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Simmons: No Bright-Line Rule as to Future Medical Specials?

Published on: June 25, 2021

The difference between the amount charged and the amount paid for medical treatment can be substantial. Knowing the dollar amount of the medical specials that a plaintiff will be allowed to seek at trial is often critical in case evaluation and resolution. In this context, the Louisiana Supreme Court provided a “bright-line” rule in Bozeman v. State, 03-1016 (La. 7/2/04), 879 So. 2d 692, that a plaintiff can only seek the amount actually paid for medical treatment, when it is funded by Medicaid. Our state’s highest court then added, in Simmons v. Cornerstone Investments, LLC, 18-0735 (La. 5/8/19), 282 So.3d 199, that only the amount actually paid for medical specials may be sought, when it is funded by workers’ compensation insurance. The “written off” amount is considered a “phantom charge” that the plaintiff will never pay. Some questions remain as to how courts will apply the holding and analysis of Simmons.

The rationale behind Simmons is that any discount in the amount of medical expenses given to the workers’ compensation carrier does not constitute a “collateral source” because the plaintiff did not give anything in exchange for the discount. Roughly six months after Simmons, the Louisiana First Circuit Court of Appeal reversed the trial court’s denial of the defendants’ motion in limine seeking to exclude evidence of the plaintiff’s total past medical expenses. Love v. Nelson, 2020-1050 (La.App. 1 Cir. 1/13/21), 2021 WL 118936, *1. Relying solely upon Simmons, the appellate court stated, “[T]he amount of medical expenses charged above the amount actually incurred is not a collateral source … . Accordingly, we find the trial court abused its discretion, and the motion in limine is granted and evidence of medical expenses not actually owed and paid by or on behalf of plaintiff … is excluded from evidence at the trial.” Id.

Federal courts, relying upon Simmons, have held that the collateral source rule does not apply to third-party-funded past medical expenses. See Collins v. Benton, Civ. A. No. 18-7465, 2021 WL 638116, *5, 8 (E.D. La. Feb. 17, 2021). However, see Lee v. United Rentals, Inc., Civ. A. No. 18-977, 2021 WL 2184763, *3 (M.D. La. May 28, 2021), where the court granted the defendant’s motion in limine to exclude evidence of the plaintiff’s past medical expenses not paid by workers’ compensation. Only the amounts paid by the employer/workers’ compensation carrier would be presented to the jury in support of the plaintiff’s past medical expenses. The court then added:

“However, there are two matters left in contention: first, may the Plaintiff offer evidence of the amounts charged by Plaintiff’s providers in connection with his back injury which [the employer] refused to pay? Second, may Plaintiff present evidence of the market rate for Plaintiff’s future medical needs or is he relegated to the amounts set out in the Workers’ Compensation Fee Schedule? As to both items, Simmons is not controlling.”

In other words, the federal court in Lee found that Simmons applied only to past medical expenses, but it did not apply to future medical expenses (i.e., the plaintiff would be allowed to present the full amount of anticipated future medical charges to the jury). As a federal court sitting in diversity, the Lee court applied the law of the state. Erie R. Co. v. Tompkins, 304 U.S. 64, 78, 58 S.Ct. 817, 82 L.Ed. 1188 (1938). The findings in Lee may be correct, but, until it is definitively resolved by legislative act or by the Louisiana Supreme Court, parties will likely continue to debate what impact the reasoning of Simmons will have as to future medical charges past the date of trial. If, as held in Lee, the reduced workers’ compensation rate is irrelevant to future medical specials, then plaintiffs will seek the full future medical charges. This blog does not address the potential impact of the “Civil Justice Reform Act of 2020” which can reduce a plaintiff’s ability seek full medical charges for cases arising after January 1, 2021 in some circumstances.

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Court Addresses the Reach of the Louisiana Health Emergency Powers Act’s Immunity Provision for Claims Against Health Care Providers

The Louisiana Health Emergency Powers Act (LHEPA), La. R.S. 29:760 et seq, was enacted in 2003 to allow the government to use extraordinary powers in order to respond to potential or actual public health emergencies. Historically, claims against medical providers have been governed by a negligence standard, which requires a plaintiff to prove the provider failed to act with reasonable care. However, La. R.S. 29:771(2)(c), which was enacted as part of the LHEPA, provides what has been described as a limited or quasi-immunity for health care providers:

During a state of public health emergency, any health care providers shall not be civilly liable for causing the death of, or injury to, any person or damage to any property except in the event of gross negligence or willful misconduct.

This provision imposes a heightened standard of gross negligence or willful misconduct for claims against health care providers and their employees. “Gross negligence” has been defined as “the entire absence of care and the utter disregard of the dictates of prudence, amounting to complete neglect of the rights of others.”* Therefore, absent a showing of gross negligence or willful misconduct, the provision provides immunity from civil liability for all claims against all health care providers.

The reach and application of this heightened standard of gross negligence under the LHEPA has been the subject of recent rulings from Louisiana courts. In Lejeune v. Steck, which was decided before COVID-19 in connection with a public health emergency declared following Hurricane Katrina, the Louisiana Fifth Circuit Court of Appeals ruled that the LHEPA’s heightened standard applied to all medical providers in the state while the state was in a public health emergency.^

In Lejeune, a doctor left a sponge in a patient during a surgery. The plaintiff argued that a general negligence standard should apply because the surgery occurred outside the Hurricane Katrina emergency area. However, the Court found that the plaintiff must prove gross negligence or willful misconduct because the LHEPA “does not provide for a limited set of health care providers, nor does it limit its application to only those medical personnel rendering emergency assistance voluntarily due to the emergency in the area.” Thus, the Court ruled the LHEPA was broad reaching and covered all health care providers in all areas of Louisiana during the public health emergency.

More recently, Governor Edwards invoked the LHEPA on March 11, 2020 in response to COVID-19. In line with the all-inclusive application seen in Lejeune, the Louisiana Second Circuit Court of Appeals recently held that the LHEPA applied to all claims against health care providers that arose during the public health emergency declared for COVID-19.

In Lathon v. Leslie Lakes Ret. Ctr., the Second Circuit applied the LHEPA to a premises liability claim.^^ The plaintiff slipped and fell in a puddle at Leslie Lakes Retirement Center. The accident occurred during the declared public health emergency. The retirement center filed a motion for summary judgment and argued that because it qualified as a health care provider, the gross negligence standard set forth in the LHEPA should apply to the plaintiff’s claim.

The court agreed and found that the statute dictated that immunity applied in favor of any healthcare provider for any personal injury or property damage claim as long as it arose during a public health emergency. In so holding, the Court stated that the purpose of the LHEPA was to alleviate the liability burden on healthcare providers during public health emergencies. Therefore, the Court found its ruling aligned with the purpose of the act. The Lathon decision is significant because it applied the LHEPA’s statutory immunity to personal injury claims against healthcare providers outside of a medical malpractice setting.

At least one justice on the Louisiana Supreme Court voiced a desire to address the constitutionality of this statutory immunity provision. However, the Court ultimately declined to review the Second Circuit’s ruling. Therefore, under Lathon, it appears the statutory immunity granted under the LHEPA applies to any claim brought against any healthcare provider for acts that occur during a public health emergency. While it remains to be seen how courts will address this issue in the future, these decisions show the reach and application of the LHEPA continue to evolve.

References:
*Ambrose v. New Orleans Police Dep't Ambulance Serv., 93-3099 (La. 7/5/94), 639 So. 2d 216.

^Lejeune v. Steck, 13-1017 (La. App. 5 Cir. 5/21/14), 138 So. 3d 1280, writ denied sub nom. Daigle v. Steck, 2014-1408 (La. 10/3/14), 149 So. 3d 800.

^^Lathon v. Leslie Lakes Ret. Ctr., 54,479 (La.App. 2 Cir. 9/21/22); 348 So.3d 888, writ denied, 2022-01566 (La. 12/20/22); 352 So.3d 80.

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Louisiana Supreme Court Now Allows Direct Negligence Claims Against Employer

In a previous blog, we outlined developing law in the Louisiana appeals courts, and federal district courts in Louisiana on the issue of whether a claimant may maintain a separate cause of action against an employer for independent negligence when it is stipulated that the employee was in the course and scope of employment.1 Most courts held a claimant could not maintain a separate action against the employer under these circumstances, reasoning that the employee’s fault would impute to the employer, and therefore, additional inquiry was not appropriate. However, the Louisiana Supreme Court recently addressed the issue and stated:

“(A) plaintiff may pursue both a negligence cause of action against an employee for which the employer is vicariously liable and a direct claim against the employer for its own negligence in hiring, supervision, training, and retention as well as a negligent entrustment claim, when the employer stipulates that the employee was in the course and scope of employment at the time of the injury.” (Emphasis added) See Martin v. Thomas et al., 21-1490 (La. 12/21/21), 328 So. 3d 1164.

This holding notably overturned the 1st Circuit Court of Appeal ruling in Elee v. White, - - So.3d - - (La. App. 1 Cir 7/24/20), 2020 WL 4251974 and other Louisiana 5th Circuit Court of Appeals decisions. The Supreme Court in Martin reasoned that “the initial assessment of fault required by the law is not bypassed due to the employer-employee relationship” and “shielding a potential tortfeasor from liability is not compatible with a comparative negligence regime.” The Court further stated that the possibility that both the employee and employer may be at fault is not “subsumed” by the employer’s admission on course and scope. In fact, if the fault of the employee is shown, then the issue of whether there is also fault on the part of the employer remains and must be decided by the evidence on a case-by-case basis.

The consequences of this decision remain to be seen, but it is expected that claimants may also pursue employers separately on theories such as negligent hiring, supervision, and entrustment. The scope of such discovery will remain within the sound discretion of the trial judge.

By: John P. Wolff, III and Richard W. Wolff

1Louisiana Appeal Courts Prohibit Direct Negligence Claims Against Employer; US District Court Uses Rule to Limit Discovery - Keogh Cox

Insight

Sentencing Juveniles in Louisiana after Miller v. Alabama

The Louisiana Supreme Court recently held that a district court must reconsider a case involving a seventeen year old who was sentenced to life in prison without the possibility of parole for second degree murder under a mandated penalty provision of a statute. See State of Louisiana v. Darrius R. Williams, 12-1723 (La. 03/08/13), --So.3d---. The defendant's application for review to the Louisiana Supreme Court was pending when, Miller v. Alabama, 567 U.S. ___, 132 S.Ct. 2455, 183 L.Ed.2d 407 (2012), was decided by the United States Supreme Court.

In Miller, the United States Supreme Court found that "the Eighth Amendment forbids a sentencing scheme that mandates life in prison without possibility of parole for juvenile offenders." The Miller Court additionally stated that "[a]lthough we do not foreclose a sentencer's ability to make that judgment in homicide cases, we require it to take into account how children are different, and how those differences counsel against irrevocably sentencing them to a lifetime in prison." Miller, 567 U.S. at ____, 132 S. Ct. at 2469.

The Williams Court found that "the Miller court did not establish a categorical prohibition against life without parole for juveniles" in homicide cases but did establish the requirement "that a sentencing court consider an offender's youth, and attendant characteristics as mitigating circumstances before deciding to impose" a life sentence without the possibility of parole on a juvenile." The requirement to consider the age and attendant characteristics of juveniles as mitigating circumstances before sentencing is the Williams Court's interpretation of Miller's mandate that the sentencer "take into account how children are different, and how those differences counsel against irrevocably sentencing them to a lifetime in prison." Id.

On remand, the district court is to reconsider the sentence of a juvenile to life in prison without the possibility of parole "after conducting a new sentencing hearing in accordance with the principles enunciated in Miller v. Alabama." State v. Williams, (La. 03/08/13), -- So.3d at ---.

Catherine S. Giering

Partner
Louisiana Supreme Court
Medical
Workers' Compensation