UFCW & EMPLOYERS BENEFIT TRUST, Plaintiff and Respondent, v. SUTTER HEALTH et al., Defendants and Appellants.
No. A143399
First Dist., Div. Five
Oct. 27, 2015
241 Cal. App. 4th 909
[No. A143399. First Dist., Div. Five. Oct. 27, 2015.]
UFCW & EMPLOYERS BENEFIT TRUST, Plaintiff and Respondent, v. SUTTER HEALTH et al., Defendants and Appellants.
COUNSEL
Hooper, Lundy & Bookman, James F. Segroves and Glenn E. Solomon for California Hospital Association as Amicus Curiae on behalf of Defendants and Appellants.
Pillsbury & Coleman, Richard L. Grossman; Farella Braun + Martel, John L. Cooper, Roderick M. Thompson, Christopher C. Wheeler; Cohen Milstein Sellers & Toll, Kit A. Pierson, Daniel A. Small, Laura M. Alexander; Davis Cowell & Bowe, Steven L. Stemerman and Elizabeth A. Lawrence for Plaintiff and Respondent.
OPINION
BRUINIERS, J.----Respondent UFCW & Employers Benefit Trust (UEBT) is a health care employee benefits trust governed by the Employee Retirement Income Security Act of 1974 (ERISA) (
In this action, UEBT sues Sutter, on behalf of a putative class of all California self-funded payors, alleging that Sutter‘s various written and oral contracts with network vendors—such as Blue Shield—contain anticompetitive terms that insulate Sutter from competition and drive up the cost of health care. UEBT seeks, inter alia, damages, restitution, and injunctive relief under the Cartwright Act (
I. FACTUAL AND PROCEDURAL BACKGROUND
This case centers on two contracts—one between Sutter and Blue Shield (the Provider Contract) and an “administrative services only” agreement between Blue Shield and UEBT (the ASO Contract).
The Terms of the Contracts
In 2007, Sutter and Blue Shield signed a “Systemwide Amendment” that, among other things, (1) provides reduced service rates to Blue Shield and third parties that contract with Blue Shield to pay those rates and (2) contains an arbitration clause.2
With respect to third party payors, the Provider Contract (see fn. 2) provides that Blue Shield‘s “provider network, which includes all the [Sutter] Providers, may be sold, leased, transferred or conveyed,” and that Blue Shield “shall comply with all requirements of . . . Section 1395.6.”3 Accordingly, the Provider Contract provides that only third party payors “that both (i) Actively Encourage their Members to use [Blue Shield]‘s provider network and (ii) use [Blue Shield]‘s provider network as their exclusive network in areas where [Blue Shield] is the contracted network for the specific Benefit Program shall be permitted to access the discounted rates set forth in this Agreement.” The Provider Contract also requires Blue Shield to disclose to Sutter the third party payors “currently eligible to access the Providers.”
In 2007, the Provider Contract required “[Blue Shield] [to] assure that Other Payers have agreed to be bound by . . . the Dispute Resolution and Binding Arbitration Process outlined in Exhibit 13.” The Provider Contract also contained a confidentiality provision that defined the agreement itself as “Confidential Information,” to be maintained “in strictest confidence.” Sutter prohibited Blue Shield from disclosing the terms of the Provider Contract without prior written authorization.
In 2009, Blue Shield and UEBT entered into the ASO Contract. Thereunder, UEBT pays Blue Shield a fee for administrative services, including processing the health care providers’ claims for payment, as well as for access to Blue Shield‘s provider network at the rates negotiated by Blue
As a result of the ASO Contract, UEBT became an “ASO Payer” under the Provider Contract. UEBT and Blue Shield acknowledged, “in making its network of Contracted Providers available to [UEBT], Blue Shield is subject to California Business and Professions Code [section] 511.1 et seq.” (Italics added & omitted.) Accordingly, UEBT agreed “to actively encourage the use of the Contracted Providers“—an obligation it has fulfilled. However, section 9.3 of the ASO Contract provides: “Benefit payments made by [UEBT] to Contracted Providers shall be in accordance with the payment provisions in the contracts between Blue Shield and Contracted providers to the extent such payment terms are communicated to Client. Nothing in this Agreement is intended to create any third party beneficiary rights in any persons or entities, including, but not limited to, Contracting Providers. This Agreement does not create any contractual relationship between [UEBT] and Contracted Providers, nor shall anything in this Agreement be construed as a sale, lease or transfer to [UEBT] of any agreement or contract between Blue Shield and any Contracting Provider.” (Italics added.)
Pursuant to the ASO Contract, Blue Shield notified Sutter that UEBT enrollees would be accessing the Blue Shield network of providers. UEBT‘s beneficiaries began presenting Blue Shield cards to Sutter to obtain medical services at the agreed rates. The existence of the Provider Contract‘s arbitration clause was not disclosed to UEBT.
In 2012, Sutter and Blue Shield amended the Provider Contract, amending the “Dispute Resolution” provision so that it expressly applied to “[a]ll disputes” between “Sutter and any . . . ASO Payer.” Blue Shield was also now contractually required to ensure “that all . . . ASO Payers . . . have agreed to be bound by the terms of this Agreement, including without limitation the Dispute Resolution and Binding Arbitration Process set forth in Exhibit 13.” However, Sutter and Blue Shield did not amend exhibit 13, which continued to provide: ”Overall Scope. The provisions for mediation and binding arbitration set forth in this Exhibit shall apply to all disputes between the Parties arising from or in any way related to the Provider Contracts and/or this Amendment . . . . [¶] . . . [¶] Agreement to Arbitrate. If they cannot resolve their disputes through the meet and confer process or mediation (if applicable), the Parties shall submit the dispute(s) to binding arbitration in lieu of any form of litigation in any court.” The “Parties” are defined in the preamble as Sutter and Blue Shield.
UEBT‘s Lawsuit Against Sutter
In April 2014, UEBT sued Sutter, on behalf of itself and a class of all other California self-funded payors who have paid Sutter, claiming that the terms of the “written or oral contracts” Sutter enters with network vendors violate the Cartwright Act and the UCL, causing the class members to overpay for Sutter‘s services. Specifically, UEBT alleges on information and belief,4 that Sutter demands inclusion of anticompetitive terms, including prohibiting disclosure of hospital pricing information, prohibiting efforts to encourage patients to select the most cost-effective providers, and requiring network vendors to include all of Sutter‘s hospitals and facilities in their networks. Through this alleged anticompetitive conduct, in combination with “punitively high [o]ut-[o]f-[n]etwork [h]ospital [c]hargemaster pricing,” Sutter forecloses price competition, allowing it to charge inflated prices that substantially exceed the prices charged by other local hospitals. UEBT alleges the cost of hospital health care in Northern California exceeds the cost of care in more competitive markets, like Southern California, by an average of 38 percent as a result. UEBT seeks, inter alia, damages, restitution, and declaratory and injunctive relief prohibiting Sutter‘s anticompetitive conduct.
Motion to Compel Arbitration
Sutter moved to compel arbitration of UEBT‘s complaint. Sutter argued, inter alia, that UEBT was bound by
In its statement of decision, the trial court observed, “under the 2012 Amendments, Sutter and Blue Shield agreed that the arbitration provision
II. DISCUSSION
It is undisputed that UEBT did not sign the Provider Contract, which contains an arbitration agreement. UEBT only signed the ASO Contract, in which it expressly agreed to litigate unresolved disputes in California courts. The question, on appeal, is whether Sutter can nonetheless compel UEBT to arbitrate its antitrust and UCL claims. Sutter contends the trial court erred in denying its motion to compel because (1)
A. Arbitration Overview
Both the Federal Arbitration Act (
Corp. (1983) 460 U.S. 1, 24–25 [“the [Federal] Arbitration Act establishes that, as a matter of federal law, any doubts concerning the scope of arbitrable issues should be resolved in favor of arbitration . . .“]; Wagner Construction Co. v. Pacific Mechanical Corp. (2007) 41 Cal.4th 19, 25–26 [strong public policy in favor of arbitration].) “The fundamental policy underlying both acts ‘is to ensure that arbitration agreements will be enforced in accordance with their terms.’ ” (Avery v. Integrated Healthcare Holdings, Inc. (2013) 218 Cal.App.4th 50, 59, italics omitted.)
” ’ ” ‘Arbitration is therefore a matter of contract. [Citation.] The . . . policy favoring arbitration cannot displace the necessity for a voluntary agreement to arbitrate.’ ” [Citation.] “Although ‘[t]he law favors contracts for arbitration of disputes between parties’ [citation], ‘there is no policy compelling persons to accept arbitration of controversies which they have not agreed to arbitrate . . . .’ ” [Citations.]’ [Citation.] ‘Absent a clear agreement to submit disputes to arbitration, courts will not infer that the right to a jury trial has been waived.’ ” ’ ” (Avery v. Integrated Healthcare Holdings, Inc., supra, 218 Cal.App.4th at p. 59, italics omitted.)
In other words, “[t]he strong public policy in favor of arbitration does not extend to those who are not parties to an arbitration agreement, and a party cannot be compelled to arbitrate a dispute that he has not agreed to resolve by arbitration.” (Benasra v. Marciano (2001) 92 Cal.App.4th 987, 990; accord, Matthau v. Superior Court (2007) 151 Cal.App.4th 593, 598.) “The party seeking arbitration bears the burden of proving the existence of an arbitration agreement . . . .” (Pinnacle Museum Tower Assn. v. Pinnacle Market Development (US), LLC (2012) 55 Cal.4th 223, 236 (Pinnacle Museum).)
Nonetheless, there are doctrines under which nonsignatories to an arbitration agreement can be compelled to arbitrate, including incorporation by reference, assumption, agency, veil-piercing or alter ego, estoppel, and third party beneficiary. (Suh v. Superior Court (2010) 181 Cal.App.4th 1504, 1513.) “Whether or not an arbitration agreement is operative against a person who has not signed it involves a question of ‘substantive arbitrability’ which is to be determined by the court.” (Boys Club of San Fernando Valley, Inc. v. Fidelity & Deposit Co. (1992) 6 Cal.App.4th 1266,
resolve the issue, because “[e]ven if the [Federal Arbitration Act] applies, the question whether a contract containing an arbitration provision can be enforced by or against nonparties to the contract is governed by state law principles.” (DMS Services, LLC v. Superior Court (2012) 205 Cal.App.4th 1346, 1353, fn. 3 (
1271. Whether an arbitration agreement is operative against a nonsignatory is a question of law reviewed de novo.9 (Suh, at p. 1512.)
B. Section 1375.7
Sutter acknowledges the trial court found that UEBT had never seen the Provider Contract, but argues that finding is irrelevant. Instead, Sutter‘s primary argument is that UEBT is bound to arbitrate its complaint by virtue of
The proper interpretation of
Despite the trial court‘s brief suggestion to the contrary, there is no legitimate dispute that Blue Shield is a “contracting agent,” that Sutter is a “health care provider,” or that UEBT is a “payor.” Instead, as the parties frame the issue, we must determine the meaning of the undefined terms “sells, leases, or transfers.” Sutter contends that the statutory terms must be given a broad interpretation—to describe the situation, as presented here, when a network vendor accepts a fee from a payor in exchange for the payor‘s access to the provider network at reduced rates. “[O]therwise, UEBT could pay Sutter the same reduced rates that Blue Shield pays but without providing the consideration Sutter bargained for in exchange for those rates. . . . As the statute recognizes, it would be manifestly unfair if UEBT could retain the benefits of the contract without providing the consideration Sutter required in exchange.” UEBT, on the other hand, argues that the Legislature intended
“In construing statutes . . . our task is to ascertain and give effect to the legislative intent. (People v. Murphy (2001) 25 Cal.4th 136, 142.) ‘We begin by examining the words of the statute, giving them their usual and ordinary meaning and construing them in the context of the statute as a whole. [Citations.] If the plain language of the statute is unambiguous and does not involve an absurdity, the plain meaning governs.’ ” (Eel River Disposal & Resource Recovery, Inc. v. County of Humboldt (2013) 221 Cal.App.4th 209, 225 (Eel River).) “Ambiguity exists when a statute is capable of being understood by reasonably well-informed persons in two or more different senses.” (Ibid.)
“Where . . . the statutory language is susceptible of more than one reasonable interpretation, . . . ’ “we look to a variety of extrinsic aids, including the ostensible objects to be achieved, the evils to be remedied, the
The trial court found the statutory interpretation issue to be “very close.” The court noted, “The parties’ briefing is insufficient to determine the issues, although given the variation in Legislative definition noted [in sections 1375.7 and 1395.6] UEBT is probably right” that UEBT had merely “accessed” the network and that “accessing” the network is something different from obtaining the right to use the network at reduced rates by sale, lease, or transfer.
Sutter maintains the trial court relied on a distinction without a difference. According to Sutter, “[t]he right to access is the result of the transaction between Blue Shield and UEBT, and a sale, lease, or transfer is how that result came about.” (Boldface & italics omitted.) Sutter contends that similar terms have already been judicially construed and that a sale, lease, or transfer can be accomplished without assignment. It relies on Patterson v. Domino‘s Pizza, LLC (2014) 60 Cal.4th 474, Korean Air Lines Co., Ltd. v. County of Los Angeles (2008) 162 Cal.App.4th 552, and Gomon v. TRW, Inc. (1994) 28 Cal.App.4th 1161. But none of these decisions involve statutory construction of what it means to “sell[], lease[], or transfer[]” a contract, much less in the instant context. (
Nor does
Confounding the problem is the fact that the Legislature employed different terms in
In our view,
However, even if we assume Sutter‘s interpretation of “sells, leases, or transfers” is correct, we would still conclude that
As amended by the Assembly on April 21, 2003, Assembly Bill No. 175 (2003–2004 Reg. Sess.) would have added the following language to
Sutter‘s reliance on Pinnacle Museum does not compel a contrary conclusion. In that case, a homeowners association sued a condominium developer for construction defects. (Pinnacle Museum, supra, 55 Cal.4th at pp. 231, 233.) The developer moved to compel arbitration, based on a clause in the recorded declaration of covenants, conditions, and restrictions providing that the association and the individual owners agreed to resolve any construction dispute with the developer through binding arbitration. (Id. at pp. 231, 232–233.) There was no dispute that the individual owners, who bought condominiums via purchase agreements referencing and incorporating the arbitration clause, were bound to arbitrate. (Id. at p. 233 & fn. 3.) The question was whether the association, which was not a party to the purchase agreements or in independent existence at the time the covenants, conditions, and restrictions were recorded, was similarly bound. (Id. at pp. 234, 240.)
A majority of our Supreme Court concluded that, under the statutory and decisional law pertaining to common interest developments, the covenants, conditions, and restrictions reflect written promises and agreements to which a developer and owners may bind the association. (Pinnacle Museum, supra, 55 Cal.4th at pp. 232, 241.) The court observed: “As discussed, the Legislature has crafted a statutory scheme providing for the capacity of a developer to create a condominium development subject to covenants and restrictions governing its operation and use. There appears no question that, under the
Pinnacle Museum merely illustrates the following principle: “[T]he Legislature may devise reasonable rules in civil litigation to permit the delegation to another party of the power to consent to arbitration instead of a jury trial.” (Ruiz v. Podolsky (2010) 50 Cal.4th 838, 853.) Other courts have similarly determined a nonsignatory bound to arbitrate due to statutory delegation of the power to consent to a party with whom the nonsignatory has a special relationship. (See id. at pp. 849, 852, 854 & fn. 5 [arbitration agreement specifically binding nonsignatory heirs also binding against wrongful death claimants under a statute clearly designed to permit patients to bind heirs in such actions].)
However, here, the Legislature has not indicated any intent to alter the obligations of third party payors, like UEBT, either in the plain language or legislative history of
C. Equitable Estoppel
We find Sutter‘s common law theories no more persuasive. Sutter argues that equitable estoppel “reinforce[s]”
“Under [the doctrine of equitable estoppel], as applied in ‘both federal and California decisional authority, a nonsignatory defendant may invoke an arbitration clause to compel a signatory plaintiff to arbitrate its claims when the causes of action against the nonsignatory are “intimately founded in and intertwined” with the underlying contract obligations.’ [Citations.] ‘By relying on contract terms in a claim against a nonsignatory defendant, even if not
Sutter contends that UEBT is “seeking to retain . . . the benefits it receives under the Provider Contract while disavowing its obligations under that same contract.” To the contrary, UEBT‘s complaint challenges the legitimacy of the terms of all “arrangements” negotiated by Sutter with Blue Shield and other network vendors, and argues they were part of Sutter‘s unlawful scheme to prevent price competition. In its complaint, UEBT is only seeking to enforce the UCL and the Cartwright Act, it is clearly not seeking to enforce or otherwise take advantage of any portion of the Provider Contract. In fact, UEBT seeks to enjoin Sutter from implementing the allegedly anticompetitive contract terms. The doctrine of equitable estoppel has no application. (See McArthur v. McArthur (2014) 224 Cal.App.4th 651, 658 [beneficiary of trust document containing arbitration clause is not bound when she argues trust is invalid and seeks to have it set aside].) UEBT did not play “fast and loose” with the commitment to arbitrate, “honoring it when advantageous and circumventing it to gain undue advantage.” (Metalclad, supra, 109 Cal.App.4th at p. 1714.)
We agree with the trial court that DMS Services, supra, 205 Cal.App.4th 1346 is on point. In that case, an employer entered into workers’ compensation insurance agreements containing arbitration clauses with an insurance company. The employer also entered into separate agreements with a third party administrator to review and adjust workers’ compensation insurance claims. None of the latter agreements contained an arbitration clause. Ultimately, the employer sued the third party administrator, alleging claims for breach of contract and tortious breach of the implied covenant of good faith and fair dealing based on the third party administrator‘s mishandling of claims. (Id. at pp. 1349–1350.) The trial court concluded that, under the
The reviewing court reversed. (DMS Services, supra, 205 Cal.App.4th at pp. 1354–1355, 1358.) It explained: “[The employer‘s] complaint alleges [the third party administrator] breached its administrator duties under the claims administration agreement; it does not allege, nor could it against [the third party administrator], a breach of the deductible or policy agreements to which [the third party administrator] is not a party. Similarly, it does not rely on any provision in those agreements to support its claims. [Citations.] Accordingly, there is no basis to find that the complaint against [the third party administrator] for breaching the claims administration agreement is ‘intimately founded in’ the deductible agreement containing the arbitration clause.” (Id. at p. 1355, italics added & fn. omitted.)
The reviewing court also rejected the third party administrator‘s argument that the employer‘s claims were ” ‘inextricably intertwined’ with the deductible agreements because those agreements give rise to [the employer‘s] claims—that is, [the third party administrator‘s] alleged breach of the claims administration contract caused [the employer] to owe more money to [the insurance company] under the deductible agreements.” (DMS Services, supra, 205 Cal.App.4th at p. 1356.) The court observed, “[t]his argument confuses the concept of ‘claims founded in and intertwined with the agreement containing the arbitration clause’ with but-for causation. A standard indemnity claim, for example, does not exist but for the precursor action giving rise to it. Nevertheless, in those circumstances, the doctrine of equitable estoppel does not bind nonsignatory indemnitors to an arbitration agreement between the parties to the underlying action when, as here, the indemnity claims are not founded in the contract containing the arbitration provision and there is no preexisting relationship between the defendants on which to base an estoppel.” (Id. at pp. 1356–1357.) The court also recognized that the litigation would involve some interpretation of the insurance policy agreements, but concluded that overlap “is a far cry from claims grounded in, and ‘inextricably intertwined with,’ the arbitration agreement.” (Id. at p. 1357.)
Here, too, UEBT is not seeking to enforce the terms or obligations of the Provider Contract, while at the same time seeking to avoid arbitration. UEBT‘s complaint does not specifically refer to the Provider Contract. Unlike in DMS Services, however, UEBT makes repeated reference to written agreements between Sutter and network vendors. The Provider Contract is one such agreement. Resolution of UEBT‘s claims may require reference to the terms of the Provider Contract, but “merely ‘mak[ing] reference to’ an
Nor did UEBT otherwise “accept the benefits” of the Provider Contract, as Sutter suggests.13 Rather, UEBT entered into a separate contract with Blue Shield—the ASO Contract—under which it paid Blue Shield consideration in exchange for access to Blue Shield‘s discounted provider rates. Blue Shield, to perform its own contractual obligations under the ASO Contract, provided UEBT with access to its provider network at the discounted rates it had separately negotiated.
In fact, Sutter specifically authorized Blue Shield to provide access to self-funded payors that actively encourage their health plan enrollees to choose a provider within the network. Blue Shield ensured that “[b]enefit payments made by [UEBT] to Contracted Providers shall be in accordance with the payment provisions in the contracts between Blue Shield and Contracted providers to the extent such payment terms are communicated to Client.” And UEBT actively encourages its members to use providers within the preferred network. Sutter is receiving an increased client base in exchange for authorizing Blue Shield to extend network rates to third party payors.
D. Ostensible Agency
Nor did the trial court err in rejecting Sutter‘s theory that Blue Shield was UEBT‘s agent in contract negotiations and thereby bound UEBT to the 2012 amendment of the Provider Contract. “An agency is either actual or ostensible.” (
“An agency is ostensible when the principal intentionally, or by want of ordinary care, causes a third person to believe another to be his agent
Even if these acts suggested Blue Shield had some authority to act on UEBT‘s behalf in administering its plan, we fail to see how UEBT members’ use of Blue Shield cards to obtain services from Sutter providers reasonably suggests that UEBT had authorized Blue Shield to bind UEBT to all terms of the Provider Contract. (See Lindsay-Field v. Friendly (1995) 36 Cal.App.4th 1728, 1734 [“persons dealing with an assumed agent are bound at their peril to ascertain the extent of the agent‘s authority“].) That Blue Shield may have led Sutter to believe it was so authorized is no matter. “Ostensible authority must be based on the acts or declarations of the principal and not solely upon the agent‘s conduct.” (Taylor v. Roseville Toyota, Inc. (2006) 138 Cal.App.4th 994, 1005; accord, Hilyar v. Union Ice Co. (1955) 45 Cal.2d 30, 42.)
In the alternative, Sutter maintains that UEBT subsequently ratified Blue Shield‘s agency when a UEBT claims adjustor neglected to follow up on a “Provider Appeal,” dated January 15, 2013. The Provider Appeal referenced Sutter‘s position that the terms and conditions of the Provider Contract “apply to BOTH Blue Shield and all payers[] accessing the Blue Shield contract,” as well as specifically referencing Blue Shield‘s obligation to ensure that such other payors have agreed to be bound by the terms of the Provider Contract, including, but not limited to, “the Dispute Resolution and Binding Arbitration Process outlined in Exhibit 13.”
An actual agency may be created by ratification. (
The trial court did not err in concluding UEBT is not bound to arbitrate. Accordingly, we need not address Sutter‘s final argument that the trial court erred in determining the arbitration agreement‘s scope.
III. DISPOSITION
The order denying Sutter‘s motion to compel arbitration is affirmed. UEBT is to recover its costs on appeal.
Simons, Acting P. J., and Needham, J., concurred.
Appellants’ petition for review by the Supreme Court was denied January 13, 2016, S231039.
