Moran v. Prime Healthcare Management, Inc.Moran v. Prime Healthcare Management, Inc.
Carpenter Law, Gretchen Carpenter; Law Office of Barry Kramer and Barry L. Kramer for Plaintiff and Appellant.
Miller Barondess, Mira Hashmall and Adam M. Agatston for Defendants and Respondents.
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This is the second appeal in this putative class action regarding hospital fees and costs for patients not covered by insurance. Plaintiff Gene Moran, who was a patient at Huntington Beach Hospital (the Hospital) three times in 2013, sued defendants Prime Healthcare Management, Inc., Prime Healthcare Huntington Beach, LLC, Prime Healthcare Services, Inc., and Prime Healthcare Foundation, Inc. (collectively defendants)1 under various theories in 2013. In our prior opinion, we found that while most of Moran‘s claims lacked merit, he had sufficiently alleged facts supporting standing to claim the amount that self-pay patients were charged was unconscionable, and we rеversed the trial court‘s dismissal of the case. (Moran v. Prime Healthcare Management, Inc. (2016) 3 Cal.App.5th 1131, 1137 (Moran).)
Moran‘s sixth amended complaint included both the allegations regarding unconscionability and a new theory of the case. The new allegations asserted defendants had violated the Unfair Competition Law (UCL;
Defendants moved to strike the allegations regarding EMS fees, arguing their disclosure obligations were defined by statute. The trial court agreed and struck the allegations from the sixth amended complaint.
We conclude that the trial court‘s order striking the EMS fee allegations was proper. The duties Moran seeks to impose on defendants interfere with
I
FACTS
Background
As our prior opinion stated, “On three occasions in October 2013, plaintiff, ‘a self-pay patient,’ went to the emergency room of a hospital owned and operated by defendants.... Each time, he signed a printed Conditions of Admission agreement (Contract) and received medical treatment. Subsequently, plaintiff received bills from the hospital for the treatment provided during the three visits that exceeded $10,000.
“In November 2013, plaintiff filed this putative class action against defendants. The initial complaint stated causes of action for breach of contract, breach of the implied covenant of good faith and fair dealing, violation of the UCL, restitutionary relief under the CLRA, and declaratory relief. Plaintiff subsequently dropped the first and second counts. His first amended complaint also expanded the scope of the CLRA cause of action to include a request for damages by alleging that he complied with the statutory requirement of giving defendants notice of the purportedly unlawful practice and a demand for correction of it. Although verbose, confusing, containing contradictory allegations, and contentions of law, each iteration of the complaint is based on allegations the rates defendants charge self-pay patients are discriminatory, exceed the reasonable value of the treatment, and are ‘artificially inflated and grossly excessive.‘” (Moran, supra, 3 Cal.App.5th at pp. 1137-1138.) In July 2014, the Hospital sent a letter to Moran stating that following an administrative review, his accounts had been settled and he had a zero balance. The Hospital also contacted the credit reporting agencies to inform them that any information regarding the Hospital should be removed, and issued Moran a partial refund of $50 for one of his visits. (Id. at p. 1137, fn. 1.)
Defendants demurred to the third amended complaint, which the trial court sustained without leave to amend. (Moran, supra, 3 Cal.App.5th at p. 1138.) We found that while Moran had standing and had sufficiently alleged the Contract was unconscionable, the remainder of his other claims were invalid. (See id. at pp. 1141-1153.)
After remand, Moran filed a fourth and eventually a fifth amended complaint. The fifth amended complaint alleged representative claims with
Following these decisions, Moran later moved to certify a class on a different basis. His proposed “issue” class was based on the question of whether the Hospital had a duty to disclose EMS fees, a subject which had not bеen raised in any of his six prior complaints. The court noted, in denying the motion for class certification, that this class was “quite different from that alleged in [Moran‘s] Fifth Amended Complaint.” The court ultimately denied the motion to certify the class and granted leave to file a sixth amended complaint, which is the operative complaint before us.
Sixth Amended Complaint
In the sixth amended complaint, filed on March 8, 2021,3 Moran stated he challenged “two specific practices of Defendants. First, on a classwide basis, Plaintiff challenges Defendants’ unfair, deceptive, and unlawful practice of charging emergency room patients an ‘Evaluation and Management Services Fee’ or ‘EMS Fee,’ without any notification of their intention to charge a prospective emergency room patient such a Fee for the patient‘s emergency room visit . . . and without any agreement by Plaintiff to pay for such a Fee.” This is the claim, new to the sixth amended complaint,4 that is at issue in this appeal.
Hospital‘s Chargemaster, but rather the fact that Defendants give no notification or warning that they charge an EMS Fee for an emergency room visit. As a result, emergency room patients end up being surprised by a substantial charge added to their bill that they were not expecting. Such charges are effectively hidden by Defendants’ intentional failure to provide notice of them in the emergency room.”
Further, the complaint alleged that the EMS fee is charged “simply for seeking treatment in the emergency room; it is independent of, and in addition to, the charges for the individual items of treatment and services provided to a patient. Rather than being tied to the individual items of treatment and services a patient receives in the emergency room, an EMS Fee is charged to all patients who receive treatment in the emergency room, regardless of what other services and treatment they receive. This Evaluation and Management Services Fee invariably comes as a complete surprise to unsuspecting emergency room patients.” The EMS fee, Moran alleged, is charged at one of five levels.
Defendants, Moran alleged, keep this fee “effectively hidden from patients who might otherwise look for less costly medical treatment and services elsewhere, such as in urgent care facilities that do not charge such fees, or even forego treatment altogether.” The EMS fee “is not visibly posted on signage in or around Hospital‘s emergency rooms or on signage at its registration windows/desks, where a patient would at least have the opportunity of knowing of its existence, nor is it disclosed to patients orally at the time of registration, or by any other means.” Nor, the complaint alleged, is the EMS fee disclosed in writing, either before admission or at the time of discharge. The complaint alleged the chargemaster did not list the EMS fee as being charged to all emergency room patients, although the chargemasters themselves reveal EMS fees for levels two through four are listed under the 25 most common procedures, with language such as “Emergency Room Visit,
Defendants moved to strike the EMS fee claims, arguing that no duty to disclose EMS fees existed outside the context of the requirements set forth in the relеvant provisions of the
After a hearing and supplemental briefing, the trial court issued its ruling granting the Hospital‘s motion to strike. This appeal followed.
II
DISCUSSION
Both parties agree that this case is appealable under the “death knell” doctrine relating to putative class actions. (In re Baycol Cases I & II (2011) 51 Cal.4th 751, 757-759.) We agree that exercising appellate jurisdiction is appropriate in this case.
A. Standard of Review
”
We agree with Moran (the defendants do not argue otherwise) that the questions involved here are questions of law, and accordingly, our review should be the same as would apply if this were a general demurrer. We assume the truth of “all material facts properly pleaded, but not contentions, deductions, or conclusions of fact or law. We also consider matters which may be judicially noticed.” (McBride v. Boughton (2004) 123 Cal.App.4th 379, 384-385.)
B. Propriety of a Motion to Strike
Moran argues that “[a] motion to strike was not the proper vehicle for the relief Hospital sought.” He argues that a motion for summary adjudication was the appropriate procedure. In offering this argument, Moran seeks to have it both ways – contending that we should apply de novo review and treat defendants’ motion to strike as a general demurrer to the specific allegations when it suits him, and claiming that failure to state a cause of action is not an appropriate ground for a motion to strike.
To the extent we treat this case, as Moran explicitly requested, under the same standard of review as a demurrer, we find no error. Moran chose to combine his two theories of liability, unconscionability and failure to disclose the EMS fees, in a single cause of action. Accordingly, a demurrer cannot lie. (Daniels v. Select Portfolio Servicing, Inc. (2016) 246 Cal.App.4th 1150, 1167.)
We find this case easily falls within the purview of PH II, Inc. v. Superior Court (1995) 33 Cal.App.4th 1680, and its progeny, which allows a court to strike a defective рortion of a cause of action. “We recognize that in some cases a portion of a cause of action will be substantively defective on the face of the complaint. Although a defendant may not demur to that portion, in such cases, the defendant should not have to suffer discovery and navigate the often dense thicket of proceedings in summary adjudication. We conclude that when a substantive defect is clear
There is no need for an expensive motion for summary adjudication to add to what must already be the high costs of this almost 10-year-old case. The purported defects are clear from the face of the complaint, and therefore, a motion to strike was proper. Moreover, Moran claims no procedural unfairness as a rеsult of the use of the motion to strike, such as the lack of adequate time to respond. This motion was extensively litigated and carefully considered by the trial court, as reflected in its tentative rulings and orders. Sending this case back for a summary adjudication motion would only be a waste of resources for both the parties and the court.
C. The Statutory Framework
The Payers’ Bill of Rights, effective July 1, 2004, and codified at
As adopted, hospitals were required to (1) “make a written or electronic copy of its charge description master available, either by posting an electronic copy of the charge description master on the hospital‘s Internet Web site, or by making one written or electronic copy available at the hospital location” (Assem. Bill No. 1627 (2003-2004 Reg. Sess.) as amended Sept. 2, 2003), and (2) “post a clear and conspicuous notice in its emergency department, if any, in its admissions office, and in its billing office that informs patients that the hospital‘s charge description master is available in the manner described in subdivision (a).” (Ibid.)
Early versions of the bill would have required facilities that use a chargemaster to provide written copies upon request. (Assem. Bill No. 1627 (2003-2004 Reg. Sess.) as introduced Feb. 21, 2003.) A subsequent version also required “a hospital to post a notice, as specified, that informs patients that the hospital’ [chargemaster] is available on request.” (Assem. Bill No. 1627 (2003-2004 Reg. Sess.) as amended Apr. 7, 2003.) These requirements were changed in the final version of the bill. Hospitals were required to post their chargemasters on
The Payers’ Bill of Rights included other requirements in furtherance of its goal of price transparency. As amended, hospitals were also required to file their chargemasters annually with the Office of Statewide Health Planning and Development (OSHPD), and to list their 25 most common outpatient procedures and the average prices with OSHPD, which publishes that information on its web site. (
Additionally, at the request of a person without insurance, hospitals must provide written estimates of expected charges, but this provision does not apply to emergency services. (
Similarly, federal law applicable to hospitals participating in Medicare, under the Emergency Medical Treatment and Active Labor Act (EMTALA), prohibits delaying treatment of an emergency room patient to inquire about payment or insurance coverage. (
In the process of adopting expanded transparency regulations under the Affordable Care Act, the Center for Medicare and Medicaid Services stated that “the price transparency provisions . . . do not require that hospitals post any signage or make any statement at the emergency department regarding the cost of emergency care or any hospital policies regarding prepayment of fees or payment of co-pays and deductibles.” (84 Fed.Reg. 65524, 65536 (Nov. 27, 2019).)
D. Recent Appellate Decisions
To provide important context, we begin by discussing four recent opinions discussing similar or identical issues, from oldest to most newest: Gray, supra, 70 Cal.App.5th 225; Torres v. Adventist Health System/West (2022) 77 Cal.App.5th 500 (Torres); Saini v. Sutter Health (2022) 80 Cal.App.5th 1054 (Saini) and Naranjo v. Doctors Medical Center of Modesto, Inc. (2023) 90 Cal.App.5th 1193 (Naranjo) (review granted July 26, 2023, S280374.)8 Before doing so, however, we must first discuss an older case which laid some of the groundwork for the later opinions: Nolte, supra, 236 Cal.App.4th 1401.
1. Nolte
The plaintiff filed this case as a putative class action against Cedars-Sinai Medical Center (Cedars) for charging him a one-time facility fee upon seeking treatment from a doctor in a Cedars medical building for the first time. The plaintiff had signed a “conditions of admission” (COA) form promising to pay Cedars for any services Cedars provided, but the plaintiff claimed he did not know he would be charged a facility fee of $167.01. (Nolte, supra, 236 Cal.App.4th at pp. 1404-1405.) The plaintiff sued under the UCL and CLRA, and for unjust enrichment, restitution, and declaratory relief. The trial court sustained Cedars’ demurrer, finding the plaintiff had obligated himself to pay the fee by signing the COA. (Nolte, at p. 1405.)
The appellate court affirmed. As to the UCL claim, the only one the plaintiff did not waive on appeal (Nolte, supra, 236 Cal.App.4th at pp. 1409-1410), the court rejected the claim that the fee was unfair and fraudulent. The fact that the law prescribed exactly what disclosures hospitals are required to provide regarding fees and charges was key to the court‘s decision. “[H]ospitals are required by law to make available a schedule of charges online or at the hospital, and to provide notice to consumers (here, patients) that they have done so in a prescribed fashion, and there is no allegation that Cedars did not do so.” (Id. at p. 1408.)
2. Gray
Gray is the first case that directly addressed the claims at issue here. The plaintiff in Gray received emergency medical care at a Dignity Health hospital, St. Mary‘s Medical Center (St. Mary‘s). He alleged violations of the UCL and CLRA and sought declaratory and injunctive relief because St. Mary‘s did not post signage or verbally tell patients during emergency room registration about an “ER Charge,” which, as far as we can tell, is substantially identical to the EMS charge at issue here. (Gray, supra, 70 Cal.App.5th at pp. 228-229.) The plaintiff did not allege that St. Mary‘s failed to comply with its statutory duties. Rather, the complaint alleged St. Mary‘s was required to do more than state and federal law required by disclosing to emergency room patients, prior to providing any treatment, that its billing will include an ER charge. This was the sole factual basis for the plaintiff‘s complaint. (Id. at pp. 234-235.) Relying largely on Nolte, the trial court sustained St. Mary‘s demurrer without leave to amend.
The appellate court affirmed. (Gray, supra, 70 Cal.App.5th at p. 229.) The court provided a lengthy history of the Payer‘s Bill of Rights9 and related federal law. As
in Nolte, the plaintiff in Gray did not allege a violation of
As the basis for his UCL claim, the plaintiff alleged failing to disclose the ER charge was “unfair” and “unlawful” because of the lack of signage or verbal mention of the charge. He also alleged St. Mary‘s “failure to disclose, prior to providing emergency medical services, that its bill for such service would include an ER Charge is both an ‘unfair’ and ‘unlawful’ business practice because the hospital ‘bills patients amounts in violation of the [CLRA]’ and therefore his UCL ‘claim is tethered to a legislatively declared policy.‘” (Gray, supra, 70 Cal.App.5th at p. 237.)
The court rejected the UCL claim, analogizing to Nolte, where the court had found that failure to specifically disclose the facility fee was not “unfair” or “fraudulent” within the meaning of the UCL. The court found the factual distinctions in Nolte to be immaterial. (Gray, supra, 70 Cal.App.5th at p. 240.) “Indeed, the circumstances in the instant case are even more compelling than those in Nolte. Not only did Dignity fully comply with all state and federal disclosure requirements, including the
We grant the request pursuant to Evidence Code sections 452 and 459 only for the purpose of demonstrating what the original bill stated. We do not take judicial notice of Moran‘s interpretation of what “admission” to a hospital means, nor do we agree with his interpretation.
requirement that there be signage in its emergency room departments stating how its pricing information can be accessed (
With respect to the CLRA claim, the plaintiff relied on
The plaintiff‘s equitable claims were entirely derivative of his UCL and CLRA claims, and could not stand on their own. Accordingly, the court affirmed the trial court‘s decision in its entirety.
3. Torres
The next case, Torres, supra, 77 Cal.App.5th at page 504, while reaching many different conclusions from Gray, ultimately ended up in the same place – with an affirmance of an order in favor of the defendant hospital. This is another case where the only issue was Hanford Community Hospital‘s (Hanford) failure to disclose an EMS fee. The operative complaint alleged this fee was not mentioned in the contract the plaintiff signed, posted in the emergency room, or verbally disclosed to her. (Id. at p. 506Id. at pp. 510-511.) The plaintiff did not allege a violation of the statutory schemes rеgarding disclosure and price transparency, including the Payer‘s Bill of Rights. (Id. at p. 510.) Rather, she alleged that the description of the EMS fee in the chargemaster was not adequate. (Ibid.)
The plaintiff sued under the UCL and CLRA and requested declaratory relief. Hanford moved for judgment on the pleadings, which was ultimately granted without leave to amend. (Torres, supra, 77 Cal.App.5th at pp. 506-507.) The precise amount of an EMS fee, the trial court determined, could not be ascertained until after a patient is evaluated. Accordingly, under
The appellate court began its analysis with the CLRA, noting that the plaintiff had alleged violations of
In its discussion of the issue of failure to disclose, the court acknowledged Nolte and Gray, and stated that its conclusions did not contradict those cases. (Torres, supra, 77 Cal.App.5th at p. 513.) Yet the court focused its analysis primarily on whether the EMS fees were “reasonably accessible” to the plaintiff. (Id. at pp. 510-513.) Rather than focusing on compliance with the extensive state and federal laws on the subject, the court stated the relevant analysis was whether the plaintiff had “reasonable access” to the EMS fees under a reasonable person standard. (Id. at p. 511.)
Hanford argued that compliance with statutory requirements regarding the accessibility of the chargemaster meant that the plaintiff had reasonable access to the material facts as a matter of law. (Torres, supra, 77 Cal.App.5th at p. 512.) But the court noted the operative complaint alleged the chargemaster was “‘unusable and effectively worthless for the purpose of providing pricing information to consumers‘; the chargemaster failed to include the standardized . . . codes recоgnized in the industry; and the chargemaster used coding and highly abbreviated descriptions that are meaningless to consumers. Accordingly, the SAC further alleges that the chargemaster was meaningless for purposes of pricing transparency. In effect, [the plaintiff] contends these allegations are sufficient to allege the material facts were not reasonably accessible and the factual question of reasonable access cannot be resolved at the pleading stage.” (Ibid.)
The court agreed with the plaintiff, finding that based on the operative complaint‘s allegations, she had “stated facts sufficient to plead a lack of reasonable access to (1) the facts that trigger [Hanford‘s] imposition of an EMS Fee and (2) the formula used to determine which level of EMS Fee to impose on an emergency room patient. In short, we cannot conclude as a matter of law that an objectively reasonable person who reviewed [Hanford‘s]
The court noted, however, that this was not the end of the analysis. Failure to disclose under the CLRA must involve material facts: “‘a fact is “material” if a reasonable consumer would deem it important in determining how to act in the transaction at issue.‘” (Torres, supra, 77 Cal.App.5th at p. 513Ibid.) “A misrepresentation or an omission of fact is material only if the plaintiff relied on it—that is, the plaintiff would not have acted as he or she did without the misrepresentation or the omission of fact.” (Ibid.) The court determined that the operative complaint did not properly plead reliance under the CLRA, and further, taken as a whole, it was not reasonable to infer that the plaintiff would have acted differently had she known of the alleged material facts. (Torres, at p. 514.) The EMS fee the plaintiff was charged was for the highest level of severity. “Therefore, without more particular facts alleged, it is reasonable to infer that [the plaintiff] suffered severe injuries that posed a significant threat based on these facts. In turn, it is not reasonable to infer [the plaintiff] would have obtained treatment elsewhere if the facts about the existence, imposition and amount of the EMS Fee had been disclosed.” (Ibid.)
With respect to active concealment, the court concluded the plaintiff had failed to plead with the required particularity or to sufficiently plead reliance. (Torres, supra, 77 Cal.App.5th at p. 514.) Accordingly, the court affirmed the trial court‘s decision to grant judgment on the pleadings.
4. Saini
The appeal in Saini, like Torres and Gray, was almost entirely about the viability of a claim for the alleged failure to disclose an EMS fee. By the time the case reached the appellate court, the UCL and declaratory relief claims had been eliminated, leaving a single cause of action under the now-familiar
The appellate court affirmed, rejecting the plaintiff‘s arguments that Gray was wrongly decided.10 (Saini, supra, 80 Cal.App.5th at pp. 1056-1057.) “We agree [with Gray that] defendant does not have a duty under the CLRA to disclose the EMS Fee by posting additional signage in its emergency rooms. As plaintiff‘s complaint acknowledges, the EMS Fee is disclosed in the hospital‘s chargemaster in compliance with state and federal law. Making the unsupported assumption that this disclosure is insufficient and does not in fact convey the necessary information to one seeking this information before receiving emergency room treatment, there nonetheless is no basis to require further disclosure.” (Id. at p. 1061.)
The plaintiff argued a duty to disclose based on the “‘exclusive knowledge‘” and “‘intentional concealment‘” prongs of the CLRA. (Saini, supra, 80 Cal.App.5th at p. 1061.) The court stated: “The hospital has a duty under the CLRA, as well as the many statutes cited above [including the Payer‘s Bill of Rights], to disclose the fees it intends to charge for its goods and services, including the EMS Fee. It does so
in its chargemaster, to which signage in the emergency room directs those interested. The question here, however, is whether defendant has a duty to call attention to the EMS Fee by additional signage in the emergency room visible to a person seeking emergency care. The Gray court concluded that for the reasons it explained no such duty exists, and we agree.” (Id. at p. 1062.) The court further noted that the Gray court “carefully considered the competing interests served by ensuring that patients are fully apprised in advance of the costs of emergency services and ensuring that patients hаve timely access to emergency services.” (Ibid.) “[A]s Gray makes clear, the state and federal legislative bodies are in a superior position to balance these competing interests and have done so in crafting the applicable ‘multifaceted statutory and regulatory scheme.’ [Citation.] Our conclusion is consistent with the balance struck by the existing regulatory scheme and does not, as plaintiff suggests, disregard the ‘important policy in favor of providing pricing transparency to medical patients.‘” (Id. at p. 1063.)
The court also distinguished Torres, stating that unlike the complaint in Torres, “plaintiff‘s complaint expressly disavows any claim that ‘defendant fails to list an EMS Fee as a line item in its published chargemasters, or that defendant fails to list the price of such fees in its chargemasters.‘” (Saini, supra, 80 Cal.App.5th at p. 1062, fn. 8.) Rejecting the remainder of the
5. Naranjo
After briefing in this case was completed, the Fifth Appellate District decided Naranjo, supra, 90 Cal.App.5th 1193, and as we mentioned above, shortly after oral argument, the California Supreme Court granted review.11 Again, Naranjo cаse was about the propriety of an EMS fee under the UCL and CLRA. The plaintiff‘s complaint alleged “he was never warned or notified” in the conditions of admission or by “signage in the emergency room” that he would be charged an EMS fee. (Naranjo, at p. 1198.)
Following Torres, also decided by the Fifth Appellate District, and the line of cases cited therein, primarily regarding the duty to disclose known facts, the Naranjo court determined the plaintiff had adequately stated claims under the UCL and CLRA.
In sum, Naranjo, supra, 90 Cal.App.5th at page 1193, is the only case which allowed this type of case to proceed on the merits. While Torres tacitly rejected the proposition that the relevant state and federal statutes are the only source of a hospital‘s duty to disclose an EMS fee, the court found no reliance under the CLRA. (Torres, supra, 77 Cal.App.5th at pp. 512-514.) Both Gray and Saini held that hospitals have no duty to disclose beyond the requirements of the state and federal regulatory schemes. (Saini, supra, 80 Cal.App.5th at pp. 1061-1062; Gray, supra, 70 Cal.App.5th at pp. 241-243.)
E. “Implied” Safe Harbor
Moran contends the trial court “effectively” found an “implied safe harbor” for defendants. As we noted in Moran, supra, 3 Cal.App.5th at page 1140, “[w]hen specific legislation provides a ‘safe harbor,’ plaintiffs may not use the general unfair competition law to assault that harbor.‘” (See Cel-Tech Communications, Inc. v. Los Angeles Cellular Telephone Co. (1999) 20 Cal.4th 163, 182.) We do not find the trial court‘s order wrongfully “implied” a safe harbor. It simply found that no duty existed to
post Moran‘s requested signage. (See Saini, supra, 80 Cal.App.5th at p. 1065; Gray, supra, 70 Cal.App.5th at p. 241.)
The UCL‘s purpose is “to safeguard the public against the creation or perpetuation of monopolies and to foster and encourage competition, by prohibiting unfair, dishonest, deceptive, destructive, fraudulent and discriminatory practices by which fair and honest competition is destroyed or prevented.” (
An “unlawful” act or practice is “‘anything that can properly be called a business practice and that at the same time is forbidden by law.‘” (Cel-Tech, supra, 20 Cal.4th at p. 180; see Moran, supra, 3 Cal.App.5th at p. 1140.) As interpreted by this district, “unfair” is defined as stated in Gregory v. Albertson‘s, Inc. (2002) 104 Cal.App.4th 845, 854: “[W]here a claim of an unfair act or practice is predicated on public poliсy,. . . the public policy which is a predicate to the action must be ‘tethered’ to specific constitutional, statutory or regulatory provisions.” (See Graham v. Bank of America, N.A. (2014) 226 Cal.App.4th 594, 613.) A “fraudulent” act or practice is one likely to deceive the public. (Shaeffer v. Califia Farms, LLC (2020) 44 Cal.App.5th 1125, 1135.)
Pursuant to the complaint and as relevant to this appeal, the following acts by the Hospital allegedly violated the UCL: “unfairly and unlawfully charg[ing] their emergency patients an EMS Fee and fail[ing] to inform and/or conceal[ing] from their patients their uniform policy of billing a substantial, unreasonable, and undisclosed EMS Fee in addition to the charges for individual items of treatment or services provided to the patient.” The complaint further alleged: “Knowledge of such an EMS Fee would be a substantial factor in a patient‘s decision as to whether to remain at the hospital and proceed with treatment.”
The legislatively declared policy that makes this practice unfair, the complaint claimed, is the violation of the CLRA. The complaint does not allege that the Hospital violated the UCL by failing to list the EMS fee in the published chargemaster, and Moran conceded that the Hospital filed its chargemaster with the OSHPD and posted it on its own web site as of the date the complaint was filed.12
While “conduct not expressly prohibited by statute may nevertheless be found to be an ‘unfair’ business practice under the UCL [citation], the alleged conduct must nevertheless meet the substantive definition of an ‘unfair’ practice to be actionable,
which the failure to disclose Gray complains of here, does not . . . .” (Gray, supra, 70 Cal.App.5th at p. 242.)
Given that both the state and federal governments have thoroughly considered patients’ need for price transparency about hospital charges, we find that as a matter of law, in accord with Gray and Saini, the Hospital‘s policy of not providing additional signage or other warnings about the EMS fee does not state a claim for unfair, unlawful, or fraudulent conduct within the UCL. “[R]equiring individualized disclosure that the hospital will include an ER Charge in its emergency room billing, prior to providing any emergency medical services, is at odds with the spirit, if not the letter, of the hospital‘s statutory and regulatory obligations with respect to providing emergency medical care.” (Gray, supra, 70 Cal.App.5th at p. 240; see Saini, supra, 80 Cal.App.5th at p. 1060.)13 A hospital‘s duty to list, post, write down, or discuss fees it may or may not charge an emergency room patient starts and ends with its duty to list prices in the chargemaster, which must be available in accordance with state law. (See Id. at p. 1062.)
To the extent that Torres and Naranjo hold otherwise, we decline to follow them. Further, we note that the chargemaster in Torres was allegedly “‘unusable and effectively worthless for the purpose of providing pricing information to consumers,‘” and “failed to include the standardized CPT codes recognized in the industry.” (Torres, supra, 77 Cal.App.5th at p. 512.) Such
through four, in plain English. The аllegations regarding the EMS fee were properly stricken from the UCL cause of action.
G. CLRA Claims Based on EMS Fee
As relevant to this appeal, the alleged portions of the CLRA Moran claims the hospital violated were
Under the CLRA, the failure to disclose is limited to a few narrow factual situations. Here, Moran argues the Hospital had “exclusive knowledge” and “intentionally conceal[ed]” the EMS fee. The court in Saini, which faced the same arguments, rejected the allegations. “[T]here is no withholding of information that is provided on the hospital‘s chargemaster.” (Saini, supra, 80 Cal.App.5th at p. 1062.)
We reject Moran‘s contention that Gray and Saini were wrongly decided. To the extent that Moran would have us reject those cases and rely on Torres, as we discussed above, that case does not help him when it comes to the issue of reliance, another essential element of a CLRA cause of action. As defendants point out, earlier versions of Moran‘s complaint undercut his claim that he “relied on not being billed” an EMS fee. Allegations in earlier complaints continue to bind plaintiff even if the allegation is omitted from subsequent versions. (Panterra GP, Inc. v. Superior Court (2022) 74 Cal.App.5th 697, 711.) To the extent Moran relies entirely on Naranjo, we disagree and decline to follow it.
In his initial complaint, Moran alleged that “patients such as Plaintiff, who
experienced a medical emergency, have no opportunity to shop for prices or negotiate fixed pricing terms in advance.” In the fifth amended complaint, he alleged that “in an emergency care situation,” it is “impossible to look up, compare, or negotiate fixed pricing amounts or payment terms in advance of receiving emergency treatment/services.”
Accordingly, for the same reasons that Gray and Saini articulate so well, we find no duty to disclose the EMS fee under the CLRA beyond those imposed by existing state and federal laws and regulations. But even if we were to disagree and find such a duty, Moran failed to adequately plead reliance. The trial court, therefore, properly struck those allegations from the complaint.
H. The Declaratory Relief Claims based on the EMS Fee
Moran‘s declaratory relief claim with respect to the EMS fee, like his UCL and CLRA claims, relies entirely on the idea that the Hospital was required to take steps beyond what is required by state law to inform him of those fees. We disagree. As the
court noted in Gray, supra, 70 Cal.App.5th at page 245, the claim for declaratory relief “has no independent vitality apart from his UCL and CLRA claims. Rather, it is a request for particular forms of equitable relief. [Citation.] Since his UCL and CLRA claims fail, so too does his request for declaratory . . . relief.” The parts of the declaratory relief action referring to the EMS fee were properly stricken from the complaint.
I. Moran‘s Claimed “Errors” in the Trial Court‘s Ruling
Despite the fact that our review is de novo and the fact that “we review [the trial court‘s] ruling, not its reasoning” (Qualcomm, Inc. v. Certain Underwriters at Lloyd‘s, London (2008) 161 Cal.App.4th 184, 204), Moran has chosen to organize the much of the argument section of his opening brief by picking apart alleged “errors” made by the trial court.15 This is unhelpful as an organizational principle in the instant
III
DISPOSITION
Moran‘s request for judicial notice is granted. The court‘s order striking certain portions of the complaint is affirmed. Defendants are entitled to their costs on aрpeal.
MOORE, J.
WE CONCUR:
O‘LEARY, P. J.
BEDSWORTH, J.
Notes
Assembly Bill No. 1045 (2005-2006 Reg.Sess.), as initially proposed, stated: “Upon admission of a patient and at the pаtient‘s request, the hospital shall provide a written estimate of the hospital‘s charges for the care that the patient is expected to receive.” The enacted version dropped the “upon admission of a patient” language and also explicitly excluded emergency room services. (Stats. 2005, ch. 532, § 3.)
Gray stated that the initial version of