Barris v. County of Los Angeles

• Decision Date: 25 March 1999
• Docket Number: No. S067733,S067733
• Citation: 972 P.2d 966,20 Cal.4th 101,83 Cal.Rptr.2d 145
• Court: California Supreme Court
• Parties: , 972 P.2d 966, 99 Cal. Daily Op. Serv. 2163, 1999 Daily Journal D.A.R. 2793 Dawnelle BARRIS, Plaintiff and Appellant, v. COUNTY OF LOS ANGELES, Defendant and Appellant

Page 145

83 Cal.Rptr.2d 145

20 Cal.4th 101, 972 P.2d 966, 99 Cal. Daily Op. Serv. 2163,

1999 Daily Journal D.A.R. 2793

Dawnelle BARRIS, Plaintiff and Appellant, v. COUNTY OF LOS ANGELES, Defendant and Appellant.

No. S067733.

Supreme Court of California

March 25, 1999.

Shernoff, Bidart, Darras & Arkin and Sharon J. Arkin, Claremont, for Consumers for Quality Care as Amicus Curiae on behalf of Plaintiff and Appellant.

Drivon & Tabak, Laurence E. Drivon, Stockton; Douglas Devries, Sacramento; Roland Wrinkle; Harvey R. Levine, San Diego; Robert Steinberg, Los Angeles; Thomas G. Stolpman, Long Beach; David Rosen; Moses Lebovits, Los Angeles; Bruce Brusavitch; Bruce Broilett; Wayne McLean; Leonard Sacks, Granada Hills; Tony Tanke, Redwood City; Stewart Tabak, Stockton; Rick Simons; David Casey, Jr., San Diego; Christine Spagnoli, Santa Monica; James Sturdevant, San Francisco; Daniel U. Smith, Kentfield; Deborah David, Los Angeles; Joseph Harbison III, Sacramento; and Cynthia Chihak, San Diego, for Consumer Attorneys of California as Amicus Curiae on behalf of Plaintiff and Appellant.

Houck & Balisok, Russell S. Balisok, Steven C. Wilheim, Los Angeles; and Peter G. Lomhoff, Oakland, for California Advocates for Nursing Home Reform, Inc., as Amicus Curiae on behalf of Plaintiff and Appellant.

Veatch, Carlson, Grogan & Nelson, Mark Weinstein, William G. Leib; Greines, Martin, Stein & Richland, Timothy T. Coates and Alison M. Turner, Beverly Hills, for Defendant and Appellant.

Horvitz & Levy, Mitchell C. Tilner and L. Rachel Lerman Helyar, Encino, for Program Beta Risk Management Authority as Amicus Curiae on behalf of Defendant and Appellant.

Thelen, Marrin, Johnson & Bridges, Curtis A. Cole and Matthew S. Levinson, Los Angeles, for California Medical Association, California Dental Association and California Healthcare Association as Amici Curiae on behalf of Defendant and Appellant.

MOSK, J.

In this matter, a hospital operated by the County of Los Angeles (hereafter the County) transferred Mychelle Williams to another hospital without providing treatment required to stabilize her emergency medical condition, in violation of section 1395dd of title 42 of the United States Code, the Emergency Medical Treatment and Active Labor Act (EMTALA). She died shortly thereafter. Dawnelle Barris, Mychelle's mother, was awarded damages for the EMTALA violation, including $1.35 million in noneconomic damages.

We granted review to address the question whether the award was subject to the $250,000 limit on noneconomic damages under Civil Code section 3333.2, which applies to causes of action "based on professional negligence." The answer is affirmative. The EMTALA claim for failure to "stabilize" Mychelle's emergency medical condition, i.e., "to provide such medical treatment of the condition as may be necessary to assure, within reasonable probability, that no material deterioration of the condition is likely to result from or occur during the transfer" (42 U.S.C. § 1395dd(e)(3)(A)), was "based on professional negligence." Accordingly, we affirm the judgment of the Court of Appeal, which arrived at the same conclusion.

I

On May 6, 1993, at approximately 5:30 p.m., Dawnelle Barris (hereafter Barris) brought her 18-month old daughter, Mychelle Williams, to the emergency room at Martin Luther King/Drew Medical Center (hereafter King/Drew) by ambulance. Mychelle was a member of the Kaiser Foundation Health Plan (hereafter Kaiser), but was taken to King/Drew because it was the nearest emergency medical facility. She had suffered episodes of vomiting and diarrhea, was lethargic, and was having difficulty breathing. Her temperature was 106.6 degrees, her pulse and respiratory rate were abnormally fast, she had abnormally low pulse oxygenation, and she had infections of the middle ear in both ears.

Mychelle was transferred to the pediatric emergency room, and examined by Dr. Trach Phoung Dang. He believed her fever might be caused by bacteria in the bloodstream. He noted signs and symptoms consistent with sepsis, a life-threatening bacterial infection that he knew requires prompt treatment with antibiotics. Nonetheless, he did not rule out sepsis or begin antibiotic treatment. Although he concluded that a complete blood culture, which could have detected sepsis, should be done, he did not order it because he believed that he had to obtain authorization from Kaiser. Kaiser had developed a program called the Emergency Prospective Review Program (EPRP) to deal with situations where a Kaiser member is brought to a non-Kaiser facility for emergency medical care. Its purpose was to facilitate the transfer of such patients to a Kaiser facility.

On the night of May 6, Brian Thompson, a Kaiser physician, was handling phone calls that came in under the EPRP. At approximately 7 p.m., Dr. Dang spoke by telephone to Dr. Thompson to arrange for possible transfer of Mychelle. Dr. Dang discussed her condition and indicated that he thought blood tests, which would rule out a bacterial infection in the blood, should be performed at King/Drew. Dr. Thompson instructed him not to perform the tests, saying that the blood work would be done at Kaiser. Apparently still concerned about the delay in treatment, Dr. Dang telephoned Dr. Thompson again, and repeatedly suggested starting the blood work at King/Drew. Again, Dr. Thompson instructed Dr. Dang not to do so. Dr. Dang noted in his chart that "Dr. Thompson at Kaiser did not want me to do any blood test."

At approximately 8 p.m., Mychelle suffered a seizure. She became increasingly lethargic and nonresponsive. Dr. Dang treated her symptoms of fever, dehydration, breathing difficult, and seizure, but did not administer antibiotics.

Shortly after 9 p.m., Mychelle was transferred by ambulance to Kaiser. At 9:50 p.m., within 15 minutes of her arrival, Mychelle suffered a cardiac arrest and was pronounced dead shortly thereafter. A blood culture performed as part of an autopsy was positive for streptococcus bacteria, which is readily treatable by antibiotics. The death certificate listed cardiac respiratory arrest caused by septicemia, or sepsis, that had been present for 10 hours.

Barris brought an action for professional negligence against the County, Kaiser, and Drs. Dang and Thompson, and an action for violation of EMTALA against the County. The EMTALA claim alleged failure to provide appropriate medical screening of Mychelle and failure to stabilize her emergency medical condition before transferring her to Kaiser.

On November 14, 1995, a jury trial began. Dr. Dang testified that he knew sepsis was a possible cause of Mychelle's fever. He explained that blood work, which would rule out a bacterial infection in the blood, was not done at King/Drew because Dr. Thompson said that it would be done at Kaiser. He also testified that he did not believe Mychelle had sepsis and thought that she was stable at the time she was transferred.

An expert for Barris opined, based on review of the medical record and Dr. Dang's testimony, that Dr. Dang actually believed or suspected that Mychelle was suffering from sepsis. According to the expert, the standard of care required that antibiotics be administered to Mychelle for possible sepsis and that she be given treatment for her abnormal respiratory status. Dr. Dang failed to meet the standard of care by failing to place Mychelle on intravenous antibiotics or to stabilize her respiratory status. At the time of her transfer, Mychelle was unstable. There was a high risk, i.e., a reasonable medical probability, that her condition would deteriorate if she were transferred. Another expert agreed that "the information obtained to that point had to lead one to the conclusion that she was not stable for transfer, and that the likelihood of there being a significant deterioration during that period of time was very real."

The County moved for a nonsuit as to the medical screening and failure to stabilize claims under EMTALA. The superior court granted the County's motion for a nonsuit as to the medical screening claim only, concluding that Barris presented evidence sufficient for the jury to conclude that Mychelle was treated for an emergency medical condition and was not stable for transfer when she was taken to Kaiser.

The jury returned a special verdict in favor of Barris both on the professional negligence cause of action and the failure to stabilize claim under EMTALA. It awarded noneconomic damages in the amount of $1.35 million, in addition to funeral expenses of $3,000.

The superior court ruled that the cap on noneconomic damages under Civil Code section 3333.2 applied to the EMTALA claim as well as the professional negligence action. It reduced the award of noneconomic damages to $250,000.

Barris appealed the superior court's application of Civil Code section 3333.2, but did not appeal the nonsuit on the screening claim under EMTALA. The County cross-appealed, contending that the jury's finding of a violation under EMTALA for failure to stabilize was not supported by the evidence. It conceded, however, that the Court of Appeal need not address the cross-appeal if it determined that the damages cap under Civil Code section 3333.2 applied to the EMTALA claim.

The Court of Appeal affirmed, concluding that the cap on noneconomic damages under Civil Code section 3333.2 applied to the EMTALA claim. Relying on Central Pathology Service Medical Clinic, Inc. v. Superior Court (1992) 3 Cal.4th 181, 191-192, 10 Cal.Rptr.2d 208, 832 P.2d 924 (hereafter Central Pathology ), it determined that Civil Code section 3333.2 applies broadly to any cause of action against a health care provider that is " directly related" to the professional services provided. It cited, as persuasive authority, the Fourth Circuit's decision in Power v. Arlington Hosp. Ass'n (4th Cir.1994) 42 F.3d 851 (hereafter Power ), which applied Virginia's $1 million cap on medical malpractice...