Joint Council of Interns & Residents v. Board of Supervisors

210 Cal. App. 3d 1202, 258 Cal. Rptr. 762, 1989 Cal. App. LEXIS 516
California Court of Appeal·Decided May 24, 1989·No. B029793·Published·Cited by 20 cases

Opinion

*1205 Opinion

COMPTON, J.

The Joint Council of Interns and Residents (JCIR) sought a peremptory writ of mandate in superior court to compel the Board of Supervisors of the County of Los Angeles (Board) to rescind a contract with the University of Southern California (USC) for the employment of medical interns and residents at county health care facilities. That agreement essentially provided that the county would cease employing such personnel directly and that commencing July 1, 1987, USC would assume the obligation of hiring the physicians needed to staff the county’s hospitals and public health facilities. As the bargaining representative for the interns and residents currently employed under the county’s civil service system, the JCIR challenged the agreement as violative of county charter provisions which permit the Board to contract for personal services only after finding that “such work can more economically or feasibly be performed by independent contractors.” The JCIR asserted that the agreement was not cost-effective and that the Board’s contrary finding was not supported by the record.

After concluding that the Board had complied with the charter and its implementing ordinance in executing the contract, the trial court denied the writ petition. This appeal follows, The sole issue raised here is whether the Board’s decision constituted a legislative or adjudicatory determination. The trial court concluded that the Board performed a legislative function in finding that USC could “more feasibly” staff the county’s medical facilities and, accordingly, restricted its review to a determination of whether that decision was arbitrary or capricious. The JCIR maintains, however, that the Board’s action was adjudicatory in nature and that the court should have undertaken an independent review of the record to determine whether the findings were supported by substantial evidence. For reasons which we shall discuss, we conclude that the trial court applied the correct standard of review in denying the writ.

The pertinent facts are not in dispute and may be briefly summarized as follows. Under the mandate of Welfare and Institutions Code section 17000, the county operates an indigent health care delivery system currently comprised of five medical centers, one general hospital, five comprehensive care centers, and forty-two community facilities. The Los Angeles County/University of Southern California Medical Center (Medical Center) is the primary medical facility maintained by the county under this system. For more than 60 years, that complex has served as the principal teaching hospital for the USC School of Medicine. Beginning in 1928, medical school faculty members, without cost to the county, began providing instruction to *1206 interns and residents working with hospital patients, and participated actively in direct patient care. In 1952, however, USC advised the Board that the school could no longer afford to provide such assistance without payment from the county. As a result, the Board agreed to contract with the university as a provider of various patient-related services. Under the terms of the contracts negotiated by the county’s chief administrative officer, both faculty members and students continued to provide patient care in exchange for the county’s payment of an annual consideration to the university. USC further agreed to expend a specified sum annually for research projects conducted at county facilities and to contribute medical equipment for scientific and clinical use.

Although these contracts initially were challenged as violative of various county civil service regulations, they were upheld by the Court of Appeal in County of Los Angeles v. Ford (1953) 121 Cal.App.2d 407 [263 P.2d 638], and subsequently implemented. Similar agreements have been executed by the parties during the past three decades. Under the present system, faculty staff physicians are employed by and receive salaries from both USC and the county. 1 In that dual capacity, they render patient care, engage in scientific research, and generally supervise the training of medical students at county facilities. Faculty members may also maintain private practices and work at other medical institutions affiliated with USC. Although interns and residents are also directly employed by the county, their positions are classified as temporary, lasting from three to seven years depending upon the nature of their specialization. To maintain their employment with the county, however, all interns and residents are expected to be concurrently enrolled at USC in a postgraduate training program. Practicing under the supervision of faculty members, and as permitted by law, these physicians are responsible for providing the majority of patient care services at the Medical Center. That complex alone currently employs over 330 faculty staff physicians and approximately 900 interns and residents.

By 1975, the Board expressed some concern that the county’s relationship with USC vis-a-vis the Medical Center and other health care facilities was not cost-effective. Although a task force convened for the purpose of studying the county’s pay policies suggested a series of monitoring guidelines to assure accurate time allocation of physician services, changes in cost accounting practices were not forthcoming. In 1984, however, the Board requested the director of health services to recommend modifications in the operating agreement with USC that would enable the county to more pre *1207 cisely account for services rendered by both faculty members and interns and residents. The plan ultimately proposed called for the county to contract with USC as the sole provider of all patient services and for the county to pay only for the cost of care actually received by patients at the Medical Center. Under this scheme, USC would initiate a billing system based upon the relative value of the services rendered by the physicians employed to staff the county facility. Each such service would be assigned a preset rate and the county would be charged accordingly. The proposal itself envisioned the execution of two separate contracts for the transfer of hiring responsibility from the county to USC on a phased-in basis. The first of these agreements provided that only newly retained interns and residents would be employees of USC, and that those currently holding such positions would remain in county employment until the completion of their training. The second contract established a similar framework for the hiring of faculty staff members.

Free access — add to your briefcase to read the full text and ask questions with AI

Joint Council of Interns & Residents v. Board of Supervisors, 210 Cal. App. 3d 1202, 258 Cal. Rptr. 762, 1989 Cal. App. LEXIS 516 (Cal. Ct. App. 1989).

210 Cal. App. 3d 1202 (Joint Council of Interns & Residents v. Board of Supervisors) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Yzaguirre v. County of Mono CA3
California Court of Appeal, 2026
Citizens for Amending Proposition v. City of Pomona
239 Cal. Rptr. 3d 750 (California Court of Appeals, 5th District, 2018)
Beverly Hills USD v. LA Metro.
California Court of Appeal, 2015
CA School Boards v. St. Bd. of Ed.
California Court of Appeal, 2015
California School Bds. Assn. v. State Bd. of Education CA1/4
240 Cal. App. 4th 838 (California Court of Appeal, 2015)
Great Oaks Water Co. v. Santa Clara Valley Water District
170 Cal. App. 4th 956 (California Court of Appeal, 2009)
Lindelli v. Town of San Anselmo
4 Cal. Rptr. 3d 453 (California Court of Appeal, 2003)
N.T. Hill Inc. v. City of Fresno
85 Cal. Rptr. 2d 562 (California Court of Appeal, 1999)
Harris v. Civil Service Commission
77 Cal. Rptr. 2d 366 (California Court of Appeal, 1998)
Kucharczyk v. Regents of the University of California
946 F. Supp. 1419 (N.D. California, 1996)
Mike Moore's 24-Hour Towing v. City of San Diego
45 Cal. App. 4th 1294 (California Court of Appeal, 1996)
ABS INSTITUTE v. City of Lancaster
24 Cal. App. 4th 285 (California Court of Appeal, 1994)
Balch Enterprises, Inc. v. New Haven Unified School District
219 Cal. App. 3d 783 (California Court of Appeal, 1990)
Poverty Resistance Center v. Hart
213 Cal. App. 3d 295 (California Court of Appeal, 1989)