Appellants Cameron Shuts and Gary Sterling represent a putative class of former and current residents of 16 separately licensed skilled nursing facilities that are in the business of providing long-term, 24-hour care for the elderly and disabled (hereafter plaintiffs).
Plaintiffs alleged that the inadequacy of the staffing levels at Covenant's facilities was demonstrated by its noncompliance with the statutory mandate that a skilled nursing facility maintain a minimum numeric ratio of 3.2 nursing hours per patient per day (NHPPD). (See § 1276.5, subd. (a).) Covenant filed a demurrer, urging the court to dismiss this dispute because a skilled nursing facility's obligation to provide its residents care at a level of 3.2 NHPPD is not enforceable by a private right of action. It argued that
In the published portion of this opinion we first conclude that while section 1276.5, subdivision (a), may not create a private right of action, section 1430, subdivision (b) does, thereby allowing plaintiffs to sue under this latter statute for a violation of section 1276.5, subdivision (a). As to the court's invocation of the abstention doctrine, at this stage of the proceedings, it is not clear that adjudicating plaintiffs' claims "would require a trial court to assume the functions of an administrative agency, or to interfere with the functions of an administrative agency. [Citations.]" (Alvarado v. Selma Convalescent Hospital (2007) 153 Cal.App.4th 1292, 1298 [64 Cal.Rptr.3d 250] (Alvarado).) Even if otherwise appropriate, the FAC contained nonequitable claims for relief, including damages, that are not subject to dismissal under the doctrine of equitable abstention. Therefore, we reverse the demurrer as to plaintiffs' first cause of action seeking relief under section 1430, subdivision (b). In the nonpublished portion of this opinion we likewise reverse the trial court's dismissal of the UCL and CLRA causes of action.
The crux of plaintiffs' FAC was their allegation that Covenant had a "duty under California law to provide sufficient nursing staff and related services." Notwithstanding this duty, plaintiffs claimed that Covenant "persisted in [its] practice of understaffing their skilled nursing facilities throughout the Class Period," which plaintiffs defined as December 15, 2006, through December 16, 2010. Plaintiffs alleged that Covenant's "pattern and practice of systematically understaffing their facilities violates California law ...."
As noted, plaintiffs asserted three causes of action. The first cause of action was based on section 1430, subdivision (b), which authorizes a "current or former resident or patient of a skilled nursing facility" to "bring a civil action against the licensee of a facility who violates any rights of the resident or patient as set forth in the Patients Bill of Rights ... or any other right provided for by federal or state law or regulation." Section 1430, subdivision (b) authorizes statutory damages, attorney fees, and injunctive relief. It provides that "[t]he licensee shall be liable for up to five hundred
Plaintiffs' section 1430, subdivision (b) claim is based on Covenant's alleged violation of several provisions of state law, including the violation of plaintiffs' right to reside in a facility that employs an "adequate number of qualified personnel," as provided in the "Skilled Nursing and Immediate Care Facility Patient's Bill of Rights" (§ 1599.1, subd. (a); see Cal. Code Regs., tit. 22, § 72527, subd. (a)(25)) (Patient's Bill of Rights). Plaintiffs assert that in order to satisfy this obligation, Covenant must provide at least 3.2 NHPPD, the minimum number of actual nursing hours per patient required in a skilled nursing facility.
The allegations of the first cause of action also supported plaintiffs' second and third causes of action based on violations of the UCL (Bus. & Prof. Code, § 17200 et seq.) and the CLRA (Civ. Code, § 1750 et seq.). As part of these two additional causes of action, plaintiffs claimed that the understaffing was systematically concealed and misrepresented to members of the general public, including plaintiffs and their families.
Plaintiffs purported to bring these claims on behalf of themselves and a putative class comprised of all persons who resided in one of Covenant's facilities for "at least one day during which the respective facility did not provide at least 3.2 hours of direct nursing care per patient day." Plaintiffs sought injunctive relief as well as statutory damages, restitution, and attorney fees. The FAC expressly disclaimed any intention to "seek damages for personal injuries, wrongful death or other resident-specific harm that may have been caused by inadequate staff."
Covenant filed a demurrer. Covenant argued that each cause of action alleged in plaintiffs' lawsuit was premised on a theory of noncompliance with the 3.2 NHPPD standard set out in section 1276.5, subdivision (a) — a
The trial court agreed with Covenant's arguments and dismissed plaintiffs' entire case without leave to amend on both grounds. The court's judgment of dismissal was filed on June 13, 2011. This appeal followed.
As this division held in Paragon Real Estate Group of San Francisco, Inc. v. Hansen (2009) 178 Cal.App.4th 177 [100 Cal.Rptr.3d 234]: "`On appeal from a judgment dismissing an action after sustaining a demurrer without leave to amend, the standard of review is well settled. The reviewing court gives the complaint a reasonable interpretation, and treats the demurrer as admitting all material facts properly pleaded. [Citations.] The court does not, however, assume the truth of contentions, deductions or conclusions of law. [Citation.] The judgment must be affirmed "if any one of the several grounds of demurrer is well taken. [Citations.]" [Citation.] However, it is
Plaintiffs suggest that this court should apply a de novo standard of review to the superior court's discretionary dismissal under the equitable abstention doctrine. Normally, this court reviews a trial court's exercise of its discretion to abstain from deciding a plaintiffs' claims only for abuse of that discretion. (Klein v. Chevron U.S.A., Inc. (2012) 202 Cal.App.4th 1342, 1361 [137 Cal.Rptr.3d 293] (Klein); Alvarado, supra, 153 Cal.App.4th at p. 1297; Arce v. Kaiser Foundation Health Plan, Inc. (2010) 181 Cal.App.4th 471, 482 [104 Cal.Rptr.3d 545] (Arce).) But, a trial court's decision that rests on an error of law is itself an abuse of discretion. (See Knapp v. AT&T Wireless Services, Inc. (2011) 195 Cal.App.4th 932, 939 [124 Cal.Rptr.3d 565]; Klein, supra, 202 Cal.App.4th at p. 1361.) In determining whether the court made an error of law, we apply the de novo standard of review. (Blickman Turkus, LP v. MF Downtown Sunnyvale, LLC (2008) 162 Cal.App.4th 858, 894 [76 Cal.Rptr.3d 325]; Gai v. City of Selma (1998) 68 Cal.App.4th 213, 219 [79 Cal.Rptr.2d 910].)
We emphasize the limited scope of the issues before us on appeal. Based on arguments made by Covenant in its demurrer, the trial court dismissed plaintiffs' lawsuit without leave to amend based on two independent grounds: (1) no private right of action was created by section 1276.5, subdivision (a), to enforce the statute's 3.2 NHPPD minimum staffing requirements and (2) the court found it "proper to exercise its discretion and abstain from adjudicating this alleged controversy."
Given the bases for the court's dismissal of plaintiffs' FAC, we emphasize at the outset that we do not intend to decide whether the complaint fails to allege facts sufficient to state a cause of action for reasons that were not raised in Covenant's demurrer or decided by the trial court. (See City of Industry v. City of Fillmore (2011) 198 Cal.App.4th 191, 205 [129 Cal.Rptr.3d 433] (City of Industry) ["we need not decide whether the complaint fails to allege facts sufficient to state a cause of action for reasons that were not raised in the demurrer"].)
In support of its demurrer to plaintiffs' first cause of action, Covenant relied heavily on Alvarado, supra, 153 Cal.App.4th 1292. The plaintiff in
On appeal, the Alvarado court generally held that courts have the discretion to abstain from providing equitable relief, such as restitution and injunctions, in cases requiring them to assume or interfere with an administrative agency's function or to take on an unnecessary burden in monitoring or enforcing injunctive relief, where other, more effective remedies exist. (Alvarado, supra, 153 Cal.App.4th at pp. 1297-1298.) Thus, in Alvarado, the trial court acted within its discretion in abstaining from adjudicating the case because CDPH's predecessor agency "has the power, expertise and statutory mandate to regulate and enforce" the 3.2 NHPPD staffing requirement set out in section 1276.5, subdivision (a). (153 Cal.App.4th at p. 1306.) The court reasoned that granting the requested relief would require the court to "assume general regulatory powers over the health care industry through the guise of enforcing the UCL, a task for which the courts are not well equipped. [Citation.]" (Alvarado, at pp. 1303-1304, fn. omitted.) Because regulatory enforcement of the 3.2 NHPPD mandate provided an "alternative and more effective means of ensuring compliance," the trial court was within its discretion in invoking the abstention doctrine. (Id. at p. 1306.)
The trial court in this case acknowledged "that section 1430(b) creates a private right of action and that Plaintiffs have alleged statutory damages in connection with this claim." However, the court indicated it was "not persuaded that Plaintiffs state[d] such a claim because the claim is still, as acknowledged by Plaintiffs, based in part on [the 3.2 NHPPD requirement imposed by] Health and Safety Code section 1276.5. In looking at the statute, it seems clear that the Legislature did not intend to create a private cause of action under section 1276.5...." The court concluded that "despite Plaintiffs' attempt to frame their claim under section 1430(b), the Court finds this claim fails because Plaintiffs cannot allege a private right of action based on a statute for which the Legislature did not intend to create one."
In arguing that the court erred in sustaining Covenant's demurrer, plaintiffs emphasize that their first cause of action was based on the private right of action created by section 1430, subdivision (b), a statute which was never invoked by the plaintiffs in Alvarado nor discussed in that opinion. Plaintiffs point out that by enacting section 1430, subdivision (b), the Legislature has specifically armed residents of skilled nursing facilities with a private right of action for violations of the Patient's Bill of Rights, including the right to reside in a facility that "employ[s] an adequate number of qualified personnel to carry out all of the functions of the facility." (§ 1599.1, subd. (a); see Cal. Code Regs., tit. 22, § 72527, subd. (a)(25).) Consequently, plaintiffs argue Alvarado is not dispositive of the issues on appeal, and does not deserve the great weight that the trial court placed upon it.
On this point we find Wehlage v. EmpRes Healthcare, Inc. (N.D.Cal. 2011) 791 F.Supp.2d 774 (Wehlage), to be persuasive authority.
The Wehlage court rejected the argument (made by Covenant in this case and found persuasive by the trial court) "that Plaintiff's section 1430(b) claim ... to the extent it is based on allegations that [the skilled nursing facilities] violated section 1276.5(a)'s minimum staffing requirement, should be dismissed" because section 1276.5, subdivision (a) "does not provide a right of action under state law ...." (Wehlage, supra, 791 F.Supp.2d at p. 787.) The Wehlage court explained, "Plaintiff asserts a cause of action under section 1430(b) to enforce a right she claims to exist under section 1276.5[, subdivision ](a); she does not bring a cause of action under section 1276.5[, subdivision ](a)." (Wehlage, at p. 787.) The Wehlage court emphasized
Covenant argues that "the Legislature did not intend the nurse staffing minimums set forth in [s]ection 1276.5[, subdivision ](a) to be among the rights enforceable under [s]ection 1430[, subdivision ](b)" because section 1276.5, subdivision (a) has "an aggregate, facility-wide focus" as opposed to an individual focus. This argument ignores the fact that section 1430, subdivision (b) authorizes plaintiffs to assert violations of rights conferred upon them by the Patient's Bill of Rights in a civil action, many of which are expressed as aggregate, facility-wide obligations. (See, e.g., § 1599.1, subds. (a) [facility shall employ adequate staff], (c) [facility shall provide appropriate food], (d) [facility shall provide activity program], (e) [facility shall be clean], (f) [facility shall provide operating nurses' call system].) Consequently, we are not concerned that the 3.2 NHPPD minimum staffing
To be sure, courts are hesitant to intervene in the absence of any legislative or regulatory guidance when a plaintiff essentially is asking the court to make an economic or policy judgment. (See, e.g., California Grocers Assn. v. Bank of America (1994) 22 Cal.App.4th 205, 218-219 [27 Cal.Rptr.2d 396] [holding that, absent a legislative determination, a court could not declare that bank's service fee was too high without rendering an economic policy judgment].) However, a court should not abstain from deciding a case when the Legislature "already has made the relevant policy determinations ...." (Arce, supra, 181 Cal.App.4th at p. 501.)
In upholding the use of the abstention doctrine, the Alvarado court concluded that compliance with the 3.2 NHPPD minimum staffing standard would require the court to make a series of factual findings that would be a "task better accomplished by an administrative agency than by trial courts." (Alvarado, supra, 153 Cal.App.4th at p. 1306.) For example, the Alvarado court was concerned that calculating the NHPPD would be extremely burdensome and difficult because "section 1276.5, subdivision (b) provides different formulas for calculating nursing hours in different skilled nursing facilities" and "the court would have to determine on a classwide basis the size, configuration and licensing status of skilled nursing and intermediate care facilities." (Id. at p. 1306.)
Importantly, since Alvarado was decided in 2007, the CDPH has made significant progress in providing administrative guidance on the 3.2 NHPPD standard, and how it should be calculated.
We note this will not be the first time courts have been called upon to adjudicate whether skilled nursing facilities have violated applicable staffing standards. In Conservatorship of Gregory (2000) 80 Cal.App.4th 514 [95 Cal.Rptr.2d 336], the court concluded that the regulation requiring a skilled nursing facility to "`employ an adequate number of qualified personnel to carry out all of the functions of the facility'" was relevant to key issues in that case involving elder abuse. (Id. at p. 524.) The court stated: "Like statutes, applicable regulations are a `factor to be considered by the jury in determining the reasonableness of the conduct in question.' [Citations.]" (Id. at p. 523.) The court rejected the argument that the jury instructions given in that case, which were based on state and federal regulations "relevant to government enforcement actions" to protect the elderly and disabled, were "too vague to provide meaningful guidance to the jury." (Ibid.) In so holding, the court noted that common knowledge of members of a particular vocation may make a regulation specific, and that "the jury heard testimony describing how nursing home professionals construed and applied the federal and state regulatory standards regarding sufficient staff." (Id. at p. 524.) As Conservatorship of Gregory illustrates, litigation of plaintiffs' claims is not beyond the capacity of a court to understand or evaluate.
We also find it significant that when the Legislature amended section 1430, subdivision (b) in 2004, it expanded rather than narrowed the scope of the legislation to allow a private right to sue for damages, not just for a violation of the Patient's Bill of Rights, but for a violation of "any other right provided for by federal or state law or regulation." (Stats. 2004, ch. 270, § 2, pp. 3138-3139; see Fitzhugh, supra, 150 Cal.App.4th at p. 473, fn. 2.) This amendment was due to the "concern that enforcement by CDPH would be constrained by financial and demographic pressures in the coming years." (Wehlage, supra, 791 F.Supp.2d at pp. 788-789.) Therefore, denying a private right of action on the grounds that statutory compliance is better achieved by turning the matter over to CDPH represents an unwarranted frustration of the Legislature's desire to supplement administrative action with private enforcement. (Ibid.)
Furthermore, because the Legislature has made the remedies prescribed by section 1430, subdivision (b) cumulative to "any other remedy provided by law," (id., subd. (c)) the arguments made by Covenant forewarning of the problems created by parallel private and administrative enforcement of the law — i.e., inconsistent rulings on calculating the 3.2 NHPPD standard and duplicative enforcement — have obviously been considered and rejected by our state lawmakers.
The judgment dismissing this action without leave to amend is reversed. The matter is remanded to the trial court for further proceedings consistent with this opinion. Costs on appeal are awarded to plaintiffs.
Reardon, J., and Rivera, J., concurred.