The Third District Court of Appeal in California recently addressed the standard in proving the reasonableness of charges for past medical services within the context of the Hospital Lien Act’s definition of emergency and ongoing medical or other services in Yaffee v. Skeen.1 This article will focus on the implications of the court’s decision in evaluating past medical damages.
BACKGROUND AND DISPUTE
A driver brought a personal injury suit against a truck driver and his employer following a collision. The Sacramento Superior Court granted judgment for the driver after a jury verdict in his favor, denied motions for a new trial and partial judgment notwithstanding the verdict, and awarded costs and interest, including $3,299,455 in past and future economic earnings and noneconomic loss.2 The defense appealed the past medical damages, future medical damages, past and future lost earnings, future noneconomic damages, and costs and prejudgment interest.3
THE BURDEN OF PROOF FOR INSURED PATIENTS
A plaintiff seeking compensatory damages for the cost of past medical services must establish that the charges for those services were reasonable.4 To do so, the plaintiff must prove: (1) she “actually incurred the medical expenses and the amount of the patient’s liability for the expense caps her potential recovery;” and (2) she must prove the reasonable value of the medical services.5 Plaintiff is entitled to no more than the expenses actually incurred.6
Further, in the landmark case Howell v. Hamilton Meats,7 the Court determined an injured plaintiff whose medical expenses are paid through private insurance may recover no more than the amounts paid by the plaintiff or his or her insurer for the medical services received or still owed at the time of trial.8 Accordingly, evidence that the reasonable value of such medical services exceeds the amount paid is therefore irrelevant and inadmissible as to past medical specials.9 If such evidence were allowed, it would likely cause jury confusion and trigger the collateral source rule for evidence.
AN ALTERNATIVE: THE HOSPITAL LIEN ACT AND THE MEANING OF EMERGENCY SERVICES
Under Section 3045.1 of the Hospital Lien Act (“HLA”), a hospital providing:
emergency and ongoing medical or other services to any person injured by reason of an accident or negligent or other wrongful act…shall, if the person has a claim against another for damages on account of his or her injuries, have a lien upon the damages recovered, or to be recovered…to the extent of the amount of the reasonable and necessary charges…10
When a hospital receives a reduced negotiated rate under a prior agreement with the insured patient and/or their health insurer, in which the hospital agreed to accept that payment as payment in full, the hospital cannot assert a lien under the HLA to recover the difference between its usual and customary charges and the amount received.11 Questions of past medical costs as they relate to the Hospital Lien Act then hinge upon the meaning and scope of “emergency and ongoing medical or other services.” This raises two key questions: how long is “ongoing,” and what services does this phrase include?
The court looked at the legislative history behind the Hospital Lien Act to determine the definition of “emergency” and concluded, “Neither the plain language of the whole statute nor the Legislative history suggests the Legislature intended to allow for a lien when no emergency services are provided.”12 The court focused on the conjunctive nature of “and,”13 limiting the scope to “services provided by a hospital when a person arrives at the hospital's emergency department and seeks care.”14
Further, despite the colloquial suggestion that emergency requires immediacy to the time of the incident, the court found that:
immediacy should be measured by the level of need when the treatment is sought and not on either (1) how soon after the injury-causing event treatment is sought, or (2) the level of an injured person's need for services at the level of need at the time of treatment.15
Next, comes the question as to the meaning of “ongoing medical or other services.” The court concluded:
[T]he HLA only applies to services obtained while the patient remains in the emergency room, hospital, or an associated care facility as needed to relieve or eliminate the emergency medical condition—i.e., the acute status that brought the patient to the emergency room—within the capability of the facility. That is, it applies to services received before the patient is discharged…16
TAKEAWAYS
How does this all tie back to past medical damages? Hypothetically, a hospital could assert a lien under the HLA for “emergency and ongoing medical or other services” provided a month after an incident. As previously mentioned, “emergency…services” relates to services sought to relieve or eliminate the acute condition, stemming from an incident, that brought the plaintiff to the emergency room in the first place. Emergency services do not require temporal immediacy and are measured by the plaintiff’s level of need when the treatment is sought.
However, there are still limits. The hospital is limited to asserting a lien under the HLA for the services plaintiff received before he or she was discharged. Further, simply providing emergency services for a condition caused by the injury, does not give a hospital a blank check to be reimbursed under the HLA for all provided services in perpetuity thereafter. The Court specifically stated that allowing so would run contrary to Howell.17 Therefore, the evidentiary evaluation for any such remaining services outside the scope of “emergency and ongoing medical or other services” must be determined under Howell.
1Yaffee v. Skeen (2024) 106 Cal.App.5th1281, 1289 [328 Cal.Rptr.3d 80], as modified on denial of reh'g (Dec. 17, 2024), order vacated (Dec. 19, 2024), as modified on denial of reh'g (Dec. 19, 2024), review denied (Mar. 26, 2025). Id.
2Yaffee v. Skeen (2024) 106 Cal.App.5th 1281, 1289 [328 Cal.Rptr.3d 80], as modified on denial of reh'g (Dec. 17, 2024), order vacated (Dec. 19, 2024), as modified on denial of reh'g (Dec. 19, 2024), review denied (Mar. 26, 2025).
3Id.
4Moore v. Mercer (2016) 4 Cal.App.5thh 424, 436-437, 209 Cal.Rptr.3d 101 (Moore); Calhoun v. Hildebrandt (1964) 230 Cal.App.2d 70, 73, 40 Cal.Rptr. 690.
5Yaffee, 106 Cal.App.5th at 1297, citing Moore, 4 Cal.App 5th at 436-7.
6Yaffee, 106 Cal.App.5th at 1297.
7Notably, Howell v. Hamilton Meats, which reshaped the personal injury litigation landscape in California, was litigated by Founding Partner Robert Tyson.
8Id. [citing Howell v. Hamilton Meats & Provisions, Inc. (2011) 52 Cal.4th 541, 129 Cal.Rptr.3d 325, 257 P.3d 1130.]
9Id. [citations omitted.]
10Cal. Civ. Code Ann. § 3045.1 (West).
11Yaffee, 106 Cal.App.5th at 1298.
12Id. at 1301.
13Id.
14Id. at 1303.
15Id. at 1305.
16Id. at 1305.
17Id. at 1307.
