Cuevas v. Contra Costa County
11 Cal. App. 5th 163
| Cal. Ct. App. | 2017Background
- Brian Cuevas (minor) suffered irreversible hypoxic brain injury at birth; sued Contra Costa County for medical malpractice; jury found liability uncontested on appeal.
- Life care plans: plaintiff’s expert (Roughan) used national billed-charge databases and did not apply Medi‑Cal or ACA discounts; defendant’s expert (Olzack) prepared alternate scenarios including Medi‑Cal, ACA private insurance, and private‑pay rates (lower than billed charges).
- Trial court excluded evidence of future ACA insurance benefits and evidence of Medi‑Cal and regional center benefits as collateral source offsets, relying on MICRA § 3333.1 and the collateral‑source rule; allowed some private‑pay estimates but not evidence tying reduced amounts to specific collateral sources.
- Jury awarded $100 million for future medical/rehabilitative care (reduced to $9,577,000 present cash value); defendant appealed the damages rulings and postjudgment awards of costs and expert fees.
- Court of Appeal held the trial court erred in excluding evidence of future ACA benefits and in barring admissible evidence about the amounts providers would accept (market/exchange value); reversed and remanded for a new trial limited to future medical damages and reversed postjudgment orders awarding costs and expert fees.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether MICRA § 3333.1 permits admission of evidence of future (prospective) collateral‑source medical benefits | § 3333.1 allows only past benefits; future benefits are speculative and inadmissible | "Amount payable" includes future benefits; jury may consider future collateral sources to reduce future medical damages | § 3333.1 is ambiguous; legislative purpose and history support admitting evidence of future benefits — trial court erred in excluding ACA future benefits |
| Whether the collateral‑source rule bars evidence of Medi‑Cal, regional center, and school services as offsets | These public benefits should be excluded from consideration under the collateral‑source protection | Evidence of amounts providers accept (market/exchange value) is relevant to reasonable value; some public benefits are not within § 3333.1 but may be relevant | Medi‑Cal and regional center benefits are not within § 3333.1; general collateral‑source rule still applies to them; trial court correctly excluded regional center/Medi‑Cal as § 3333.1 collateral sources but erred to the extent it barred evidence of market values and ACA benefits |
| Whether billed (list) charges may form the basis for future medical damages | Plaintiff relied on billed rates from national databases as reasonable future costs | Defendant argued recovery should be based on amounts providers actually accept (negotiated/insurance rates), not billed charges, per Howell | Billed charges are not the proper measure of reasonable value when negotiated rates or market/exchange values exist; expert testimony must address reasonable/probable future payment amounts |
| Whether evidence supports that ACA coverage is sufficiently certain to be considered | Future ACA availability is speculative (esp. post‑2016 political developments) | Expert evidence showed ACA and ACA‑compatible plans reasonably likely to be available and applicable to plaintiff | Sufficient evidence supported admissibility of future ACA benefits; trial court abused discretion excluding such evidence |
Key Cases Cited
- Fein v. Permanente Medical Group, 38 Cal.3d 137 (Cal. 1985) (discusses § 3333.1 and treatment of collateral benefits in future medical awards)
- Howell v. Hamilton Meats & Provisions, 52 Cal.4th 541 (Cal. 2011) (billed charges above negotiated payments are not recoverable economic loss)
- Corenbaum v. Lampkin, 215 Cal.App.4th 1308 (Cal. Ct. App. 2013) (full billed amounts are not relevant to future medical damages when discounted/negotiated rates apply)
- Brown v. Stewart, 129 Cal.App.3d 331 (Cal. Ct. App. 1982) (Medi‑Cal payments are not covered by § 3333.1 due to federal Medicaid reimbursement law)
- Markow v. Rosner, 3 Cal.App.5th 1027 (Cal. Ct. App. 2016) (reasonable market/exchange value, not billed amount, is proper metric for insured plaintiffs' future medical costs)
- Barme v. Wood, 37 Cal.3d 174 (Cal. 1984) (background on MICRA's purpose to limit malpractice costs and awards)