Snyder v. Stanislaus County

CourtDistrict Court, E.D. California
DecidedJune 1, 2021
Docket1:19-cv-00679
StatusUnknown

This text of Snyder v. Stanislaus County (Snyder v. Stanislaus County) is published on Counsel Stack Legal Research, covering District Court, E.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Snyder v. Stanislaus County, (E.D. Cal. 2021).

Opinion

1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 FOR THE EASTERN DISTRICT OF CALIFORNIA 10 11 KAREN SNYDER, No. 1:19-cv-00679-DAD-EPG 12 Plaintiff, 13 v. ORDER GRANTING IN PART AND DENYING IN PART DEFENDANT’S 14 STANISLAUS COUNTY, et al., MOTION TO DISMISS 15 Defendants. (Doc. No. 15) 16 17 This matter came before the court on defendant POMCO Insurance’s (“defendant” or 18 “POMCO”) motion to dismiss plaintiff’s complaint for failure to state a claim. (Doc. No. 15.) A 19 hearing on the motion was held on December 17, 2019.1 Attorney Lawrence Niermeyer appeared 20 on behalf of plaintiff Karen Snyder (“plaintiff”). Attorney Courtney Hill appeared on behalf of 21 defendant. Having reviewed the parties’ briefing and heard oral argument, and for the reasons set 22 forth below, the court will grant in part and deny in part defendant’s motion to dismiss. 23 ///// 24

25 1 The undersigned apologizes for the excessive delay in the issuance of this order. This court’s overwhelming caseload has been well publicized and the long-standing lack of judicial resources 26 in this district has reached crisis proportion. Unfortunately, that situation sometimes results in the 27 court not being able to issue orders in submitted civil matters within an acceptable period of time. This situation is frustrating to the court, which fully realizes how incredibly frustrating it is to the 28 parties and their counsel. 1 BACKGROUND 2 Plaintiff’s complaint (Doc. No. 1-1 (“Compl.”)) alleges as follows. On or about January 3 1, 2015, Stanislaus County unilaterally selected and contracted with POMCO to provide county 4 employees with medical coverage under a group health plan administered by POMCO. (Id. at 5 ¶ 6.) On or about August 1, 2015, Stanislaus County designated POMCO to plaintiff as her 6 medical health insurance provider. (Id. at ¶ 7.) 7 On August 22, 2017, plaintiff presented to her primary care physician a five-day history of 8 right lower back pain radiating to her groin. (Id. at ¶ 10.) On August 23, 2017, plaintiff’s 9 primary care physician submitted a medical procedure authorization request for an immediate, 10 “STAT”, CT scan of plaintiff’s abdomen and pelvis to POMCO. (Id. at ¶ 11.) POMCO received 11 the authorization request that day. (Id. at ¶ 12.) According to plaintiff, on or about August 23 or 12 24, 2017, POMCO placed or misclassified her medical authorization request within an area 13 calling for regular review and not within the area calling for immediate “STAT” review. (Id. at 14 ¶ 13.) As of August 30, 2017, POMCO had not reviewed, processed, denied, sought clarification 15 of, or approved the medical authorization request for plaintiff’s treatment. (Id. at ¶ 14.) 16 On August 31, 2017, plaintiff returned to her primary care physician with complaints of 17 vomiting, severe bloating, and the inability to urinate. (Id. at ¶ 15.) Plaintiff was admitted to the 18 hospital. (Id.) POMCO reviewed and approved the medical authorization on August 31, 2017, 19 and plaintiff underwent the CT scan that day. (Id. at ¶ 16.) In the absence of a timely, 20 immediate, “STAT”, CT scan, plaintiff was unable to receive the required medical diagnostic 21 studies, medical treatment, and medical interventions required to treat her condition. (Id. at ¶ 17.) 22 As a proximate cause, plaintiff suffered an obstruction to her kidneys, kidney failure, renal 23 failure, and sepsis requiring her to initially be hospitalized for twelve days. (Id.) Plaintiff was 24 subsequently hospitalized again, and she underwent surgery. (Id.) 25 On September 14, 2018, plaintiff filed this action in Stanislaus County Superior Court 26 against Stanislaus County and POMCO. (Compl.) The complaint asserts causes of action for 27 negligence and breach of contract. (Id.) Plaintiff filed a notice of dismissal of and request for 28 ///// 1 dismissal in the Stanislaus County Superior Court on February 20, 2019, thereby voluntarily 2 dismissing Stanislaus County from this action with prejudice. (See Doc. No. 1-3, Ex. 2.) 3 On March 1, 2019, plaintiff amended the complaint to add former defendant HealthCare 4 Strategies, Inc. (“HCS”). (Compl. at 11.) On May 16, 2019, HCS removed the action to the 5 Eastern District of California. (Doc. No. 1.) HCS filed a motion to dismiss on May 22, 2019. 6 (Doc. No. 5.) Plaintiff and HCS stipulated to the dismissal of HCS from this action with 7 prejudice on July 17, 2019. (Doc. No. 9.) This court gave effect to that stipulation on July 24, 8 2019 and HMS was dismissed as a defendant with prejudice. (Doc. No. 10.) 9 POMCO filed the pending motion to dismiss on October 25, 2019. (Doc. No. 15.) On 10 November 14, 2019, plaintiff filed her opposition. (Doc. No. 19.) POMCO replied on December 11 10, 2019. (Doc. No. 20.) 12 LEGAL STANDARD 13 A plaintiff is required to allege “enough facts to state a claim to relief that is plausible on 14 its face.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007). “A claim has facial plausibility 15 when the plaintiff pleads factual content that allows the court to draw the reasonable inference 16 that the defendant is liable for the misconduct alleged.” Ashcroft v. Iqbal, 556 U.S. 662, 678 17 (2009). The purpose of a motion to dismiss pursuant to Rule 12(b)(6) is to test the legal 18 sufficiency of the complaint. N. Star Int’l v. Ariz. Corp. Comm’n, 720 F.2d 578, 581 (9th Cir. 19 1983). “Dismissal can be based on the lack of a cognizable legal theory or the absence of 20 sufficient facts alleged under a cognizable legal theory.” Balistreri v. Pacifica Police Dep’t, 901 21 F.2d 696, 699 (9th Cir. 1990). 22 In determining whether a complaint states a claim on which relief may be granted, the 23 court accepts as true the allegations in the complaint and construes the allegations in the light 24 most favorable to the plaintiff. Hishon v. King & Spalding, 467 U.S. 69, 73 (1984); Love v. 25 United States, 915 F.2d 1242, 1245 (9th Cir. 1989). However, the court need not assume the truth 26 of legal conclusions cast in the form of factual allegations. U.S. ex rel. Chunie v. Ringrose, 788 27 F.2d 638, 643 n.2 (9th Cir. 1986). While Rule 8(a) does not require detailed factual allegations, 28 “it demands more than an unadorned, the defendant-unlawfully-harmed-me accusation.” Iqbal, 1 556 U.S. at 678. A pleading is insufficient if it offers mere “labels and conclusions” or “a 2 formulaic recitation of the elements of a cause of action.” Twombly, 550 U.S. at 555; see also 3 Iqbal, 556 U.S. at 676 (“Threadbare recitals of the elements of a cause of action, supported by 4 mere conclusory statements, do not suffice.”). Moreover, it is inappropriate to assume that the 5 plaintiff “can prove facts which it has not alleged or that the defendants have violated the . . . laws 6 in ways that have not been alleged.” Associated Gen. Contractors of Cal., Inc. v. Cal. State 7 Council of Carpenters, 459 U.S. 519, 526 (1983). 8 In ruling on such a motion, the court may consider material which is properly submitted as 9 part of the complaint; documents that are not physically attached to the complaint, if their 10 authenticity is not contested and the plaintiff’s complaint necessarily relies on them; and matters 11 of public record. Lee v. City of Los Angeles, 250 F.3d 668, 688–89 (9th Cir. 2001).

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Bluebook (online)
Snyder v. Stanislaus County, Counsel Stack Legal Research, https://law.counselstack.com/opinion/snyder-v-stanislaus-county-caed-2021.