King v. CompPartners

California Court of Appeal·Decided January 5, 2016·No. E063527·Published

Opinion

Filed 1/5/16 CERTIFIED FOR PUBLICATION

IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA FOURTH APPELLATE DISTRICT DIVISION TWO

KIRK KING et al., Plaintiffs and Appellants, E063527 v. (Super.Ct.No. RIC1409797) COMPPARTNERS, INC. et al., OPINION Defendants and Respondents.

APPEAL from the Superior Court of Riverside County. Sharon J. Waters, Judge.

Affirmed in part; reversed in part.

Law Offices of Patricia A. Law, Patricia A. Law and Jonathan A. Falcioni for Plaintiffs and Appellants.

Murchison & Cumming, William D. Naeve, Ellen M. Tipping and Terry L.

Kesinger for Defendants and Respondent.

Kirk King (Kirk)1 sued CompPartners, Inc. (CompPartners) and Naresh Sharma, M.D. (Sharma), for (1) professional negligence; (2) negligence; (3) intentional infliction of emotional distress; and (4) negligent infliction of emotional distress. Kirk’s wife, Sara King (Sara), sued CompPartners and Sharma (collectively, “defendants”) for loss of consortium. Kirk and Sara (collectively, “the Kings”) sought general, special, exemplary, and punitive damages.2 The trial court sustained defendants’ demurrer without leave to amend.

The Kings raise three issues on appeal. First, the Kings contend their claims are not preempted by the Workers’ Compensation Act (WCA). Second, the Kings assert defendants owed them a duty of care. Third, the Kings contend the trial court erred by denying them leave to amend. We affirm the sustaining of the demurrer but reverse the denial of leave to amend.

FACTUAL AND PROCEDURAL HISTORY A. COMPLAINT The facts in this section are taken from the allegations in the Kings’ complaint.

On February 15, 2008, Kirk sustained a back injury while at work. In July 2011, Kirk suffered anxiety and depression due to chronic back pain resulting from the back injury. In 2011, Kirk was prescribed a psychotropic medication known as Klonopin.

1 We use first names for the sake of clarity. No disrespect is intended.

2 The Kings also sued Mohammed Ashraf Ali, M.D. (Ali); Whittier Drugs; and Does 1 through 100. The forgoing three defendants are not respondents in this appeal. At the time of the hearing on the demurrer, Ali had not been served with the complaint.

The Klonopin was provided to Kirk through Workers’ Compensation. In July 2013, a Workers’ Compensation utilization review was conducted to determine if the Klonopin was medically necessary.3 (Labor Code, § 4610, subd. (a).)4 Sharma, an anesthesiologist, conducted the utilization review. Sharma determined the drug was unnecessary and decertified it. As a result, Kirk was required to immediately cease taking the Klonopin. Typically, a person withdraws from Klonopin gradually by slowly reducing the dosage. Due to the sudden cessation of Klonopin, Kirk suffered four seizures, resulting in additional physical injuries.

In September 2013, someone requested Kirk again be permitted to take Klonopin. In October 2013, Ali, a psychiatrist, conducted a second utilization review. Ali also determined Klonopin was medically unnecessary. Neither Sharma nor Ali examined Kirk in-person, and neither warned Kirk of the dangers of an abrupt withdrawal from Klonopin. Sharma and Ali were employees of CompPartners. CompPartners was a Workers’ Compensation utilization review company.

B. DEMURRER Defendants demurred to the complaint. Defendants asserted the Kings’ claims were preempted by the WCA because they arose out of a utilization review. Defendants interpreted the complaint as objecting to the decision to decertify Klonopin. Defendants

3“Utilization review” is the process by which employers “review and approve, modify, delay, or deny” employees’ medical treatment requests within the Workers’ Compensation system. (Labor Code, § 4610, subd. (a); State Compensation Ins. Fund v. Workers’ Comp Appeals Bd. (2008) 44 Cal.4th 230, 234, fn. 3 (State Fund).)

4 All subsequent statutory references will be to the Labor Code unless indicated.

asserted the utilization review was performed at the behest of Kirk’s employer and was conducted in connection with the payment of benefits for Kirk’s workplace back injury. Defendants contended the Labor Code set forth a procedure for objecting to a utilization review decision, and that procedure preempted the Kings’ complaint.

Alternatively, defendants asserted they did not owe Kirk a duty of care.

Defendants argued there was no doctor-patient relationship because they never personally examined Kirk and did not treat him. Defendants reasoned that because there was no relationship, there was no duty of care.

Defendants further asserted the Kings had improperly split a medical malpractice cause of action into two negligence causes of action. Defendants contended the emotional distress causes of action were subsumed by what should have been a single medical malpractice claim, and that Sara’s loss of consortium claim failed because there was no underlying tort cause of action to support it.

C. OPPOSITION The Kings opposed the demurrer. First, the Kings asserted their claims were not preempted by the WCA. The Kings asserted their claims concerned the failure to provide Kirk with a Klonopin-weaning regimen; they were not disputing the decision to decertify the Klonopin. The Kings contended this claim fell within the ambit of a negligence cause of action—it did not fall within the procedures set forth in the Labor Code/WCA for disputing a utilization review decision.

Second, the Kings asserted defendants owed Kirk a duty of care because Kirk’s medical treatment was effectively being determined by defendants’ decisions at the

utilization reviews. Third, the Kings asserted they did not improperly split a medical malpractice cause of action because their cause of action for general negligence was brought in the alternative, in case the court determined the defendants were not healthcare providers for purposes of the professional negligence cause of action. Fourth, the Kings asserted Kirk’s cause of action for intentional infliction of emotional distress set forth sufficient facts to support an independent cause of action; however, the Kings also referenced a proposed First Amended Complaint filed concurrently with the opposition that alleged additional facts to support the cause of action for intentional infliction of emotional distress.5 Fifth, the Kings asserted there were sufficient facts alleged to support the loss of consortium cause of action.

D. HEARING The trial court issued a tentative opinion sustaining the demurrer due to the lawsuit being preempted by the WCA. At the hearing on the demurrer, the Kings explained they were not disputing the decision to decertify Klonopin; rather, they were focused on the manner in which the decision was carried out—the decision to abruptly halt the medication rather than gradually reduce the dosage. The Kings asserted there were two requirements that triggered Workers’ Compensation—(1) the employee was working at the time of the injury, and (2) the injury was proximately caused by the employee’s job. The Kings asserted Kirk’s seizures did not meet these two

5The Kings did not file the Proposed First Amended Complaint. The proposed First Amended Complaint is not included with the Opposition in the Appellant’s Appendix.

requirements and, thus, fell outside the ambit of the WCA. Further, to the extent the WCA encompasses derivative or collateral claims, the seizures were “a wholly separate injury.”

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