80 Cal.App.5th 1054
Cal. Ct. App.2022Background
- Plaintiff Dar Saini alleged he received emergency care at a Sutter Health ER in April 2016 and was billed an EMS Fee of $2,811 as part of $4,593 in charges.
- Saini's third amended complaint asserted a single CLRA claim (Civ. Code § 1770(a)(5), (a)(14)) alleging omission: Sutter did not visibly post signage in its ERs or at registration notifying patients pre-treatment that an EMS Fee would be billed.
- Sutter’s chargemaster (published online and available at the hospital) lists the EMS Fee and the hospital posts notice in the ER about how to access pricing information in compliance with Health & Safety Code § 1339.51.
- The trial court sustained Sutter’s demurrer without leave to amend, ruling there is no CLRA duty to provide the additional pre-treatment signage given the statutory/regulatory scheme prioritizing immediate emergency care.
- On appeal the court affirmed, following and applying Gray v. Dignity Health and related authorities; Saini’s arguments that Gray was wrongly decided and that he should be allowed to amend (including to add a breach of contract claim) were rejected.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether failing to post visible ER signage disclosing an EMS Fee before treatment violates the CLRA (omission under §1770(a)(5) & (a)(14)) | Saini: hospital has exclusive knowledge and intentionally conceals EMS Fee; patients have right to pre-treatment notice so they can make informed choices | Sutter: fee is disclosed in chargemaster per law; additional pre-treatment signage would conflict with statutory/regulatory policies that emergency care not be delayed or conditioned on payment inquiry | Court: No CLRA duty to post the additional ER signage; compliance with chargemaster/statutory scheme is sufficient and pre-treatment disclosure would conflict with emergency-care priorities (affirmed) |
| Whether Gray v. Dignity Health is controlling or wrongly decided | Saini: Gray misapplied law and failed to distinguish informing patients from questioning ability to pay | Sutter: Gray is on point and properly balances disclosure against emergency-care statutes/regulations | Court: Gray is persuasive and controlling on these facts; its reasoning is adopted |
| Whether compliance with chargemaster and statutory posting is inadequate to make fees reasonably accessible | Saini: chargemaster may be unusable or insufficient for consumers to learn about EMS Fee pre-treatment | Sutter: statutory scheme requires chargemaster posting and oversight by state agency; chargemaster disclosure satisfies duties | Court: Chargemaster disclosure meets statutory duties; any adequacy concerns are for administrative enforcement, not CLRA omission here |
| Whether leave to amend to add breach of contract or website-disclosure claims should have been granted | Saini: should be allowed to plead breach of contract (COA) or seek website disclosure | Sutter: Saini omitted prior contract allegations and cannot revive waived claims; website disclosure issue not pleaded | Court: Denied leave—contract theories were waived by earlier amendment and website disclosure was beyond the pleaded claim |
Key Cases Cited
- Gray v. Dignity Health, 70 Cal.App.5th 225 (Cal. Ct. App. 2021) (holding pre-treatment ER charge disclosure claim under CLRA/UCL fails where hospital complied with chargemaster and disclosure would conflict with emergency-care obligations)
- Nolte v. Cedars-Sinai Med. Ctr., 236 Cal.App.4th 1401 (Cal. Ct. App. 2015) (hospital satisfied disclosure obligations by making schedule of charges available; no requirement to disclose every individual charge in advance)
- Gutierrez v. Carmax Auto Superstores Cal., 19 Cal.App.5th 1234 (Cal. Ct. App. 2018) (identifies circumstances creating CLRA duty to disclose: fiduciary duty, exclusive knowledge, active concealment, or partial representations that are misleading)
- Cel-Tech Commc’ns, Inc. v. Los Angeles Cellular Tel. Co., 20 Cal.4th 163 (Cal. 1999) (limits on using general unfair competition law to attack conduct expressly regulated by statute)
- Aubry v. Tri-City Hosp. Dist., 2 Cal.4th 962 (Cal. 1992) (amendment and pleading choices can waive earlier theories/claims)
- Torres v. Adventist Health Sys./West, 77 Cal.App.5th 500 (Cal. Ct. App. 2022) (affirming judgment for hospital on an identical ER-fee omission claim)