Prospect Med. Group, Inc. v. Northridge Emergency Med. Group (Full Text)

Filed 1/8/09

IN THE SUPREME COURT OF CALIFORNIA

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PROSPECT MEDICAL GROUP, INC.,
)

et al.,
)

)
Plaintiffs and Appellants,

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v.
)

)
NORTHRIDGE EMERGENCY
)
MEDICAL GROUP et al.,
)

Defendants and Respondents. )
___________________________________ )

)
)
PROSPECT HEALTH SOURCE
)
MEDICAL GROUP,

)
)

)

)
)

)
SAINT JOHN’S EMERGENCY
)
MEDICINE SPECIALISTS, INC., et al.,

)

Defendants and Respondents. )
___________________________________ )

Plaintiff and Appellant,

S142209

Ct.App. 2/3 B172737

Los Angeles County
Super. Ct. No. BC300850

Ct.App. 2/3 B172817

Los Angeles County
Super. Ct. No. SC076909

A health maintenance organization (HMO) commonly manages medical
care in California. In the typical model, familiar to many, doctors contract to
provide medical care to enrolled HMO members. Members generally use the
services of one of the contracting doctors. When they do, and except for
copayments the members must make when services are rendered, the HMO (or its

delegate) pays the doctor under the existing contract. In this way, the parties agree
upon, and know in advance, what their obligations and rights are and who must
pay, and how much, for medical care.
The typical payment model sometimes breaks down, however, in the case
of emergency care. In an emergency, an HMO member goes to the nearest
hospital emergency room for treatment. The emergency room doctors at that
hospital may or may not have previously contracted with the HMO to provide care
to its members. In that situation, the doctors are statutorily required to provide
emergency care without regard to the patient’s ability to pay. Additionally, when
the patient is a member of an HMO, the HMO is statutorily required to pay for the
emergency care.1 For HMO members, it is always clear in advance who has to
provide emergency services — any emergency room doctor to whom the member
goes in an emergency — and who has to pay for those services — the HMO. The
conflict arises when there is no advance agreement between the emergency room
doctors and the HMO regarding the amount of the required payment.
Thus, the potential inherently exists for disputes between the emergency
room doctors and the HMO regarding how much the HMO owes the doctors for
emergency services. When no preexisting contract exists, the doctors sometimes
submit a bill to the HMO that they consider reasonable for the services rendered
but that the HMO considers unreasonably high; conversely, the HMO sometimes
makes a payment that it considers reasonable for the services rendered but that the

1
For ease of discussion, we will sometimes refer rather loosely to those
required to provide emergency services without regard to the patient’s ability to
pay as emergency room doctors, while recognizing that the category is broader
than just doctors (Health & Saf. Code, § 1345, subd. (i)), and to the entities
required to reimburse those emergency room doctors for services rendered to their
subscribers as HMO’s, while recognizing that the entities are more technically
described as “health care service plan[s]” and include the plans’ delegates (Health
& Saf. Code, § 1371.4, subd. (e)).

doctors consider unreasonably low. The resolution of such disputes can create
difficult problems.
But the question of how to resolve disputes between the doctors and the
HMO over the amount due for emergency care is not before us in this case. The
issue here is narrow, although quite important for emergency room doctors,
HMO’s, and their members: When the HMO submits a payment lower than the
amount billed, can the emergency room doctors directly bill the patient for the
difference between the bill submitted and the payment received — i.e., engage in
the practice called “balance billing”?
Interpreting the applicable statutory scheme as a whole — primarily the
Knox-Keene Health Care Service Plan Act of 1975, Health and Safety Code
section 1340 et seq. (Knox-Keene Act)2 — we conclude that billing disputes over
emergency medical care must be resolved solely between the emergency room
doctors, who are entitled to a reasonable payment for their services, and the HMO,
which is obligated to make that payment. A patient who is a member of an HMO
may not be injected into the dispute. Emergency room doctors may not bill the
patient for the disputed amount.
I. FACTUAL AND PROCEDURAL BACKGROUND
Because neither party petitioned the Court of Appeal for a rehearing, we
take our facts largely from that court’s opinion. (Richmond v. Shasta Community
Services Dist. (2004) 32 Cal.4th 409, 415; see Cal. Rules of Court, rule
8.500(c)(2).)

2
All further statutory references are to the Health and Safety Code unless
otherwise indicated.

Plaintiffs and appellants, Prospect Medical Group, Inc., et alia (collectively
Prospect), are individual practice associations.3 Prospect manages patient care by
executing written contracts with health care service plans.4 It provides for medical
care to persons who are members of a health care service plan and who select a
Prospect physician. Prospect also provides billing services to the health care
service plans contracted with Prospect. As such, it is a “delegate” of those health
care service plans and is statutorily obligated to pay for emergency services
provided to patients who have subscribed to those health care service plans.
(§ 1371.4, subds. (b) & (e).)
Defendants and respondents, Northridge Emergency Medical Group and
Saint John’s Emergency Medicine Specialists, Inc. (collectively Emergency
Physicians), have exclusive licenses at two California hospitals to provide
emergency room physician care. Emergency Physicians are health care providers
and are statutorily required to provide emergency care without regard to an
individual’s insurance or ability to pay. (§ 1317, subd. (d); see also 42 U.S.C.
§ 1395dd.)
When patients who are members of a health care service plan schedule
medical services in advance, they generally go to physicians with whom the health
care service plan or its delegate, like Prospect, has an express preexisting contract.
On occasion, when these same patients need emergency medical care, they may be

3
Section 1373, subdivision (h)(6), defines an individual practice association
by reference to title 42 United States Code section 300e-1(5), which provides as
relevant: “The term ‘individual practice association’ means a . . . legal entity
which has entered into a services arrangement (or arrangements) with persons who
are licensed to practice medicine . . . .”
4
As pertinent here, section 1345, subdivision (f)(1), defines a health care
service plan as “[a]ny person who undertakes to arrange for the provision of health
care services to subscribers or enrollees, or to pay for or to reimburse any part of
the cost for those services, in return for a prepaid or periodic charge paid by or on
behalf of the subscribers or enrollees.”

taken to a hospital where the doctors staffing the emergency room do not have a
preexisting contract with the health care plan or its delegate. In this case, after
Emergency Physicians provided emergency medical services to patients who were
members of health care service plans that contracted with Prospect, they submitted
reimbursement claims to Prospect. Sometimes Prospect paid Emergency
Physicians less than the amount billed. In those cases, Prospect paid what it
alleged was reasonable for the services rendered. Emergency Physicians then
billed the patients directly for the differences between the bills they submitted and
what Prospect paid. The parties refer to this practice as “balance billing.”
After billing disputes arose between Prospect and Emergency Physicians,
Prospect filed two related actions against Emergency Physicians seeking, among
other things, a judicial determination that (1) Emergency Physicians were entitled
only to “reasonable” compensation for emergency medical care, which Prospect
claimed was equivalent to the Medicare rate; and (2) the practice of balance billing
is unlawful. In one of the actions, Prospect alleged that Saint John’s Emergency
Medicine Specialists, Inc., “routinely bills Prospect’s patients, threatens to turn
over Prospect’s patients to an outside collection agency, and threatens to take legal
measures against Prospect’s patients.” The trial court sustained Emergency
Physicians’ demurrers without leave to amend and entered judgments accordingly.
Prospect appealed both judgments, and the Court of Appeal consolidated the
appeals.
The Court of Appeal concluded that balance billing is not statutorily
prohibited. Second, it concluded that Prospect is not entitled to a judicial
declaration imposing the Medicare rate as the reasonable rate. Third, it concluded
the trial court abused its discretion by denying leave to amend the complaint to
permit Prospect to allege that Emergency Physicians charged more than a
reasonable rate for a specific medical procedure. We granted Prospect’s petition

for review, which raised the sole question whether Emergency Physicians may
engage in balance billing.

II. DISCUSSION
The Knox-Keene Act governs this case. “The Knox-Keene Act is a
comprehensive system of licensing and regulation under the jurisdiction of the
Department of Managed Health Care.” (Bell v. Blue Cross of California (2005)
131 Cal.App.4th 211, 215 (Bell).) In addition, one statute not part of the act is
pertinent here. Section 1317 requires emergency care providers to provide
emergency services without first questioning the patient’s ability to pay. (Bell,
supra, 131 Cal.App.4th at pp. 215-216 & fn. 4.) Federal law is similar. (42
U.S.C. § 1395dd; see Bell, supra, at p. 215, fn. 4.)
Today, by statute, when emergency room doctors provide emergency
services, HMO’s are required to reimburse those doctors for the services rendered
to their subscribers or enrollees. As Bell explained, the Knox-Keene Act “compels
for-profit health care service plans to reimburse emergency health care providers
for emergency services to the plans’ enrollees. . . . [S]ection 1371.4 provides that
a for-profit ‘health care service plan shall reimburse providers for emergency
services and care provided to its enrollees, until the care results in stabilization of
the enrollee, except as provided in subdivision (c). As long as federal or state law
requires that emergency services and care be provided without first questioning
the patient’s ability to pay, a health care service plan shall not require a provider to
obtain authorization prior to the provision of emergency services and care
necessary to stabilize the enrollee’s emergency medical condition.’ (§ 1371.4,
subd. (b); see § 1371.4, subd. (f).) ‘Payment for emergency services and care may
be denied only if the health care service plan reasonably determines that the
emergency services and care were never performed . . . .’ (§ 1371.4, subd. (c); see
§ 1371.4, subd. (f); and see Cal. Code Regs., tit. 28, § 1300.71, subd. (a).)” (Bell,

supra, 131 Cal.App.4th at p. 215.) “Subdivision (b) of section 1371.4 was enacted
in 1994 to impose a mandatory duty upon health care plans to reimburse
noncontracting providers for emergency medical services. [Citations.]” (Id. at p.
216.)

The combination of circumstances that (1) in an emergency a patient might
go to emergency room doctors who have no preexisting contractual relationship
with the HMO, (2) the doctors are required to render emergency care without
asking whether the patient can pay for it, and (3) the HMO is required to pay the
doctors for those services, creates the problem underlying the issue before us. By
the very nature of things, disputes may arise regarding how much the emergency
room doctors may charge and how much the HMO must pay for emergency
services.
Regulations of the Department of Managed Health Care provide that the
HMO must pay “the reasonable and customary value for the health care services
rendered based upon statistically credible information that is updated at least
annually and takes into consideration: (i) the provider’s training, qualifications,
and length of time in practice; (ii) the nature of the services provided; (iii) the fees
usually charged by the provider; (iv) prevailing provider rates charged in the
general geographic area in which the services were rendered; (v) other aspects of
the economics of the medical provider’s practice that are relevant; and (vi) any
unusual circumstances in the case . . . .” (Cal. Code Regs., tit. 28, § 1300.71,
subd. (a)(3)(B); see Bell, supra, 131 Cal.App.4th at p. 216.) Thus, the HMO has a
“duty to pay a reasonable and customary amount for the services rendered.” (Bell,
supra, at p. 220.) But how this amount is determined can create obvious
difficulties. In a given case, a reasonable amount might be the bill the doctor
submits, or the amount the HMO chooses to pay, or some amount in between. In
Bell, supra, 131 Cal.App.4th 211, the Court of Appeal interpreted the Knox-Keene

Act to permit, when disputes arise, emergency room doctors to sue the HMO
directly for the reasonable value of their services.
Prospect argues that section 1379, part of the Knox-Keene Act, prohibits
balance billing. That section, enacted in 1975 and never amended, provides:
“(a) Every contract between a plan and a provider of health care services
shall be in writing, and shall set forth that in the event the plan fails to pay for
health care services as set forth in the subscriber contract, the subscriber or
enrollee shall not be liable to the provider for any sums owed by the plan.
“(b) In the event that the contract has not been reduced to writing as
required by this chapter or that the contract fails to contain the required
prohibition, the contracting provider shall not collect or attempt to collect from the
subscriber or enrollee sums owed by the plan.
“(c) No contracting provider, or agent, trustee or assignee thereof, may
maintain any action at law against a subscriber or enrollee to collect sums owed by
the plan.”
Although no express contractual relationship exists between Prospect and
Emergency Physicians, Prospect argues that the combination of statutes requiring
emergency room doctors to render, and HMO’s to pay for, emergency services
creates an implied contract between emergency room doctors and HMO’s that has
not been reduced to writing under section 1379, subdivision (b). The Court of
Appeal disagreed. Interpreting section 1379 as a whole (but not in the context of
the Knox-Keene Act as a whole), it held that this section does not cover the
situation here. It found “that the language of subdivision (b) of section 1379 refers
to and includes within its scope only voluntarily negotiated contracts between
providers of health care services, like Emergency Physicians, and health care
service plans or their delegates, like Prospect, based upon traditional contractual
principles such as a meeting of the minds. Subdivision (b) does not include within

its scope the implied contract as Prospect asserts.” Accordingly, it “conclude[d]
that section 1379, subdivision (b), was not intended to, and does not, prohibit the
balance billing practices alleged in this case.”
Reading the language of section 1379 in isolation, it does not readily apply
to the precise situation here. No doubt the Legislature did not contemplate the
situation of this case in 1975, when it enacted section 1379, for this situation did
not exist in 1975. Section 1371.4, which obligates HMO’s to pay for emergency
services to its subscribers, was enacted in 1994, long after the Legislature enacted
section 1379. But we must not view section 1379 in isolation. “We do not
examine [statutory] language in isolation, but in the context of the statutory
framework as a whole in order to determine its scope and purpose and to
harmonize the various parts of the enactment.” (Coalition of Concerned Citizens,
Inc. v. City of Los Angeles (2004) 34 Cal.4th 733, 737.)
We have already seen that in 1975, the Legislature banned balance billing
when an HMO is contractually obligated to pay the bill (§ 1379); that since 1994,
HMO’s have been obligated to pay for emergency care (§ 1371.4); and that the
Knox-Keene Act permits emergency room doctors to sue HMO’s directly over
billing disputes (Bell, supra, 131 Cal.App.4th 211). These provisions strongly
suggest that doctors may not bill patients directly when a dispute arises between
doctors and the HMO’s. Other provisions point in the same direction. Section
1317, subdivision (d), which requires emergency room doctors to render
emergency care without questioning a patient’s ability to pay, also provides that
“the patient or his or her legally responsible relative or guardian shall execute an
agreement to pay [for the services] or otherwise supply insurance or credit
information promptly after the services are rendered.” (Italics added.) This
provision implies that once patients who are members of an HMO provide
insurance information, they have satisfied their obligation towards the doctors.

Section 1342, subdivision (d), expresses a legislative intent to “[help] to ensure the
best possible health care for the public at the lowest possible cost by transferring
the financial risk of health care from patients to providers.”
Additionally, the Legislature contemplated there may be disputes over the
amounts owed to noncontracting providers such as emergency room doctors, and
therefore the Knox-Keene Act requires that each HMO “shall ensure that a dispute
resolution mechanism is accessible to noncontracting providers for the purpose of
resolving billing and claims disputes.” (§ 1367, subd. (h)(2); see also § 1371.38,
subd. (a) [directing the Dept. of Managed Health Care to adopt regulations
ensuring that each HMO adopt a dispute resolution mechanism that is “fair, fast,
and cost-effective for contracting and noncontracting providers”].) Finally, the
Legislature has acted to protect the interests of noncontracting providers in
reimbursement disputes by prohibiting HMO’s from engaging in unfair payment
patterns involving unjust payment reductions, claim denials, and other unfair
practices as defined, and by authorizing monetary and other penalties against
HMO’s that engage in these patterns. (§ 1371.37; see also § 1371.39 [authorizing
providers to report HMO’s that engage in unfair payment patterns to the Dept. of
Managed Health Care].)
The only reasonable interpretation of a statutory scheme that (1) intends to
transfer the financial risk of health care from patients to providers; (2) requires
emergency care patients to agree to pay for the services or to supply insurance
information; (3) requires HMO’s to pay doctors for emergency services rendered
to their subscribers; (4) prohibits balance billing when the HMO, and not the
patient, is contractually required to pay; (5) requires adoption of mechanisms to
resolve billing disputes between emergency room doctors and HMO’s; and (6)
permits emergency room doctors to sue HMO’s directly to resolve billing disputes,
is that emergency room doctors may not bill patients directly for amounts in

dispute. Emergency room doctors must resolve their differences with HMO’s and
not inject patients into the dispute. Interpreting the statutory scheme as a whole,
we conclude that the doctors may not bill a patient for emergency services that the
HMO is obligated to pay. Balance billing is not permitted.5
Any doubt about the meaning of the Knox-Keene Act in this regard is
easily resolved when legislative policy is considered. If statutory language
permits more than one reasonable interpretation, courts may consider extrinsic
aids, including the purpose of the statute, the evils to be remedied, and public
policy. (Torres v. Parkhouse Tire Service, Inc. (2001) 26 Cal.4th 995, 1003.) We
perceive a clear legislative policy not to place patients in the middle of billing
disputes between doctors and HMO’s. Indeed, the Department of Managed Health
Care argued in Bell, and the Court of Appeal concluded, that doctors may directly
sue HMO’s to resolve billing disputes in order to avoid the necessity of balance
billing. The Bell court quoted the department’s argument: “ ‘If providers are
precluded from bringing private causes of action to challenge health plans’
reimbursement determinations, health plans may receive an unjust windfall and
patients may suffer an economic hardship when providers resort to balance billing
activities to collect the difference between the health plan’s payment and the
provider’s billed charges. If collection actions are pursued, unsuspecting enrollees
can be forced to reimburse the full amount of a provider’s billed charges even
though those charges are in excess of the reasonable and customary value of the
services rendered. [¶] The prompt and appropriate reimbursement of emergency
providers ensures the continued financial viability of California’s health care

5
Our holding is limited to the precise situation before us — billing the
patient for emergency services when the doctors have recourse against the
patient’s HMO. We express no opinion regarding the situation when no such
recourse is available; for example, if the HMO is unable to pay or disputes
coverage.

delivery system. . . . [D]enying emergency providers judicial recourse to
challenge the fairness of a health plan’s reimbursement determination[] allows a
health plan to systematically underpay California’s safety-net providers and
unnecessarily involve[s] the patient[s] in billing disputes between the provider and
their health plan[s].’ ” (Bell, supra, 131 Cal.App.4th at p. 218, italics added.)
Because emergency room doctors prevailed in Bell, supra, 131 Cal.App.4th
211, and won the right to resolve their disputes directly with HMO’s, no reason
exists to permit balance billing. Thus, the Department of Managed Health Care,
which supported doctors’ rights to sue the HMO’s directly in Bell, has appeared in
this case as amicus curiae supporting patients’ rights to be free of balance billing.
When a dispute exists between doctors and an HMO, the bill the doctors
submit may or may not be the reasonable payment to which they are entitled. The
Bell court made clear that an HMO does not have “unfettered discretion to
determine unilaterally the amount it will reimburse a noncontracting
provider . . . .” (Bell, supra, 131 Cal.App.4th at p. 220.) But the converse is also
true; emergency room doctors do not have unfettered discretion to charge
whatever they choose for emergency services. Emergency room doctors and
HMO’s must resolve their disputes among themselves. Interjecting patients into
the dispute by charging them for the amount in dispute has only an in terrorem
effect. As Prospect notes, although emergency room doctors “are entitled to
‘reasonable’ compensation for the services rendered, they cannot lawfully seek
unreasonable payment from anyone.” But a patient will have little basis by which
to determine whether a bill is reasonable and, because the HMO is obligated to
pay the bill, no legitimate reason exists for the patient to have to do so. Billing the
patient, and potentially attempting to collect from the patient, will put unjustifiable
pressure on the patient, who will often complain to the HMO, which complaints

will in turn pressure the HMO to make the payment even if it is unreasonable.
Such a billing practice is not a legitimate way to resolve disputes with an HMO.
Relying in part on dicta in Ochs v. PacifiCare of California (2004) 115
Cal.App.4th 782, Emergency Physicians argue that they may collect from the
patient, who may then collect from the HMO. The Ochs court held that it did not
have to decide the issue presented in this case, but it went on to “observe,
however, that section 1379 appears only to limit ‘balance billing’ of insured
patients by physicians who have contracted with the patients’ plans. [The
provider] may have a remedy against the individual patients, and those patients a
remedy against PacifiCare.” (Id. at p. 796.) But this is not what the statutory
scheme provides. Section 1371.4, subdivision (b), does not say that patients must
pay the emergency room doctors and then turn to their HMO’s for reimbursement.
Rather it states that the “health care service plan shall reimburse providers for
emergency services and care provided to its enrollees . . . .” This language does
not authorize the roundabout route of the doctor collecting from the patient, who
must then collect from the HMO. Rather, it mandates that the HMO pay the
doctor directly. It does not involve the patient in the payment process at all.
Emergency Physicians and their supporting amici curiae argue that
emergency room doctors are entitled to a reasonable fee for their services, and that
HMO’s must be held accountable and forced to pay a reasonable amount for those
services. An amicus curiae brief supporting Emergency Physicians adds
arguments that the California Constitution “requires that emergency physicians
receive adequate compensation to cover their losses for serving the indigent,” and
that “California’s emergency departments are already operating at capacity and
risk jeopardizing quality of care.” These arguments do not address the issue
before us. Emergency room doctors are entitled to reasonable payments for
emergency services rendered to HMO patients. All we are holding is that this

entitlement does not further entitle the doctors to bill patients for any amount in
dispute.
Emergency Physicians argue that two recent bills that the Legislature
passed but the Governor vetoed show that the Legislature believes that balance
billing is currently permitted. (Sen. Bill No. 981 (2007-2008 Reg. Sess.); Assem.
Bill No. 2220 (2007-2008 Reg. Sess.).) We find no significance in these bills.
They were legislative attempts to address broader concerns and, perhaps, clarify
what is currently unclear. The Governor’s veto messages state that he opposes
balance billing but found the bills objectionable in other respects. This area of the
law might benefit from comprehensive legislation. Failed attempts to provide
some such legislation do not help us interpret the existing statutory scheme.
In support of its conclusion that emergency room doctors may engage in
balance billing, the Court of Appeal cited a regulation that became operative
sometime before 1978 and requires health care service plans to advise their
subscribers that “in the event the health plan fails to pay a noncontracting
provider, the member may be liable to the noncontracting provider for the cost of
the services.” (Cal. Code Regs., tit. 28, § 1300.63.1, subd. (c)(15).) This
regulation, the Court of Appeal believed, shows that the Department of Managed
Health Care “recognizes balance billing.” (As noted, that department argues
against permitting balance billing in this case.) In our view, the regulation does
not support the conclusion that balance billing is permissible in the situation here.
It was promulgated long before the statute obligating HMO’s to pay for
emergency services was enacted in 1994 and governs a different situation. HMO
members are not required to go to doctors who have contracted with their HMO.
In a nonemergency situation, members may, if they choose, seek professional
services from anyone. If they obtain services from a noncontracting provider, the
HMO might not be obligated to pay all or even part of that provider’s bill,

depending on the exact terms of the health care plan. If the HMO is not obligated
to pay the noncontracting provider, obviously, the member would be liable to pay
for the services. This circumstance does not change the fact that under the Knox-
Keene Act, HMO members are not liable to pay for emergency care.
The Court of Appeal also relied on the fact that the Department of Managed
Health Care had, in the past, proposed but never adopted a regulation that would
prohibit balance billing. While this matter was pending before this court, the
Department of Managed Health Care did adopt a regulation that defines balance
billing as an unfair billing pattern. (Cal. Code Regs., tit. 28, § 1300.71.39.) The
parties dispute the meaning and validity of this regulation and whether we should
give it deference. We need not get into such matters. Although we have given
some deference to contemporaneous interpretations of a statute by an administrative
agency charged with its administration, especially when the interpretation is in the
form of a regulation adopted in accordance with the Administrative Procedure Act
(e.g., Sara M. v. Superior Court (2005) 36 Cal.4th 998, 1011-1014), here the
regulation — adopted during the pendency of this litigation — is not
contemporaneous with the statutory scheme. It is doubtful that we owe the
regulation any deference. (See Dyna-Med, Inc. v. Fair Employment & Housing
Com. (1987) 43 Cal.3d 1379, 1389 [not deferring to a noncontemporaneous
interpretation]; Jones v. Tracy School Dist. (1980) 27 Cal.3d 99, 107 [not deferring
to an interpretation by an agency after the agency had become an amicus curiae in
the case].) We base our holding on our interpretation of the relevant statutory
scheme and not on the previous absence or current presence of any regulation.
The parties discuss the larger problem of adequate compensation for
emergency room doctors. But this larger issue is not before us. Like the Bell
court, “we reject the parties’ suggestion that we can solve the societal and
economic problems defined by their rhetoric, and emphasize that our decision is

limited to the precise issue before us . . . .” (Bell, supra, 131 Cal.App.4th at p.
222.)

CHIN, J.

III. CONCLUSION
We reverse the judgment of the Court of Appeal and remand the matter for
further proceedings consistent with this opinion.

WE CONCUR:

GEORGE, C.J.
KENNARD, J.
BAXTER, J.
MORENO, J.
CORRIGAN, J.
MCDONALD, J.*

_____________________________
* Associate Justice of the Court of Appeal, Fourth Appellate District, Division
One, assigned by the Chief Justice pursuant to article VI, section 6 of the
California Constitution.

See next page for addresses and telephone numbers for counsel who argued in Supreme Court.

Name of Opinion Prospect Medical Group, Inc. v. Northridge Emergency Medical Group
__________________________________________________________________________________

Unpublished Opinion
Original Appeal
Original Proceeding
Review Granted XXX 136 Cal.App.4th 1155
Rehearing Granted
__________________________________________________________________________________

Opinion No. S142209
Date Filed: January 8, 2009
__________________________________________________________________________________

Court: Superior
County: Los Angeles
Judge: Gerald Rosenberg
__________________________________________________________________________________

Attorneys for Appellant:

Bird, Marella, Boxer, Wolpert, Nessim, Drooks & Lincenberg, Thomas R. Freeman; Miller & Holguin,
Stephan, Oringer, Richman, Theodora & Miller, Theodora Oringher Miller & Richman, Harry W. R.
Chamberlain II, Kenneth E. Johnson, Robert M. Dato and Stacey L. Zill for Plaintiffs and Appellants.

Epstein Becker & Green, William A. Helvestine, Michael T. Horan and Carri L. Becker for California
Association of Health Plans as Amicus Curiae on behalf of Plaintiffs and Appellants.

Fulbright & Jaworski, Buchalter, Nemer, Fields & Younger, Buchalter Nemer and Carol K. Lucas for
California Association of Physicians Groups as Amicus Curiae on behalf of Plaintiffs and Appellants.

Amy L. Dobberteen, Debra L. Denton, Michael D. McClelland and Drew Brereton for Department of
Managed Health Care as Amicus Curiae on behalf of Plaintiffs and Appellants.
__________________________________________________________________________________

Attorneys for Respondent:

Howard Rice Nemerovski Canady Falk & Rabkin, Jerome B. Falk, Jr., Ethan P. Schulman, Steven L.
Mayer, Jonas M. Nahoum; Law Offices of Andrew H. Selesnick, Alleguez & Selesnick and Andrew H.
Selesnick for Defendants and Respondents.

Catherine I. Hanson for California Medical Association as Amicus Curiae on behalf of Defendants and
Respondents.

Astrid G. Meghrigian for American College of Emergency Physicians, California Chapter of the American
College of Emergency Physicians and California Chapter, American Academy of Emergency Medicine as
Amici Curiae on behalf of Defendants and Respondents.

Physicians’ Advocates and Charles Bond for American Medical Association as Amicus Curiae on behalf of
Defendants and Respondents.

Hooper, Lundy & Bookman, Lloyd A. Bookman, Suzanne S. Chou and Felicia Y Sze for California
Hospital Association as Amicus Curiae on behalf of Defendants and Respondents.

Counsel who argued in Supreme Court (not intended for publication with opinion):

Thomas R. Freeman
Bird, Marella, Boxer, Wolpert, Nessim, Drooks & Lincenberg
1875 Century Park East, 23rd Floor
Los Angeles, CA 90067-2561
(310) 201-2100

Michael D. McClelland
980 Ninth Street, Suite 500
Sacramento, CA 95814
(916) 323-0435

Jerome B. Falk, Jr.
Howard Rice Nemerovski Canady Falk & Rabkin
Three Embarcadero Center, 7th Floor
San Francisco, CA 94111-4024
(415) 434-1600