Rhonda S. v. Kaiser Foundation Health Plan(July 28, 2023, B318650) __ Cal.App.5th __ [2023 WL 5318406], ordered published Aug. 18, 2023

Health plan’s duty to transport conservatee to psychiatric facility for assessment and evaluation is triggered by an authorized professional’s custodial determination, not by the conservator’s demand.

Rhonda S. was appointed as the conservator of her adult son (David, who suffers from schizophrenia) under the Lanterman-Petris-Short Act (LPS; Welf. & Inst. Code, § 5350). Both Rhonda and David are Kaiser HMO health plan enrollees. When David’s condition worsened, Rhonda asked his psychiatrist to order David transported to a Kaiser facility for admission and treatment, but the psychiatrist declined to do so. Kaiser declined Rhonda’s request as “not medically necessary” because no doctor had evaluated David and validated Rhonda’s concerns. Kaiser suggested that Rhonda arrange an evaluation by the Psychiatric Mobile Response Team, but Rhonda did not do so. David continued to decline until he was apprehended by police and placed under a LPS section 5150 involuntary hold. Rhonda sued Kaiser seeking a declaration of its obligations to transport and accept for assessment and evaluation conservatees like David upon the conservator’s demand. The trial court sustained Kaiser’s demurrer, and Rhonda appealed.

The Court of Appeal affirmed. The court rejected Rhonda’s argument that section 5150, subdivision (a), required Kaiser to transport and admit David for an assessment and evaluation. The statutory language is permissive, not mandatory, and provides that authorized persons (peace officers and designated professionals) “may, upon probable cause, take  . . . the person into custody . . . for assessment, evaluation, and crisis intervention.” Kaiser’s statutory obligation to perform a minimum assessment and evaluation was not triggered here because no authorized person exercised professional judgment to recommend taking David into custody. Rhonda lacked authority to trigger these statutory requirements. Finally, the court rejected Rhonda’s contention that Kaiser had a per se obligation to pay for David’s ambulance transportation, assessment, and evaluation whenever she requested it, explaining that Kaiser’s obligation arises only when an “Emergency Medical Condition” exists and such a condition is not presumed to exist merely because David had been adjudicated to have a grave disability.

The bulletin describing this appellate decision was originally prepared for the California Society for Healthcare Attorneys (CSHA) by H. Thomas Watson, Peder K. Batalden, and Lacey Estudillo at the appellate firm Horvitz & Levy LLP, and is republished with permission.

For more information regarding this bulletin, please contact H. Thomas Watson, Horvitz & Levy LLP, at 818-995-0800 or htwatson@horvitzlevy.com.