Rodriguez v. Eisenhower Med. Ctr.

Decision Date03 February 2022
Docket NumberE075172
PartiesLEONOR RODRIGUEZ, Plaintiff and Appellant, v. EISENHOWER MEDICAL CENTER, Defendant and Respondent.
CourtCalifornia Court of Appeals Court of Appeals


APPEAL from the Superior Court of Riverside County No. PSC1706058. Sunshine S. Sykes, Judge. Affirmed.

McCune Wright Arevalo, Richard D. McCune, Michele M. Vercoski Steven A. Haskins and Tuan Q. Nguyen for Plaintiff and Appellant.

Jones Day and Nathaniel P. Garrett for Defendant and Respondent.



Plaintiff Leonor Rodriguez appeals from a judgment dismissing her complaint against defendant Eisenhower Medical Center after the trial judge granted the hospital's motion for summary judgment. Rodriguez alleged Eisenhower violated California's Unfair Competition Law (UCL) (Bus. &amp Prof. Code, § 17200 et seq.) by failing to adequately disclose the facility fee associated with her outpatient procedure. She alleged she would have gone elsewhere for the procedure had she known of the fee.

In granting Eisenhower's motion, the judge concluded the evidence indisputably demonstrated the hospital complied with the applicable pricing disclosure obligations contained in Health and Safety Code section 1339.51[1] (part of the "Payers' Bill of Rights") and thus had acted both lawfully and fairly under the UCL. Rodriguez argues the judge misinterpreted the evidence and dismissed her lawsuit in error. We disagree and affirm.


A. The Payers' Bill of Rights

A hospital's duty to inform patients about anticipated pricing before they receive treatment is defined by a series of statutes in the Health and Safety Code called the Payers' Bill of Rights. (§ 1339.50 et seq.) Enacted in 2003, the Payers' Bill of Rights recognizes the importance of pricing transparency and endeavors to strike a balance between a consumer's right to make informed choices and the burden of disclosure on hospitals. In this vein, the Payers' Bill of Rights does not require hospitals to directly disclose anticipated fees and charges to patients in all circumstances. Rather, pretreatment disclosures are required only when an uninsured patient seeks a nonemergency service. (§ 1339.585.)[2]

In all other circumstances, a hospital meets the Legislature's standard of pricing transparency by giving patients access to a "uniform schedule of . . . its gross billed charge for a given service or item, regardless of payer type." (§ 1339.51, subd. (b)(1).) This schedule is called a "charge description master" or "chargemaster," and should contain a "list of all the billable medical goods or services" a hospital provides. (Sarun v. Dignity Health (2019) 41 Cal.App.5th 1119, 1125.)

There are two requirements for providing adequate chargemaster access under the Payers' Bill of Rights-availability and notice. A hospital must make "a written or electronic copy of its charge[master] available, either by posting an electronic copy . . . [on its] Web site, or by making one written or electronic copy available at the hospital location." (§ 1339.51, subd. (a)(1).) A hospital must also "post a clear and conspicuous notice in its emergency department, if any, in its admissions office, and in its billing office that informs patients that the hospital's charge[master] is available in the manner described in subdivision (a)." (§ 1339.51, subd. (c).) The Legislature imposed these disclosure obligations with the goal that "making public the chargemaster . . . will bring more transparency to hospital billing practices." (Assem. Com. On Appropriations, 3d reading analysis of Assem. Bill No. 1637 (2003-2004) as amended May 23, 2003, p. 2.)

B. Rodriguez's Lawsuit

Eisenhower is a licensed hospital that provides 24-hour inpatient care at its main campus in Rancho Mirage and also maintains a number of outpatient facilities in the low desert area. In 2014, 2015, and 2016, Rodriguez underwent elective hyaluronic acid knee injections for the treatment of arthritis at one such outpatient facility, the Desert Orthopedic Center (DOC) in La Quinta.

In November 2018, Rodriguez filed the operative complaint in Riverside Superior Court, a putative class action lawsuit alleging that she and others similarly situated who received treatment at the DOC were charged a "facility fee" which Eisenhower failed to adequately disclose under section 1339.51. Specifically, she alleged the hospital failed to post a copy of their chargemaster on their web site and failed to post chargemaster notices in the required areas (emergency, administrative, and billing departments) as well as in the DOC. She alleged these violations of section 1339.51 constituted both unlawful and unfair business practices under the UCL.

According to the factual allegations in her complaint, Rodriguez received three knee injections in 2014 and another three in 2015. On each of those occasions, DOC staff provided her with a "Conditions of Admissions" form advising she would be billed both a "provider" fee and a "facility" fee for each visit. At that time, she was covered by an HMO insurance policy through Healthnet under which she paid a minimal copay amount for each visit.

In 2016, Rodriguez switched to a PPO insurance policy through Anthem Blue Cross. She informed DOC staff about the change, and, after looking into her new policy, they contacted her to let her know the injections were still covered. That year, the total of Rodriguez's out-of-pocket medical bills for the three injections was $3, 810, and she believed the facility fees made up about $3, 489 of that total.

Rodriguez alleged she was harmed by Eisenhower's failure to adequately disclose their facility fee, because had she known the amount she was going to be responsible for under her new insurance policy, she would have either switched back to her previous policy or "sought medical care at a medical office not owned by a hospital," as facility fees are unique to hospitals.

C. Eisenhower's Motion for Summary Judgment

After the parties engaged in discovery, Eisenhower filed a motion for summary judgment, arguing Rodriguez's UCL claim failed because the undisputed evidence showed they had complied with section 1339.51's disclosure requirements. In support of their argument, Eisenhower attached a declaration from Hallary Scheideman, their chargemaster coordinator and analyst, who is responsible for maintaining and updating their chargemaster. Scheideman said she prepared Eisenhower's chargemaster in 2016, submitted it to the Office of Statewide Health Planning and Development (OSHPD), and "arranged for a copy of it to be available for viewing at the hospital."[3]

Eisenhower also submitted a declaration from their director of patient access, Michael Sythe, who is responsible for posting the hospital's chargemaster notices. Sythe said in 2016, Eisenhower had notices alerting patients to the availability of their chargemaster in their "admitting area," "emergency department," and "billing office." Eisenhower also submitted a copy of the notice entitled "Payer's Bill of Rights Chargemaster." The notice contains the following message in English and Spanish: "The Payer's Bill of Rights requires that hospitals make available to the public a master listing of retail prices for its services, known as the chargemaster. [¶] This facility's chargemaster is available for your inspection. To make an appointment to view the hospital's chargemaster or obtain a list of the 25 most common outpatient procedures, please contact the Admissions Manager at 760-837-8974."

Rodriguez opposed Eisenhower's motion and attached deposition testimony from Scheideman and Sythe that she argued undercut the hospital's claim of section 1339.51 compliance. During her deposition, Scheideman elaborated on how she had "arrange[d] for a copy of the Chargemaster to be available for viewing at the hospital." She explained she had placed an electronic copy of the document in the hospital's shared drive. She said the admissions department employees have access to the shared drive and can open the chargemaster with their login credentials (username and password). During his deposition, Sythe wasn't able to elaborate on precisely what would happen if a person followed the directions on Eisenhower's chargemaster notice and called the admissions manager to make an appointment to view the chargemaster. This was because it had never happened before; no patient had ever asked to see the chargemaster. Sythe's testimony also made it clear that Eisenhower posted only two copies of the notice in their hospital or main campus-one in the emergency department and one in the "admissions/billing area."

Rodriguez also submitted the deposition testimony of Lilian Hoag, Eisenhower's Director of Operations, who said there is no chargemaster notice posted at the DOC.

In reply, Eisenhower submitted deposition testimony from Sythe explaining they posted only two notices (as opposed to three) because of the main campus's layout. Sythe said Eisenhower's billing area is located within the admissions area. He also said that any patient who visits billing would necessarily walk past the chargemaster notice in the admissions area because you can't reach billing without going through admissions.

After a hearing on Eisenhower's motion, Riverside Superior Court Judge Sunshine S. Sykes concluded Rodriguez's claim failed under both theories, unlawful business practices and unfair business practices. As to unlawful practices, the judge found the undisputed evidence showed the hospital had complied with both the availability and notice requirements in section 1339.51. As to unfair practices, the judge concluded the theory failed because it was based on the same alleged conduct as the unlawful...

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