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Andrew Selesnick and Robin James Secure Major Appellate Win for Health Care Provider Clients

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April 16, 2014

Andrew Selesnick and Robin James secured a major victory for M&R’s health care clients. In Centinela-Freeman Emergency Medical Associates v. Health Net of California, our clients, a large medical group, staffed the Emergency Room (ER) at multiple hospitals. By law, ER doctors must see any patient who walks through the door, regardless of their ability to pay or the status of their insurance. La Vida, an Independent Physician Association (IPA), sent many patients to the ER, but the IPA was struggling financially and failed to reimburse the ER doctors before going out of business.
Robin James   

IPAs are middlemen in the health care process. An HMO (here, Health Net) by law must pay for ER care, but can delegate that responsibility to IPAs. In this case the ER doctors sued every major HMO in California, alleging that they knew that La Vida could not pay its bills. The trial court sustained the HMOs’ demurrer to the ER doctors’ complaint without leave to amend, finding that the HMOs could delegate their responsibility to IPAs with immunity.

In a unanimous published decision, the Court of Appeal reversed the trial court and held in favor of the ER doctors. Finding the HMOs’ conduct demonstrated negligence and showed a degree of “callousness,” the Court ruled that negligent delegation is a viable cause of action in California.