Judge: Alison Mackenzie, Case: 23STCV00571, Date: 2024-09-17 Tentative Ruling



Case Number: 23STCV00571    Hearing Date: September 17, 2024    Dept: 55

NATURE OF PROCEEDINGS:  Hearing on Kaiser Foundation Health Plan, Inc.’s Motion for Summary Judgment

Kaiser Foundation Health Plan, Inc.’s Motion for Summary Judgment is granted. 

 

BACKGROUND

Plaintiff Angela Reyes brings this action against Kaiser Foundation Health Plan, Inc. (“the Plan”), Kaiser Foundation Hospitals, Southern California Permanente Medical Group, Chuong Khac Do, M.D., and Doe defendants 1 to 50 alleging that while treating Plaintiff, Defendants failed to remove a surgical sponge, resulting in an infection. 

The causes of action are: 1) Medical Negligence and 2) Managed Care Negligence.

The motion now before the Court is the Plan’s Motion for Summary Judgment. Plaintiff did not file an opposition.

 

 

LEGAL STANDARD

In moving for summary judgment or summary adjudication, a “defendant… has met his or her burden of showing that a cause of action has no merit if the party has shown that one or more elements of the cause of action, even if not separately pleaded, cannot be established, or that there is a complete defense to the cause of action.” Code Civ. Proc., § 437c, subd. (p)(2). Once the defendant has satisfied that burden, the burden shifts to the plaintiff to “show, by responsive separate statement and admissible evidence, that triable issues of fact exist.” Ostyan v. Serrano Reconveyance Co. (2000) 77 Cal.App.4th 1411, 1418, disapproved on other grounds by Black Sky Cap., LLC v. Cobb (2019) 7 Cal.5th 156, 165; see also Code Civ. Proc., § 437c, subd. (p)(2). Courts “liberally construe the evidence in support of the party opposing summary judgment and resolve doubts concerning the evidence in favor of that party.” Dore v. Arnold Worldwide, Inc. (2006) 39 Cal.4th 384, 389.

 

ANALYSIS

The Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene) governs health care services in California. Gopal v. Kaiser Foundation Health Plan, Inc. (2016) 248 Cal.App.4th 425, 430 (Gopal); see Health & Saf. Code § 1340 et seq. Under the Act, a “health care service plan” is defined as “[a]ny person who undertakes to arrange for the provision of health care services to subscribers or enrollees, or to pay for or to reimburse any part of the cost for those services, in return for a prepaid or periodic charge paid by or on behalf of the subscribers or enrollees.” Health & Saf. Cod, § 1345(f)(1). Health care service plans “are not health care providers under any provision of law,” (Civ. Code, § 3428 (c)), but “may employ, or contract with, any professional” licensed in the state. Health & Saf. Code § 1395 (b). A “provider” is “any professional person, organization, health facility, or other person or institution licensed by the state to deliver or furnish health care services.” Health & Saf. Code § 1345(i).

“Knox-Keene bars claims against a plan for vicarious liability.” Gopal, supra, 248 Cal.App.4th at p. 431. “A plan, any entity contracting with a plan, and providers are each responsible for their own acts or omissions, and are not liable for the acts or omissions of, or the costs of defending, others.” Health & Saf. Code § 1371.25. Likewise, a healthcare service plan generally cannot be held liable under an enterprise theory of liability. See Gopal, supra, 248 Cal.App.4th at p. 432. 

Here, the Plan proffers the following facts: Defendant is a health care service plan licensed by the California Department of Managed Health Care under the Knox Keene Health Care Service Plan Act of 1975. Separate Statement of Undisputed Material Facts (“UMF”) 13. The Plan contracts with Permanente Medical Groups and Kaiser Foundation Hospitals to arrange for the provision of healthcare services for its members. UMF 14. As a plan member, Plaintiff was provided medical care and treatment by the physicians and staff of Southern California Permanente Medical Group and Kaiser Foundation Hospitals. The Plan did not provide medical care or treatment to Plaintiff at any time. UMF 16. Both of Plaintiff’s causes of action concern Defendants’ alleged negligence in their management of Plaintiff’s treatment and breach of the duty of care by not ensuring that all sponges and gauzes were removed following surgery. UMF 8-11. 

Because the Plan has established that it is a health care service plan under the Knox-Keene Act, it did not owe Plaintiff a duty of care for medical treatment and cannot be held vicariously liable for the other Defendants’ alleged negligence.  Therefore, the Plan has met its burden to demonstrate that there are no triable issues of material fact.

As she did not file an opposition, Plaintiff has not met her burden of showing that a triable issue of material fact exists. Accordingly, the Plan’s Motion for Summary Judgment is granted. 

 

CONCLUSION

The Plan’s Motion for Summary Judgment is granted.