LOS ANGELES (Legal Newsline) - California’s Medicaid program was awarded too big a share of a $1.25 million “wrongful life” settlement between a severely disabled child and the doctor who allegedly failed to inform his parents of birth defects in time to abort the fetus, an appeals court ruled.
Saying a trial court got the math wrong, California’s Second District Court of Appeals remanded the case of Daniel C. to recalculate how much of the settlement the child’s parents must surrender to Medi-Cal to compensate the child’s medical care. In August 2020, the trial court ruled that Medi-Cal could recover $229,696, reflecting $358,000 in past medical expenses the state program paid, minus 25% in plaintiff attorney fees.
The trial court failed to make precise calculations of past and future medical expenses, however, the appeals court ruled in a May 26 decision. State law gives Medi-Cal the power to recover its outlays when someone wins an injury settlement from a third party, but federal law and a U.S. Supreme Court decision limit how aggressive the state can be in getting that money. An “anti-lien” provision in federal law prevents the state from placing a lien on a beneficiary’s personal assets, although California courts have interpreted that to exclude settlement proceeds designated for medical expenses.
Daniel’s parents argued the court approved a $1.25 million of a $13.7 million claim, meaning they only got 9% of what they were seeking. Medi-Cal said it has paid all of Daniel’s medical expenses so far and is likely to continue to pay them in the future. But the appeals court said the trial record doesn’t provide enough evidence that is the case.
On remand, the court must determine how much California will pay in future medical expenses as a share of the $13 million his parents said their original claim was worth, plus how much the state has paid for Daniel’s care so far. Then it must subtract 25% from that to account for his legal fees.
California has allowed some form of “wrongful life” suit since the state Supreme Court in 1982 decided Turpin v. Sortini, awarding the cost of medical care for a child who was born with a hereditary condition that could have been avoided before conception if his parents had been notified they both carried genes for the disease. Plaintiffs can only recover medical expenses and other costs directly related to the care of a child born with birth defects.