Judge: David B. Gelfound, Case: 22STCP04080, Date: 2025-02-28 Tentative Ruling

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Case Number: 22STCP04080    Hearing Date: February 28, 2025    Dept: F49

LOS ANGELES SUPERIOR COURT

NORTH VALLEY DISTRICT

DEPARTMENT F49

DEMURRER WITH MOTION TO STRIKE

Motion filed: 2/6/23

MOVING PARTY: Defendants Providence Health System – Southern California d/b/a Providence Holy Cross Medical Center, and Providence Health System – Southern California d/b/a Providence Holy Cross Sub-Acute and Providence Holy Cross Med Center D/P SNF

RESPONDING PARTY: Plaintiff Theodore Sandoval

NOTICE: OK.

RELIEF REQUESTED: An order sustaining the demurrer to Plaintiff’s Complaint, and striking portions of the Complaint.

TENTATIVE RULING: The demurrer is OVERRULED. The motion to strike is DENIED AS MOOT.

BACKGROUND

This action arises from injuries that Plaintiff allegedly sustained while receiving treatment and care from Defendants, including medical facilities and healthcare providers.

On November 14, 2022, Plaintiff Theodore Sandoval (“Plaintiff” or “Sandoval”) filed the operative Complaint against Defendants Providence Health System – Southern California, d/b/a Providence Holy Cross Medical Center (“Providence Medical Center”), and Providence Health System – Southern California d/b/a Providence Holy Cross Sub-Acute and Providence Holy Cross Med Center D/P SNF (“Providence Sub-Acute and SNF”), Boris Borazani, M.D., Evan J. Valle, M.D., Providence Health & Services, Parkwest Rehabilitation Center, LLC, d/b/a Parkwest Healthcare Center (“Parkwest”), Crystal Solorzano, and Does 1 through 100. The Complaint alleges two causes of action: (1) Dependent Adult Abuse/Neglect (Pursuant to Welfare and Institutions Code § 15600, et seq.), and (2) Violation of Resident’s Rights (Pursuant to Health & Safety Code § 1430(b)).

On February 6, 2023, Defendants Providence Medical Center and Providence Sub-Acute and SNF (collectively, “Demurring Defendants”) filed the instant Demurrer (the “Demurrer”), concurrently with a Motion to Strike (the “Motion”).

On April 15, 2023, Department F47 Court denied Defendant Parkwest’s motion to compel binding arbitration. Subsequently, on May 15, 2023, Defendant Parkwest filed a Notice of Appeal and, on the following day, May 16, 2023, a Notice of Stay Pending Appeal. On May 25, 2023, Department F47 Court issued an order staying the entire action. (5/25/2023 Minute Order.)

On October 30, 2024, the Court received a Remittitur certifying that the order and opinion entered by the Court of Appeal in this matter, dated August 29, 2024, became final. Subsequently, on November 14, 2024, the Court entered an order lifting the stay pending appeal. (11/14/24 Minute Order.)

On February 13, 2025, Plaintiff filed his Oppositions to the instant Demurrer and Motion. On February 21, 2025, Providence Medical Center and Providence Sub-Acute and SNF submitted their Reply.  

ANALYSIS

A demurrer can be used only to challenge defects that appear on the face of the pleading under attack; or from matters outside the pleading that are judicially noticeable. (Blank v. Kirwan (1985) 39 Cal.3d 311, 318.) No other extrinsic evidence can be considered.

A demurrer for sufficiency tests whether the complaint states a cause of action. (Hahn v. Mirda (2007) 147 Cal.App.4th 740, 747 (Hahn).) When considering demurrers, courts read the allegations liberally and in context. (Taylor v. City of Los Angeles Dep’t of Water & Power (2006) 144 Cal.App.4th 1216, 1228.) In a demurrer proceeding, the defects must be apparent on the face of the pleading or via proper judicial notice. (Donabedian v. Mercury Ins. Co. (2004) 116 Cal.App.4th 968, 994.)

“A demurrer tests the pleadings alone and not the evidence or other extrinsic matters. Therefore, it lies only where the defects appear on the face of the pleading or are judicially noticed.” (SKF Farms v. Superior Ct. (1984) 153 Cal.App.3d 902, 905.) “The only issue involved in a demurrer hearing is whether the complaint, as it stands, unconnected with extraneous matters, states a cause of action.” (Hahn, supra, 147 Cal.App.4th at 747.) 

A.    Meet and Confer Requirement

A party filing a demurrer “shall meet and confer in person or by telephone with the party who filed the pleading that is subject to demurrer for the purpose of determining whether an agreement can be reached that would resolve the objections to be raised in the demurrer.” (Code Civ. Proc., § 430.41, subd. (a).) A failure to meet and confer does not constitute grounds to sustain or overrule a demurrer. (See Code Civ. Proc., § 430.41, subd. (a)(4).)

            The Court finds that the parties have satisfied the requirement for an in-person or telephonic meet and confer, under Code of Civil Procedure section 430.41, subd. (a). (Dik Decl., ¶ 2.)

B.     Request for Judicial Notice

Demurring Defendants request the Court take judicial notice of the following:

1.      Request for Judicial Notice (“RJN”) No. 1: The existence and contents of the Articles of Incorporation for Providence Health System–Southern California. (RJN Ex. “A.”)

2.      That the Articles of Incorporation for Providence Health System–Southern California bear a stamp stating: "Filed in the office of the Secretary of State of the State of California" dated "Dec 22, 1999" and the signature and name of "Bill Jones Secretary of State."

3.      That Providence Health System–Southern California is listed with the California Secretary of State as a California non-profit religious corporation.

4.      That the Articles of Incorporation for Providence Health System–Southern California at Article V states: "This corporation is a religious corporation and is not organized for the private gain of any person. It is organized under the Nonprofit Religious Corporation Law primarily for religious purposes."

Evidence Code section 452 provides, in pertinent part, that: “Judicial notice may be taken of the following matters ... (c) Official acts of the legislative, executive, and judicial department of the United States and of any state of the United States.” (Evid. Code, § 452, subd. (c).)

Additionally, courts may take judicial notice of the article of incorporation from the California Secretary of State’s website. (Evid. Code, § 452, subd. (c); Jones v. Goodman (2020) 57 Cal.App.5th 521, fn. 6.)

Accordingly, the Court GRANTS the RJN.

C.    First Cause of Action – Dependent Adult Abuse/Neglect (Welfare and Institutions Code § 15600, et seq.)

(1)   The Applicable Law

Pursuant to the Elder Abuse and Dependent Adult Civil Protection Act (the “Act”), heightened remedies are available to plaintiffs who successfully sue for dependent adult abuse. Plaintiffs must allege facts establishing that the defendant: (1) had responsibility for meeting the basic needs of the elder or dependent adult, such as nutrition, hydration, hygiene or medical care; (2) knew of conditions that made the elder or dependent adult unable to provide for his or her own basic needs; (3) denied or withheld goods or services necessary to meet the elder or dependent adult's basic needs, either with knowledge that injury was substantially certain to befall the elder or dependent adult (if the plaintiff alleges oppression, fraud or malice) or with conscious disregard of the high probability of such injury (if the plaintiff alleges recklessness); (4) the neglect caused the elder or dependent adult to suffer physical harm, pain or mental suffering; and (5) the facts constituting the neglect and establishing the causal link between the neglect and the injury “must be pleaded with particularity,” in accordance with the pleading rules governing statutory claims. (Carter v. Prime Healthcare Paradise Valley LLC (198 Cal.App.4th 396, 406-407 (Carter).)

“Neglect” includes all of the following: “(1) Failure to assist in personal hygiene, or in the provision of food, clothing, or shelter. (2) Failure to provide medical care for physical and mental health needs. A person shall not be deemed neglected or abused for the sole reason that the person voluntarily relies on treatment by spiritual means through prayer alone in lieu of medical treatment. (3) Failure to protect from health and safety hazards. (4) Failure to prevent malnutrition or dehydration. (5) Substantial inability or failure of an elder or dependent adult to manage their own finances. (6) Failure of an elder or dependent adult to satisfy any of the needs specified in paragraphs (1) to (5), inclusive, for themselves as a result of poor cognitive functioning, mental limitation, substance abuse, or chronic poor health.” (Welf. & Inst. Code, § 15610.57, subd. (b).)

The Act excludes liability for acts of professional negligence. (Welf. & Inst. Code, § 15657.2; Delaney v. Baker (1999) 20 Cal.4th 23, 32 (Delaney).) Hence, it does not apply to simple or gross negligence by health care providers. (Covenant Care, Inc. v. Superior Court (2004) 32 Cal.4th 771, 785 (Covenant).)

(2)   Neglect – Failure to Provide Medical Care

Demurring Defendants argue that the Complaint fails to sufficiently allege egregious abuse which is required to rise above medical malpractice.  (Dem. at p. 6.)

The Court notes that conduct sufficiently egregious to warrant the award under the Act have been illustrated in case law and summarized in Carter, supra.

For instance, in Covenant, supra, our Supreme Court found the plaintiff’s amended complaint “contained detailed and specific allegations of elder abuse.” (Covenant, supra, 32 Cal.4th at p. 777.) These allegations include that, while decedent was at defendants' nursing facility, defendants knew he was suffering from Parkinson's disease and was unable to care for his personal needs. The defendants nevertheless failed to provide decedent with proper care, nutrition, hydration, and medication. Defendants' conduct was in conscious disregard of decedent's rights and safety. Decedent was left in his bed, unattended and unassisted, for excessively long periods. Although decedent increasingly could not feed or hydrate himself, he was for long periods not provided assistance with these activities. As a result, decedent was inadequately stimulated, became malnourished, and lost much of his body weight. Decedent was left in his excrement for long periods; he developed ulcers on his body that exposed muscle and bone and became septic; and he also became severely dehydrated. The defendants deliberately failed to report such symptoms, neglect, and misrepresented decedent's condition and failed to inform plaintiffs of his true condition. Furthermore, when decedent reached in such condition that without immediate intervention and aggressive care he would surely die from the effects of starvation, dehydration, and infection, the defendants did not transfer decedent to an acute care facility but, rather, to a 24–hour care setting where, without any care for his acute needs, he languished and deteriorated further, and died. (Id. at p. 778.)

             Conversely, in Alexander v. Scripps Memorial Hospital La Jolla (2018) 23 Cal.App.5th 206 (Alexander), the Court of Appeal affirmed the trial court’s order sustaining without leave to amend the defendant’s demurrer to the plaintiff’s cause of action for elder abuse based on neglect and physical abuse. In that case, the plaintiff’s third amended complaint alleged that the defendants, including doctors, nurses and hospital, “recklessly failed to provide Elizabeth [decedent] medical care, recklessly failed to protect her from health and safety hazards, and recklessly abandoned her.” (Id. at p. 221.) The Alexander court held that “Plaintiffs' general statements of recklessness are not sufficient to survive a demurrer to their elder abuse cause of action. . . . Although Plaintiffs may disagree with the frequency and quantity of the medication, hydration, and nutrition Defendants provided to Elizabeth, Plaintiffs' allegations do not constitute abuse or neglect within the meaning of the Elder Abuse Act. At most, Plaintiffs' allegations might constitute professional negligence.” (Ibid.)

            The Court next analyzes the specific allegations in the operative Complaint.

First, Plaintiff relies on paragraphs 69 and 70 in the Complaint, arguing that these paragraphs contain “very specific factual allegations regarding how Defendants failed to provide medical care and failed to protect Mr. Sandoval from health and safety hazards by failing to prevent wounds and infections.” (Opp’n. at p. 12.)

             “Among other things, DEFENDANTS, including their managing agents,

employees and contractors, failed to adhere to the guidelines regarding the prevention of

bed sores and ulcers, failed to monitor Mr. Sandoval’s skin on a regular basis, failed to

collect or effectively utilize process of care data, failed to care plan wounds in need of

care, failed to provide the proper diet needed to address the pressure sores and ulcers,

failed to appropriately assess and/or use an appropriate assessment tool to identify that

patients at risk for pressure sores and ulcers, failed to take adequate preventative

measures and implement adequate preventive strategies to avoid the development of the

pressure sores and ulcers, failed to perform reassessment after learning of the sores and ulcers, failed to manage wounds by measuring them on a regular basis, failed to provide

the proper bed to address the sores and ulcers, failed to properly rotate and or position

patients to prevent the growth of the sores and ulcers, failed to take the steps necessary

to identify new wounds and failed to prevent and address infections.” (Compl. ¶ 69.)

“The failures did not occur on one specific point in time. Rather, they were part of a reckless pattern of neglect and abuse of his basic care needs.” (Compl. ¶ 70.)

The Court notes that although paragraph 69 outlines multiple areas of care that Defendants purportedly failed to meet, the allegations are too conclusory, lacking specific instances when these failures occurred. Similar to the insufficiency in the pleadings in Alexander, a list of general statements regarding “failures” without specific factual allegations indicating at least reckless, does not constitute abuse or neglect within the meaning of the Act. (Carter, supra, 198 Cal.App.4th at p. 408.)

Moreover, paragraph 70 consists of a legal conclusion, which is not supported by factual allegations in the Complaint. Plaintiff cites Sababin v. Superior Court (2006) 144 Cal.App.4th 81 (Sababin), which states:“[I]f a care facility knows it must provide a certain type of care on a daily basis but provides that care sporadically, or is supposed to provide multiple types of care but only provides some of those types of care, withholding of care has occurred. In those cases, the trier of fact must determine whether there is a significant pattern of withholding portions or types of care. A significant pattern is one that involves repeated withholding of care and leads to the conclusion that the pattern was the result of choice or deliberate indifference.” (Id. at p. 90.)

Unlike the Demurrer at hand, the Sababin court considered a different proceeding – a motion for summary adjudication – and found triable issues as to whether the rehabilitation center defendant’s employee’s conduct was neglect under Welfare and Institutions Code section 15610.57. This finding was based on the evidence that the defendant had a care plan requiring “[its] staff ...[to] monitor Plaintiff’s skin daily for redness or breakdown and report to the physician for a treatment order.” (Sababin, supra, 144 Cal.App.4th at p. 89.) However, the defendant did not have any documentation of the plaintiff’s skin condition, and its treatment nurse stated that she had not done a skin condition report for plaintiff and was not aware of plaintiff’s reddened buttocks. Furthermore, a review of medical chart revealed that no one had notified a physician of the need to a treatment order. (Id. at p. 87.) The Sababin court concluded that although conflicting evidence exists regarding the care provided, a triable issue remained as to whether the defendant’s employee ignores a care plan and fails to check the skin condition of a resident, such conduct showed deliberate disregard of the high degree of probability that she will suffer injury. (Ibid.)

Notably, the Sababin holding does not suggest that a different pleading standard applies when the plaintiff alleges neglect based on “a significant pattern of withholding portions or types of care” rather than one of fundamentally “failure to provide medical care.” The Sababin court’s findings are not inconsistent with the case law interpretation of the statutory definition of “neglect” – namely, that it “speaks not of the undertaking of medical services, but of the failure to provide medical care,” as outlined in Covenant. (Covenant, supra, 32 Cal.4th at p. 783, italics in original.) In Sababin, the rehabilitation center’s complete ignorance of its own care plan – marked by a total absence of care with no existence of any documentation or notification of a physician for treatment order – amounted to “the failure to provide medical care.”

As such, paragraph 70 of the Complaint is deficient, as it merely asserts: “The failures did not occur on one specific point in time. Rather, they were part of a reckless pattern of neglect and abuse of his basic care needs.” (Compl. ¶ 70.) The Court has determined that “the failures” referred to in paragraph 70 are conclusory. Furthermore, the statement “they were part of a reckless pattern of negligence and abuse of his basic care needs” constitutes a conclusion of law, which the Court does not consider when reviewing the Demurrer.

Accordingly, the Court finds that the Complaint’s allegations regarding Demurring Defendants’ failure to provide medical care are insufficient to state a claim for neglect under the Act.

(3)   Neglect – Violations of Standards of Care Set by Health Facility Regulations

Next, Plaintiff analogizes his allegations to those in Fenimore v. Regents of University of California (2016) 245 Cal.App.4th 1339 (Fenimore), arguing that the Complaint alleges Defendants intentionally engaged in understaffing that is in direct violation of established regulation and was intentional and part of a pattern and practice of failing to provide the level of staffing necessary to meet the needs of their residents.

            The Fenimore court distinguished Worsham v. O’Connor Hospital (2014) 226 Cal.App.4th 331 (Worsham), explaining that “while Worsham focused on a ‘fundamental “[f]ailure to provide medical care”’ as the way to show neglect under the Act, that is not the only way to prove neglect.” (Fenimore, supra, 245 Cal.App.4th at p. 1350.) (Underlines added.)

“The Act defines neglect generally as the negligent failure of custodians or care providers to exercise the degree of care a similarly situated reasonable person would exercise, and then provides examples of neglect, including but not limited to the “[f]ailure to provide medical care for physical and mental health needs.” (§ 15610.57, subds. (a), (b)(2).) As Norman and Gregory teach, violations of standards of care set by health facility regulations may provide a basis for finding the requisite negligent failure. Reckless understaffing might be neglectful under the Act even if it is not a fundamental failure to provide medical care.” (Fenimore, supra, 245 Cal.App.4th at p. 1351.) (Underlines added.)

The Court finds that Fenimore is instructive in this matter. In Fenimore, the appellate court reversed the trial court’s order sustaining defendant Hospital’s demurrer without leave to amend as to the elder abuse claim. According to the plaintiff’s first amended complaint, the defendant Hospital committed neglect by alleging all three things: “allowing George to fall minutes after entering the facility, failing to treat George's fractured hip for four days, and violating certain state regulations for acute psychiatric hospitals.” (Fenimore, supra, 245 Cal.App.4th at p. 1351.)

The Fenimore court explained that “[i]f the Fenimores alleged only these first two things, we might agree that the trial court correctly sustained the demurrer . . . . [However,] [t]he allegations that the Hospital's regulatory violations constituted elder abuse add more to the story.” (Fenimore, supra, 245 Cal.App.4th at p. 1348.) The plaintiffs further alleged facts specific to those violations, specifically:

“The Hospital had a pattern and practice of understaffing and undertraining its staff to cut costs, which foreseeably resulted in the abuse and neglect of its residents, including George. It consciously chose not to increase staff numbers or increase training. The Hospital knew that insufficient staff in number and competency would lead to it not meeting patients' needs, and injuries to patients would be not only likely but inevitable. Had there been sufficient staff at the Hospital, George would have received proper supervision and assistance and would not have suffered his injuries.”

(Fenimore, supra, 245 Cal.App.4th at p. 1349.)

            The Fenimore court found that “[t]he FAC supplied allegations that may show recklessness” because Plaintiffs had alleged “a pattern and knowing practice of improperly understaffing to cut costs” such that “had the Hospital been staffed sufficiently, George would have been properly supervised and would not have suffered injury.” (Fenimore, supra, 245 Cal.App.4th at p. 1349.)

            Here, Plaintiff’s Complaint includes allegations consistent with those found sufficient by the Fenimore court. It asserts that Defendants failed to meet the minimum staffing requirements by law. (Compl. ¶ 63.) “DEFENDANTS ... cut costs in the operation of the

HOSPITAL, PROVIDENCE FACILITY and PARKWEST FACILITY, and in other ways as

alleged, to usurp the sole legal responsibility of the planning and operation of their respective facilities...” (Id. ¶ 75.) “Integral to this plan was the practice and pattern of staffing, as described herein, with an insufficient number of and incompetent staff[.]” (Ibid.) “The "understaffing" and "lack of training" plan was designed as a mechanism as to reduce labor costs and predictably and foreseeably resulted in the violations of rights and the abuse and neglect of many residents and most specifically, Mr. Sandoval.” (Ibid.) “The DEFENDANTS were motivated by a desire to increase their profits, and thus they reduced staff, supervision, care to dangerously low levels, which they knew, or should have known, would lead to Mr. Sandoval’s injuries. In choosing to maximize profits by deliberately understaffing their facilities, DEFENDANTS knew that their plan posed a substantial and imminent danger to the health, safety and well-being of the residents at their facility, including Mr. Sandoval.” (Compl. ¶ 76.)” And they failed to have a sufficient

number of adequately trained staff to provide services to and supervision of Mr. Sandoval

and other residents despite knowing that understaffing and lack of adequate training leads

to injuries and death of residents.” (Id. ¶ 91.)

             By way of analogy, here, admitting the allegation as true as required on a demurrer, Defendants knew of the staffing regulations and violated them. From this, the Court could infer recklessness – specifically, “conscious choice of a course of action ... with knowledge of the serious danger to others involved in it.” (Delaney, supra, 20 Cal.4th at pp. 31-32.)

            In alignment with Fenimore, the Court finds that the operative Complaint stated at least one viable theory of dependent adult abuse based on recklessness. Because the Court should not sustain a demurrer when the plaintiff has stated a cause of action under any possible legal theory, the Demurrer must be overruled.

            Accordingly, the Demurrer is OVERRULED as to the First Cause of Action.

D.    Second Cause of Action – Violation of Residents’ Rights under Health & Safety Code § 1430(b)

Demurring Defendants assert that the Second Cause of Action, brought pursuant to Health & Safety Code section 1430, applies only to skilled nursing facilities, arguing that Providence Medical Center, an acute care hospital, cannot be liable under this statute as it is exempt. (Mot. at p. 10.)

The Court notes that the heading of the Second Cause of Action states the following: “Plaintiff Against Defendant PROVIDENCE HEALTH SYSTEM – SOUTHERN CALIFORNIA, Individually and Doing Business as, PROVIDENCE HOLY CROSS SUB-ACUTE and PROVIDENCE HOLY CROSS MED CENTER D/P SNF; PARKWEST REHABILITATION CENTER, LLC, Individually and Doing Business as, PARKWEST HEALTHCARE CENTER and DOES 1 Through 100.”

Accordingly, Demurring Defendants’ argument is moot as the claim is not alleged against Providence Medical Center. The Court finds no controversy regarding this issue.

Therefore, the Court OVERRULES the Demurrer as Moot as to the Second Cause of Action.

E.     Motion to Strike

The court may, upon a motion, or at any time in its discretion, and upon terms it deems proper, strike any irrelevant, false, or improper matter inserted in any pleading. (Code Civ. Proc., § 436, subd. (a).) The court may also strike all or any part of any pleading not drawn or filed in conformity with the laws of this state, a court rule, or an order of the court. (Code Civ. Proc., § 436, subd. (b).) The grounds for a motion to strike are that the pleading has irrelevant, false, or improper matter, or has not been drawn or filed in conformity with laws. (Code Civ. Proc., § 436.) The grounds for moving to strike must appear on the face of the pleading or by way of judicial notice. (Code Civ. Proc., § 437.)

In its Motion to Strike, Defendants Providence Medical Center and Providence Sub-Acute and SNF (the “Moving Defendants”) seek to strike the following portions from the Complaint:

1.      Paragraph 96, 25: 25-28 as follows: "As a result of the recklessness, malice, oppression and/or fraud alleged herein, Plaintiff is entitled, in addition to special and general damages, to an award of punitive damages pursuant to Civ. Code § 3294."

2.      In the Prayer, Item E, 33:15-16, as follows: “For punitive damages pursuant to Civ. Code § 3294; . . . "

(1)   Parties’ Stipulation

On February 13, 2025, Plaintiff filed an Opposition to the Motion, stating that the parties have entered into a stipulation to remove references to the request and claims for punitive damages, without prejudice. No Reply has been filed.

Based on the above records, the filing of the stipulation renders the Motion moot.

Therefore, the Court DENIES the Motion as Moot.

CONCLUSION

The Demurrer to the Complaint, filed by Defendants Providence Health System – Southern California, d/b/a Providence Holy Cross Medical Center and Providence Health System – Southern California d/b/a Providence Holy Cross Sub-Acute and Providence Holy Cross Med Center D/P SNF, is OVERRULED.

Defendants Providence Health System – Southern California, d/b/a Providence Holy Cross Medical Center and Providence Health System – Southern California d/b/a Providence Holy Cross Sub-Acute and Providence Holy Cross Med Center D/P SNF are ordered to file their Answer within 20 days.

The Motion to Strike, filed by Defendants Providence Health System – Southern California, d/b/a Providence Holy Cross Medical Center and Providence Health System – Southern California d/b/a Providence Holy Cross Sub-Acute and Providence Holy Cross Med Center D/P SNF, is DENIED AS MOOT.

Moving party to give notice.