Filed 6/5/26 Mejia v. Gurvits CA4/2
NOT TO BE PUBLISHED IN OFFICIAL REPORTS California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.
IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA
FOURTH APPELLATE DISTRICT
DIVISION TWO
CHONA MEJIA et al.,
Plaintiffs and Appellants, E083293
v. (Super.Ct.No. CVRI2105631)
VADIM GURVITS D.O. et al., OPINION
Defendants and Respondents.
APPEAL from the Superior Court of Riverside County. Erica A. Keen, Judge.
Affirmed.
Chona Mejia and James Mejia, in pro. per., for Plaintiffs and Appellants.
Davis, Grass, Goldstein & Finlay and Gabriel M. Benrubi for Defendants and
Respondents.
1 In this medical malpractice action, plaintiffs Chona and James Mejia appeal from
the summary judgment entered in favor of defendants Vadim Gurvits, D.O.; Abigail
Baker, N.P.; and Britanny Travis, M.A.1 We affirm.
FACTUAL AND PROCEDURAL BACKGROUND
A. Plantiffs’ Lawsuit
Plaintiffs represented themselves in the trial court, as they do on appeal. In the
operative complaint, the Second Amended Complaint (SAC), Chona asserted three
causes of action—(1) medical negligence against all three defendants; (2) medical
negligence against Baker; and (3) negligent hiring and supervision against Dr. Gurvits—
and James asserted a claim for loss of consortium.2
To support her claims, Chona alleged the following: She was a patient of Dr.
Gurvits at his practices of Premier Family Care and Premier Urgent Care from 2018
through April 2021. She suffered from hyperthyroidism, but Dr. Gurvits misdiagnosed
her with hypothyroidism and wrongly prescribed a non FDA-approved medication called
Armour Thyroid to address the misdiagnosed hypothyroidism. Dr. Gurvits first
prescribed the Armour Thyroid medication in June 2019. In August 2019, Dr. Gurvits
instructed Chona to reduce her dosage by half. In February 2020, after she had been
taking the medication for eight months, Dr. Gurvits advised her to stop taking it
1 Because they share a last name, we use the Mejias’ first names when referring to them individually. No disrespect is intended.
2 In response to defendants’ demurrer, the trial court dismissed Chona’s claim of fraud against all three defendants.
2 altogether. For the next 14 months, Chona received no thyroid treatment from Dr.
Gurvits. Then, in May 2021, she saw an endocrinologist who diagnosed her with
“grave[s’] disease/hyperthyroidism” and prescribed the FDA-approved drug
Methimazole.
Chona alleged that Dr. Gurvits was negligent for failing to detect her
hyperthyroidism and prescribing Armour Thyroid, that Baker (Dr. Gurvits’s nurse
practitioner) was negligent for refilling the prescription, and that Travis (Dr. Gurvits’s
medical assistant) was negligent for telling her that “Armour Thyroid is for
hypothyroidism and hyperthyroidism and will go away without treatment.” Chona
alleged that defendants were the “proximate cause” of her “harm, past damages, and
future damages.” She alleged that “if Dr. Gurvits did not abandon my thyroid treatment,
I would have obtained a better result, or as an alternative, if he had timely referred me to
an endocrinologist, this lawsuit would not have been filed.”
To support his claim, James alleged that he “suffered a loss of consortium” due to
“the damage suffered by” Chona.
Plaintiffs did not allege in the SAC the particular damages or injuries the
defendants caused. They alleged: “[We] sent Dr. Gurvits [a] notice of intent and
statement of claims [and were] willing to settle with him and with . . . insurance [but] to
no avail; that is why we filed this lawsuit.”
B. Defendants’ Summary Judgment Motion
Defendants filed a motion for summary judgment, arguing that they did not breach
the standard of care when treating Chona’s thyroid condition and did not cause her to
3 suffer any injuries. Dr. Gurvits, the principal and medical director of Premier Family
Care and Premier Urgent Care, filed a declaration in support of the motion, stating that he
first saw Chona in May 2018 and she became his primary care patient in December 2018.
He explained that he initially prescribed Armour Thyroid for Chona because the “clinical
and laboratory evidence” suggested a hypoactive thyroid, but when “subsequent lab
values . . . showed hyperactive thyroid changes,” he reduced and later stopped the
medication. In support of his plan for treatment, Dr. Gurvits attached to his declaration
Chona’s medical records and his progress notes.
Dr. Gurvits also provided the following summary of Chona’s medical care. She
first visited him on May 29, 2018, at Premier Urgent Care, complaining of neck and
shoulder pain, joint pain that existed off and on for several months, and chronic vertigo
and fatigue. He assessed her with cervical pain and radiculopathy, right rotator cuff
tendonitis, degenerative joint disease of the cervical spine, and fatigue. Her lab studies
revealed that she had uncontrolled type 2 diabetes, as well as what Dr. Gurvits believed
to be “suboptimal” thyroid functioning. Specifically, her “free T3” value was in the low
range (at 3.7), as was her “free T4” value (at 1.4).
In December 2018, when Chona became Dr. Gurvits’s primary care patient, she
completed an intake form and a hormone checklist for women, in which she complained
of mild fatigue, mild memory loss, mild dry and wrinkled skin, moderate hair loss, and
constantly feeling cold. Her next set of lab studies, taken in January 2019, revealed
elevated blood glucose and hemoglobin AIC values, indicating “an ongoing problem with
diabetes.”
4 In May 2019, Chona saw Dr. Gurvits, complaining of heart palpitations, which she
said had been occurring off and on for at least a year, beginning around the same time
that she started menopause. The results of her physical examination, as well as various
heart tests, were normal, but Dr. Gurvits referred her to a cardiologist for additional
assessment.
Chona’s next set of lab studies, taken in June 2019, again indicated suboptimal
thyroid functioning. Her “TSH” level was 1.86, and both her free T3 and free T4 values
were lower than they had been the previous year. (Her free T3 had reduced from 3.7 to
3.2, and her free T4 had reduced from 1.4 to 1.2.) Dr. Gurvits believed that the
“downward trend of the free T3 and free T4,” in combination with her “reported history
of fatigue, memory loss, dry and wrinkled skin, loss of hair, and feeling cold,” indicated
that she had a hypothyroid condition. To address that condition, on June 5, 2019, he
prescribed “Armour Thyroid 1.5 grain (90 mg) with 10 refills.”
In July 2019, Dr. Gurvits referred Chona to a rheumatologist after her lab tests
revealed “positive antinuclear antibodies,” which could indicate an underlying
autoimmune disease.
In August 2019, nurse practitioner Baker approved Chona’s request for additional
refills of Armour Thyroid at 90 mg. The following month, Chona attended a visit,
complaining of dizziness and stomach pain. Her physical examination revealed that she
had lost weight and had low blood pressure. Dr. Gurvits assessed her as having low
blood pressure and instructed her to increase her water intake and stop taking her high
blood pressure medication until he could analyze the results of follow-up lab studies.
5 Chona’s next set of lab studies, taken in September 2019, revealed a low TSH of
0.005, elevated free T3 of 11.0, and elevated free T4 of 1.76. In response to the increase
in free T3 and T4 values, Dr. Gurvits instructed her to reduce the Armour Thyroid dosage
by half, to 45 mg per day.
In December 2019, Chona visited Premier Family Care with complaints of
stomach and lower back pain. She reported that she was taking the reduced dosage of
Armour Thyroid. Her physical examination was normal. She had not followed up with
the cardiology referral Dr. Gurvits ordered in May 2019. Dr. Gurvits ordered spinal and
abdominal x-rays and instructed her to discontinue caffeine and her blood pressure
medication. When she returned about a week later for a follow-up appointment, she
complained of intermittent stomach pain. Her physical examination was normal, and Dr.
Gurvits assessed her with a history of lumbar pain and constipation, hypothyroidism, and
type 2 diabetes. He instructed her to increase her water intake and add bran, fiber, and a
stool softener into her daily routine. He also ordered follow-up lab studies.
Her next lab studies, taken in February 2020, revealed “continued elevation” of
thyroid values, with her free T3 elevated at 15.5 and her free T4 elevated at 3.67. “On
the basis of those results,” Dr. Gurvits instructed her to stop taking Armour Thyroid.
Nurse practitioner Baker relayed Dr. Gurvits’s instructions to Chona on February 13,
2020 and directed her to return to the clinic “to discuss results and [a] treatment plan.”
Chona’s next visit was on June 1, 2020 and was telephonic because of the
COVID-19 pandemic. She complained of a urinary tract infection. She also informed
6 Dr. Gurvits that she was still taking Armour Thyroid, against his earlier advice. He
ordered lab studies and again instructed her to stop taking the Armour Thyroid.
The next time Chona visited Dr. Gurvits was in October 2020 for her annual
physical exam. She reported significant weight loss, as well as intermittent pain and
stiffness in her hands and shoulder that had lasted for months. Her physical examination
results were normal, but because of her weight loss, Dr. Gurvits became concerned that
she was suffering from a hyperthyroid condition and ordered lab studies.
The results of her lab studies revealed that she continued to test positive for
antinuclear antibodies and that her free T3 and T4 levels continued to be elevated (at 9.1
and 2.84 respectively). As a result, on October 19, 2020, Dr. Gurvits ordered a referral to
“an endocrinology consult regarding hyperthyroidism.” On January 15, 2021, an
endocrinology referral request was forwarded to her insurance for approval.
The defendants’ medical expert, Dr. Bridget Briggs, submitted a declaration in
support of the summary judgment motion. Dr. Briggs is board certified in family
practice, as well as in holistic, integrative, and functional medicines. She owns The
Briggs Institute of Epigenetic Medicine, where she provides a full-service family practice
for patients ranging from children to senior adults. She specializes in bio-identical
hormones, nutritional and dietary support, weight management, and integrative and
functional medicine. She is therefore familiar with the integrative and functional
medicine techniques Dr. Gurvits and his clinical staff use at Premier Urgent Care and
Premier Family Care. She described functional medicine as a well-recognized holistic
approach to medical care that seeks to address the root causes of a patient’s symptoms.
7 To form her opinions, Dr. Briggs reviewed Chona’s medical records, Dr. Gurvits’s
progress notes, and the declarations of Dr. Gurvits, Baker, and Travis. On the basis of
that evidence, she concluded that Dr. Gurvits and his staff met the standard of care in
treating Chona’s thyroid condition and that they did not cause her to suffer any injury or
damages.
Regarding the standard of care, she explained that Dr. Gurvits’s initial prescription
of 90 mg of Armour Thyroid (in June 2019) was reasonable and fell within the standard
of care, given Chona’s “lab values that showed . . . downward trending free T3 and free
T4 values” and her “history of chronic fatigue, hair loss, memory problems, . . . skin
changes and other symptoms.” She also explained that it was reasonable for Dr. Gurvits
to reduce the prescription when lab studies (in September 2019) showed elevated thyroid
function levels and to stop the medication (in February 2020), when lab studies showed
that those function levels continued to be elevated. Dr. Briggs concluded: “Dr. Gurvits
met the standard of care by timely having [Chona] seen in follow up, timely ordering
follow up lab testing, and timely and appropriately responding to [her] presentations
during each office encounter, and . . . referring [her] to medical specialists in response to
various changes in [her] complaints and presentation[s].”
As to injury, Dr. Briggs opined that Chona did not suffer any harm from taking the
Armour Thyroid prescription and that her hyperthyroid condition was not caused by the
medication. She explained that Armour Thyroid is “a natural thyroid replacement
product that stays within the body for no longer than 48 to 72 hours” and leaves no
lingering effects. She concluded that Chona’s hyperthyroid condition and her underlying
8 auto-immune disease were “the natural result of [her] underlying medical condition that
could and did occur, irrespective of any of the reasonable medical treatment provided” by
defendants. Finally, she opined that Dr. Gurvits did not cause or exacerbate any of
Chona’s underlying conditions or symptoms by delaying thyroid treatment or by delaying
referral to an endocrinologist.
Chona opposed the motion for summary judgment. In support, she filed a
document purporting to be her own affidavit, but which did not satisfy the rules for
affidavits or declarations under penalty of perjury set out in section 2015.5. In that
document, Chona stated that she left Dr. Gurvits and changed her primary care physician
in May 2021, “was referred to an endocrinologist, and was prescribed Methimazole for
Graves’ Disease due to hyperthyroidism.” She said that her “body has significantly
improved after taking the correct medication for Graves’ Disease caused by
hyperthyroidism” and that “[t]his lawsuit would not have been filed if I had been referred
to a specialist and an endocrinologist sooner.” She stated, “I just wanted my health to
improve, be seen promptly with empathy, and enjoy the continuous relationship with a
high-quality clinician I chose. They should give me exactly the help I need and want
exactly when I need and want it.” Chona did not certify that the statements in her
affidavit were true under penalty of perjury. Instead, she had the document notarized,
which certifies only that the notary’s disclosures are true under penalty of perjury.
In a written ruling, the trial court overruled plaintiffs’ objections to defendants’
evidence, sustained defendants’ objections to Chona’s affidavit, and granted defendant’s
motion for summary judgment. The court concluded that defendants met their burden of
9 demonstrating that plaintiffs could not satisfy at least one element of each of their claims
by presenting Dr. Briggs’s expert opinion that defendants did not breach the standard of
care and did not cause plaintiffs to suffer any injuries. The court further concluded that,
because plaintiffs failed to “present their own competent medical expert testimony,” they
failed to demonstrate the existence of a triable issue of fact. Plaintiffs timely appealed.
DISCUSSION
On appeal, we presume the judgment is correct, and it is the appellant’s burden to
demonstrate reversible error. (Denham v. Superior Court (1970) 2 Cal.3d 557, 564.)
California Rules of Court, rule 8.204(a)(1)(C) provides that each brief must “[s]upport
any reference to a matter in the record by a citation to the volume and page number of the
record where the matter appears.” “The purpose of this rule is to enable appellate justices
and staff attorneys to locate relevant portions of the record expeditiously.” (Alki
Partners, LP v. DB Fund Services, LLC (2016) 4 Cal.App.5th 574, 590 (Alki), citing City
of Lincoln (2002) 102 Cal.App.4th 1211, 1239, fn. 16.) “ ‘[A]n appellant must do more
than assert error and leave it to the appellate court to search the record and the law books
to test his claim. The appellant must present an adequate argument including citations to
supporting authorities and to relevant portions of the record.’ ” (Ribakoff v. City of Long
Beach (2018) 27 Cal.App.5th 150, 162.) These rules apply to represented and self-
represented litigants alike. (Ballard v. Uribe (1986) 41 Cal.3d 564, 574; Huang v. Hanks
(2018) 23 Cal.App.5th 179, 183 & fn. 1.)
10 Plaintiffs raise various arguments for reversing the trial court’s grant of summary
judgment, but their brief does not contain a factual summary or any record citations.3
“By failing to support the factual assertions in their legal arguments with citations to the
evidence, plaintiffs have forfeited their argument the court erred in granting summary
judgment.” (Alki, supra, 4 Cal.App.5th at p. 590, citing City of Lincoln v. Barringer
(2002) 102 Cal.App.4th 1211, 1239 [Arguments not supported by adequate citations to
the record need not be considered on appeal.].) In reviewing a ruling on a motion for
summary judgment, “ ‘de novo review does not obligate us to cull the record for the
benefit of the appellant in order to attempt to uncover the requisite triable issues. As with
an appeal from any judgment, it is the appellant’s responsibility to affirmatively
demonstrate error and, therefore, to point out the triable issues the appellant claims are
present by citation to the record and any supporting authority.’ ” (Alki, at p. 590, quoting
Lewis v. County of Sacramento (2001) 93 Cal.App.4th 107, 116.)
Forfeiture aside, we have examined the record and conclude that the court
properly entered summary judgment. “The purpose of the law of summary judgment is
to provide courts with a mechanism to cut through the parties’ pleadings in order to
determine whether, despite their allegations, trial is in fact necessary to resolve their
dispute.” (Aguilar v. Atlantic Richfield Co. (2001) 25 Cal.4th 826, 843 (Aguilar ).)
3 In addition, plaintiffs did not include in their appellants’ appendix defendants’ motion for summary judgment, the briefs and evidence defendants filed in support of their motion, or the trial court’s ruling on the motion. We were able to summarize the factual and procedural background of this case because defendants included those documents in their respondents’ appendix and provided a factual summary, with record citations, in their respondent’s brief.
11 A defendant moving for summary judgment must show that one or more elements
of the causes of action cannot be established or that there is a complete defense to the
causes of action. (Code Civ. Proc., § 437c, subd. (p)(2); Aguilar, supra, 25 Cal.4th at
p. 849.) Once the defendant clears this initial hurdle, the burden shifts to the plaintiff to
demonstrate a triable issue of material fact. (Aguilar, at pp. 850-851.) The trial court
may grant the motion if there is no triable issue of material fact and the issues raised by
the pleadings may be decided as a matter of law. (Code Civ. Proc., § 437c, subd. (c);
Biancalana v. T.D. Service Co. (2013) 56 Cal.4th 807, 813.) We review the court’s
summary adjudication and summary judgment orders de novo and apply the same
standard as the trial court. (Travelers Property Casualty Co. of America v. Superior
Court (2013) 215 Cal.App.4th 561, 574.)
To succeed on a claim of professional negligence, the plaintiff must show, among
other things, the defendant breached the standard of care required of other members of
the profession and the breach caused the plaintiff to suffer harm. (Giacometti v. Aulla,
LLC (2010) 187 Cal.App.4th 1133, 1137 [There must be “a causal connection between
the negligent conduct and the resulting injury.”].) In the medical malpractice context,
“causation must be proven within a reasonable medical probability based upon competent
expert testimony. Mere possibility alone is insufficient to establish a prima facie case.”
(Jones v. Ortho Pharm. Corp. (1985) 163 Cal.App.3d 396, 402.)
“The standard of care in a medical malpractice case requires that physicians
exercise in diagnosis and treatment that reasonable degree of skill, knowledge and care
ordinarily possessed and exercised by members of the medical profession under similar
12 circumstances.” (Munro v. Regents of Univ. of Cal. (1989) 215 Cal.App.3d 977, 983-984
(Munro).) “ ‘Expert evidence in a malpractice suit is conclusive as to the proof of the
prevailing standard of skill and learning in the locality and of the propriety of particular
conduct by the practitioner in particular instances because such standard and skill is not a
matter of general knowledge and can only be supplied by expert testimony.’ ” (Willard v.
Hagemeister (1981) 121 Cal.App.3d 406, 412.) “The question remains one of fact, to be
decided on the basis of expert testimony: ‘The standard of care against which the acts of
a physician are to be measured is a matter peculiarly within the knowledge of experts; it
presents the basic issue in a malpractice action and can only be proved by their
testimony.’ ” (Landeros v. Flood (1976) 17 Cal.3d 399, 410.) Thus, “ ‘[w]hen a
defendant moves for summary judgment and supports his motion with expert declarations
that his conduct fell within the community standard of care, he is entitled to summary
judgment unless the plaintiff comes forward with conflicting expert evidence.’ ” (Munro,
at p. 985, italics added.)
Defendants were entitled to summary judgment in this case. They supported their
motion with admissible evidence, including an expert declaration opining that their
conduct fell within the standard of care. Dr. Gurvits detailed the medical care he
provided to Chona to treat what he believed to be a low functioning thyroid, as well as
the steps he took to respond to elevations in Chona’s thyroid functioning. Dr. Briggs
opined that Dr. Gurvits’s decision to prescribe Armour Thyroid and later to taper and
ultimately discontinue the medication was reasonable and fell within the community
standard of care for functional medicine, given Chona’s symptoms and the results of her
13 lab studies. That plaintiffs failed to present any admissible evidence in rebuttal, let alone
an admissible expert declaration opining that defendants breached the standard of care,
compelled summary judgment in defendants’ favor. (Munro, supra, 215 Cal.App.3d at
p. 985.)
The failure to produce an opposing expert opinion is reason alone to grant
summary judgment. However, we also note that plaintiffs’ claims fail for the additional
reason that they did not allege any damages or injuries that they suffered from the alleged
acts or omissions of defendants. Chona’s belief that she did not receive “exactly the help
I need and want exactly when I need and want it” is not a legally cognizable injury, nor is
her belief that her results would have been “better” if she had been treated for
hyperthyroidism sooner.
DISPOSITION
The judgment is affirmed. Defendants shall recover their costs on appeal.
NOT TO BE PUBLISHED IN OFFICIAL REPORTS
FIELDS J. We concur:
McKINSTER Acting P. J.
MILLER J.