Opinion
NOT TO BE PUBLISHED
Super. Ct. No. 04AS02982
BLEASE, Acting P. J.
Defendant Patricia Irene Gallegos appeals from the judgment awarding plaintiff Fong Her $104,589.25 in special and general damages for personal injuries sustained in an automobile collision caused when Gallegos drove her vehicle through a red light and struck Her’s vehicle.
Her was taken to the trauma unit at the University of California Davis (University) where he was examined and treated. The University submitted a bill of $15,705 for its medical services. Medi-Cal paid the University $418.97 as payment in full and the University wrote off the unpaid balance.
On the question of special and general damages, Gallegos proffered evidence of the amount Medi-Cal paid to the University for the purpose of limiting Her’s recovery for medical expenses and to rebut Her’s evidence that the amount billed by the University was the reasonable value of its services. The trial court excluded the evidence finding it would be misleading as to the reasonable value of the medical expenses and in a post-verdict hearing, reduced the amount of the special damages for medical expenses to those actually paid by Medi-Cal.
On appeal, defendant contends the trial court erred by excluding this evidence on the question of general damages. We find no error and shall affirm the judgment.
FACTUAL AND PROCEDURAL BACKGROUND
On September 21, 2003, Gallegos ran a red light at the intersection of Palmer House and Florin Road in Sacramento and hit Her’s Honda Civic broadside just as he was driving through the intersection. Gallegos was traveling approximately 40 to 45 miles per hour at the time of the collision.
The impact propelled the Honda across the intersection and into a fence, causing Her to lose consciousness. The car door on the driver’s side was crushed, pinning Her’s legs together and trapping him inside. Rescue personnel cut open the door and Her was transported by ambulance to the trauma center at the University where he was given a “complete trauma exam” that involved extensive diagnostic testing to determine the extent of his injuries. He was diagnosed with a closed-head injury resulting in a concussion and a contusion on his left thigh.
According to Dr. Sokolove, the emergency room physician, although Her’s x-rays were normal, he could not rule out soft-tissue injuries because those type of injuries are not reflected by x-rays but will more likely than not occur in this type of collision. After five hours of testing and observation, Her was discharged from the hospital, able to walk without assistance.
The University submitted an itemized bill for its services in the amount of $15,705.00, which according to Dr. Sokolove, was a reasonable charge for the medical services provided to Her.
Her awoke the next morning with leg, neck, and back pain and some memory loss. The following day, he sought treatment from Dr. Yang, a chiropractor. He had difficulty walking on his left leg, had limited range of motion in his neck, and was experiencing a great deal of pain. Dr. Yang diagnosed Her’s neck and back injuries as whiplash, a soft-tissue injury to those areas, and began treatment three times a week. Dr. Yang saw some improvement in Her’s condition in October and reduced the number of treatments to twice weekly. Her stopped going to Dr. Yang in December because, although he was still in pain, he was unable to pay for further treatment on his salary as a store clerk.
Prior to the collision, Her was a physically active 18 year-old who enjoyed running and had run cross-country track while in high school. He had been employed as a cashier at Frye’s Electronics where he also helped load heavy purchases into customer’s vehicles. As a result of his injuries, Her missed about nine days of work and at the time of trial, suffered persistent leg pain and occasional neck and back pain. He also continued to have some short term memory loss, which affected him “a lot.” Because of the pain, he no longer ran or did any lifting.
Her filed the instant suit to recover damages for negligence. Gallegos conceded liability and the matter was tried before a jury solely on the question of damages. The jury returned a special verdict finding Gallegos liable in the amount of $119,875.28 for past medical expenses, which included inter alia, $15,705 for medical care and services provided by the University and general damages for past and future noneconomic losses of $100,000.
The 28 cents in the jury’s award of $119,875.28 is not supported by the sum of the individual components.
The special damage award also included $990 for ambulance services, $2,610 for chiropractic services, and $570 for past lost earnings.
In a post-verdict hearing, the trial court reduced the award of damages to $104,589.25 pursuant to Hanif v. Housing Authority (1988) 200 Cal.App.3d 635 (Hanif), which limits the award for medical expenses to the amount paid by Medi-Cal. Gallegos filed a timely notice of appeal from the judgment.
DISCUSSION
Gallegos contends the trial court erred by excluding her proffered evidence that Medi-Cal did not pay most of the University’s bill, arguing that this evidence was relevant to rebut the reasonable value of the University’s charges. Her contends there was no abuse of discretion. We agree with Her.
A. Procedural Background
Her initially moved in limine under Hanif, supra, 200 Cal.App.3d 635, to exclude evidence of the University’s charges in excess of the amount ($418.97) paid by Medi-Cal, while Gallegos opposed the motion and moved to exclude evidence of the Medi-Cal lien.
The trial court agreed with Her and ruled that evidence of the Medi-Cal lien was inadmissible to prove the amount paid for the medical expenses because the document proffered in support of the lien was “ambiguous on its face” and failed to establish that Her’s liability was limited to the amount of the lien. The court reserved the right to modify the judgment to the amount actually paid for the medical expenses if Gallegos provided further evidence on the legal significance of the Medi-Cal lien.
The court further ruled that the amount of the lien was inadmissible to prove the reasonable value of the medical expenses because it would be misleading to the jury in determining the value of the medical services actually provided. The court found that evidence of the University’s total charges was a more accurate indicator of the extent of Her’s injuries because the University had provided extensive medical services while the amount paid was “nominal.”
At the close of Her’s case in chief, the court heard defense evidence outside the presence of the jury on the question of the Medi-Cal lien. Rosanna Villanueva, a senior tax-compliance representative supervisor with the State Department of Health Services, Medi-Cal Recovery Branch, testified that when a Medi-Cal recipient is injured by a third party who is liable for those injuries, the Medi-Cal Recovery Branch may place a lien against the judgment in the third-party action in order to recover the funds it paid for medical expenses incurred by the injured Medi-Cal recipient.
Medi-Cal recipients may elect to receive “straight Medi-Cal” or be enrolled in a Medi-Cal managed care plan. At the time of the collision, Her was a Medi-Cal recipient in a managed-care plan covered by Health Net. As part of that plan, the state contracted with Health Net to provide Medi-Cal coverage to eligible recipients, paid Health Net a fixed sum per recipient, and Health Net agreed to give Medi-Cal the lien rights to collect the amount Health Net paid for the recipient’s medical services from the liable third party. As required, Health Net notified Medi-Cal of the third-party lawsuit and advised Medi-Cal it had paid the University $418.97 for its medical expenses. Medi-Cal then sent a final lien notice to Her’s counsel for that amount. Health Net cannot seek reimbursement from the Medi-Cal recipient.
Health Net’s report to Medi-Cal shows the date of service, the name of the provider, the billed amount, and the amount paid. Payment was broken down as follows: $336.51 for the medical center, $44.60 for Dr. Sokolove and $37.86 for Dr. McFall.
At the end of the hearing, the court affirmed its earlier ruling that in fairness, evidence of the lien amount remained inadmissible but reserved the right to reduce the verdict if counsel provided further evidence from the University as to its lien rights.
The court was not satisfied as to the University’s lien rights and whether all of the bills had been submitted to Medi-Cal. After the jury returned its verdict, the defense called Karen Weekes, the custodian of records at the University who testified that the total payment made to the University by Medi-Cal for the medical services rendered to Her was $478.02 and that the University accepted that amount as full and final payment of its bill and wrote off the unpaid balance. No amount remained due by anyone.
Defendant asserts the trial court voiced two reasons for its decision to exclude evidence of the amount of the Medi-Cal claim. We disagree. Evidence of the lien was proffered for two purposes, (1) to limit the amount of the special damages recoverable for medical expenses under Hanif, supra, 200 Cal.App.3d 635 and (2) to rebut evidence of the reasonable value of the medical expenses as a basis for determining general damages. As to the first purpose, the court was concerned about the legal effect of the lien on the Hanif issue, but ultimately ruled in Gallegos’ favor and reduced the award for medical expenses. As to the second purpose, the court excluded evidence of the amount of the lien under Evidence Code section 352 because it concluded the nominal amount of the lien was an inaccurate measure of the value of the medical expenses and would mislead the jury. We therefore consider whether the court abused its discretion in excluding the amount of the lien.
B. Analysis
The trial court has broad discretion over the admission and exclusion of evidence. (Greer v. Buzgheia (2006) 141 Cal.App.4th 1150, 1156.) Although all relevant evidence is admissible (Evid. Code, § 351), the trial court has discretion to “exclude evidence if its probative value is substantially outweighed by the probability that its admission will (a) necessitate undue consumption of time or (b) create substantial danger of undue prejudice, of confusing the issues, or of misleading the jury.” (Evid. Code, § 352.)
Relevant evidence “means evidence . . . having any tendency in reason to prove or disprove any disputed fact that is of consequence to the determination of the action.” (§ 210.)
The trial court has broad discretion under section 352 to weigh the probative value of proffered evidence against its prejudicial impact (People v. Harrison (2005) 35 Cal.4th 208, 234) and its determination will not be overturned on appeal unless one factor clearly outweighs the other. (Akers v. Miller (1998) 68 Cal.App.4th 1143. 1146.)
In a tort action, the plaintiff is entitled to recover special damages for past medical expenses for “the reasonable value of medical services rendered to the plaintiff, including the amount paid by a collateral source, such as an insurer.” (Nishihama v. City and County of San Francisco (2001) 93 Cal.App.4th 298, 306 (Nishihama); Smalley v. Baty (2005) 128 Cal.App.4th 977, 984 (Smalley).)
However, as the court held in Hanif, supra, 200 Cal.App.3d at page 643, the plaintiff is only entitled to recover “up to, and no more than, the actual amount expended or incurred for past medical services so long as that amount is reasonable,” even if that amount “may have been less than the prevailing market rate.” (Id. at p. 641.) The court therefore directed a reduction of the award for past medical services and care because the amount charged exceeded the amount paid by Medi-Cal. (Id. at pp. 643-644.)
Medi-Cal is California’s medical assistance program, which pays medical costs for financially needy persons. (Olszewski v. Scripps Health (2003) 30 Cal.4th 798, 804.) Final payment by Medi-Cal to a medical provider constitutes payment in full (Welf. & Inst. Code, § 14019.3, subd. (d)) and a provider that accepts payment from Medi-Cal is precluded from seeking the unpaid balance other than the nominal deductible or cost sharing amount from the Medi-Cal recipient. (42 C.F.R. § 447.15; Welf. & Inst. Code, §§ 14019.3, subd. (d), 14019.4, subd. (a); Olszewski v. Scripps Health, supra, 30 Cal.4th at pp. 820, 822.) Medi-Cal, on the other hand, may under certain circumstances, seek reimbursement from the recipient or other responsible party for the amount it paid the provider. (42 U.S.C. §§ 1396a, subd. (a)(25)(B)and (a)(45), 1396k, subds. (a)(1)(A) and (b); Arkansas Dept. of Health & Human Services v. Ahlborn (2006) 547 U.S. 268, __ [164 L.Ed.2d 459, 469, 474].)
The parties do not dispute this principle or its application. The amount of Medi-Cal’s lien was directly relevant to the question of special damages for medical expenses and was admissible for that purpose. However, because the trial court ultimately applied the rule stated in Hanif by reducing the jury’s award for medical expenses to the amount paid by Medi-Cal, exclusion of the evidence of the lien amount had no prejudicial effect on this issue.
Turning to the question whether the trial court abused its discretion by excluding the lien amount on the issue of general damages, we conclude it did not. General damages compensate the plaintiff for noneconomic injuries resulting from past and future physical, mental, and emotional suffering. (Greater Westchester Homeowners’ Assn. v. City of Los Angeles (1979) 26 Cal.3d 86, 103.) In determining the amount of those damages “the cost of medical care often provides both attorneys and juries in tort cases with an important measure for assessing the plaintiff’s general damages.” (Helfend v. Southern Cal. Rapid Transit Dist. (1970) 2 Cal.3d 1, 11.) Moreover, there is no reason to assume the usual rates charged by the provider are a less accurate indicator of the extent of the plaintiff’s injuries than the lower rates negotiated by the insurer. (Nishihama, supra, 93 Cal.App.4th at p. 309.)
Citing Latky v. Wolfe (1927) 85 Cal.App. 332 and Smalley, supra, 128 Cal.App.4th 977, Gallegos argues that the amount of the Medi-Cal lien was relevant to rebut the inference the amount charged by the University was the reasonable value of the medical expenses. We disagree and find both cases inapposite because neither case addressed the exclusion of evidence that a third party insurer paid only a nominal portion of the charged medical expenses in connection with an award for general damages.
Latky, supra, 85 Cal.App. 332 merely applied the rule stated in Hanif by reducing the award of special damages for medical expenses by the amount of the bills that were not shown to have been paid. There was no claim that excluding evidence of nonpayment of certain bills prejudicially affected the general damage award. (Id. at pp. 347, 349-352.)
Nevertheless, Gallegos relies on language in Smalley, supra, 93 Cal.App.4th at page 985, where the court recognized that “‘[i]n some instances . . . evidence that a medical bill was not paid may be introduced to show that the amount charged was unreasonable.’” Although this language is dicta, we have no quarrel with it. It is significant however, that the statement is qualified by the words “‘[i]n some instances’” and the present case is not one of those instances.
There may be any number of reasons for nonpayment of a bill. In the case of an insurer, the reason may be a negotiated rate or lack of coverage. Here, however, Gallegos failed to present any evidence as to why Medi-Cal paid such a nominal portion of the University’s bill or that the University performed unnecessary tests or other procedures or charged excessive fees for the ones it performed. While Gallegos argues the lien amount is itself some evidence the charges were excessive, she failed to proffer any evidence as to how Health Net arrived at the amount it paid. In the absence of such evidence, the meager amount of the lien, which is less than two percent of the charges billed, had little if any probative value to prove the reasonableness of those charges, much less the extent of Her’s injuries.
We therefore agree with the trial court below that the amount of the lien would have misled the jury as to the reasonable value of the medical expenses. Without evidence explaining how Health Net arrived at the amount it paid to the University, the jury would be free to speculate and draw an unsupported inference that the University’s charges were unreasonable.
Gallegos argues however, that the unchallenged medical bill led the jury to believe Her’s relatively minor injuries were more serious than they actually were, leading to an award of $100,000 for pain and suffering. We disagree. The medical bill went unchallenged because, as stated above, Gallegos failed to proffer any relevant evidence to prove the reasonable value of the medical expenses. Nor was the jury misled on the nature of Her’s injuries. The evidence clearly established that the University’s charges were largely for diagnostic tests and that Her’s injuries were limited to a concussion and soft tissue injuries. Nevertheless, evidence unrelated to the University’s billing, established that Her’s injuries caused him to suffer a great deal of pain, limited his range of motion and mobility, for which he required at least three months of chiropractic treatment, and continued to plague him two years after the collision.
For these reasons, we find the trial court did not abuse its discretion by excluding the amount of the lien on the issue of general damages.
DISPOSITION
The judgment is affirmed. Fong Her is awarded his costs on appeal. (Cal. Rules of Court, rule 8.276(a)(1).)
We concur: RAYE, J., MORRISON, J.
In Smalley, supra, 128 Cal.App.4th 977, the court held that where the award for medical expenses was less than the actual amount paid by the plaintiff, it was a prejudicial abuse of discretion to exclude evidence that the plaintiff had paid his own medical bills. (Id. at p. 986.)