Source: http://www.lawlink.com/research/CaseLevel3/60529
Timestamp: 2019-04-26 16:22:09+00:00

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JAMES CORNELIUS BROWN et al., Plaintiffs and Appellants, v. THE REGENTS OF THE UNIVERSITY OF CALIFORNIA et al., Defendants and Respondents.
Bowley & Kmeto, Peter Kmeto and Gordon F. Bowley for Plaintiffs and Appellants.
John J. Hannegan, John S. Gilmore, Raymond M. Cadei, Diepenbrock, Wulff, Plant & Hannegan for Defendants and Respondents.
 Plaintiffs appeal from a judgment entered after a demurrer to the class action allegations of their first amended complaint [151 Cal.App.3d 986] was sustained without leave to amend. fn. 1 They contend the trial court erred in determining there is no reasonable possibility plaintiffs can establish a community of interest among the potential class members and that individual issues predominate over common questions of law and fact. We will affirm the judgment.
The allegations of the complaint focus on both negligent and intentional factual concealment and misrepresentation regarding the level of coronary care at the University of California, Davis, Medical Center (Medical Center), and the Medical Center's failure to provide adequate coronary care. The allegations are not confined to a specific date or time period.
Plaintiffs are categorized by the complaint into 10 groups. Plaintiffs in groups "A" and "B" died as a result of complications and injuries sustained during coronary care at the Medical Center. Plaintiffs in groups "C" and "D" suffered complications and injuries from coronary care at the Medical Center. The remaining groups of plaintiffs are spouses and heirs of the four principal groups.
The second cause of action is for intentional misrepresentation. Plaintiffs contend defendants made oral and written representations regarding the quality of coronary care received at the Medical Center: that the most modern equipment was used, that patients benefit from the most advanced surgical techniques and equipment available, that patients are provided specially trained physicians and staff, that the hospital stay is made as comfortable and short as possible, and that appropriate referrals are made as needed. Plaintiffs allege that each representation was false, that plaintiffs relied on such representations and, as a consequence, they suffered damages.
The third cause of action is for battery. This cause of action is predicated on the theory that plaintiffs' consent to surgery was not "informed" by reason of the failure to disclose the "morbidity and mortality statistics resulting from elective heart surgery." If full disclosure had been made, say plaintiffs, either the surgery would not have been performed or would have been performed at another facility.
The fourth cause of action is for negligence in failing to comply with numerous government and industry standards relating to the quality of coronary care. These violations range from the failure to maintain peer review groups to failure to monitor patient care.
The balance of the causes of action represent refinements and extensions of the first four causes of action. The fifth cause of action is for negligent misrepresentation of the facts set forth in the first two causes of action. The sixth cause of action is for breach of contract. In this regard, plaintiffs allege the conduct contained in the prior five causes of action constitutes a breach of defendants' agreement to provide proper coronary care. The seventh cause of action is for breach of the implied covenant of good faith and fair dealing. Plaintiffs contend the conduct alleged in the first six causes of action contravenes the good faith duty imposed by the fiduciary relationship between the parties.
 The right to bring a class action, however, is not unlimited. Class actions will not be permitted, for example, where there are diverse factual issues to be resolved, even though there may be many common questions [151 Cal.App.3d 989] of law. "The ultimate question in every case of this type is whether, given an ascertainable class, the issues which may be jointly tried, when compared with those requiring separate adjudication, are so numerous or substantial that the maintenance of a class action would be advantageous to the judicial process and to the litigants." (Collins v. Rocha (1972) 7 Cal.3d 232, 238 [102 Cal.Rptr. 1, 497 P.2d 225]; Bozaich v. State of California, supra, 32 Cal.App.3d at p. 695.) If the ability of each member of the class to recover clearly depends on a separate set of facts applicable only to him, then all of the policy considerations which justify class actions equally compel the dismissal of such inappropriate actions at the pleading stage. In our review of the complaint at issue, we have determined that individual issues substantially predominate over common questions.
As discussed above, the primary theories of recovery are in the first four causes of action.  The first and second causes of action allege plaintiffs were induced to receive coronary care at the Medical Center by certain affirmative misrepresentations or the failure to disclose certain facts. Certain elements of a fraud cause of action, in the present context, could lend themselves to a class action method of proof. The fact that a certain representation was made, for example, probably could be proved for the class by reference to defendants' publications regarding coronary care. Proof of falsity also would be common to all members of the class. Beyond these elements, however, we encounter a veritable quagmire of tough factual questions which can only be resolved by individual proof. Whether a particular class member relied on the representation, for example, will require close scrutiny of what was said between a class member and his physician. A class member's particular medical condition and method of treatment must be examined in order to determine proximate cause of any claimed damage and the actual extent of such damage. All of the foregoing involve questions of what is medically appropriate for a particular patient under his particular circumstances. Viewed in this context, the complaint raises numerous and substantial individual questions of fact such that it is not reasonably possible plaintiffs will be able to establish a sufficient community of interest to warrant class action.
Plaintiffs rely heavily on Vasquez v. Superior Court, supra, 4 Cal.3d 800, in support of their right to maintain a class action for fraud. Vasquez, however, is readily distinguishable. There, plaintiffs had brought a class action seeking recovery for alleged misrepresentations concerning the sale of freezers and food packages. In upholding the right to maintain a class action for rescission based on consumer fraud, the court noted the misrepresentations were based on a memorized standard statement in a sales manual. Proof of falsity also was provable on a common basis, particularly in view of the standardized nature of the contracts at issue. Finally, the court held [151 Cal.App.3d 990] it was permissible to infer justifiable reliance on defendant's misrepresentations if the reasonable man would have so relied. Individual proof of reliance by each member of the class, therefore, was not required. (Id, at pp. 814-815.) What may be appropriate to a determination of common issues in a relatively simple consumer fraud action, however, is entirely inappropriate when the alleged fraud relates to the decision to obtain heart surgery. Rather than dealing with straightforward issues such as the price of meat and life-expectancy of freezers, the court must grapple with complex issues relating to a patient's medical condition prior to surgery, the need for medical care and the extent of such care required by his condition, the variable nature of the dialogue between physician and patient, the surgical process itself, and postsurgical complications and care.
Damage issues compound the problem. Although the court in Vasquez permitted individual proof of damage by each member of the class, the total amount of damages claimed by any one plaintiff was $7,700, of which $5,000 was for punitive damages. Compensatory damages in excess of $15,000 are claimed by each plaintiff in the present case, together with punitive damages of $500 million. Even if we were to ignore the problems relative to common proof of reliance as previously discussed, the complexity of the damage question alone, fully litigated by each class member, would far outweigh any small benefit derived from those issues which could be tried on a common basis.
 The third cause of action for battery is equally unsuited to class action. Basic to the concept of an informed consent is communication between doctor and patient. Concepts of implied reliance based on the reasonable man, as discussed in Vasquez, have no validity when plaintiff puts into issue the exact communication between hospital and patient. Some of the difficulties in pursuing a class action for lack of informed consent are highlighted in Harrigan v. United States (E.D.Pa. 1974) 63 F.R.D. 402, 405: "The thrust of plaintiff's complaint is that the Veterans Administration failed to obtain the informed consent of the members of the purported class prior to surgery and that such surgery was negligently performed. The concept of informed consent is a complex one involving such issues as what information was supplied to each patient, what the emotional condition of each patient was, what each patient's understanding of the information conveyed was, and whether there was a necessity of dispensing with the requirement of informed consent due to emergency conditions. A determination of informed consent in each case depends on a separate inquiry into the facts surrounding each operation and an application of the facts to the governing legal principles."
We find the Harrigan reasoning persuasive.  The extent of a physician's duty to disclose is directly controlled by the unique situation of each [151 Cal.App.3d 991] patient. The physician must disclose all information "[he] knows or should know would be regarded as significant by a reasonable person in the patient's position when deciding to accept or reject the recommended medical procedure. [Citations.] ... If the physician knows or should know of a patient's unique concerns or lack of familiarity with medical procedures, this may expand the scope of required disclosure. [Citation.]" (Truman v. Thomas (1980) 27 Cal.3d 285, 291 [165 Cal.Rptr. 308, 611 P.2d 902].) Since this duty will necessarily vary from case to case, we determine that individual issues will predominate over common questions.
The failure of plaintiffs to establish a sufficient community of interest as to the first four causes of action necessarily extends to the remaining causes of action. We conclude, therefore, that the demurrer was properly sustained without leave to amend as to all unnamed class plaintiffs.

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