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Horvitz & Levy successfully petitioned the California Supreme Court to review a Court of Appeal opinion adverse to its hospital clients, then persuaded the Supreme Court to reverse. The Supreme Court’s decision ensures that emergency medical service providers seeking reimbursement for emergency services rendered will have the same judicial remedies against public health care service plans that they have against private plans.
As required by state and federal law, two Hospitals provided emergency medical services to three patients enrolled in a health care service plan operated by the County of Santa Clara. The Hospitals had no contract with the County governing rates payable for emergency services rendered to plan members. The Hospitals billed the County for the emergency services rendered, but the County paid only a portion of the billed amounts. The Hospitals then sued the County for the balance under a provision of the Knox-Keene Act (and implementing regulations) requiring a health care service plan to reimburse emergency medical service providers for the “reasonable and customary value” of the emergency care.
The County filed a demurrer, arguing it was immune from liability under Government Code section 815, a provision of the Government Claims Act, which provides that a public entity is not liable for an injury except as otherwise provided by statute. The trial court overruled the County’s demurrer, but the Court of Appeal granted the County’s petition for a writ of mandate. In a published opinion, the Court of Appeal held the County was immune from the Hospitals’ suit.
The Hospitals then retained Horvitz & Levy to seek review in the California Supreme Court. The Court granted the Hospitals’ petition for review and reversed the Court of Appeal’s judgment. In a unanimous opinion, the Supreme Court accepted the Hospitals’ argument that “[t]he immunity provisions of the Government Claims Act are directed toward tort claims; they do not foreclose liability based on contract or the right to obtain relief other than money or damages. [Citation.] The Hospitals have not alleged a conventional common law tort claim seeking money damages. Instead, they have alleged an implied-in-law contract claim based on the reimbursement provision of the Knox-Keene Act, and seek only to compel the County to comply with its statutory duty. Accordingly, the County is not immune from suit under the circumstances and the Hospitals’ claim may proceed.”
