McMeans v. Scripps Health

118 Cal. Rptr. 2d 215, 97 Cal. App. 4th 38
CourtCalifornia Court of Appeal
DecidedApril 22, 2002
DocketD035486
StatusPublished

This text of 118 Cal. Rptr. 2d 215 (McMeans v. Scripps Health) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McMeans v. Scripps Health, 118 Cal. Rptr. 2d 215, 97 Cal. App. 4th 38 (Cal. Ct. App. 2002).

Opinion

118 Cal.Rptr.2d 215 (2002)
97 Cal.App.4th 38

Paul E. McMEANS et al., Plaintiffs and Appellants,
v.
SCRIPPS HEALTH, INC., Defendant and Respondent.

No. D035486.

Court of Appeal, Fourth District, Division One.

March 26, 2002.
Rehearing Granted April 22, 2002.

*218 Blumenthal, Ostroff & Markham, Sheldon A. Ostroff, David R. Markham, San Diego, and Michael D. Marchesini for Plaintiffs and Appellants.

Friestad & Giles and Deborah Giles, San Diego, for Defendant and Respondent.

Masnatt, Phelps & Phillips, Barry S. Landsberg and Harvey L. Rochman, Los Angeles, for Catholic Healthcare West as Amicus Curiae on behalf of Defendant and Respondent.

Rehearing Granted April 22, 2002. See 123 Cal.Rptr.2d 143.

O'ROURKE, J.

Paul E. McMeans, Joseph P. Denny, and Mary Ann Shaul, as class representatives (Class members), appeal from an order granting summary judgment in favor of Scripps Health, Inc. (Scripps) and Medical Liability Recoveries, Inc. (MLR).[1] The Class members are patients who were treated at a Scripps hospital for injuries caused by third parties and who sued those third parties. The Class members were insured by providers who had entered into contracts with Scripps that specified fixed charges agreed to in advance for covered services. Class members and/or their insurance providers paid Scripps in full for the care provided to Class members. MLR then placed liens in favor of Scripps on the judgments or settlements Class members received from the third parties or their insurance providers under California's Hospital Lien Act (HLA), Civil Code[2] sections 3045.1 through 3045.6. In each case, the liens were based upon charges that were greater than the amounts Scripps had agreed to accept from the insurance providers.

Class members contend the court erred in granting summary judgment because Scripps placed section 3045.1 liens on Class members' recovery when Class members owed no debts to Scripps. Class members also contend the court should have granted their motion for summary adjudication of Scripps's affirmative defense that it was privileged to assert the liens under section 47, subdivision (b)(2) and of their cause of action for declaratory relief. We reverse the order granting *219 summary judgment in favor of Scripps. We affirm the court's denial of Class members' motion for summary adjudication of Scripps affirmative defense of the section 47, subdivision (b)(2) privilege. We affirm in part and reverse in part the court's denial of Class members' motion for summary adjudication of the cause of action for declaratory relief.

FACTUAL AND PROCEDURAL HISTORY

In November 1996, McMeans was injured in an automobile accident caused by an uninsured third party and was treated at Scripps Mercy Hospital. As a result of his accident, McMeans suffered pain in his ribs that interrupted his sleep and prevented him from sitting, standing, driving and bending. Because he could not work for a period, he sustained lost income of $6,250. McMeans settled with Farmers Insurance for $35,500, the uninsured motorist limits of the insurance policy that covered the car in which McMeans was a passenger.

At that time of his treatment, McMeans was insured under a preferred provider insurance plan issued by Aetna Life Insurance Company (Aetna) and Scripps Mercy Hospital was a participating provider under the Aetna plan. Although Aetna paid Scripps the contract rate for McMeans's treatment and Farmers Insurance paid McMeans's share of the contract rate, MLR asserted a lien on behalf of Scripps in the amount of $4,298.86 against McMeans's settlement.

On June 5, 1998, Shaul was injured in an automobile accident and underwent surgery at Scripps Memorial Hospital, consisting of open reduction internal fixation of her medial malleolus and right talus, and bone grafting of her right talus. As a result, she was totally disabled for about six months and lost income of about $60,000. She continues to have chronic right leg and ankle pain, which may require additional medical treatment. Further, Shaul has incurred out-of-pocket expenses of about $5,000 for therapy, orthotic devices, and chiropractic treatment.

In June 1998, Shaul was insured under Sharp Health Plan, a managed care plan. Sharp Health Plan paid Scripps the contracted rate for Shaul's treatment and Shaul paid a $100 copayment. Shaul settled with Farmer's Insurance for $100,000, the insurance policy limits of the tortfeasor responsible for her injuries. MLR filed a lien on behalf of Scripps in the amount of $6,168.17 "upon any damages which a claim of action has been brought or will be brought."

On April 17, 1996, Denny was injured in an automobile accident and sustained multiple head, neck, shoulder and knee injuries. He later had neck surgery at Scripps Memorial Hospital, which consisted of an anterior cervical discectomy and fusion. Denny was disabled for several months, resulting in lost wages in excess of $4,000. As a result of his injuries, Denny continues to suffer limited movement in his neck and chronic pain. He can no longer participate in activities he used to enjoy, such as hiking, bicycling, and physical education with his students. Denny received $100,000 in settlement.

At the time of surgery, Denny was insured under the CaliforniaCare HMO plan of Blue Cross of California and Scripps Memorial was a participating provider under that plan. Blue Cross paid Scripps the contract rate for its services and Denny paid any applicable copayments or deductibles. Nine days after Denny's settlement, MLR filed a lien on behalf of Scripps for $13,790.38 on Denny's recovery from the tortfeasor.

*220 This class action was filed on July 1, 1998. The operative complaint is the third amended complaint, which was filed on October 18, 1999, and contains causes of action for unfair business practices, violation of the consumer legal remedies act, trespass to chattels, breach of contract, negligence, accounting, unjust enrichment, declaratory relief, mandatory injunction and prohibitory injunction.

On April 21, 1999, the trial court certified the lawsuit as a class action "to include as class plaintiffs all persons who: [1] were injured in accidents and thereafter treated at hospitals operated by ScrippsHealth (`Scripps'); [2] were insured under individual or group medical insurance plans, including but not limited to Health Maintenance Organization plans, Preferred Provider Organization plans and/or Managed Care plans; [3] whose medical insurers have contracted with Scripps in which Scripps agreed to provide covered services for the insurer's policyholders/beneficiaries at negotiated discounted rates; or alternatively, pursuant to the Knox-Keene Health Care Service Plan Act of 1975, the payments received by Scripps based on pre-determined rates from the patient's insurer (plus any applicable co-pay or deductible) constitute full payment; [4] whose bills at such negotiated discounted rates or pre-determined rates have been paid; and [5] against whom Scripps within the last four years either directly, or through the action of Medical Liability Recoveries, Inc. or any other agent of Scripps, has asserted a lien under Civil Code section 3045.1 demanding payment of the difference between the negotiated discounted rate or pre-determined rate and Scripps' ordinary full charge for the covered service."

On May 21, the court denied Scripps's motion for judgment on the pleadings, which asserted that each cause of action was barred by the litigation privilege. (§ 47, subd.

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118 Cal. Rptr. 2d 215, 97 Cal. App. 4th 38, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mcmeans-v-scripps-health-calctapp-2002.