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Palmer v. Superior Court of San Diego County11/19/2002
CERTIFIED FOR PUBLICATION
Petitioner William Palmer, plaintiff in an underlying action against his health maintenance organization, PacifiCare of California (PacifiCare or the HMO) and the medical group that is his primary health care provider, Sharp Rees-Stealy Medical Group, Inc. (SRS), seeks a writ of mandate setting aside an order of the superior court that struck his allegations of entitlement to punitive damages against SRS. Palmer contends the trial court misinterpreted the protective provisions of Code of Civil Procedure section 425.13, which require an order to amend a pleading to add claims for punitive damages against health care providers. In Palmer's view, these provisions should not apply to SRS in the capacity in which it acted concerning his case, as a utilization review service provider to the PacifiCare HMO, rendering advice to the HMO about whether requested medical services, equipment, or supplies were "medically necessary" within the terms of the PacifiCare plan. Palmer questions whether (1) SRS, a medical group, qualifies as a health care provider within the definitions of the statute, and (2) whether his particular allegations of intentional infliction of emotional distress "arise out of" the professional negligence of such a health care provider, again under the statutory definitions. (ยง 425.13, subds. (a), (b).)
When we examine the allegations that identify the nature and cause of the injuries that are claimed, we determine as a matter of law that they are directly related to the manner in which professional services were provided in this health care context, as it is affected by MICRA public policies. (Central Pathology Service Medical Clinic, Inc. v. Superior Court (1993) 3 Cal.4th 181, 192 (Central Pathology); Williams v. Superior Court (1994) 30 Cal.App.4th 318, 324-325 (Williams).) Accordingly, compliance with the requirements of section 425.13 was required, and we deny the petition for relief.
FACTUAL AND PROCEDURAL BACKGROUND
"In the early 1990's, Palmer suffered from a bacterial disease, complications of which caused him to lose both legs below the knee, four fingers on his left hand and 45 percent of his skin. As a result of this, Palmer needs leg prostheses to walk. Palmer is a part-time school teacher for the Poway Unified School District and, through the district, is covered by a health care service plan managed by PacifiCare. . . .
"In January 2000, Palmer's prosthetist, Justin Norton, concluded that Palmer's prostheses needed to be replaced. (All relevant dates are in 2000.) In a letter addressed to Dr. Jonathan Rivkin, a physician in Sharp Rees-Stealy Medical Group, Inc. (SRS) who is Palmer's primary care provider, Norton recommended the use of newly-available (ultra light) prostheses based on Palmer's 'active lifestyle.' At Dr. Rivkin's request, Norton prepared a cost estimate, indicating that the recommended prostheses would cost $18,438.02." (Prior opn., p. 2.)
Palmer's complaint further alleges there is an agreement between PacifiCare and SRS pursuant to which SRS provides medical services to PacifiCare members in return for a negotiated monthly rate paid per member. SRS employs physicians and other health care providers and owns and operates health care equipment and facilities. Palmer also alleges there is an agreement between PacifiCare and SRS pursuant to which SRS provides "utilization review" services to PacifiCare, "including making decisions as to whether requested medical services, equipment, and supplies for PacifiCare members are 'medically necessary.'" Services that are not medically necessary are not covered by the HMO subscriber agreement.
On February 7, 2000, an
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