Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_17-cv-02265/USCOURTS-cand-3_17-cv-02265-6/pdf.json

Nature of Suit Code: 362
Nature of Suit: Medical Malpractice
Cause of Action: 28:1331 Fed. Question

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United States District Court

Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

RONALD TURNER,

Plaintiff,

v.

UNITED STATES, et al.,

Defendants.

Case No. 17-cv-02265-WHO 

ORDER ON MOTIONS IN LIMINE 

AND OTHER TRIAL-RELATED 

MATTERS

This Order follows argument on the parties’ Motions in Limine and related legal issues 

raised at the Pretrial Conference on February 25, 2019. I start with the arguments concerning the 

amendment of the complaint to assert explicitly claims for violation of the Confidentiality of 

Medical Information Act (“CMIA”), public disclosure of private facts, and for false light invasion 

of privacy (the “additional claims”), because these are central to the trial. 

Defendants argue that plaintiff Ronald Turner cannot amend his complaint at this late date 

to allege the additional claims, reasoning that they would be prejudiced by not having had a 

chance to do discovery and move for summary judgment on them. Turner represented himself 

pro se until his current counsel took the case on a pro bono basis on the eve of trial, and while 

Turner did not articulate the additional claims in the way his lawyer has, this case has always been 

about Dr. Rivera’s disclosure of Turner’s private information.

I would not normally preclude Turner from alleging the additional claims, but I do so in 

exercise of my discretion for the following reasons. The additional claims all flow from the same 

factual predicate--Dr. Rivera’s disclosure of Turner’s private information because of her asserted

belief that she had a duty to warn under Civil Code § 43.92. The case turns on whether Turner 

communicated a serious threat of physical violence to her in her professional capacity, a 

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requirement under Civil Code § 43.92. I conclude below that MICRA would apply to all of the 

claims because Dr. Rivera’s decision was directly related to the professional services she 

provided. The liability determination would be the same under each claim, and so would the 

remedies. Allowing Turner to present four essentially identical claims with different names risks 

jury confusion. At worst, it is prejudicial to the defendants. At best, it is meaningless to Turner. 

The discussion below explains why, and in the process I deny Plaintiff’s Motion in Limine #4 and 

grants Defendants’ Motion in Limine #6.

Central to my analysis is the applicability of MICRA to all the additional claims. MICRA

limits damages to no more than $250,000 for non-economic losses in “any action for injury 

against a health care provider based on professional negligence[.]” Cal. Civ. Code § 3333.2. This 

raises two questions that the parties dispute. First, is Dr. Rivera a health care provider? Second, 

are Turner’s claims based on her professional negligence?

A “health care provider” is defined as including persons who are licensed or certified by 

the state to practice medicine. Id. at § 3333.2(c)(1). MICRA is meant to be interpreted 

expansively because of the strong public policy to lower the cost of health care in California by 

reducing insurance premiums, and courts have interpreted it to cover health care providers 

lawfully rendering medical services pursuant to an express exception in the licensing regime. 

Chosak v. Alameda Cty. Med. Ctr., 153 Cal. App. 4th 549, 567 (2007) (unlicensed optometry 

student found to be a healthcare practitioner pursuant to an exception). California Business and

Professions Code § 715(b) creates an exception to the licensing requirement for health care 

providers practicing solely pursuant to a contract with the federal government, on a federal 

reservation, or at any facility wholly supported and maintained by the United States government. 

Because the Eureka Veterans Administration clinic, where Dr. Rivera worked, is a facility wholly 

supported and maintained by the federal government, Dr. Rivera is a health care provider for the 

purposes of MICRA.

“Professional negligence” is defined as a “negligent act or omission to act by a health care 

provider in the rendering of professional services, which act or omission is the proximate cause of 

a personal injury[,] . . . provided that such services are within the scope of services for which the 

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provider is licensed and which are not within any restriction imposed by the licensing agency or 

licensed hospital.” Cal. Civ. Code § 3333.2(c)(2). In arguing that the additional claims provide 

non-MICRA remedies, Turner points out that in certain circumstances intentional torts based on 

the same conduct can serve as the basis for both MICRA and non-MICRA claims. Waters v. 

Bourhis, 40 Cal. 3d 424, 437 (1985) (finding that sexual assault by psychiatrist could support both

MICRA and non-MICRA claims). In order to determine if a plaintiff’s claims fall under MICRA, 

courts ask whether the claims flow or originate from a healthcare provider's negligent act or 

omission. See Central Pathology Service Medical Clinic, Inc. v. Superior Court (1992) 3 Cal.4th 

181, 187–188, fn. 3.

Defendants point to Hedlund v. Superior Court, 34 Cal. 3d 695 (1983) as relevant 

authority. In Hedlund, the California Supreme Court found that MICRA applied in a Tarasoff

failure to warn case despite that the duty to warn was based on ordinary negligence because the 

diagnosis of the dangerous behavior “and the appropriate steps necessary to protect the victim are 

not separate or severable, but together constitute the duty giving rise to the cause of action.” Id. at 

703-704. Although Turner contends that Hedlund should no longer apply after the enactment of 

California Civil Code § 43.92, it is routinely cited by both federal and state courts as an example 

of how a failure to warn claim involves professional negligence subject to MICRA. For example, 

in Sloan v. Marin Speciality Surgery Ctr., the California Court of Appeal, citing Hedlund, 

determined that a clinic’s failure to provide a wheelchair to a surgery patient who fell attempting 

to leave the facility on clinic supplied crutches constituted professional negligence because the 

negligent act occurred in the rendering of services for which the clinic was licensed. No. 

A124831, 2010 WL 2543621, at *3 (Cal. Ct. App. June 23, 2010). In Unruh-Haxton v. Regents of 

Univ. of California, a case about a fertility clinic that allegedly stole and sold patients’ eggs and 

pre-embryos, the California Court of Appeal cited Hedlund as an example of a case where a 

plaintiff’s legal theory based on something other than medical malpractice was subject to MICRA. 

162 Cal. App. 4th 343, 353 (2008). In Romar ex rel. Romar v. Fresno Cmty. Hosp. & Med. Ctr., 

the District Court for the Eastern District of California discussed Hedlund in the context of 

determining whether a disparate screening claim under the federal Emergency Medical Treatment 

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and Labor Act (“EMTALA”) fell under MICRA. 583 F. Supp. 2d 1179, 1188 (E.D. Cal. 2008). 

Hedlund remains good law on this point.

Turner cites Jackson v. E. Bay Hosp., 980 F. Supp. 1341 (N.D. Cal. 1997) and Flores v. 

Natividad Med. Ctr., 192 Cal. App. 3d 1106 (Ct. App. 1987) to argue that the additional claims 

should not fall under MICRA. In Jackson, the plaintiff brought claims pursuant to both state law 

and EMTALA in relation to the death of her husband. Id. at 1343. The court cited but did not 

follow the state law precedent because it was reluctant to condition the federal substantive cause 

of action (EMTALA) on the reasoning in Central Pathology, a case that explicitly involves a state 

procedural requirement. 980 F. Supp. at 1349. Here, there is no such federal substantive cause of 

action; Jackson does not help Turner. 

In Flores, a prisoner patient sued certain doctors, a medical center, a county, and the State

of California for medical negligence and for failure to summon medical care pursuant to California 

Government Code § 845.6. 192 Cal. App. 3d at 1110. The court found that MICRA applied to 

both claims as to the doctors but not to the State because the failure to summon aid claim was a 

distinct claim (not based on professional negligence, because “the State is immune from liability 

for such negligence of its employees.”) Id. at 1116. Here, all of Turner’s claims inherently flow 

from Dr. Rivera’s allegedly negligent conduct, as the court held with respect to the two doctors in 

Flores. Accordingly, all of Turner’s claims are subject to MICRA.

Because the facts proving liability for each claim and the remedy Turner could achieve for 

each claim are identical, there is no purpose in requiring the jury to wade through separate 

instructions on liability for four claims. The task would be legally and practically pointless and 

the risk of jury confusion would be high. Repetition of claims against defendants might have a 

prejudicial effect; a verdict on all four claims in Turner’s favor would not increase his damages 

recovery (and a verdict on some but not all of the claims might well result in an inconsistent 

verdict and mistrial). It would waste time. Accordingly, I will not allow Turner to proceed on the 

additional claims at trial and would deny the alternative request to amend. 

This determination affects the amount of damages Turner may recover in a second way--

MICRA alters the collateral source rule in medical malpractice cases. Cuevas v. Contra Costa 

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Cty., 11 Cal. App. 5th 163, 172 (Ct. App. 2017). A medical malpractice defendant may introduce 

evidence of “any amount payable as a benefit to the plaintiff as a result of the personal injury 

pursuant to the United States Social Security Act, any state or federal income disability or 

worker's compensation act, any health, sickness or income-disability insurance, accident insurance 

that provides health benefits or income-disability coverage, and any contract or agreement of any 

group, organization, partnership, or corporation to provide, pay for, or reimburse the cost of 

medical, hospital, dental, or other health care services.” Id. (citing Cal. Civ. Code § 3333.1(a)). 

Because all of Turner’s claims are subject to MICRA, the collateral source rule does not apply. If 

defendants introduce evidence of Turner’s collateral source benefits, Turner may introduce 

evidence of any payments made to obtain these benefits. Id. 

Accordingly, plaintiff’s motion in limine #4 is denied and defendants’ motion in limine #6 

is granted. I address the remaining motions in limine below.

PLAINTIFF’S MOTIONS IN LIMINE

#1. Grant. I have previously concluded, following Ewing v. Northridge Hosp. Med. Ctr., 

120 Cal. App. 4th 1289 (2004), that whether Turner communicated to the psychotherapist a 

serious threat of physical violence against a reasonably identifiable victim or victims is a question 

of fact for the jury. Testimony about what the law requires in this regard is inadmissible; I will 

instruct the jury on the law. On the other hand, testimony on the standard of care is admissible.

#2. Grant. Defendants must choose between the two experts they propose to call, Mr. 

Quinby and Dr. Vinogradov, because their testimony would be cumulative and duplicative and 

would waste time under Federal Rule of Evidence 403.

#3. Grant. The restraining order proceeding is irrelevant and unduly prejudicial and is 

excluded under Rule 403. The relationship between Van Auken and Turner is only relevant to the 

extent Dr. Rivera learned about it prior to disclosing the information.

#5. Grant, as agreed by the parties. Dr. Rivera may testify on her consideration of 

Turner’s status as a veteran to the extent it was relevant to her decision to disclose.

DEFENDANTS’ MOTIONS IN LIMINE 

#1. Denied. Dr. Vieten may testify as an expert on the standard of care. Defendants may 

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cross-examine her on her alleged lack of expertise regarding the duties of California practitioners.

#2. Grant. The question of whether medication prescribed to Turner caused the 

“behavioral complaints” about him is irrelevant to the issues in this case and testimony about it is 

excluded under Rule 403.

#3. Denied. Plaintiff may offer evidence, and cross-examine Dr. Rivera, concerning 

McLaughlin and Reeves’s lack of reporting a threat of physical violence by Turner to the 

authorities or Turner’s supervisor.

#4. Denied in part. It is true that Dr. Rivera’s state of mind is relevant, and what Turner 

said, as opposed to what he was thinking, is most probative. However, his state of mind is 

relevant to his testimony to corroborate what he remembers saying. Mrs. Turner’s understanding 

of his state of mind may also be relevant to corroborate her telephone conversation with Dr. 

Rivera before the disclosure was made.

#5. Denied. Testimony regarding Turner’s absence of a history of violence is relevant to 

explore the assumptions Dr. Rivera may have made regarding his military history (see plaintiff’s 

MIL #5).

#7. Granted in part. Turner may not argue that any judgment against defendants would be 

paid by insurance, but he may introduce the agreement between Dr. Rivera and Locumtenens and 

explore the terms as part of the evidence of employment or agency.

#8. Granted. The parties shall not refer to settlement discussions. If it becomes relevant, 

Turner may show that he delivered a written notice of intent to sue on November 8, 2016.

#9. Granted, absent the testimony of a person with knowledge from the VA of the 

relationship between Dr. Rivera and Locumtenens.

#10. Denied, in light of the VA’s policy and the training Dr. Rivera may have received 

concerning it.

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#11. Denied. The failure of Locumtenens and Dr. Rivera to produce tax and other records 

to support their theory of their relationship may be explored (and explained).

IT IS SO ORDERED.

Dated: February 26, 2019

William H. Orrick

United States District Judge

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