Loucks v. Kaiser Foundation Hospitals, 3:20-cv-01216

Decedent Shawn Loucks suffered two strokes in February 2019 after visits to Kaiser Santa Rosa and transfer to UCSF; Plaintiffs allege delayed diagnosis, failure to administer tPA, and delays in arranging a critical-care ambulance and UCSF acceptance.
Plaintiffs (heirs and family) sued Kaiser, AMR, and the Regents of the University of California asserting medical malpractice, dependent adult abuse, negligent infliction of emotional distress, EMTALA violations, intentional misconduct, and wrongful death.
The Regents moved to dismiss under Rule 12(b)(2) asserting Eleventh Amendment immunity; Kaiser moved to compel arbitration (or dismiss) based on an arbitration clause in the Health Plan Evidence of Coverage and group enrollment materials.
Kaiser relied on a signed 2018 enrollment form (and a 2019 group agreement) plus the EOC arbitration clause; Plaintiffs challenged formation, statutory compliance with Cal. Health & Safety Code §1363.1 (and §1295), and argued risk of conflicting outcomes from non‑signatories.
The court concluded (1) the Regents are an arm of the state entitled to Eleventh Amendment immunity and dismissed them for lack of personal jurisdiction, and (2) Kaiser’s arbitration clause was enforceable (statutory disclosure complied with §1363.1), so Plaintiffs’ claims against Kaiser were compelled to arbitration and those claims stayed; Kaiser’s alternative motion to dismiss was denied as moot.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether UC Regents are immune under the Eleventh Amendment	Regents are not absolutely immune or waiver may apply (e.g., EMTALA)	Regents are a state instrumentality entitled to Eleventh Amendment immunity	Court: Regents entitled to Eleventh Amendment immunity; Motion to dismiss for lack of personal jurisdiction granted
Whether EMTALA or other law abrogates state immunity	EMTALA (and other contract theories) may waive immunity	EMTALA contains no clear intent to abrogate state immunity; no showing of waiver	Court: Plaintiffs failed to show waiver; immunity stands
Enforceability of Kaiser arbitration clause under California law (§1363.1/§1295)	Disclosure and prominence requirements not satisfied; clause therefore unenforceable	Enrollment form and EOC substantially comply with statutory disclosure and prominence requirements	Court: Disclosure satisfied §1363.1; arbitration clause enforceable
Formation and scope: whether heirs/non‑signatories are bound and whether employer/group agreement binds members	No signed 2019 enrollment; lack of acceptance; risk of conflicting rulings with non‑signatories	Parties’ conduct (continued coverage), employer group agreement, and precedent bind members and heirs; CCP §1281.2(c) not a bar	Court: Contract formation evidenced by performance and group agreement; heirs/relatives can be bound; compelled arbitration and stay entered

Regents of the Univ. of California v. Doe, 519 U.S. 425 (1997) (Regents are an instrumentality of the state entitled to Eleventh Amendment immunity)
Brayton Purcell LLP v. Recordon & Recordon, 606 F.3d 1124 (9th Cir. 2010) (plaintiff need only make a prima facie showing of jurisdictional facts to survive a 12(b)(2) motion)
Durning v. Citibank, N.A., 950 F.2d 1419 (9th Cir. 1991) (five‑factor test for arm‑of‑the‑state analysis)
Doe v. Lawrence Livermore Nat. Lab., 131 F.3d 836 (9th Cir. 1997) (state liability is the most important factor in arm‑of‑the‑state inquiry)
AT&T Mobility LLC v. Concepcion, 563 U.S. 333 (2011) (FAA creates liberal federal policy favoring enforcement of arbitration agreements)
Epic Sys. Corp. v. Lewis, 138 S. Ct. 1612 (2018) (reaffirming federal policy favoring arbitration agreements)
Granite Rock Co. v. Int’l Bhd. of Teamsters, 561 U.S. 287 (2010) (courts should order arbitration only where formation of the arbitration agreement is not in issue)
Malek v. Blue Cross of California, 121 Cal. App. 4th 44 (Cal. Ct. App. 2004) (violation of Cal. Health & Safety Code §1363.1 can render an arbitration clause unenforceable)
Madden v. Kaiser Found. Hosps., 17 Cal. 3d 699 (Cal. 1976) (employer acting as agent can bind employees to arbitration in group health agreements)
Jackson v. Hayakawa, 682 F.2d 1344 (9th Cir. 1982) (University/Regents treated as instrumentalities of the state for Eleventh Amendment purposes)