Doctors Med. Ctr. Of Modesto Inc v. Dep't Of Health Care Serv.

• Decision Date: 02 November 2010
• Docket Number: C062480,No.34200880000093CUWMGDS,34200880000093CUWMGDS
• Parties: DOCTORS MEDICAL CENTER OF MODESTO, INC., Plaintiff and Appellant, v. DEPARTMENT OF HEALTH CARE SERVICES et al., Defendants and Respondents.
• Court: California Court of Appeals Court of Appeals

DOCTORS MEDICAL CENTER OF MODESTO, INC., Plaintiff and Appellant,

v.DEPARTMENT OF HEALTH CARE SERVICES et al., Defendants and Respondents.

C062480

No.34200880000093CUWMGDS

COURT OF APPEAL OF THE STATE OF CALIFORNIA

THIRD APPELLATE DISTRICT

Filed 11/2/10

NOT TO BE PUBLISHED

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 This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.

Since Merced County resident R.W. received severe head injuries from a motor vehicle accident in September 2006, Doctors Medical Center of Modesto, Inc. (Doctors Medical), has incurred more than $2 million in largely unreimbursed costs for his care at its hospital. Although Doctors Medical was able to provide initial acute care to R.W., it is not designed to be a long-term care facility for a patient with injury-induced dementia and violent tendencies. Although R.W. has had a conservator appointed by the Merced County Superior Court since August 2007, the conservator has not made arrangements for R.W. to be moved to a secure, long-term facility or for payment ofthe actual costs of the constant nursing and security precautions that Doctors Medical provides.

Seeking to have R.W. removed from its neurosurgical floor and to be reimbursed for its mounting costs of care, Doctors Medical filed a petition for writ of mandate under Code of Civil Procedure section 1085 in the Sacramento County Superior Court. Respondents Department of Health Care Services (DHCS), Department of Mental Health (DMH), and the County of Merced demurred on grounds that the trial court lacked jurisdiction to adjudicate the action and that Doctors Medical had no statutory or regulatory right to reimbursement of its actual costs. The trial court sustained the demurrers without leave to amend and dismissed the petition.

On appeal, Doctors Medical argues that the trial court erred in concluding that (1) DHCS, DMH, and the County of Merced have no ministerial duty to pay for R.W.'s placement in a secure, long-term care facility, and (2) Doctors Medical failed to exhaust its administrative remedies prior to seeking reimbursement for its costs of care by petition for writ of mandate. We affirm the judgment of dismissal.

FACTUAL AND PROCEDURAL HISTORY

In January 2009, Doctors Medical filed an amended petition for writ of mandate in Sacramento County Superior Court against DHCS, DMH, and the County of Merced. The petition did not name R.W. or his court-appointed conservator as parties.

Allegations of the Petition

In its petition, Doctors Medical alleged the following: On September 23, 2006, Merced County resident R.W. suffered a severe traumatic brain injury when he was hit by a motor vehicle in Merced County. He was transported by ambulance to the nearest trauma center, Doctors Medical, which is located in Stanislaus County. R.W. has remained a patient in Doctors Medical's hospital since that time.

R.W. is medically stable but unable to communicate. He requires one-on-one nursing and poses a risk of harm to himself and others. He is often violent and aggressive toward hospital staff and the security guards hired by Doctors Medical to watch him 24 hours a day. R.W. has been diagnosed with severe dementia and behavioral problems resulting from a traumatic brain injury.

On August 10, 2007, the Merced County Superior Court appointed the Merced County Public Conservator to serve as conservator of R.W.'s person and estate under Welfare and Institutions Code sections 5358 to 5368, the Lanterman-Petris-Short (LPS) Act. The appointment gave the conservator "the power to detain the Conservatee in the intensive treatment facility or to place the Conservatee for treatment in one of the treatment facilities set out in Welfare and Institutions Code Section 5358."¹ The court also found that "the least restrictiveand most appropriate available facility to be Doctor's [sic] Medical Center...."

On August 23, 2007, the conservator filed an amended letter of conservatorship for R.W. for authority to seek placement under Probate Code section 2356.5, subdivision (b).² In March 2008, the Merced County Superior Court authorized the conservator to place R.W. in a secured residential facility or a secure nursing facility specializing in the care of patients with dementia. Doctors Medical is not designed or equipped toprovide long-term care for patients with dementia as a result of a traumatic brain injury.

In September 2008, Doctors Medical sent a letter to R.W.'s conservator to request that an LPS conservatorship be established so that R.W. could be transferred to a secure facility designed to care for his special needs. The conservator did not file a petition for an LPS conservatorship or identify any appropriate facility to which to transfer R.W.

Doctors Medical engaged in its own intensive, national search for an appropriate long-term care facility for R.W. and was able to locate only a single facility-in Oakland, California-that expressed a willingness to accept R.W. However, the Oakland facility requires payment of Medi-Cal funds as well as an additional $170 per day in "patch" funds.

DHCS is the California agency responsible for administering the federal program known as Medicaid. (42 U.S.C. § 1396a, subd. (a)(5).) As administered in California, the program is referred to as Medi-Cal. (Welf. & Inst. Code, § 10740.)

DHCS has delegated responsibility for administering California's mental health services program for Medi-Cal patients to DMH. (Welf. & Inst. Code, § 5750, subd. (a).) DMH, in turn, has delegated some oversight of mental health services to individual counties. (Welf. & Inst. Code, § 5650, subd. (a).)

R.W. is eligible to receive Medi-Cal benefits. Doctors Medical is being reimbursed with Medi-Cal funds at the "administrative day rate" of $220 per day. However, the actualcost to care for R.W. exceeds $1,500 per day. Since September 2008, Doctors Medical has incurred more than $2 million in costs for R.W.'s care.

Doctors Medical alleges that DHCS refuses to pay for R.W. to be placed in a facility that can properly provide long-term care for him. Doctors Medical further alleges that DHCS refuses to direct its delegee, DMH, to provide the "patch" funds necessary to transfer R.W. to the Oakland facility.

Relief Sought in the Petition

The petition for writ of mandate filed by Doctors Medical requested that the Sacramento County Superior Court issue an order:

(1) "requiring the conservator appointed by the Superior Court of Merced to find a placement that will provide appropriate treatment for R.W. pursuant to her power as authorized by the Merced County court order of August 10, 2007 providing placement in an intensive treatment facility.... and for the conservator to facilitate R.W.'s discharge from Doctors to such facility forthwith";

(2) "requiring DHCS... to pay the actual reasonable costs of R.W.'s treatment and care at the appropriate and necessary level";

(3) "requiring DHCS to compel its delegee, DMH, to provide mental health funding as may be required for the costs of R.W.'s placement and treatment";

(4) "requiring DMH to provide funding as may be required for R.W.'s placement and treatment as set forth in the Short- Doyle Act as a patient with a serious mental disorder and as authorized and required by Welfare and Institutions Code § 5600.3(b)³ and/or the [LPS] Act (Welfare & Institutions Code § 5344)"; ⁴ (Underlining omitted.)

(5) "finding that it is an abuse of the conservator's discretion to fail to file for an order clarifying R.W.'s eligibility for an LPS conservatorship as was ordered by the Merced County Superior Court on August 10, 2007 or filing a new petition for an LPS conservatorship for R.W., thus insuringfunding for his care and treatment as provided by the Short-Doyle-Act";

(6) "requiring DHCS to reimburse Doctors for the actual and reasonable costs of R.W.'s care and treatment of $1,500 per day which Doctors has been required to expand [sic] for R.W. for 21/2 years";

(7) attorneys fees and costs.

The Demurrers

DHCS, DMH, and the County of Merced each demurred to the petition. After a hearing, the trial court sustained the demurrers without leave to amend and entered a judgment of dismissal.

As to the County of Merced, the court concluded that "this court lacks jurisdiction to issue a writ of mandate requiring the Merced County Public Conservator, appointed by the Superior Court for the County of Merced as the probate conservator of R.W., to pursue a conservatorship of R.W. under the [LPS] Act. The Superior Court for the County of Merced has sole jurisdiction to direct the actions to be taken by the Merced County Public Conservator on behalf of R.W."

As to DHCS and DMH, the court explained that "the petition fails to state facts sufficient to constitute a cause of action against either State Department for the funding of a residential care facility for R.W. Neither the State Department of Health Care Services nor the State Department of Mental Health have a legal duty to fund a residential care facility for an individual like R.W. whose eligibility for funded placement in aresidential care facility has not been assessed by appropriate county personnel pursuant to an application by R.W. (through his legally authorized representative, the Merced County Public Conservator) and approved either by such county personnel or by an administrative agency or court deciding an appeal by R.W. from a denial of his eligibility by the county personnel. R.W., not petitioner, has standing to pursue his eligibility for funded placement in a residential care facility in administrative and judicial proceedings, and he is an indispensible party to any judicial proceeding involving the determination of his eligibility. No evidence presented indicates that R.W. has pursued and exhausted administrative...