Category: Daily News

On 9/1/2022 Sonia Arteaga filed an Application for Adjudication of Claim alleging injury, while employed by Starcrest Products of California, to hernia, excretory system, back, shoulders and multiple parts during the period of 6/7/2021 through 6/7/2022.

Arteaga began treating with Dr. Haghighinia, of Medland Medical, on 10/07/2022. The initial Request for Authorization was sent by Medland to Defendant, Zenith Insurance on 10/24/2022. Zenith did send notice of the intent to defer Utilization Review on a basis other than medical necessity to Medland on 10/24/2022.

Zenith denied the claim on 11/29/2022. Nonetheless Sonia Arteaga continued to treat with Medland subsequent to the denial.

On 10/12/2023 the case settled by Compromise and Release for for $35,000, with the Order Approving Compromise and Release.

A Notice and Request for Allowance of Lien was filed by Medland on 11/9/2023, followed by a Declaration of Readiness on 11/17/2023. The matter came before the WCJ for a lien trial on 5/1/2024. The matter was submitted on 5/1/2024 and a Findings and Order issued on 6/28/2024.

Among the findings, the WCJ found that Arteaga sustained injury AOE/COE, Zenith did not retain medical control through the MPN during the delay period, Zenith was liable for the Med-Legal services performed by Medland on 2/22/2023 and Zenith was permitted to conduct retrospective UR regarding dates of service 10/07/2022 through 8/28/2023 (excluding date of service 2/22/2023).

Medland filed a Petition for Reconsideration disputing only the finding that Defendant is permitted to conduct retrospective UR regarding dates of service 10/07/2022 through 8/28/2023 (excluding date of service 2/22/2023).

The WCAB panel denied reconsideration in the case of Arteaga v Starcrest Products of California -ADJ16637235 (October 2024)

In its Petition for Reconsideration the Lien claimant contends that the WCJ erred in deferring the issue of the medical treatment lien pending retrospective utilization review. Lien claimant argues that defendant waived its ability to conduct retrospective utilization review by not timely responding to each request for authorization.

California Code of Regulation §9792.9.1(b) governs the deferral of Utilization Review when there are threshold disputes other than medical necessity. CCR §9792.9.1(b)(1) indicates that “a written decision deferring utilization review of the requested treatment unless the requesting physician has been previously notified under this subdivision of a dispute over liability..”

Defendant did issue an Utilization Review deferral notice to the initial Request for Authorization from Medland dated 10/24/2022. That notice dated 10/24/2022 was timely issued (within five business days of the date of the Request for Authorization). At the time of all subsequent Requests for Authorization, Medland was already on notice that Defendant was disputing their request for treatment of the Applicant due to a threshold issue other than medical necessity.

In his report, the WCJ agreed with the rational in the panel case of Ghattas v. O’Reilly Auto Parts, Safety Nat’l Cas. Co., 2018 Cal. Wrk. Comp. P.D. LEXIS 86, which notes that Defendant is not required to submit Requests for Authorization to Utilization Review following a timely denial of the case.

The WCAB panel concluded by saying “Here, the WCJ correctly determined that defendant was entitled to retrospective utilization review. The WCJ found that the defendant responded to lien claimant’s first request for authorization with a timely and proper notice to defer utilization review on a basis other than medical necessity.”

“As noted above, Administrative Rule 9792.9.1(b)(1) exempts the defendant from having to issue subsequent delay notices to subsequent requests for authorization if ‘the requesting physician has been previously notified under this subdivision of a dispute over liability and an explanation for the deferral of utilization review for a specific course of treatment.’ Since defendant timely and properly advised the lien claimant of the liability dispute in response to the first request for authorization, it did not have an obligation to issue any subsequent delay notices.”

The #MeToo movement highlighted concerns that compelled arbitration of sexual harassment claims can perpetuate unacceptable behavior and minimize its consequences by diverting such claims from public court proceedings into a private forum. In response, Congress enacted the Ending Forced Arbitration of Sexual Assault and Sexual Harassment Act of 2021 (EFAA; 9 U.S.C. §§ 401-402).

As codified, the EFAA amended the Federal Arbitration Act (FAA; § 1 et seq.), and was placed within the FAA’s other provisions. Section 402, added by the EFAA, states, “Notwithstanding any other provision of [the FAA], at the election of the person alleging conduct constituting a sexual harassment dispute . . . , no predispute arbitration agreement or predispute joint-action waiver shall be valid or enforceable with respect to a case which is filed under Federal, Tribal, or State law and relates to the . . . sexual harassment dispute.” (§ 402(a).)

Yongtong “Jade” Liu sued Miniso Depot CA, Inc., USA Miniso Depot, Inc., Lin Li and unnamed Doe defendants on October 5, 2023. Liu alleged that Li was the chief executive officer of the Miniso entities. According to Liu, Miniso owns and operates retail stores which sell “goods such as toys, collectables, stationary, cosmetics, and household items.”

Liu alleged she was hired by Miniso in around April 2021 as a human resources administrator, and was paid an hourly wage. In around January 2022, Miniso changed Liu’s job title and, although her duties “remained generally the same,” she was classified as exempt from various wage and hour requirements imposed by the Labor Code, Industrial Welfare Commission Wage Orders, and regulations. Liu alleged that Miniso misclassified her as an exempt employee, and as a result improperly failed to pay her for all the hours she worked, to pay her the minimum wage, to pay the required rates for overtime, and to provide her with appropriate rest and meal breaks and with accurate wage statements.

Liu, who alleges she “identifies as lesbian and dresses in a unisex non-gender specific style,” further asserted that during her employment “[she] and others in her presence were subjected to unwelcome, severe and pervasive sexual harassment, sex discrimination and race discrimination, sexual orientation/gender harassment and sexual harassment/gender discrimination.”

Liu alleged the following specific incidents and types of offensive conduct: Li and others at Miniso commented on Liu’s appearance during company meetings; Li twice suggested during meetings that if Miniso’s products looked like Liu then no one would purchase them; Li remarked that Liu was unattractive because she was “too skinny” and that she needed to eat more to have more curves. and would comment that “a man should do what a man should do, and a woman should do what a woman should do.”

Liu also alleged that Miniso asked her, in her position in human resources, to participate in practices which she considered to be illegal, including failing to pay female employees “equally or comparably to male counterparts,” “hir[ing] only young Korean employees,” and falsifying “immigration-related documents” to facilitate Miniso hiring Chinese individuals who could not legally work in the United States. Liu alleged she complained about these practices to Li and others and refused to comply. Liu alleged that after she refused to participate in various practices she believed were illegal, she faced increased harassment and discrimination.

Based on these allegations, Liu asserted the following claims: violation of various wage and hour requirements set forth in the Labor Code and California Code of Regulations, title 8, section 11040; sexual harassment in violation of the Fair Employment and Housing Act (FEHA; Gov. Code, § 12900 et seq.); sex discrimination in violation of the FEHA; sexual orientation/gender identity harassment in violation of the FEHA; sexual orientation/gender identity discrimination in violation of the FEHA; retaliation for complaining about unlawful activities in violation of Labor Code section 1102.5; retaliation for refusing to participate in unlawful activities in violation of Labor Code section 1102.5; constructive termination in violation of public policy; and intentional infliction of emotional distress. Liu sought compensatory damages, statutory penalties, punitive damages, injunctive relief, and attorney’s fees.

On January 31, 2024, Miniso filed a motion to compel arbitration of all of Liu’s claims under the Federal Arbitration Act. Miniso argued that, under the terms of the arbitration agreement, “Liu must arbitrate her entire [c]omplaint, because it consists solely of Labor Code counts, FEHA claims, and employment and other torts, all of which arise in connection with Liu’s employment with Miniso.” Miniso contended that the EFAA did not apply because Liu’s allegations of sexual harassment failed to state a claim for harassment and, thus, her complaint effectively had no harassment claim. In particular, Miniso argued that Liu’s complaint concerned “mere annoying, offensive, and stray remarks,” which could not state a viable harassment claim under the FEHA.

The trial court denied Miniso’s motion to compel arbitration in the published case of Liu v. Miniso Depot CA, Inc. – B338090 (October 2024)

Miniso’s sole appellate contention is that the trial court erred in concluding the parties’ arbitration agreement was unenforceable as to all of Liu’s claims, and not just as to the two harassment claims. In other words, Miniso contends the trial court should have compelled Liu to arbitrate all of her claims except for the two harassment claims.

“We disagree. Under the EFAA, when a plaintiff’s lawsuit contains at least one claim that fits within the scope of the act, the arbitration agreement is unenforceable as to all claims asserted in the lawsuit.”

“We agree with our colleagues in Division Three of this appellate district, who recently concluded in Doe v. Second Street Corp. (Sept. 30, 2024, B330281) ___ Cal.App.5th ___ [2024 WL 4350420] that the plain language of the EFAA exempts a plaintiff’s entire case from arbitration where the plaintiff asserts at least one sexual harassment claim subject to the act. Here, at least one of Liu’s claims is subject to the EFAA, and thus the trial court did not err in refusing to compel Liu to arbitrate any of her claims.”

In 2022, Congress amended the Federal Arbitration Act (FAA) by passing the Ending Forced Arbitration of Sexual Assault and Sexual Harassment Act (EFAA) (9 U.S.C. §§ 401- 402). In general terms, the EFAA renders arbitration agreements unenforceable at the plaintiff’s election in sexual assault and sexual harassment cases that arise or accrue on or after March 3, 2022, the EFAA’s effective date.

In October 2021, the Second Street Corporation dba The Huntley Hotel hired Jane Doe’s (fictitiously named plaintiff) co-worker Rivani as its food and beverage director. During Rivani’s training, plaintiff’s manager told Rivani that Jackson had sexually assaulted Jane Doe and should not be scheduled with her unless it was absolutely necessary.

The following month, Rivani called Jane Doe into his office and asked for details of the assault. Jane Doe said she did not feel comfortable describing it, but Rivani said he would schedule Doe and Jackson together unless she did. After Jane Doe described the assault, Rivani told her it was her fault.

The following day, Rivani scheduled Doe and Jackson to work on the same shift, and after that, Doe and Jackson were regularly scheduled to work together. Jane Doe began throwing up before nearly every shift. In February 2022, Raman told Doe’s general manager that Doe and Jackson had a consensual sexual relationship.

In April 2022, Jane Doe ran into Jackson when she arrived for her shift. She ran up to the stairwell and tried to access the roof, but the exit code to the roof access door had been changed. Doe was relieved because she had thoughts of jumping off the roof. When she came down the stairs, Rivani saw that she was crying and asked, “Is this work related?” Rivani then “looked her up and down and . . . walked away.”

In early May 2022, when Rivani saw Jane Doe, he loudly asked another employee, “[W]hat [is] the new code to the roof?” Doe began to have another panic attack and called in sick.

Several days later, Jane Doe reported to her medical provider that she was suicidal, and she was placed on an involuntary psychiatric hold pursuant to Welfare and Institutions Code section 5150. On the advice of her doctors, plaintiff has not returned to work since May 10, 2022.

Jane Doe filed the present case against Second Street Corporation dba The Huntley Hotel and two of its supervisors in 2023. The operative complaint alleges a pattern of sexual harassment and discrimination both before and after the Ending Forced Arbitration of Sexual Assault and Sexual Harassment Act’s effective date, as well as a variety of wage-and-hour violations.

Defendants moved to compel arbitration, citing an arbitration provision in the hotel’s employee handbook. The trial court denied the motion to compel, concluding that the EFAA rendered the arbitration provision unenforceable as to all of plaintiff’s claims. The trial court also granted plaintiff leave to file a first amended complaint adding additional claims, including a claim for constructive wrongful termination.

The California Court of Appeal affirmed the trial court in the published case of Doe v Second Street Corporation -B330281 (Sept 2024).

The hotel contends that where, as here, a plaintiff alleges sexually harassing conduct that occurred both before and after the EFAA’s effective date, the case should be sent to arbitration if the plaintiff’s claims accrued, or the “crux” of the alleged wrongful conduct occurred, before the EFAA’s effective date.

The parties agreed that no California case has addressed when a sexual harassment claim “accrues” under the EFAA where, as here, a plaintiff alleges sexually harassing conduct

“By its terms, the EFAA applies “with respect to any dispute or claim that arises or accrues on or after the date of enactment of this Act” i.e., March 3, 2022. Courts have interpreted this occurring both before and after the EFAA’s enactment.

“We affirm the trial court’s order in its entirety. We conclude that the trial court properly found that under the EFAA’s plain language, (1) plaintiff’s sexual harassment claims alleging continuing violations both before and after the EFAA’s effective date are exempt from mandatory arbitration, and (2) plaintiff’s other causes of action are also exempt from mandatory arbitration under the EFAA because they are part of the same “case.” Accordingly, the trial court properly denied defendants’ motion to compel arbitration.”

“We further conclude that the trial court did not abuse its discretion by permitting plaintiff to file a first amended complaint.”

The California attorney general filed a lawsuit against AHMC Healthcare on Oct. 2, claiming the Alhambra-based health system’s service reductions at one Bay Area hospital and closure of another facility violate conditions set by the state when it acquired the facilities in 2020.

The lawsuit alleges that the closure of Seton Medical Center Coastside in Moss Beach and failure to maintain stroke center certification at Seton Medical Center in Daly City breach the terms of the purchase agreement.

In the lawsuit, filed in San Mateo County, the Attorney General alleges that AHMC Seton Medical Center, LLC  violated the Attorney General’s July 27, 2020 conditions by closing Seton Coastside in its entirety. The Attorney General is seeking specific performance and civil penalties. Additionally, the injunctive relief the Attorney General is seeking is crucial to the reopening of the Seton Coastside facilities and the restoration of services at Seton.

“The conditions that were set forth with AHMC were specifically implemented to protect patients, ensure continued access to critical healthcare services, and safeguard the community’s health and well-being,” said the Attorney General. “Unfortunately, AHMC clearly has not upheld its obligations. This failure to meet the required standards is completely unacceptable, and I’m holding them fully accountable for placing patient care and public health at risk.”

Under California law, any transaction involving the sale or transfer of control of a healthcare facility owned by a nonprofit corporation must secure the approval of, or waiver of notice and consent of, the Attorney General.

The Attorney General’s July 27, 2020, conditions required the continuation of services, including emergency departments (ED) at both hospitals, a stroke center certification, STEMI receiving center designation, general acute care hospital (GACH) and the skilled nursing facilities (SNF), among others.

AHMC has permitted the stroke certification and STEMI designation to lapse at Seton Medical Center and has closed the SNF, GACH, and ED at Seton Coastside since April 2024, without notifying nor seeking an amendment of the conditions from the Attorney General.

These reductions in services have negative consequences for the community including requiring people to travel farther for care, increasing volumes of patients at neighboring hospitals that offer those services, and escalating rates for services at those competing hospitals.

In a statement to Becker’s Hospital Review, the health system said it was “surprised” by the lawsuit, calling the attorney general’s claims “misleading” and emphasizing its intention to reopen the facility once structural repairs are complete. It also said the temporary closure was required by regulators and that the state’s health department approved the closure.

“The AG is under the false impression that Seton Coastside could open its doors once the roof replacement was completed earlier this fall,” AHMC said. “Not so. Even after the roof was replaced, the building was still unsafe for human occupancy, and there was no safe option to occupy the building when the other emergency repairs were still required. We believe the claims made by the AG’s office that Seton was merely engaged in cosmetic upgrades and deferred maintenance are false and misleading.

“We have been diligently addressing these matters and undertaking the repairs necessary to reopen the Seton Coastside Emergency Department and SNF and to otherwise comply with the AG’s conditions. We have also been cooperating with the AG office’s investigation into these issues as they relate to the AG’s 2020 conditional approval of the sale of this distressed hospital, which was facing closure if AHMC had not purchased it.”

In taking legal action, the attorney general is seeking to resume operations at Seton Coastside and restore primary stroke services at Seton Medical Center. The move marks his second lawsuit against a hospital this week.

On Sept. 30, his office filed suit against Providence St. Joseph Hospital in Eureka for refusing to provide an emergency abortion to a woman experiencing an obstetric emergency. In doing so, Providence violated multiple state laws, the lawsuit claims.

A new survey from Black Book Research highlights multiple healthcare IT implementations that have failed to meet expectations, with industry technology professionals pointing to issues like poor user experience, lack of interoperability, and high costs. In the third part of Black Book’s “What’s Hot and What’s Not in Healthcare IT Investments.” 907 healthcare professionals shared their insights on which systems have not delivered the return on investment (ROI) expected after deployment.

Every participant in the survey reported having worked in a hospital, physician practice or payer organization where an IT software or outsourcing engagement resulted in financial loss, significant workflow interruptions, reputational damage, or loss of key staff sometime in the past decade.

A 2017 report by Black Book Market Research estimated that U.S. hospitals lost around $1.7 billion annually due to outdated or poorly performing IT systems. In 2024, respondents indicated that the compounding inefficiencies, system downtimes, and ineffective integration of health IT have led to total losses estimated to exceed $8.0 billion annually across the industry. The costs include reduced operational efficiency, data breaches, delayed patient care, and administrative burdens. In some cases, hospitals may lose millions individually due to these issues, especially when productivity and revenue cycle disruptions are factored in.

“Three-quarters of IT leaders surveyed indicated that they have no plans to allocate funds for replacing these flawed systems in 2025, reflecting a broader trend of financial constraints across the sector,” said Doug Brown, President of Black Book. Additionally, 60% of respondents expressed concern they will likely lack the capital needed to address these critical system issues even through 2027, underscoring the long-term financial challenges that may delay much-needed improvements in healthcare IT infrastructure.

“CIOs are understandably cautious about replacing underperforming systems when the ROI is uncertain, given the track record of many healthcare IT vendors failing to meet expectations,” said Brown. “Without clear evidence that a new investment will deliver tangible financial or operational improvements, justifying the expense becomes challenging.”

The primary IT systems that have drained the most value from hospitals and healthcare providers include:

1. Overly Complex or Unintuitive EHR Systems:  Electronic Health Record (EHR) systems were a significant point of criticism by IT staffers. Among the major EHR systems surveyed respondents have worked with:
– – 77% of users reported ongoing user experience issues, such as cumbersome workflows, poor customization, and difficult navigation. These problems contribute to “click fatigue,” leading to inefficiencies and more time-consuming daily tasks.
– – 91% of small medical practices criticized major hospital system EHRs they were compelled or required to engage with as being overly complex and difficult to implement and maintain without adequate IT support, particularly for independent physician settings.

2. Poorly Integrated Telehealth Platforms:  The rush to adopt telehealth during the COVID-19 pandemic revealed ongoing flaws in many of the leading platforms:
– – 81% of respondents reported that some telehealth solutions failed to integrate well with existing EHR systems, creating data silos, duplicating data entry, and resulting in workflow inefficiencies.

3. Revenue Cycle Management (RCM) Systems with Poor Automation:  Revenue cycle management systems have also faced challenges in delivering value:
– – 70% of respondents gave negative feedback on their RCM software vendor or outsourcing partners, describing them as outdated and lacking advanced automation features such as functioning AI. This led to longer processing times for claims and higher denial rates according to 79% of their clientele.
– – 61% of providers expressed frustration over poor claims scrubbing and denial management capabilities, which led to lost revenue.

4. Health Information Exchanges (HIEs) with Limited Interoperability:  Health Information Exchange (HIE) platforms are another area where systems have fallen short:
– – 23% of physician practices said their early-stage HIE platforms still struggle with data standardization and integration, limiting their ability to leverage shared patient information.
– – 28% of medical practices reported ongoing issues due to EHR interoperability shortcomings, further hampering their ability to access complete patient records and coordinate care.

5. Clinical Decision Support (CDS) Systems with Poor Integration: Clinical Decision Support (CDS) tools have also been problematic for many:
– – 80% of users cited a lack of proper integration with EHRs, which severely undermined the value of CDS systems. First-generation CDS tools often generated excessive or irrelevant alerts, contributing to “alert fatigue” among clinicians.
– – 93% of respondents with outdated or static CDS tools said they lacked real-time, evidence-based guidance, rendering them ineffective in driving clinical decisions.

6. Patient-Engagement Platforms with Low Adoption:  Patient-engagement tools, especially early versions of patient portals, struggled with adoption:
– – 77% of reporting hospital systems with implemented patient portals had poor user interfaces and limited functionality, making them difficult for patients to navigate and reducing their effectiveness in fostering communication and engagement.
– – Smaller vendors offering niche patient engagement solutions also failed to gain traction in 88% of providers, often due to poor EHR integration and a lack of mobile-friendly features.

7. AI and Machine Learning Tools with Unrealized Promises:  Despite high expectations and funding hype for artificial intelligence and machine learning in healthcare, most AI systems have underdelivered so far say health systems:
– – 96% of healthcare IT executives said they faced challenges with AI ROI, with 92% of early adopters reported that their current AI systems were not accurate or actionable enough in clinical settings.
– – 85% of early adopters aimed at automating diagnostics or treatment planning saw little to no ROI, as these AI systems failed to grasp the complexities of real-world clinical environments.

8. Interoperability Solutions with Limited Support:  Interoperability remains an ongoing, critical issue for many healthcare providers:
– – 31% of providers expressed dissatisfaction with their data interoperability vendors, citing poor API support and slow updates. Many smaller platforms struggled to keep pace with evolving standards like FHIR (Fast Healthcare Interoperability Resources), leaving 8% of current providers with outdated, non-interoperable systems.

Key Reasons for Failure to Deliver Value:  When asked to identify the one top reason for the failure of healthcare IT systems, professionals ranked the following:

– – Poor User Experience: 48% of respondents cited user-unfriendly systems that increased provider burnout and inefficiency.
– – Lack of Interoperability: 24% mentioned systems that don’t integrate well with other platforms, leading to data silos.
– – High Costs: 20% noted that expensive systems without sufficient ROI are placing financial strain on providers.
– – Lack of Flexibility: 6% pointed to inflexible software that couldn’t adapt to specific workflows or needs.
– – Alert Fatigue: 2% cited excessive or irrelevant alerts from CDS systems, which devalued the software.

“As healthcare IT continues to evolve, addressing these issues will be critical,” said Brown. “Improving the user experience, ensuring seamless integration between systems, and managing the escalating costs are all essential steps for the industry to realize the full potential of these technologies.” Without resolving these pain points, hospitals may struggle to achieve the operational efficiency and enhanced patient outcomes that well-functioning IT systems can offer. “Ultimately, the future success of healthcare IT hinges on its ability to provide real, sustainable value without imposing additional burdens on providers.”