Renwick v. Sutter Medical Foundation CA3 ( 2016 )


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  • Filed 1/12/16 Renwick v. Sutter Medical Foundation CA3
    NOT TO BE PUBLISHED
    California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for
    publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication
    or ordered published for purposes of rule 8.1115.
    IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA
    THIRD APPELLATE DISTRICT
    (Sutter)
    ----
    CHERYL ELDER RENWICK,                                                                        C077380
    Plaintiff and Appellant,                                    (Super. Ct. No. CVCS130911)
    v.
    SUTTER MEDICAL FOUNDATION et al.,
    Defendants and Respondents.
    Plaintiff Cheryl Elder Renwick, the daughter and sole heir of decedent Faye Perry,
    sued defendants Kaiser, Sutter Medical Foundation, and Eskaton Care Center after her
    mother died of a pulmonary embolism (blood clot in the lungs). The theory of
    Renwick’s case was that Kaiser, Eskaton, and Sutter were liable for her mother’s death
    based on elder abuse and wrongful death because they failed to ensure that her mother
    was provided with the blood thinner, Lovenox, even though she had a history of blood
    clots and pulmonary embolisms. Kaiser is no longer part of the lawsuit. The trial court
    1
    sustained the demurrers of Eskaton and Sutter and entered judgment in their favor.
    Renwick appeals, and we affirm.
    FACTUAL AND PROCEDURAL BACKGROUND
    Renwick alleged the following facts in her lawsuit against Eskaton and Sutter:
    On May 5, 2011, the mother fell at her house and injured her ankle and foot. She
    was first treated at Kaiser Roseville, with whom she had a managed health care plan.
    After being treated at Kaiser, the mother was transferred to Eskaton the same day.
    “Kaiser, at all times mentioned herein, was [her mother’s] primary care giver” and
    “referred her to Eskaton Care Center merely for convalescent care.” “Kaiser retained the
    primary duty of care for [the mother] for anything related to the fall, including the risk of
    pulmonary embolisms, right up to her death on May 28, 2011, from a pulmonary
    embolism.”
    Eight days after being transferred to Eskaton, on May 13, 2011, Eskaton faxed a
    referral regarding the mother to Sutter. The referral consisted of two forms: (1) a
    discharge and transfer-discharge plan of care; and (2) a resident admission record. “Both
    forms showed that the [mother] had a diagnosis of pulmonary embolism/infarction and
    Lovenox ordered,” meaning the referral contained a prescription for Lovenox.
    On May 16, 2011, the mother was discharged from Eskaton, and she returned
    home. Renwick “was told that a nurse from Sutter would be coming to the home within
    two days . . . to take care of [her mother] and administer Lovenox injections.” The
    mother was supposed to receive a Lovenox injection once a day for 14 days after her
    release back home. When no nurse came to the home, Renwick made daily phone calls
    to Kaiser, Eskaton, and Sutter to ask when a nurse would come. Sutter told Renwick it
    was “waiting for authorization from KAISER before making an initial visit.”
    Sutter had its own admission criteria and policy process that required it to perform
    the initial assessment within 48 hours of the referral, and if that time frame could not be
    met, Sutter was required to inform the patient’s physician, the referral source, and the
    2
    patient for approval of the delay. If approval was not obtained, Sutter was required to
    refer the patient to another agency for services. No “staff” at Sutter did any of this.
    At no time did Kaiser, Eskaton, or Sutter tell Renwick of the vital need for her to
    take her mother to the emergency room or any other facility to receive the life-preserving
    Lovenox injections.
    On May 28, 2011, the mother was rushed to the hospital and died that day of a
    pulmonary embolism.
    The California Department of Health found Sutter violated a state regulation that
    required Sutter to have established and implemented procedures to handle medical
    emergencies when Sutter violated its own admission criteria and process policy. (See
    Cal. Code Regs., tit. 22, § 74721, subd. (c)(1) [home health care providers are required to
    have in place written policies and procedures that include “[a] plan to handle medical
    emergencies”].)
    Renwick’s lawsuit here (originally filed on May 23, 2013) alleged Eskaton and
    Sutter committed elder abuse and wrongful death (the wrongful death was premised on
    the same facts as the elder abuse). As to Eskaton, Renwick alleged that her mother was
    under the care of Eskaton when it recklessly neglected to provide her mother injections of
    Lovenox knowing there was a high probability of death without them, and Eskaton’s
    failure to make a referral to another agency or advise Renwick how to obtain those
    injections amounted to abandonment of her mother under Eskaton’s continuing duty of
    care. As to Sutter, Renwick alleged Sutter had care of her mother from the time of the
    referral on May 13, 2011, based on the regulation and its own policies and procedures.
    Renwick also alleged she was entitled to punitive damages against Sutter under the
    statute imposing employer liability upon the acts of an employee if the employer
    “authorized or ratified the wrongful conduct.” (Civ. Code, § 3294, subd. (b); see Welf. &
    Inst. Code, § 15657, subd. (c).)
    3
    Eskaton and Sutter demurred to the complaint. The trial court sustained both the
    demurrers without leave to amend. As to the elder abuse claim against Eskaton, the trial
    court ruled that Renwick’s lawsuit specifically alleged that Sutter had care of her mother
    during the time she suffered the embolism, and not Eskaton. As to the wrongful death
    claim against Eskaton, the court sustained the demurrer because it was based on the elder
    abuse allegations. It denied leave to amend this claim because to the extent Renwick
    could amend the complaint to allege wrongful death based on professional negligence,
    such a claim would be barred by the one-year statute of limitations. As to the elder abuse
    claim against Sutter, the trial court ruled Renwick did not “plead with particularity that an
    officer, director, or managing agent authorized or ratified Sutter’s failure to send a nurse
    or refer to another facility.” As to the wrongful death claim against Sutter, the court ruled
    that if as alleged in the complaint, Sutter is a licensed health care provider, any claims
    based on professional negligence were time barred.
    The court entered judgment in favor of Eskaton and Sutter, and Renwick now
    timely appeals.
    DISCUSSION
    I
    The Trial Court Properly Sustained
    Eskaton’s Demurrer Without Leave To Amend
    The function of a demurrer “is to test the sufficiency of a pleading as a matter of
    law,” and on appeal following an order sustaining a demurrer without leave to amend,
    “we apply the de novo standard of review.” (California Logistics, Inc. v. State of
    California (2008) 
    161 Cal. App. 4th 242
    , 247.) We do not assume the truth of contentions
    or conclusions of fact or law contained in the plaintiff’s pleadings. (Moore v. Regents of
    University of California (1990) 
    51 Cal. 3d 120
    , 125.)
    4
    As is relevant here, the elements of elder abuse include: (1) the defendant “had
    responsibility for meeting the basic needs of the elder or dependent adult”; (2) the
    defendant “knew of conditions that made the elder or dependent adult unable to provide
    for his or her own basic needs”; and (3) the defendant “denied or withheld goods or
    services necessary to meet the elder or dependent adult’s basic needs, either with
    knowledge that injury was substantially certain . . . (if the plaintiff alleges oppression,
    fraud or malice) or with conscious disregard of the high probability of such injury (if the
    plaintiff alleges recklessness).” (Carter v. Prime Healthcare Paradise Valley LLC (2011)
    
    198 Cal. App. 4th 396
    , 406-407.)
    Renwick contends the trial court erred in sustaining Eskaton’s demurrer with
    respect to her elder abuse claim because her mother was under the care of Eskaton when
    it recklessly neglected to provide her mother injections of Lovenox knowing there was a
    high probability of death without them, and Eskaton’s failure to make a referral to
    another agency or advise Renwick how to obtain those injections amounted to
    abandonment of the mother under Eskaton’s continuing duty of care. As we explain
    below, Renwick’s contention lacks merit for at least four reasons. One, Renwick failed
    to allege facts showing her mother was in Eskaton’s care or custody when injured. Two,
    Renwick failed to allege facts that Eskaton abandoned her mother. Three, Renwick failed
    to allege facts showing Eskaton acted recklessly or maliciously. And four, Renwick’s
    claim is really one for professional negligence, for which the one-year statute of
    limitations had expired.
    Since Renwick has stated that her claim of wrongful death is premised on her elder
    abuse claim, the wrongful death claim fails as well.
    A
    The Mother Was Not In Eskaton’s Custody Or Care When She Was Injured
    Renwick could not meet the first element of elder abuse, namely, that Eskaton had
    care or custody of the mother. Specifically, the mother was not in Eskaton’s care when
    5
    the failure to give Lovenox injections occurred. The failure to give the injections
    occurred between May 16, 2011, and May 28, 2011. But Renwick pled that Eskaton
    admitted her mother on May 5, 2011, and discharged her on May 16, 2011. Since the
    injury did not take place until after the mother was discharged from Eskaton, Eskaton
    cannot be liable based on a care or custody theory.
    Moreover, as the trial court observed, Renwick pled facts in her complaint that
    were inconsistent with the conclusion that Eskaton had responsibility for her mother’s
    outpatient care after Eskaton discharged her. Specifically, Renwick alleged that Sutter
    was responsible for caring for her mother “ ‘from the time of her referral to Sutter North
    on or about May 13, 2011.’ ” Renwick further alleged that “[d]efendant Kaiser, at all
    times mentioned herein, was [her mother’s] primary care giver” and “referred her to
    Eskaton Care Center merely for convalescent care.” “Kaiser retained the primary duty of
    care for [the mother] for anything related to the fall, including the risk of pulmonary
    embolisms, right up to her death on May 28, 2011, from a pulmonary embolism.” Where
    a plaintiff alleges a conclusion and inconsistent special facts from which the conclusion is
    drawn, the sufficiency of the complaint is determined from the special facts, not from the
    conclusion. (Iverson, Yoakum, Papiano & Hatch v. Berwald (1999) 
    76 Cal. App. 4th 990
    ,
    995.)
    Finally, Eskaton owed no continuing duty of care to the mother after it discharged
    her to ensure her mother received the Lovenox injections or to warn Renwick about harm
    to her mother if her mother did not get such injections or was not taken to the emergency
    room if her mother failed to get the injections. One owes no duty to control the conduct
    of another, nor to warn those endangered by such conduct, unless there is a special
    relationship. (Zelig v. County of Los Angeles (2002) 
    27 Cal. 4th 1112
    , 1129.) This rule
    derives from the common law’s distinction between misfeasance and nonfeasance, and its
    reluctance to impose liability for nonfeasance. (Ibid.) Eskaton did not have a special
    relationship with the mother simply because she was a patient of Eskaton at one point.
    6
    (See Katona v. County of Los Angeles (1985) 
    172 Cal. App. 3d 53
    , 59 [where a mental
    health facility had unconditionally discharged the patient and did not continue to treat
    her, the facility was not responsible for her suicide six weeks later].)
    B
    Renwick Has Not Pled Facts Necessary To Establish
    An Abandonment Theory Of Elder Abuse As To Eskaton
    Renwick contends that regardless of whether she could meet the element of care or
    custody, she established that Eskaton abandoned her mother, which is sufficient to
    constitute elder abuse. She has not, however, because Renwick failed to plead facts
    establishing abandonment. A plaintiff must plead all “essential facts of . . . her case,”
    which are “those upon which liability depends.” (Prakashpalan v. Engstrom, Lipscomb
    & Lack (2014) 
    223 Cal. App. 4th 1105
    , 1120.)
    “[A]bandonment is defined as ‘the unilateral severance by the physician of the
    professional relationship between himself and the patient without reasonable notice at a
    time when there is still the necessity of continuing attention.” (James v. Board of Dental
    Examiners (1985) 
    172 Cal. App. 3d 1096
    , 1113.) Here, Renwick failed to allege in her
    complaint a lack of consent by either herself or her mother regarding her mother’s
    discharge from Eskaton. Thus, she has failed to allege that her mother’s discharge from
    Eskaton was unilateral. She also has failed to allege lack of reasonable notice. To the
    contrary, Renwick pled that an alternative provider, Sutter, was actually located to care
    for her mother and that Sutter or Kaiser had responsibility for her medical care during the
    relevant time frame.
    C
    Renwick Has Failed To Alleged Facts Establishing
    Malicious Or Reckless Conduct As To Eskaton
    Elder abuse requires that the defendant “denied or withheld goods or services
    necessary to meet the elder or dependent adult’s basic needs, either with knowledge that
    7
    injury was substantially certain . . . (if the plaintiff alleges oppression, fraud or malice) or
    with conscious disregard of the high probability of such injury (if the plaintiff alleges
    recklessness).” (Carter v. Prime Healthcare Paradise Valley 
    LLC, supra
    , 198
    Cal.App.4th at pp. 406-407.) Thus, “ ‘a plaintiff must demonstrate . . . that defendant is
    guilty of something more than negligence; he or she must show reckless, oppressive,
    fraudulent, or malicious conduct.’ ” (Smith v. Ben Bennett, Inc. (2005) 
    133 Cal. App. 4th 1507
    , 1518-1519.)
    Here, the only specific wrongful conduct that Renwick attributed to Eskaton was
    its failure to tell Renwick over a period of 12 days of the vital need for her to take her
    mother to the emergency room or any other facility to receive the life-preserving
    Lovenox injections. This conduct does not rise to the level of malice or recklessness for
    at least two reasons. One, there was no allegation that Renwick or her mother were
    unaware of the importance of Lovenox to the mother’s health or that if they were indeed
    unaware, Eskaton was aware of their lack of knowledge. Thus, it cannot be said Eskaton
    deliberately disregarded a high probability that the mother would be injured. And two,
    there was no allegation that Eskaton knew about the other factors that prevented the
    Lovenox injections here, namely, that Kaiser was not approving the referral to Sutter or
    that Sutter was not going to provide the injections.
    In sum, there were no allegations that Eskaton knew that the highly likely
    consequence of it failing to warn Renwick or her mother of the need for Lovenox would
    result in her mother’s injury, because there were other variables that led to this result and
    Renwick failed to allege Eskaton knew about and disregarded those factors. Renwick
    also has not stated she can amend its complaint to make these allegations.
    8
    D
    The Complaint Cannot Be Amended To State A Claim For Professional
    Negligence Because The One-Year Statute Of Limitations Has Expired
    “A problem that sometimes arises is when a plaintiff hoping to evade the
    restrictions of [Medical Injury Compensation Reform Act (MICRA)], will choose to
    assert intentional torts, ‘seemingly non-MICRA causes of action. Thus, when a cause of
    action is asserted against a health care provider on a legal theory other than medical
    malpractice, the courts must determine whether it is nevertheless based on the
    “professional negligence” of the health care provider so as to trigger MICRA.’ ” (Unruh-
    Haxton v. Regents of University of California (2008) 
    162 Cal. App. 4th 343
    , 353.)
    MICRA claims based on professional negligence of a health care provider have a more
    restrictive one-year statute of limitations that runs from when a plaintiff discovered or
    should have discovered the injury. (Code Civ. Proc., § 340.5.)
    Here, MICRA governed Renwick’s claims because the claims were for injury
    were (1) against a health care provider; and (2) based on professional negligence. (Code
    Civ. Proc., § 340.5, subds. (1), (2).)
    As to (1), the complaint alleged that Eskaton was a nursing home facility licensed
    by the California Department of Public Health. Such “[a] skilled nursing facility is a
    health care provider for purposes of section 340.5.” (Guardian North Bay, Inc. v.
    Superior Court (2001) 
    94 Cal. App. 4th 963
    , 974.)
    As to (2), the complaint alleged that the mother was injured because Eskaton
    failed to tell her or Renwick over a period of 12 days of the vital need for Renwick to
    take her mother to the emergency room or any other facility to receive the life-preserving
    Lovenox injections. The definition of professional negligence in the MICRA context is
    “a negligent act or omission to act by a health care provider in the rendering of
    professional services, which act or omission is the proximate cause of a personal injury or
    wrongful death, provided that the services are within the scope of services for which the
    9
    provider is licensed and which are not within any restriction imposed by the licensing
    agency or licensed hospital.” (Code. Civ. Proc., § 340.5, subd. (2).) A warning about the
    need for life-saving medication is both medical advice and a determination of the
    appropriate level of care needed for the patient. (See Cal. Code of Regs., tit. 22,
    §§ 72301, subd. (a), 72303, subds. (a), (b)(4) [patients at a skilled nursing facility shall
    be under a doctor’s care and be provided physician’s services, which includes advice,
    treatment, and a determination of the appropriate level of care needed].)
    As MICRA applied here, Renwick had until approximately May 28, 2012, to file
    her complaint. That is because her mother died on May 28, 2011, and prior to that,
    Renwick should have at least suspected her mother’s injury was caused by wrongdoing,
    in that she made daily telephone calls to Kaiser, Sutter, and Eskaton when no nurse
    showed up at her mother’s house. Accordingly, any claim by Renwick based on
    professional negligence would be time-barred by MICRA’s one-year statute of
    limitations (Code Civ. Proc., § 340.5), as Renwick filed her complaint on May 23, 2013.
    II
    The Trial Court Properly Sustained Sutter’s Demurrer Without Leave To Amend
    Renwick contends the trial court erred in sustaining Sutter’s demurrer with respect
    to her elder abuse claim and her wrongful death claim (on which her elder abuse claim is
    based) because Sutter had a duty of care for her mother, imposed under statute, its own
    procedures and the facts here, as soon as it received the referral from Eskaton. The trial
    court ruled Renwick did not “plead with particularity that an officer, director, or
    managing agent authorized or ratified Sutter’s failure to send a nurse or refer to another
    facility.”
    As we explain, the trial court was correct in sustaining the demurrer without leave
    to amend for at least three reasons. One, the mother was not in Sutter’s care or custody
    when she was injured. Two, Renwick failed to allege facts establishing malicious or
    reckless conduct. And three, Renwick failed to allege facts establishing that an officer,
    10
    director, or manager of Sutter authorized or ratified any reckless neglect, which is
    required for Renwick’s request in her complaint for heightened remedies against Sutter.
    A
    The Mother Was Not In Sutter’s Custody Or Care When She Was Injured
    Renwick contends Sutter had a duty of care for her mother, imposed by statute, its
    own procedures and the facts here, as soon as it received the referral from Eskaton. We
    take each contention in turn, finding merit in none.
    As to the statute, Renwick’s position is that an administrative regulation relating to
    the implementation of internal procedures to handle medical emergencies created a duty
    of care here. Not so. The regulation is as follows: home health care providers are
    required to “establish[] and implement[]” administrative written policies and procedures
    that include “[a] plan to handle medical emergencies.” (Cal. Code Regs., tit. 22, § 74721,
    subd. (c)(1).)   The totality of Renwick’s argument on this point is “[t]his statute, at least,
    created a duty of care that required the implementation of emergency procedures in this
    present case to ensure that the vital, life-preserving injections of Lovenox were
    administered by someone to [her mother].” Renwick cites no authority for the
    proposition that this statute created a duty in Sutter to care for her mother simply because
    the statute required written policies and procedures that include a plan to deal with
    medical emergencies. This statute simply does not address the fundamental question of
    whether Sutter had care or custody or even a duty of care for the mother.
    As to Sutter’s own procedures and the facts here, Renwick alleged Sutter had its
    own admission criteria and policy process that required it to perform the initial
    assessment within 48 hours of the referral, and if that time frame could not met, Sutter
    was required to inform the patient’s physician, the referral source, and the patient for
    approval of the delay. If approval was not obtained, Sutter was required to refer the
    11
    patient to another agency for services. No “staff” at Sutter did any of this. Renwick also
    alleged that “according to the California Department of Health [i]nvestigation, the
    referral was accepted by [Sutter], contingent on insurance authorization.” The problem
    here, of course, is that the contingency was never met because by Renwick’s own
    allegation, it was “Kaiser [that] violated its duty to approve or disapprove the request [of]
    in home care by Sutter . . . including the necessary post-stabilization medical care which
    included the life preserving Loven[o]x injections.”
    B
    Renwick Has Failed To Allege Facts
    Establishing Malicious Or Reckless Conduct On Sutter’s Part
    As we have noted, the elder abuse alleged here required that the defendant “denied
    or withheld goods or services necessary to meet the elder or dependent adult’s basic
    needs, either with knowledge that injury was substantially certain . . . (if the plaintiff
    alleges oppression, fraud or malice) or with conscious disregard of the high probability of
    such injury (if the plaintiff alleges recklessness).” (Carter v. Prime Healthcare Paradise
    Valley 
    LLC, supra
    , 198 Cal.App.4th at pp. 406-407.) Thus, “ ‘a plaintiff must
    demonstrate . . . that defendant is guilty of something more than negligence; he or she
    must show reckless, oppressive, fraudulent, or malicious conduct.’ ” (Smith v. Ben
    Bennett, Inc. (2005) 
    133 Cal. App. 4th 1507
    , 1518-1519.)
    Renwick makes only one claim with respect to recklessness. She asserts that with
    respect to Sutter failing to comply with the statutory requirement to implement
    emergency procedures to ensure the mother was administered Lovenox, Sutter
    “recklessly neglected this duty of care.” Renwick pled no facts to demonstrate
    recklessness, rather simply asserting the conduct was reckless, which was insufficient to
    survive sustaining Sutter’s demurrer. (See Carter v. Prime Healthcare Paradise Valley
    12
    
    LLC, supra
    , 198 Cal.App.4th at p. 410 [to avoid the sustaining of a demurrer for an elder
    abuse cause of action, a plaintiff must plead facts that show the conduct was reckless, not
    simply assert that it was reckless]; Moore v. Regents of University of 
    California, supra
    ,
    51 Cal.3d at p. 125 [when we review a ruling on a demurrer, we do not assume the truth
    of conclusions of fact or law, such as those contained in a plaintiff’s pleadings].)
    C
    Renwick Was Required To Allege Facts In The Complaint That
    An Officer, Director, Or Manager Of Sutter Authorized Or Ratified
    Any Alleged Reckless Neglect For Punitive Damages Liability Against Sutter
    The real crux of the dispute at the trial court and here on appeal with regard to
    Renwick’s claims against Sutter was and is whether Renwick alleged facts sufficient to
    establish she was entitled to heightened remedies against Sutter. Specifically, the trial
    court did not reach the issue of whether Sutter had care or custody of the mother because
    it ruled that Renwick failed to plead with particularity that an officer, director, or
    managing agent authorized or ratified Sutter’s failure to send a nurse or refer her to
    another facility.
    This language comes from Renwick’s request in her complaint for heightened
    remedies against Sutter under a statute imposing employer liability upon the acts of an
    employee if the employer “authorized or ratified the wrongful conduct.” (Civ. Code,
    § 3294, subd. (b); see Welf. & Inst. Code, § 15657, subd. (c).) “With respect to a
    corporate employer, the . . . conscious disregard, authorization, ratification or act of
    oppression, fraud, or malice must be on the part of an officer, director, or managing agent
    of the corporation.” (Civ. Code, § 3294, subd. (b).) Renwick’s complaint did not plead
    any managerial conduct or managerial authorization of the alleged reckless act of Sutter,
    namely, Sutter’s failure to comply with the statutory requirement to implement
    13
    emergency procedures to ensure the mother was administered Lovenox. According to
    Renwick, however, these “facts need only be proven at trial, not pled” and in any event,
    “[m]anagerial conduct is implied by the facts alleged in the present case.” (Bold text
    omitted.) Not so as to either.
    As to whether the facts establishing managerial conduct or managerial
    authorization of the alleged reckless act must be pled in the complaint, they must. The
    elder abuse statute embodies the necessity of pleading the elemental facts prior to proving
    them with sworn evidence. Specifically, the California Supreme Court had held that “[i]n
    order to obtain the [Elder Abuse] Act’s heightened remedies, a plaintiff must allege
    conduct essentially equivalent to conduct that would support recovery of punitive
    damages. (Compare Welf. & Inst. Code, § 15657 [requiring ‘clear and convincing
    evidence that a defendant is liable for’ elder abuse and ‘has been guilty of recklessness,
    oppression, fraud, or malice in the commission of the abuse’] with Civ. Code, § 3294,
    subd. (a) [requiring ‘clear and convincing evidence’ that the defendant has been guilty of
    oppression, fraud, or malice].)” (Covenant Care, Inc. v. Superior Court (2004) 
    32 Cal. 4th 771
    , 789, italics added.) Moreover, the punitive damages statute itself, although
    expressly referring only to “prov[ing]” facts (Civ. Code, § 3294, subd. (a)) requires a
    plaintiff also to plead in the complaint facts establishing an employer’s liability for the
    conduct of its employees. (College Hospital Inc. v. Superior Court (1994) 
    8 Cal. 4th 704
    ,
    721-722.) Specifically, in that case involving punitive damage allegations under the
    punitive damages statute itself, the California Supreme Court “independently review[ed]
    the proposed amended complaint and the evidence submitted in support of and in
    14
    opposition to the motion [to strike] to determine whether plaintiffs have stated and
    substantiated a legally sufficient punitive damages claim against the Hospital.”1 (Ibid.)
    Here, Renwick not only failed to plead facts establishing managerial ratification of
    the failure to establish emergency medical procedures, she also failed to establish that
    such facts were implied in the complaint. The allegations in the complaint actually
    indicate the opposite, i.e., that Sutter management did establish procedures to be followed
    where there was a delay in getting access to a referred patient, but there was a question as
    to whether Sutter employees followed the internal procedure. Specifically, the complaint
    alleged that Sutter had its own admission criteria and policy process that required it to
    perform the initial assessment within 48 hours of the referral, and if that time frame could
    not met, Sutter was required to inform the patient’s physician, the referral source, and the
    patient for approval of the delay. If approval was not obtained, Sutter was required to
    refer the patient to another agency for services. No “staff” at Sutter did any of this.
    Moreover, regarding Sutter’s failure to take action upon Eskaton’s faxing of referral
    papers, while this arguably may have constituted negligence by a Sutter staff member
    tasked with reviewing such papers, this error is not the same thing as managerial
    authorization to disregard a medical emergency under Sutter’s control. Simply put, there
    is no allegation or implication in the complaint that any officer, director, or manager at
    Sutter knew of the potential danger to the mother and ignored it. Renwick has not stated
    she can amend her complaint to make these allegations (or the others that we have
    identified as deficient).
    1      In that case, because punitive damages allegations did not constitute a cause of
    action, they were instead tested by a motion to strike, rather than a demurrer. (Grieves v.
    Superior Court (1984) 
    157 Cal. App. 3d 159
    , 164.)
    15
    DISPOSITION
    The judgment is affirmed. Eskaton and Sutter shall recover their costs on appeal.
    (Cal. Rules of Court, rule 8.278(a)(1).)
    /s/
    Robie, J.
    We concur:
    /s/
    Blease, Acting P. J.
    /s/
    Hull, J.
    16