196 Cal. App. 4th 1128
Cal. Ct. App.2011Background
- Fuchino, Sacramento County indigent, received CMISP medical care and has no copay.
- During a 2007 Monterey County trip, she suffered diabetic shock and needed emergency ambulance transport.
- Westmed transported her to Monterey Peninsula Hospital; ambulance bill totaled $1,391.04.
- Sacramento CMISP denied coverage for out-of-county ambulance costs; administrative appeal exhausted.
- Monterey County denied responsibility; Sacramento County petitioned for writs seeking coverage under §17000.
- Trial court denied the ambulance-cost portion; appellate court reversed to compel payment under §17000.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether §17000 obligates Sacramento County to cover out-of-county emergency ambulance costs. | Fuchino's residence-trust status triggers county duty. | Monterey or another county bears responsibility due to location of services; no contract relief. | Sacramento County must relieve and reimburse the out-of-county emergency ambulance costs. |
| Do §29606 and Health and Safety Code §1444 negate Sacramento's duty here? | Statutes support county responsibility for indigent emergency care. | Those statutes do not apply or assign Monterey County the cost. | Statutes do not negate Sacramento's §17000 duty for this indigent resident. |
| Do Lomita I/II control the outcome for nonresident indigents in out-of-county ambulance cases? | Lomita framework supports county liability for indigent emergency transport. | Lomita I/II are inapplicable or distinguishable; not dispositive here. | Lomita I and II are not controlling; Sacramento bears cost under §17000. |
| Does absence of a contract between Sacramento and the Monterey provider excuse payment? | §16817 allows flexibility to fulfill §17000; lack of contract does not relieve duty. | Contracted-provider framework could limit liability absent agreement. | No; lack of contract does not absolve Sacramento of §17000 obligation. |
| Is the claim of an “unworkable” system a valid basis to deny relief here? | Legislature—not court—should address administrative burdens; duty remains. | Impracticality justifies avoiding out-of-county cost-shifting. | Unworkable systemic concerns do not defeat the duty under §17000. |
Key Cases Cited
- Hunt v. Superior Court, 21 Cal.4th 984 (1999) (last-resort obligation for indigents; minimum standard of care)
- County of San Diego v. State of California, 15 Cal.4th 68 (1997) (emergency care obligations under §17000; indigent relief)
- City of Lomita v. County of Los Angeles, 148 Cal.App.3d 671 (1983) (duty to provide/pay emergency ambulance within county to indigents)
- City of Lomita v. Superior Court, 186 Cal.App.3d 479 (1986) (clarified ambulance cost responsibilities; resident-focused duties)
- Alford v. County of San Diego, 151 Cal.App.4th 16 (2007) (emergency care scope under §17000; limits of state funding)
- Union of American Physicians & Dentists v. County of Santa Clara, 149 Cal.App.3d 45 (1983) (noncontracting physicians; statutory authority required for payment)
- County of San Diego v. Viloria, 276 Cal.App.2d 350 (1969) (statutory obligation to furnish hospitalization to indigents)