Judicial Advocacy for Hospitals
In addition to its federal and state legislative and regulatory advocacy, CHA also advocates for hospitals through the judicial system by filing amicus (“friend of the court”) briefs in cases that may potentially have a broad impact on hospitals and health systems. Amicus briefs allow CHA to provide important factual context and legal analysis from hospitals’ perspectives. CHA’s most recent amicus efforts beginning in 2021 are summarized below.
CHA is also a longstanding member of, and financial contributor to, a committee that submits amicus briefs presenting the health care provider perspective. This is done primarily in cases in which plaintiffs seek to challenge or restrict the protections for health care providers enacted in the Medical Injury Compensation Reform Act (MICRA) but also in cases that potentially negatively impact potential liability for those providers. This amicus committee consists of representatives from CHA, the California Medical Association, the California Dental Association, some individual hospitals or health systems, and major professional liability insurance carriers. In the last 10 years, this committee, through its association members, has filed amicus briefs and letters in approximately 40 different cases pending in California’s appellate courts.
2024
In an unpublished opinion (see below), the Court of Appeal held that the eligibility requirements in an exclusive contract between the hospital and its ED medical group–which provided that no group provider had been reprimanded, sanctioned or disciplined by any licensing board or had their medical staff membership or clinical privileges at any health care facility suspended, limited or revoked for a medical disciplinary cause or reason—was a quasi-legislative action that gave rise to no hearing rights for the physician.
CHA submitted an amicus letter in support of the hospital’s request that the court order the opinion to be published so it could serve as precedent in other cases.
OUTCOME: The Court of Appeal ordered the opinion to be published, allowing it to serve as precedent in other cases.
Martinez v. ZoomInfo Technologies
The United States Court of Appeals for the Ninth Circuit has elected to hear en banc (to be decided by an 11-judge panel) a case previously decided by a customary 3-judge panel to consider (1) whether California’s anti-SLAPP protections should apply in federal court at all and, if so, (2) whether denial of anti-SLAPP motions are appealable under the collateral-order doctrine.
The anti-SLAPP statute provides critical protections to hospitals and medical staff members because statements made in connection with peer review are subject to its protections.
CHA therefore joined with the Los Angeles Times to file an amicus brief arguing that anti-SLAPP protections should apply in federal court.
Outcome: PENDING.
American Hospital Association v. Ranier
The American Hospital Association joined with other plaintiffs to file suit challenging a December 2022 Bulletin issued by the Department of Health and Human Services Office for Civil Rights (OCR) (“Use of Online Tracking Technologies by HIPAA Covered Entities and Business Associates”) that severely restricts hospitals’ ability to rely on common third-party technologies they use to analyze their websites and communicate reliable, accurate health information to the communities they serve. This lawsuit seeks, among other things, to permanently freeze OCR’s enforcement of this rule.
CHA joined with 16 other state and regional hospital associations to file an amicus brief in support of the plaintiffs’ position.
Outcome: PENDING.
A hospital filed suit against Department of Health Care Services seeking to stop the department from recouping almost $700,000 paid to the hospital years earlier under a special EHR incentive payment program available to hospitals participating in Medi-Cal; the hospital contended, among other things, that the Department’s methodology for the audit calculation was inconsistent with controlling federal enabling legislation, and that the Department was barred from recouping the EHR incentive payments because of its delay in seeking them. The hospital filed a petition to challenge the Department’s recoupment determination, which the trial court denied. The hospital then appealed to the Court of Appeal.
CHA, joined by certain members, filed an amicus brief in support of the hospital’s position.
Outcome: Court of Appeal AFFIRMED the trial court’s judgment against the hospital.
Mission Hospital Regional Medical Center v. Superior Court
In a medical malpractice action, plaintiff claimed that the hospital failed to appropriately consent the decedent for a coronary angiogram and failed to advise or recommend a minimally invasive alternative. The hospital sought judgment in its favor on the ground, in part, that it was the duty of the physician, not the hospital or nursing staff, to obtain the patient’s informed consent for the procedure. The trial court denied the hospital’s motion, finding that the hospital failed to foreclose the possibility that the hospital may have shared the duty to obtain informed consent. The hospital unsuccessfully petitioned the Court of Appeal to review and overturn this ruling and then petitioned the California Supreme Court to review and overturn it.
CHA submitted an amicus letter in support of the hospital’s petition for review.
Outcome: Petition for review DENIED.
2023
The trial court ruled in favor of the hospital in a lawsuit brought by a physician challenging the hospital’s decision to discontinue processing his application for medical staff membership and privileges on the grounds the physician was ineligible to provide emergency department (ED) services at the hospital. The physician had been the subject of prior disciplinary proceedings by both the Medical Board and the medical staff of another hospital; this made him ineligible to provide services at the defendant hospital under the terms of its exclusive contract with its ED medical group (Group), which provided that no Group Provider “has been reprimanded, sanctioned or disciplined by any licensing board . . . “ or had their “medical staff membership or clinical privileges at any hospital or health care facility . . . suspended, limited or revoked for a medical disciplinary cause or reason,”. The physician appealed, arguing that he was entitled to notice and a hearing under § 809 of the Business and Professions Code and that the exclusive ED Agreement was invalid because the hospital’s board was not directly involved in approving it.
CHA submitted an amicus brief in support of the hospital’s position on appeal.
Outcome: In an unpublished opinion, the Court of Appeal AFFIRMED the judgment in favor of the hospital, holding that the eligibility requirements in the exclusive contract were quasi-legislative and the physician had no right to a hearing.
Naranjo v. Doctors Medical Center of Modesto, Inc.
In a published decision, the Court of Appeal held that the plaintiff had stated valid claims against a hospital under California’s Consumer Legal Remedies Act (Civ. Code § 1750 et seq.) and its Unfair Competition Law (Bus. & Prof. Code, § 17200 et seq.) based on the fact that the hospital charged an allegedly undisclosed “evaluation and management services fee” for emergency department services. The court ruled that these claims could proceed against the hospital notwithstanding that the hospital had complied with federal and state regulatory policies addressing hospitals’ disclosure obligations for such fees. (This is one of at least 15 cases making similar claims filed around the state since 2007. See, for example, Capito v. San Jose Healthcare System, Gray v. Dignity Health, Yebba v. AHMC Healthcare, below.)
CHA submitted an amicus letter brief in support of the hospital’s petition seeking review of this decision by the California Supreme Court.
Outcome: Petition for review by Supreme Court GRANTED.
Hodges v. Cedars-Sinai Medical Center
In an unpublished opinion, the appellate court had analyzed and rejected the plaintiff’s claims that the termination of her employment—which was based on her refusal to obtain a flu vaccine as required by hospital policy—violated California’s Fair Employment and Housing Act; consequently, the court upheld the dismissal of her lawsuit.
As this opinion, if published, would establish helpful precedent for hospitals in enforcing their vaccination policies, CHA submitted an amicus letter brief in support of the hospital’s request for publication of the unpublished appellate decision in this case.
Outcome: Request for publication GRANTED.
Capito v. San Jose Healthcare System, LP
In an unpublished opinion, the appellate court rejected the plaintiff’s claims that an “Evaluation and Management Services” fee charged by the defendant hospital for the plaintiff’s emergency room visits violated California’s Consumers Legal Remedies Act (Civ. Code, §1750 et seq.) and its Unfair Competition Law (Bus. & Prof. Code, §17200 et seq.) (See also Naranjo v. Doctors Medical Center above.)
As this opinion, if published, would provide helpful precedent for hospitals, CHA submitted an amicus letter brief in support of the hospital’s request for publication of this decision.
Outcome: Request for publication DENIED. Petition for review by Supreme Court GRANTED.
In a published opinion, the Court of Appeal had ruled that Santa Clara County is immune under the Government Claims Act (Gov. Code, § 810 et seq.) from an action brought by hospitals seeking reimbursement for emergency medical care provided to persons covered by the county’s health care service plan. The Supreme Court granted review.
CHA and CMA jointly submitted an amicus brief on the merits of the issues, supporting the hospitals’ position that Government Claims Act § 815 immunity does not apply to a claim for reimbursement authorized by the Knox-Keene Act.
Outcome: Supreme Court REVERSED the judgment of the Court of Appeal, holding that the county health plan is not immune from suit under the Government Claims Act.
Wit v. United Behavioral Health
Following the filing of a “corrected” opinion by a three-judge panel of the Ninth Circuit (see below) that still reversed the district court’s order, CHA again joined with the National Association for Behavioral Healthcare, AHA, American Psychological Association, American Association for the Treatment of Opioid Dependence, Federation of American Hospitals, National Association of Addiction Providers, National Council for Mental Wellbeing, and REDC Consortium in submitting an amicus brief in support of the plaintiffs’ second request for a rehearing en banc. (Ordinarily in the Ninth Circuit, a three-judge panel hears and decides a case. When a case is granted en banc review, an 11-judge panel hears and decides the case.)
Outcome: The panel filed (1) an order vacating the prior opinion, replacing it with a new opinion, granting a petition for panel rehearing, and denying as moot the petition for rehearing en banc; and (2) an opinion affirming in part and reversing in part the district court’s judgment.
2022
In the underlying action, the plaintiff sued Uber alleging individual and class claims contending that Uber misclassified employees as independent contractors; after the trial court granted Uber’s motion to compel arbitration of the plaintiff’s individual claims and dismissed the class claims, the plaintiff filed an amended complaint seeking only civil penalties under California’s Private Attorneys General Act of 2004 (PAGA). The principal issue before the Supreme Court was whether the plaintiff still had standing to litigate the non-individual claims in court once the trial court compelled arbitration of the plaintiff’s individual claims.
CHA joined a coalition including the California Chamber of Commerce and six other trade associations in submitting an amicus brief arguing for a narrower interpretation of standing to assert PAGA claims.
Outcome: The Supreme Court ruled that where the plaintiff filed a PAGA action with both individual and non-individual claims, an order compelling arbitration of individual claims does not strip the plaintiff of standing to litigate non-individual claims in court.
Gavriiloglou v. Prime Healthcare Management, Inc.
In a published opinion, the Court of Appeal ruled that an arbitrator’s ruling against an employee on her individual claims for damages against her employer based on Labor Code violations did not bar the employee from pursuing a representative claim for civil penalties for Labor Code violations under the Private Attorneys General Act (PAGA) (Lab. Code § 2698 et seq.) The defendant petitioned the Supreme Court to review this decision.
CHA joined with three other amici in filing an amicus letter brief supporting the defendant’s petition for review, arguing that the appellate court’s decision improperly expanded the ability to bring PAGA claims.
Outcome: Petition for review DENIED.
Medical Staff of St. Mary Medical Center v. St. Mary Medical Center
After new leadership at the defendant hospital declined to make changes to the medical staff peer review process and solicited proposals for new exclusive contracts for several departments, the hospital’s medical staff filed a petition for writ of mandate to challenge these actions. The trial court denied the petition, and the medical staff appealed.
CHA filed an amicus brief in support of the hospital, arguing that the hospital had full authority under law to take all the challenged actions.
Outcome: Court of Appeal AFFIRMED the judgment of the trial court in favor of the defendant hospital.
Wit v. United Behavioral Health
In a 100+ page ruling, the district court found that the defendant was wrong to deviate from widely accepted clinical standards of care for mental health and addiction and ordered the defendant to reprocess some 67,000 coverage claims within the accepted clinical standards of care. On appeal, a three-judge panel of the Ninth Circuit reversed the district court order with a seven-page ruling holding that it was “not unreasonable” for insurers to determine coverage inconsistently with generally accepted standards of care. The plaintiffs petitioned the appellate court for en banc review. (Ordinarily in the Ninth Circuit, a three-judge panel hears and decides a case. When a case is granted en banc review, an 11-judge panel hears and decides the case.)
CHA joined with the National Association for Behavioral Healthcare, AHA, American Psychological Association, American Association for the Treatment of Opioid Dependence, Federation of American Hospitals, National Association of Addiction Providers, National Council for Mental Wellbeing, and REDC Consortium in submitting an amicus brief in support of the plaintiffs’ second request for a rehearing en banc.
Outcome: Prior to a ruling on the request for rehearing en banc, the same 3-judge panel of the Ninth Circuit issued a corrected ruling holding that even though the defendant violated both its fiduciary duty by creating the medical necessity criteria in issue and the laws of four states, plan members have no right to have their claims reprocessed.
Bonni v. St. Joseph Health System, et al.
In an unpublished appellate decision arising out of a physician’s challenge to conduct on the part of the hospital and its medical staff in connection with peer review of the physician, the appellate court found that the litigation privilege barred all eight of the plaintiff’s claims, as it protected, among other things, the initiation of the peer review process, allegedly defamatory statements made during peer review, and appellate committee recommendations made to a hospital’s board of trustees. The court’s opinion also provided helpful analysis of the application of California’s anti-SLAPP law (Code Civ. Proc. § 425.16) to the peer review process.
CHA submitted an amicus letter brief supporting publication of this decision that could be helpful to hospitals.
Outcome: Request for publication of the opinion GRANTED.
In a published opinion, the Court of Appeal had ruled that Santa Clara County is immune under the Government Claims Act (Gov. Code, § 810 et seq.) from an action brought by hospitals seeking reimbursement for emergency medical care provided to persons covered by the county’s health care service plan.
CHA submitted an amicus letter in support of the hospitals’ petition requesting that the California Supreme Court review this decision. CHA also submitted an amicus letter brief requesting, in the alternative, that the Court of Appeal’s decision be depublished (which would largely eliminate its use as precedent in other cases).
Outcome: Petition for review GRANTED, with the issue to be addressed limited to: Is Santa Clara County immune under the Government Claims Act (Gov. Code, § 810 et seq.) from an action seeking reimbursement for emergency medical care provided to persons covered by the county’s health care service plan?
Facey Medical Group v. Superior Court
CHA filed an amicus letter brief in support of a petition filed by a medical group seeking reversal of a trial court order requiring the medical group to disclose documents and other information regarding its peer review of a physician. The appellate court issued an alternative writ of mandate ordering the trial court to either (1) vacate the orders in issue and reconsider whether to compel disclosure of the information in light of the appellate court’s articulation of the relevant law, or (2) show cause why it hasn’t done so.
Outcome: The appellate court issued the alternative writ of mandate, in response to which the trial court vacated the orders being challenged.
In a published opinion, the Court of Appeal held that “the predominant relationship between a medical resident and a hospital residency program is an employer-employee relationship, and so academic deference does not apply to the jury’s determination whether the resident was terminated for discriminatory or retaliatory reasons.” Dignity petitioned the Supreme Court to review the matter.
CHA joined with the Loma Linda University Health Education Consortium in submitting an amicus letter brief in support of Dignity’s petition for review.
Outcome: Petition for review DENIED.
2021
The Court of Appeal had issued a published opinion holding that a hospital is not required, prior to providing emergency medical care to a patient, to disclose that an emergency room visit fee will be included in its billing for the visit. The plaintiff requested that the Supreme Court depublish this decision.
CHA submitted an amicus letter brief opposing the plaintiff’s request that this decision helpful to hospitals be depublished (which would largely eliminate its use as precedent in other cases). (This is one of at least 15 cases making similar claims filed around the state since 2007. See, for example, Naranjo v. Doctors Medical Center and Capito v. San Jose Healthcare System, above; Yebba v. AHMC Healthcare, below.)
Outcome: Request for depublication DENIED.
Steger v. CSJ Providence St. Joseph Medical Center
In this unpublished opinion, the appellate court provided helpful clarification to hospitals of the circumstances in which they may, or may not, be held vicariously liable for the conduct of physicians who are independent contractors. It also provided useful guidance concerning the application of those principles in the context of hospital emergency rooms.
CHA submitted an amicus letter brief requesting publication of this opinion.
Outcome: Request for publication DENIED.
Sharp Healthcare v. Superior Court
Following a trial court’s decision authorizing a jury trial in a lawsuit brought by a peer review-disciplined physician under Health and Safety Code § 1278.5, the defendant hospital unsuccessfully petitioned the Court of Appeal to reverse the trial court’s order. The defendant hospital then sought review by the California Supreme Court.
Given the impact of the issue of Section 1278.5 jury trial rights on the peer review process, CHA submitted an amicus letter brief requesting Supreme Court review of the Court of Appeal’s summary denial of their petition.
Outcome: Petition for review DENIED.
American Hospital Association, et al. v. Becerra
The plaintiffs’ lawsuit challenged a CMS final rule cutting 2018 and 2019 reimbursement rates for drugs acquired through the 340B program. The district court ruled in favor of the plaintiffs, but the Court of Appeals reversed.
Upon review by the Supreme Court, CHA joined with 36 other state and regional hospital associations in submitting an amicus brief on the merits in support of plaintiffs’ position.
Outcome: The Supreme Court REVERSED, finding (1) that judicial review of reimbursement rates was not precluded and (2) absent a survey of hospitals’ acquisition costs, HHS may not vary reimbursement rates only for 340B, rendering the 2018 and 2019 reimbursement rates unlawful.
American Hospital Association, et al. v. Becerra
The district court ruled in favor of the plaintiffs in their lawsuit challenging a CMS final rule cutting 2018 and 2019 reimbursement rates for drugs acquired through the 340B program, but on appeal, the Court of Appeals reversed the district court’s decision. Plaintiffs filed a petition seeking review by the Supreme Court.
CHA joined with 36 other state and regional hospital associations in submitting an amicus brief in support of the plaintiffs’ petition seeking Supreme Court review.
Outcome: Petition for review GRANTED.
American Hospital Association v. Becerra
The plaintiffs’ lawsuit challenged a CMS final rule which cut Medicare reimbursements to off-campus provider-based departments of hospitals as falling outside of the agency’s statutory authority. The district court agreed, setting aside the challenged regulation, but the Court of Appeals reversed. Plaintiffs filed a petition for writ of certiorari seeking review by the Supreme Court.
CHA joined with 32 other state and regional hospital associations in submitting an amicus brief in support of the plaintiffs’ petition seeking Supreme Court review.
Outcome: Petition DENIED.
A college student brought a petition for writ of mandate challenging his expulsion from a private university. The trial court denied the student’s petition, but the Court of Appeal, in a published decision, reversed and remanded the matter, ruling, among other things, that fair procedure required that the student be given the opportunity to cross-examine critical witnesses at an in-person hearing. The Supreme Court granted defendants’ petition for review.
Because the Court of Appeal’s opinion, if left standing, would chill whistleblower reporting and exclude evidence from non-testifying witnesses in medical disciplinary hearings, CHA filed an amicus brief in support of no party to the litigation to demonstrate the flaws in the appellate court’s reasoning and the potential adverse impact of that decision, if it was allowed to stand, in the medical staff peer review context.
Outcome: The Supreme Court REVERSED the judgment of the Court of Appeal, finding that the university was not required to provide the student with the opportunity to directly or indirectly cross-examine the alleged victim and other witnesses at a live hearing with the student in attendance, whether in person or virtually.
Yebba v. AHMC Healthcare, Inc.
This is another of the cases challenging a hospital’s imposition of an “Evaluation and Management Services Fee” (see Naranjo v. Doctors Medical Center, Capito v. San Jose Health System, and Gray v. Dignity Health, above). Here, the trial court dismissed the action on the ground, among others, that the hospital had no duty to disclose this fee before treating the plaintiff. In an unpublished opinion, the Court of Appeal affirmed the judgment of dismissal.
Believing that, if published, this opinion would provide helpful precedent for hospitals facing similar claims, CHA submitted an amicus letter brief requesting that this opinion be published.
Outcome: Request for publication DENIED.
Woodworth v. Loma Linda University Medical Center
In this “wage and hour” case, the trial court had entered judgment in favor of the hospital, rejecting, among other things, the plaintiff’s claims that the hospital’s election disclosures for a proposed alternative work schedule (AWS) were inadequate; that the employer had no right to terminate AWS arrangements; and that the wage statements the hospital issued her were inadequate because they did not have a separate line item listing “total hours worked.” The plaintiff appealed.
CHA filed an amicus brief in support of the hospital, primarily addressing the AWS issues.
Outcome: Affirmed in part (consistent with CHA’s arguments regarding AWS) and reversed in part.
Hoag Memorial Hospital Presbyterian v. Superior Court
The defendant hospital petitioned the Supreme Court to review the trial court decision denying the hospital’s motion for summary judgment in an action based on the hospital failing to notify plaintiff when it prescribed him a drug not covered by Medicare.
CHA filed an amicus letter brief in support of the hospital.
Outcome: Petition for review DENIED.