Cha Health Systems Inc vs Kaiser Foundation Hospitals Et Al

Motion for Leave to Amend

Cal. Super. - 2nd Dist.June 13, 2018

© 0 3 O& O n n B B Ww W N = P N O D N N N N D N D = = = e e e m e e e e c o N N O N n m B A W D = O o O V N N N B R W L ND Y - = O O LAW OFFICES OF STEPHENSON, ACQUISTO & COLMAN,INC. JOY STEPHENSON-LAWS, ESQ. RICHARD A. LOVICH, ESQ. CHRISTOPHER HAPAK, ESQ. NESREIN EL-HADDAD, ESQ. 303 N. Glenoaks Blvd., Suite 700 Burbank, CA 91502 Telephone: (818) 559-4477 Facsimile: (818) 559-5484 Attorneys for Plaintiff (SBN 113755) (SBN 113472) (SBN 267212) (SBN 314965) CHA HEALTH SYSTEMS, INC., a California for- profit corporation, doing business as Hollywood Presbyterian Medical Center SUPERIOR COURT OF CALIFORNIA FOR THE COUNTY OF LOS ANGELES UNLIMITED JURISDICTION CHA HEALTH SYSTEMS, INC., a California for-profit corporation, doing business as Hollywood Presbyterian Medical Center, Plaintiff, V. KAISER FOUNDATION HEALTH PLAN, INC., a California corporation; and DOES 1 THROUGH 25, INCLUSIVE, Defendants. Case No.: BC710014 Reservation Number is 292936825141 Judge: Hon. Malcolm H. Mackey, Dept. 1. NOTICE OF MOTION AND MOTION FOR LEAVE TO FILE A FIRST AMENDED COMPLAINT; 2. MEMORANDUM OF POINTS AND AUTHORITIES; AND 3. DECLARATION OF NESREIN EL-HADDAD. Hearing Date: February 22, 2019 Time: 8:30 a.m. Dept.: 55 FC 22458 1. NOTICE OF MOTION AND MOTION FOR LEAVE TOFILE A FIRST AMENDED COMPLAINT: 2.MEMORANDUM OF POINTS & AUTHORITIES; AND 3.DECLARATION OF NESREIN EL-HADDAD.-1- O O 0 0 3 S N n h B A W N P Y N Y N Y N Y N N N N N e e = e e e e e e e d p e e e e d 0 0 N N S N n h RA R W N = O 0 0 R E W D = O TO ALL PARTIES AND THEIR ATTORNEYS OF RECORD: PLEASE TAKE NOTICE THAT on February 22, 2019, at 8:30 a.m., in Department 55 of the Superior Court of the State of California for the County of Los Angeles, Stanley Mosk Courthouse, located at 111 North Hill Street, Los Angeles, CA 90012, Plaintiff CHA HEALTH SYSTEMS, INC., a California for- profit corporation, doing business as Hollywood Presbyterian Medical Center ("Hollywood Presbyterian") will move and hereby does move for an order granting it leave to file its First Amended Complaint, pursuant to Cal. Civ. Proc. Code §§ 473(a)(1), 576, against Defendant KAISER FOUNDATION HEALTH PLAN,a California corporation; (hereinafter “KFHP”). Hollywood Presbyterian brings this motion on the grounds that through its investigation,it discovered that the facts at issue in this case give rise to additional causes of action that were inadvertently omitted at the time Plaintiff filed its Complaint. Hollywood Presbyterian also requests an Order that the attached Proposed First Amended Complaint be deemed to be the amended pleading and that it be deemed filed and served as of the date the motion is granted. 111 111 I 1 FC 22458 2- 1. NOTICE OF MOTION AND MOTION FOR LEAVE TO FILE A FIRST AMENDED COMPLAINT: 2. MEMORANDUM OF POINTS & AUTHORITIES; AND 3. DECLARATION OF NESREIN EL-HADDAD. O © © 3 O& O W n B r Ww W N D PR N N N N D N N N N N m e e e e a e e e e e e a e e C O 3 O N W n B A W N = O O O V N N N R E W I N D - O o This motion is based upon this notice of motion and motion, the attached memorandum of points and authorities, the attached declaration of Nesrein El-Haddad, the attached exhibits, and such other further evidence and argument as the Court will entertain at the hearing. Dated: 8 January 2019 STEPHENSON, ACQUIST 0 NESREIN EL-FYAIDDAD Attorney for CHA HEALTH SYSTEMS, INC., a California for-profit corporation, doing business as Hollywood Presbyterian Medical Center FC 22458 -3- 1. NOTICE OF MOTION AND MOTION FOR LEAVE TO FILE A FIRST AMENDED COMPLAINT; 2. MEMORANDUM OF POINTS & AUTHORITIES; AND 3. DECLARATION OF NESREIN EL-HADDAD. O O 0 N N O N n n BR A W N N D D N D N N N N = = e m = e e e e e e e s e e c c 1 O N W n B A W I N D - = O O V O N N N B W N N = O MEMORANDUM OF POINTS AND AUTHORITIES I. INTRODUCTION AND SUMMARY OF ARGUMENT Plaintiff, CHA HEALTH SYSTEMS, INC., a California for-profit corporation, doing business as Hollywood Presbyterian Medical Center (“Hollywood Presbyterian’) broughtthis action for a simple reason: it wants to be fully paid for the medical care it rendered. This particular action arises out of Hollywood Presbyterian’s treatment of individuals enrolled in a health care plan sponsored and/ or administrated by Kaiser Foundation Health Plan (“KFHP”). See Declaration of Nesrein El-Haddad (hereinafter “El-Haddad Decl.” §3). Although KFHP represented to Hollywood Presbyterian that it would pay the costs associated with the medical servicesit rendered to its enrollees, it grossly underpaid the claims by unilaterally deciding what represents the “customary charges” for the services, instead of paying Hollywood Presbyterian’s reasonable and customary rates. (El-Haddad Decl.q7). During the course of Hollywood Presbyterian’s investigation of the 87 claims at issue, it discovered that the facts at issue in this case also give rise to an additional cause of action that was inadvertently omitted at the time Plaintiff filed its Complaint. (El-Haddad Decl.§6). In addition to the cause ofaction in the Complaint (Quantum Meruit and Breach of Contract), Hollywood Presbyterian seeks to amend the complaint to include the following cause of action: (1) Breach of Implied In Fact Contract. (El-Haddad Decl.4). This cause of action pertains to KFHP’s promise and agreement to pay for the services rendered by Hollywood Presbyterian for each ofits members, and KFHP’s failure to pay for these services, FC 22458 -4- 1. NOTICE OF MOTIO N AND MOTION FOR LEAVE TO FILE A FIRST AMENDED COMPLAINT; 2. MEMORANDUM OF POINTS & AUTHORITIES; AND 3. DECLARATION OF NESREIN EL-HADDAD. S S O O 0 0 N N O N n n B A W P N N N N N N Y N N D = = e a e m e d e d e t e d p d c o ~ ~ O N W n k A W D = O O O 0 0 N Y n n B R N which are reflected as claims at issue. (El-Haddad Decl.§7). Consequently, Hollywood Presbyterian now seeks to amend its operative Complaint to reflect the additional cause of action. (El-Haddad Decl.{8,9). This change will be of no prejudice to any party since the cause of action relates to the same general facts of the operative complaint, and KFHP is aware ofthe facts and issues giving rise to this lawsuit, and the trial is ten months away. IL. THE LEGAL STANDARDS FOR ALLOWING AMENDMENTS TO COMPLAINTS Hollywood Presbyterian brings this motion pursuant to California Code of Civil Procedure section 473(a) (1), which states: The court may . . in its discretion, after notice to the adverse party, allow, upon any terms as may be just, an amendment to any pleading or proceeding in other particulars; and may upon like terms allow an answer to be made after the time limited by this code. Similarly, California Code of Civil Procedure section § 576 also provides grounds for this motion: "[a]ny judge, at any time before or after commencementoftrial, in the furtherance of justice, and upon such terms as may be proper, may allow the amendment of any pleading . . . "An application to amend a pleading is addressed to the trial judge's FC 22458 -5- 1. NOTICE OF MOTION AND MOTION F OR LEAVE TO FILE A FIRST AMENDED COMPLAINT; 2. MEMORANDUM OF POINTS & AUTHORITIES; AND3. DECLARATION OF NESREIN EL-HADDAD. O © 0 J O N U n B A Ww W N = R N N N N N N N D N D N D e m e m e m a e d pe d p a C 0 3 O N W n B A W D = O O N R W N D -- = O O sound discretion." (Thompson Pacific Const., Inc. v. City ofSunnyvale (2007) 155 Cal. App. 4™ 525, 544.) Such discretion must be tempered in favor of granting such a request: California courts 'have a policy of great liberality in allowing amendments at any stage of the proceeding so as to dispose of cases upon their substantial merits where the authorization does not prejudice the substantial rights of others." [citation omitted]. Indeed, 'it is a rare case in which "a court will be justified in refusing a party leave to amend his [or her] pleading so that he "ne[or she] may properly present his [or her] case." ‘[citation omitted]. (Board of Trustees ofLeland Stanford Jr. University v. Superior Court (2007) 149 Cal. App. 4" 1154, 1163.) The proximity of the request to amend to the trial date is immaterial if the plaintiff is the party who seeks to amend and is amenable to a postponement of the trial. (Mesler v. Bragg Management Co. (1985) 39 Cal. 3" 290, 296-97.) Thus, even if a motion to amend is made on the day oftrial, leave still should be granted absent prejudice to the other party. (Higgins v. Del. Faro (1981) 123 Cal. App. 3" 558, 564-65 ("[i]f plaintiff has a good cause of action, which by accident or mistake he has failed to set out in his complaint, the court, on motion for judgment on the pleadings, should, on his application so to do, permit him to amend.")). Thus, "[w]here no prejudice is shown to the adverse party, the liberal rule of allowance prevails. (/d. at 564.) "Moreover,it is irrelevant that new legal theories are introduced as FC 22458 -6- I. NOTICE OF MOTION AND MOTION FOR LEAVE TO FILE A FIRST AMENDED COMPLAINT; 2. MEMORANDUM OFPOINTS & AUTHORITIES; AND 3. DECLARATION OF NESREIN EL-HADDAD. O O 0 3 O N n n B A W W N D - PR N N N M N N D N N N N D a a p e p m e e e d e d p e p e 0 N O n n B A W N D = O O 0 N Y B R E W N D - O o long as the proposed amendments relate to the same general set of facts. (Kittredge Sports Co. v. Super. Ct. (1989) 213 Cal. App. 3" 1045, 1048). III. DEFENDANT WOULD SUFFER NO PREJUDICE IF HOLLYWOOD PRESBYTERIAN WERE ALLOWED TO FILE ITS FIRSTAMENDED COMPLAINT. It is well-established that "[w]here no prejudice is shown to the adverse party, the liberal rule of allowance prevails. (Higgins, supra, 123 Cal. App. 3" at 564). Here, Defendant would suffer no prejudice if Hollywood Presbyterian were given leave to file its First Amended Complaint because Hollywood Presbyterian only seeks to add a cause of action, which arise under the same set of facts already alleged and of which Defendant is aware. The cause of action for Breach of Implied-In-Fact Contract directly relates to the underpayments of the claims at issue in this case where KFHP agreed to pay for services rendered by Hollywood Presbyterian for each of its members but failed to do so. Since amendments to complaints are acceptable even on the day of trial, and this request comes almost ten months before trial, it does not disturb in any material way the allegations in the complaint or the discovery exchanged by the parties. The "liberality" rule calls for Hollywood Presbyterian's request for leave to file an amended complaint to be granted. Therefore, this Court should apply the liberal rule of allowance and grant leave for Hollywood Presbyterian to amend its pleading. FC 22458 -7- 1. NOTICE OF MOTION AND MOTION FOR LEAVE TO FILE A FIRST AMENDED COMPLAINT; 2. MEMORANDUM OF POINTS & AUTHORITIES; AND 3. DECLARATION OF NESREIN EL-HADDAD. O O 0 0 9 O N U n B A W N R O N D N N N N N N N = = e e e e e e e m e s C 0 2 O N W n B A W D = O O 0 N Y R W N D = O IV. CONCLUSION Based on the foregoing reasons, Hollywood Presbyterian respectfully requests that it be granted leave to file its Proposed First Amended Complaint. Dated: 8 January 2019 STEPHENSON, ACQUISTQ & COLMAHENSON, nm /] A /] 9, AN) | NESREIN EL-HADDAD Attorneys for CHA HEALTH SYSTEMS, INC, a California for-profit corporation, doing business as Hollywood Presbyterian Medical Center { 1. NOTICE OF MOTION AND MOTION FOR LEAVE TO “OT FILE A FIRST AMENDED COMPLAINT;2. MEMORANDUMOF POINTS & AUTHORITIES; AND 3. DECLARATION OF NESREIN EL-HADDAD. I'C 22458 S O O 0 N N O N n n B W P N Y N Y N N N N N N N = e m e e e e e d p e e d p d e d p e d c o N N L n B A W W N D ~ ~ O O 0 0 N N N R W N D - DECLARATION OF NESREIN EL-HADDAD I, Nesrein El-Haddad, declare: 1. I am over the age of eighteen years and am not a party to this action. I am an attorney at the firm of Stephenson, Acquisto & Colman, attorneys of record for CHA HEALTH SYSTEMS, INC., a California for-profit corporation, doing business as Hollywood Presbyterian Medical Center (hereinafter “Hollywood Presbyterian”), against defendant KAISER FOUNDATION HEALTH PLAN, INC., a California corporation (hereinafter “KFHP”). As such, I am familiar with all the files and pleadings in this matter. If called upon to testify to the facts within this declaration, I could and would competently so testify because such facts come from my own personal knowledge. 2. I am familiar with the files, pleadings, and records of this case. 3. Hollywood Presbyterian provided medical services to individuals enrolled in a health care plan sponsored and/or administrated by KFHP for payment of the costs associated with the medical services. 4. On or about June 13, 2018, Hollywood Presbyterian filed its Complaint for Quantum Meruit and Breach of Contract against Kaiser Foundation Hospitals, a California corporation, Kaiser Foundation Health Plan, Inc., a California corporation, Southern California Permanente Medical Group, a California partnership, Kaiser Permanente Insurance Company, and The Permanente Medical Group, Inc., a California corporation, in the Superior Court of California, County of Los Angeles. 22458 -0. 1. NOTICE OF MOTION AND MOTION FOR LEAVE TO FILE A SECOND AMENDED COMPLAINT; 2. MEMORANDUM OF POINTS AND AUTHORITIES; 3. DECLARATION OF NESREIN EL-HADDAD O O 0 N N O O h n B H Ww W N n - - B N N D N N N N N N = = e e e s e e e m e e e e e e 0 0 9 O N i B A W O N ~ ~ O O N N N B R E W N D = O 5. Thereafter, the parties entered into a Stipulation on November 12,2018 to dismiss certain defendants without prejudice. The Court issued an Order on November 12, 2018 dismissing the following Defendants: (1) Kaiser Foundation Hospitals, (2) Southern California Permanente Medical Group, and (3) Kaiser Permanente Insurance Company, and (4) The Permanente Medical Group, Inc. 6. During the course of Hollywood Presbyterian’s investigation of the 87 claims at issue, it discovered that the facts at issue in this case also give rise to an additional cause of action that was inadvertently omitted at the time Plaintifffiled its Complaint. 7. Although KFHP represented to Hollywood Presbyterian that it would pay the costs associated with the medical services it rendered to its enrollees, it grossly underpaid the claims by unilaterally deciding what represents the “customary charges”for the services, instead of paying Hollywood Presbyterian’s reasonable and customary rates. 8. I make this declaration in support of Hollywood Presbyterian’s Motion for Leave to File a First Amended Complaint. A true and accurate copy of the First Amended Complaint has been attached hereto as Exhibit A and is incorporated by this reference as though set forth in full. 9. The [Proposed] First Amended Complaint seeks to add the following cause of action for: a) Breach of Implied In Fact Contract. This cause of action pertains to KFHP’s promise and agreement to pay for the services rendered by Hollywood 22458 -10 - 1. NOTICE OF MOTION AND MOTION FOR LEAVE TO FILE A SECOND AMENDED COMPLAINT: 2. MEMORANDUM OF POINTS AND AUTHORITIES; 3. DECLARATION OF NESREIN EL-HADDAD O © 0 0 J O N h n B A Ww W N D ~ ~ P R N D N D N D N N N N N m e e e e t p m e t p d p t p e p e Co O N N O N w n B A W N = O O N Y R A W N D - O O Hollywood Presbyterian for each of its members, and KFHP’s failure to pay for these services, which are reflected as claims at issue. I declare under the penalty of perjury pursuant to the laws of the State of California that the foregoing is true and correct. Executed on January 8, 2019 in Burbank, California. lie,4 NESREIN EL-HXDDAD 22458 -11 - 1. NOTICE OF MOTION AND MOTION FOR LEAVE TO FILE A SECOND AMENDED COMPLAINT; 2. MEMORANDUM OF POINTS AND AUTHORITIES; 3. DECLARATION OF NESREIN EL-HADDAD EXHIBIT A O O 0 9 O N W n B s W N = 0 1 O N n h B A W N ~ ~ O O O O 0 N N N A W N - ~ O o LAW OFFICES OF STEPHENSON, ACQUISTO & COLMAN, INC. JOY STEPHENSON-LAWS, ESQ. (SBN 113755) RICHARD A. LOVICH, ESQ. (SBN 113472) CHRISTOPHER HAPAK,ESQ. (SBN 267212) NESREIN EL-HADDAD, ESQ. (SBN 314965) 303 N. Glenoaks Blvd., Suite 700 Burbank, CA 91502 Telephone: (818) 559-4477 Facsimile: (818) 559-5484 Attorneys for Plaintiff CHA HEALTH SYSTEMS, INC., a California for- profit corporation, doing business as Hollywood Presbyterian Medical Center SUPERIOR COURT OF CALIFORNIA FOR THE COUNTY OF LOS ANGELES UNLIMITED JURISDICTION Case No.: BC710014 CHA HEALTH SYSTEMS, INC., a California for-profit corporation, doing Judge: Hon. Malcolm H. Mackey, Dept. business as Hollywood Presbyterian 35 MedicalCenter, [Demand Amount Exceeds $25,000] Plaintiff, [PROPOSED] FIRST AMENDED Vv. COMPLAINT FOR DAMAGES FOR: KAISER FOUNDATION HEALTH 1. BREACH OF WRITTEN PLAN, INC., a California corporation; CONTRACT; and DOES 1 THROUGH 25 ’ . MERUIT; ANDINCLUSIVE, 2. QUANTUM Defend 3. BREACHOF IMPLIED IN clendants. FACT CONTRACT. 22458 - | - FIRST AMENDED COMPLAINT FOR DAMAGES FOR: BREACH OF IMPLIED IN FACT CONTRACT S S O O 0 0 9 O N W n B A W O N N Y N N N N N N N N e e e e e e e e e t p e d p e d p e a c o ~ ~ O N w n k A W N = O O O O 0 0 N N N N n W N [PROPOSED] FIRST AMENDED COMPLAINT FOR DAMAGES PARTIES 1. Plaintiff CHA Health Systems, Inc.is a for-profit corporation organized and existing pursuant to the laws of the State of California. CHA Health Systems, Inc. hasits principal place of operation in the City of Los Angeles, County of Los Angeles, State of California. CHA Health Systems, Inc. owns and operates Hollywood Presbyterian Medical Center (throughout this complaint CHA Health Systems, Inc. shall be referred to as "Hollywood Presbyterian"). Hollywood Presbyterian provides medical care to patients. 2. Defendant Kaiser Foundation Health Plan, Inc. (“KFHP”) is a corporation organized and existing pursuant to the laws of the State of California. KFHPhas its principal place of business in the City of Oakland, State of California. 3. Hollywood Presbyterian is unaware of the true names and capacities, whether corporate, associate, individual, partnership or otherwise of defendants Does 1 through 25, inclusive, and therefore sues such defendants by such fictitious names. Hollywood Presbyterian will seek leave of the Court to amend this complaint to allege their true names and capacities when ascertained. 4. KFHP and Does 1 through 235, inclusive, shall be collectively referred to as “KFHP.” 22458 - 2 - FIRST AMENDED COMPLA INT FOR DAMAGES FOR: BREACH OF IMPLIED IN FACT CONTRACT S S O O 0 N N O N B R W N N D N N N N N N = = = e e e e e e e s e d e s c o N N S N W n B R W I N D - = O O 0 N N N R W 5. Defendants, and each of them, at all relevant times, have transacted business in the State of California. The violations alleged within this complaint have been and are being carried out in the State of California. 6. At all relevant times each of the defendants, including the defendants named "Doe," was and is the agent, employee, employer, joint venturer, representative, alter ego, subsidiary, and/or partner of one or more of the other defendants, and was, in performing the acts complained of herein, acting within the scope of such agency, employment, joint venture, or partnership authority, and/or is in some other way responsible for the acts of one or more of the other defendants. COMMON FACTUAL BACKGROUND 7. The pattern of misconduct by KFHP of which Hollywood Presbyterian’s complains in this action began in 2015. This action covers claims arising on or after January 30, 2015 to November 1, 2017. 8. KFHP owns and operates various health care services within the State of California. As such, in return for a prepaid or periodic charge (i.e., monthly premiums) from its subscribers/members/beneficiaries/enrollees of such plans (or their employers), KFHP agreed to provide specific plan benefits to those individuals and their enrolled dependents (collectively, “Members” or “Health Care Service Plan Members”). 0. Aspart of its duty to arrange for delivery of medicalcare to its Members, KFHP prints identification cards and distributes them to its Members at the time of their enrollment. 22458 - 3 - FIRST AMENDED COMPLAINT FOR DAMAGES FOR: BREACH OF IMPLIED IN FACT CONTRACT O O 0 3 & n h B A W N o 0 N N N N N N N N = m e m E m e e e e e e e e p e p e C 0 9 O N h n B A W N = O O 0 N N N N R W N D -~ = O o 10. Given that the Patients carried identification information and/or cards identifying them as belonging to a health plan sponsored, paid for, and/or administered by KFHP, Hollywood Presbyterian looked to KFHP to be financially responsible for paying for medical care rendered by Hollywood Presbyterian to its Patients. 11. On various dates during the period from on or about January 30, 2015 to November 1, 2017, Hollywood Presbyterian provided medical treatment and care to individuals who were members/beneficiaries of health benefit plans sponsored and/or administered by KFHP (collectively, the "Patients"). A spreadsheet showing the dates of admission and discharge (if known) for Patients is attached as Exhibit “A” (collectively, the “Patients”) and is incorporated by this reference as though set forth in full.’ 12. At or about the time each Patient received medical care from Hollywood Presbyterian, the Patient (or, on the Patient's behalf, a responsible family member or other representative) signed a written standard Terms and Conditions of Service contract. That standard contract contains a clause in which each Patient (or, on the Patient's behalf, a responsible family member or other representative) made an express promise to Hollywood Presbyterian to "pay . . . [at Hollywood Presbyterian 's] regular rates" for such care. 13. Though the written standard Terms and Conditions of Service In deference to the Patients’ privacy concerns enumerated in Cal. Const. art. I, § 1, as well as the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. §§ 1320d ef seq.), Hollywood Presbyterian included no information here sufficient to reveal the identity of any ofthe Patients. 22458 - 4 - FIRST AMENDED COMPLAINT FOR DAMAGES FOR: BREACH OF IMPLIED IN FACT CONTRACT S S O W 0 N N O N W n B W N D P R N N N N N N N N = e a e m e m e d e t e e p e c o N N O N U n B A W D = O O N N N B R W N - contract also contains an "Assignment of Insurance Benefits" clause, in this action Hollywood Presbyterian has chosen not to pursue any rights conferred uponit by that "Assignment of Insurance Benefits" clause and thus does not stand here "in the shoes" of the Patient. Rather, by this action Hollywood Presbyterian pursues only such rights as have been conferred upon it by the express promises to "pay . . [at Hollywood Presbyterian’s] regular rates" clause as made by Patients or their representatives. 14. Hollywood Presbyterian timely and properly submitted valid bills to KFHP for reimbursement for the medical care it rendered to Patients. Each such bill itemized each category of medical care rendered and priced such medical care at Hollywood Presbyterian's regular rates in place on that day of service. The rates reflected on each such submitted bill were precisely the same rates Hollywood Presbyterian would have charged that day for any individual receiving such care regardless of that individual's ability to pay or that individual's health plan, or lack thereof. 15. On information and belief, most if not all of the above- described medical care rendered by Hollywood Presbyterian to the Patients constitutes "emergency services" as that term is used in both Cal. Health & Safety Code § 1371.4(b) and Cal. Welf. & Inst. Code § 14454(a). 16. Asa consequence, KFHP also has dual statutory duties to fully and properly pay Hollywood Presbyterian for such medical care. 17. Despite demands therefore, KFHP failed to fully pay for the medical care rendered by Hollywood Presbyterian to Patients, directly and proximately damaging Hollywood Presbyterian in the form of an aggregate FIRST AMENDED COMPLAINT FOR DAMAGES22458 -5- TFOR AGESFOR: BREACH OF IMPLIED IN FACT CONTRACT O O 0 3 O O U n B h Ww W N n = P N B N N N N N N N N e m e m e e e d p d p e d e t p e d p e c o 1 O N W n B A W O N = O O OV O 0 N N N R W N = o underpayment in a sum to be proven at trial of $160,213.24, exclusive of interest ("the Amount Due"). FIRST CAUSE OF ACTION (Breach of Written Contract) (Against KFHP (and/or including Does 1 through 17, inclusive)) 18. Hollywood Presbyterian incorporates by reference and re- alleges paragraphs 1 through 17 as though set forth in full. 19. As stated above, under the Multiplan Contract, Hollywood Presbyterian agreed to provide medically necessary services to KFHP members in exchange for which KFHP agreed to pay the Contract Rates to Hollywood Presbyterian pursuant to the terms of the Multiplan Contract. 20. Hollywood Presbyterian provided medically necessary services to the Patients listed in Exhibit A and performed all conditions, covenants, and promises required on its part to be performed in accordance with the terms and conditions of the Contract. 21. Hollywood Presbyterian demanded that KFHP perform its obligations to properly reimburse Hollywood Presbyterian at the Contract Rates for the medical services, supplies and/or equipment rendered to the Patients. 22. KFHP breached the Contract by failing to fully pay Hollywood Presbyterian the amount due under the Contract. FIRST AMENDED COMPLAINT FOR DAMAGES22458 -6- . ; s . i. FOR: BREACH OF IMPLIED IN FACT CONTRACT O 0 0 3 O N U n B h W N = - o 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 23. As aresult of the breaches by KFHP, Hollywood Presbyterian suffered damages in a sum to be proven at trial but not less than $160,213.24, exclusive of interest. SECOND CAUSE OF ACTION (Quantum Meruit) (Against defendants KFHP (and/or including Does 1 through 25, inclusive)) 24. Hollywood Presbyterian incorporates by reference and re- alleges paragraphs 1 through 17 as though set forth in full. 25. Hollywood Presbyterian provided emergency medical care to the Patients for whom KFHP was responsible for providing medical care generally and/or at the special request of KFHP. KFHP knew these services would be provided and promised its members that KFHP would be financially responsible for paying such bills (except for the portion of the bill deemed to be the member's responsibility to pay. 26. At all times herein, the "reasonable and customary" value of the medical care provided was and is the total billed charges submitted to KFHP by Hollywood Presbyterian. Despite demand therefore, KFHP has refused to fully pay the value of that medical care to Hollywood Presbyterian. 27. Hollywood Presbyterian is entitled to reasonable and customary reimbursement for the value ofits services. 28. As a direct and proximate result of KFHP's conduct, Hollywood 22458 - 7] - FIRST AMENDED COMPLAINT FOR DAMAGE S FOR: BREACH OF IMPLIED IN FACT CONTRACT O o 0 0 N N O N h n B s W N = B Y N N N N N N N N e m e e e t e d p e d p e d e d e d p e c o J O N W n k A W N = O O 0 N N N N R W N D = O Presbyterian remains to be paid the full reasonable value of such care, the unpaid balance of which is $160,213.24, exclusive of prejudgment interest. THIRD CAUSE OF ACTION (Breach of Implied in Fact Contract) (Against defendants KFHP (and/or including Does 1 through 28, inclusive)) 29. Hollywood Presbyterian incorporates by reference and re- alleges paragraphs 1 through 17 here as though set forth in full. 30. Based upon the conduct of Defendants by issuing KFHP identification cards to the Patients, and because of the federal EMTALA and state statutes prohibiting medical providers from asking patients for information about how they were to pay for care prior to treatment, KFHP impliedly agreed and understood that medical providers such as Hollywood Presbyterian would render medically necessary care to KFHP enrollees, submit bills for such care to KFHP, and that KFHP would pay those medical providers (such as Hollywood Presbyterian) for the necessary medical treatment rendered to those patients (such as the Patients here). Specifically, upon stabilization of those patients in medical providers' emergency departments (such as Hollywood Presbyterian's emergency department with respect to the Patients), KFHP fully expected Hollywood Presbyterian to treat and then bill KFHP for such care post-treatment. In response, with respectto the Patients, KFHP represented that the Patients were beneficiaries of KFHP's health plans. 31. Hollywood Presbyterian properly billed KFHP for the medically necessary services for the Patients, and as demonstrated by Exhibit “A,” 22458 - 8 - FIRST AMENDED COMPLAINT FOR DAMAGE S FOR: BREACH OF IMPLIED IN FACT CONTRACT S S O O 0 N N O N n n B A W N - N D N Y N N N N N N = = = = e s e m e e e e e e e e 0 N N S N B l W N ~ ~ O O 0 N N B W N D KFHP did in fact actually pay Hollywood Presbyterian for a portion of the services rendered in partial compliance with the implied-in-fact contract. The dispute in this matter is not whether KFHP should have paid Hollywood Presbyterian, but rather as to the amount KFHP should have paid to Hollywood Presbyterian for each of the Patients. 32. Since KFHP is a "health care service plan" as defined in the California Health and Safety Code,at all relevant times KFHP was under a statutory duty to pay for emergency services and care provided to its enrollees until each enrollee was stabilized pursuant to California Health and Safety Code §1371.4(b). Hollywood Presbyterian rendered medically necessary, emergency services, supplies and/or equipment to various Patients from the time of the Patients’ admission, as set forth in Exhibit “A,” to the time when each of the Patients' condition had sufficiently stabilized to enable each ofthe Patients to be discharged or transferred. California Health & Safety Code § 1371.4(b) provides, in pertinent part: "[a] health care service plan shall reimburse providers for emergency services and care provided to its enrollees." KFHP violated California Health & Safety Code § 1371.4 by failing to fully reimburse Hollywood Presbyterian for the medically necessary, emergency services, supplies, and/or equipment rendered to the Patients. 33. Hollywood Presbyterian performed all conditions required on its part to be performed in accordance with the terms and conditions ofthat implied-in-fact contract. Hollywood Presbyterian reasonably relied on KFHP's promises and conduct to pay for medical services and continued treating the Patients in reliance on those promises and upon such conduct. 34, KFHP breached that implied-in-fact contract by underpaying 22458 - 0 - FIRST AMENDED COMPLAINT FOR DAMAGE S FOR: BREACH OF IMPLIED IN FACT CONTRACT O O 0 9 O N W n B A W o N = D D N N N D N N N N ) = = e e e s e e e e e e e e e m c o N N O N B A W D = O O 0 N Y R R W N = O Hollywood Presbyterian for the medically necessary services, supplies, and/or equipment rendered or supplied to the Patients. 35. As aresult of KFHP's breach of breach of the implied-in-fact contract, Hollywood Presbyterian has suffered damages in a sum to be proven at trial of $160,213.24, exclusive ofinterest. PRAYER FOR RELIEF WHEREFORE, Hollywood Presbyterian prays for judgment as follows: For the first, second, and third causes of action: 1. in a sum to be proven attrial according to proof, but which exceeds $160,213.24; 2. for interest on such principal sum at the rate of 15% per annum, pursuant to Cal. Health & Safety Code § 1371; or, in the alternative, for interest on such principal sum at the rate of 10% per annum, pursuant to Cal. Civ. Code § 3289; 3. for all costs of suit incurred herein; and, 22458 - 10 - FIRST AMENDED COMPLAINT FOR DAMAGES FOR: BREACH OF IMPLIED IN FACT CONTRACT O o 0 N N O N n n B A W N R O N D N N N N N N D = = e m e a e e e e e m ee d p t p e 0 0 9 A N n n A W D ~ ~ O O Y N B R A W N - = O O proper. 4. for such other and further relief as the Court deems just and Dated: 8 January 2019 LAW OFFICES OF STEPHENSON, NESREIN EL-HADDAD,ESQ\ Attorneys for CHA HEALTH SYSTEMS, INC., a California for-profit corporation, doing business as Hollywood Presbyterian Medical Center 22458 - 11 - FIRST AMENDED COMPLAINT FOR DAMAGES FOR: BREACH OF IMPLIED IN FACT CONTRACT © O O 0 N N O N n m h k W N P N N D M N N Y N N N MN D = e e e e e e e e e e e e e d e e 0 1 O N W n B A W N O~ = © V W O o N N N R s W D PROOF OF SERVICE I am employed in the county of Los Angeles, State of California. I am over the age of 18 and not a party to the within action; my business address is 303 North Glenoaks Boulevard, Suite 700, Burbank, California 91502-3226. On 8 January 2019, I served the foregoing document(s) entitled: NOTICE OF MOTION AND MOTION FOR LEAVE TO FILE A FIRST AMENDED COMPLAINT; MEMORANDUM OF POINTS AND AUTHORITIES; AND DECLARATION OF NESREIN EL- HADDAD by placing a true copy thereof enclosed in a sealed envelope addressed per the attached Service List. [ 1] BY U.S. MAIL: Iam "readily familiar" with the firm's practice of collection and processing correspondence for mailing. Under that practice it would be deposited with the United States Postal Service on that same day with postage thereon fully prepaid at Burbank, California in the ordinary course of business. I am aware that on motion of the party served, service is presumed invalid if postal cancellation date or postage meter date is more than one day after date of deposit for mailing in affidavit. [C.C.P. 1013a(3); F.R.C.P. 5(b)] [ X] BY FEDERAL EXPRESS: I caused such envelope(s), with overnight Federal Express Delivery Charges to be paid by this firm, to be deposited with the Federal Express Corporation at a regularly maintained facility on the aforementioned date. [C.C.P. 1013(c) 1013(d)] [ ] BY PERSONAL SERVICE: I caused the above-stated document(s) to be served by personally delivering a true copy thereofto the individuals identified above. [C.C.P. 1011(a); F.R.C.P. 5(b)] [ 1] BY EXPRESS MAIL: I caused such envelope(s), with postage thereon fully prepaid and addressed to the party(s) shown above, to be deposited in a facility operated by the U.S. Postal Service and regularly maintained for the receipt of Express Mail on the aforementioned date. [C.C.P. 1013(c)] [ 1] BY TELECOPIER: Service was effected on all parties at approximately 6:30 pm by transmitting said document(s) from this firm's facsimile machine (818/559-4477) to the facsimile machine number(s) shown above. Transmission to said numbers was successful as evidenced by a © O O 0 N N n n k s W N R Y N D N N N N N N N D = = e e e e e e e e 0 N N O N W n R A W D = O O O v N N Y B N Transmission Report produced by the machine indicating the documents had been transmitted completely and without error. C.R.C. 2008(e), Cal. Civ. Proc. Code § 1013(e). [ 1] BY ELECTRONIC SERVICE: By emailing true and correct copies to the persons at the electronic notification address(es) shown on the accompanying service list. The document(s) was/were served electronically and the transmission was reported as complete and without error. [ X] State: I declare under penalty of perjury under the laws of the State of California that the aboveis true and correct. [ 1] Federal: Ideclare that I am employed in the office of a member ofthe bar of this court at whose direction the service was made. Executed on 8 January 2019 in Burbank, California. vd Karine Isagulyan SERVICE LIST Mark Palley, Esq. Denise Ngo, Esq. MARION’S INN LLP 1611 Telegraph Avenue, Suite 707 Oakland, CA 94612-2145 Attorneysfor Defendants Make a Reservation | Journal Technologies Court Portal Page 1 of 2 Journal Technologies Court Portal Make a Reservation CHA HEALTH SYSTEMS INC VS KAISER FOUNDATION HOSPITALS ET AL Case Number: BC710014 Case Type: Civil Unlimited Category: Other Breach of Contract/Warranty (not fraud or negligence) Date Filed: 2018-06-13 Location: Stanley Mosk Courthouse - Department 55 Reservation Case Name: CHAHEALTH SYSTEMS INC VS KAISER Case Number: FOUNDATION HOSPITALSET AL BC710014 Type: Motion for Leave to Amend (Motion for Leave Status: to File a First Amended Complaint) RESERVED Party: Location: CHA Health Systems, Inc. (Plaintiff) Date/Time: 02/22/2019 8:30 AM Reservation ID: Stanley Mosk Courthouse - Department 55 Number of Motions: 1 Confirmation Code: 292936825141 CR-FYESFBOPAUIKARHIQ Fees Description Fee Qty Amount Motion for Leave to Amend (name extension) 60.00 1 60.00 Credit Card Percentage Fee (2.75%) 1.65 1 1.65 TOTAL $61.65 Payment Amount: Type: $61.65 Visa Account Number: Authorization: XXXX2016 008145 https://portal-lasc.journaltech.com/public-portal/?q=calendar/reserve 1/8/2019 Make a Reservation | Journal Technologies Court Portal Page 2 of 2 4 Print Receipt = Reserve Another Hearin Copyright © Journal Technologies, USA. All rights reserved. https://portal-lasc.journaltech.com/public-portal/?q=calendar/reserve 1/8/2019