Aguilera v. Loma Linda Univ. Med. Center
Annotate this CaseThis case centered on a claim for reimbursement made by California's State Department of Health Care Services for funds expended on behalf of an injured party by the state's Medi-Cal program. The injured party, Ashlynn Aguilera, filed a special motion to determine the Department's lien under Welfare & Institutions Code section 14124.76. When Ashlynn was two months old she suffered injuries as a result of the negligence of a physician. She underwent a hemispherectomy (removal of half of the cerebral portion of her brain). Ashlynn suffered from global developmental delay, mental retardation and behavioral disorders. Ashlynn filed an action for medical malpractice and her parents settled the action for $950,000. The settlement was near the defendant's liability policy limits. The trial court approved the settlement, along with the request of Ashlynn's counsel for attorney fees and costs totaling $253,006. Ashlynn's parents received $85,000 of the settlement as a resolution of their prospective wrongful death action against the defendant. The balance of the settlement was placed in a special needs trust. The Department asserted a lien on Ashlynn's recovery, based on the $211,191 that it spent on her behalf. Ashlynn supported her special motion with declarations from her counsel and two physicians, presenting evidence regarding: her life expectancy; the care she will need throughout her life; the cost of future care; lost earning capacity; and the value of her pain and suffering. Among other things, Ashlynn presented evidence that she needs 16 hours per day of licensed vocational nurse (LVN) attendant care until she reaches the age of 21, and 24 hours per day LVN attendant care for the rest of her life. Upon review, the Court of Appeal concluded the trial court properly employed the methodology used in "Arkansas Dept. of Health and Human Services v. Ahlborn,"(547 U.S. 268 (2006)) but erred when it refused to reduce the Department's lien to account for the attorney fees and expenses Ashlynn incurred. The matter was remanded to the trial court to set aside the order and conduct further proceedings: (1) regarding whether the cost of Ashlynn's future at-home attendant care and medical care should be included in its Ahlborn calculation; and (2) apply section 14124.72 (d) to determine the Department's share of Ashlynn's attorney fees and costs.
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