Judge Thomas D. Long, Case Number: 23STCV25669, Date: 2024-10-10 Tentative Ruling

On December 8, 2023, Plaintiff Carlice Etame filed a first amended complaint (“FAC”) against Defendant Inland Empire Health Plan, alleging (1) breach of contract; (2) medical negligence; (3) intentional infliction of emotional distress “(IIED”); and (4) negligent infliction of emotional distress (“NIED”).

Defendant’s request for judicial notice of IEHP’s 2024 Member Handbook is denied. The Court disagrees with Defendant that it is an “official act” of a government agency and that “[n]otice is also proper because the document is available online and is ‘not reasonably subject to dispute and is capable of immediate and accurate determination by resort to sources of reasonably indisputable accuracy.’” Information on websites, even official governmental agency websites, can be reasonably subject to dispute and are not proper subjects for judicial notice. (Jolley v. Chase Home Finance, LLC (2013) 213 Cal.App.4th 872, 888-889; see also Huitt v. Southern Cal. Gas Co. (2010) 188 Cal.App.4th 1586, 1605 fn. 10.)

The Court does, however, take judicial notice of the fact that Defendant is a not-for-profit Medicare-Medicaid public health plan.

A demurrer for sufficiency tests whether the complaint states a cause of action. (Hahn v. Mirda (2007) 147 Cal.App.4th 740, 747.) When considering demurrers, courts read the allegations liberally and in context, accepting the alleged facts as true. (Nolte v. Cedars-Sinai Medical Center (2015) 236 Cal.App.4th 1401, 1406.) “Because a demurrer challenges defects on the face of the complaint, it can only refer to matters outside the pleading that are subject to judicial notice.” (Arce ex rel. Arce v. Kaiser Found. Health Plan, Inc. (2010) 181 Cal.App.4th 471, 556.)

Under the Government Claims Act, no person may sue a public entity or public employee for money or damages unless a timely written claim has been presented to and denied by the public entity. (County of Los Angeles v. Superior Court (2005) 127 Cal.App.4th 1263, 1267.) Absent an applicable exception, failure to timely present a claim for money or damages to a public entity bars a plaintiff from filing suit against that entity bars a plaintiff from filing a lawsuit against that entity. (State of California v. Superior Court (2004) 32 Cal.4th 1234, 1239.)

Defendant correctly notes that Plaintiff does not allege compliance with, nor exemption from, the Government Claims Act. (Demurrer at pp. 7-8.)

B. The FAC Does Not Allege Any Statutory Basis for the Second, Third, and Fourth Causes of Action.

A public entity is not liable for an injury arising from an act or omission of the entity, a public employee, or any other person except as provided by statute. (Gov. Code, § 815.)

Defendant argues that it is immune from the second, third, and fourth causes of action (medical negligence, IIED, and NIED), which lack a statutory basis. (Demurrer at p. 10.)

The demurrer to the second, third, and fourth causes of action is sustained on this ground.

Defendant argues that the first, second, and third causes of action are insufficiently pleaded. (Demurrer at pp. 11-12.)

The first cause of action alleges breach of contract. The standard elements of a claim for breach of contract are (1) the contract, (2) plaintiff’s performance or excuse for nonperformance, (3) defendant’s breach, and (4) damage to plaintiff therefrom. (Wall Street Network, Ltd. v. New York Times Co. (2008) 164 Cal.App.4th 1171, 1178.) “A written contract may be pleaded by its terms—set out verbatim in the complaint or a copy of the contract attached to the complaint and incorporated therein by reference—or by its legal effect.” (McKell v. Washington Mutual, Inc. (2006) 142 Cal.App.4th 1457, 1489.) To plead a contract by its legal effect, a plaintiff must “allege the substance of its relevant terms. This is more difficult, for it requires a careful analysis of the instrument, comprehensiveness in statement, and avoidance of legal conclusions.” (Ibid.) Plaintiff alleges that she “entered into a valid insurance contract, the Policy, with Defendant” and diligently paid all premiums, but Defendant “unreasonably and unjustifiably refused to fulfill its obligation to pay for medically necessary treatments for Plaintiff.” (FAC at p. 10.) This does not sufficiently allege the terms of the contract.

The second cause of action alleges medical negligence. In a medical malpractice action, a plaintiff must establish the following elements: “(1) the duty of the professional to use such skill, prudence, and diligence as other members of his profession commonly possess and exercise; (2) a breach of that duty; (3) a proximate causal connection between the negligent conduct and the resulting injury; and (4) actual loss or damage resulting from the professional’s negligence. [Citations.]” (Galvez v. Frields (2001) 88 Cal.App.4th 1410, 1420.) The FAC alleges that when Plaintiff’s daughter was treated at Loma Linda Children’s Hospital and the Center for Discovery, Defendant did not pay for some of her treatment, often requested her early release, did not provide adequate information, and forced the Center for Discovery to stop the treatment early. However, Defendant provides insurance, not direct medical treatment. (See, e.g., FAC at pp. 5, 8, 13, 15.) Plaintiff alleges that she and Defendant “entered a formal health insurance /patient relationship, a confidential and fiduciary relationship.” (FAC at p. 8.) Plaintiff cannot allege medical negligence against an insurer who is not a medical provider.

The third cause of action alleges IIED. “‘[T]o state a cause of action for intentional infliction of emotional distress a plaintiff must show: (1) outrageous conduct by the defendant; (2) the defendant’s intention of causing or reckless disregard of the probability of causing emotional distress; (3) the plaintiff’s suffering severe or extreme emotional distress; and (4) actual and proximate causation of the emotional distress by the defendant’s outrageous conduct.’ [Citation.] ‘Conduct, to be ‘outrageous’ must be so extreme as to exceed all bounds of that usually tolerated in a civilized society.’ [Citation.]” (Huntingdon Life Sciences, Inc. v. Stop Huntingdon Animal Cruelty USA, Inc. (2005) 129 Cal.App.4th 1228, 1259.) When a plaintiff does not suffer physical injury, the conduct must involve “extreme and outrageous intentional invasions of one’s mental and emotional tranquility.” (Alcorn v. Anbro Engineering, Inc. (1970) 2 Cal.3d 493, 498.) The FAC alleges that Defendant “did not care” about Plaintiff’s daughter’s treatment, refused to pay, went against doctor recommendations, and “stopped the treatment after we talked with them, intentionally inflicting emotional distress on parents and family.” (FAC at pp. 15-16.) These are not sufficient facts to allege extreme and outrageous conduct.

The demurrer to the first, second, and third causes of action is sustained on this ground.

The court may, upon a motion or at any time in its discretion: (1) strike out any irrelevant, false, or improper matter inserted in any pleading; or (2) strike out all or any part of any pleading not drawn or filed in conformity with the laws of California, a court rule, or an order of the court. (Code Civ. Proc., § 436, subds. (a)-(b).)

Defendant moves to strike allegations relating to punitive damages. A public entity is not liable for punitive damages or other damages imposed primarily for the sake of example and by way of punishing the defendant. (Gov. Code, § 818.)

Plaintiff did not file any opposition and therefore did not show any ability to amend the FAC to cure its deficiencies. Accordingly, no leave to amend is granted.

Parties who intend to submit on this tentative must send an email to the Court at SMCDEPT48@lacourt.org indicating intention to submit. If all parties in the case submit on the tentative ruling, no appearances before the Court are required unless a companion hearing (for example, a Case Management Conference) is also on calendar.

Hon. Thomas D. Long

Judge of the Superior Court