Opinion ID: 4510943
Heading Depth: 2
Heading Rank: 2

Heading: CPPA Claims Against Medical Service Providers

Text: Historically, “learned professions” were not considered a “trade” subject to consumer protection laws. See Quimby v. Fine, 724 P.2d 403, 405 (Wash. Ct. App. 1986). 8 When enacted, the CPPA specifically prohibited the District’s Department of Consumer and Regulatory Affairs (DCRA) from applying the CPPA to the “professional services of clergymen, lawyers, practitioners of the healing arts and Christian Science practitioners engaging in their respective professional endeavors,” D.C. Code § 28-3903(c)(2)(C) (1981), highlighting that “religion, law, and medicine” were exempt under the statute. See D.C. Council, Report on Bill 1-253 at 17 (Mar. 24, 1976). Any limitation of the CPPA with respect to the practice of medicine, 8 In fact, the Maryland Consumer Protection Act expressly exempts professional services, such as services by lawyers or medical or dental practitioners, from suit. See Md. Code Ann., Com. Law § 13-104 (2001); see also Hogan v. Md. State Dental Ass’n, 843 A.2d 902, 906 (Md. Ct. Spec. App. 2004). 12 however, ended in 1991 when the D.C. Council amended the statute and deleted “practitioners of the healing arts” from § 28-3903(c)(2)(C), thereby extending the CPPA’s protections to the field of medicine. See District of Columbia Consumer Protection Procedures Amendment Act of 1989, D.C. Law 8-234, § 2(d), 38 DCR 296 (Mar. 8, 1991). While the legislative history is silent as to the D.C. Council’s intent behind this amendment, a statement from the Director of the DCRA highlighted that the agency had received, and been forced to reject, complaints against doctors. Statement of Donald G. Murray, Director, DCRA, on Bill 8-271 and Bill 8-111 Amendments to the Consumer Protection Procedures Act Before the Committee on Consumer and Regulatory Affairs, at pp. 6-7 (May 25, 1990). Although Mr. Murray’s statement acknowledged that the lodged complaints “usually involve[d] fees,” he stressed that amending the CPPA to include doctors would allow DCRA “to handle fee cases that involve misrepresentations, the practitioner’s failure to state a material fact, and other activities described as unlawful trade practices.” Id. at 6-7. By enacting the statutory amendment and deleting “practitioners of the healing arts,” the D.C. Council ended the exclusion of the practice of medicine from the CPPA’s coverage. As this court held in Caulfield, the practice of medicine is considered a “trade practice” under the CPPA. 893 A.2d at 976.9 9 As we have construed the Act in light of subsequent amendments, the (continued . . .) 13 We acknowledge that some courts have limited the reach of consumer protection laws to the practice of medicine, expressing concern that lawsuits brought under consumer protection laws may blur the line between consumer protection and medical malpractice claims or render the “well-developed body of law concerning medical malpractice . . . obsolete.” Nelson v. Ho, 564 N.W.2d 482, 486 (Mich. Ct. App. 1997). Accordingly, some courts have attempted to distinguish between traditional medical malpractice claims, which pertain to the “actual performance of medical services or the actual practice of medicine,” from consumer protection claims, which pertain to “allegations of unfair, unconscionable, or deceptive methods, acts, or practices in the conduct of the entrepreneurial, commercial, or business aspect of a physician’s practice.” Id. Only the latter fall within the definition of “trade or commerce” and are thereby encompassed within consumer protection laws. Id. The federal district court in Dorn I and II sought to adopt this distinction, concluding that a consumer claiming a violation of the CPPA against a medical service provider must present evidence of an “entrepreneurial nexus” between the alleged misrepresentation and the (. . . continued) CPPA does not extend a private cause of action to the acts of those professionals expressly excluded from the statute. See Gomez v. Ind. Mgmt. of Del., Inc., 967 A.2d 1276, 1288 (D.C. 2009) (observing that the CPPA did not intend to extend a private cause of action to acts of clergymen, lawyers, and Christian Science practitioners, among others). 14 “economic considerations related to the medical profession,” which “does not cover the skill or performance of a medical practitioner.” Dorn I, 121 F. Supp. 2d at 19-20; see also Dorn II, 157 F. Supp. 2d at 48. Contrary to GWUH’s assertion, and despite having the opportunity to do so, we have not adopted the holdings in Dorn I and II and the “entrepreneurial nexus” requirement for CPPA claims related to the practice of medicine. See, e.g., Caulfield, 893 A.2d at 979 (“[W]e need not adopt a formulation, such as Dorn II’s entrepreneurial nexus requirement – or any other – at this time.”). 10 We now take this opportunity to reject such an “entrepreneurial nexus” requirement. There is no statutory basis for adopting an “entrepreneurial nexus” for CPPA claims related to the practice of medicine, as the statute does not create any limitation in defining medical services as a “trade practice.” Rather, the D.C. Council amended the CPPA to fully include medical professionals within the statute’s coverage. Appellees claim that CPPA claims should be applied “more restrictively” in the context of medical services to “ensure that medical malpractice claims are not improperly brought . . . as consumer protection claims.” However, 10 Moreover, Dorn I and II, which the trial court here read as calling for an “entrepreneurial motive” test, are federal decisions that are not binding on this court. See M.A.P. v. Ryan, 285 A.2d 310, 312 (D.C. 1971). Although we have considered these cases, we do not find them persuasive in light of the statute’s text and legislative history. 15 any concern that the line between CPPA claims and traditional medical malpractice claims will be blurred appears to be overstated. While a rare medical malpractice case may also meet the elements of a CPPA claim, the two have different elements, require different types of evidence, and permit different types of damages.11 The elements of a CPPA claim and medical malpractice claim are very different: unlike those pursuing a medical malpractice claim, claimants under the CPPA need not prove a doctor/hospital-patient relationship giving rise to a duty of care, the strictures of an applicable standard of care, violation of that standard of care, causation, or injury. Morrison v. MacNamara, 407 A.2d 555, 560 (D.C. 1979). Moreover, the type of evidence that must be presented is also different, as a medical malpractice claim will usually require expert evidence to establish the standard of care, see Snyder v. George Washington Univ., 890 A.2d 237, 244 (D.C. 2006) (“Expert testimony is typically required to establish each of the three elements [in a medical malpractice case] except where proof is so obvious as to lie within the ken of the average lay juror.” (internal citations and quotations omitted)), which is not required (though may be relevant) to a CPPA claim. We expressly hold that there is not a different burden of proof for “general” 11 It remains unclear whether the CPPA allows for damages for “personal injury of a tortious nature,” Gomez, 967 A.2d at 977 n.9, and we decline to clarify that issue here. 16 CPPA claims and those against medical service providers, and a consumer is not required to proffer evidence of an “entrepreneurial motive” or an “entrepreneurial nexus” for the latter. Moreover, our cases have rejected the need for a consumer to prove a showing of “motive” or intent in connection with CPPA misrepresentation claims under D.C. Code § 28-3904(a) & (d)-(f), and we now reach the same conclusion as to CPPA claims against medical service providers. At no point in Fort Lincoln or in subsequent cases did we distinguish between different types of CPPA claims, and nothing in the plain language of the statute makes such a distinction. By rejecting the entrepreneurial nexus, we do not eliminate all restraints on the CPPA’s reach to the medical profession. The Supreme Court, in recognizing that the anticompetitive conduct of lawyers falls within the reach of federal antitrust laws, acknowledged that it is “unrealistic to view the practice of [learned] professions as interchangeable with other business activities, and automatically to apply to the professions antitrust concepts which originated in other areas.” Goldfarb v. Va. State Bar, 421 U.S. 773, 788-89 n.17 (1975). The Court acknowledged that the “public service aspect, and other features of the profession, may require that a particular practice, which could properly be viewed as a violation of the Sherman Act in another context, be treated differently.” Id. 17 Similarly here, we acknowledge that certain aspects of the practice of medicine, such as those premised on public service or ethical norms, may lend necessary context to evaluate a medical professional’s conduct and determine whether it can support a CPPA claim. See, e.g., Arizona v. Maricopa Cty. Med. Soc., 457 U.S. 332, 348-49 (1982) (holding that doctors’ price-fixing agreements were “not premised on public service or ethical norms” and therefore fell within the scope of federal antitrust laws). Because we find any such limitation to be inapplicable here, however, we decline to address the contours of such an exclusion.