An injured employee (plaintiff Lydia Sanchez, a home health care worker) filed a personal injury action against the trustees of the estate of a third party tortfeasor (the late Dorothea B. Kavanaugh, the elderly woman for whom Sanchez had provided care). The trustees (defendants Darrell G. Brooke and Darryl Denning) asserted as an affirmative defense the comparative negligence of Sanchez and her employer (Glendale Adventist Health, also known as Western Health Resources (Western or employer)). Western, which is not a party to this action, filed a workers' compensation lien against Sanchez's potential recovery.
The jury found that Kavanaugh, Western, and Sanchez all were negligent, but that Sanchez's negligence was not a substantial factor in causing her own injuries. The jury apportioned 50 percent of the fault to Kavanaugh and 50 percent to Western. Based on the jury's finding that Sanchez had sustained total damages of $903,000, the trial court calculated Kavanaugh's share and entered a judgment against defendants for $570,949.87.
Sanchez and defendants filed separate appeals, which we consolidated. In Sanchez's appeal from the order denying her motion for judgment notwithstanding the verdict, she challenges the sufficiency of the evidence to support the finding of employer negligence. We conclude that because the finding was supported by substantial evidence, the motion was properly denied.
We conclude that the same result applies where an injured employee's medical provider accepts a discounted amount as payment in full from the employer under the workers' compensation law. In both situations, because the injured person/employee is not liable for the undiscounted sum stated in the provider's bill, the unpaid balance does not represent an economic loss to the plaintiff and is not recoverable as damages. We therefore reverse the judgment in part as to the amount of damages only and remand for a limited rehearing and recalculation of damages.
Sanchez, a home health aide employed by Western, was working as Kavanaugh's live-in caregiver when a fire broke out in Kavanaugh's bedroom at around midnight on September 20, 2006. The evidence at trial showed that the fire was caused by Kavanaugh's negligent smoking in bed, and that Sanchez was injured while attempting to rescue Kavanaugh, who died in the fire.
The jury found that Sanchez suffered total damages of $903,000, which included $300,000 in noneconomic damages and $603,000 in economic damages. The jury also found that the economic damages consisted of $575,000 in past medical expenses and $28,000 in lost earnings.
Given that Western was apportioned 50 percent of the liability and had paid $272,622.38 in workers' compensation benefits to Sanchez, the trial
Before calculating the Witt v. Jackson offset, the trial court had to resolve the parties' disagreement over the amount of past medical expenses that were recoverable by Sanchez as economic damages. Defendants contended that the jury's award of $575,000 in medical expenses was excessive because it included amounts that were billed to but not paid by Western. Defendants argued that because the medical providers had accepted $241,818:38 from Western (the amount of Western's medical lien) as payment in full, Sanchez's recovery of past medical expenses must be capped at that amount under Hanif v. Housing Authority (1988) 200 Cal.App.3d 635, 640 [246 Cal.Rptr. 192] (Hanif) and Nishihama v. City and County of San Francisco (2001) 93 Cal.App.4th 298, 306-307 [112 Cal.Rptr.2d 861] (Nishihama).
In Hanif, the injured plaintiff's recovery of past medical expenses from the defendant tortfeasor was capped at the amount the provider had accepted from Medi-Cal as payment in full. (Hanif, supra, 200 Cal.App.3d at pp. 643-644.) In Nishihama, the injured plaintiff's recovery of past medical expenses from the defendant tortfeasor was capped at the amount the provider had accepted from the private health insurer as payment in full. (Nishihama, supra, 93 Cal.App.4th at pp. 306-309.)
Based on their view that a Hanif-Nishihama reduction is required in this case, defendants argued that Sanchez could recover only $269,818.38 of the $603,000 economic damages award, consisting of $241,818.38 in past medical expenses (the amount of Western's medical lien) and $28,000 in lost earnings, reduced by a Witt v. Jackson offset of $129,091.16. Using these reduced figures, defendants calculated a proposed judgment of $290,727.22.
The trial court adopted Sanchez's calculations and entered a final judgment against defendants for $570,949.87. In rejecting defendants' contention that a Hanif-Nishihama reduction is required in this case, the trial court relied on an appellate decision that was reversed while this appeal was pending (Howell, supra, 52 Cal.4th 541).
After judgment was entered, Sanchez moved for judgment notwithstanding the verdict, seeking to overturn the apportionment of fault to Western on the ground that the finding of employer negligence was not supported by substantial evidence. In support of her motion, Sanchez cited the lack of any expert testimony setting forth the standard of care applicable to home health care providers such as Western. In opposition to the motion, defendants argued that expert testimony is not required on matters that are within the common experience of lay jurors. The trial court denied the motion based on its determination that lay jurors are as qualified as any expert to assess whether Western was negligent in allowing Sanchez to work in a home where Kavanaugh was permitted to smoke in bed while unsupervised.
The denial of a motion for judgment notwithstanding the verdict is reviewed for substantial evidence to support the verdict. (Dell'Oca v. Bank of
Sanchez contends that her motion for judgment notwithstanding the verdict should have been granted because the jury's finding of employer negligence was not supported by substantial evidence. Sanchez cites the following grounds for reversal: (1) the lack of evidence of a breach of a duty of care owed by Western to Sanchez; (2) the failure to instruct the jury on the duty of care owed by Western to Sanchez; (3) Western's conduct (advising Kavanaugh about the hazards of smoking and recommending the purchase of air purifiers)
Sanchez filed a motion in limine
The jury received ordinary negligence instructions as to Sanchez's claim of negligence against Kavanaugh and defendants' defense of comparative fault
After the time to appeal from the judgment had expired, Sanchez appealed from the order denying her motion for judgment notwithstanding the verdict.
At the hearing on plaintiff's motion for judgment notwithstanding the verdict, the trial court found the evidence reasonably supported the jury's finding that Western was negligent in allowing Sanchez to work in a home where Kavanaugh was permitted to smoke in bed while unsupervised and without imposing any rules or restrictions on her smoking in order to reduce the risk of fire. The trial court pointed out that Western could "have put in place rules and regulations ... telling Lydia Sanchez what she could or could not do in regards to allowing Mrs. Kavana[u]gh to smoke and to smoke in bed without any precautions taken." In the trial court's opinion, expert testimony was not required to establish a standard of care because "a lay person could certainly understand and recognize and come to grips with" the ordinary hazards of smoking in bed.
In response, Sanchez's counsel stated: "I think the Court is absolutely correct when you say that the issue is, could they, for example, implement rules? Could—what should they have done in supervising, for example, Lydia Sanchez, and telling Lydia Sanchez, here's what you should or shouldn't do? What should they have done in terms of preparing policies and procedures and protocol? [¶] THE COURT: Independent of what she [(Sanchez)] does. [¶] MR. LALLANDE [(Sanchez's counsel)]: The problem is, Your Honor, that you're now saying that a lay jury that is not in the business of providing health care is now going to sit there and say, we think without any—without any evidence to guide them whatever, nothing. I mean, there's no testimony to guide them whatever—in terms of expert testimony—that they are supposed to now come up with a standard of care as to what regulations should exist. Perhaps one juror thinks that the regulation should be that she shouldn't be allowed to smoke at all in the house, because, by the way, she's an infirm[] little old lady. Perhaps another juror thinks, hey, it's her house. She can smoke anywhere she wants. [¶] THE COURT: Could they not say, if we're going to give care, you can't smoke?"
Sanchez's counsel replied that it was unclear whether a licensed medical care provider such as Western could simply deny care based on a client's refusal to stop smoking. Counsel argued there was "a question of whether that is an appropriate policy and procedure." "[T]he issue of whether—how— what policies and procedures they create is an issue for an expert."
We distinguish cases such as Jacoves v. United Merchandising Corp. (1992) 9 Cal.App.4th 88, 106 [11 Cal.Rptr.2d 468], where expert testimony was required to establish the applicable standard of care. In that case, expert
Our case is analogous to Ewing v. Northridge Hospital Medical Center (2004) 120 Cal.App.4th 1289 [16 Cal.Rptr.3d 591], which held that expert testimony was not required to establish a psychotherapist's liability for failure to warn a third person of a patient's violent propensities under Civil Code section 43.92. Even though Ewing involved a negligence claim against a licensed medical professional, expert testimony on the standard of care was not necessary because, as the court explained: "A psychotherapist may be held liable for failure to warn under section 43.92 only if the jury is persuaded the therapist actually believed or predicted his or her patient posed a serious risk of inflicting grave bodily injury upon an identifiable victim. Applied here, this rule means simply that, because there is no need for expert guidance on the `standard of care' for psychotherapists' statutory duty to warn, the court erred when it found, as a matter of law, that plaintiffs could not establish their claim without presenting expert testimony. If resort to expertise is unnecessary, so is the expert. [Citations.] Under section 43.92, liability is not premised on a breach of the standard of care. [Fn. omitted.] Instead, it rests entirely on the fact finder's determination that each factual predicate is satisfied: the existence of a psychotherapist-patient relationship; the psychotherapist's actual belief or prediction that the patient poses a serious risk of inflicting grave bodily injury; a reasonably identifiable victim; and the failure to undertake reasonable efforts to warn the victim and a law enforcement agency. [Citations.]" (120 Cal.App.4th at pp. 1301-1302.)
Similarly, in this case, the jury was instructed that in order to establish their comparative negligence defense, defendants "must prove both of the following: One: That Western Health Resources was negligent. And two: That the negligence of Western Health Resources was a substantial factor in causing Lydia Sanchez' harm." The comparative negligence defense rested entirely on the jury's determination that the elements of negligence and causation were proven, not in terms of a standard of care applicable to medical professionals, but in terms applicable to ordinary persons. Negligence was defined simply as "the failure to use reasonable care to prevent harm to oneself or to others. A person can be negligent by acting or by failing to act. A person is negligent if he or she does something that a reasonably careful person would not do in the same situation or fails to do something that a reasonably careful person would do in the same situation."
As the hazards of smoking in bed are well understood, lay jurors are capable of assessing Western's lack of response to those hazards without the benefit of expert testimony. Given the lack of evidence that any fire-preventative measures were taken by Western (such as offering a second caregiver who would stay awake during the night, or removing all matches and cigarettes from Kavanaugh's bedroom at night), the record contains substantial evidence to support the finding of employer negligence.
Defendants contend that because Sanchez's medical bills of $575,000 were paid by Western at the reduced amount of $241,818.38, Sanchez's award for past medical expenses must be capped at $241,818.38. (Citing Hanif, supra, 200 Cal.App.3d at p. 640; Nishihama, supra, 93 Cal.App.4th at pp. 306-307.)
According to Howell: "When a tortiously injured person receives medical care for his or her injuries, the provider of that care often accepts as full payment, pursuant to a preexisting contract with the injured person's health insurer, an amount less than that stated in the provider's bill. In that circumstance, may the injured person recover from the tortfeasor, as economic damages for past medical expenses, the undiscounted sum stated in the provider's bill but never paid by or on behalf of the injured person? We hold no such recovery is allowed, for the simple reason that the injured plaintiff did not suffer any economic loss in that amount. (See Civ. Code, §§ 3281 [damages are awarded to compensate for detriment suffered], 3282 [detriment is a loss or harm to person or property].)
Defendants contend that because Western paid Sanchez's medical bills, presumably at the rate set forth in the statutory fee schedule, the judgment must be modified to reflect a correct damages award of $290,727.22. Sanchez argues, however, that the record is silent as to the statutory fee schedule and does not disclose whether Western's payment of $241,818.38 in medical expenses was based on the statutory fee schedule. Sanchez contends that there is no evidence to support a finding that the providers were paid the full amount due under the workers' compensation law.
Given that the decision in Howell was issued while this appeal was pending, it is understandable that neither the parties nor the trial court anticipated the type of workers' compensation payment evidence that would be relevant to calculate Sanchez's permissible recovery of past medical expenses from a third party. We therefore find it appropriate to remand the matter to the trial court for the limited purpose of determining the full amount owed by Western to the medical care providers under the workers' compensation law. That amount will establish the past medical expenses that are
As to Sanchez's appeal, the order denying judgment notwithstanding the verdict is affirmed. As to defendants' appeal, the judgment is reversed in part as to damages only and the matter is remanded for a limited hearing and recalculation of damages in accordance with the views set forth in this opinion. Defendants are entitled to their costs on appeal.
Epstein, P. J., and Manella, J., concurred.
Sanchez suffered burns on her hands and feet and injuries from smoke inhalation. After surgery, she spent three weeks on a ventilator in intensive care. She then spent two more weeks in a rehabilitation unit where she received speech, occupational, and physical therapies.
(1) The $603,000 economic damages award must be reduced to $269,818.38 ($241,818.38 medical lien + $28,000 lost earnings = $269,818.38 economic damages).
(2) The $903,000 total damages award must be reduced to $569,818.38 ($269,818.38 economic damages + $300,000 noneconomic damages = $569,818.38).
(3) The $269,818.38 economic damages award is 47.35164 percent of the total verdict ($269,818.38 / $569,818.38 = 0.4735164).
(4) Multiplying the workers' compensation benefits of $272,622.38 by 0.4735164 (the percentage of the total verdict attributable to economic damages) produces a Witt v. Jackson offset of $129,091.16 ($272,622.38 × 0.4735164 = $129,091.16).
(5) Adding the (reduced) noneconomic damages award of $150,000 to the economic damages award of $269,818.38, and subtracting the Witt v. Jackson offset of $129,091.16, results in a final judgment of $290,727.22 ($150,000 + $269,818.38 - $129,091.16 = $290,727.22).
(1) The $603,000 economic damages award is 66.7774 percent of the total damages award of $903,000 ($603,000 / $903,000 = 0.667774).
(2) Multiplying the workers' compensation benefits of $272,622.38 by 0.667774, produces a Witt v. Jackson offset of $182,050.13 ($272,622.38 × 0.667774 = $182,050.13).
(3) Adding the (reduced) noneconomic damages award of $150,000 to the economic damages award of $603,000, and subtracting the Witt v. Jackson offset of $182,050.13, results in a final judgment of $570,949.87 ($150,000 + $603,000 - $182,050.13 = $570,949.87).
As to defendants' defense of Western's comparative negligence, the jury was instructed: "Defendant Dorothea B. Kavana[u]gh claims that the negligence of Western Health Resources was also a substantial factor in causing Lydia Sanchez' harm.
"To succeed on this claim, defendant Dorothea B. Kavana[u]gh must prove both of the following:
"One: That Western Health Resources was negligent.
"And two: That the negligence of Western Health Resources was a substantial factor in causing Lydia Sanchez' harm."
The jury received the following instruction on causation:
"A substantial factor in causing harm is a factor that a reasonable person would consider to have contributed to the harm. It must be more than a remote or trivial factor. It does not have to be the only cause of the harm.
"Conduct is not a substantial factor in causing harm if the same harm would have occurred without that conduct. A person's negligence may combine with another factor to cause harm.
"If you find that Dorothea Kavana[u]gh's negligence was a substantial factor in causing Lydia Sanchez' harm, then Dorothea Kavana[u]gh is responsible for the harm. Dorothea Kavana[u]gh cannot avoid responsibility just because some other person, condition or event was also a substantial factor in causing Lydia Sanchez' harm."