Villazon v. Prudential Health Care Plan, Inc., 3D00-1509.

• Decision Date: 14 March 2001
• Docket Number: No. 3D00-1509.,3D00-1509.
• Citation: 794 So.2d 625
• Parties: Rolando VILLAZON, etc., Appellant, v. PRUDENTIAL HEALTH CARE PLAN, INC., Appellee.
• Court: Florida District Court of Appeals

794 So.2d 625

Rolando VILLAZON, etc., Appellant, v. PRUDENTIAL HEALTH CARE PLAN, INC., Appellee.

No. 3D00-1509.

District Court of Appeal of Florida, Third District.

March 14, 2001.

Rehearing and Rehearing Denied May 23, 2001.

Deutsch & Blumberg, and James C. Blecke, Miami, for appellant. Steven M. Ziegler, Hollywood, and Diane H. Tutt, Plantation, for appellee.

Before SCHWARTZ, C.J., and LEVY, and RAMIREZ, JJ.

Rehearing and Rehearing En Banc Denied May 23, 2001.

RAMIREZ, J.

Rolando Villazon, plaintiff below, appeals the entry of an adverse summary judgment in a wrongful death action filed against his deceased wife's health care provider, appellee Prudential Health Care Plan, Inc. Because the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1144(a), preempts Villazon's claim, we affirm.

Villazon's late wife, Susan Villazon, was a member of Prudential Health through her employer. Prudential Health is a federally qualified and state licensed independent practice associated health maintenance organization (IPA HMO). During treatment for a certain mouth ailment, her condition was misdiagnosed, and the existing cancerous condition went untreated. She eventually died of tongue cancer.

Mr. Villazon brought a wrongful death action against Drs. Melvyn Sarnow, Harvey S. Satz, and Basilio Garcia-Selleck in which he raised negligence claims, as well as against Prudential Health, in which he raised claims of vicarious liability and breach of a non-delegable duty, directly relating to the manner in which Prudential Health had administered the health plan. The actions against Drs. Satz and Garcia-Selleck were settled and the only claims that remain are against Dr. Sarnow and Prudential Health. Dr. Sarnow was the Primary Care Physician, as well the Participating Health Care Provider.

Villazon's theories of liability against Prudential Health are premised on Prudential Health's administration of the health plan through which Prudential Health influenced the manner in which the contracted health care providers rendered care and treatment. In his complaint, Villazon specifically alleged that Prudential Health breached a non-delegable duty to provide comprehensive health care, and was vicariously liable for the negligence of its contracted health care providers. Villazon argues that Prudential Health care controlled the referral process and required that authorization be obtained prior to the performance of diagnostic and therapeutic procedures. Prudential Health also required that the contracted physicians adhere to rules and seek approval for diagnostic tests. Physicians had to provide and arrange health care services through Prudential Health and refer subscribers to contracted providers. Villazon, however, does not allege that his wife was denied proper medical testing and referrals to specialists.

Prudential Health filed a motion for summary judgment asserting that eleven of the claims filed against them were preempted by section 1144(a) of ERISA, as a matter of law, because all of the claims sought to hold Prudential Health liable by challenging the administration of the health plan, and because Villazon could not prevail on any theories of liability as a matter of state law. At the summary judgment hearing, Villazon attacked the administration of the health plan and argued that Prudential Health was liable because they limited subscribers' access to certain physicians, required treatment to be pre-approved by a medical director, and required physicians to comply with directives and guidelines created by Prudential Health.

The trial court entered summary judgment in favor of Prudential Health holding that ERISA governed the claims filed against Prudential Health because the claims related to the manner in which Prudential Health administered its health care plans, and further, that there were no issues of fact as to the theory of vicarious liability or any recognizable cause of action for breach of a non-delegable duty against Prudential Health under state law. We agree.

Under section 1144(a), "the provisions of this subchapter ... shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan described in section 1003(a) of this title and not exempt under section 1003(b) of this title." 29 U.S.C. § 1144(a). If a claim relates to the manner in which the ERISA plan is administered, ERISA preempts the claim. See Estate of Frappier v. Wishnov, 678 So.2d 884 (Fla. 4th DCA 1996)

; see also Jass v. Prudential Health Care Plan, Inc., 88 F.3d 1482, 1493 (7th Cir.1996)(holding that vicarious liability claims were preempted by ERISA because any agency relationship was based on the benefit plan and would require an examination of the plan to determine that relationship).

In Estate...