On 02/01/2016 LUZ D'LUNA QUINTEROS filed a Personal Injury - Medical Malpractice lawsuit against CA HOSPITAL MEDICAL CENTER ET. This case was filed in Los Angeles County Superior Courts, Stanley Mosk Courthouse located in Los Angeles, California. The case status is Pending - Other Pending.
Pending - Other Pending
Los Angeles County Superior Courts
Stanley Mosk Courthouse
Los Angeles, California
TILLEY IAN BRENT M.D.
MIELKE RUTH KYRIE
CLAASSEN MARY ELIZABETH
USC-EISNER FAMILY MEDICINE CENTER AT CA-
CALIFORNIA HOSPITAL MEDICAL CENTER
DOES 1 THROUGH 30
USC-EISNER FAMILY MEDICINE CENTER AT CA- DBA USC-EISNER FAMILY MEDICINE CENTER AT CALIFORNIA HOSPITAL
CALIFORNIA HOSPITAL MEDICAL CENTER DBA CALIFORNIA HOSPITAL MEDICAL CENTER
QUINTEROS LUZ D'LUNA
UNITED STATES OF AMERICA
LAW OFFICES OF MICHELS & LEW
LAW BRANDMEYER + PACKER LLP
O'LEARY TED H.
PACKER ROBERT BRUCE
MCKENNA ROBERT LOWELL III
CARROLL KELLY TROTTER FRANZEN & MCKENNA
7/27/2018: NOTICE OF NEW DATE OF POST MEDIATION STATUS CONFERENCE
7/27/2018: NOTICE OF CASE REASSIGNMENT
8/7/2018: PEREMPTORY CHALLENGE TO JUDICIAL OFFICER
8/28/2018: NOTICE TO STATE COURT OF REMOVAL TO UNITED STATES DISTRICT COURT BY DEFENDANTS PEI)IATRIC & FAMILY MEDICAL CENTER, DB USC-EISNER FAMILY MEDICINE CENTER AT CALIFORNIA HOSPITAL, MARY ELIZABETH CLAASSEN,
1/25/2019: Motion to Seal
2/6/2019: Petition to Confirm Minor's Compromise Hearing
2/11/2019: Case Management Statement
3/13/2019: Minute Order
3/21/2019: Notice of Hearing on Petition
4/18/2019: Notice of Ruling
6/7/2016: DEFENDANTS' AMENDED ANSWER TO PLAINTIFFS' COMPLAINT
2/16/2017: PLAINTIFFS' OPPOSITION TO MOTION FOR STAY OF ACTION; ETC.
3/1/2017: DEFENDANTS EISNER FAMILY MEDICINE CENTER, IAN BRENT TILLEY, M.D., RUTH MIELKE, AND MARY ELIZABETH CLAASSEN'S NOTICE OF MOTION AND MOTION FOR STAY
4/21/2017: DECLARATION OF GREGORY G. LYNCH IN RESPONSE TO ORDER TO SHOW CAUSE RE. FAILURE TO APPEAR AT CASE MANAGEMENT CONFERENCE
4/27/2017: RESPONSE OF DEFENDANTS IAN BRENT TILLEY, M.D., AND RUTH KYRIE MIELKE PLAINTIFFS' MOTION FOR TRIAL SETTING PREFERENCE UNDER CCP SECTION 36(B)
at 08:30 AM in Department 56; Post-Mediation Status Conference - Not Held - Advanced and Continued - by CourtRead MoreRead Less
at 08:30 AM in Department 56; Order to Show Cause Re: (re Proof of Deposit) - Not Held - Advanced and Continued - by CourtRead MoreRead Less
Petition to Confirm Minor's Compromise with Special Needs Trust; Filed by Carolina Quinteros (Plaintiff); Luz D'Luna Quinteros (Plaintiff)Read MoreRead Less
Notice of Entry of Dismissal and Proof of Service; Filed by Pediatric & Family Medical Center Erroneously Sued As USC-Eisner Family Medicine Center at California Hospital (Defendant); Mary Elizabeth Claassen (Defendant); Pediatric & Family Medical Center dba (Defendant)Read MoreRead Less
Request for Dismissal; Filed by Pediatric & Family Medical Center Erroneously Sued As USC-Eisner Family Medicine Center at California Hospital (Defendant); Mary Elizabeth Claassen (Defendant); Pediatric & Family Medical Center dba (Defendant)Read MoreRead Less
Notice Re: Continuance of Hearing and Order; Filed by ClerkRead MoreRead Less
Notice of Ruling; Filed by Pediatric & Family Medical Center Erroneously Sued As USC-Eisner Family Medicine Center at California Hospital (Defendant); Mary Elizabeth Claassen (Defendant); Pediatric & Family Medical Center dba (Defendant)Read MoreRead Less
Order Approving Compromise of Disputed Claim or Pending Action or Disposition of Proceeds of Judgment for Minor or Person With a Disability (Miscellaneous); Filed by Carolina Quinteros (Plaintiff); Luz D'Luna Quinteros (Plaintiff)Read MoreRead Less
at 10:42 AM in Department 56; Court OrderRead MoreRead Less
at 10:29 AM in Department 56; Nunc Pro Tunc OrderRead MoreRead Less
Proof-Service/Summons; Filed by Carolina Quinteros (Plaintiff); Luz D'Luna Quinteros (Plaintiff)Read MoreRead Less
Proof-Service/Summons; Filed by Carolina Quinteros (Plaintiff); Luz D'Luna Quinteros (Plaintiff)Read MoreRead Less
SUMMONSRead MoreRead Less
Summons; Filed by ClerkRead MoreRead Less
Summons Issued; Filed by ClerkRead MoreRead Less
Ord Apptng Guardian Ad Litem; Filed by Plaintiff/PetitionerRead MoreRead Less
Application ; Filed by Plaintiff/PetitionerRead MoreRead Less
APPLICATION AND ORDER FOR APPOINTMENT OF GUARDIAN AD LITEM CIVIL III EX PARTERead MoreRead Less
Complaint; Filed by nullRead MoreRead Less
COMPLAINT FOR DAMAGES 1) NEGLIGENCE ON BEHALF OF CAROLINA QUINTEROS; ETCRead MoreRead Less
Case Number: BC608973 Hearing Date: February 06, 2020 Dept: 56
SUPERIOR COURT OF THE STATE OF CALIFORNIA
FOR THE COUNTY OF LOS ANGELES - CENTRAL DISTRICT
LUZ D’LUNA QUINTEROS, etc., et al.,
CALIFORNIA HOSPITAL MEDICAL CENTER, et al.,
CASE NO.: BC608973
[TENTATIVE] ORDER RE: MOTION TO DETERMINE DHCS LIEN CLAIM
Date: February 6, 2020
Time: 8:30 a.m.
MOVING PARTIES: Plaintiff Luz D’Luna Quinteros, by and through her guardian ad litem, Carolina Quinteros (“Ms. Quinteros”)
RESPONDING PARTY: California Department of Health Care Services (“DHCS”)
The Court has considered the moving, opposition, and reply papers.
Plaintiff, by and through her guardian ad litem, Ms. Quinteros filed a complaint against Defendants arising from alleged medical malpractice during the labor and delivery of Plaintiff, alleging causes of action against Defendants for: (1) negligence; and (2) negligence.
On June 7, 2019, this action settled via two petitions to approve a compromise of a pending action on behalf of Plaintiff and the Court granted approval of both petitions. This action settled for a total amount of $3,000,000.00. DHCS claims that it has advanced a sum of $672,658.59 for medical services for Plaintiff. (Plaintiff’s Evidence in Support of Motion at Exhibit 5.) DHCS instituted a personal injury lien with respect to Plaintiff’s settlement. (Id.) DHCS is requesting payment in the amount of $477,264.04 to satisfy the personal injury lien.
Plaintiff, by and through her guardian ad litem, Ms. Quinteros filed a motion pursuant to for an order: (1) to determine that DHCS’s lien claim on Plaintiff’s action should be zero dollars; or (2) if DHCS does in fact have a valid lien, to determine that the lien claim is no more than $33,120.00 or some other amount calculated according to law.
Plaintiff asserts that: (1) the California Welfare and Institutions Code Medi-Cal Lien Statutes violate the Federal Medicaid Act and therefore violate the United States Constitution’s Supremacy Clause; (2) even if California’s Medi-Cal Lien Statutes were constitutional, DHCS cannot assert a lien on funds that are compensation for other injuries; and (3) the calculation of DHCS’s Medi-Cal lien claim should be properly apportioned.
DHCS opposes Plaintiff’s motion on the grounds that: (1) reimbursement is consistent with federal law and does not violate the Supremacy Clause of the United States Constitution; (2) Plaintiff is required by law to reimburse DHCS from the settlement proceeds obtained from third-party tortfeasors; and (3) the reimbursement to DHCS is based on the first calculation methodology under California Welfare and Institutions Code, Section 14124.72(d) because it results in the lowest reimbursement to DHCS.
Thus, the crux of the dispute presented by the papers of the parties is: (1) whether DHCS can in fact assert a lien against Plaintiff’s settlement to obtain reimbursement of medical expenses; and (2) if a lien is so authorized, should the lien claim of DHCS be limited.
The Court OVERRULES the evidentiary objections of DHCS numbers 1 and 2 to the evidence presented by Plaintiff in support of her motion.
The Court SUSTAINS Plaintiff’s evidentiary objections numbers 1-3 and 5-10 to the evidence presented by DHCS in support of its opposition to Plaintiff’s motion. The Court OVERRULES Plaintiff’s evidentiary objection number 4 to the evidence presented by DHCS in support of its opposition to Plaintiff’s motion.
“When interpreting a statute, the court will not merely look to a particular clause in which general words may be used, but will take in connection with it the whole statute . . . and the objects and policy of the law, as indicated by its various provisions, and give to it such a construction as will carry into execution the will of the Legislature.” (Kokoszka v. Belford (1974) 417 U.S. 642, 650.) California Welfare and Institutions Code, Section 14124.74(a) says that in the event of a settlement, judgment, or award in a suit or claim against a third party or carriers “[i]f the action or claim is prosecuted by the beneficiary alone, the court or agency shall first order paid from any settlement, judgment, or award the reasonable litigation expenses incurred in preparation and prosecution of the action or claim, together with reasonable attorney’s fees when an attorney has been retained.” California Welfare and Institutions Code, Section 14124.76(a) says that “[n]o settlement, judgment, or award in any action or claim by a beneficiary to recover damages for injuries, where the director has an interest, shall be deemed final or satisfied without first giving the director notice and a reasonable opportunity to perfect and satisfy the director’s lien. Recovery of the director’s lien from an injured beneficiary’s action or claim is limited to that portion of a settlement, judgment, or award that represents payment for medical expenses, or medical care, provided on behalf of the beneficiary.” Pursuant to California Welfare and Institutions Code, Section 14124.70 a beneficiary is “any person who has received benefits or will be provided benefits under this chapter because of an injury for which another person or party may be liable.” California Welfare and Institutions Code, Section 14124.70(d) defines a line as “the director’s claim for recovery, from a beneficiary’s tort action or claim, of the reasonable value of benefits provided on behalf of the beneficiary.” California Welfare and Institutions Code, Section 14124.72(d) says that “[t]he director’s claim for reimbursement of the benefits provided to the beneficiary shall be limited to the amount of the director’s lien as defined in subdivision (d) of Section 14124.70.”
Issue No. 1: Constitutionality of California’s Medi-Cal Reimbursement Structure
“Although participation in the Medicaid program is entirely optional, once a State elects to participate, it must comply with the requirements of Title XIX.” (Harris v. McRae (1980) 448 U.S. 297, 301.) “California’s Medi-Cal program implements the federal Medicaid program, which funds medical services for elderly and low-income persons.” (Espericueta v. Shewry (2008) 164 Cal.App.4th 615, 622.) “The Department administers the Medi-Cal program in accordance with federal law.” (Id.) “The Department can obtain reimbursement by filing an action directly against a third-party tortfeasor, by intervening in a Medi-Cal beneficiary’s action against a third party or by filing a lien against a beneficiary’s settlement, judgment, or award.” (Id. at 622-623.)
United States Code, Section 1396k(a)(1)(A) provides that in order to assist the purpose of collection of medical support payments and other payments for medical care owed to recipients of medical assistance under a state plan, a state plan must require a beneficiary “to assign the State any rights, of the individual or of any other person who is eligible for medical assistance under this subchapter and on whose behalf the individual has the legal authority to execute an assignment of such rights, to support (specified as support for the purpose of medical care by a court or administrative order) and to payment for medical care from any third party.”
Pursuant to United States Code, Section 1396k(a)(1)(C) a beneficiary is required “to cooperate with the State in identifying, and providing information to assist the State in pursuing, any third party who may be liable to pay for care and services available under the plan.” United States Code, Section 1396a(a)(25)(H) says “that to the extent that payment has been made under the State plan for medical assistance in any case where a third party has legal liability to make payment for such assistance. . . the State is considered to have acquired the rights of such individual to payment by any other party for such health care items or services.” In order to participate in the Medicaid program, a state is required to submit “to the Secretary . . . a plan for pursuing claims against such third parties.” (42 U.S.C. § 1396a(a)(25)(A)(ii).) United States Code, Section 1396p(a)(1) says that “[n]o lien may be imposed against the property of an individual prior to his death on account of medical assistance paid or to be paid on his behalf.” California Civil Code, Section 953 says that “[a] thing in action is a right to recover money or other personal property by a judicial proceeding.” “[T]he right to sue for damages for injury to the person is a chose in action and is therefore property.” (Franklin v. Franklin (1945) 67 Cal.App.2d 717, 725.) “[T]he word property may be properly used to signify any valuable right or interest protected by law.” (Id.) Money recovered for personal injuries is deemed property. (Id.)
United States Code, Section 1396p(b)(1) provides that “[n]o adjustment or recovery of any medical assistance correctly paid on behalf of an individual . . . may be made, except that the State shall seek adjustment or recovery of any medical assistance correctly paid on behalf of an individual under the State Plan” only in certain instances. These instances include: (1) adjustment or recovery from the individual’s estate or upon the sale of property subject to a lien; or (2) an individual age 55 years or older when the individual received medical assistance. (42 U.S.C. § 1396p(b)(1)(A)-(C).) The implied intent of Congress to preempt state law is found where complying with state and federal law is an impossibility. (Eckler v. Neutrogena Corp. (2015) 238 Cal.App.4th 433, 447.)
The Court finds that DHCS’s argument that the state may make a claim on the portion of a Medicaid beneficiary’s tort recovery based on the Ahlborn case is unpersuasive. (Arkansas Dept. of Health and Human Services v. Ahlborn (2006) 547 U.S. 268.) In Ahlborn, petitioner determined that respondent was eligible for medical assistance and paid providers $215,645.30 on respondent’s behalf. (Id. at 274.) Respondent ADHS intervened in petitioner’s lawsuit to assert a lien on any third-party proceeds she might obtain. (Id.) The petitioner in Ahlborn had sustained severe and permanent injuries resulting from a car accident and her case settled for $550,000.00. (Id.) Petitioner filed suit seeking a declaration that the lien on the proceeds of any third-party recovery she may obtain violated Federal Medicaid laws inso far as its satisfaction would require depletion of compensation for injuries other than her past medical expenses. (Id.)
The issue in Ahlborn was “whether ADHS can lay claim to more than the portion of Ahlborn’s settlement that represents medical expenses.” (Id. at 280.) The Ahlborn court expressly declined to reach the issue of whether liens may be assessed from an individual because neither party discussed the anti-recovery provision of Section 1396p(b). (Id. at 284, fn. 14.) Ahlborn is not persuasive because “an opinion is not authority for a proposition not therein considered.” (Ginns v. Savage (1964) 61 Cal.2d 520, 524, fn.2.) Moreover, “[i]n Ahlborn, the Court remarked in dictum that provisions of the federal Medicaid law regulating the imposition of liens . . . if [r]ead literally and in isolation, . . . would appear to ban even a lien on that portion of the settlement proceeds that represents payments for medical care, and forestall any attempt by the State to recover benefits paid, at least from the individual.” (McMillan v. Stroud (2008) 166 Cal.App.4th 692, 705.) Moreover, Ahlborn did not address the argument raised by Plaintiff here: that the DHCS is barred from asserting a lien against, or recovery from, the property of a Medicaid beneficiary—in this case settlement proceeds to pay for medical expenses expended by DHCS.
DHCS’s citation to Wos is also meritless. (Wos v. E.M.A. ex rel. Johnson (2013) 568 U.S. 627.) This issue in Wos was the interaction between federal law and a North Carolina state law that required “up to one-third of any damages recovered by a beneficiary for a tortious injury [to] be paid to the State to reimburse it for payments it made for medical treatment on account of the injury.” (Id. at 630.) The Wos court held that the North Carolina law was preempted by the Medicaid anti-lien provision. (Id. at 644.) The Wos court even relevantly indicated that “the beneficiary has a property right in the proceeds of the settlement, bringing it within the ambit of the anti-lien provision.” (Id. at 633.) The Wos court, however, did not address the issue of whether DHCS can assert a lien against a Medi-Cal recipient’s tort recovery settlement where medical expenses were correctly paid.
The Court finds that DCHS’s citation to Tristani is both not binding and unpersuasive. That case involved a Pennsylvania statute and is a decision from the United States Court of Appeals for the Third Circuit. (Tristani ex rel. Karnes v. Richman (2011) 652 F.3d 360, 367.) Tristani also was not analyzing the California Welfare and Institutions Code in connection with anti-lien and anti-recovery provisions. (Id.) The Tristani majority court, however, acknowledged that “the plain language of the forced assignment and reimbursement provisions of the Social Security Act irreconcilably conflicts with that of the anti-lien and anti-recovery provisions.” (Id. at 372, fn. 13.) Tristaini was addressing a completely different issue than the argument Plaintiff has raised in her moving and reply papers.
DHCS’s citation to Kizer is meritless to support its argument with respect to the constitutionality of its lien because Kizer involved an issue of the statute of limitations and not the anti-lien or anti-recovery provisions arising under federal law in connection with the California Welfare and Institutions Code. (Kizer v. Ortiz (1990) 219 Cal.App.3d 1055, 1059.) For similar reasons in that they do not discuss the anti-lien and anti-recovery provisions arising under federal law in conjunction with the California Welfare Institutions Code, DHCS’s citations to: (1) Hanif; (2) Kain; (3) Wright; and (4) the Giraldo cases are all unpersuasive. (See Hanif v. Housing Authority (1988) 200 Cal.App.3d 635; see also Kain v. Department of Health Services (2001) 91 Cal.App.4th 325; Wright v. Department of Benefit Payments (1979) 90 Cal.App.3d. 446; Giraldo v. Agency for Health Care Administration (2016) 208 So.3d 244.)
The Court finds that the plain language of Section 1396p(a)(1) bars a lien from being imposed against Plaintiff’s settlement proceeds arising from medical expenses properly and correctly paid by DHCS. Under California Civil Code, Section 953 and the Franklin case, Plaintiff’s settlement proceeds that she has or will obtain are her property. DHCS does not argue that medical assistance benefits were incorrectly paid to Plaintiff which would allow the opportunity for DHCS to recover from Plaintiff pursuant to Section 1396p(b)(1). DHCS has instituted a lien due to the expenses it paid for Plaintiff’s medical care. Thus, based on the statutory language complying with the federal and state provisions with respect to recovery of advanced medical expenses pursuant to a settlement is an impossibility under Eckler. “Under the Supremacy Clause, [w]here state and federal law . . . conflict, state law must give way.” (Wos v. E.M.A. ex rel. Johnson (2013) 568 U.S. 627, 636.) Here, there is a conflict between the right of DHCS to be paid from a beneficiary’s settlement proceeds and federal statutory law which prohibits a lien from being imposed against a settlement of an individual, before death, due to medical assistance expenses paid for that beneficiary.
Therefore, the Court finds that DHCS is not entitled to any recovery on its lien and the Court finds that DHCS will recover zero dollars on its lien claim with respect to this action pursuant to the Court’s discussion above.
Moving party is ordered to give notice of this ruling.
Parties who intend to submit on this tentative must send an email to the Court at SMC_DEPT56@lacourt.org as directed by the instructions provided on the court website at www.lacourt.org. If the department does not receive an email and there are no appearances at the hearing, the motion will be placed off calendar.
Dated this 6th day of February 2020
Hon. Holly J. Fujie
Judge of the Superior Court
 “Questions which merely lurk in the record, neither brought to the attention of the court nor ruled upon, are not to be considered as having been so decided as to constitute precedents.” (Shalala v. Illinois Council on Long Term Care, Inc. (2000) 529 U.S. 1, 41.)
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