Title: Covenant Care v. Sup. Ct.

State: california

Issuer: California Supreme Court

Document:

1
Filed 3/25/04 
 
 
 
IN THE SUPREME COURT OF CALIFORNIA 
 
 
 
COVENANT CARE, INC., et al., 
) 
 
 
) 
 
Petitioners, 
) 
 
 
) 
S098817 
 
v. 
) 
 
 
) 
Ct. App. 2/1 B145406 
THE SUPERIOR COURT OF LOS 
) 
ANGELES COUNTY, 
) 
 
) 
Los Angeles County 
 
Respondent; 
) 
Super. Ct. No. LC041017 
 
 
) 
LOURDES M. INCLAN et al., 
) 
 
 
) 
 
Real Parties in Interest. 
) 
___________________________________ ) 
 
We granted review in this matter to resolve a conflict among the Courts of 
Appeal as to whether the procedural prerequisites to seeking punitive damages in 
an action for damages arising out of the professional negligence of a health care 
provider, codified at Code of Civil Procedure section 425.13, subdivision (a) 
(section 425.13(a)), apply to punitive damage claims in actions alleging elder 
abuse subject to heightened civil remedies under the Elder Abuse and Dependent 
Adult Civil Protection Act (Welf. & Inst. Code, § 15600 et seq.) (Elder Abuse Act 
or Act).  The Court of Appeal concluded section 425.13(a) does not apply.  We 
agree, finding nothing in the text, legislative history, or purposes of either section 
425.13(a) or the Elder Abuse Act to suggest the Legislature intended to afford 
health care providers that act as elder custodians, and that egregiously abuse the 
 
2
elders in their custody, the special protections against exemplary damages they 
enjoy when accused of negligence in providing health care.  Accordingly, we 
affirm the judgment of the Court of Appeal. 
Background1 
Lourdes M. Inclan and Juan C. Inclan (plaintiffs) sued Covenant Care 
California, Inc., and Covenant Care, Inc. (defendants), for damages caused by 
defendants’ care and treatment of their father, Juan A. Inclan (decedent), during 
the approximately eight weeks that decedent, an elder,2 resided at defendants’ 
skilled nursing facility in Los Angeles.  More than two years after filing their 
initial complaint, plaintiffs moved for leave to file a fourth amended complaint.  In 
their proposed fourth amended complaint, plaintiffs sought damages, including 
“general damages for pain and suffering according to proof,” for willful 
misconduct, intentional infliction of emotional distress, constructive fraud, fraud, 
battery, false imprisonment, elder abuse, and wrongful death.  They also sought 
punitive damages. 
Plaintiffs’ fourth amended complaint contained detailed and specific factual 
allegations of elder abuse.  Specifically, plaintiffs alleged that decedent suffered 
from Parkinson’s disease.  Plaintiffs contracted with a managed care organization 
to oversee decedent’s care, to act within plaintiffs’ directives, and to inform 
plaintiffs of any change in decedent’s condition or other situation requiring their 
attention.  The managed care organization, however, assumed rights and usurped 
                                             
 
1  
Plaintiffs’ motions for judicial notice, filed on January 30, 2002, and on 
May 1, 2002, respectively, are denied.  (Mangini v. R. J. Reynolds Tobacco Co. 
(1994) 7 Cal.4th 1057, 1064.)  Defendants’ motion for judicial notice, filed on 
November 20, 2001, is granted. 
2  
“ ‘Elder’ means any person residing in this state, 65 years of age or older.”  
(Welf. & Inst. Code, § 15610.27.) 
 
3
powers over decedent neither contemplated nor agreed to by decedent or plaintiffs.  
The managed care organization, sometimes in conspiracy with defendants, 
admitted and ordered the discharge of decedent, without his consent, from various 
health care facilities, including a convalescent hospital owned and operated by 
defendants, and “withh[e]ld essential care, treatment and medical services from 
decedent including . . . food, fluids, medicine, and basic nursing care including 
basic palliative care.” 
Plaintiffs alleged that defendants conspired and otherwise “acted with 
malice and oppression” in moving and treating decedent in order to maximize 
revenue from the Medicare and Medicaid programs and to avoid regulatory 
penalties for noncompliance with certain federal and state regulations.  At one 
point, decedent was compelled to transfer to defendants’ skilled nursing facility.  
At that facility, defendants provided decedent only with hospice services and 
deprived him of skilled nursing services to which he was legally entitled.  
Decedent’s subsequent injury and death flowed in part from defendants’ actions. 
While decedent was at defendants’ nursing facility, plaintiffs further 
alleged, defendants knew he was suffering from Parkinson’s disease and was 
unable to care for his personal needs.  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. 
 
4
As decedent deteriorated, he manifested signs and symptoms of starvation, 
dehydration, neglect, and abuse.  Plaintiffs alleged that defendants deliberately 
failed to report such symptoms, neglect, and abuse to public authorities as they 
were legally required to do.  Moreover, defendants misrepresented decedent’s 
condition and failed to inform plaintiffs of his true condition, thus concealing his 
deterioration from plaintiffs. 
When decedent was transferred out of defendants’ nursing facility to 
another facility (where he died approximately a week later), plaintiffs alleged, 
decedent was in such condition that without immediate intervention and 
aggressive care he would surely die from the effects of starvation, dehydration, 
and infection.  Decedent, however, was not transferred 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.  As a direct and proximate result of 
defendants’ neglect and abuse, decedent sustained personal injury, including 
severe emotional distress, and died. 
Plaintiffs filed their motion for leave to file the fourth amended complaint 
claiming punitive damages on May 14, 1999.  Defendants opposed the motion, 
arguing that under section 425.13(a), which requires such a motion be “filed 
within two years after the complaint or initial pleading is filed,” this was too late.  
The trial court granted plaintiffs’ motion, ruling plaintiffs were not required to 
comply with section 425.13(a) because the causes of action alleged in the fourth 
amended complaint “go beyond mere or simple professional negligence.”  The 
Court of Appeal summarily denied defendants’ petition for writ relief, and we 
denied review. 
Subsequent to the trial court’s ruling, a different district of the Court of 
Appeal issued an opinion in Community Care & Rehabilitation Center v. Superior 
Court (2000) 79 Cal.App.4th 787 (Community Care).  The court in Community 
 
5
Care held that section 425.13(a) applies to elder abuse actions in which punitive 
damages are sought, “whenever the gravamen of an action is professional 
malfeasance—that is, malfeasance in the provision of health care services.”  
(Community Care, supra, at p. 797.)  Defendants moved the trial court for 
reconsideration in light of Community Care, but the court denied the motion. 
The Court of Appeal again denied defendants’ petition for writ relief.  
Rejecting Community Care, the Court of Appeal ruled that plaintiffs’ elder abuse 
claim was exempt from “the procedural hurdles created by section 425.13.”  We 
granted review. 
Discussion 
As originally enacted in 1982, the Elder Abuse Act established 
requirements and procedures for mandatory and nonmandatory reporting to local 
agencies of elder abuse, as defined,3 and the abuse of other dependent adults.  The 
Act also addressed local agency investigation and criminal prosecution of such 
cases.  (See Stats. 1982, ch. 1184, § 3, p. 4223.)  The Act continues to contain 
such provisions.  (See generally Welf. & Inst. Code, § 15600 et seq.)4 
                                             
 
3  
“ ‘Abuse of an elder or a dependent adult’ means either of the following: 
[¶] (a) Physical abuse, neglect, financial abuse, abandonment, isolation, abduction, 
or other treatment with resulting physical harm or pain or mental suffering.  
[¶] (b) The deprivation by a care custodian of goods or services that are necessary 
to avoid physical harm or mental suffering.”  (Welf. & Inst. Code, § 15610.07.) 
4  
Although “[s]ubsequent amendment refined the 1982 enactment, . . . the 
focus remained on reporting abuse and using law enforcement to combat it.  
[Citation.]  Also, Penal Code section 368 was enacted, making it [a criminal 
offense] for, among other things, a custodian of an elder or dependent adult to 
willfully cause or permit various types of injury.”  (Delaney v. Baker (1999) 20 
Cal.4th 23, 33.) 
 
6
In 1991, in order “to enable interested persons to engage attorneys to take 
up the cause of abused elderly persons and dependent adults” (Welf. & Inst. Code, 
§ 15600, subd. (j)), the Legislature added Welfare and Institutions Code section 
15657 to the Act.  That section makes available, to plaintiffs who prove especially 
egregious elder abuse to a high standard, certain remedies “in addition to all other 
remedies otherwise provided by law” (Welf. & Inst. Code, § 15657).  Specifically, 
a plaintiff who proves “by clear and convincing evidence” that a defendant is 
liable for physical abuse, neglect, or financial abuse (as these terms are defined in 
the Act), and that the defendant has been guilty of “recklessness, oppression, 
fraud, or malice” in the commission of such abuse, may recover attorney fees and 
costs.  (Id., subd. (a), incorporating by reference Welf. & Inst. Code, §§ 15610.30, 
15610.57, 15610.63.)5  On the same conditions, a plaintiff who brings suit as the 
personal representative of a deceased elder is partially relieved of the limitation on 
damages in a decedent’s action imposed by Code of Civil Procedure section 
                                             
 
5  
In its entirety, Welfare and Institutions Code section 15657 provides:  
“Where it is proven by clear and convincing evidence that a defendant is liable for 
physical abuse as defined in Section 15610.63, neglect as defined in Section 
15610.57, or financial abuse as defined in Section 15610.30, and that the 
defendant has been guilty of recklessness, oppression, fraud, or malice in the 
commission of this abuse, in addition to all other remedies otherwise provided by 
law:  [¶] (a) The court shall award to the plaintiff reasonable attorney’s fees and 
costs.  The term ‘costs’ includes, but is not limited to, reasonable fees for the 
services of a conservator, if any, devoted to the litigation of a claim brought under 
this article.  [¶] (b) The limitations imposed by Section 337.34 [sic: should be 
377.34] of the Code of Civil Procedure on the damages recoverable shall not 
apply.  However, the damages recovered shall not exceed the damages permitted 
to be recovered pursuant to subdivision (b) of Section 3333.2 of the Civil Code.  
[¶] (c) The standards set forth in subdivision (b) of Section 3294 of the Civil Code 
regarding the imposition of punitive damages on an employer based upon the acts 
of an employee shall be satisfied before any damages or attorney’s fees permitted 
under this section may be imposed against an employer.” 
 
7
377.34 and thus may recover damages up to $250,000 for emotional distress 
suffered by the decedent prior to death.  (Welf. & Inst. Code, § 15657, subd. (b).) 
Section 425.13(a) provides, in relevant part, that “[i]n any action for 
damages arising out of the professional negligence of a health care provider, no 
claim for punitive damages shall be included” unless the plaintiff “within two 
years after the complaint or initial pleading is filed or not less than nine months 
before the date the matter is first set for trial, whichever is earlier” files a motion 
demonstrating a “substantial probability” he or she will prevail on the claim.6  The 
question presented is whether plaintiffs’ elder abuse claim is one “arising out of 
the professional negligence of a health care provider” for the purposes of section 
425.13(a).  We have not previously addressed whether a plaintiff seeking 
                                             
 
6  
In its entirely, section 425.13 provides:  “(a) In any action for damages 
arising out of the professional negligence of a health care provider, no claim for 
punitive damages shall be included in a complaint or other pleading unless the 
court enters an order allowing an amended pleading that includes a claim for 
punitive damages to be filed.  The court may allow the filing of an amended 
pleading claiming punitive damages on a motion by the party seeking the amended 
pleading and on the basis of the supporting and opposing affidavits presented that 
the plaintiff has established that there is a substantial probability that the plaintiff 
will prevail on the claim pursuant to Section 3294 of the Civil Code.  The court 
shall not grant a motion allowing the filing of an amended pleading that includes a 
claim for punitive damages if the motion for such an order is not filed within two 
years after the complaint or initial pleading is filed or not less than nine months 
before the date the matter is first set for trial, whichever is earlier.  [¶] (b) For the 
purposes of this section, ‘health care provider’ means any person licensed or 
certified pursuant to Division 2 (commencing with Section 500) of the Business 
and Professions Code or licensed pursuant to the Osteopathic Initiative Act, or the 
Chiropractic Initiative Act, or licensed pursuant to Chapter 2.5 (commencing with 
Section 1440) of Division 2 of the Health and Safety Code; and any clinic, health 
dispensary, or health facility, licensed pursuant to Division 2 (commencing with 
Section 1200) of the Health and Safety Code.  ‘Health care provider’ includes the 
legal representatives of a health care provider.” 
 
8
heightened remedies under the Elder Abuse Act must comply with section 425.13 
in order to claim punitive damages. 
Plaintiffs assert that our reasoning in Delaney v. Baker, supra, 20 Cal.4th 
23 (Delaney), precludes application of section 425.13 to Elder Abuse Act causes 
of action.  In Delaney, we held unanimously that a cause of action seeking the 
Act’s heightened remedies for reckless, oppressive, fraudulent, or malicious elder 
abuse is not based on “professional negligence” within the meaning of Welfare 
and Institutions Code section 15657.2,7 a section of the Act that excludes from its 
purview causes of action based on such negligence.  (Delaney, supra, at pp. 29-
32.)  Our rationale, which we derived from the language and history of the Act, 
was that the Legislature intended section 15657.2 to clarify “that the acts 
proscribed [by the Act] do not include acts of simple professional negligence, but 
refer to forms of abuse or neglect performed with some state of culpability greater 
than mere negligence.”  (Delaney, supra, at p. 32.) 
Observing that the relevant language in section 425.13 (“arising out of the 
professional negligence of a health care provider”) is similar to the Welfare and 
Institutions Code section 15657.2 language we construed in Delaney (“based on 
the health care provider’s alleged professional negligence”), plaintiffs argue we 
should rule here, as we did there, that causes of action against health care 
providers that otherwise come within the scope of the Elder Abuse Act are not 
                                             
 
7  
In its entirety, Welfare and Institutions Code section 15657.2 provides:  
“Notwithstanding this article, any cause of action for injury or damage against a 
health care provider, as defined in Section 340.5 of the Code of Civil Procedure 
based on the health care provider’s alleged professional negligence, shall be 
governed by those laws which specifically apply to those professional negligence 
causes of action.” 
 
9
within the meaning of the section 425.13 language.  (Delaney, supra, 20 Cal.4th at 
p. 32.)   
Factually, as noted, plaintiffs alleged their decedent suffered bodily injury, 
pain, and suffering (including severe emotional distress) at defendants’ hands.  
More specifically, plaintiffs alleged decedent’s injuries were caused by 
defendants’ willful misconduct in violation of the Elder Abuse Act, consisting in 
fraudulent business practices, intentional infliction of emotional distress, battery 
upon, and false imprisonment of decedent.  In describing defendants’ abuse of 
decedent, plaintiffs specifically alleged despicable and deceptive business 
practices, as well as other unlawful conduct by defendants, some of which 
constituted conspiracy and all of which was reckless, intentional, deliberate, or 
knowing.  Plaintiffs also alleged that in abusing decedent, defendants consciously 
disregarded his rights and safety, acting with fraud, oppression, and malice. 
In its ordinary sense, “professional negligence” is failure to exercise 
“ ‘knowledge, skill, and care ordinarily employed by members of the profession in 
good standing.’ ”  (Delaney, supra, 20 Cal.4th at p. 31.)  Hence, such misconduct 
as plaintiffs alleged—intentional, egregious elder abuse—cannot be described as 
mere “professional negligence” in the ordinary sense of those words.  But as 
defendants point out, in light of our prior pronouncements respecting section 
425.13(a), that fact is not necessarily dispositive.  (See Central Pathology Service 
Medical Clinic, Inc. v. Superior Court (1992) 3 Cal.4th 181, 191-192 (Central 
Pathology).) 
In Central Pathology, a patient sued a physician and a laboratory, alleging 
they failed to notify her she was developing cancer when a pap smear the 
physician performed and sent to the laboratory for analysis revealed the presence 
of abnormal cells.  (Central Pathology, supra, 3 Cal.4th at p. 185.)  The patient’s 
initial complaint was for negligence in the provision of medical services, but she 
 
10
moved to amend it to add causes of action for fraud and intentional infliction of 
emotional distress and to seek punitive damages in connection with those claims.  
Construing section 425.13(a)’s reference to “any action for damages arising out of 
the professional negligence of a health care provider,” we concluded the statute 
applied to the proposed additional intentional tort causes of action, as well as to 
the ordinary negligence causes of action already contained in the complaint.  
(Central Pathology, supra, at p. 192.)  Were we to hold otherwise, we reasoned, 
“injured patients seeking punitive damages in an action involving professional 
negligence could readily assert that their health care providers committed an 
intentional tort” and thus by “artful pleading” effectively “annul the protection 
afforded [health care providers] by that section.”  (Id. at p. 191.) 
Relying primarily on Central Pathology, defendants argue in effect that 
even egregious elder abuse arises out of professional negligence (§ 425.13(a)) 
when such abuse is “directly related to the professional services provided” 
(Central Pathology, supra, 3 Cal.4th at p. 191) by a health care provider.  
Defendants acknowledge that, on its face, section 425.13(a) applies only to causes 
of action arising from negligence, and that in Delaney we distinguished between 
“professional negligence” and statutory elder abuse.  Nevertheless, defendants 
point out, health care providers can at once be subject to liability under the Elder 
Abuse Act and protected by section 425.13(a)’s restrictions on the pleading of 
punitive damages.  Because Central Pathology’s broad phrasing potentially 
supports this possibility and Delaney does not expressly bar it, defendants urge 
that we declare it to be the law. 
Notwithstanding the parties’ focus on Central Pathology and Delaney, 
resolution of the issue here is not simply an exercise in conforming our result to 
our previous phraseology.  Judicial precedent on similar facts may be relevant, but 
“[e]stablishing terminological uniformity throughout our codified law is less 
 
11
important than discerning ‘ “the intent of the Legislature so as to effectuate the 
purpose” ’ of each individual statute.”  (Delaney, supra, 20 Cal.4th at p. 42.)  
Ultimately, “the ascertainment of legislative intent is the paramount principle of 
statutory interpretation.”  (In re Michael G. (1988) 44 Cal.3d 283, 289.)  For the 
following reasons, we agree with the Court of Appeal that section 425.13’s 
limitations on actions for damages arising out of professional negligence 
(§ 425.13(a)) were not meant to burden those who pursue the cause of abused 
elderly persons (Welf. & Inst. Code, § 15600, subd. (j)) under the Elder Abuse 
Act. 
Plain language.  First, nothing in the text of either section 425.13(a) or the 
Elder Abuse Act suggests the Legislature meant to link the two statutes.  While 
section 425.13 by its terms applies only to causes of action arising out of 
“negligence” (§ 425.13(a)), every cause of action seeking the Act’s heightened 
civil remedies, by definition, arises out of “recklessness, oppression, fraud, or 
malice” (Welf. & Inst. Code, § 15657).  The earlier enacted section 425.13(a), of 
course, contains no reference to the Elder Abuse Act or to elder abuse; neither 
does the subsequently enacted Act contain any reference to section 425.13(a). 
It is true that statutory elder abuse includes “neglect as defined in Section 
15610.57” (Welf. & Inst. Code, § 15657), which in turn includes negligent failure 
of an elder custodian “to provide medical care for [the elder’s] physical and 
mental health needs” (id., § 15610.57, subd. (b)(2)).  But as we explained in 
Delaney, “neglect” within the meaning of Welfare and Institutions Code section 
15610.57 covers an area of misconduct distinct from “professional negligence.”  
As used in the Act, neglect refers not to the substandard performance of medical 
services but, rather, to the “failure of those responsible for attending to the basic 
needs and comforts of elderly or dependent adults, regardless of their professional 
standing, to carry out their custodial obligations.”  (Delaney, supra, 20 Cal.4th at 
 
12
p. 34.)  Thus, the statutory definition of neglect speaks not of the undertaking of 
medical services, but of the failure to provide medical care.  (Ibid.)  Notably, the 
other forms of abuse, as defined in the Act—physical abuse and fiduciary abuse 
(Welf. & Inst. Code, § 15657)—are forms of intentional wrongdoing also distinct 
from “professional negligence.”  (Delaney, supra, at p. 34.) 
As we determined in Delaney, if the neglect (or other abuse) is reckless or 
done with oppression, fraud, or malice, “then the action falls within the scope of 
[Welfare and Institution Code] section 15657 and as such cannot be considered 
simply ‘based on . . . professional negligence’ . . . .  That only these egregious acts 
were intended to be sanctioned under section 15657 is further underscored by the 
fact that the statute requires liability to be proved by a heightened ‘clear and 
convincing evidence’ standard.”  (Delaney, supra, 20 Cal.4th at p. 35.) 
Because in Delaney we were construing the term “professional negligence” 
as used in the Elder Abuse Act, our actual holding did not impinge on the holding 
of Central Pathology that professional negligence within the meaning of section 
425.13 can encompass intentional torts.  (Central Pathology, supra, 3 Cal.4th at 
p. 192.)  Nevertheless, our conclusion that the Legislature intended the Elder 
Abuse Act to sanction only egregious acts of misconduct distinct from 
professional negligence contravenes any suggestion that, in defining elder abuse to 
include failure to provide medical care, the Legislature intended that health care 
providers, alone among elder custodians, would enjoy under the Act the 
procedural protections they enjoy when sued for negligence in their professional 
health care practice.  (See Delaney, supra, 20 Cal.4th at p. 35 [discussing the 
anomaly of such a result].) 
Legislative history.  Second, nothing in the legislative history of either 
section 425.13(a) or the Elder Abuse Act suggests the Legislature meant to link 
the two statutes.  Our past pronouncements succinctly describe the relevant 
 
13
history.  (See Central Pathology, supra, 3 Cal.4th at pp. 189-190; Delaney, supra, 
20 Cal.4th at pp. 31-34.) 
Section 425.13 was added to the Code of Civil Procedure in 1987.  “As 
originally enacted, the section was not limited to medical malpractice.  The statute 
provided, ‘No claim for punitive damages against a health care provider shall be 
included in a complaint or other pleading unless the court enters an order allowing 
an amended pleading that includes a claim for punitive damages to be filed.’  
(Stats. 1987, ch. 1498, § 7, p. 5782.)  The next year the Legislature amended the 
section by incorporating former section 425.13 into new subdivision (a) of that 
section and by altering the first sentence to read, ‘In any action for damages 
arising out of the professional negligence of a health care provider, no claim for 
punitive damages shall be included . . . .’  (Stats. 1988, ch. 1205, § 1, p. 4028.)”  
(Central Pathology, supra, 3 Cal.4th at pp. 188-189, italics omitted.) 
The Legislature enacted the Elder Abuse Act’s heightened civil damage 
remedies for egregious elder abuse three years later, in 1991.  (Stats. 1991, ch. 
774, § 3, p. 3477 [enacting Sen. Bill No. 679 (1991-1992 Reg. Sess.].)  As we 
recounted in Delaney, in the 1991 amendments to the Act, the Legislature shifted 
the focus in protecting vulnerable and dependent adults from reporting abuse and 
using law enforcement to combat it, “to private, civil enforcement of laws against 
elder abuse and neglect.  ‘[T]he Legislature declared that “infirm elderly persons 
and dependent adults are a disadvantaged class, that cases of abuse of these 
persons are seldom prosecuted as criminal matters, and few civil cases are brought 
in connection with this abuse due to problems of proof, court delays, and the lack 
of incentives to prosecute these suits.”  ([Welf. & Inst. Code,] § 15600, subd. (h), 
added by Stats. 1991, ch. 774, § 2.)  . . . As was stated in the Senate Rules 
Committee’s analysis of Senate Bill No. 679, ‘in practice, the death of the victim 
and the difficulty in finding an attorney to handle an abuse case where attorneys 
 
14
fees may not be awarded, impedes many victims from suing successfully.  [¶] This 
bill would address the problem by:  . . . authorizing the court to award attorney’s 
fees in specified cases; [and by] allowing pain and suffering damages to be 
awarded when a verdict of intentional and reckless abuse was handed down after 
the abused elder dies.’  (Sen. Rules Com., Analysis of Sen. Bill No. 679 (1991-
1992 Reg. Sess.) as amended May 8, 1991, p. 3.)”  (Delaney, supra, 20 Cal.4th at 
p. 33.) 
As we determined in Central Pathology, the legislative history of section 
425.13 demonstrates that the Legislature’s intent in enacting the statute was to 
protect health care providers (or practitioners) only in their professional capacity 
as providers; there was no intent to protect them in any other capacity.  (Central 
Pathology, supra, 3 Cal.4th at p. 189; see also id. at p. 190.)  Without question, 
health care provider and elder custodian “capacities” are conceptually distinct.  
“Health care provider” means any person licensed or certified pursuant to 
specified licensing provisions and any licensed clinic, health dispensary, or health 
facility and their legal representatives.  (§ 425.13, subd. (b).)  Neglectful elder 
abuse, by contrast, as noted, is “the failure of those responsible for attending to the 
basic needs and comforts of elderly or dependent adults, regardless of their 
professional standing, to carry out their custodial obligations.”  (Delaney, supra, 
20 Cal.4th at p. 34, italics added.) 
Moreover, the legislative history of the Elder Abuse Act “indicates that 
those who enacted the statute thought that the term ‘professional negligence,’ . . . 
within the meaning of [Welfare and Institutions Code] section 15657.2, was 
mutually exclusive of the abuse and neglect specified in [Welfare and Institutions 
Code] section 15657” as actionable under the Act.  (Delaney, supra, 20 Cal.4th at 
p. 30.)  As we have noted, the Legislature apparently concluded that the high 
standard imposed by section 15657—clear and convincing evidence of (i) liability 
 
15
and (ii) recklessness, malice, oppression or fraud—adequately protects health care 
providers from liability under the statute for acts of simple or even gross 
negligence.  (Delaney, supra, at p. 32.)  We are not authorized to gainsay that 
legislative judgment.8 
Defendants argue the Legislature’s failure expressly to exempt Elder Abuse 
actions from section 425.13 obliges us to construe the section as including such 
actions.  In support, they contend that elder abuse, when committed by a health 
care provider, is “an injury that is directly related to the professional services 
provided by a health care provider acting in its capacity as such” (Central 
Pathology, supra, 3 Cal.4th at p. 191).  Defendants’ argument fails on three 
counts. 
First, the rules of statutory construction defendants invoke—viz., that 
presumably the Legislature knew how to create an exemption if it wished to do so 
and that courts generally may not insert what the Legislature has omitted from a 
statute (see California Fed. Savings & Loan Assn. v. City of Los Angeles (1995) 11 
Cal.4th 342, 349)—have no application unless one assumes, at the outset, the 
facial applicability of section 425.13.  But section 425.13(a), which references 
“professional negligence,” is not facially applicable to claims for heightened civil 
remedies under the Elder Abuse Act, which entail “recklessness, oppression, 
fraud, or malice” (Welf. & Inst. Code, § 15657, subd. (a)). 
Second, elder abuse as defined in the Act, even when committed by a 
health care provider, is not an injury that is “directly related” to the provider’s 
                                             
 
8  
As we conclude the Legislature did not intend section 425.13 to apply to 
causes of action seeking heightened remedies under the Elder Abuse Act, we do 
not reach the additional question raised by plaintiffs whether all defendants were 
or are health care providers entitled to invoke the protection of section 425.13. 
 
16
professional services.  That statutory elder abuse may include the egregious 
withholding of medical care for physical and mental health needs is not 
determinative.  As a failure to fulfill custodial duties owed by a custodian who 
happens also to be a health care provider, such abuse is at most incidentally related 
to the provider’s professional health care services.  
That is, claims under the Elder Abuse Act are not brought against health 
care providers in their capacity as providers but, rather, against custodians and 
caregivers that abuse elders and who may or may not, incidentally, also be health 
care providers.  Statutorily, as well as in common parlance, the function of a 
health care provider is distinct from that of an elder custodian, and “the fact that 
some health care institutions, such as nursing homes, perform custodial functions 
and provide professional medical care” (Delaney, supra, 20 Cal.4th at p. 34, italics 
added) does not mean that the two functions are the same.  
Third, the Legislature did not have the benefit of our 1992 opinion in 
Central Pathology either when it limited section 425.13(a) to damage actions 
arising out of the professional negligence of a health care provider (Stats. 1988, 
ch. 1205, § 1, p. 4028) or three years later when it added heightened civil remedies 
to the Elder Abuse Act (Stats. 1991, ch. 774, § 3, p. 3475).  Accordingly, 
regardless of its language, Central Pathology affords no basis for concluding the 
Legislature intended its reference in section 425.13(a) to “professional negligence” 
to encompass elder abuse, let alone as yet uncreated statutory causes of action for 
elder abuse committed with recklessness, oppression, fraud, or malice (Welf. & 
Inst. Code, § 15657).  Nor does the opinion afford any basis for deeming the 
Legislature to have intended, when adding heightened civil remedies as an 
 
17
incentive to the prosecution of elder abuse actions, that section 425.13(a) restrict 
the availability of those remedies.9 
Statutory purposes.  The fundamental legislative purposes underlying the 
Elder Abuse Act, on the one hand, and section 425.13, on the other, would not be 
promoted were we to link the two regimes.  Indeed, such linkage actually would 
undermine the purposes of the Elder Abuse Act. 
“The purpose of the [Act was] essentially to protect a particularly 
vulnerable portion of the population from gross mistreatment in the form of abuse 
and custodial neglect.”  (Delaney, supra, 20 Cal.4th at p. 33.)  To this end, the 
Legislature added to the Act heightened civil remedies for egregious elder abuse, 
seeking thereby “to enable interested persons to engage attorneys to take up the 
cause of abused elderly persons and dependent adults.”  (Welf. & Inst. Code, 
§ 15600, subd. (j).)  To burden such causes with section 425.13’s procedural 
requirements when claims are made for punitive damages would undermine the 
Legislature’s intent to foster such actions by providing litigants and attorneys with 
incentives to bring them. 
Defendants concede that application of section 425.13 would preclude 
plaintiffs’ punitive damage claim but, they maintain, only because plaintiffs 
                                             
 
9  
With respect to section 425.13(a), in fact, the presumption would be to the 
contrary.  “At the time Senate Bill No. 679 was enacted, the terms ‘arising out of 
professional negligence’ and ‘based on professional negligence’ had been quite 
narrowly construed.”  (Delaney, supra, 20 Cal.4th at p. 42, fn. 8, citing inter alia 
Bommareddy v. Superior Court (1990) 222 Cal.App.3d 1017, 1024 [which 
interpreted § 425.13(a) as excluding intentional torts]; Flores v. Natividad Medical 
Center (1987) 192 Cal.App.3d 1106, 1114-1116 [which interpreted the phrase 
“based on professional negligence” in the Medical Injury Compensation Reform 
Act (MICRA) to exclude failure to summon medical care pursuant to Gov. Code, 
§ 845.6].) 
 
18
delayed filing their motion for punitive damages until more than two years after 
they filed suit.  Nevertheless, making it more difficult for Elder Abuse Act 
plaintiffs to plead punitive damages would, as a general matter, likely diminish the 
willingness of attorneys to undertake such cases on a contingency basis.  (See 
Welf. & Inst. Code, § 15600, subd. (h) [reciting Legislature’s observation when 
enacting Elder Abuse Act that “few civil cases are brought in connection with this 
abuse due to . . . the lack of incentives to prosecute such suits”].) 
Section 425.13(a) “was enacted amid concern over routine inclusion of 
sham punitive damages claims in medical malpractice actions.  The statute 
apparently seeks to alleviate this problem by shifting to the plaintiff the procedural 
burden that would otherwise fall on the defendant to remove a ‘frivolous’ or 
‘unsubstantiated’ claim early in the suit.”  (College Hospital, Inc. v. Superior 
Court (1994) 8 Cal.4th 704, 717; see also id. at p. 719 [motion required by 
§ 425.13(a) “operates like a demurrer or motion for summary judgment in 
‘reverse’ ”].)  More specifically, section 425.13(a) “was designed to address two 
problems.  First, the Legislature sought in all cases to require greater certainty of 
the propriety of imposing punitive damages by requiring clear and convincing 
evidence of fraud, malice, or oppression and by modifying the definition of malice 
to include despicable, willful conduct.  [¶] Second, because it was concerned that 
unsubstantiated claims for punitive damages were being included in complaints 
against health care providers, the Legislature sought to provide additional 
protection by establishing a pretrial hearing mechanism by which the court would 
determine whether an action for punitive damages could proceed.”  (Central 
Pathology, supra, 3 Cal.4th at p. 189.) 
Applying section 425.13 to Elder Abuse Act causes of action would not 
significantly heighten the “certainty of the propriety of imposing punitive 
damages” (Central Pathology, supra, 3 Cal.4th at p. 189), because a plaintiff 
 
19
prosecuting a claim for heightened civil remedies under the Elder Abuse Act is 
required in any event to plead and to prove by clear and convincing evidence 
“recklessness, oppression, fraud, or malice” (Welf. & Inst. Code, § 15657).  Thus, 
with or without application of section 425.13(a), a health care provider sued for 
violating the Elder Abuse Act must defend against allegations of egregious 
conduct.     
Neither would applying section 425.13 to Elder Abuse Act causes of action 
afford health care providers significant additional protection against the type of 
unsubstantiated claims for punitive damages that concerned the Legislature when 
it enacted section 425.13(a).  As we have noted, the fundamental problem section 
425.13 seeks to address arises because the kinds of negligent acts supporting a 
malpractice cause of action might also support a cause of action for an intentional 
tort, such that plaintiffs might through artful pleading “sidestep” the section by 
including an intentional tort cause of action in a negligence action and thereby 
annul the protection the Legislature intended to afford health care providers in the 
medical malpractice context.  (Central Pathology, supra, 3 Cal.4th at pp. 191, 
192.)  No analogous threat looms here; praying for punitive damages in an action 
based on a violation of the Elder Abuse Act does not substantively transform the 
action as does adding an intentional tort claim in a malpractice action.  While 
“minimally culpable defendants are often charged with intentional torts” (Far 
West Financial Corp. v. D & S Co. (1988) 46 Cal.3d 796, 830 (conc. & dis. opn. 
of Eagleson, J.)) supporting punitive damage claims, elder abuse triggering the 
Act’s heightened remedy provisions entails by its nature egregious conduct.  
(Welf. & Inst. Code, §§ 15657, 15610.30, 15610.57, 15610.63.)  And while in the 
medical malpractice context “there may be considerable overlap of intentional and 
negligent causes of action” (Central Pathology, supra, at p. 192), no such overlap 
occurs in the Elder Abuse Act context, where the Legislature expressly has 
 
20
excluded ordinary negligence claims from treatment under the Act (Welf. & Inst. 
Code, § 15657.2; Delaney, supra, 20 Cal.4th at p. 30).10 
In order to obtain the Act’s heightened remedies, a plaintiff must allege 
conduct essentially equivalent to conduct that would support recovery of punitive 
damages.  (Compare Welf. & Inst. Code, § 15657 [requiring “clear and convincing 
evidence that a defendant is liable for” elder abuse and “has been guilty of 
recklessness, oppression, fraud, or malice in the commission of the abuse”] with 
Civ. Code, § 3294, subd. (a) [requiring “clear and convincing evidence” that the 
defendant has been guilty of oppression, fraud, or malice].)  Accordingly, that 
plaintiffs in an Elder Abuse Act action may, on appropriate proof (Civ. Code, 
§ 3294, subd. (a)), recover punitive damages entails no danger directly analogous 
to the danger that exists when “ ‘punitive damages may be awarded on what is 
traditionally considered a negligence cause of action’ ” (Central Pathology, supra, 
3 Cal.4th at p. 190). 
Section 425.13(a) also contains timing requirements, including the 
requirement at issue in this case that any motion under the statute be “filed within 
two years after the complaint or initial pleading is filed . . . .”  The purpose of this 
requirement is to provide a health care provider with adequate notice of a punitive 
damages claim, as well as to prevent “last minute” insertion of punitive damages 
issues into a case that has been prepared for trial without consideration of such, 
and past the time when positions and discovery issues have become fixed.  
                                             
 
10  
In so noting, we have no occasion to decide whether or on what theory a 
plaintiff may be able to obtain common law remedies for ordinary negligence that 
also constitutes neglect as defined in the Elder Abuse Act.  (See, e.g., Norman v. 
Life Care Centers of America, Inc. (2003) 107 Cal.App.4th 1233, 1242-1243, rev. 
den. Aug. 13, 2003.) 
 
21
(Goodstein v. Superior Court (1996) 42 Cal.App.4th 1635, 1642.)  As discussed, 
however, in any Elder Abuse Act action issues of egregious conduct are by 
definition always present, so a defendant has the relevant notice from the outset. 
Judicial precedent.  To the extent we are presented in this case with the 
necessity of choosing between application of Central Pathology’s holding to facts 
only at its outer reaches and Delaney’s well-documented understanding of the 
Elder Abuse Act’s subject matter and purposes, we choose the latter.  
Where the gravamen of an action is violation of the Elder Abuse Act, 
Central Pathology’s rationale for applying section 425.13 to the common law 
intentional torts at issue in that case does not obtain.  In contrast with Central 
Pathology, this case cannot be resolved by application of the principle “that a 
statute should not be interpreted in a manner that would lead to absurd results” 
(Central Pathology, supra, 3 Cal.4th at p. 191), because neither of the possible 
results—i.e., that section 425.13 applies to Elder Abuse Act claims or that it does 
not—is absurd.  Thus, in declining to apply section 425.13, the courts below did 
not by implication “render the statute virtually meaningless” (Central Pathology, 
supra, at p. 191).  Central Pathology itself guarantees that, notwithstanding our 
affirmance of the Court of Appeal’s judgment in this case, section 425.13 will 
continue to apply to a broad range of intentional torts typically pled in medical 
malpractice cases.  (See Central Pathology, supra, at p. 184.)  
Defendants fail to acknowledge the factual aspects of Central Pathology 
that qualify its holding, including that the case addressed common law causes of 
action for fraud and intentional infliction of emotional distress that arose in the 
medical malpractice context.  (Central Pathology, supra, 3 Cal.4th at pp. 185, 
 
22
192.)11  While Central Pathology thus speaks to situations in which claims for 
punitive damages are, as a factual matter, “predicated on mere negligence or a 
conscious disregard of the rights or safety of others” in which intentional torts are 
nevertheless alleged (Central Pathology, supra, at p. 191), its rationale does not 
extend to situations, as here, in which a claim for punitive damages accompanies 
allegations of a statutory violation, proof of which will require clear and 
convincing evidence the defendant has been guilty of recklessness, oppression, 
fraud, or malice in the commission of physical, neglectful, or financial elder abuse.  
(See Welf. & Inst. Code, §§ 15657, 15610.30, 15610.57, 15610.63.) 
In light of the general rule that statutory causes of action must be pleaded 
with particularity (Lopez v. Southern Cal. Rapid Trans. Dist. (1985) 40 Cal.3d 
780, 795), a rule plaintiffs’ fourth amended complaint satisfies, we cannot 
conclude, as we concluded in Central Pathology when considering section 
425.13’s application to common law intentional torts, that the Legislature intended 
the statute to apply in an action under the Elder Abuse Act.   
                                             
 
11  
It is axiomatic that an unnecessarily broad holding is “informed and limited 
by the fact[s]” of the case in which it is articulated.  (Cassista v. Community 
Foods, Inc. (1993) 5 Cal.4th 1050, 1061; see generally id. at p. 1057; Thor v. 
Superior Court (1993) 5 Cal.4th 725, 743.)  
 
23
Disposition 
The judgment of the Court of Appeal is affirmed.12 
 
 
 
 
 
 
 
WERDEGAR, J. 
WE CONCUR: 
GEORGE, C. J. 
KENNARD, J. 
BAXTER, J. 
BROWN, J. 
MORENO, J. 
RYLAARSDAM, J.P.T.* 
 
                                             
 
12 
To the extent it is inconsistent with our opinion here, Community Care & 
Rehabilitation Center v. Superior Court, supra, 79 Cal.App.4th 787, is 
disapproved. 
*  
Associate Justice of the Court of Appeal, Fourth Appellate District, 
Division Three, assigned by the Chief Justice pursuant to article VI, section 6 of 
the California Constitution. 
 
24
See next page for addresses and telephone numbers for counsel who argued in Supreme Court. 
 
Name of Opinion Covenant Care v. Superior Court 
__________________________________________________________________________________ 
 
Unpublished Opinion 
Original Appeal 
Original Proceeding 
Review Granted XXX 89 Cal.App.4th 928 
Rehearing Granted 
 
__________________________________________________________________________________ 
 
Opinion No. S098817 
Date Filed: March 25, 2004 
__________________________________________________________________________________ 
 
Court: Superior 
County: Los Angeles 
Judge: Richard B. Wolfe 
 
__________________________________________________________________________________ 
 
Attorneys for Appellant: 
 
Horvitz & Levy, Julie L. Woods, David S. Ettinger; Even, Crandall, Wade, Lowe & Gates, Randolph M. 
Even & Associates, Randolph M. Even and Stephanie Charles for Petitioners. 
 
Hooper, Lundy & Bookman, Mark E. Reagan and Mark A. Johnson for California Association of Health 
Facilities as Amicus Curiae on behalf of Petitioners. 
 
Hanson, Bridgett, Marcus, Vlahos & Rudy, Paul A. Gordon and Michelle L. Sullivan for California 
Association of Homes and Services for the Aging as Amicus curiae on behalf of Petitioners. 
 
Fred J. Hiestand for Californians Allied for Patient Protection and the Civil Justice Association of 
California as Amici Curiae on behalf of Petitioners. 
 
Thelen Reid & Priest, Curtis A. Cole, Kenneth R. Pedroza and E. Todd Chayet for California Medical 
Association, California Dental Association and California Healthcare Association as Amici Curiae on 
behalf of Petitioners. 
__________________________________________________________________________________ 
 
Attorneys for Respondent: 
 
No appearance for Respondent. 
 
Houck & Balisok, Russell S. Balisok, Steven Wilheim, Patricia L. Canner; Law Office of Carol S. Jimenez 
and Carol S. Jimenez for Real Parties in Interest. 
 
Peter G. Lomhoff for California Advocates for Nursing Home Reform, Inc., as Amicus Curiae on behalf of 
Respondent and Real Parties in Interest. 
 
Wilkes & McHugh, Stephen M. Garcia, David T. Bamberger; Robinson, Calcagnie & Robinson and Sharon 
J. Arkin for Consumer Attorneys of California as Amicus Curiae on behalf of Real Parties in Interest. 
 
25
 
 
 
 
Counsel who argued in Supreme Court (not intended for publication with opinion): 
 
David S. Ettinger 
Horvitz & Levy 
15760 Ventura Blvd., 18th Floor 
Encino, CA  91436-3000 
(818) 995-0800 
 
Curtis A. Cole 
Thelen Reid & Priest 
333 South Grand Avenue, Suite 3400 
Los Angeles, CA  90071-3193 
(213) 621-9800 
 
Russell S. Balisok 
Houck & Balisok 
535 North Brand Boulevard, Suite 501 
Glendale, CA  91203 
(818) 506-7890