Appellate Updates

Faiaipau v. THC-Orange County, LLC (Dec. 19, 2025, A171351) __ Cal.App.5th __ (2025 WL 3704596)

Ana Faiaipau was admitted to a long-term acute care hospital to recover from heart surgery. After she died at the facility, her successors-in-interest sued the hospital for negligence, Elder Abuse neglect, fraud or breach of fiduciary duty, violation of the unfair competition law (UCL), and wrongful death. The wrongful death claim turned on the hospital’s alleged failure to monitor Ana’s ventilator, which became disconnected, leading to a fatal anoxic brain injury. The hospital moved to compel arbitration of all claims based on an arbitration agreement signed on Ana’s behalf at the time she was admitted. The trial court ordered arbitration of the negligence and elder neglect claims, but denied arbitration of the wrongful death, fraud, and UCL claims. The hospital appealed.

The Court of Appeal reversed in part, expanding the trial court’s arbitration order to include the wrongful death claim in addition to the negligence and elder neglect claims. Relying on Holland v. Silverscreen Healthcare, Inc. (2025) 18 Cal.5th 364, the court distinguished claims arising out of the hospital’s acts or omissions in its capacity as a health care provider, from claims arising out of the hospital’s acts or omissions as an elder custodian. Failing to monitor a ventilator is medical negligence, not custodial neglect, because it concerns the hospital’s alleged inadequate provision of medical care rather than its failing to provide custodial care. Because the parties had agreed to arbitrate medical negligence claims, and Code of Civil Procedure section 1295 applies to such agreements, plaintiffs’ wrongful death claim was subject to arbitration. The court distinguished Delany v. Baker (1999) 20 Cal.4th 23, 34-35, explaining that Holland “drew a clear line between the types of activities that constitute professional negligence and neglect, rather than relying on differences in [the] mental state” of the healthcare provider.

Doe v. Dynamic Physical Therapy, LLC, 607 U.S. __, __ S. Ct. __, 2025 WL 3506945 (Dec. 8, 2025, No. 25–180)

In a Louisiana case, Plaintiff brought federal discrimination claims under the Americans with Disabilities Act (ADA) and the Rehabilitation Act, as well as state-law claims, against Dynamic Physical Therapy, alleging that it unlawfully denied him needed aquatic physical therapy due to his HIV-positive status. Dynamic asserted immunity under Louisiana’s Health Emergency Powers Act (LHEPA), which shields healthcare providers from civil liability during declared public health emergencies, including the COVID-19 emergency in effect when plaintiff was denied care. The trial court dismissed plaintiff’s complaint based on LHEPA immunity and the Louisiana Court of Appeal affirmed. 

The U.S. Supreme Court granted certiorari and summarily reversed, holding that LHEPA cannot immunize healthcare providers from federal statutory liability. States are “bound” by the Supremacy Clause of the United States Constitution to “follow federal law” and have “no power to confer immunity from federal causes of action.”

The Court’s holding would apply equally to California immunity statutes, which cannot bar liability for violation of federal law. For example, Government Code section 8659, which is a part of the California Emergency Services Act (CESA), immunizes medical and veterinary providers from liability during a state of emergency when they act “at the express or implied request of any responsible state or local official or agency,” except for “willful act[s] or omission[s].” (Gov. Code, § 8659.) Under Dynamic, the CESA cannot bar liability for violating federal laws. Likewise, the California Tort Claims Act protects “public employee[s] acting within the scope of [their] employment” from liability “for injury resulting from diagnosing or failing to diagnose that a person is afflicted with mental illness.” (Gov. Code, § 855.8.) Assertions of section 855.8 immunity against federal causes of action would be barred by Dynamic. For example, if a prisoner brings an Eighth Amendment claim under 42 U.S.C. § 1983 against his prison doctor alleging deliberate indifference for failing to diagnose his mental illness, courts should reject the doctor’s assertion of immunity consistent with Dynamic’s ruling that state-law immunities do not trump federal claims.

Snover v. Gupta (Nov. 18, 2025, No. A172568) __ Cal.App.5th __ [2025 WL 3215132]

The guardian of Adria Snover sued Dr. Aruna Gupta, Dr. Neel Pandya, and Riverside Community Hospital after medical complications during a cesarean section left her in a permanent coma. Before trial, Snover settled separately with Dr. Pandya and with the hospital. The hospital’s settlement allocated $250,000 to Snover’s son in exchange for a waiver of his right to bring a future wrongful death claim. At trial against Dr. Gupta, the jury awarded Snover almost $7.5 million in economic damages and $10 million in noneconomic damages; the jury allocated 15 percent fault to Dr. Gupta. To prepare a judgment, the trial court reduced the verdict to account for the pretrial settlements and Dr. Gupta’s percentage of fault. The court calculated Dr. Gupta’s noneconomic liability by first reducing the noneconomic damages award to $250,000 (the then-existing MICRA cap) and then reducing that sum to $37,500 (Dr. Gupta’s 15 share of fault). In calculating economic damages, the trial court followed Mayes v. Bryan (2006) 139 Cal.App.4th 1075 by calculating the ratio of economic damages to total damages (here, economic damages plus $37,500), and then applying that percentage to the pretrial settlement amounts to determine the amount of setoffs to apply to the total damages. The court included the $250,000 allocated to Snover’s son in its setoff calculation. Snover appealed.

The Court of Appeal affirmed the trial court’s sequencing and result. It held that, consistent with Gilman v. Beverly California Corp. (1991) 231 Cal.App.3d 121 and Rashidi v. Moser (2014) 60 Cal.4th 718, the trial court correctly applied the MICRA cap before apportioning liability for noneconomic damages because all defendants were healthcare providers covered by MICRA. The court explained that reversing the order of operations—i.e., first multiplying noneconomic damages by a defendant’s percentage of fault and then capping noneconomic damages at $250,000 under MICRA—would improperly inflate the noneconomic damages award. The court next explained that, under Mayes, the trial court must apply the MICRA cap before determining the portion of pretrial settlements setoff against economic damages because all defendants were protected by MICRA. This prevents skewed allocation of settlement dollars to noneconomic damages (thereby reducing the amount of settlements offsetting the economic damage award) and ensures that settlement allocations are consistent with defendant’s MICRA-capped exposure. Finally, the court rejected Snover’s argument that, when valuing her settlement with the hospital, the trial court should have excluded the $250,000 allocated to her son’s future wrongful death claim, reasoning that plaintiff’s son was not a party to the settlement and Snover failed to prove the amount disbursed to her son was “arrived at in a sufficiently adversarial proceeding that it should be deducted from the hospital’s settlement with her.”

Pritchard v. Blue Cross Blue Shield of Ill., __ F.4th __, 2025 WL 3202338 (9th Cir. Nov. 17, 2025)

Class action plaintiffs sued Blue Cross alleging it violated section 1557 of the Affordable Care Act, which prohibits sex-based discrimination, by denying coverage for gender dysphoria treatment pursuant to exclusions in certain employer sponsored health plans. A federal district court granted summary judgment for Plaintiffs, ruling that section 1557 applied to Blue Cross, that Blue Cross was not shielded from liability by the Religious Freedom Restoration Act (RFRA), and that gender dysphoria exclusions discriminated based on sex under Bostock v. Clayton County, 590 U.S. 644 (2020). Blue Cross appealed.

The Ninth Circuit vacated the district court’s judgment and remanded for further proceedings. The court first held that section 1557 applies to entities (not merely to plans) if any part of the entity receives federal funds, even if the plans at issue are not federally funded. Accordingly, Blue Cross was governed by section 1557. Next, the Ninth Circuit affirmed the district court’s conclusion that third-party administrators can be liable for violating section 1557 when implementing plan terms drafted by a plan sponsor, because ERISA does not permit administrators to violate federal law. In addition, Blue Cross could not invoke RFRA as a defense because (1) a RFRA defense applies only to government action, not disputes between private parties; and (2) Blue Cross is a secular entity.

Finally, the Ninth Circuit held that the district court’s Bostock-based decision addressing the gender dysphoria exclusion “ran afoul of” United States v. Skrmetti, 145 S. Ct. 1816 (2025), but Plaintiffs could still potentially prevail on remand. The court explained that mere reference to “sex” in the policy exclusions, without more, is insufficient to establish that sex was a “but for” cause of the coverage denial since dysphoria treatment coverage was denied for all patients regardless of their sex.  But some of the class plaintiffs alleged diagnoses other than gender dysphoria that would entitle them to treatment Blue Cross had refused to cover. Also, plaintiffs may claim that Blue Cross’s categorical gender dysphoria coverage exclusion was a pretext for proxy-discrimination against transgender individuals, since Blue Cross admitted that such treatments are sometimes medically necessary. The Ninth Circuit remanded for the district court to assess these arguments.

Taking Offense v. State of California (Nov. 6, 2025, S270535) ___ Cal.5th ___ [2025 WL 3097904]

Taking Offense, an association opposed to laws requiring recognition of transgender identities, filed a writ petition challenging Health and Safety Code section 1439.51, subdivision (a)(5)’s pronouns provision as facially unconstitutional under the First Amendment. This pronouns provision prohibited staff at long-term care facilities from “[w]illfully and repeatedly fail[ing] to use a resident’s preferred name or pronouns after being clearly informed of the preferred name or pronouns,” when they do so “wholly or partially on the basis of a person’s actual or perceived sexual orientation, gender identity, gender expression, or human immunodeficiency virus (HIV) status.” After the trial court denied Taking Offense’s petition, the Court of Appeal reversed in part, holding that, under a strict scrutiny analysis, the challenged provision violates the First Amendment because it is insufficiently tailored to address the state’s interest in eliminating discrimination, and thus is facially unconstitutional.

The Supreme Court reversed the Court of Appeal and upheld the pronouns provision. The Court concluded the provision must be analyzed as a regulation of discriminatory conduct that incidentally affects speech, analogous to Title VII’s bar against hostile work environments, not as an abridgment of speech subject to First Amendment strict scrutiny. The Court emphasized the narrow context in which the statute operates. It regulates the professional conduct of long-term care staff, seeks to promote a caring environment, and protects long-term care residents (a “captive audience”) from discrimination in what is “in effect” their homes. The Court reasoned that the provision is “carefully calibrated” to achieve those ends and does not restrict staff from “expressing their views about gender to anyone (including a resident) in any otherwise lawful manner other than by misgendering a resident—and even then, the prohibition is limited to willful, repeated, knowing acts done because of a legally protected characteristic.” The Court concluded that, even assuming the provision were subject to intermediate scrutiny, it “easily satisfies that test.” Finally, the Court concluded that the possibility of enforcement through pre-existing criminal penalties for particularly egregious violations of the statute does not render the pronouns provision facially unconstitutional.

Doe v. Kachru (Oct. 13, 2025, A168669) ___ Cal.App.5th ___, 2025 WL 2902027

Jane and John Doe sued an obstetrician, Dr. Amita Kachru, and the hospital and other medical personnel involved in the birth of their child. They alleged nine causes of action against Dr. Kachru, including medical battery, gender violence, and dependent adult abuse. The Does’ claims against Dr. Kachru were premised on allegations (a) that they consented only to low-intervention care, (b) that Dr. Kachru performed a vacuum-assisted delivery without their consent, and (c) that she forcibly removed Jane’s placenta, inserted and removed a catheter in Jane’s urethra, and sutured Jane. Jane was diagnosed with postpartum PTSD, among other conditions. The trial court sustained Dr. Kachru’s demurrer to all causes of action against her except John’s consortium claim, which the Does dismissed. The Does then appealed the judgment of dismissal.

The Court of Appeal affirmed dismissal of all claims except Jane’s medical battery cause of action based on the allegedly unconsented vacuum-assisted delivery. The court explained that this was not a “no-consent” case because Jane necessarily consented to obstetric care and most of the “touching” allegations in support of her medical battery claim by presenting to the hospital for delivery. The court concluded that Jane alleged a potentially viable claim that Dr. Kachru exceeded the scope of Jane’s consent by performing a procedure that substantially differed from what she authorized. But the court noted that Dr. Kachru might prevail eventually by proving (a) the vacuum-assisted delivery was not “substantially” different from the care Jane authorized or (b) she reasonably determined that an emergency situation had developed requiring immediate delivery. The court also affirmed dismissal of Jane’s gender violence claim under Civil Code section 52.4, holding that “some discriminatory motive” is required and Jane failed to allege that “Dr. Kachru performed a vacuum-assisted delivery because she was motivated, in some part, by bias or animus against Jane because of Jane’s status as a woman in childbirth.” Finally, Jane’s dependent adult abuse claim failed because she failed to allege that Dr. Kachru “acted with “ ‘recklessness, oppression, fraud or malice’ ” as required to state such a claim.

Regents of University of California v. State Department of Public Health (Sept. 23, 2025) __ Cal.App.5th __ [2025 WL 2701640]

California Department of Public Health (DPH) imposed a $75,000 penalty on University of California hospital affiliate Resnick Neuropsychiatric Hospital (Resnick) after a Resnick employee photographed confidential patient information and posted the picture on social media. DPH found that Resnick violated Health and Safety Code section 1280.15, which provides that healthcare facilities “shall prevent unlawful or unauthorized” disclosure of patient medical information “consistent with” the facility’s statutory duty under section 1280.18 to use “reasonable” and “appropriate safeguards” to protect the privacy of that information. Although DPH did not that find that Resnick violated section 1280.18, DPH maintained that Resnick was strictly liable for any confidentiality breach regardless whether it complied with section 1280.18. The administrative law judge (ALJ) upheld DPH’s penalty. The trial court granted Resnick’s petition for administrative mandamus, ruling that section 1280.15 incorporates section 1280.18’s reasonableness standards and therefore cannot be violated absent a concurrent violation of section 1280.18.  DPH appealed.

The Court of Appeal affirmed. The court held that “the plain and unambiguous language of section 1280.15 effectively incorporates the reasonableness standard set forth in section 1280.18.” The court reasoned that a “finding of violation of section 1280.15 . . . where the facility had implemented appropriate safeguards in compliance with section 1280.18 would not be ‘consistent with’ section 1280.18.” Thus, the “ ‘only reasonable interpretation’ of the statutory framework ‘is that a violation of section 1280.15 cannot occur without a concurrent violation of section 1280.18.’ ”

Doe v. County of Orange (Sept. 2, 2025, G064562) __ Cal.App.4th __ [2025 WL 2505955]

After John Doe was placed on an involuntary 72-hour psychiatric hold pursuant to Welfare and Institutions Code section 5150, the Orange County Sheriff’s Department generated a confidential mental health record of the incident. Sheriff’s Department employee Robert Reyna later gave this record to Doe’s sister, who claimed she was concerned about him. She and her attorney then used the information to coerce Doe to dismiss his lawsuit against her. Doe sued the County under section 5330, which authorizes an action against anyone who unlawfully discloses section 5150 records. A jury found that Reyna unlawfully disclosed records, awarded Doe damages, and apportioned 25 percent fault to Doe’s sister and her attorney. The trial court granted the County’s motion for partial JNOV, ruling there was no substantial evidence of willfulness, and refused to award treble damages as required for willful violations. Doe appealed.

The Court of Appeal reversed. The court explained that under section 5330, persons who “willfully and knowingly” disclose confidential medical records to unauthorized recipients are liable for the greater of $10,000 or treble damages, plus costs and attorney’s fees. The court held that a person “willfully and knowingly” releases confidential records when they intentionally release them to a person they know is not entitled to them and the disclosure violates the Lanterman-Petris-Short Act. The court held the plaintiff did not need to establish bad faith, ill intent, or knowledge that further harm would flow from the wrongful disclosure. Applying that standard, the trial court erred by granting JNOV: there was substantial evidence that Reyna willfully and knowingly released Doe’s confidential section 5150 record to his sister knowing she was not entitled to it.

Frankland v. Etehad (Aug. 8, 2025, B338370) ___ Cal.App.5th ___ [2025 WL 2267750]

James Frankland was admitted to Casitas Care Center, where Dr. Siamak Etehad provided in-facility resident care. After several months, Frankland’s health deteriorated and he was transferred to a hospital where he later died. Plaintiff, Frankland’s brother, sued Casitas and Dr. Etehad, alleging neglect and financial abuse under the Elder Abuse and Dependent Adult Civil Protection Act. Dr. Etehad filed a demurrer, arguing plaintiff’s neglect claim failed because Dr. Etehad lacked a caretaking or custodial relationship with Frankland, and plaintiff’s financial abuse claim failed because Medicare payments are not a property right belonging to Frankland. The trial court agreed and sustained the demurrer without leave to amend. Plaintiff appealed.

The Court of Appeal affirmed. The court concluded that plaintiff failed to state a claim for “neglect” under the Act because plaintiff had not sufficiently alleged that Dr. Etehad had the requisite “robust caretaking or custodial relationship” with Frankland. The court explained that intermittent, episodic, limited, or casual engagement or interaction with an elder does not create the necessary relationship. The court reasoned that physicians working in care facilities do not enter into a caretaking or custodial relationship with the facility’s patients simply by providing services to the facility’s patients. The court held the financial abuse claim failed because Welfare and Institutions Code section 15657.2 is inapplicable to claims based solely on professional negligence.

Holland v. Silverscreen Healthcare, Inc. (Aug. 14, 2025, S285429) __ Cal.5th __ [2025 WL 2349863]

Following the death of their son at a skilled nursing facility operated by Silverscreen Healthcare, plaintiffs sued Silverscreen, alleging survivor claims on their son’s behalf as well as a wrongful death claim as heirs. Silverscreen moved to compel arbitration pursuant to its agreement with the son. The agreement stated it was binding on the son’s representatives, executors, family, and heirs and it required arbitration of all medical malpractice disputes and other claims involving the provision of care to a resident. The trial court agreed that plaintiffs’ survivor claims were subject to arbitration, but—relying on Avila v. Southern California Specialty Care, Inc. (2018) 20 Cal.App.4th 835, 843—ruled that the wrongful death claim was not subject to arbitration because it was based on Elder Abuse Act neglect, rather than medical malpractice. Silverscreen appealed, and the Court of Appeal reversed. The Supreme Court granted plaintiffs’ petition for review.

The Supreme Court announced a new test and remanded for further proceedings. The Court acknowledged that, as a general rule, plaintiffs cannot be compelled to arbitrate their disputes if they have not previously agreed to arbitration. The Court explained that Ruiz v. Podolsky (2010) 50 Cal.4th 838 identified a narrow exception for certain wrongful death claims based on medical malpractice: if a patient agreed to arbitrate medical malpractice disputes in compliance with MICRA’s arbitration provision (Code Civ. Proc., § 1295), the agreement may bind the patient’s heirs in a wrongful death action, even if they never agreed to arbitration. The key question is whether a wrongful death claim sounds in professional negligence against a medical provider. The Court acknowledged that deciding that question is difficult when the defendant is a skilled nursing facility, which “wears multiple hats, rendering services in its capacity as a medical provider as well as in its capacity as custodian of residents’ general well-being, which includes responsibilities such as providing nutrition and hydration.” The test, the Court stated, is “whether ‘the primary basis for the wrongful death claim sounds in’ medical malpractice or in custodial neglect.” Here, the Court could not apply the test at this stage because “there remains substantial uncertainty about whether plaintiffs seek to challenge the defendants’ provision of medical care, its provision of custodial care, or both.” Accordingly, the Court remanded to give plaintiffs a chance to amend their complaint.