Winn v. Pioneer Med. Grp., Inc.
| Decision Date | 19 May 2016 |
| Docket Number | No. S211793.,S211793. |
| Court | California Supreme Court |
| Parties | Kathleen A. WINN, et. al, Plaintiffs and Appellants, v. PIONEER MEDICAL GROUP, INC., et. al, Defendants and Respondents. |
63 Cal.4th 148
370 P.3d 1011
202 Cal.Rptr.3d 447
Kathleen A. WINN, et. al, Plaintiffs and Appellants
v.
PIONEER MEDICAL GROUP, INC., et. al, Defendants and Respondents.
No. S211793.
Supreme Court of California
May 19, 2016.
Magaña, Cathcart & McCarthy and Clay Robbins III, Los Angeles, for Plaintiffs and Appellants.
Balisok & Associates and Russell S. Balisok, Glendale, for California Advocates for Nursing Home Reform, Inc., as Amicus Curiae on behalf of Plaintiffs and Appellants.
Evans Law Firm, Ingrid Evans and Elliot Wong, San Francisco, for Consumer Attorneys of California as Amicus Curiae on behalf of Plaintiffs and Appellants.
Cole Pedroza, Curtis A. Cole, Kenneth R. Pedroza, Matthew S. Levinson, Cassidy C. Davenport, San Marino; Carroll, Kelly, Trotter, Franzen & McKenna, Carroll, Kelly, Trotter, Franzen, McKenna & Peabody, Richard D. Carroll, David P. Pruett and Jennifer A. Cooney, Long Beach, for Defendants and Respondents.
Tucker Ellis, E. Todd Chayet and Rebecca A. Lefler for California Medical Association, California Dental Association, California Hospital Association and American Medical Association as Amici Curiae on behalf of Defendants and Respondents.
Manatt, Phelps & Phillips and Harry W.R. Chamberlain II, Los Angeles, for Association of Southern California Defense Counsel as Amicus Curiae on behalf of Defendants and Respondents.
Fred J. Hiestand, Sacramento, for The Civil Justice Association of California as Amicus Curiae on behalf of Defendants and Respondents.
CUÉLLAR, J.
The Elder Abuse and Dependent Adult Civil Protection Act affords certain protections to elders and dependent adults. Section 15657 of the Welfare and Institutions Code provides heightened remedies to a plaintiff who can prove “by clear and convincing evidence that a defendant is liable for physical abuse as defined in Section 15610.63, or neglect as defined in Section 15610.57,” and who can demonstrate that the defendant acted with “recklessness, oppression, fraud, or malice in the commission of [this] abuse.” Section 15610.57, in turn, defines “neglect” in relevant part as “ [t]he negligent failure of any person having the care or custody of an elder or a dependent adult to exercise that degree of care that a reasonable person in a like position would exercise.” (Welf. & Inst.Code § 15610.57, subd. (a) (1).)
We granted review to determine whether the definition of neglect under the Elder Abuse and Dependent Adult Civil Protection Act (Welf. & Inst.Code § 15600 et seq. ; the Elder Abuse Act or Act)1 applies when a health care provider—delivering care on an outpatient basis—fails to refer an elder patient to a specialist. What we conclude is that the Act does not apply unless the defendant health care provider had a substantial caretaking or custodial relationship, involving ongoing responsibility for one or more basic needs, with the elder patient. It is the nature of the elder or dependent adult's relationship with the defendant—not the defendant's professional standing—that makes the defendant potentially liable for neglect. Because defendants did not have a caretaking or custodial relationship with the decedent, we find that plaintiffs cannot adequately allege neglect under the Elder Abuse Act.
I. Background
This case involves the Court of Appeal's reversal of a trial court order sustaining defendants' demurrer. In considering whether that demurrer should have been sustained, we treat the demurrer as an
admission by defendants of all material facts properly pled in plaintiffs' first amended complaint—but not logical inferences, contentions, or conclusions of fact or law. (Evans v. City of Berkeley (2006) 38 Cal.4th 1, 6, 40 Cal.Rptr.3d 205, 129 P.3d 394.)
Plaintiffs Kathleen A. Winn and Karen Bredahl allege the following facts. They are the daughters and surviving heirs of Elizabeth M. Cox. As early as
November 2000, Mrs. Cox sought medical care on an outpatient basis at the facilities of Pioneer Medical Group, Inc. (Pioneer) and received treatment from Dr. Csepanyi, a medical doctor working at Pioneer and another named defendant. In 2004, Dr. Lowe, a podiatrist and one of the named defendants in this case, treated Mrs. Cox for “painful onychomycosis,” a condition
that may limit mobility and impair peripheral circulation. Dr. Lowe recorded pulses that reflected impaired vascular flow in the lower legs, and sent a copy of his report to Dr. Csepanyi.
In January and February 2007, Mrs. Cox's lower extremity vascular symptoms worsened, and in February 2007, Dr. Csepanyi diagnosed Mrs. Cox with peripheral vascular disease. In December 2007, Dr. Lowe evaluated Mrs. Cox and found a reduced pulse in her extremities. He advised her to return for a follow-up visit in two months, but did not refer her to a vascular specialist. In February 2008, Dr. Lowe found an abscess and cellulitic changes, both of which are consistent with tissue damage resulting from vascular insufficiency. Dr. Lowe drained the infection, prescribed medication, and recommended another follow-up appointment, but again did not refer Mrs. Cox to a specialist.
When Dr. Csepanyi examined Mrs. Cox in July 2008, he found that she still suffered from peripheral vascular disease. He saw her a month later but did not perform a vascular examination. After suffering a laceration on her right foot in December 2008, Mrs. Cox sought treatment from Dr. Lee—another podiatrist at Pioneer—who prescribed antibiotics and instructed Mrs. Cox to return for follow-up treatment in January 2009. Mrs. Cox returned to Dr. Lee in January 2009, but the wound had not healed and Mrs. Cox saw Dr. Csepanyi later that month. She noted the wound was painful and Dr. Csepanyi recommended medication and foot soaks. The following month, Dr. Csepanyi diagnosed cellulitis of the toes, cyanosis, and a toe abscess, all of which point to cellular deterioration and tissue destruction from peripheral vascular ischemia.
Mrs. Cox saw Dr. Lowe four times in February and March 2009. Dr. Lowe noted that Mrs. Cox suffered from chronic nondecubitus ulcer of the toes, caused by vascular compromise. He recommended topical cream and a special shoe, but did not refer Mrs. Cox to a specialist. During two visits, Dr. Lowe reported that he could not feel a pulse in Mrs. Cox's feet. On March 18, 2009, Mrs. Cox saw Dr. Csepanyi. Dr. Csepanyi noted that Mrs. Cox had suffered abnormal weight loss, but also failed to refer Mrs. Cox to a specialist.
The following day, Mrs. Cox was admitted to a hospital with symptoms consistent with ischemia and gangrene. She suffered from sepsis, or blood
poisoning, which caused her foot to appear black, and doctors unsuccessfully attempted a revascularization procedure. In April of that year doctors amputated Mrs. Cox's right leg below the knee and in June doctors performed an above-the-knee amputation. In January 2010 Mrs. Cox was hospitalized for blood poisoning. She died several days later.
Plaintiffs filed a complaint alleging medical malpractice against defendants on
March 19, 2010. Later, on February 23, 2011, plaintiffs filed a complaint for elder abuse, alleging that defendants consciously failed “to make a vascular referral.” The trial court sustained defendants' demurrer based on plaintiffs' failure to sufficiently allege more than “mere negligence” and the “provision of inadequate care.” In their first amended complaint, plaintiffs alleged again the conduct highlighted above.
Defendants again demurred. They also sought and obtained judicial notice of the March 2010 complaint plaintiffs had filed alleging medical malpractice. The trial court sustained defendants' demurrer to the first amended complaint without leave to amend. It concluded that plaintiffs had not offered facts sufficient to show that defendants had recklessly denied the needed care to Mrs. Cox, as would be necessary to show a violation of the Elder Abuse Act. Instead, the trial court concluded, plaintiffs' allegations again showed only professional negligence and “incompetence.” Absent malice, oppression, or fraud, the trial court determined, plaintiffs could not support a claim of neglect under the Act. The court ordered the complaint dismissed and plaintiffs appealed.
The Court of Appeal then reversed the trial court in a split opinion. It held that the Elder Abuse Act does not require the existence of a custodial relationship in order for the plaintiff to establish a cause of action for
neglect.2 The...
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Winn v. Pioneer Med. Grp., Inc., S211793.
...63 Cal.4th 148370 P.3d 1011202 Cal.Rptr.3d 447Kathleen A. WINN, et. al, Plaintiffs and Appellants,v.PIONEER MEDICAL GROUP, INC., et. al, Defendants and Respondents.No. S211793.Supreme Court of CaliforniaMay 19, 2016.202 Cal.Rptr.3d 448Magaña, Cathcart & McCarthy and Clay Robbins III, Los An......