2 Cal. App. 5th 638
Cal. Ct. App.2016Background
- Gloria Glover-Woods, a Medicare-eligible resident at St. John skilled nursing facility, elected hospice care provided by St. Liz while residing at St. John.
- St. Liz’s attending physician ordered Ms. Woods transferred to an acute hospital for psychiatric evaluation after a psychotic episode; St. John admitted she was transferred out of the facility to a hospital bed.
- After hospital treatment, St. John refused to readmit Ms. Woods, claiming it could not provide specialized services recommended in a PASRR and arguing the transfer had been directed by the hospice, not the facility.
- The DHCS hearing officer found St. John violated 42 C.F.R. § 483.12 (federal involuntary transfer/discharge rules) and ordered St. John to offer readmission to the first available semi-private bed; DHCS’s decision formed the basis of a writ petition in superior court.
- While the appeal was pending, Ms. Woods moved out of state and no longer sought readmission; the Court of Appeal held the specific readmission order was moot but addressed the controlling legal issue because it was likely to recur in related civil litigation.
Issues
| Issue | Plaintiff's Argument (St. John) | Defendant's Argument (Woods) | Held |
|---|---|---|---|
| Whether § 483.12’s readmission and involuntary transfer requirements apply when a hospice provider, not the facility, orders hospitalization | If hospice (St. Liz) ordered the hospital transfer, St. John did not "transfer" the resident and thus § 483.12 obligations (notice, documentation, readmit-to-first-available-bed) do not apply to St. John | § 483.12 protects residents of a facility regardless who ordered the hospitalization; the facility remains responsible for complying with transfer/discharge rules and readmission rights | § 483.12 applies to the facility regardless of whether a hospice provider ordered the hospitalization; St. John’s refusal to readmit was subject to the regulation’s requirements |
| Whether readmitting then later discharging while complying with § 483.12 would expose St. John to liability under Cal. Health & Safety Code § 1432 (retaliation prohibition) | Readmitting then lawfully discharging within 180 days of a complaint would create a presumption of retaliation under § 1432(b) and risk liability | Compliance with § 483.12 (proper notice, documentation, procedures) rebuts any retaliation presumption; evidence of lawful discharge would defeat the presumption | No real conflict: complying with § 483.12 would provide the evidence to rebut the § 1432 presumption, so readmission followed by a proper discharge would not automatically violate § 1432 |
| Mootness of DHCS’s readmission order | St. John argued subsequent facts rendered the order moot | Woods conceded she no longer sought readmission and relocated out of state | The specific readmission order was moot; appeal reversed and remanded with instructions to dismiss as moot, but court exercised discretion to decide the legal question likely to recur |
| Whether St. John had to coordinate with hospice or would be forced to dictate hospice care to satisfy § 483.12 | St. John claimed § 483.12 duties might conflict with hospice’s statutory authority and contractual allocation of hospice management | § 483.12 obligations can be performed in consultation with hospice; applicable hospice regs contemplate coordination | No conflict: facility may satisfy § 483.12 duties in cooperation with hospice; regulations envision coordination between facility and hospice |
Key Cases Cited
- Building a Better Redondo, Inc. v. City of Redondo Beach, 203 Cal.App.4th 852 (court may exercise discretion to decide moot issue when controversy likely to recur)
- City of Hollister v. Monterey Ins. Co., 165 Cal.App.4th 455 (discretion to decide moot issues when fully litigated and likely to recur)
- Giles v. Horn, 100 Cal.App.4th 206 (procedure on disposition of appeals decided as moot: reverse and direct dismissal)
- Goleta Valley Community Hospital v. Department of Health Services, 149 Cal.App.3d 1124 (principles for construing administrative regulations)
- Rancho Santa Fe Pharmacy, Inc. v. Seyfert, 219 Cal.App.3d 875 (effect of presumptions that affect burden of producing evidence)