The plaintiff, Michael Palmer, who is a bilateral below-the-knee amputee, brought this lawsuit because his primary care physician, who is a member of Sharp Rees-Stealy, rendered a utilization review opinion that new ultra-light prostheses, costing over $18,000, were not medically necessary and that, instead, revision of Mr. Palmer’s current prostheses was appropriate. Mr. Palmer sued the medical group, PacificCare, and his primary care physician (who was dismissed from the case) for bad faith and negligent and intentional infliction of emotional distress. Mr. Palmer included a claim for punitive damages in the complaint filed with the court.

The statute allowing punitive damages in medical cases, Code of Civil Procedure section §425.13, has special procedural requirements that a plaintiff must follow in order to state a claim for punitive damages against a health care provider. A plaintiff cannot, as Mr. Palmer did, claim them in the complaint. Instead the plaintiff must get special permission from the court after stating specific facts that support such damages. The trial court ruled that the claim for punitive damages should be stricken because it did not comply with §425.13. The plaintiff asked the Court of Appeal for an immediate decision as to the propriety of the trial court’s decision on this issue.

Mr. Palmer contends the trial court misinterpreted the protective provisions of §425.13. In his view, these provisions should not apply to the medical group because a doctor’s utilization review rendering advice to the HMO about whether requested medical services, equipment, or supplies are "medically necessary," is an administrative decision, not an activity arising out of professional services.

CMA’s brief argued that the medical group was acting as the plaintiff’s health care provider and that the conduct complained of by the plaintiff did arise out of professional services and was within the protections afforded by MICRA and related punitive-damages pleading restrictions. The Court of Appeal agreed, and ruled in favor of the defendant. The case will be returned to the trial court, and Mr. Palmer will be required to follow the procedural requirements for claiming punitive damages against a health care provider.

For more information, including a copy of CMA's brief, click here.

Contact: CMA’s legal information specialists, 415/882-5144 or legalinfo@cmanet.org.