Court Opinion

ID: 9412076
Source: CourtListenerOpinion
Date Created: 2023-07-28 20:03:54.906762+00
Date Added: 2024-06-11T16:41:26.879505
License: Public Domain

Filed 7/28/23 Rhonda S. v. Kaiser Foundation Health Plan CA2/8
   NOT TO BE PUBLISHED IN THE OFFICIAL REPORTS

California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not
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IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

                         SECOND APPELLATE DISTRICT

                                       DIVISION EIGHT

 RHONDA S., as Conservator, etc.,                                      B318650

         Plaintiff and Appellant,                                     Los Angeles County
                                                                      Super. Ct. No. 20STCV05001
           v.

 KAISER FOUNDATION HEALTH
 PLAN et al.,

         Defendants and Respondents.

      APPEAL from a judgment of the Superior Court of Los
Angeles County. Carolyn B. Kuhl, Judge. Affirmed.
      Kantor & Kantor, Lisa S. Kantor, J. David Oswalt; Law
Offices of Kathryn Trepinski and Kathryn M. Trepinski for
Plaintiff and Appellant.
      Sheppard, Mullin, Richter & Hampton, Moe Keshavarzi,
Robert J. Guite and Matthew G. Halgren for Defendants and
Respondents.
                         ________________
       Plaintiff and appellant Rhonda S. is the conservator,
appointed pursuant to section 5350 of the Lanterman-Petris-
Short Act (LPS; Welf. & Inst. Code,1 § 5000 et seq.), of her adult
son David S. Plaintiff sued defendants and respondents Kaiser
Foundation Health Plan, Inc. and Kaiser Foundation Hospitals2
for a declaration of their obligations, under LPS and the terms of
David’s health plan, to transport and accept for “assessment and
evaluation” (each as defined in LPS) conservatees like David
upon their conservators’ demand. The trial court sustained
Kaiser’s demurrer. We affirm.
                          BACKGROUND
       Plaintiff and David are enrollees under an HMO health
plan issued by Kaiser Health Plan. David suffers from
schizophrenia with symptoms of paranoia and psychosis. He
received treatment for his condition from Dr. Nathalie Maullin, a
psychiatrist practicing at a Kaiser healthcare facility in Los
Angeles’s Chinatown neighborhood.
       Dr. Maullin recommended plaintiff become David’s
conservator. LPS conservatorships may be established only for
persons who are “gravely disabled.” (§ 5350.) A “gravely
disabled” person includes one who, “as a result of a mental health
disorder, is unable to provide for his or her basic personal needs
for food, clothing, or shelter.” (§ 5008, subd. (h)(1)(A).)

1     Undesignated statutory references are to the Welfare and
Institutions Code.

2     We refer to defendants collectively as “Kaiser.” Where
necessary to distinguish between them, we refer to Kaiser
Foundation Health Plan, Inc. as “Kaiser Health Plan” and Kaiser
Foundation Hospitals as “Kaiser Hospitals.”

                                2
       In September 2018, following a hearing attended by
Dr. Maullin, the Los Angeles County Mental Health Court found
David to be gravely disabled and appointed plaintiff his
conservator. The conservatorship order authorized plaintiff to,
among other things, “transport, or cause another to transport,
[David] to a psychiatric facility designated by the County within
the meaning of . . . Section 5150, or to a member of the attending
staff of such facility, for purpose of evaluation for intensive
treatment.”
       In April 2019, David became suicidal. Plaintiff contacted
David’s then-treating psychiatrist, Dr. Eric Lee, and requested
that David be transported to the Kaiser Chinatown facility to be
admitted and administered psychotropic medication. The
Chinatown facility is a “facility designated by the county for
evaluation and treatment” within the meaning of section 5008,
subdivision (n),3 a designation Kaiser voluntarily sought to obtain
attendant rights and benefits under LPS. Dr. Lee explained he
was unable to help plaintiff with her request. According to
plaintiff’s allegations, Dr. Lee alluded to a “personal mobile team
that Kaiser used for transport, but he could not access it,” and
was unable, per Kaiser policy, to secure a bed for David under the
circumstances.

3      The parties use the term “county designated treatment
facility,” which is not defined in LPS but appears in
section 5358.5. Because plaintiff’s explanation of the process for
becoming a “county designated treatment facility” is the same as
that for becoming a “facility designated by the county for
evaluation and treatment,” we understand the parties to use
“county designated treatment facility” as shorthand for “facility
designated by the county for evaluation and treatment.” We
follow the parties’ convention.

                                 3
       Three days later, Kaiser sent a follow-up letter to plaintiff
regarding her requests for “David to be admitted to an inpatient
psychiatric hospital without prior evaluation” and
“[t]ransportation for David to a psychiatric hospital.” It
explained these requests had been denied as “not medically
necessary” because David had not been evaluated by a doctor to
validate plaintiff’s concerns. The letter noted that plaintiff had
declined Dr. Lee’s offers of in-person and telephonic
appointments in the preceding month, and that Kaiser had
suggested that plaintiff “consider arranging an evaluation with
the Psychiatric Mobile Response Teams . . . which can usually
arrive within an hour.” The letter further recommended “David
present for an evaluation for possible psychiatric hospitalization,”
and that plaintiff call 911 for assistance from “an ambulance or
law enforcement” if she was concerned David would not comply.
       Plaintiff alleges she “did not want to ask for the assistance
of law enforcement because it created a risk of harm to David,
who was suffering from schizophrenia with symptoms of
paranoia.” Her allegations do not address Kaiser’s alternative
suggestion of requesting an ambulance.
       After Kaiser sent its follow-up letter, “David continued to
decompensate until he was ultimately apprehended by police and
placed on a Section 5150 involuntary hold.”
       Plaintiff sued Kaiser, on her own behalf and on behalf of
“[a]ll California residents who, during the Class Period, were LPS
Conservators whose Conservatees were covered by a health plan
or policy issued by [Kaiser Health Plan].” Her operative second
amended complaint “seeks a declaration that, under [LPS],
[Kaiser Hospitals] must accept for assessment and evaluation
and, if necessary, treatment a conservatee who has been removed

                                 4
to one of its county designated treatment facilities by a
conservator pursuant to Section 5358.5” and a further
“declaration that [Kaiser Health Plan] must provide insurance
coverage for the transport of the conservatee to the county
designated treatment facility pursuant to Section 5358.5 and,
once transported, for the conservatee’s assessment and
evaluation at the Kaiser county designated treatment facility as
required by [LPS].”
      The trial court sustained Kaiser’s demurrer to the second
amended complaint. It found plaintiff had failed to adequately
plead any basis for the duties she alleged Kaiser owed her. It
found no such duties could arise under section 5358.5 because
that section “does not create any rights or obligations of a county
designated treatment facility vis-[á]-vis a conservatee or LPS
conservator.” And it found that no such duties could arise under
section 5150 because plaintiff is not a member of the class of
persons entitled to subject a person to custody under that
provision. Finally, the trial court rejected plaintiff’s claim for a
declaration of Kaiser’s obligations to transport a conservatee at
the conservator’s request because the claim was one to “ ‘provide
coverage,’ not a request for a declaration that Kaiser must comply
with the requirements of the existing contractual agreement for
coverage.” The trial court gave plaintiff the opportunity to file a
third amended complaint. Rather than do so, plaintiff requested
dismissal and filed this appeal.
                           DISCUSSION
1.    Standard of Review
      Although plaintiff acknowledges that a judgment on a
cause of action for declaratory relief is sometimes reviewed for
abuse of discretion, Kaiser argues that our review is de novo. As

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it appears the relevant facts are undisputed and the issues turn
on questions of statutory and contract interpretation, we review
the judgment de novo. (Cf. Widders v. Furchtenicht (2008)
167 Cal.App.4th 769, 776 [“The sustaining of a demurrer on a
claim for declaratory relief is generally reviewed for an abuse of
discretion. [Citation.] Our review is de novo where the relevant
facts are essentially undisputed and the issue involves statutory
interpretation.”].)
2.     Declaratory Judgment
       Code of Civil Procedure section 1060 provides that a party
to a contract may bring an action to declare the legal rights and
duties of the parties that are in “actual controversy.” (Ibid.)
Disputed rights and obligations arising by statute are likewise
the proper subject of an action for declaratory relief. (See Bess v.
Park (1955) 132 Cal.App.2d 49, 52 [“statutes are inherently
proper subjects of declaratory relief”].)
       The plaintiff must show that an actual controversy exists
involving justiciable questions relating to the rights or
obligations of a party. (Brownfield v. Daniel Freeman Marina
Hospital (1989) 208 Cal.App.3d 405, 410.) “The ‘actual
controversy’ requirement concerns the existence of present
controversy relating to the legal rights and duties of the
respective parties pursuant to contract [citation], statute or
order.” (Ibid.) “Where the allegations of the complaint reveal the
controversy to be conjectural, anticipated to occur in the future,
or an attempt to obtain an advisory opinion from the court, the
fundamental basis of declaratory relief is lacking.” (Ibid.)
3.     Analysis
       We consider plaintiff’s requested declarations against
Kaiser Hospitals and Kaiser Health Plan in turn.

                                 6
       a.     Kaiser Hospitals
       Plaintiff first seeks a declaration that section 5358.5
authorizes an LPS conservator to cause the transport of her
conservatee, who is enrolled in a Kaiser Health Plan HMO, to a
Kaiser county-designated treatment facility without the aid of
law enforcement. Plaintiff asserts in briefing that Kaiser does
not dispute this proposition. In the absence of a dispute,
declaratory relief is inappropriate and we affirm the trial court’s
denial of a declaration as to this issue. (See Auberry Union
School Dist. v. Rafferty (1964) 226 Cal.App.2d 599, 603 [“Where it
is apparent that the defendant does not actually oppose the
position taken by the plaintiff, there obviously can be no
controversy and there is nothing to be determined by the court.”];
see also Application Group, Inc. v. Hunter Group, Inc. (1998)
61 Cal.App.4th 881, 893 [in declaratory relief action where the
defendant “never really disputed, and indeed, conceded” the
plaintiff’s interpretation, “declaratory relief would be
inappropriate”].)
       Plaintiff says in her reply brief, “the real question is what
happens when the conservatee arrives at the Kaiser facility[?]”
This brings us to plaintiff’s second requested declaration—that,
once a Kaiser-covered conservatee has been transported and
delivered to a Kaiser county-designated treatment facility, the
facility is “required to conduct an assessment and evaluation and,
if necessary, placement of the conservatee under the provisions of
[LPS].”
       Put simply, plaintiff seeks a declaration that she, as a
conservator, has authority under LPS to require Kaiser Hospitals
to evaluate and treat her conservatee simply by delivering him to

                                 7
a Kaiser county-designated treatment facility. Plaintiff relies
exclusively on section 5150 for this proposition.
       Whether LPS imposes the obligations plaintiff claims is a
question of statutory interpretation. We apply well-settled rules
of statutory construction to ascertain legislative intent. We look
first to the statutory language and give the words their usual and
ordinary meaning. (Reid v. Google, Inc. (2010) 50 Cal.4th 512,
527.) “ ‘ “The statute’s plain meaning controls the court’s
interpretation unless its words are ambiguous.” ’ ” (Ibid.) If the
words are ambiguous, we may consider other interpretive tools,
such as the statute’s purpose, legislative history, and public
policy. (Ibid.)
       We must follow the construction that “ ‘comports most
closely with the apparent intent of the Legislature, with a view to
promoting rather than defeating the general purpose of the
statute, and avoid an interpretation that would lead to absurd
consequences.’ ” (Chaffee v. San Francisco Library Com. (2004)
115 Cal.App.4th 461, 468.) When possible, we “give effect to the
statute as a whole, including every clause, so that no provision is
rendered useless or meaningless.” (In re Marriage of Watt (1989)
214 Cal.App.3d 340, 352; see also Code Civ. Proc., § 1858.)
       Section 5150, subdivision (a) provides: “When a person, as
a result of a mental health disorder, is a danger to others, or to
themselves, or gravely disabled, a peace officer, professional
person in charge of a [county-designated treatment facility],
member of the attending staff, as defined by regulation, of a
[county-designated treatment facility], designated members of a
mobile crisis team, or professional person designated by the
county may, upon probable cause, take, or cause to be taken, the
person into custody for a period of up to 72 hours for assessment,

                                 8
evaluation, and crisis intervention, or placement for evaluation
and treatment in a [county-designated treatment facility] and
approved by the State Department of Health Care Services. The
72-hour period begins at the time when the person is first
detained. At a minimum, assessment, as defined in
Section 5150.4, and evaluation, as defined in subdivision (a) of
Section 5008, shall be conducted and provided on an ongoing
basis. Crisis intervention, as defined in subdivision (e) of
Section 5008, may be provided concurrently with assessment,
evaluation, or any other service.”
       Kaiser argues plaintiff lacks authority to trigger Kaiser
Hospitals’ obligations under section 5150, subdivision (a) because
she is not a member of the limited class of persons—peace officers
and certain designated professionals—the statute authorizes to
do so. Kaiser also points to the statute’s permissive language—
that the specifically authorized persons “may, upon probable
cause, take . . . the person into custody for a period of up to
72 hours for assessment, evaluation, and crisis intervention, or
placement for evaluation and treatment” (ibid.)—as establishing
that a section 5150 process may be commenced only by a
statutorily designated person in the exercise of their professional
judgment.
       Plaintiff acknowledges the permissive language but notes
the statute contains mandatory language as well. In her reading,
section 5150, subdivision (a)’s penultimate sentence requires a
county-designated treatment facility, when a conservator
presents her conservatee for care, to perform “[a]t a minimum,
assessment, as defined in Section 5150.4, and evaluation, as
defined in subdivision (a) of Section 5008” before making the
decision whether to take the conservatee into custody.

                                9
       Kaiser reasons, as the trial court did, that the obligations
imposed by the penultimate sentence arise only after the
professional determination has been made to take the patient
into custody. In Kaiser’s view, if such a decision has not been
made, “the duty to assess has not been triggered.”
       Based on the plain language of section 5150, subdivision
(a),4 we agree with Kaiser that the penultimate sentence does not
obligate a county-designated treatment facility to perform a
section 5150.4 assessment and section 5008, subdivision (a)
evaluation of a conservatee merely on his or her conservator’s
demand. Rather, these obligations are triggered only once an
authorized person has exercised his or her professional judgment,
on probable cause, to take the conservatee into custody in
accordance with the first sentence of section 5150, subdivision (a).
       First, plaintiff’s interpretation of section 5150,
subdivision (a)’s penultimate sentence fails to account for the
word “ongoing.” Plaintiff’s interpretation would require Kaiser
Hospitals to assess and evaluate a conservatee “on an ongoing
basis” even in the absence of probable cause for custody and
based solely on the judgment of a lay conservator. (Ibid.) This
interpretation would lead to absurd consequences. The
obligations of the penultimate sentence can therefore only arise
after an authorized person makes the determination to take
custody of the conservatee pursuant to the first sentence,
whereupon assessment and evaluation are “ongoing” throughout
the period of custody of up to 72 hours.

4      Because we find the language of section 5150 unambiguous,
we deny Kaiser’s motion for judicial notice of certain LPS
legislative history. (Green v. Laibco, LLC (2011) 192 Cal.App.4th
441, 449.)

                                10
       Second, section 5150, subdivision (a) plainly states that
custody may be taken of a person in order to perform an
assessment. (Ibid. [authorized persons “may, upon probable
cause, take . . . the person into custody for a period of up to
72 hours for assessment, evaluation, and crisis intervention, or
placement for evaluation and treatment” (italics added)].)
       Finally, section 5150, subdivision (c) does not change the
analysis. That a professional person must “assess the person to
determine whether the person can be properly served without
being detained” does not mean the person is not in custody at the
time of the assessment. Section 5150, subdivision (c) requires a
professional person to ascertain through “assess[ment]” whether
maintaining custody is appropriate. It does not require
assessment before the person is in custody.
       b.     Kaiser Health Plan
       Plaintiff seeks declarations “[t]hat Kaiser Health Plan is
required to provide coverage under Class members’ health plans
for an LPS Conservator’s request for ambulance transportation of
his or her conservatee to Kaiser county designated treatment
facility for assessment and evaluation,” and, “[t]hat once
transported, Kaiser Health Plan is required to provide coverage
under Class members’ health plans for the conservatee’s
assessment and evaluation and, if necessary, placement at the
Kaiser county designated treatment facility.”
       Plaintiff does not assert that Kaiser Health Plan owes any
duty to her or David under LPS. The only source of Kaiser
Health Plan obligations she identifies is David’s health plan. We
agree with the trial court that plaintiff failed to establish a right
under the terms of David’s health plan to the declarations she
requests.

                                 11
       Plaintiff alleges that David’s health plan provides coverage
for ambulance services “if a ‘reasonable person would have
believed that the medical condition was an Emergency Medical
Condition which required ambulance services.’ ” “Emergency
Medical Condition” is further defined in the plan and includes
mental health conditions under certain circumstances. Among
other things, a mental health condition is an “Emergency Medical
Condition” when manifested “by acute symptoms of sufficient
severity” such that “[t]he person is immediately unable to provide
for, or use, food, shelter, or clothing, due to the mental disorder.”
Plaintiff notes that inability to feed, clothe, or shelter oneself due
to a mental disorder amounts to a “grave disability” under LPS
(§ 5008, subd. (h)(1)(A)), and David was judicially determined to
be gravely disabled when plaintiff was made his conservator.
       Plaintiff’s requested declaration that ambulance coverage is
mandatory based solely on an LPS conservator’s request for the
conservatee’s transport would substantially modify the terms of
David’s health plan.
       First, we reject plaintiff’s implication that an LPS
conservatee is per se suffering from an “Emergency Medical
Condition” at all times following the judicial determination of
grave disability. The purposes of LPS conservatorship include
providing treatment to the conservatee. (§ 5350.1.) To assume a
conservatee’s condition remains static following the
conservatorship order is to assume treatment is always
ineffectual. We are offered no basis for such an assumption. For
a mental health condition to be an “Emergency Medical
Condition” under the plan, “acute symptoms of sufficient
severity” must result in an “immediate” specified danger or
mental health disorder induced disability. Plaintiff’s suggestion

                                 12
that a past finding of grave disability results in a perpetual
“Emergency Medical Condition” would read these elements out of
the plan. Entitlement to coverage for ambulance service under
David’s plan is measured at the time of the request, not at the
time of a prior judicial order.
       Second, even if conservatees were in a state of perpetual
“Emergency Medical Condition” within the meaning of the plan,
plaintiff’s requested declaration would eliminate the coverage
requirement that a “reasonable person would have believed that
the medical condition was an Emergency Medical Condition
which required ambulance services.” (Italics added.) Not every
trip to see a doctor requires an ambulance. Considerations such
as distance, alternative transportation options, traffic conditions,
and the character and severity of the medical condition are
relevant to whether an ambulance is required. Indeed, plaintiff’s
allegations reflect that, at the time of the episode that prompted
her lawsuit, she did not believe an ambulance was required. At
best, she believed an ambulance was desirable, provided it was
sent by Kaiser and not by a 911 dispatcher. This is evident from
the fact that she did not call 911 when her preferred avenues of
obtaining an ambulance were unavailing, and days passed
between her initial request for an ambulance and when David
was apprehended and placed on a section 5150 hold.
       Plaintiff’s last requested declaration—“[t]hat once
transported, Kaiser Health Plan is required to provide coverage
under Class members’ health plans for the conservatee’s
assessment and evaluation and, if necessary, placement at the
Kaiser county designated treatment facility”—is not
substantively addressed in her appellate briefing. We therefore

                                 13
deem it forfeited. (See Rodriguez v. County of Los Angeles (2013)
217 Cal.App.4th 806, 809, fn. 5.)
                         DISPOSITION
      The judgment is affirmed. Defendants are to recover their
costs on appeal.

                              GRIMES, J.

      WE CONCUR:

                        STRATTON, P. J.

                        VIRAMONTES, J.

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