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Lomeli v. State Department of Health Care Services

California Court of Appeals, Second District, Eighth Division

June 25, 2019

ETHAN LOMELI, a Minor, etc., Plaintiff and Appellant,

          APPEAL from an order of the Superior Court of Los Angeles County, No. BC569989 Lori Ann Fournier, Judge. Affirmed.

          Steven B. Stevens and Steven Weinberg, for Plaintiff and Appellant.

          Xavier Becerra, Attorney General, Julie Weng-Gutierrez, Senior Assistant Attorney General, Richard T. Waldow, Supervising Deputy Attorney General, Nicole J. Kau, Deputy Attorney General, for Defendant and Respondent.

          WILEY, J.

         If you are needy and someone injures you, the government may pay for your medical care but later ask you for repayment if you get a large settlement from the tortfeasor. In California this is by way of Medi-Cal. Medi-Cal seeks repayment from people with settlements so it can provide care to others in need.

         This case displays that situation. The trial court approved the existence and amount of the Medi-Cal settlement lien in this case. We affirm. Statutory citations are to the Welfare and Institutions Code.


         We recount the main facts, which are undisputed.

         Ethan Lomeli's guardian sued medical care providers for his catastrophic birth injuries. Through the Medi-Cal system, the Department of Health Care Services paid for his care before and during his lawsuit. Lomeli settled with defendants for $4 million. The Department moved to impose a $267, 159.60 lien on this settlement. The trial court granted this motion. Lomeli appeals this May 23, 2018 order.


         Federal law does not block the Department's lien. Our review of this legal question is independent.

         Lomeli argues to the contrary, saying sections 14124.72 and 14124.76 violate the Supremacy Clause of the federal constitution. Lomeli's argument relies solely on an analysis from the dissent in Tristani ex rel. Karnes v. Richman (3rd Cir. 2011) 652 F.3d 360, 379-387 (Tristani). The trial court went with the Tristani majority. So do we. At pages 367-375, the Tristani majority correctly determined federal law does not prohibit liens like this one.

         Briefly, the Tristani debate is this. The Tristani majority held two provisions of the Social Security Act did not bar state Medicare liens. To effectuate Congress's goals in enacting the federal Medicare program, the Tristani majority interpreted federal statutes as containing implied exceptions to provisions that otherwise seemed to bar the liens. (See Tristani, supra, 652 F.3d at p. 370.) The dissent agreed some implicit federal exception to these two Social Security statutes did exist. (Id. at pp. 384 (dis. opn. of Pollack, J.) [“must constitute an explicit exception”] & 385 (dis. opn. of Pollack, J.) [“a limited implied exception must be read into the anti-recovery provision”].) The dissent argued this implicit exception was narrower than the majority's expression of it.

         The Tristani majority analysis is better for two reasons.

         First, a desire to effectuate the legislative purpose drove the majority's analysis.

         “The dominant mode of statutory interpretation over the past century has been one premised on the view that legislation is a purposive act, and judges should construe statutes to execute that legislative purpose. This approach finds lineage in the sixteenth-century English decision Heydon's Case, which summons judges to interpret statutes in a way ‘as shall suppress the mischief, and advance the remedy.'” (Katzmann, Judging Statutes (2014) p. 31.)

         California courts follow this dominant mode. In our state, we must interpret words to promote rather than to defeat the general purpose of a statute. Suppose the language of a statute is reasonably susceptible of two constructions. If one would produce results that are reasonable, fair, and harmonious with the statute's manifest purpose, and another would produce absurd consequences, we must adopt the former construction. (Department of Motor Vehicles v. Industrial Acc. Com. (1939) 14 Cal.2d 189, 195.) Like the Tristani majority, our fundamental task is to ascertain the intent of the lawmakers to effectuate the purpose of the statute. (E.g., Apple Inc. v. Superior Court (2013) 56 Cal.4th 128, 135.)

         Federal and California state law agree on this point: read a statute to effectuate its purpose. The Tristani majority correctly discerned Congress's purpose: to ensure Medicaid beneficiaries do not receive a windfall by recovering ...

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