Winn v. Pioneer Medical Group, Inc.
63 Cal. 4th 148
Cal.2016Background
- Plaintiffs (daughters and heirs of Elizabeth Cox) allege outpatient providers at Pioneer Medical Group failed to refer Mrs. Cox to a vascular specialist despite worsening peripheral vascular disease, leading to infection, sepsis, amputations, and death.
- Plaintiffs originally sued for medical malpractice and later for elder abuse under the Elder Abuse and Dependent Adult Civil Protection Act (Elder Abuse Act), alleging defendants ‘‘consciously failed to make a vascular referral.’’
- Trial court sustained defendants’ demurrer, finding plaintiffs pleaded only professional negligence, not the recklessness, malice, or custodial neglect required for the Act’s heightened remedies; Court of Appeal reversed.
- Supreme Court granted review to decide whether neglect under Welfare & Institutions Code §15610.57(a)(1) requires a caretaking or custodial relationship (i.e., ongoing responsibility for basic needs) with the elder.
- Court held the Elder Abuse Act’s neglect requires a caretaking/custodial relationship (more than intermittent outpatient treatment); absent such a relationship, outpatient medical negligence does not qualify for the Act’s heightened remedies.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether §15610.57(a)(1) applies to outpatient providers who fail to refer to specialists | Winn: any person who provides care can be liable; Pioneer’s outpatient treatment made them "care custodians" | Pioneer: statute requires having "the care or custody" — a substantive caretaking/custodial relationship, not mere episodic treatment | Held: Neglect under the Act requires a caretaking/custodial relationship involving ongoing responsibility for basic needs; outpatient treatment alone insufficient |
| Whether statutory phrase "having the care or custody" should be read broadly to include episodic providers | Winn: "care or custody" is disjunctive and includes anyone providing care | Pioneer: definite article and context show a distinct custodial/caretaking relationship is required | Held: Context, examples in §15610.57(b), statutory structure, and legislative history support a caretaking/custodial requirement |
| Whether §15610.17’s definition of “care custodian” automatically satisfies §15610.57’s relationship requirement | Winn: clinics and entities listed as care custodians mean Pioneer is a custodian as a matter of law | Pioneer: §15610.17 is broad and does not automatically establish the particular custodial relationship needed for §15610.57 | Held: §15610.17 does not automatically satisfy §15610.57; relationship must be alleged and shown on the facts |
| Whether prior appellate authority (e.g., Mack) permits elder-abuse neglect claims against noncustodial doctors | Winn: Mack supports liability without formal custodial relationship | Pioneer: Delaney and Covenant Care require custodial responsibility; Mack is inconsistent | Held: Court disapproves Mack to the extent it allowed neglect claims absent a caretaking/custodial relationship; Delaney/Covenant Care are consistent with the requirement |
Key Cases Cited
- Delaney v. Baker, 20 Cal.4th 23 (1999) (interprets "neglect" as failure of those responsible for basic needs to carry out custodial obligations)
- Covenant Care, Inc. v. Superior Court, 32 Cal.4th 771 (2004) (Elder Abuse Act claims target custodians/caregivers who abuse dependent elders, not routine medical providers)
- Mack v. Soung, 80 Cal.App.4th 966 (2000) (court approves liability where physician assumed a caretaking relationship; disapproved here to extent it dispensed with custodial requirement)
- People v. Heitzman, 9 Cal.4th 189 (1994) (construing "having the care or custody" in felony abuse statute to protect vulnerable dependents and requiring caretaker responsibility)