Aguilera v. Loma Linda University Medical Center
185 Cal. Rptr. 3d 699
Cal. Ct. App.2015Background
- Ashlynn Aguilera, a severely injured minor, settled medical malpractice claims for $950,000; $85,000 of the settlement went to her parents with remaining funds placed in a special needs trust.
- California Department of Health Care Services (Medi-Cal) asserted a lien for $211,191 of the settlement funds.
- The trial court calculated the lien using an Ahlborn-based formula and allowed no reduction for Ashlynn’s attorney fees and costs; it controversially included future attendant care costs but excluded some future medical costs.
- Ashlynn presented evidence of extensive future care needs, including substantial 24/7 attendant care, future medical expenses, and lost earnings, to support a reduced lien.
- The Department opposed including Ashlynn’s future health care costs in the Ahlborn calculation and sought to keep a larger lien; the Department later adopted the Ahlborn approach but contested its application to future care expenses.
- The matter was remanded for further proceedings to determine whether future attendant and medical care should be included in the Ahlborn calculation and to apply § 14124.72(d) to allocate Ashlynn’s attorney fees and costs.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether future health care expenses should be included in the Ahlborn calculation. | Aguilera argued future attendant and medical care must be included. | Department argued future costs should be excluded because Medi-Cal will pay them. | Remanded for fact-finding on inclusion of future care; Ahlborn framework remains appropriate. |
| Whether the Department’s lien should be reduced to reflect Ashlynn’s attorney fees and costs under § 14124.72(d). | Ashlynn contends § 14124.72(d) requires reduction for her attorney fees. | Department argues no reduction is required beyond the statutory framework. | The lien must be reduced under § 14124.72(d); remanded for calculation. |
| Whether the trial court erred in relying on Wyatt's declaration to determine Medi-Cal will or will not pay future expenses. | Wyatt's declarations were insufficient to prove future Medi-Cal payment. | Wyatt's declarations supported future Medi-Cal payment; the court should rely on them. | Remand to permit proper evidentiary submissions establishing Medi-Cal funding and eligibility for future care. |
Key Cases Cited
- Ahlborn v. Mental Health & Retardation (In re Ahlborn), 547 U.S. 268 (U.S. 2006) (limits recovery to medical expenses portion of settlement)
- Bolanos v. Superior Court, 169 Cal.App.4th 744 (Cal. Ct. App. 2008) (guides allocation and the use of Ahlborn in California)
- Lopez v. DaimlerChrysler Corp., 179 Cal.App.4th 1373 (Cal. Ct. App. 2009) (endorses Ahlborn-based allocation methods)
- Lima v. Vouis, 174 Cal.App.4th 242 (Cal. Ct. App. 2009) (discusses future medical expenses and evidentiary support)
- Branson v. Sharp Healthcare, Inc., 193 Cal.App.4th 1467 (Cal. Ct. App. 2011) (discusses pre-Ahlborn lien limits and Branson approach)
- Espericueta v. Shewry, 164 Cal.App.4th 615 (Cal. Ct. App. 2008) (statutory framework after Ahlborn; guides calculation)