009 WL 1396235, 2009 Cal.App. Unpub. Lexis 3982 . . . . . . . . . . . . . . . . . . . . . . . . . . . 77, 78 Vazquez de Mercado v. Superior Court (2007) 148 Cal.App.4th 711 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26, 27 Verba v. Ghaphery (2001) 210 W.Va. 30 [552 S.E.2d 406] . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Victoria v. Superior Court (1985) 40 Cal.3d 734 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 Wallace v. Hibner (1985) 171 Cal.App.3d 1042 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Warren v. Schecter (1997) 57 Cal.App.4th 1189 . . . . . . . . . . . . . . . . . . . . . . . . . . 100, 118, 119 Washington v. Barnes Hospital (Mo. 1995) 897 S.W.2d 611 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72, 73 Waters v. Bourhis (1985) 40 Cal.3d 424 . . . . . . . . . . . . . . . . . . . . 2, 20, 27, 28, 30, 32, 35, 43 Watts v. Valley Medical Center (1992) 8 Cal.App.4th 1050 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Weeks v. Crow (1980) 113 Cal.App.3d 350 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Wells Fargo Bank v. Superior Court (1977) 74 Cal.App.3d 890 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Western Steamship Lines, Inc. v. San Pedro Peninsula Hospital (1994) 8 Cal.4th 100 . . . . . . . . . . . . . . . . . . . . 1, 3, 12, 36, 37, 38, 81, 138 White ex rel. Smith v. Apfel (7th Cir. 1999) 167 F.3d 369 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Wienholz v. Kaiser Foundation Hospitals (1989) 217 Cal.App.3d 1501 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43, 47H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxiii Copyright © 2012 Horvitz & Levy LLP Williams v. Macomber (1990) 226 Cal.App.3d 225 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Williams v. Superior Court (1994) 30 Cal.App.4th 318 . . . . . . . . . . . . . . . . . . . . . . . . . . . 18, 23, 83, 85 Wilson v. Kaiser Foundation Hospitals (1983) 141 Cal.App.3d 891 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Wilson v. Tri-City Hospital Dist. (1990) 221 Cal.App.3d 441 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Woods v. Young (1991) 53 Cal.3d 315 . . . . . . . . . . . . . 1, 100, 113, 114, 128, 129, 132, 133 Wurts v. County of Fresno (1996) 44 Cal.App.4th 380 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129, 130 Yates v. Law Offices of Samuel Shore (1991) 229 Cal.App.3d 583 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45, 46 Yates v. Pollock (1987) 194 Cal.App.3d 195 . . . 44, 54, 76, 77, 78, 80, 83, 84, 85, 129, 140 Yee v. Tse (Sept. 9, 2011, B222570) 2011 WL 3964647, 2011 Cal.App. Unpub. Lexis 6862 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Young v. Haines (1986) 41 Cal.3d 883 . . . . . . . . . . . . . . . . . 3, 101, 104, 121, 124, 125, 126 Zakarian v. Bekov (2002) 98 Cal.App.4th 316 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Zambrano v. Dorough (1986) 179 Cal.App.3d 169 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112, 113 Zinman v. Shalala (9th Cir. 1995) 67 F.3d 841 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Constitutions Cal. Constitution, art. I, § 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxiv Copyright © 2012 Horvitz & Levy LLP Statutes 20 U.S.C. § 1400 et seq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 § 1401(9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 § 1401(26) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 § 1401(29) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 28 U.S.C. § 2401 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103, 130 42 U.S.C. § 402 et seq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 § 403 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 § 423 et seq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 § 1395 et seq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 § 1395dd(d)(2)(A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 § 1395dd(d)(2)(C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 § 1395y(b)(2)(B)(ii) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Business and Professions Code § 500 et seq. . . . . . . . . . . . . . . . . . . . . . . . 6, 42, 51, 76, 99, 127, 136, 186 § 2406 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 § 2408 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 § 2415 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 § 6146 . . . . . . . . . . . . . . . . . . . . . . . . . . 2, 28, 42, 43, 44, 49, 71, 175, 196 § 6146, subd. (a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6, 43, 47, 190 § 6146, subd. (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxv Copyright © 2012 Horvitz & Levy LLP § 6146, subd. (c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 § 6146, subd. (c)(1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43, 45 § 6146, subd. (c)(2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 § 6146, subd. (c)(3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17, 44 Civil Code §§ 1431.1-1431.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 § 1431.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81, 171 § 3291 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148, 173 § 3294 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 § 3333.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 63, 64, 65, 66, 67, 68, 69, 73 § 3333.1, subd. (a) . . . . . . . . . . . . . . 2, 6, 52, 53, 55, 57, 59, 61, 65, 67, 68 § 3333.1, subd. (b) . . . . . . . . . . . . . . . . 2, 44, 53, 56, 57, 58, 59, 62, 63, 64 § 3333.1, subd. (c)(1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 § 3333.1, subd. (c)(2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17, 54 § 3333.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3, 13, 14, 31, 36, 72, 76, 77, 78, 79, 80, 81, 82, 86, 91, 92, 97, 155, 166, 196, 197 § 3333.2, subd. (a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6, 76, 82 § 3333.2, subd. (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76, 82, 196 § 3333.2, subd. (c)(1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6, 76 § 3333.2, subd. (c)(2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17, 76 § 3428, subd. (c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Code of Civil Procedure § 335.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103, 109, 113H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxvi Copyright © 2012 Horvitz & Levy LLP § 340, former subd. (3) . . . . . . . . . . . . . . . . . . . . . . . . . 108, 109, 113, 133 § 340.4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 § 340.5 . . . . . . . 3, 6, 17, 27, 32, 35, 37, 40, 99, 100, 101, 102, 103, 104, 107, 108, 113, 114, 115, 117, 118, 120, 122, 123, 124, 126 § 340.5, subd. (1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 § 340.5, subd. (2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 § 351 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 § 352, subd. (a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114, 125 § 352.1, subd. (a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 § 364 . . . . . . . . . . . . . . . . . . . . . . . . . . 4, 33, 127, 128, 129, 130, 131, 134 § 364, subd. (a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6, 127, 128, 131, 132 § 364, subd. (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127, 128, 130, 133 § 364, subd. (d) . . . . . . . 28, 36, 37, 41, 100, 114, 120, 127, 128, 132, 133 § 364, subd. (e) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127, 132 § 364, subd. (f) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 § 364, subd. (f)(1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6, 127 § 364, subd. (f)(2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17, 127, 129 § 365 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128, 134 § 372 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 § 425.10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91, 97 § 425.13 . . . . . . . . . . . . . . . . . . . . . . . . . . . 8, 9, 10, 23, 24, 28, 31, 32, 39 § 425.13, subd. (a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29, 31 § 425.13, subd. (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxvii Copyright © 2012 Horvitz & Levy LLP § 473 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16, 157 § 473, subd. (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 § 473, subd. (d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 § 597.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 § 663 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97, 156 § 663, subd. (2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 § 664 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 § 667.7 . . . . . . . . . . . . . . . . . . . . 4, 42, 48, 135, 137, 138, 139, 140, 141, 142, 144, 155, 156, 157, 158, 161, 164, 166, 179, 180, 182 § 667.7, subd. (a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6, 135, 158 § 667.7, subd. (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 § 667.7, subd. (b)(1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135, 137, 138 § 667.7, subd. (b)(2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 § 667.7, subd. (c) . . . . . . . . . . . . . . . . . . . . . . . . . 135, 138, 142, 168, 181 § 667.7, subd. (d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 § 667.7, subd. (e) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 § 667.7, subd. (e)(2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 § 667.7, subd. (e)(3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6, 136 § 667.7, subd. (e)(4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6, 17, 136, 140 § 667.7, subd. (f) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136, 138 § 697.320, subd. (a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 § 697.350, subd. (c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 § 697.400, subd. (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxviii Copyright © 2012 Horvitz & Levy LLP §§ 724.210-724.260 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 § 724.220 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 § 998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148, 173, 181 § 1062.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 § 1281 et seq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 § 1286.2, subd. (a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 § 1286.6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 § 1286.6, subd. (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 § 1295 . . . . . . . . . . . . . . . . . . . . . . . . 4, 185, 186, 187, 188, 191, 192, 196 § 1295, subd. (a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6, 185, 189 § 1295, subd. (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 § 1295, subd. (c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185, 189 § 1295, subd. (d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185, 196 § 1295, subd. (e) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 § 1295, subd. (f) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185, 187, 188 § 1295, subd. (g)(1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6, 186 § 1295, subd. (g)(2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17, 186 Corporations Code, § 13400 et seq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Education Code § 56000 et seq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 §§ 56000-56001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 § 56040 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 § 56363 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxix Copyright © 2012 Horvitz & Levy LLP Family Code § 4400 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 § 6602 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 § 6921 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 § 6925 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 Government Code § 911.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 § 945.6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 § 950.6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 § 984 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 § 984, subd. (c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 § 985, subd. (l) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 § 23004.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Health & Safety Code § 1200 et seq. . . . . . . . . . . . . . . . . . . . . . . 6, 42, 51, 76, 99, 127, 136, 186 § 1200 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 § 1201 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 § 1204 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 § 1205 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 § 1206 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 § 1206, subd. (a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 § 1367.01, subd. (m) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 § 123870, subd. (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxx Copyright © 2012 Horvitz & Levy LLP § 123872 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 § 123982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Labor Code § 3600 et seq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 § 3852 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 § 3861 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Penal Code § 270c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 § 368 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Probate Code § 58 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 § 2644 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 §§ 3600-3601 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 § 8400 et seq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Unemployment Insurance Code § 2601 et seq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 § 2653 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Vehicle Code, § 17151 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96, 157 Welfare and Institutions Code § 12103 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 § 12350 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 § 15600 et seq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 § 15610.57 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxxi Copyright © 2012 Horvitz & Levy LLP § 15610.57, subd. (b)(2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 § 15657 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 § 15657, subd. (a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 § 15657, subd. (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 § 15657.2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 § 15657.5, subd. (b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 § 19000 et seq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Rules of Court Cal. Rules of Court rule 7.955 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 rule 7.955(b)(14) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 rule 7.955 (d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 rule 8.1105(e)(1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 rule 8.1115 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 rule 8.1125(d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Miscellaneous Annotation, Arbitration of Medical Malpractice Claims (1994) 24 A.L.R.5th 1 . 198 Annotation, Collateral Source Rule: Admissibility of Evidence of Availability to Plaintiff of Free Public Special Education on Issue of Amount of Damages Recoverable from Defendant (1996) 41 A.L.R.5th 771 . . . . . . 72 Annotation, Medical Malpractice: Who Are “Health Care Providers," or the Like, Whose Actions Fall Within Statutes Specifically Governing Actions and Damages for Medical Malpractice (1993) 12 A.L.R.5th 1 . . . . . . . . . 16 Annotation, Treatment of Subrogation Rights of ERISA-Qualified, Self-Funded Employee Benefit Plans (1997) 138 A.L.R. Fed. 611 . . . . . 63H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxxii Copyright © 2012 Horvitz & Levy LLP Annotation, Validity, Construction, and Application of State Statutory Provisions Limiting Amount of Recovery in Medical Malpractice Claims (1995) 26 A.L.R.5th 245 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Annotation, What Nonpatient Claims Against Doctors, Hospitals, or Similar Health Care Providers Are Not Subject to Statutes Specifically Governing Actions and Damages for Medical Malpractice (1991) 88 A.L.R.4th 358 . 41 Annotation, What Patient Claims Against Doctor, Hospital, or Similar Health Care Provider Are Not Subject to Statutes Specifically Governing Actions and Damages for Medical Malpractice (1991) 89 A.L.R.4th 887 . . . . . . . 41 BAJI (Fall 2011 ed.) No. 16.01 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97, 142, 143, 145, 154 appen. B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 CACI No. VF-500 (Fall 2011 ed.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97, 143 Cal. Judges Benchbook: Civil Proceedings After Trial (CJER 1998) § 1.20 . . . 16 Cal. Law Revision Com. com., 17 West’s Ann. Code Civ. Proc. (2009 ed.) foll. § 724.220 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Gallegos ex rel. Rynes v. Dick Simon Trucking — The Use of Price-of-Annuity Evidence as Present Value of Compensatory Damages (June 2006) 19 Utah B.J. 36 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Grodin, The Depublication Practice of the California Supreme Court (1984) 72 Cal. L.Rev. 514 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Haning et al., Cal. Practice Guide: Personal Injury (The Rutter Group 2011) ¶ 1:185.1 et seq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 ¶ 4:185.4 et seq. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 ¶ 4:210-4:232.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Havins & Dalessio, Limiting the Scope of Arbitration Clauses in Medical Malpractice Disputes Arising in California (2000) 28 Cap.U. L.Rev. 331 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192H O R V I T Z & L E V Y L L P M I C R A M A N U A L xxxiii Copyright © 2012 Horvitz & Levy LLP Hindert et al., Structured Settlements and Periodic Payment Judgments (2011) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 ch. 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 § 3.05[6][a] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 § 9.03[3][a] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Johns, Cal. Damages — Law and Proof (5th ed. 2011) § 1.90(b) . . . . . . . . . . 148 4 Levy et al., Cal. Torts (2011) § 52.21[3] . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 5 Levy et al., Cal. Torts (2011) ch. 75 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 § 74.06[3] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Montgomery & Horstman, The Annuitist — A Key Defense Witness on the Issue of Damages (July 1988) 30 For the Defense 20 . . . . . 150, 151, 153 Webster’s 3d New Internat. Dict. (1981) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 1 Witkin, Cal. Evidence (4th ed. 2000) Hearsay, § 294 . . . . . . . . . . . . . . . . . . 149 3 Witkin, Cal. Procedure (5th ed. 2008) Actions, § 770 et seq. . . . . . . . . . . . . 122 5 Witkin, Cal. Procedure (5th ed. 2008) Pleading, § 1117 . . . . . . . . . . . . . . . 126 6 Witkin, Cal. Procedure (5th ed. 2008) Proceedings Without Trial § 567 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 §§ 574-578 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 § 578 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 7 Witkin, Cal. Procedure (5th ed. 2008) Judgment, § 67 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Trial, §§ 342-349 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75H O R V I T Z & L E V Y L L P M I C R A M A N U A L 1 Copyright © 2012 Horvitz & Levy LLP A. THE LEGISLATIVE INTENT BEHIND MICRA. 1. The importance of legislative intent. The principal purposes of this Manual are to collect and analyze the case law construing the MICRA tort reforms, and to suggest approaches to MICRA issues not yet resolved by the appellate courts. Of course, in order to understand what the courts have done and are likely to do, it is essential to understand the legislative intent behind MICRA. “[O]ur first task in construing a statute is to ascertain the intent of the Legislature so as to effectuate the purpose of the law.” (Central Pathology Service Medical Clinic, Inc. v. Superior Court (1992) 3 Cal.4th 181, 186, internal quotation marks omitted.) 2. The overall purpose of MICRA. The best statement of MICRA’s overall purpose is by the Supreme Court in Western Steamship Lines, Inc. v. San Pedro Peninsula Hospital (1994) 8 Cal.4th 100, 111-112: “[T]he Legislature enacted MICRA in response to a medical malpractice insurance ‘crisis,’ which it perceived threatened the quality of the state’s health care. [Citation.] In the view of the Legislature, ‘the rising cost of medical malpractice insurance was imposing serious problems for the health care system in California, threatening to curtail the availability of medical care in some parts of the state and creating the very real possibility that many doctors would practice without insurance, leaving patients who might be injured by such doctors with the prospect of uncollectible judgments.’ [Citations.] The continuing availability of adequate medical care depends directly on the availability of adequate insurance coverage, which in turn operates as a function of costs associated with medical malpractice litigation. [Citation.] Accordingly, MICRA includes a variety of provisions all of which are calculated to reduce the cost of insurance by limiting the amount and timing of recovery in cases of professional negligence. [Citations.] [¶] MICRA thus reflects a strong public policy to contain the costs of malpractice insurance by controlling or redistributing liability for damages, thereby maximizing the availability of medical services to meet the state’s health care needs.” (Emphasis added.) • Other Supreme Court cases stating the overall purpose of MICRA are: American Bank & Trust Co. v. Community Hospital (1984) 36 Cal.3d 359, 363-364, 371-372; Barme v. Wood (1984) 37 Cal.3d 174, 178-179; Roa v. Lodi Medical Group, Inc. (1985) 37 Cal.3d 920, 930; Fein v. Permanente Medical Group (1985) 38 Cal.3d 137, 158-159; Woods v. Young (1991) 53 Cal.3d 315, 319, 325; Burgess v. Superior Court (1992) 2 Cal.4th 1064, 1082-1083; Russell v. Stanford University Hospital (1997) 15 Cal.4th 783, 786; DelaneyH O R V I T Z & L E V Y L L P M I C R A M A N U A L 2 Copyright © 2012 Horvitz & Levy LLP v. Baker (1999) 20 Cal.4th 23, 33-34; Barris v. County of Los Angeles (1999) 20 Cal.4th 101, 108; Preferred Risk Mutual Ins. Co. v. Reiswig (1999) 21 Cal.4th 208, 214-215; Reigelsperger v. Siller (2007) 40 Cal.4th 574, 577-578. And see Potter v. Firestone Tire & Rubber Co. (1993) 6 Cal.4th 965, 992-993. An excellent statement of MICRA’s overall purpose by the Court of Appeal is found in Perry v. Shaw (2001) 88 Cal.App.4th 658, 667-668. 3. The specific purpose of each MICRA statute. a. Business and Professions Code section 6146 (limiting contingent attorney fees). One purpose is to reduce the cost of settlements: “[B]ecause section 6146 permits an attorney to take only a smaller bite of a settlement, a plaintiff will be more likely to agree to a lower settlement since he will obtain the same net recovery from the lower settlement.” (Roa v. Lodi Medical Group, Inc. (1985) 37 Cal.3d 920, 931.) Another purpose is to “reduc[e] plaintiffs’ attorneys’ incentive to encourage their clients to pursue marginal claims . . . .” (Id. at pp. 931-932.) Another purpose is to protect the plaintiff’s recovery, already reduced by MICRA, from “further reduction by high contingency fees.” (Id. at p. 932; see Waters v. Bourhis (1985) 40 Cal.3d 424, 437.) b. Civil Code section 3333.1, subdivision (a) (allowing evidence of collateral source payments). “The purpose of section 3333.1, subdivision (a) has generally been viewed as an attempt to eliminate the so-called ‘double recovery’ obtained by plaintiffs who have their medical expenses paid by their own health insurance and still obtain damages for such expenses from defendant tortfeasors.” (Barme v. Wood (1984) 37 Cal.3d 174, 179, fn. 5.) The jury is given the opportunity to “set plaintiff’s damages at a lower level because of its awareness of plaintiff’s ‘net’ collateral source benefits.” (Fein v. Permanente Medical Group (1985) 38 Cal.3d 137, 164-165, fn. omitted.) c. Civil Code section 3333.1, subdivision (b) (precluding subrogation by collateral source). One purpose is to protect the plaintiff from the “double reduction” that would occur if the jury reduced its award because of collateral source benefits, yet the collateral source could obtain repayment of those benefits from the plaintiff’s tort recovery. (Fein v. Permanente Medical Group (1985) 38 Cal.3d 137, 165.) Another purpose is to “assure[ ] that anyH O R V I T Z & L E V Y L L P M I C R A M A N U A L 3 Copyright © 2012 Horvitz & Levy LLP reduction in malpractice awards that may result from the jury’s consideration of the plaintiff’s collateral source benefits will inure to [the defendant health care provider’s] benefit rather than to the benefit of the collateral source” (ibid.); in other words, to “shift[ ] some of the costs in the area [of medical malpractice] to other insurers” (id. at p. 166; see Barme v. Wood (1984) 37 Cal.3d 174, 181; California Physicians’ Service v. Superior Court (1980) 102 Cal.App.3d 91, 97). d. Civil Code section 3333.2 (limiting recovery of noneconomic damages to $250,000). One purpose is to “provide a more stable base on which to calculate insurance rates” by eliminating the “unpredictability of the size of large noneconomic damage awards, resulting from the inherent difficulties in valuing such damages and the great disparity in the price tag which different juries placed on such losses.” (Fein v. Permanente Medical Group (1985) 38 Cal.3d 137, 163; see Western Steamship Lines, Inc. v. San Pedro Peninsula Hospital (1994) 8 Cal.4th 100, 112; Lathrop v. HealthCare Partners Medical Group (2004) 114 Cal.App.4th 1412, 1419; Perry v. Shaw (2001) 88 Cal.App.4th 658, 668.) Another purpose is to “promote settlements by eliminating ‘the unknown possibility of phenomenal awards for pain and suffering that can make litigation worth the gamble.’ ” (Fein, supra, 38 Cal.3d at p. 163.) Another purpose is to be fair to medical malpractice plaintiffs by “reduc[ing] only the very large noneconomic damage awards, rather than to diminish the more modest recoveries for pain and suffering and the like in the great bulk of cases.” (Ibid.) e. Code of Civil Procedure section 340.5 (shortening the statute of limitations). “The Legislature’s objective was to reduce the number of ‘long tail’ claims attributable to the tolling provisions formerly available in malpractice actions.” (Photias v. Doerfler (1996) 45 Cal.App.4th 1014, 1019-1020.) “Commentators had observed that the delayed discovery rule and the resulting ‘long tail’ claims made it difficult to set premiums at an appropriate level. [Citations.] Presumably, the legislative goal in amending section 340.5 was to give insurers greater certainty about their liability for any given period of coverage, so that premiums could be set to cover costs.” (Young v. Haines (1986) 41 Cal.3d 883, 900; see David M. v. Beverly Hospital (2005) 131 Cal.App.4th 1272, 1277.)H O R V I T Z & L E V Y L L P M I C R A M A N U A L 4 Copyright © 2012 Horvitz & Levy LLP f. Code of Civil Procedure section 364 (requiring 90 days’ notice of intent to sue). “The purpose of the notice of intent to sue and the 90-day [statute-of-limitations] tolling period of section 364 was to decrease the number of actions premised on professional negligence by establishing a procedure to encourage the parties to negotiate ‘ “outside the structure and atmosphere of the formal litigation process.” ’ ” (Preferred Risk Mutual Ins. Co. v. Reiswig (1999) 21 Cal.4th 208, 214.) g. Code of Civil Procedure section 667.7 (allowing periodic payment of future damages). One purpose is to reduce “the need for insurance companies to retain large reserves to pay out sizable immediate lump sum awards. The adoption of a periodic payment procedure permits insurers to retain fewer liquid reserves and to increase investments, thereby reducing the costs to insurers and, in turn, to insureds.” (American Bank & Trust Co. v. Community Hospital (1984) 36 Cal.3d 359, 372-373.) Another purpose is to “limit[ ] a defendant’s obligation to those future damages that a plaintiff actually incurs, eliminating the so-called ‘windfall’ obtained by a plaintiff’s heirs when they inherit a portion of a lump sum judgment that was intended to compensate the injured person for losses he in fact never sustained.” (Id. at p. 369; see Deocampo v. Ahn (2002) 101 Cal.App.4th 758, 772.) Another purpose is to prevent the dissipation of damages for future losses by improvident expenditures or investments: “The fundamental goal of the statute is ‘matching losses with compensation by helping to ensure that money paid to an injured plaintiff will in fact be available when the plaintiff incurs the anticipated expenses or losses in the future’ [citations], i.e., ‘affording a fair correlation between the sustaining of losses and the payment of damages’ [citations].” (Holt v. Regents of University of California (1999) 73 Cal.App.4th 871, 881.) “The goal is to prevent early dissipation of an award, and ensure that when the plaintiff incurs losses or expenses in the future, the money awarded to him [or her] will be there.” (Deocampo, supra, 101 Cal.App.4th at p. 772.) h. Code of Civil Procedure section 1295 (encouraging and facilitating arbitration). “The purpose of section 1295 is to encourage and facilitate arbitration of medical malpractice disputes. [Citations.] Accordingly, the provisions of section 1295 are to be construed liberally.” (Reigelsperger v. Siller (2007) 40 Cal.4th 574, 578.) “In other words, the encouragement of arbitration ‘ “as aH O R V I T Z & L E V Y L L P M I C R A M A N U A L 5 Copyright © 2012 Horvitz & Levy LLP speedy and relatively inexpensive means of dispute resolution” ’ [citation] furthers MICRA’s goal of reducing costs in the resolution of malpractice claims and therefore malpractice insurance premiums.” (Ruiz v. Podolsky (2010) 50 Cal.4th 838, 844.) “The purpose . . . is to encourage and facilitate the arbitration of medical malpractice claims by specifying uniform language to be used in binding arbitration agreements, so that the patient knows what he or she is signing and knows its ramifications.” (County of Contra Costa v. Kaiser Foundation Health Plan, Inc. (1996) 47 Cal.App.4th 237, 246; see Gross v. Recabaran (1988) 206 Cal.App.3d 771, 775-776.) 4. MICRA should be liberally construed. “The cases agree that MICRA provisions should be construed liberally in order . . . to reduce malpractice insurance premiums.” (Preferred Risk Mutual Ins. Co. v. Reiswig (1999) 21 Cal.4th 208, 215; see Reigelsperger v. Siller (2007) 40 Cal.4th 574, 578.)H O R V I T Z & L E V Y L L P M I C R A M A N U A L 6 Copyright © 2012 Horvitz & Levy LLP B. DEFINITIONS COMMON TO ALL MICRA STATUTES. 1. In general. The MICRA statutes apply in an action for injury (1) against a health care provider (2) based on professional negligence. (Bus. & Prof. Code, § 6146, subd. (a); Civ. Code, §§ 3333.1, subd. (a), 3333.2, subd. (a); Code Civ. Proc., §§ 340.5, 364, subd. (a), 667.7, subds. (a), (e)(4), 1295, subd. (a).) 2. “Health care provider” defined. a. Statutory definition. The MICRA statutes each define “health care provider” as follows: “ ‘Health care provider’ means any person licensed or certified pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or licensed pursuant to the Osteopathic Initiative Act, or the Chiropractic Initiative Act, or licensed pursuant to Chapter 2.5 (commencing with Section 1440) of Division 2 of the Health and Safety Code; and any clinic, health dispensary, or health facility, licensed pursuant to Division 2 (commencing with Section 1200) of the Health and Safety Code. ‘Health care provider’ includes the legal representatives of a health care provider.” (Bus. & Prof. Code, § 6146, subd. (c)(2); Civ. Code, §§ 3333.1, subd. (c)(1), 3333.2, subd. (c)(1); Code Civ. Proc., §§ 340.5, subd. (1), 364, subd. (f)(1), 667.7, subd. (e)(3), 1295, subd. (g)(1).) b. An emergency medical technician is a “health care provider.” In Canister v. Emergency Ambulance Service, Inc. (2008) 160 Cal.App.4th 388, the Court of Appeal held that an EMT is a health care provider within the meaning of MICRA. When MICRA was enacted, it covered mobile intensive care paramedics, because they were licensed pursuant to Chapter 2.5 of Division 2 of the Health and Safety Code, which is one of the statutory categories listed in MICRA’s definition of “health care provider.” Subsequently, the paramedic act was repealed and comprehensive legislation governing prehospital emergency medical services was enacted. The new statutes were located in Division 2.5 of the Health and Safety Code, which is not one of the statutory categories listed in MICRA’s definition of “health care provider.” Thereafter, the Legislature added a statute to Division 2.5 providing that any reference in any provision of law to mobile intensive care paramedics shall be deemed a reference to EMTs. The Court of Appeal held this cross-reference “indicates a legislative intent thatH O R V I T Z & L E V Y L L P M I C R A M A N U A L 7 Copyright © 2012 Horvitz & Levy LLP EMT’s . . . be deemed ‘health care providers’ within MICRA’s purview.” (Id. at pp. 396-403.) c. An unlicensed social worker, registered with the Board of Behavioral Sciences and working toward licensure, is a “health care provider.” In Prince v. Sutter Health Care (2008) 161 Cal.App.4th 971, the Court of Appeal held that “an unlicensed social worker, registered with the appropriate agency and working toward licensure, is a ‘health care provider’ ” within the meaning of MICRA. (Id. at p. 974.) First, “Business and Professions Code section 23.7 . . . states ‘Unless otherwise expressly provided, “license” means license, certificate, registration, or other means to engage in a business or profession regulated by this code . . . .’ (Italics added.) Stevenson’s profession is regulated by that code, and she registered with the Board. In effect, she was licensed.” (Id. at p. 976.) Second, “MICRA’s purpose would be frustrated by eliminating its protections from persons, such as Stevenson, lawfully practicing a healing art as part of their training to become licensed.” (Id. at p. 977.) The facts that Stevenson was not receiving the supervision required by law and failed to disclose to the patient that she was not licensed did not change her status as a health care provider. (Id. at pp. 977, 978.) d. A medical student lawfully practicing under a statutory exemption to the licensing requirement is a “health care provider.” In Chosak v. Alameda County Medical Center (2007) 153 Cal.App.4th 549, the Court of Appeal held that, because an optometry student serving her internship was “practicing lawfully under an express exemption from the licensing and certification requirements of Division 2 [of the Business and Professions Code], . . . she was within the definition of ‘health care provider’ . . . .” (Id. at p. 567.) “An action based on the negligence of a medical student or an out-of-state doctor legally practicing in California under the licensing and certification exemptions of Division 2 is just as much a medical malpractice action as an action against a licensed or certified doctor. If the statute was intended, as it unquestionably was, to cover all medical malpractice claims, it should be construed to cover all actions against medical professionals operating lawfully under the licensing and certification statutes, whether licensed or exempt.” (Id. at p. 566.) “[T]he activities of medical students and other exempt professionals in California affect ‘the insurance premiums that health care providers pay,’ just as the activities ofH O R V I T Z & L E V Y L L P M I C R A M A N U A L 8 Copyright © 2012 Horvitz & Levy LLP licensed health care providers do. . . . [W]e are unwilling to interpret the statute in a manner that would work at cross-purposes to the Legislature’s objective in enacting . . . MICRA.” (Id. at p. 567.) e. A blood bank is a “health care provider.” In Coe v. Superior Court (1990) 220 Cal.App.3d 48, the Court of Appeal held a blood bank is a health care provider within the meaning of MICRA. Specifically, the court held a blood bank is a health dispensary licensed pursuant to Division 2 of the Health and Safety Code because “a blood bank dispenses a product and provides a service inextricably identified with the health of humans.” (Id. at p. 53, fn. omitted.) The court also noted that, by referring to divisions of the codes in defining “health care provider,” the Legislature “provided for the evolution of health care professions and organizations. New categories of providers could be automatically covered by MICRA simply by regulating them within the same statutory scheme as other health care providers.” (Id. at p. 52, fn. omitted.) The court used home dialysis agencies as an example. (Id. at p. 52, fn. 3.) f. A sperm bank is a “health care provider.” So is a tissue bank. In Johnson v. Superior Court (2002) 101 Cal.App.4th 869, the Court of Appeal held a sperm bank is a health care provider within the meaning of Code of Civil Procedure section 425.13 (which governs the inclusion of a punitive damage claim in an action for professional negligence against a health care provider). (Id. at pp. 877-883.) Section 425.13 uses the same definition of “health care provider” as MICRA and has a similar legislative purpose; therefore, the Legislature intended that “health care provider” have the same meaning in section 425.13 and MICRA. (Id. at pp. 877-879; see Palmer v. Superior Court (2002) 103 Cal.App.4th 953, 961.) A sperm bank is a health dispensary licensed pursuant to Division 2 of the Health and Safety Code because a sperm bank “dispenses a product (sperm), and provides a service (provision of donor sperm to health care practitioners and their clients)” (Johnson, supra, 101 Cal.App.4th at p. 881), and “the service provided . . . is ‘inextricably identified with the health of humans’ ” (id. at p. 882). In Cryolife, Inc. v. Superior Court (2003) 110 Cal.App.4th 1145, the Court of Appeal held a tissue bank is a health care provider within the meaning of section 425.13. (Id. at pp. 1158-1160.) A tissue bank is a health dispensary licensed pursuant to Division 2 of theH O R V I T Z & L E V Y L L P M I C R A M A N U A L 9 Copyright © 2012 Horvitz & Levy LLP Health and Safety Code “because it dispenses human tissue for transplantation and provides tissue-related services that are identified with human health.” (Id. at p. 1160.) g. A skilled nursing facility is a “health care provider.” “A skilled nursing facility is a health care provider for purposes of [MICRA].” (Guardian North Bay, Inc. v. Superior Court (2001) 94 Cal.App.4th 963, 974, citing Alcott Rehabilitation Hospital v. Superior Court (2001) 93 Cal.App.4th 94, 99-100.) h. A residential care facility is not a “health care provider.” In Kotler v. Alma Lodge (1998) 63 Cal.App.4th 1381, the Court of Appeal held a residential care facility is not a health care provider within the meaning of MICRA. Specifically, the court held that, although a residential care facility is licensed pursuant to Division 2 of the Health and Safety Code, it is not a clinic, health dispensary, or health facility. (Id. at pp. 1390-1395.) i. There are conflicting decisions on whether a medical group is a “health care provider.” In Palmer v. Superior Court (2002) 103 Cal.App.4th 953, the Court of Appeal held a medical corporation is a health care provider within the meaning of Code of Civil Procedure section 425.13 (which governs the inclusion of a punitive damage claim in an action for professional negligence against a health care provider). (Id. at pp. 962-967.) Section 425.13 uses the same definition of “health care provider” as MICRA and has a similar legislative purpose; therefore, the Legislature intended that “health care provider” have the same meaning in section 425.13 and MICRA. (Johnson v. Superior Court (2002) 101 Cal.App.4th 869, 877-879.) The defendant in Palmer, Sharp Rees-Stealy Medical Group, Inc. (SRS), “is a corporation which is a medical group made up of licensed physician/shareholders, and it provides clinic or health facility outpatient services. SRS operates as a medical group under a fictitious name as allowed by Business and Professions Code section 2415, subdivision (a): ‘Any physician and surgeon . . . , who as a sole proprietor, or in a partnership, group, or professional corporation, desires to practice under any name that would otherwise be a violation of Section 2285 may practice under that name if the proprietor, partnership, group, or corporation obtains and maintains in current status a fictitious-name permit issued by theH O R V I T Z & L E V Y L L P M I C R A M A N U A L 1 0 Copyright © 2012 Horvitz & Levy LLP Division of Licensing . . . under the provisions of this section.’ Under Business and Professions Code sections 2406 and 2408, a medical corporation comprised of licensed professionals may render professional services as long as it is in compliance with the Moscone-Knox Professional Corporation Act (Corp. Code, § 13400 et seq.), which requires that only licensed persons render professional services on behalf of the corporation. (Corp. Code, §§ 13405, 13406, subd. (a).)” (Palmer v. Superior Court, supra, 103 Cal.App.4th at p. 963, fn. omitted.) “. . . SRS must be considered to fall under the statutory definition in [Code of Civil Procedure] section 425.13, subdivision (b) of a health care provider, because it is a medical group comprised of licensed medical practitioners, who provide direct medical services to patients, albeit under a fictitious name. (Bus. & Prof. Code, § 2415.) The statutory scheme does not contemplate that an additional license need be obtained for the medical group itself. (Bus. & Prof. Code, §§ 2406 & 2408; Corp. Code, § 13400 et seq.) Rather, the definition in section 425.13, subdivision (b) of ‘health care provider’ should be read broadly to implement its statutory purpose, protecting this type of health care provider, which delivers services to patients, from potentially unfounded punitive damages claims.” (Palmer v. Superior Court, supra, 103 Cal.App.4th at pp. 966-967.) In Scripps Clinic v. Superior Court (2003) 108 Cal.App.4th 917, the Court of Appeal held a medical group is a health care provider within the meaning of Code of Civil Procedure section 425.13. “Scripps is a group medical practice governed by a group of physicians who represent Scripps’s physicians.” (Id. at p. 926.) “. . . Scripps is a health care provider, governed by a group of representative physicians. Scripps’s governing physicians established the policy [at issue].” (Id. at p. 942.) Despite the logic of Palmer v. Superior Court, supra, 103 Cal.App.4th at pages 962-967, and Scripps Clinic v. Superior Court, supra, 108 Cal.App.4th at page 942, another Court of Appeal held in Lathrop v. HealthCare Partners Medical Group (2004) 114 Cal.App.4th 1412, 1419-1421, that “a medical group consisting of a partnership of physicians is not a ‘health care provider’ as that term is defined under the Medical Injury Compensation Reform Act (MICRA), because the medical group is not itself licensed to practice medicine.” (Id. at p. 1416.) The Lathrop court reasoned:H O R V I T Z & L E V Y L L P M I C R A M A N U A L 1 1 Copyright © 2012 Horvitz & Levy LLP “The statutory definition refers to ‘any person.’ While a ‘person’ includes a corporation as well as a natural person [citation], there is no clear indication that a ‘person’ includes an unincorporated group or partnership. In any event, the definition of ‘health care provider’ extends only to a ‘person licensed’ under the Business and Professions Code. The Business and Professions Code sets out the licensing provisions pertaining to medicine in the Medical Practice Act [citation], and that act is quite explicit that ‘only natural persons shall be licensed’ to practice medicine. [Citation.] . . . The Medical Practice Act clearly intends only individual persons to be licensed to practice medicine. “Distinct from the concept of medical licensing is the concept of conducting a medical business. . . . [P]hysicians have been statutorily authorized to conduct their medical practices in the form of a medical corporation, group, or partnership as long as the shareholders or partners and the employees rendering professional services are themselves licensed. [Citations.] An artificial legal entity needs a permit from the Division of Licensing in order to conduct the business under a fictitious name [citation], and HealthCare Partners had such a permit. But having authority to conduct business as an artificial entity is not the same as having a license to practice medicine. Again, only natural persons are licensed to practice medicine. [Citation.] Because HealthCare Partners is not itself a medically licensed person, it does not qualify as a ‘health care provider.’ ” (Lathrop v. HealthCare Partners Medical Group, supra, 114 Cal.App.4th at pp. 1420-1421, original emphasis.) • One cannot help but wonder whether the Lathrop court’s unwillingness to broadly construe the licensed practitioners category of health care provider was influenced by the court’s apparent belief that HealthCare Partners had dropped the ball by not arguing that it fell within the licensed facilities category of health care provider. (See Lathrop v. HealthCare Partners Medical Group, supra, 114 Cal.App.4th at pp. 1419-1420 [“A clinic is defined by the Health and Safety Code as an establishment providing direct outpatient health services. (Health & Saf. Code, § 1200.) There was evidence that HealthCare Partners provided outpatient health services to [the plaintiff]”], 1421, fn. 1 [“We emphasize that we do not reach the question whetherH O R V I T Z & L E V Y L L P M I C R A M A N U A L 1 2 Copyright © 2012 Horvitz & Levy LLP HealthCare Partners could qualify as a health care provider under MICRA as a licensed facility” (first emphasis added, second emphasis original)].) The Court of Appeal’s reading of the Health and Safety Code seems mistaken, however. The definition of “clinic” is broad, but few clinics are actually required to be licensed. (Health & Saf. Code, §§ 1201, 1204, 1205, 1206.) In particular, a medical group’s outpatient facility is exempt from licensing. (Health & Saf. Code, § 1206, subd. (a).) On the other hand, if an exemption from licensing is treated the same as a license (see Chosak v. Alameda County Medical Center (2007) 153 Cal.App.4th 549, 566-567), the Court of Appeal in Lathrop may have been correct in suggesting that a medical group that meets the definition of a clinic is a health care provider within the meaning of MICRA. Because Lathrop conflicts with Palmer and Scripps Clinic, the trial courts can choose which to follow. (Auto Equity Sales, Inc. v. Superior Court (1962) 57 Cal.2d 450, 456.) Palmer and Scripps Clinic are much better reasoned than Lathrop. It makes little sense to apply MICRA in a professional negligence action against a natural person who is a licensed health care provider, but not in a professional negligence action against a legal entity that is wholly owned and entirely controlled by natural persons who are licensed health care providers. MICRA should be interpreted to effectuate the Legislature’s intent to “contain the costs of malpractice insurance by controlling or redistributing liability for damages, thereby maximizing the availability of medical services to meet the state’s health care needs.” (Western Steamship Lines, Inc. v. San Pedro Peninsula Hospital (1994) 8 Cal.4th 100, 112; see also Preferred Risk Mutual Ins. Co. v. Reiswig (1999) 21 Cal.4th 208, 215 [“The cases agree that MICRA provisions should be construed liberally in order . . . to reduce malpractice insurance premiums”].) In order to effectuate legislative intent, the definition of “health care provider” in MICRA should be interpreted to include not just individual licensed physicians, but also groups of licensed physicians practicing under fictitious names in medical corporations, unincorporated medical groups, and medical partnerships. All of this having been said, it usually does not matter whether a medical group is covered by MICRA. The medical group’s liability is vicarious, and if the group member or employee whose conductH O R V I T Z & L E V Y L L P M I C R A M A N U A L 1 3 Copyright © 2012 Horvitz & Levy LLP injured the plaintiff is a health care provider, then MICRA applies to the medical group as well. (See section l.1), below.) Only if the employee whose conduct injured the plaintiff is not a health care provider does it matter whether the medical group itself is a health care provider. j. An HMO is not a “health care provider.” Health care service plans and managed care entities are not health care providers within the meaning of MICRA. (Civ. Code, § 3428, subd. (c); Health & Saf. Code, § 1367.01, subd. (m); Palmer v. Superior Court (2002) 103 Cal.App.4th 953, 970-971 & fn. 9.) k. A federally employed doctor or a federal hospital is a “health care provider.” (Taylor v. United States (9th Cir. 1987) 821 F.2d 1428, 1431-1432; Fetter v. United States (S.D.Cal. 1986) 649 F.Supp. 1097, 1099-1101.) l. Vicarious liability. 1) For the professional negligence of a health care provider. MICRA applies. (Lathrop v. HealthCare Partners Medical Group (2004) 114 Cal.App.4th 1412, 1421-1427.) “Because the vicarious liability of [an] employer is wholly dependent upon or derivative from the liability of the employee, any substantive defense that is available to the employee inures to the benefit of the employer. [Citation.] An employer cannot be held vicariously liable for an amount of compensatory damages that exceeds the amount for which the employee is liable.” (Id. at p. 1423.) “Nothing in MICRA reflects any legislative intention to abrogate the common law rules related to the doctrine of respondeat superior. Accordingly, we conclude that the liability of HealthCare Partners, as employer or principal, is limited to the liability of its employees or agents, Drs. Friedman, Diamond, and Rapaport. Under Civil Code section 3333.2, HealthCare Partners cannot be held vicariously liable for noneconomic damages in excess of $250,000.” (Id. at p. 1424.) “We reject the argument made by plaintiffs that the rule limiting damages from a vicariously liable employer applies only when a judgment is also entered against the employee. . . . The rationale for limiting damages operates to the same effect whether the limitations on theH O R V I T Z & L E V Y L L P M I C R A M A N U A L 1 4 Copyright © 2012 Horvitz & Levy LLP employee’s liability are set by the judgment or by statute. In either event, the employer can have no greater liability than the employee.” (Ibid.) “Exempting vicariously liable defendants from the $250,000 damages cap would undermine the legislative goal of replacing unpredictable jury awards with an across-the-board limit. Plaintiffs would need only to sue the entity employing the negligent physician to circumvent the MICRA cap. In order to preserve the purposes and policies of MICRA, the $250,000 limit on noneconomic damages imposed by Civil Code section 3333.2 must be applied to actions against the employers of health care providers based on respondeat superior just as the limit is applied to actions against health care providers directly.” (Id. at p. 1426.) Citing Lathrop, the court in Canister v. Emergency Ambulance Service, Inc. (2008) 160 Cal.App.4th 388, said: “Under the respondeat superior doctrine, MICRA applies to an employing entity held vicariously liable for the professional negligence of its agents, if such agents are health care providers. [Citation.] When the liability of an employer in a medical malpractice action is wholly derivative and not based on fault, the vicariously liable employer is entitled to invoke against the injured plaintiff whatever limitations on liability are available to its health care provider employee.” (Id. at p. 395, fn. 4; see id. at p. 403 [“The services that EMT’s provide to patients are ‘inextricably identified’ with the health of patients, and an ambulance company vicariously assumes the same standing with such patients through its licensed employees”].) 2) For the negligence of an unlicensed employee of a health care provider. MICRA should apply. See Taylor v. United States (9th Cir. 1987) 821 F.2d 1428, 1432 (MICRA applied where patient in Army hospital became disconnected from ventilator for unknown reason; hospital had professional duty to prevent disconnection “regardless of whether separation was caused by the ill-considered decision of a physician or the accidental bump of a janitor’s broom”); Scholz v. Metropolitan Pathologists, P.C. (Colo. 1993) 851 P.2d 901, 905 (Colorado’s version of MICRA applied to health care provider that employed unlicensed lab technicianH O R V I T Z & L E V Y L L P M I C R A M A N U A L 1 5 Copyright © 2012 Horvitz & Levy LLP who mislabeled slides). The Scholz case was cited with approval in Chosak v. Alameda County Medical Center (2007) 153 Cal.App.4th 549, 567. Chosak said the following about Scholz: “In Scholz . . . , the plaintiff suffered an unnecessary surgery as a result of a laboratory technician’s error in labeling tissue sample slides. [Citation.] Like California, Colorado has a statute limiting noneconomic damages in medical malpractice actions. The Colorado statute covers actions against ‘health care professionals,’ defined as persons licensed to practice medicine. [Citation.] The plaintiff argued that his claims against the technician were not covered by the statute because the technician was not a licensed professional. In rejecting the argument, notwithstanding the language of the statute, the court noted, ‘In seeking to curb the increasing costs of malpractice insurance in this state, there is nothing in the [statute limiting noneconomic damages] which suggests the legislature sought to do so only by limiting recoveries for actions brought against licensed professionals or professional corporations and entities whose liability results solely from the conduct of those professionals. The reason that no such suggestion exists is clear: the negligent conduct of unlicensed employees, such as [the laboratory technician], who contribute to providing health care services affects the insurance premiums that health care providers pay, just as the conduct of professionals within those entities does.’ ” (Ibid.) m. The phrase “legal representatives” in the definition of “health care provider” has been construed to mean a health care provider’s estate. This seems incorrect. In Flores v. Natividad Medical Center (1987) 192 Cal.App.3d 1106, 1116, footnote 3, the Court of Appeal said: “The apparent intent of the Legislature in including the term ‘legal representatives’ in the code definition of a health care provider was to extend to the heirs of a physician, or other medical classifications considered therein, the same protection afforded to the medical provider in suits against the provider’s estate if the provider is deceased at the time the legal action is brought.” This narrow construction of the term “legal representatives” seems incorrect. If the Legislature only intended to refer to cases in which the health care provider is deceased, it would have used the term “personal representative” instead of “legalH O R V I T Z & L E V Y L L P M I C R A M A N U A L 1 6 Copyright © 2012 Horvitz & Levy LLP representatives.” A health care provider’s estate has a personal representative — the executor or administrator. (See Prob. Code, §§ 58, 8400 et seq.) More likely, the Legislature used the term “legal representatives” in the same sense that this term is used in Code of Civil Procedure section 473, subdivision (b), which provides in part: “The court may, upon any terms as may be just, relieve a party or his or her legal representative from a judgment . . . .” (Emphasis added.) In Clemmer v. Hartford Insurance Co. (1978) 22 Cal.3d 865, the Supreme Court held that a party’s insurer was its “legal representative”: “The term ‘legal representative’ has been interpreted with considerable liberality to permit one who would not normally be considered a ‘representative’ of a party but has a sufficient interest in the action to maintain the [section 473] motion.” (Id. at p. 885, emphasis added.) “The standing of Hartford to move to set aside the default judgment which it might otherwise be required to satisfy is therefore clear.” (Id. at p. 886, emphasis added; see also Cal. Judges Benchbook: Civil Proceedings After Trial (CJER 1998) § 1.20, p. 21 [“The term ‘legal representative’ [in section 473] has been interpreted broadly to permit the motion to be filed by a person or entity that would not normally be considered the defendant’s representative, but which has a substantial interest in the action, e.g., because the person or entity might be required to satisfy the judgment”].) By parity of reasoning, the “legal representatives” of a health care provider should include any person or entity that might be required to pay damages as a result of the health care provider’s professional negligence, such as a vicariously liable employer. n. The law in other states. See generally Annotation, Medical Malpractice: Who Are “Health Care Providers,” or the Like, Whose Actions Fall Within Statutes Specifically Governing Actions and Damages for Medical Malpractice (1993) 12 A.L.R.5th 1. 3. “Based upon professional negligence” defined. a. Statutory definition. The MICRA statutes each define “professional negligence” as follows: “ ‘Professional negligence’ means a negligent act or omission to act by a health care provider in the rendering of professional services, which act or omission is theH O R V I T Z & L E V Y L L P M I C R A M A N U A L 1 7 Copyright © 2012 Horvitz & Levy LLP proximate cause of a personal injury or wrongful death, provided that such services are within the scope of services for which the provider is licensed and which are not within any restriction imposed by the licensing agency or licensed hospital.” (Bus. & Prof. Code, § 6146, subd. (c)(3); Civ. Code, §§ 3333.1, subd. (c)(2), 3333.2, subd. (c)(2); Code Civ. Proc., §§ 340.5, subd. (2), 364, subd. (f)(2), 667.7, subd. (e)(4), 1295, subd. (g)(2).) b. “Professional negligence” defined. 1) Broadly construed. The appellate courts have broadly construed “professional negligence” to mean negligence during the rendering of services for which the health care provider is licensed: a) Murillo v. Good Samaritan Hospital (1979) 99 Cal.App.3d 50. The plaintiff was injured when she fell out of bed while a patient in the hospital. Seeking to apply a shorter period of limitations than would be available under MICRA’s Code of Civil Procedure section 340.5, the hospital argued the failure to raise the bedrails was “ordinary negligence” rather than “professional negligence.” (Id. at p. 53.) The Court of Appeal disagreed: “[T]he test is not whether the situation calls for a high or low level of skill, or whether a high or low level of skill was actually employed, but rather the test is whether the negligent act occurred in the rendering of services for which the health care provider is licensed. When a seriously ill person is left unattended and unrestrained on a bed or gurney, the negligent act is a breach of the hospital’s duty as a hospital to provide appropriate care and a safe environment for its patients.” (Id. at p. 57.) • In Flowers v. Torrance Memorial Hospital Medical Center (1994) 8 Cal.4th 992, the Supreme Court disapproved Murillo “to the extent [it] may be inconsistent with the analysis herein.” (Id. at p. 1002, fn. 6.) Flowers held, “whether the cause of action is denominated ‘ordinary’ or ‘professional’H O R V I T Z & L E V Y L L P M I C R A M A N U A L 1 8 Copyright © 2012 Horvitz & Levy LLP negligence or both, ultimately only a single standard [of care] can obtain under any given set of facts and any distinction is immaterial to resolving a motion for summary judgment.” (Id. at p. 1000, fn. omitted.) It is difficult to see what, if anything, in Murillo “may be” inconsistent with Flowers. The Supreme Court itself said Murillo was irrelevant to the issue presented in Flowers. (Id. at p. 999.) b) Williams v. Superior Court (1994) 30 Cal.App.4th 318. The Court of Appeal followed Murillo: “The test of whether a health care provider’s negligence constitutes professional negligence is whether the negligence occurred in rendering services for which the health care provider is licensed.” (Id. at pp. 324-325.) “We agree with the Murillo court that it is not the degree of skill required but whether the injuries arose out of the rendering of professional services that determines whether professional as opposed to ordinary negligence applies.” (Id. at p. 327.) Allegations that the defendant became aware of a patient’s dangerous propensities and failed to warn a nonemployee who was drawing blood from the patient were directly related to the manner in which professional services were rendered. Accordingly, the action was one for “professional negligence.” (Id. at pp. 325-326.) c) Bellamy v. Appellate Department (1996) 50 Cal.App.4th 797. The plaintiff fell off an X-ray table that was not secured. The Court of Appeal followed Murillo: “That the alleged negligent omission was simply the failure to set a brake on the rolling X-ray table or the failure to hold the table in place, neither of which requires any particular skill, training, experience or exercise of professional judgment, does not affect our decision. We presume that during the course of administering an examination or therapy like that which Bellamy underwent, an X-ray technician may perform aH O R V I T Z & L E V Y L L P M I C R A M A N U A L 1 9 Copyright © 2012 Horvitz & Levy LLP variety of tasks, such as assisting the patient onto the table, manipulating the table into one or more desired positions, instructing the patient to move from one position to another, activating the X-ray machine, removing the photographic plates, assisting the patient from the table, etc. Some of those tasks may require a high degree of skill and judgment, but others do not. Each, however, is an integral part of the professional service being rendered. Trying to categorize each individual act or omission, all of which may occur within a space of a few minutes, into ‘ordinary’ or ‘professional’ would add confusion in determining what legal procedures apply if the patient seeks damages for injuries suffered at some point during the course of the examination or therapy. We do not see any need for such confusion or any indication the Legislature intended MICRA’s applicability to depend on such fine distinctions.” (Id. at p. 808, fn. omitted.) d) Taylor v. United States (9th Cir. 1987) 821 F.2d 1428. The plaintiff’s husband was hospitalized in an Army hospital and became disconnected from the ventilator on which he was dependent for oxygen. The Ninth Circuit, relying on Murillo, held this was a case of “professional negligence,” reasoning: “There is little evidence concerning the reason that Taylor’s husband’s ventilator became disconnected. However, Taylor’s husband was under the care of government physicians at the time of the incident, the injury occurred in the hospital, and the injury was caused by removal of medical equipment integral to treatment . . . . [¶] The government had a professional duty to prevent Taylor’s husband from becoming separated from his ventilator, regardless of whether separation was caused by the ill-considered decision of a physician or the accidental bump of a janitor’s broom.” (Id. at p. 1432.)H O R V I T Z & L E V Y L L P M I C R A M A N U A L 2 0 Copyright © 2012 Horvitz & Levy LLP e) Hedlund v. Superior Court (1983) 34 Cal.3d 695. The health care provider defendants, seeking to apply a shorter period of limitations than MICRA allows, argued that “professional negligence” involves only acts in the course of diagnosis or treatment resulting in injury to the patient, and an injury to a third person resulting from a therapist’s failure to warn of a threat made by the patient is “ordinary negligence.” (Id. at p. 702.) “We rejected that contention in Hedlund, concluding that the duty to warn was ‘inextricably interwoven’ with the doctor’s professional responsibilities. We reasoned: ‘Tarasoff [v. Regents of University of California (1976) 17 Cal.3d 425] recognizes a right to expect that a licensed psychotherapist will realize when a patient poses a serious danger to another and, if that potential victim is identifiable, will act reasonably to protect the victim. The diagnosis and the appropriate steps necessary to protect the victim are not separate or severable, but together constitute the duty giving rise to the cause of action.’ ” (Waters v. Bourhis (1985) 40 Cal.3d 424, 432.) Following Hedlund, in Limon v. College Hospital (Aug. 17, 2011, B230179) 2011 WL 3612229, 2011 Cal.App. Unpub. Lexis 6227, an unpublished and thus uncitable opinion, the Court of Appeal held that a psychiatric hospital’s negligence in failing to protect a patient from sexual assault by another patient was professional, not ordinary negligence. “Acute psychiatric hospitals . . . admit patients who generally are, as a result of a mental disorder, a danger to themselves or others. [Citation.] Thus, just as the duty to warn a third party of a patient’s dangerousness is interwoven with a psychologist’s professional duty to properly diagnose the patient’s condition, here, [the hospital’s] duty to ensure the physical safety of psychiatric patients from themselves and each other cannot be extricated from its professional duty to properly diagnose and treat the patients’ mental disorders.” (2011 WL 3612229 at *5, 2011 Cal.App. Unpub. Lexis 6227 at *14.)H O R V I T Z & L E V Y L L P M I C R A M A N U A L 2 1 Copyright © 2012 Horvitz & Levy LLP f) Canister v. Emergency Ambulance Service, Inc. (2008) 160 Cal.App.4th 388. The Court of Appeal held that negligence by an emergency medical technician (EMT) while driving an ambulance transporting a patient was “professional negligence” within the meaning of MICRA. The plaintiff, a police officer, was accompanying an arrestee in the back of the ambulance when it hit a curb, injuring the officer. “The accident occurred while EAS’s employees were transporting the patient from one hospital to another, activities for which the ambulance driver and attendant were licensed. An integral part of the duties of an EMT includes transporting patients and driving or operating an ambulance.” (Id. at p. 407.) “We hold, as a matter of law, that the act of operating an ambulance to transport a patient to or from a medical facility is encompassed within the term ‘professional negligence.’ ” (Id. at p. 404.) “That appellant was not a patient does not affect application of MICRA. By their terms, MICRA statutes apply to negligent conduct by a health care provider in the rendering of professional services and is [sic] not limited to actions by the recipient of professional services. [Citations.] Indeed, MICRA limitations apply ‘to any foreseeable injured party, including patients, business invitees, staff members or visitors, provided the injuries alleged arose out of professional negligence.’ [Citation.] As applied to the present facts, it is foreseeable as a matter of law that a police officer accompanying an arrestee in an ambulance might be injured in the operation of the ambulance.” (Id. at pp. 407-408.) g) David M. v. Beverly Hospital (2005) 131 Cal.App.4th 1272. The Court of Appeal held that “allegations that a physician negligently failed to report suspected child abuse, which should have been discovered during a medical examination while rendering professional services, constitute a claim for professional negligence within the meaning of [MICRA] . . . .” (Id. at pp. 1274-1275; see id. at pp.H O R V I T Z & L E V Y L L P M I C R A M A N U A L 2 2 Copyright © 2012 Horvitz & Levy LLP 1277-1278, 1281.) Also, “negligence in the failure of [a] hospital to fulfill its duty to ensure compliance by its doctors, nurses and other agents with the mandatory child abuse reporting requirements . . . would amount to professional negligence within the meaning of [MICRA] . . . .” (Id. at p. 1281.) h) Bell v. Sharp Cabrillo Hospital (1989) 212 Cal.App.3d 1034. The Court of Appeal held “professional negligence” includes a hospital’s failure to fulfill its duty under Elam v. College Park Hospital (1982) 132 Cal.App.3d 332, 346, to screen the competency of its medical staff to insure the adequacy of medical care rendered to patients at its facility. “Because a hospital’s effectiveness in selecting and periodically reviewing the competency of its medical staff is a necessary predicate to delivering quality health care, its inadequate fulfillment of that responsibility constitutes ‘professional negligence’ involving conduct necessary to the rendering of professional services within the scope of the services a hospital is licensed to provide.” (Bell, supra, 212 Cal.App.3d at p. 1051.) “Employing the terminology in Hedlund [v. Superior Court (1983) 34 Cal.3d 695, 703-704], the competent performance of this responsibility is ‘inextricably interwoven’ with delivering competent quality medical care to hospital patients.” (Bell, supra, 212 Cal.App.3d at p. 1051.) i) Palmer v. Superior Court (2002) 103 Cal.App.4th 953. The Court of Appeal held that “allegedly injurious utilization review” (i.e., advising whether requested medical services, equipment, or supplies were “medically necessary”), performed under a contract between an HMO and a medical group by a physician employed by the medical group, “amounted to a medical clinical judgment such as would arguably arise out of professional negligence. We disagree . . . that this was a purely administrative or economic role played by [the medical group]. Rather, the statutes require that utilization review beH O R V I T Z & L E V Y L L P M I C R A M A N U A L 2 3 Copyright © 2012 Horvitz & Levy LLP conducted by medical professionals, and they must carry out these functions by exercising medical judgment and applying clinical standards.” (Id. at p. 972.) “The [medical group’s] medical director who made the disputed ‘lack of medical necessity’ decision was acting as a health care provider as to the medical aspects of that decision. That there was also a financial coverage consequence of that decision is not dispositive for purposes of applying [Code of Civil Procedure] section 425.13 definitions of professional negligence of a health care provider. Such medical necessity decisions take place in the context of professional duties of care.” (Id. at p. 969; see Scripps Clinic v. Superior Court (2003) 108 Cal.App.4th 917, 942.) Palmer involved Code of Civil Procedure section 425.13, which governs the inclusion of a punitive damage claim in an action for professional negligence against a health care provider. But section 425.13 uses the MICRA definition of “professional negligence.” (Williams v. Superior Court (1994) 30 Cal.App.4th 318, 322-323; see Palmer v. Superior Court, supra, 103 Cal.App.4th at p. 961 [“It is well established that the legislative history of the term, ‘professional negligence,’ as found in MICRA, may be used to interpret that term as used in section 425.13, to determine the scope of conduct afforded these protections under MICRArelated provisions. [Citation.] It is also well accepted that ‘statutory sections relating to the same subject must be read together and harmonized’ ”].) Therefore, negligent utilization review should be considered “professional negligence” within the meaning of MICRA as well as section 425.13. j) Scripps Clinic v. Superior Court (2003) 108 Cal.App.4th 917. The Court of Appeal held that “a decision to withdraw from the treatment of a patient is a medical decision, not an administrative decision, which falls within the context of medical negligence because it is a decision that occurs during medicalH O R V I T Z & L E V Y L L P M I C R A M A N U A L 2 4 Copyright © 2012 Horvitz & Levy LLP treatment and is governed by the law of abandonment.” (Id. at pp. 942-943.) Therefore, “Scripps’s termination of medical care [because the patient sued two Scripps physicians for medical malpractice] arose in the context of professional negligence” within the meaning of Code of Civil Procedure section 425.13. (Id. at p. 942.) k) Osborn v. Irwin Memorial Blood Bank (1992) 5 Cal.App.4th 234. The Court of Appeal said “there is no question that donor screening and blood testing are ‘professional services’ for purposes of MICRA . . . .” (Id. at p. 271.) l) Johnson v. Superior Court (2002) 101 Cal.App.4th 869. The Court of Appeal held that doctors employed by a sperm bank were providing professional services when they interviewed and approved a donor. (Id. at pp. 883-886.) m) Cryolife, Inc. v. Superior Court (2003) 110 Cal.App.4th 1145. The Court of Appeal held that a tissue bank provides professional services, not a product. (Id. at p. 1158.) n) Rose v. Fife (1989) 207 Cal.App.3d 760. The plaintiff alleged both professional negligence and ordinary negligence. The Court of Appeal said: “All of Fife’s alleged wrongful acts in these two causes of action stem from actions taken in his capacity as plaintiff’s doctor and therefore come within the terms of [the MICRA statute of limitations].” (Id. at p. 767, fn. 6.) o) Mero v. Sadoff (1995) 31 Cal.App.4th 1466. The plaintiff filed a workers’ compensation claim and was examined by a doctor retained by the employer’s attorney. The plaintiff sued the doctor, alleging that her injury was exacerbated by the examination. The Court of Appeal held the limitations period applicable to “medical malpractice” applied. “[A] negligence action involving services rendered by aH O R V I T Z & L E V Y L L P M I C R A M A N U A L 2 5 Copyright © 2012 Horvitz & Levy LLP physician will be considered one for medical malpractice if it involves or substantially relates to the rendition of medical treatment by a licensed physician.” (Id. at p. 1479.) p) Francies v. Kapla (2005) 127 Cal.App.4th 1381. The Court of Appeal held that a doctor’s violation of the Confidentiality of Medical Information Act, by disclosing the patient’s HIV status to the patient’s employer, was based on professional negligence. (Id. at p. 1386, fn. 11.) q) Titolo v. Cano (2007) 157 Cal.App.4th 310. The Court of Appeal said, “Communications between physicians and insurance companies regarding the diagnosis and treatment of patients are a necessary part of the provision of medical services to those patients.” (Id. at p. 318.) 2) Some unusual circumstances. a) Flores v. Natividad Medical Center (1987) 192 Cal.App.3d 1106. The Court of Appeal held that MICRA does not apply to an action by a prisoner against the State for failure to summon medical aid, even though the employees who failed to summon medical aid, i.e., failed to transfer the plaintiff to a hospital, were doctors. The court explained: “If the gravamen of the action against the State were professional negligence, MICRA would not apply as the State is immune from liability for such negligence of its employees.” (Id. at p. 1116.) In response to the State’s argument that “it would be anomalous to apply MICRA limitations to recovery against the State doctors but not to recovery against the State itself based upon the same negligent acts of the doctors in failing to summon medical care,” the court said, “It would be at least equally anomalous, we think, to insulate the State from liability simply because, fortuitously, the employees who failed to summon assistance were doctors rather than other prison personnel.” (Id. at pp. 1116-1117.)H O R V I T Z & L E V Y L L P M I C R A M A N U A L 2 6 Copyright © 2012 Horvitz & Levy LLP b) Ellis v. City of San Diego (9th Cir. 1999) 176 F.3d 1183. The plaintiff, an arrestee, brought a federal civil rights action against a doctor who catheterized him against his will. The Ninth Circuit held that MICRA does not apply to suits for violation of federal civil rights. (Id. at pp. 1186, 1190-1191.) The court explained, “Ellis is suing [the doctor] not for incorrectly inserting the catheter or needle while treating him, but for searching his bladder and bloodstream without a warrant or probable cause, and for using excessive force while doing so. [The doctor] is therefore not being sued for the manner in which she performed medical services or treatment, but because of her assumption of the function of a law enforcement official; MICRA does not protect her with respect to the latter form of conduct.” (Id. at p. 1191, original emphasis.) c) Vazquez de Mercado v. Superior Court (2007) 148 Cal.App.4th 711. The plaintiffs hired a veterinarian to examine a horse before they purchased it. Subsequently, they sued the veterinarian seeking damages for the purchase price of the horse and costs of its care. The Court of Appeal held a veterinarian is a “health care provider” within the meaning of MICRA, but the harm the plaintiffs alleged did not fall within MICRA’s definition of “professional negligence,” i.e., a “ ‘negligent act or omission to act by a health care provider in the rendering of professional services, which act or omission is the proximate cause of a personal injury or wrongful death . . . .’ ” (Id. at p. 715, emphasis added.) The court concluded, quite simply, that the plaintiffs “did not suffer personal injuries or wrongful death.” (Ibid.) In response to the plaintiffs’ argument that, if personal injury or wrongful death applies only to humans, “veterinarians will never fall within the statute,” the court said: “We can conceive of situations where an animal’s owner could experience personal injury based on a veterinarian’s professional negligence. That this might not be the norm or occur with frequency does not lead to the conclusion thatH O R V I T Z & L E V Y L L P M I C R A M A N U A L 2 7 Copyright © 2012 Horvitz & Levy LLP the statute defining professional negligence should be interpreted any more broadly than its plain language. We express no opinion whether the statute covers injuries to or the death of animals being treated by veterinarians.” (Id. at p. 716; see also Scharer v. San Luis Rey Equine Hospital, Inc. (2012) 204 Cal.App.4th 421, 427-429.) 3) A statutory proviso. In Waters v. Bourhis (1985) 40 Cal.3d 424, 435-436, the Supreme Court construed the proviso in MICRA’s definition of “professional negligence” that excepts acts or omissions of a health care provider that are “within any restriction imposed by the licensing agency or licensed hospital.” The court held the proviso “was not intended to exclude an action from . . . MICRA . . . simply because a health care provider acts contrary to professional standards or engages in one of the many specified instances of ‘unprofessional conduct.’ Instead, it was simply intended to render MICRA inapplicable when a provider operates in a capacity for which he is not licensed — for example, when a psychologist performs heart surgery.” (Id. at p. 436.) c. “Based upon” professional negligence defined. 1) Intentional torts. The Court of Appeal has consistently held that MICRA does not apply to intentional torts, i.e., that intentional torts are not “based upon” professional negligence. The Supreme Court seems to agree. a) Nelson v. Gaunt (1981) 125 Cal.App.3d 623. The Court of Appeal held the plaintiff’s fraud claim against her doctor fell under the fraud statute of limitations, not MICRA’s Code of Civil Procedure section 340.5. (Id. at pp. 635-636.) The court said the case law cited by the defendant “involved professional negligence and the application of Code of Civil Procedure section 340.5. Here, each of Nelson’s causes of action was for an intentional tort.” (Id. at p. 636.) “The 1975 amendments to Code of Civil Procedure section 340.5, which narrowly define professional negligence, indicate that the LegislatureH O R V I T Z & L E V Y L L P M I C R A M A N U A L 2 8 Copyright © 2012 Horvitz & Levy LLP attempted to curb fraud by health care providers by another route.” (Id. at p. 636, fn. 6.) b) Brown v. Bleiberg (1982) 32 Cal.3d 426. The Supreme Court held, without discussion, that the MICRA statute of limitations applied to the plaintiff’s professional negligence theory, but not to the plaintiff’s battery and breach-of-warranty theories. (Id. at pp. 431, fn. 1, 437.) c) Waters v. Bourhis (1985) 40 Cal.3d 424. In this fee dispute between a former medical malpractice plaintiff and her attorney, the attorney argued that the plaintiff’s recovery in the underlying medical malpractice action “was based on intentional misconduct in which the psychiatrist engaged for personal, as opposed to professional, motives . . . .” (Id. at p. 433, original emphasis; see id. at pp. 434-435.) The Supreme Court viewed the underlying action as a “ ‘hybrid’ proceeding” alleging both non-MICRA and MICRA theories. (Id. at p. 436.) The court held that Business and Professions Code section 6146, MICRA’s limit on contingent attorney fees, did not apply “when a plaintiff knowingly chooses to proceed on both non-MICRA and MICRA causes of action, and obtains a recovery that may be based on a non-MICRA theory . . . .” (Id. at p. 437.) d) Noble v. Superior Court (1987) 191 Cal.App.3d 1189. The plaintiff alleged battery by unauthorized surgery. (Id. at p. 1191.) The Court of Appeal held that Code of Civil Procedure section 364, subdivision (d), the MICRA provision that tolls the statute of limitations when a notice of intent to sue is served within 90 days of the end of the limitations period, did not apply to the statute of limitations for battery. (Id. at pp. 1192-1194.) e) Central Pathology Service Medical Clinic, Inc. v. Superior Court (1992) 3 Cal.4th 181. The Supreme Court held that Code of Civil Procedure section 425.13, which restricts punitive damage claims inH O R V I T Z & L E V Y L L P M I C R A M A N U A L 2 9 Copyright © 2012 Horvitz & Levy LLP actions “arising out of the professional negligence of a health care provider,” applies to claims directly related to the manner in which professional services were provided, even if the claims could be characterized as intentional torts. In reaching this conclusion, the Supreme Court noted that the MICRA statutes are not limited to pure negligence actions: “We recognize that in the medical malpractice context, there may be considerable overlap of intentional and negligent causes of action. Because acts supporting a negligence cause of action might also support a cause of action for an intentional tort, we have not limited application of MICRA provisions to causes of action that are based solely on a ‘negligent act or omission’ as provided in these statutes. To ensure that the legislative intent underlying MICRA is implemented, we have recognized that the scope of conduct afforded protection under MICRA provisions (actions ‘based on professional negligence’) must be determined after consideration of the purpose underlying each of the individual statutes.” (Id. at p. 192.) f) Delaney v. Baker (1999) 20 Cal.4th 23. The Supreme Court narrowly interpreted the phrase “based on professional negligence” in the Elder Abuse Act to exclude reckless, oppressive, fraudulent, or malicious conduct by a health care provider. (Id. at pp. 31-32, 35.) The Supreme Court said: “The Central Pathology court made clear that it was not deciding the meaning of the term ‘professional negligence’ used in MICRA or in statutes other than [Code of Civil Procedure section 425.13, subdivision (a)].” (Id. at p. 39.) The Supreme Court also said: “We emphasize that our interpretation of the phrase ‘based on professional negligence’ found in the unique statutory scheme of the Elder Abuse Act is not necessarily applicable to other statutes in which that phrase appears. Consistent with the Central Pathology court, we stress that the meaning of the phrase would depend upon the legislative history and underlying purpose of each of theH O R V I T Z & L E V Y L L P M I C R A M A N U A L 3 0 Copyright © 2012 Horvitz & Levy LLP statutes. [Citation.] Specifically, we do not purport to construe the meaning of the same phrase within the context of the MICRA statutes.” (Id. at p. 41.) g) Barris v. County of Los Angeles (1999) 20 Cal.4th 101. The Supreme Court held, “A claim under EMTALA [the federal Emergency Medical Treatment and Active Labor Act] for failure to stabilize [the plaintiff’s emergency medical condition before transfer to another facility] is . . . necessarily ‘based on professional negligence’ within the meaning of MICRA . . . .” (Id. at p. 110.) The Supreme Court refused, however, to adopt the Court of Appeal’s rationale that the broad interpretation of the phrase “arising out of professional negligence” in Central Pathology should be extended to all MICRA provisions. (Id. at p. 115.) “We have not previously held that MICRA applies to intentional torts. Nor does Central Pathology, which involved a non-MICRA provision, so hold. As explained in our recent decision in Delaney v. Baker (1999) 20 Cal.4th 23, 40 . . . , Central Pathology did not purport to define the meaning of the term ‘professional negligence’ as used in MICRA. . . . Rather, Central Pathology emphasized that the scope and meaning of the phrases ‘arising from professional negligence’ and ‘based on professional negligence’ could vary depending upon the legislative history and ‘the purpose underlying each of the individual statutes.’ ” (Barris, supra, 20 Cal.4th at pp. 115-116.) In a footnote, the Supreme Court strongly suggested that MICRA does not apply to intentional torts, citing Waters v. Bourhis (1985) 40 Cal.3d 424, 437, and Noble v. Superior Court (1987) 191 Cal.App.3d 1189, 1190. (Barris, supra, 20 Cal.4th at p. 116, fn. 9.) h) Perry v. Shaw (2001) 88 Cal.App.4th 658. The Court of Appeal said: “We take the Supreme Court at its word [in Barris v. County of Los Angeles (1999) 20 Cal.4th 101, 115-116, that the meaning of ‘basedH O R V I T Z & L E V Y L L P M I C R A M A N U A L 3 1 Copyright © 2012 Horvitz & Levy LLP on professional negligence’ may vary depending upon the legislative history and the purpose underlying each of the individual statutes] and hold in this case that where, as here, a common law battery — something more than a ‘technical battery’ — has been proved, the limitation imposed by [Civil Code] section 3333.2 does not apply.” (88 Cal.App.4th at p. 661.) Perry emphasized: “Although we sometimes refer to ‘intentional torts’ generally . . . our holding is limited to the type of battery that occurred in this case” (id. at p. 668, fn. 4), i.e., performing an operation to which the patient did not consent (id. at p. 664). i) Guardian North Bay, Inc. v. Superior Court (2001) 94 Cal.App.4th 963. The Court of Appeal held that a health care provider sued for damages after being convicted of felony elder abuse (Pen. Code, § 368) is not covered by MICRA. “To be convicted of a violation of Penal Code section 368, the defendant custodian or caretaker must have willfully caused or permitted injury to or endangerment of an elder person. [¶] The willful nature of criminal conduct in violation of Penal Code section 368 takes this conduct beyond the scope of professional negligence, and, therefore, beyond the scope of MICRA.” (Id. at pp. 977-978.) j) Covenant Care, Inc. v. Superior Court (2004) 32 Cal.4th 771. The Supreme Court held that Code of Civil Procedure section 425.13, restricting punitive damage claims in actions “arising out of the professional negligence of a health care provider,” does not apply to a claim for punitive damages against a health care provider under the Elder Abuse Act. “In its ordinary sense, ‘professional negligence’ is failure to exercise ‘ “knowledge, skill, and care ordinarily employed by members of the profession in good standing.” ’ [Citation.] Hence, such misconduct as plaintiffs alleged — intentional, egregious, elder abuse — cannot be described as mere ‘professional negligence’ in the ordinary sense of thoseH O R V I T Z & L E V Y L L P M I C R A M A N U A L 3 2 Copyright © 2012 Horvitz & Levy LLP words. But . . . in light of our prior pronouncements respecting section 425.13(a) [referring to Central Pathology Service Medical Clinic, Inc. v. Superior Court (1992) 3 Cal.4th 181, 191-192], that fact is not necessarily dispositive.” (32 Cal.4th at pp. 781-782.) Central Pathology held that section 425.13 applies in medical malpractice actions alleging intentional torts. (Id. at p. 782.) “Were we to hold otherwise, we reasoned, ‘injured patients seeking punitive damages in an action involving professional negligence could readily assert that their health care providers committed an intentional tort’ and thus by ‘artful pleading’ effectively ‘annul the protection afforded [health care providers] by that section.’ ” (Ibid.) “No analogous threat looms here; praying for punitive damages in an action based on a violation of the Elder Abuse Act does not substantively transform the action as does adding an intentional tort claim in a malpractice action. While ‘minimally culpable defendants are often charged with intentional torts’ [citation] supporting punitive damage claims, elder abuse triggering the Act’s heightened remedy provisions entails by its nature egregious conduct. [Citations.] And while in the medical malpractice context ‘there may be considerable overlap of intentional and negligent causes of action’ [citation], no such overlap occurs in the Elder Abuse context, where the Legislature expressly has excluded ordinary negligence claims from treatment under the Act [citation].” (Id. at pp. 788-789.) “Central Pathology . . . guarantees that, notwithstanding our [decision] in this case, section 425.13 will continue to apply to a broad range of intentional torts typically pled in medical malpractice cases.” (Id. at p. 790.) k) David M. v. Beverly Hospital (2005) 131 Cal.App.4th 1272. The Court of Appeal said: “Had plaintiff alleged that defendant physician intentionally concealed his failure to report [suspected child abuse] [citation] or that he intentionally failed to report known or suspected abuse, the restrictive limitations period provided byH O R V I T Z & L E V Y L L P M I C R A M A N U A L 3 3 Copyright © 2012 Horvitz & Levy LLP [Code of Civil Procedure] section 340.5 would not apply.” (Id. at p. 1278, citing Noble v. Superior Court (1987) 191 Cal.App.3d 1189, 1193; Waters v. Bourhis (1985) 40 Cal.3d 424, 432-433; and Perry v. Shaw (2001) 88 Cal.App.4th 658, 668.) l) Smith v. Ben Bennett, Inc. (2005) 133 Cal.App.4th 1507. In the course of holding that Code of Civil Procedure section 364 (90-day notice of intent to sue) does not apply in an elder abuse action, the Court of Appeal observed: “The problem is that additional causes of action frequently arise out of the same facts as a medical malpractice cause of action. These may include battery, products liability, premises liability, fraud, breach of contract, and intentional or negligent infliction of emotional distress. Indeed, a plaintiff hoping to evade the restrictions of MICRA may choose to assert only seemingly non-MICRA causes of action. Thus, when a cause of action is asserted against a health care provider on a legal theory other than medical malpractice, the courts must determine whether it is nevertheless based on the ‘professional negligence’ of the health care provider so as to trigger MICRA. [¶] The answer is sometimes yes and sometimes no, depending on the particular cause of action and the particular MICRA provision at issue. [Citations.] The Supreme Court has cautioned repeatedly that ‘the scope and meaning of the phrases “arising from professional negligence” and “based on professional negligence” could vary depending upon the legislative history and “the purpose underlying each of the individual statutes.” ’ ” (Id. at pp. 1514-1515, original emphasis.) m) Unruh-Haxton v. Regents of University of California (2008) 162 Cal.App.4th 343. The Court of Appeal held that MICRA does not apply to a genetic material stealing case. “It is settled that additional causes of action may arise out of the same facts as a medical malpractice action that do not trigger MICRA. [Citation.] A problem that sometimes arises is when a plaintiff hoping to evadeH O R V I T Z & L E V Y L L P M I C R A M A N U A L 3 4 Copyright © 2012 Horvitz & Levy LLP the restrictions of MICRA, will choose to assert intentional torts, ‘seemingly non-MICRA causes of action. Thus, when a cause of action is asserted against a health care provider on a legal theory other than medical malpractice, the courts must determine whether it is nevertheless based on the “professional negligence” of the health care provider so as to trigger MICRA.’ [Citation.] [¶] ‘The answer is sometimes yes and sometimes no, depending on the particular cause of action and the particular MICRA provision at issue.’ ” (Id. at pp. 352-353.) “Based on our review of the complaints, we conclude the patients’ claims for fraud, conversion, and intentional infliction of emotional distress related to wrongful intentional conduct, not mere negligence. The allegations of stealing and then selling a person’s genetic material for financial gain is an intentional act of egregious abuse against a particularly vulnerable and trusting victim. None of the patients assert the egg harvesting medical procedures fell below the standard of care. Rather, it is the intentional and malicious quest to steal genetic material that is the focus of the lawsuit. [¶] . . . The legislators deliberately used the limiting term ‘professional negligence.’ It would be inconsistent with the letter and spirit of the statutory scheme to hold allegations of intentional fraud, emotional distress, and stealing are really just other forms of professional negligence. . . . MICRA’s statute of limitations would not apply to these intentional tort claims against the doctors directly, or against the Regents and the Medical Center based on a theory of vicarious liability or joint venture liability.” (Id. at pp. 355-356.) n) Arguing that MICRA should apply to intentional torts. Stress the overall purpose of MICRA and the specific purpose of the particular MICRA statute at issue (besides Central Pathology, Delaney, and Barris, the Supreme Court’s equitable indemnity decisions, discussed post, page 36, demonstrate that the overall and specific legislative purposes are key). Argue that, in order to effectuate those purposes, theH O R V I T Z & L E V Y L L P M I C R A M A N U A L 3 5 Copyright © 2012 Horvitz & Levy LLP MICRA statute should apply to an intentional tort that is insurable. The overall purpose of MICRA is discussed ante, page 1. Briefly stated, that purpose is to “ameliorate the impact of increasing costs of liability coverage for health care providers.” (Burgess v. Superior Court (1992) 2 Cal.4th 1064, 1083.) Accordingly, it makes little sense to refuse to apply MICRA in any case where the health care provider’s liability is insurable. Liability is insurable unless it arises from an act that is expected or intended to cause harm or inherently harmful. (Downey Venture v. LMI Ins. Co. (1998) 66 Cal.App.4th 478, 499-501.) • In Waters v. Bourhis (1985) 40 Cal.3d 424, the Supreme Court noted, but did not resolve, the argument that “based upon professional negligence” should be construed to include the intentional acts of a health care provider that are insurable under Insurance Code section 533. (Id. at p. 435, fn. 11.) • In Benun v. Superior Court (2004) 123 Cal.App.4th 113, the Court of Appeal said: “[O]ur own analysis of the legislative history of [Code of Civil Procedure] section 340.5 and related MICRA amendments does not indicate that the Legislature specifically considered the scope of coverage of medical liability policies, i.e., whether medical liability insurance covered reckless or intentional acts, as opposed to simple negligence.” (Id. at pp. 125-126, fn. 6.) Whether the Legislature specifically considered the scope of insurance coverage is not determinative, however. “ ‘In determining intent, . . . [w]hen the language is susceptible of more than one reasonable interpretation, . . . we look to a variety of extrinsic aids, including the ostensible objectsH O R V I T Z & L E V Y L L P M I C R A M A N U A L 3 6 Copyright © 2012 Horvitz & Levy LLP to be achieved, the evils to be remedied, the legislative history, public policy, contemporaneous administrative construction, and the statutory scheme of which the statute is a part. [Citations.]’ ” (Granberry v. Islay Investments (1995) 9 Cal.4th 738, 744.) The specific purpose of each MICRA statute is discussed ante, page 2. 2) Equitable indemnity action. a) Western Steamship Lines, Inc. v. San Pedro Peninsula Hospital (1994) 8 Cal.4th 100. A concurrent tortfeasor sued a health care provider for partial equitable indemnity. (Id. at p. 104.) The Supreme Court “assumed that an action for partial equitable indemnity may be based upon professional negligence” (Preferred Risk Mutual Ins. Co. v. Reiswig (1999) 21 Cal.4th 208, 217), and held: “After careful review of the legislative intent underlying MICRA in general and section 3333.2 in particular, we conclude that as a necessary adjunct to effectuating the statutory purpose and goals, a health care provider may invoke the $250,000 limit on noneconomic damages in an action for partial equitable indemnity based upon professional negligence.” (Western Steamship, 8 Cal.4th at p. 111; see id. at pp. 111-114.) b) Preferred Risk Mutual Ins. Co. v. Reiswig (1999) 21 Cal.4th 208. The Supreme Court held the MICRA provision tolling the statute of limitations for 90 days after notice of intent to sue is served (Code Civ. Proc., § 364, subd. (d)) applies in an equitable indemnity action against a health care provider. The court held the indemnity action is “based upon” professional negligence: “[A]lthough we have never attempted to define for all purposes the phrase ‘based upon’ professional negligence, we have recognized that, in deciding whether an action is ‘based upon’ professional negligence, the test is whether it flows orH O R V I T Z & L E V Y L L P M I C R A M A N U A L 3 7 Copyright © 2012 Horvitz & Levy LLP originates from a healthcare provider’s negligent act or omission. (See Central Pathology Service Medical Clinic, Inc. v. Superior Court (1992) 3 Cal.4th 181, 187-188, fn. 3, 192 . . . [court must examine allegations of complaint to determine whether plaintiff’s injury is related to manner in which professional services were rendered].)” (21 Cal.4th at p. 217.) “[E]quitable indemnity actions that flow from professional negligence actions (as opposed to unrelated tort actions) are ‘based upon’ professional negligence . . . .” (Id. at p. 218.) The Supreme Court stressed the need to effectuate the purpose of MICRA’s 90-day notice provision: “By applying section 364, subdivision (d), to cases based upon a health care provider’s professional negligence, including derivative claims for equitable indemnity that follow settlement of the original action, we further the legislative purpose of the 90-day tolling period, and MICRA in general, to give doctors and their insurers an opportunity to negotiate with prospective plaintiffs and settle derivative claims without unnecessary litigation.” (Preferred Risk, 21 Cal.4th at pp. 218-219; see id. at pp. 214-215.) The Supreme Court also held the MICRA statute of limitations (Code Civ. Proc., § 340.5) does not apply to an indemnity action against a health care provider. (Preferred Risk, 21 Cal.4th at p. 213, fn. 2; see id. at pp. 219-222 (dis. opn. of Kennard, J.).) c) County of Contra Costa v. Kaiser Foundation Health Plan, Inc. (1996) 47 Cal.App.4th 237. The Court of Appeal refused to require arbitration of an indemnity claim against a health care provider. The court relied on a suggestion in Western Steamship Lines, Inc. v. San Pedro Peninsula Hospital (1994) 8 Cal.4th 100, 114-115, that procedural, as opposed to substantive, MICRA provisions, such as the statute of limitations, might not apply to indemnity actions. (County of Contra Costa, 47 Cal.App.4th at p. 244.)H O R V I T Z & L E V Y L L P M I C R A M A N U A L 3 8 Copyright © 2012 Horvitz & Levy LLP Subsequently, however, in Preferred Risk Mutual Ins. Co. v. Reiswig (1999) 21 Cal.4th 208, the Supreme Court expressly declined to rely on procedural versus substantive, noting that Western Steamship itself relied on an out-of-state case that construed a medical malpractice statute of limitations to apply to contribution actions against health care providers. The Supreme Court concluded that the Legislature intended the parallel “based upon professional negligence” language in the MICRA statutes to be construed identically. (Preferred Risk, 21 Cal.4th at pp. 216-217.) After Preferred Risk, County of Contra Costa may not be good law. d) SeaRiver Maritime v. Industrial Medical Services (N.D.Cal. 1997) 983 F.Supp. 1287. A federal district court applied MICRA’s collateral source provision (Civ. Code, § 3333.1) in an equitable indemnity action against health care providers. (983 F.Supp. at p. 1301.) 3) EMTALA action. In Barris v. County of Los Angeles (1999) 20 Cal.4th 101, the Supreme Court held, “A claim under EMTALA [the federal Emergency Medical Treatment and Active Labor Act] for failure to stabilize [the plaintiff’s emergency medical condition before transfer to another facility] is . . . necessarily ‘based on professional negligence’ within the meaning of MICRA — it involves ‘a negligent . . . omission to act by a health care provider in the rendering of professional services’ [citation] — although it requires more.” (Id. at p. 110.) “The trier of fact must, under EMTALA as in a medical negligence claim, consider the prevailing medical standards and relevant expert medical testimony to determine whether material deterioration of the patient’s condition was reasonably likely to occur.” (Id. at p. 114.) The Supreme Court majority expressed no opinion on whether a medical screening claim under EMTALA would be based on professional negligence within the meaning of MICRA. (Barris, 20 Cal.4th at p. 111, fn. 4.) Two concurring justices said a medical screening claim would beH O R V I T Z & L E V Y L L P M I C R A M A N U A L 3 9 Copyright © 2012 Horvitz & Levy LLP based on professional negligence. (Id. at pp. 117-118 (conc. opn. of Baxter, J., joined by Chin, J.).) In Romar v. Fresno Community Hosp. and Medical Center (E.D.Cal. 2008) 583 F.Supp.2d 1179, the federal district court held that an EMTALA action for disparate medical screening is not based on professional negligence within the meaning of MICRA. “[U]nder a disparate screening theory, [the hospital’s] conduct is not judged against the prevailing professional standard of care. [Citations.] Rather, [the hospital’s] conduct is compared to its own individualized screening standards or protocols in order to determine if [the patient] received the same screening as other similarly symptomed patients. . . . The key is whether Plaintiff was treated differently, it is not whether [the hospital] breached the standard of professional medical care, i.e. did not act like a reasonable hospital under the circumstances.” (Id. at p. 1187.) 4) Elder abuse action. The Elder Abuse and Dependent Adult Civil Protection Act (Welf. & Inst. Code, § 15600 et seq.) provides heightened remedies (award of reasonable attorney fees and costs; recovery for pain and suffering by a decedent plaintiff’s estate) if the defendant abused or neglected an elderly or dependent adult with recklessness, oppression, fraud, or malice. (See Covenant Care, Inc. v. Superior Court (2004) 32 Cal.4th 771, 779-780; Delaney v. Baker (1999) 20 Cal.4th 23, 26.) In Delaney, the Supreme Court held the Elder Abuse Act applies to health care providers like nursing homes and other health care facilities, because an action against a health care provider under the Elder Abuse Act is not “based on . . . professional negligence” within the meaning of the exclusion for professional negligence in that Act. In Covenant Care, the Supreme Court held an action against a health care provider under the Elder Abuse Act does not “aris[e] out of the professional negligence of a health care provider” within the meaning of Code of Civil Procedure section 425.13, the statute that restricts punitive damage claims in medical malpractice actions. (See also Country Villa Claremont Healthcare Center, Inc. v. Superior Court (2004) 120 Cal.App.4th 426, 435 [extending Covenant Care to commonH O R V I T Z & L E V Y L L P M I C R A M A N U A L 4 0 Copyright © 2012 Horvitz & Levy LLP law intentional torts where the gravamen of the action is violation of the Elder Abuse Act].) In Benun v. Superior Court (2004) 123 Cal.App.4th 113, the Court of Appeal, relying on Covenant Care and Delaney, held that an action against a health care provider under the Elder Abuse Act is not “based upon professional negligence” within the meaning of MICRA; therefore, Code of Civil Procedure section 340.5, the MICRA statute of limitations, does not apply. “[A] cause of action for custodial elder abuse against a health care provider is a separate and distinct cause of action from one for professional negligence against a health care provider.” (Benun, 123 Cal.App.4th at p. 124.) “[T]he legislative history of the Elder Abuse Act indicates that [Welfare and Institutions Code] section 15657.2 was added to specify that ‘professional negligence’ is to be controlled by other statutes specifically applicable thereto, and ‘professional negligence’ is mutually exclusive of the elder abuse and neglect specified in [Welfare and Institutions Code] section 15657 as actionable under the act.” (Benun, 123 Cal.App.4th at p. 126.) This is a point the Supreme Court emphasized in Covenant Care: “It is true that statutory elder abuse includes ‘neglect as defined in Section 15610.57’ (Welf. & Inst. Code, § 15657), which in turn includes negligent failure of an elder custodian ‘to provide medical care for [the elder’s] physical and mental health needs’ (id., § 15610.57, subd. (b)(2)). But as we explained in Delaney, ‘neglect’ within the meaning of Welfare and Institutions Code section 15610.57 covers an area of misconduct distinct from ‘professional negligence.’ As used in the Act, neglect refers not to the substandard performance of medical services but, rather, to the ‘failure of those responsible for attending to the basic needs and comforts of elderly or dependent adults, regardless of their professional standing, to carry out their custodial obligations.’ (Delaney, supra, 20 Cal.4th at p. 34.) Thus, the statutory definition of neglect speaks not of the undertaking of medical services, but of the failure to provide medical care.” (Covenant Care, Inc. v. Superior Court, supra, 32 Cal.4th at p. 783, original emphasis.)H O R V I T Z & L E V Y L L P M I C R A M A N U A L 4 1 Copyright © 2012 Horvitz & Levy LLP Benun also reasoned that, “Delaney, in determining that elder abuse causes are separate and distinct from professional negligence causes, recognized that the intent of the Elder Abuse Act is to subject health care providers to its ‘heightened remedies’ when their acts or omissions are reckless or willful and, thus, more culpable than professional negligence. No reason is apparent why this analysis does not apply equally to the statute of limitations issue.” (Benun, supra, 123 Cal.App.4th at p. 126.) In Smith v. Ben Bennett, Inc. (2005) 133 Cal.App.4th 1507, the Court of Appeal held that Code of Civil Procedure section 364, subdivision (d), the MICRA provision that tolls the statute of limitations for 90 days when notice of intent to sue is served within the last 90 days of the limitations period, does not apply to an action against a health care provider under the Elder Abuse Act. “Under Delaney, [the Elder Abuse Act] works like a toggle switch. If a claim is a ‘cause of action . . . based on . . . professional negligence [within the meaning of the Elder Abuse Act],’ then ‘those laws which specifically apply to . . . professional negligence causes of action’ apply, and the Elder Abuse Act does not. If, on the other hand, a claim is not a ‘cause of action . . . based on . . . professional negligence,’ then the Elder Abuse Act can apply . . . ; moreover, ‘those laws which specifically apply to . . . professional negligence causes of action’ cannot . . . . This is true regardless of whether the claim is based on ‘professional negligence’ within the meaning of such other laws. Moreover, it is true regardless of whether such other laws would apply but for [the Elder Abuse Act].” (Smith, supra, 133 Cal.App.4th at pp. 1522-1523.) d. The law in other states. See generally Annotation, What Patient Claims Against Doctor, Hospital, or Similar Health Care Provider Are Not Subject to Statutes Specifically Governing Actions and Damages for Medical Malpractice (1991) 89 A.L.R.4th 887; Annotation, What Nonpatient Claims Against Doctors, Hospitals, or Similar Health Care Providers Are Not Subject to Statutes Specifically Governing Actions and Damages for Medical Malpractice (1991) 88 A.L.R.4th 358.H O R V I T Z & L E V Y L L P M I C R A M A N U A L 4 2 Copyright © 2012 Horvitz & Levy LLP C. BUSINESS AND PROFESSIONS CODE SECTION 6146: LIMITING CONTINGENT ATTORNEY FEES. 1. Text of section 6146. (a) An attorney shall not contract for or collect a contingency fee for representing any person seeking damages in connection with an action for injury or damage against a health care provider based upon such person’s alleged professional negligence in excess of the following limits: (1) Forty percent of the first fifty thousand dollars ($50,000) recovered. (2) Thirty-three and one-third percent of the next fifty thousand dollars ($50,000) recovered. (3) Twenty-five percent of the next five hundred thousand dollars ($500,000) recovered. (4) Fifteen percent of any amount on which the recovery exceeds six hundred thousand dollars ($600,000). The limitations shall apply regardless of whether the recovery is by settlement, arbitration, or judgment, or whether the person for whom the recovery is made is a responsible adult, an infant, or a person of unsound mind. (b) If periodic payments are awarded to the plaintiff pursuant to Section 667.7 of the Code of Civil Procedure, the court shall place a total value on these payments based upon the projected life expectancy of the plaintiff and include this amount in computing the total award from which attorney’s fees are calculated under this section. (c) For purposes of this section: (1) “Recovered” means the net sum recovered after deducting any disbursements or costs incurred in connection with prosecution or settlement of the claim. Costs of medical care incurred by the plaintiff and the attorney’s office-overhead costs or charges are not deductible disbursements or costs for such purpose. (2) “Health care provider” means any person licensed or certified pursuant to Division 2 (commencing with section 500), or licensed pursuant to the Osteopathic Initiative Act, or the Chiropractic Initiative Act, or licensed pursuant to Chapter 2.5 (commencing with Section 1440) of Division 2 of the Health and Safety Code; and any clinic, health dispensary, or health facility, licensed pursuant to Division 2 (commencing with Section 1200) of the Health and Safety Code. “Health care provider” includes the legal representatives of a health care provider. (3) “Professional negligence” is a negligent act or omission to act by a health care provider in the rendering of professional services, which act or omission is the proximate cause of a personal injury or wrongful death,H O R V I T Z & L E V Y L L P M I C R A M A N U A L 4 3 Copyright © 2012 Horvitz & Levy LLP provided that the services are within the scope of services for which the provider is licensed and which are not within any restriction imposed by the licensing agency or licensed hospital. 2. Summary of section 6146. Section 6146 prohibits the plaintiff’s attorney from collecting a contingent fee in excess of the statutory fee schedule. The maximum fee permitted by the statute is: 40% of the first $50,000; 33a% of the next $50,000; 25% of the next $500,000; and 15% of any amount over $600,000. (Subd. (a).) (If the recovery is over $600,000, the easiest way to calculate the fee is to subtract $600,000 from the recovery, take 15% of the remainder, and add $161,667 (the fee on the first $600,000).) The statutory fee schedule applies whether the recovery is by settlement, arbitration, or judgment, and whether the plaintiff is an adult, minor, or incompetent. (Ibid.) The plaintiff’s attorney’s disbursements and costs must be deducted from the recovery before the fee schedule is applied. (Subd. (c)(1).) 3. Section 6146 is constitutional. a. In Roa v. Lodi Medical Group, Inc. (1985) 37 Cal.3d 920, the Supreme Court upheld section 6146 against due process, equal protection, and separation of powers challenges. The court held section 6146 is rationally related to the goal of reducing medical malpractice insurance costs because it encourages plaintiffs to accept lower settlement offers, discourages plaintiffs’ attorneys from filing frivolous or marginal suits, and protects the already diminished awards of malpractice plaintiffs from further reduction by high contingent fees. (Id. at pp. 931-932.) b. In Fineberg v. Harney & Moore (1989) 207 Cal.App.3d 1049, 1054-1055, the Court of Appeal held section 6146 does not deprive medical malpractice plaintiffs of the right to counsel. 4. Section 6146 cannot be waived. In Fineberg v. Harney & Moore (1989) 207 Cal.App.3d 1049, the Court of Appeal held section 6146 “was intended to further a significant public policy and . . . its protection cannot be waived . . . .” (Id. at p. 1050; accord, Waters v. Bourhis (1985) 40 Cal.3d 424, 439, fn. 15; Schultz v. Harney (1994) 27 Cal.App.4th 1611, 1618-1619, 1621-1622; Wienholz v. Kaiser Foundation Hospitals (1989) 217 Cal.App.3d 1501, 1503, fn. 1; Hathaway v. Baldwin Park Community Hospital (1986) 186 Cal.App.3d 1247, 1251-1253.)H O R V I T Z & L E V Y L L P M I C R A M A N U A L 4 4 Copyright © 2012 Horvitz & Levy LLP 5. Other contexts in which section 6146 may apply. a. Wrongful death action. Section 6146 applies in a wrongful death as well as a personal injury action. (§ 6146, subd. (c)(3); see Yates v. Pollock (1987) 194 Cal.App.3d 195, 198-199.) b. Action against public entity or employee. Section 6146 applies. (E.g., Nguyen v. Los Angeles County Harbor/UCLA Medical Center (1995) 40 Cal.App.4th 1433 [applying section 6146 in an action against a county].) c. EMTALA action. It is unclear whether section 6146 applies in an EMTALA action. The issue is one of federal law. EMTALA allows the plaintiff to “obtain those damages available for personal injury under the law of the State in which the hospital is located.” (42 U.S.C. § 1395dd(d)(2)(A).) But state procedural requirements do not apply. (Power v. Arlington Hosp. Ass’n (4th Cir. 1994) 42 F.3d 851, 865-866; see Barris v. County of Los Angeles (1999) 20 Cal.4th 101, 113, fn. 7.) In Jackson v. United States (9th Cir. 1989) 881 F.2d 707, 711-712, the Court of Appeals held that section 6146 does not apply in an action brought under the Federal Tort Claims Act, which, like EMTALA, incorporates state damages law. If section 6146 applies at all, it would apply to an EMTALA action for failure to stabilize, but probably not to an EMTALA action for failure to provide an appropriate medical screening examination. (See ante, p. 38.) d. Elder abuse action. The Elder Abuse Act itself requires the court to award reasonable attorney’s fees to the plaintiff. (Welf. & Inst. Code, § 15657, subd. (a).) Presumably, if the plaintiff also has a contingent fee contract, the contingent fee could be limited by section 6146. It is unlikely, however, that any of the MICRA statutes apply in an elder abuse action. (See ante, p. 39.) e. Equitable indemnity action. Other MICRA statutes apply in equitable indemnity actions. (See ante, p. 36.) There is no apparent reason why section 6146 should not apply as well. f. Action under Federal Tort Claims Act. Section 6146 does not apply. The federal statute permitting a maximum fee of 25%H O R V I T Z & L E V Y L L P M I C R A M A N U A L 4 5 Copyright © 2012 Horvitz & Levy LLP applies. (Jackson v. United States (9th Cir. 1989) 881 F.2d 707, 713.) 6. Statutory definitions. a. Definition of “health care provider.” See ante, page 6. b. Definition of “based upon professional negligence.” See ante, page 16. c. Definition of “recovered.” 1) Deduction of costs. The attorney’s disbursements and costs must be deducted from the recovery before applying the fee schedule. (§ 6146, subd. (c)(1); Ojeda v. Sharp Cabrillo Hospital (1992) 8 Cal.App.4th 1, 8; see Haning et al., Cal. Practice Guide: Personal Injury (The Rutter Group 2011) ¶ 1:185.1 et seq., p. 1-94.3 et seq.) 2) Recovery by multiple plaintiffs. In Yates v. Law Offices of Samuel Shore (1991) 229 Cal.App.3d 583, the Court of Appeal held that section 6146’s decreasing sliding scale does not apply separately to each heir’s share of the recovery in a wrongful death action; it applies once to the recovery of all the heirs combined. (Id. at pp. 588-590.) The court noted: “We need not and do not consider plaintiffs’ broader suggestion that section 6146 mandates a single contingent fee calculation in all cases with multiple plaintiffs. . . . Future cases, presenting different configurations of plaintiffs, claims, and incidents of professional negligence, will merit their own evaluation.” (Id. at pp. 590-591, fn. 4.) 3) Recovery against multiple defendants. When the plaintiff settles with one or more defendants and goes to judgment against another, is the plaintiff’s attorney entitled to apply the decreasing sliding scale separately to each settlement and to the judgment? (See Schultz v. Harney (1994) 27 Cal.App.4th 1611, 1617, fn. 3 [noting the issue, but expressing no opinion].) The answer should be no. Much of what was said in Yates v. Law Offices of Samuel Shore (1991) 229 Cal.App.3d 583, about why the decreasing sliding scale applies once to the combined recovery of all theH O R V I T Z & L E V Y L L P M I C R A M A N U A L 4 6 Copyright © 2012 Horvitz & Levy LLP heirs in a death case, is pertinent to an injury case with multiple defendants. Yates reasoned that, since each heir in a death case cannot recover a separate maximum of $250,000 for noneconomic damages, each heir should not have to pay a separate attorney fee based on the higher sliding scale percentages. (Id. at pp. 589-590.) Similarly, since the plaintiff in an injury case cannot recover a separate maximum of $250,000 for noneconomic damages from each defendant (Gilman v. Beverly California Corp. (1991) 231 Cal.App.3d 121, 128, 129 [“a plaintiff cannot recover more than $250,000 in noneconomic damages from all health care providers for one injury”]; Colburn v. United States (S.D.Cal. 1998) 45 F.Supp.2d 787, 793 [“MICRA provides a $250,000 maximum aggregate recovery for a single plaintiff”]; see Francies v. Kapla (2005) 127 Cal.App.4th 1381, 1388-1389 & fn. 14 [noting that the plaintiff cited “no authority supporting the view that a separate $250,000 limit applies to each health care provider who contributes to a single injury”]), the plaintiff should not have to pay a separate attorney fee on the recovery from each defendant. Yates also reasoned that the potential recovery in a death case is relatively stable regardless of the number of heirs; therefore, if each heir has to pay a fee based on the higher sliding scale percentages, “the size of the attorney’s fee would largely turn on how many close relatives the decedent left. This is not a rational intention to attribute to the Legislature.” (229 Cal.App.3d at p. 590.) Similarly, in an injury case, the potential recovery is the same regardless of the number of defendants. Basing the size of the fee on how many defendants are involved would not be a rational intention to attribute to the Legislature. 7. The fee limit includes the hourly fee paid to an associate counsel to handle an appeal. In Yates v. Law Offices of Samuel Shore (1991) 229 Cal.App.3d 583, attorney Shore argued section 6146 did not apply to the hourly fees Shore paid to another attorney hired to represent the heirs on appeal from the judgment in a wrongful death action. The Court of Appeal disagreed. (Id. at pp. 591-592.) “[S]ection 6146 fixes the maximum allowable contingent fee for a medical malpractice action as a whole, including an appeal after judgment, and the limitation may not be avoided by charging separate fees for segments of the case or by charging both contingent and hourly fees.” (Id. at p. 591.)H O R V I T Z & L E V Y L L P M I C R A M A N U A L 4 7 Copyright © 2012 Horvitz & Levy LLP 8. The fee limit includes the contingent fee paid to a medical-legal consultant. In Ojeda v. Sharp Cabrillo Hospital (1992) 8 Cal.App.4th 1, the Court of Appeal held the plaintiff’s contract with a medical-legal consulting firm, which required payment of a contingent fee to the consulting firm, was not automatically invalid. But the court also held the total amount paid by the plaintiff to the consulting firm and to the attorneys must equal or be less than the MICRA limit. “Reduced to a mathematical formula, this means that what Ojeda pays in (A) attorney’s fees, (B) fees to the Foundation, and (C) separately identified expenses cannot exceed (1) the maximum attorney fee allowed under Business and Professions Code section 6146, subdivision (a) plus (2) all allowable ‘disbursements and costs’ within the meaning of section 6146, subdivision (c).” (Id. at p. 19.) The case was remanded to the trial court to determine the consulting firm’s reasonable fee and to decide “what portion of that fee is properly characterized as a ‘cost’ of prosecuting the case and what if any portion of that fee is for services which should properly be performed by the attorneys as part of the standard MICRA contingent fee.” (Id. at pp. 19-20.) 9. The fee limit applies to the contingent fee paid by a minor or incompetent. a. The usual pre-MICRA fee was 25%. If the plaintiff is a minor or incompetent, the attorney fee must be approved by the court. (Code Civ. Proc., § 372; Fam. Code, § 6602; Prob. Code, §§ 2644, 3600-3601.) “[B]efore the enactment of MICRA, courts generally approved contingent fees for professional services rendered on behalf of minors . . . on the basis of 25 percent of the recovery.” (Schneider v. Kaiser Foundation Hospitals (1989) 215 Cal.App.3d 1311, 1320-1321, fn. 8, disapproved on another ground in Moncharsh v. Heily & Blase (1992) 3 Cal.4th 1, 27-28.) b. If the MICRA fee was less than 25%, the court had to award the MICRA amount. In Schultz v. Harney (1994) 27 Cal.App.4th 1611, the Court of Appeal held that 25% fee awards in orders approving compromise of a minor’s claims (see id. at pp. 1616-1617) “were erroneous insofar as they awarded attorney’s fees greater than are allowed by Business and Professions Code section 6146.” (Id. at p. 1618; see also Wienholz v. Kaiser Foundation Hospitals (1989) 217 Cal.App.3d 1501, 1508 [“The trial court had no discretion to order fees in excess of [section 6146’s] statutory limits even if the contract’s terms were subject to [judicial] modification” pursuant to Probate Code section 2644].)H O R V I T Z & L E V Y L L P M I C R A M A N U A L 4 8 Copyright © 2012 Horvitz & Levy LLP c. If the MICRA fee was greater than 25%, the court could award 25%. Nothing in the legislative history of MICRA indicates any intention to increase contingent fees in any setting. A trial court making a fee award as part of a minor’s compromise had the authority to award less than the MICRA fee limit. (Schneider v. Friedman, Collard, Poswall & Virga (1991) 232 Cal.App.3d 1276, 1280, fn. 4.) d. Now, courts must use the reasonable fee standard. Rule 7.955 of the California Rules of Court has preempted all local rules relating to determination of the attorney’s fee to be awarded from the proceeds of a compromise, settlement, or judgment in an action to which a minor, a person with a disability, or a conservatee is a party. (Cal. Rules of Court, rule 7.955(d); see Gonzalez v. Chen (2011) 197 Cal.App.4th 881, 884-885.) Rule 7.955 lists 14 nonexclusive factors the court may consider in determining a reasonable attorney’s fee. One of the factors is “[s]tatutory requirements for representation agreements applicable to particular cases or claims.” (Cal. Rules of Court, rule 7.955(b)(14).) Presumably, then, in a medical malpractice action, the MICRA contingent fee cannot be exceeded. Nor does the MICRA contingent fee have to be awarded. (Gonzalez, supra, 197 Cal.App.4th at pp. 885-887, 888.) “MICRA establishes caps on a recovery, not guarantees.” (Id. at p. 885, original emphasis.) 10. Factoring periodic payments into the fee calculation. a. The fee on periodic payments is based on the present value of the payments. Where a recovery includes Code of Civil Procedure section 667.7 periodic payments, the attorney fee statute directs that “the court shall place a total value on these payments based upon the projected life expectancy of the plaintiff and include this amount in computing the total award from which attorney’s fees are calculated . . . .” (Bus. & Prof. Code, § 6146, subd. (b).) “The ‘total value’ is not the arithmetic sum of all future payments required by the award; it is the present value of the periodic payments.” (Holt v. Regents of University of California (1999) 73 Cal.App.4th 871, 883.)H O R V I T Z & L E V Y L L P M I C R A M A N U A L 4 9 Copyright © 2012 Horvitz & Levy LLP b. Present value is based on the jury’s present value verdict. In the absence of a jury determination of present value, the cost of an annuity should be used. “[W]hen the jury has made a specific finding of the present value of future damages, the trial court does not abuse its discretion by calculating attorney fees on that amount.” (Holt v. Regents of University of California (1999) 73 Cal.App.4th 871, 884, fn. omitted; accord, Hrimnak v. Watkins (1995) 38 Cal.App.4th 964, 979-980; see Padilla v. Greater El Monte Community Hospital (2005) 129 Cal.App.4th 667, 671 [“To the extent the statute should be read literally to require the court, not the jury, to make that calculation, the court discharged that duty when it entered judgment on the verdict [adopting the jury’s calculation of present value] without objection by the parties”].) When the jury has not made a specific finding, the present value of future damages is “normally best represented by the cost of the annuity purchased to fund the payments.” (Schneider v. Kaiser Foundation Hospitals (1989) 215 Cal.App.3d 1311, 1314, disapproved on another ground in Moncharsh v. Heily & Blase (1992) 3 Cal.4th 1, 27-28; accord, Nguyen v. Los Angeles County Harbor/UCLA Medical Center (1995) 40 Cal.App.4th 1433, 1440, 1448-1454; see Salgado v. County of Los Angeles (1998) 19 Cal.4th 629, 647-648, fn. 6 [declining to address the question “whether the cost of an annuity to fund the judgment can properly be used by the trial court as the basis for calculating attorney fees”].) 11. Ensuring compliance with the fee limit. a. It matters to the defendant. The plaintiff’s attorney may take the position that the fee owed by the plaintiff is of no concern to the defendant. Not so. If a periodic-payment judgment will be entered, the defendant usually will have a financial interest in ensuring compliance with the fee limit. It is in the defendant’s best interest to maximize the portion of the judgment payable periodically. Generally, the larger the fee, the less money payable periodically — because more money has to be paid as upfront cash to cover the fee. (See post, p. 174.) b. An excessive fee can be exposed by anyone. In Jackson v. United States (9th Cir. 1989) 881 F.2d 707, the issue was whether the attorney fee in a Federal Tort Claims Act (FTCA) case arising from medical malpractice in a federal hospital in California is governed by section 6146 or by the FTCA’s fee limitation provision.H O R V I T Z & L E V Y L L P M I C R A M A N U A L 5 0 Copyright © 2012 Horvitz & Levy LLP The plaintiffs argued the government lacked standing to challenge the validity of a private contingent fee agreement. The Ninth Circuit disagreed: “[A]ll courts possess an inherent power to prevent unprofessional conduct by those attorneys who are practicing before them. This authority extends to any unprofessional conduct, including conduct that involves the exaction of illegal fees. [Citations.] [¶] That the court’s attention is drawn to such unprofessional conduct by an opposing party who otherwise lacks an interest in the outcome simply does not detract from the court’s inherent authority to regulate the members of its bar.” (Id. at p. 710, fn. omitted, original emphasis.)H O R V I T Z & L E V Y L L P M I C R A M A N U A L 5 1 Copyright © 2012 Horvitz & Levy LLP D. CIVIL CODE SECTION 3333.1: ALLOWING EVIDENCE OF COLLATERAL SOURCE BENEFITS AND PRECLUDING SUBROGATION. 1. Text of section 3333.1. (a) In the event the defendant so elects, in an action for personal injury against a health care provider based upon professional negligence, he may introduce evidence of any amount payable as a benefit to the plaintiff as a result of the personal injury pursuant to the United States Social Security Act, any state or federal income disability or worker’s compensation act, any health, sickness or income-disability insurance, accident insurance that provides health benefits or income-disability coverage, and any contract or agreement of any group, organization, partnership, or corporation to provide, pay for, or reimburse the cost of medical, hospital, dental, or other health care services. Where the defendant elects to introduce such evidence, the plaintiff may introduce evidence of any amount which the plaintiff has paid or contributed to secure his right to any insurance benefits concerning which the defendant has introduced evidence. (b) No source of collateral benefits introduced pursuant to subdivision (a) shall recover any amount against the plaintiff nor shall it be subrogated to the rights of the plaintiff against a defendant. (c) For the purposes of this section: (1) “Health care provider” means any person licensed or certified pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or licensed pursuant to the Osteopathic Initiative Act, or the Chiropractic Initiative Act, or licensed pursuant to Chapter 2.5 (commencing with Section 1440) of Division 2 of the Health and Safety Code; and any clinic, health dispensary, or health facility, licensed pursuant to Division 2 (commencing with Section 1200) of the Health and Safety Code. “Health care provider” includes the legal representatives of a health care provider; (2) “Professional negligence” means a negligent act or omission to act by a health care provider in the rendering of professional services, which act or omission is the proximate cause of a personal injury or wrongful death, provided that such services are within the scope of services for which the provider is licensed and which are not within any restriction imposed by the licensing agency or licensed hospital.H O R V I T Z & L E V Y L L P M I C R A M A N U A L 5 2 Copyright © 2012 Horvitz & Levy LLP 2. Summary of section 3333.1. a. Collateral source rule. “Under the collateral source rule, plaintiffs in personal injury actions can still recover full damages even though they already have received compensation for their injuries from such ‘collateral sources’ as medical insurance.” (Arambula v. Wells (1999) 72 Cal.App.4th 1006, 1009; see generally Smock v. State of California (2006) 138 Cal.App.4th 883, 886-888.) The collateral source rule applies to medical insurance benefits (Helfend v. Southern Cal. Rapid Transit Dist. (1970) 2 Cal.3d 1), pension and disability benefits (Rotolo Chevrolet v. Superior Court (2003) 105 Cal.App.4th 242; McKinney v. California Portland Cement Co. (2002) 96 Cal.App.4th 1214, 1220-1227), gratuitous benefits from a private source (Arambula, supra, 72 Cal.App.4th at p. 1014), and Medi-Cal and county hospital benefits (Hanif v. Housing Authority (1988) 200 Cal.App.3d 635, 639-640; Reichle v. Hazie (1937) 22 Cal.App.2d 543, 547-548). It is an open question whether the rule applies to free public benefits, like special education, available to anyone with a qualifying disability. (See Arambula, supra, 72 Cal.App.4th at p. 1015.) In Howell v. Hamilton Meats & Provisions, Inc. (2011) 52 Cal.4th 541, the Supreme Court held the collateral source rule does not apply to “amounts that were included in a [health care] provider’s bill but for which the plaintiff never incurred liability because the provider, by prior agreement [with the plaintiff’s health insurer], accepted a lesser amount as full payment.” (Id. at p. 548.) “[T]he negotiated rate differential—the discount medical providers offer the insurer—is not a benefit provided to the plaintiff in compensation for his or her injuries and therefore does not come within the rule.” (Id. at p. 566.) b. Section 3333.1, subdivision (a). Subdivision (a) overrides the collateral source rule to a considerable extent in medical malpractice cases, allowing a health care provider to introduce evidence of benefits payable to the plaintiff from the following collateral sources: private health, sickness, accident, or disability insurance, state disability insurance (SDI), workers’ compensation, Social Security survivor’s insurance, Social Security disability insurance (SSDI), or the Supplemental Security Income (SSI) program. If such evidence is introduced by the defendant, the plaintiff is entitledH O R V I T Z & L E V Y L L P M I C R A M A N U A L 5 3 Copyright © 2012 Horvitz & Levy LLP to introduce evidence of any insurance premiums or other payments made to secure the right to those collateral source benefits. While evidence of certain collateral source benefits is admissible under subdivision (a), “evidence of the tax treatment of those benefits is not.” (Cox v. Superior Court (2002) 98 Cal.App.4th 670, 672 [precluding evidence that the plaintiff’s disability insurance benefits, totaling $180,000 per year, were not taxable].) Subdivision (a) is a rule of evidence only. It does not mandate that the plaintiff’s damages be reduced by the collateral source benefits. It is up to the jury to decide what to do with the collateral source evidence. (Fein v. Permanente Medical Group (1985) 38 Cal.3d 137, 165, fn. 21; Barme v. Wood (1984) 37 Cal.3d 174, 179, fn. 5; Hernandez v. California Hospital Medical Center (2000) 78 Cal.App.4th 498, 506.) c. Section 3333.1, subdivision (b). Subdivision (b) provides that, if evidence of collateral source benefits is introduced, the benefit provider is precluded from recouping its payments, either directly from the plaintiff or in a subrogated action against the defendant. 3. Section 3333.1 is constitutional. a. Subdivision (a). In Fein v. Permanente Medical Group (1985) 38 Cal.3d 137, the Supreme Court upheld the constitutionality of subdivision (a) against due process and equal protection challenges. The court ruled that plaintiffs do not have a vested right in a particular measure of damages, and that abolition of the collateral source rule is rationally related to the legitimate state goal of reducing medical malpractice insurance costs. (Id. at p. 166.) “[T]he Legislature apparently assumed that in most cases the jury would set plaintiff’s damages at a lower level because of its awareness of plaintiff’s ‘net’ collateral source benefits.” (Id. at pp. 164-165, fn. omitted.) b. Subdivision (b). In Barme v. Wood (1984) 37 Cal.3d 174, the Supreme Court upheld the constitutionality of subdivision (b), ruling that the providers of collateral source benefits have no vested right to subrogation, and that subdivision (b) is rationally related to the legitimate goals of MICRA because it shifts some of the costs imposed on medical malpractice insurers to other insurers. (Id. at p.H O R V I T Z & L E V Y L L P M I C R A M A N U A L 5 4 Copyright © 2012 Horvitz & Levy LLP 181; see Fein v. Permanente Medical Group (1985) 38 Cal.3d 137, 165-166.) 4. Other contexts in which section 3333.1 may apply. a. Wrongful death action. Section 3333.1 applies in a wrongful death action as well as a personal injury action. (Subd. (c)(2); see Yates v. Pollock (1987) 194 Cal.App.3d 195, 198-199.) b. Action against public entity or employee. Government Code section 985, the collateral source statute generally applicable to suits against public entities or employees, does not apply if the defendant is a “health care provider” within the meaning of section 3333.1. Instead, section 3333.1 applies. (Gov. Code, § 985, subd. (l).) c. EMTALA action. Section 3333.1 should apply in an EMTALA action for failure to stabilize, but probably does not apply in an EMTALA action for failure to provide an appropriate medical screening examination. (See ante, p. 38.) d. Elder abuse action. It is unlikely that any of the MICRA statutes apply in an elder abuse action. (See ante, p. 39.) e. Equitable indemnity action. In SeaRiver Maritime v. Industrial Medical Services (N.D.Cal. 1997) 983 F.Supp. 1287, 1301, a federal district court applied section 3333.1 in an equitable indemnity action against health care providers. (See also ante, p. 36.) f. Action under Federal Tort Claims Act. Section 3333.1 should apply in an action brought under the Federal Tort Claims Act. “A federal court applies state law in matters involving the collateral source rule.” (In re Air Crash Disaster Near Cerritos, Cal. (9th Cir. 1992) 982 F.2d 1271, 1277.) 5. Statutory definitions. a. Definition of “health care provider.” See ante, page 6. b. Definition of “based upon professional negligence.” See ante, page 16.H O R V I T Z & L E V Y L L P M I C R A M A N U A L 5 5 Copyright © 2012 Horvitz & Levy LLP 6. Meaning of other statutory terms. a. “. . . any amount payable as a benefit to the plaintiff . . . .” (Subd. (a).) Section 3333.1 speaks in terms of benefits “payable” to the plaintiff, not just “paid” to the plaintiff, so it should be interpreted to encompass future as well as past collateral source benefits. “The cases agree that MICRA provisions should be construed liberally in order . . . to reduce malpractice insurance premiums.” (Preferred Risk Mutual Ins. Co. v. Reiswig (1999) 21 Cal.4th 208, 215.) Fein v. Permanente Medical Group (1985) 38 Cal.3d 137, sheds light on the issue of future benefits. The Supreme Court noted: “Plaintiff, pointing out that he may not be covered by medical insurance in the future, apparently objects to any reduction of future damages on the basis of potential future collateral source benefits.” (Id. at p. 165, fn. 21.) The Supreme Court did not respond to this issue by holding that section 3333.1 applies only to past collateral source benefits. Instead, the court pointed out that, under the terms of the (somewhat unusual) judgment, the defendant’s liability for future medical expenses would be reduced only to the extent the plaintiff in fact received medical insurance payments. (Ibid.) The Supreme Court went on to say: “Indeed, if anything, the trial court may have given plaintiff more than he was entitled to, since it did not reduce the jury’s $63,000 award by the collateral source benefits plaintiff was likely to receive . . . .” (Ibid., emphasis added.) The implication is strong that the statute applies to future as well as past collateral source benefits. In Graham v. Workers’ Comp. Appeals Bd. (1989) 210 Cal.App.3d 499, the Court of Appeal held section 3333.1 applies to future workers’ compensation benefits. (Id. at pp. 503-506.) The workers’ compensation subrogation statutes include both reimbursement provisions and credit provisions that apply when an injured employee recovers from a third party tortfeasor. (Id. at p. 503.) “[R]eimbursement applies to benefits paid prior to a third party judgment or settlement. With respect to future workers’ compensation benefits due the injured party, a different mechanism applies — credit. An employer is entitled to a credit against its obligation to pay further compensation benefits in the amount of the worker’s net recovery against the third party tortfeasor.” (State Comp. Ins. Fund v. Workers’ Comp. Appeals Bd. (1997) 53 Cal.App.4th 579,H O R V I T Z & L E V Y L L P M I C R A M A N U A L 5 6 Copyright © 2012 Horvitz & Levy LLP 583, original emphasis.) The Graham court concluded, “the sensible interpretation of Civil Code [section] 3333.1 is that it includes [i.e., bars] the employer’s credit remedies as well as its reimbursement remedies.” (Graham, supra, 210 Cal.App.3d at p. 506.) The court explained, “the California Supreme Court noted in Fein [v. Permanente Medical Group (1985) 38 Cal.3d 137] that the medical malpractice defendant may introduce evidence of benefits received by or payable to the plaintiff, and that the Legislature assumed that the jury would reduce the plaintiff’s damages to reflect such benefits. (Fein, supra, 38 Cal.3d at pp. 164-165.)” (Graham, supra, original emphasis.) Unless section 3333.1, subdivision (b) precludes the employer from exercising its credit rights as to the plaintiff’s future workers’ compensation benefits, the plaintiff’s tort recovery could be hit by a double deduction. (Ibid.) Since section 3333.1 applies to future workers’ compensation benefits, it also should apply to future health insurance benefits, future Social Security disability benefits, and so on. There is no apparent reason to conclude otherwise. Of course, with regard to any of the collateral source benefits listed in section 3333.1, if the jury concludes it is not reasonably likely the benefits will be paid in the future, the jury will not deduct the benefits from the plaintiff’s future damages. For a suggested jury instruction to this effect, see post, page 74. b. “. . . pursuant to the United States Social Security Act . . . .” (Subd. (a).) In Brown v. Stewart (1982) 129 Cal.App.3d 331, the Court of Appeal held that subdivision (a) encompasses only those Social Security programs that pay money directly to the plaintiff, not those that pay for medical services provided to the plaintiff. (Id. at pp. 336-338; see id. at p. 343 (conc. opn. of Blease, J.).) “[P]ayments to recipients under the Medi-Cal program are not ‘any amount payable as a benefit to the plaintiff pursuant to the United States Social Security Act.’ First, the funds provided are paid to the State of California, to be administered as part of its program of providing medical care for the needy. . . . Second, Medi-Cal payments are made directly to the medical service providers upon proof of rendition of health care services to an eligible Medi-Cal beneficiary. In a technical sense, a benefit is conferred upon the Medi-Cal recipient by the receipt of medical services but the thrust of the statutory language is directed to sums payable to the plaintiff.” (Id.H O R V I T Z & L E V Y L L P M I C R A M A N U A L 5 7 Copyright © 2012 Horvitz & Levy LLP at p. 337.) The concurring justice disagreed with the majority on this issue and concluded that subdivision (a) applies to the monetary value of medical services provided under the Social Security Act. (Id. at p. 343 (conc. opn. of Blease, J.).) c. “. . . any contract or agreement of any group, organization . . . .” (Subd. (a).) In Brown v. Stewart (1982) 129 Cal.App.3d 331, the Court of Appeal held the term “contract” means a “contract which includes as a contractual party the recipient of [the] health care services.” (Id. at p. 340.) “The statutory reference to a benefit provided pursuant to ‘any contract or agreement of any group, organization, partnership, or corporation to provide, pay for, or reimburse the cost of . . . health care services’ applies typically to such private health care plans, as Blue Cross, Blue Shield, and the Foundation Health Plan of Sacramento.” (Id. at p. 338.) “The term ‘contract’ . . . refers not to an implied, unilateral contract between the payor and the provider of services as . . . [exists for Medi-Cal], but rather to an express, bilateral contract between the payor and the recipient of services.” (Id. at p. 339.) “The statute contemplates a contract to which the hypothetical plaintiff is a party and by which an organization agrees to either provide directly or pay for health care services, or to reimburse the plaintiff in the event he has expended personal funds for such services.” (Ibid.) The court also held the term “organization” does not include the state in the context of the Medi-Cal program. (Id. at p. 340, fn. 4.) d. “. . . source of collateral benefits introduced pursuant to subdivision (a) . . . .” (Subd. (b).) In Miller v. Sciaroni (1985) 172 Cal.App.3d 306, the Court of Appeal held that, where evidence of some but not all benefits provided by a collateral source is introduced under subdivision (a), subdivision (b) bars recovery by the collateral source of all benefits conferred on the plaintiff by that source, even benefits not introduced into evidence by the defendant. (Id. at pp. 314-315.) The court reasoned that the purpose of section 3333.1 is not just to prevent double recovery by plaintiffs, but also to shift some of the costs of medical malpractice from malpractice insurers to other sources of indemnity. (Ibid.) In Graham v. Workers’ Comp. Appeals Bd. (1989) 210 Cal.App.3d 499, the Court of Appeal addressed the question whetherH O R V I T Z & L E V Y L L P M I C R A M A N U A L 5 8 Copyright © 2012 Horvitz & Levy LLP subdivision (b) precludes an employer from obtain-ing credit for future workers’ compensation benefits where the employee’s medical malpractice claim was settled. The Court of Appeal held: “To harmonize Civil Code section 3333.1 with the Labor Code credit provisions, we interpret section 3333.1 as impliedly creating an exception to the credit provisions whenever an injured party has demon-strably had his recovery reduced to reflect collateral source contributions. . . . In this case, the parties in the underlying medical malpractice case made an adequate factual record that Graham’s settlement was reduced to exclude any recovery for collateral source benefits.” (Id. at p. 508.) The court reasoned: “We cannot construe the collateral source benefit rules in a way that would discourage settlements and thus defeat the major purpose of the legislation.” (Ibid.) The “adequate factual record” in Graham consisted of Graham’s counsel’s statement to the court at the settlement conference that Graham’s medical expenses and disability would not be considered in the settlement because the defense would introduce evidence at trial that workers’ compensation benefits would pay those damages. (Id. at p. 502.) The parties stipulated at the settlement conference to dismiss the claims for special damages. (Id. at p. 507.) “The settlement thus did not include any sum for past or future medical costs or economic loss, on the assumption that Graham had been compensated for such loss by his ‘collateral source,’ the workers’ compensation carrier.” (Ibid.) To avoid unwarranted subrogation claims when a medical malpractice action is settled rather than tried, a factual record should be made at the time of settlement demonstrating that the collat
