John Hulsman v. Behavioral Health Systems, Inc.
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IN THE COURT OF APPEALS OF THE STATE OF MISSISSIPPI
NO. 2008-CA-00635-COA
JOHN HULSMAN AND DONNA HULSMAN
APPELLANTS
v.
BEHAVIORAL HEALTH SYSTEMS, INC. AND
BLUE CROSS & BLUE SHIELD OF ALABAMA
DATE OF JUDGMENT:
TRIAL JUDGE:
COURT FROM WHICH APPEALED:
ATTORNEYS FOR APPELLANTS
ATTORNEYS FOR APPELLEES:
NATURE OF THE CASE:
TRIAL COURT DISPOSITION:
DISPOSITION:
MOTION FOR REHEARING FILED:
MANDATE ISSUED:
APPELLEES
03/20/2008
HON. WILLIAM E. CHAPMAN III
RANKIN COUNTY CIRCUIT COURT
ROBERT NICHOLAS NORRIS
LOUIS H. WATSON
JAMES N. BULLOCK
PHILLIP ANDREW LAIRD
R. PEPPER CRUTCHER JR.
JONATHAN LEE BULLOCK
RANDALL H. SELLERS
CAVENDER C. KIMBLE
CIVIL - TORTS-OTHER THAN PERSONAL
INJURY AND PROPERTY DAMAGE
SUMMARY JUDGMENT ENTERED
AFFIRMED – 07/21/2009
BEFORE LEE, P.J., IRVING AND BARNES, JJ.
IRVING, J., FOR THE COURT:
¶1.
John and Donna Hulsman filed a suit in the Rankin County Circuit Court against
Behavioral Health Systems, Inc. (BHS) and Blue Cross & Blue Shield of Alabama (Blue
Cross), alleging several state-law claims, including vicarious liability, intentional and/or
negligent infliction of emotional distress, negligent hiring, negligent supervision, corporate
negligence, and gross negligence. Blue Cross and BHS filed a joint motion to dismiss or, in
the alternative, a motion for summary judgment on the basis of federal preemption under the
Employment Retirement Income Security Act (ERISA). The circuit court granted the
motion. Feeling aggrieved, the Hulsmans appeal and assert that the circuit court erred in
holding that their claims were preempted by ERISA.
¶2.
Finding no reversible error, we affirm.
FACTS
¶3.
John’s employer, Motion Industries, Inc., provided a healthcare insurance plan to its
employees that was administered by Blue Cross. John and Donna were participants in the
plan which included a mental health program that was managed by BHS. In December 2005,
Donna underwent surgery to treat nerve pain; however, the surgery did not relieve all of her
pain. Accordingly, Donna’s physician recommended that she be treated by a psychiatrist to
help her cope with the remaining pain. In order to receive mental health treatment, BHS
requires the insured to contact BHS for a referral to the nearest certified assessment provider.
Donna contacted BHS and was referred to Dr. David Richardson, a psychiatrist. Dr.
Richardson prescribed several medications, which Donna alleges caused her to experience
a number of adverse side effects, including uncontrollable muscle spasms and fear that she
would harm herself or others.
¶4.
Because of the side effects, the Hulsmans contacted BHS for a referral to a
psychologist, so Donna could be treated without medication. BHS referred Donna to Mark
Trailer, a local psychologist. According to Donna, her family physician informed her that
she should still continue to see a psychiatrist. The Hulsmans asked BHS for another
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psychiatrist referral, and ultimately, they were referred back to Dr. Richardson.
¶5.
On August 31, 2006, Donna called John and told him that she thought it would be best
for her to be admitted to a hospital because she was afraid that she was going to hurt herself
or someone around her. John then called BHS and informed them of what Donna was
experiencing. He requested that BHS refer Donna to an in-patient treatment facility.
According to John, the BHS representative stated that she would contact him the following
week with a referral because it would be difficult to have Donna admitted into an in-patient
facility over the Labor Day holiday weekend. On September 8, 2006, after having not
received a referral, John again contacted BHS and requested an in-patient referral. However,
no referral was given on that date. On September 11, 2006, Donna attempted suicide by
slitting her wrists.
¶6.
Additional facts, as necessary, will be discussed during the analysis and discussion
of the issue.
ANALYSIS AND DISCUSSION OF THE ISSUE
¶7.
“[An appellate court] applies a de novo standard of review to the trial court’s grant
of summary judgment.” Windham v. Latco of Miss., Inc., 972 So. 2d 608, 610 (¶4) (Miss.
2008) (citing Moss v. Batesville Casket Co., 935 So. 2d 393, 398 (¶15) (Miss. 2006)). “The
evidence must be viewed in the light most favorable to the non-moving party. If, in this
view, the moving party is entitled to a judgment as a matter of law, then summary judgment
should be granted in [the movant’s] favor. Otherwise, the motion should be denied.” Palmer
v. Anderson Infirmary Benevolent Ass’n, 656 So. 2d 790, 794 (Miss. 1995) (citing Brown v.
Credit Ctr., Inc., 444 So. 2d 358, 362 (Miss. 1983)). Our rules of civil procedure require the
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trial court to grant summary judgment where “the pleadings, depositions, answers to
interrogatories and admissions on file, together with the affidavits, if any, show that there is
no genuine issue as to any material fact and that the moving party is entitled to a judgment
as a matter of law.” M.R.C.P. 56(c). “A fact is material if it ‘tends to resolve any of the
issues properly raised by the parties.’” Simpson v. Boyd, 880 So. 2d 1047, 1050 (¶9) (Miss.
2004) (quoting Palmer, 656 So. 2d at 794).
¶8.
Our supreme court has held that preemption is proper in three circumstances: (1)
“where Congress explicitly preempts state law”; (2) “where preemption is implied because
Congress has occupied the entire field”; or (3) “where preemption is implied because there
is an actual conflict between federal and state law.” Cooper v. Gen. Motors Corp., 702 So.
2d 428, 434 (¶16) (Miss. 1997) (citing English v. Gen. Elec. Co., 496 U.S. 72, 78-79 (1990)).
¶9.
In Aetna Health, Inc. v. Davila, 542 U.S. 200, 207-09 (2004), the United States
Supreme Court discussed in extensive detail ERISA’s purpose and preemption powers:
“When a federal statute wholly displaces the state-law cause of action through
complete pre-emption,” the state claim can be removed. Beneficial Nat. Bank
v. Anderson, 539 U.S. 1, 8, 156 L. Ed. 2d 1, 123 S. Ct. 2058 (2003). This is
so because “when the federal statute completely pre-empts the state-law cause
of action, a claim which comes within the scope of that cause of action, even
if pleaded in terms of state law, is in reality based on federal law.” Ibid.
ERISA is one of these statutes.
Congress enacted ERISA to “protect . . . the interests of participants in
employee benefit plans and their beneficiaries” by setting out substantive
regulatory requirements for employee benefit plans and to “provide for
appropriate remedies, sanctions, and ready access to the Federal courts.” 29
U.S.C. § 1001(b) . . . . The purpose of ERISA is to provide a uniform
regulatory regime over employee benefit plans. To this end, ERISA includes
expansive pre-emption provisions, see ERISA § 514, 29 U.S.C. § 1144, . . .
which are intended to ensure that employee benefit plan regulation would be
“exclusively a federal concern.” Alessi v. Raybestos-Manhattan, Inc., 451
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U.S. 504, 523, 68 L. Ed. 2d 401, 101 S. Ct. 1895 (1981).
ERISA’s “comprehensive legislative scheme” includes “an integrated system
of procedures for enforcement.” [Mass. Mut. Life Ins. Co. v.] Russell, 473
U.S. [134,] 147, 87 L. Ed. 2d 96, 105 S. Ct. 3085 (1985) (internal quotation
marks omitted). This integrated enforcement mechanism, ERISA § 502(a), 29
U.S.C. § 1132(a) . . . is a distinctive feature of ERISA, and essential to
accomplish Congress’ purpose of creating a comprehensive statute for the
regulation of employee benefit plans. As the Court said in Pilot Life Ins. Co.
v. Dedeaux, 481 U.S. 41, 95 L. Ed. 2d 39, 107 S. Ct. 1549 (1987):
“The detailed provisions of § 502(a) set forth a comprehensive
civil enforcement scheme that represents a careful balancing of
the need for prompt and fair claims settlement procedures
against the public interest in encouraging the formation of
employee benefit plans. The policy choices reflected in the
inclusion of certain remedies and the exclusion of others under
the federal scheme would be completely undermined if
ERISA-plan participants and beneficiaries were free to obtain
remedies under state law that Congress rejected in ERISA. ‘The
six carefully integrated civil enforcement provisions found in §
502(a) of the statute as finally enacted . . . provide strong
evidence that Congress did not intend to authorize other
remedies that it simply forgot to incorporate expressly.’” 1 Id.,
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ERISA § 502(a), as set forth in 29 U.S.C. § 1132(a), provides:
A civil action may be brought -(1) by a participant or beneficiary -(A) for the relief provided for in subsection (c) of this section
[concerning requests to the administrator for information], or
(B) to recover benefits due to him under the terms of his plan,
to enforce his rights under the terms of the plan, or to clarify his
rights to future benefits under the terms of the plan;
(2) by the Secretary, or by a participant, beneficiary or fiduciary for
appropriate relief under section 1109 of this title [breach of fiduciary duty];
(3) by a participant, beneficiary, or fiduciary (A) to enjoin any act or practice
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at 54, 95 L. Ed. 2d 39, 107 S. Ct. 1549 (quoting Russell, supra,
at 146, 87 L. Ed. 2d 96, 105 S. Ct. 3085).
Therefore, any state-law cause of action that duplicates, supplements, or
supplants the ERISA civil enforcement remedy conflicts with the clear
congressional intent to make the ERISA remedy exclusive and is therefore
pre-empted. See 481 U.S., at 54-56, 95 L. Ed. 2d 39, 107 S. Ct. 1549; see also
Ingersoll-Rand Co. v. McClendon, 498 U.S. 133, 143-145, 112 L. Ed. 2d 474,
111 S. Ct. 478 (1990).
(Emphasis and footnote added).
¶10.
The Hulsmans contend that the Mississippi Supreme Court has not yet determined
whether a claim like theirs—a claim that the medical provider failed to provide for or arrange
for medical treatment—is preempted by ERISA. Accordingly, they argue that the Florida
Supreme Court case, Villazon v. Prudential Health Care Plan, Inc., 843 So. 2d 842 (Fla.
2003), provides persuasive authority in support of their position and that its reasoning should
be adopted by this court. In their briefs, the Hulsmans assert: “[Villazon] held that based on
the U.S. Supreme Court’s decision in New York Blue Cross v. Travelers Ins., 514 U.S. 645
which violates any provision of this subchapter or the terms of the plan, or (B)
to obtain other appropriate equitable relief (i) to redress such violations or (ii)
to enforce any provisions of this subchapter or the terms of the plan;
(4) by the Secretary, or by a participant, or beneficiary for appropriate relief
in the case of a violation of 1025(c) of this title [information to be furnished
to participants];
(5) except as otherwise provided in subsection (b) of this subsection, by the
Secretary (A) to enjoin any act or practice which violates any provision of this
subchapter, or (B) to obtain other appropriate equitable relief (i) to redress
such violation or (ii) to enforce any provision of this subchapter;
(6) by the Secretary to collect any civil penalty under paragraph (2), (4), (5),
(6), (7), (8), or (9) subsection (c) or under subsection (i) or (l) is section.
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(Miss 1995), a distinction is to be made between suits which relate to the administration of
employee benefit plans and those which do not.” The Hulsmans assert that when “ERISA
is implicated by a complaint for failing to provide, arrange for, or supervise qualified doctors
to provide the actual medical treatment for plan participants, federal preemption is
inappropriate.” They contend that Blue Cross and BHS failed to provide or arrange for
medical treatment for Donna and that as a result, they suffered serious injuries. We find John
and Donna’s arguments unpersuasive.
¶11.
In Davila, Juan Davila and Ruby Calad, two beneficiaries of healthcare plans covered
by ERISA, brought separate Texas state-court suits, alleging (1) that the health maintenance
organizations (HMOs) that administered the plans had refused to cover certain medical
services in violation of an HMO’s duty to exercise ordinary care under a Texas healthcare
statute and (2) that those refusals had proximately caused injuries to the beneficiaries.
Davila, 542 U.S. at 204-05. Aetna Health, Inc. (Aetna) administered Davila’s ERISAregulated employee benefit plan by reviewing requests for coverage and paying providers.
Id. at 204. Calad’s plan was administered by CIGNA Health Care of Texas, Inc. (CIGNA),
which was responsible for plan benefits and coverage decisions. Id. Davila and Calad
suffered injuries that allegedly were proximately caused by Aetna’s and CIGNA’s decisions
not to cover particular treatment and services recommended by their physicians. Id. at 20405. Davila and Calad argued that these decisions violated legal duties independent of
ERISA. Specifically, they brought their claims against the insurance providers under the
Texas Health Care Liability Act (THCLA), alleging that Aetna and CIGNA “‘controlled,
influenced, participated in and made decisions which affected the quality of the diagnosis,
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care, and treatment provided’ in a manner that violated ‘the duty of ordinary care. . . .’” Id.
at 212.
¶12.
In holding that Davila’s and Calad’s claims were completely preempted by ERISA,
the Supreme Court stated:
The duties imposed by the THCLA in the context of these cases, however, do
not arise independently of ERISA or the plan terms. The THCLA does impose
a duty on managed care entities to “exercise ordinary care when making health
care treatment decisions,” and makes them liable for damages proximately
caused by failures to abide by that duty. However, if a managed care entity
correctly concluded that, under the terms of the relevant plan, a particular
treatment was not covered, the managed care entity’s denial of coverage would
not be a proximate cause of any injuries arising from the denial. Rather, the
failure of the plan itself to cover the requested treatment would be the
proximate cause. . . .
Thus, interpretation of the terms of respondents’ benefit plans forms an
essential part of their THCLA claim, and THCLA liability would exist here
only because of petitioners’ administration of ERISA-regulated benefit plans.
Petitioners’ potential liability under the THCLA in these cases, then, derives
entirely from the particular rights and obligations established by the benefit
plans. . . .
Hence, respondents bring suit only to rectify a wrongful denial of benefits
promised under ERISA-regulated plans, and do not attempt to remedy any
violation of a legal duty independent of ERISA. We hold that respondents’
state causes of action fall “within the scope of” ERISA § 502(a)(1)(B) 2 . . . and
are therefore completely pre-empted by ERISA § 502 and removable to federal
district court.
Id. at 212-14 (internal citations omitted) (footnote added).
¶13.
Accordingly, we find that Davila stands for the proposition that if a party’s claim
2
As noted earlier, ERISA § 502(a)(1)(B) states: “A civil action may be brought by
a participant or beneficiary -- to recover benefits due to him under the terms of his plan, to
enforce his rights under the terms of the plan, or to clarify his rights to future benefits under
the terms of the plan[.]”
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emanates from the administration of an ERISA-regulated benefit plan, then the claim is
preempted. Additionally, we find that Congress intended that the only remedies afforded to
a party are those authorized by ERISA.
¶14.
The Hulsmans allege that Blue Cross’s and BHS’s failure to timely refer Donna to an
in-patient facility caused her suicide attempt. We find that this is not a denied-benefits claim;
rather, it is a delayed-benefits claim. Regardless, the claim is related to the administration
of the medical benefit plan. Therefore, in accordance with Davila, the claim is preempted
by ERISA.
¶15. THE JUDGMENT OF THE RANKIN COUNTY CIRCUIT COURT IS
AFFIRMED. ALL COSTS OF THIS APPEAL ARE ASSESSED TO THE
APPELLANTS.
KING, C.J., LEE AND MYERS, P.JJ., GRIFFIS, BARNES, ISHEE, ROBERTS,
CARLTON AND MAXWELL, JJ., CONCUR.
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