Opinion
G063923
10-09-2024
BENEFICIARY A et al., Plaintiffs and Appellants, v. MICHAEL HUNN, as Chief Executive Officer, etc., et al. Defendants and Respondents.
Jones Day, Eric C. Tung, Sarah G. Conway, and Jeremy R. Kauffman for Plaintiffs and Appellants. Procopio, Cory, Hargreaves & Savitch, Kendra J. Hall, Paul A. Tyrell, and Justin Martin; Kennaday Leavitt, Troy R. Szabo, and James F. Novello for Defendants and Respondents.
NOT TO BE PUBLISHED
Appeal from orders of the Superior Court of Orange County, No. 30-2024-01375928 Scott A, Steiner, Judge. Affirmed. Request for judicial notice denied.
Jones Day, Eric C. Tung, Sarah G. Conway, and Jeremy R. Kauffman for Plaintiffs and Appellants.
Procopio, Cory, Hargreaves & Savitch, Kendra J. Hall, Paul A. Tyrell, and Justin Martin; Kennaday Leavitt, Troy R. Szabo, and James F. Novello for Defendants and Respondents.
OPINION
GOETHALS, J.
The Orange County Health Authority (CalOptima) operates the Medi-Cal and Medicare programs in Orange County, providing services to qualified county residents through its contracted provider network of over 30 local hospitals. Some months ago, CalOptima decided to terminate its hospital services contracts with four of those hospitals. As a result, CalOptima members can no longer receive non-emergency medical treatment at those hospitals.
Eight CalOptima members filed a petition for writ of mandate and sought a preliminary injunction requiring CalOptima to "retain" its now-cancelled contracts with those hospitals. The trial court denied injunctive relief, concluding the petitioners had not established a likelihood of success on the merits or demonstrated that the balance of harms weighed in their favor. Finding no abuse of discretion, we affirm.
FACTS
CalOptima operates the Medi-Cal and Medicare programs in Orange County. The system provides services to nearly one million members, including some of the county's most vulnerable residents.
Established under title XIX of the Social Security Act (42 U.S.C. § 1396 et seq.), the federal Medicaid program provides funds to the states to defray the cost of medical care for qualified low-income persons. (Blue v. Bonta (2002) 99 Cal.App.4th 980, 985.) The Medi-Cal program implements Medicaid in California. (Ibid.)
CalOptima's contracted provider network presently includes about three dozen hospitals. CalOptima members use these hospitals for a variety of purposes, including emergency care, post-stabilization services, and primary and specialty care.
Until recently, CalOptima's network also included four private hospitals that are part of Prime Healthcare: (1) Garden Grove Hospital Medical Center, (2) La Palma Intercommunity Hospital, (3) Huntington Beach Hospital, and (4) West Anaheim Medical Center (collectively, the Prime Hospitals). All four Prime Hospitals are "safety-net providers," meaning they provide services to a significant number of Medi-Cal recipients, patients who receive charity, and patients who are medically underinsured, in relation to the number of patients served.
According to Prime Healthcare's president, in the past two years, Medi-Cal patients accounted for over 30 percent of inpatient discharges and inpatient days and over 50 percent of emergency department visits at the four Prime Hospitals.
Last year, CalOptima decided to terminate its hospital services contracts with the Prime Hospitals. In November 2023, CalOptima gave the Prime Hospitals notice of its decision, advising the termination would take effect on February 5, 2024. Each notice cited the contract's "termination without cause" provision, which allows either party to terminate the contract without cause upon 90 days' written notice.
The notices did not specify a reason for the terminations. However, CalOptima later explained it terminated the contracts in order "to operationally align its overall healthcare delivery network." According to CalOptima's chief operating officer, during the previous 12-month period, only about 1.5 percent of its members had used the Prime Hospitals, 98.6 percent of those visits were to the emergency departments (which are unaffected by the contract terminations), and only 364 visits were not provided or admitted through the emergency department.
Before terminating the contracts, CalOptima gave notice of the contract terminations to the Department of Health Care Services (DHCS), the agency that regulates CalOptima's Medi-Cal program; such notice was required because the terminations would "impact[] 2,000 or more members." DHCS reviewed and approved CalOptima's written plan for transitioning away from the Prime Hospitals as network providers.
During the review process, DHCS required CalOptima to demonstrate that it would continue to maintain an adequate network for its members and ensure continuity of care. In response, CalOptima provided a map of in-network hospitals within three, five, and ten mile radii of each Prime Hospital; it also included a table showing the services offered at each Prime Hospital, the nearest in-network hospitals that provide those services, and the travel time and distance to those hospitals. DHCS approved the termination plan.
According to that table, all services offered at Garden Grove Hospital Medical Center are available at an in-network hospital two miles away; all services offered at West Anaheim Medical Center are available at an in-network hospital five miles away; all services offered at La Palma Intercommunity Hospital are available at an in-network hospital five miles away, except psychiatric services, which are available at a hospital nine miles away; and all services offered at Huntington Beach Hospital are available at an in-network hospital two miles away, except psychiatric services, which are available at a hospital 12 miles away.
On January 5, 2024, CalOptima sent a termination notice to all members who had recently used a Prime Hospital or who had upcoming care scheduled at a Prime Hospital, advising them it was eliminating the Prime Hospitals from its network. The notice explained that after the contract termination on February 5, 2024, members could no longer obtain healthcare from the Prime Hospitals, though they could "continue to seek emergency medical treatment" there. The notice also explained that if CalOptima or the member's network authorized services to be provided by that Prime Hospital, then the member could continue to receive those services at that hospital.
As stated in the notices, the contract terminations do not affect members' ability to seek emergency medical services from the Prime Hospitals; members who enter the Prime Hospitals' emergency departments will continue to receive emergency and stabilizing care as required by law. However, once a patient is stabilized following emergency treatment at a Prime Hospital, CalOptima may transfer him or her to an in-network hospital at CalOptima's expense.
CalOptima members generally will no longer receive non-emergency services at the Prime Hospitals and will instead need to go to a nearby in-network hospital to receive such services. Of the 35 in-network hospitals with which CalOptima contracts, seven are within five miles of the Prime Hospitals.
The petitioners in this action, Beneficiaries A, B, C, D, E, F, G, and H (collectively, Plaintiffs), allege they are beneficiaries of Medi-Cal and are dependent upon the Prime Hospitals for their medical needs. Like many Medi-Cal users, some face barriers to accessing healthcare and are therefore more reliant on emergency and acute inpatient hospital care than other individuals. Some Plaintiffs are experiencing homelessness. Others lack access to transportation and so they depend on the Prime Hospitals' proximity to their homes.
Plaintiffs' names were filed under seal to preserve the confidentiality of their private medical information.
On January 29, 2024, just a few weeks after receiving notice of CalOptima's plan to eliminate the Prime Hospitals from its network, and one week before the effective date of the contract terminations, Plaintiffs filed a petition for writ of mandate and complaint for declaratory relief. In their prayer for relief, Plaintiffs sought (among other things) an order enjoining CalOptima "from eliminating the [Prime] Hospitals from CalOptima's network and compelling CalOptima to retain the [Prime] Hospitals in its network."
Two days later, Plaintiffs filed an ex parte application for a temporary restraining order (TRO) to prevent CalOptima from eliminating the Prime Hospitals from its network. Their proposed order granting the TRO sought to (1) enjoin "CalOptima's elimination of four safety-net hospitals-Garden Grove Hospital Medical Center, La Palma Intercommunity Hospital, Huntington Beach Hospital, and West Anaheim Medical Center-from the CalOptima Medi-Cal network and the termination of each of these hospital's contracts with CalOptima to provide services to CalOptima members"; and (2) require CalOptima to "provide notice to Petitioners and all CalOptima members that these four hospitals remain in the CalOptima network temporarily and that members can continue to receive all covered care at the hospitals."
At the TRO hearing on February 2, the trial court expressed concern about an apparent lack of irreparable harm to Plaintiffs, given that they can continue to receive emergency and stabilization care at the Prime Hospitals notwithstanding the contract terminations. Plaintiffs' counsel acknowledged that CalOptima members will still receive emergency care at the Prime Hospitals, but explained "what happens next is the problem": members will have to be transferred from Prime Hospital emergency departments to in-network hospitals for post-stabilization care, and those transfers are inefficient, are often delayed, and will hinder patient care. Plaintiffs' counsel also argued CalOptima members might choose to forego medical care altogether because their usual hospitals are no longer in-network. Unpersuaded, the court found no irreparable harm to Plaintiffs, denied Plaintiffs' TRO request, and set a hearing for an order to show cause.
One week later on February 9, after the February 5 termination of CalOptima's contracts with the Prime Hospitals, Plaintiffs filed a motion for preliminary injunction, asking the trial court to "preserv[e] the status quo that existed when this litigation was filed, and requir[e] CalOptima to retain the [network contracts for the] Hospital's [sic] in-network until final judgment." Plaintiffs argued that CalOptima is contractually obligated to retain the Prime Hospitals as safety-net hospitals, that the elimination of the contracts rendered CalOptima's network inadequate in violation of its statutory obligations, and that its termination of the contracts was arbitrary and therefore an abuse of discretion.
Plaintiffs' moving papers did not include a notice of motion, an order to show cause, or a new proposed order separate from the previously requested TRO. (See Cal. Rules of Court, rule 3.1150(a), (c).) After CalOptima opposed the motion on due process grounds (among other arguments), Plaintiffs belatedly filed a notice of motion asking for an injunction to "preserve the status quo that existed when this litigation was filed, and requir[e] CalOptima to retain the network contracts for the four safety-net hospitals-Garden Grove Hospital Medical Center, La Palma Intercommunity Hospital, Huntington Beach Hospital, and West Anaheim Medical Center-until final judgment."
Plaintiffs maintain that CalOptima, as a county organized health system, is required to maintain an adequate network of providers and ensure its members have reasonably timely access to care and continuity of care. (See Health & Saf. Code, §§ 1367, subd. (d) & (e), 1367.03, subd. (a)(1); Welf. & Inst. Code, §§ 14184.200, subd. (a)(2), 14197; Cal. Code Regs., tit. 28, §§ 1300.67.2, 1300.67.2.2, subd. (c); see also 42 C.F.R. § 438.206 (2024).)
To demonstrate that CalOptima is contractually obligated to retain the Prime Hospitals as safety-net hospitals, Plaintiffs cited two provisions in CalOptima's contract with DHCS (§§ 3.1.8.A and 5.2.3.H). These provisions require CalOptima to offer a contract to and include in its network any safety-net provider that is willing to contract with CalOptima under the same terms and conditions that CalOptima requires of other similar providers.
To show that CalOptima's network had been rendered inadequate, Plaintiffs submitted declarations by several Prime Hospital doctors, who recounted recent instances where CalOptima patients had sought treatment at the Prime Hospitals' emergency departments after the contract terminations and had suffered "agonizing" delays while awaiting post-stabilization transfers to nearby in-network hospitals. According to a declaration by Prime Healthcare's president, in the four days that had passed since the contract terminations, the average transfer time for patients was 26 hours, with some patients waiting more than 60 hours.
CalOptima objected to much of Plaintiffs' evidence, asserting the doctor declarations lacked foundation and were based on speculation or hearsay. CalOptima also opposed Plaintiffs' motion, asserting various procedural defects, lack of irreparable harm, and lack of a likelihood of success on the merits.
Among other things, CalOptima argued the contract terminations are expressly allowed by CalOptima's contract with DHCS, which requires CalOptima to give DHCS 60 days' notice of its intent to terminate a network provider agreement with a safety-net provider (§ 3.1.8.B). CalOptima also argued much of Plaintiffs' data on increased transfers was inaccurate or misleading, and its remaining network was adequate to provide all required services, as confirmed by DHCS's approval of the contract terminations.
As for the balancing of the harms, CalOptima asserted Plaintiffs would not be harmed since they could continue to receive emergency care at the hospital of their choice, and there was no evidence the alleged transfer delays had been caused by the contract terminations. Instead, CalOptima claimed the delays resulted from the Prime Hospitals' retaliatory insistence on unnecessary transfers. CalOptima also asserted that if it were required to enter into new contracts with the Prime Hospitals, it would suffer significant financial and administrative hardships.
In their reply, Plaintiffs submitted supplemental doctor declarations providing additional information about transfer delays that occurred after Plaintiffs' motion was first filed. CalOptima again objected to those declarations.
After hearing oral argument and taking the matter under submission, the trial court denied Plaintiffs' motion for preliminary injunction. The court first ruled on the parties' respective evidentiary objections, sustaining without discussion CalOptima's objections to over 40 paragraphs in Plaintiffs' doctor declarations. The court also found that issuing the requested injunction would be procedurally improper because the act Plaintiffs sought to enjoin (i.e., the contract terminations) had already occurred.
Though not addressed in its minute order, during oral argument the trial court indicated it would not consider Plaintiffs' supplemental doctor declarations "because it was reply evidence," "[i]t was not timely," and CalOptima "didn't have a chance to respond."
The trial court then ruled that even if a preliminary injunction could be issued under the circumstances, Plaintiffs had not established a likelihood of prevailing on the merits. The court found CalOptima had acted permissibly under the terms of its contracts with both DHCS and the Prime Hospitals and with the approval of DHCS. It further found Plaintiffs had failed to submit admissible evidence showing the CalOptima network is inadequate to ensure proper care for its patients.
Finally, the trial court found the balance of harm did not support injunctive relief. It noted Plaintiffs' evidence of harm (i.e., the doctor declarations) was speculative and often included hearsay, Plaintiffs had not submitted declarations from the patients themselves attesting to the alleged harm, and they had not submitted any evidence demonstrating that CalOptima's actions had deteriorated patients' medical conditions or caused excessive wait times. CalOptima, on the other hand, had presented evidence that nearly all member visits to the Prime Hospitals were for emergency department visits, which are not impacted by the contract terminations, and members could obtain non-emergency care at multiple other in-network hospitals not far away from the Prime Hospitals.
Plaintiffs filed a notice of appeal from the orders denying their application for TRO and motion for preliminary injunction. They then requested an expedited appeal schedule, which we granted in part.
DISCUSSION
I.
Standard of Review
"As its name suggests, a preliminary injunction is an order that is sought by a plaintiff prior to a full adjudication of the merits of its claim." (White v. Davis (2003) 30 Cal.4th 528, 554, italics omitted.) "To obtain a preliminary injunction, a plaintiff ordinarily is required to present evidence of the irreparable injury or interim harm that it will suffer if an injunction is not issued pending an adjudication of the merits." (Ibid.)
'"[T]rial courts should evaluate two interrelated factors when deciding whether or not to issue a preliminary injunction. The first is the likelihood that the plaintiff will prevail on the merits at trial. The second is the interim harm that the plaintiff is likely to sustain if the injunction were denied as compared to the harm that the defendant is likely to suffer if the preliminary injunction were issued.'" (ITV Gurney Holding Inc. v. Gurney (2017) 18 Cal.App.5th 22, 28-29.)
We review the trial court's evaluation of the parties' likelihood of success and weighing of the balance of harm for abuse of discretion; such abuse occurs when a court's ruling exceeds the bounds of reason or contravenes the uncontradicted evidence. (Anderson v. County of Santa Barbara (2023) 94 Cal.App.5th 554, 568; Oiye v. Fox (2012) 211 Cal.App.4th 1036, 1047 (Oiye).) We review the court's factual findings for substantial evidence, interpreting the facts in the light most favorable to the prevailing party and indulging in all reasonable inferences in support of the court's order. (Anderson, at p. 568; Costa Mesa City Employees Assn. v. City of Costa Mesa (2012) 209 Cal.App.4th 298, 306.) In applying these standards, we disregard contrary evidence, and we cannot reweigh the evidence. (Loy v. Kenney (2022) 85 Cal.App.5th 403, 406 (Loy).)
"When a trial court denies an application for a preliminary injunction, it implicitly determines that the plaintiffs have failed to satisfy either or both of the 'interim harm' and 'likelihood of prevailing on the merits' factors." (Cohen v. Board of Supervisors (1985) 40 Cal.3d 277, 286 (Cohen).) To prevail in an appeal from an order denying a motion for preliminary injunction, the appellant must show "the trial court abused its discretion in ruling on both factors. Even if the appellate court finds that the trial court abused its discretion as to one of the factors, it nevertheless may affirm the trial court's order if it finds no abuse of discretion as to the other." (Id. at pp. 286-287.)
II. Mandatory or Prohibitory Injunction
An injunction can be prohibitory or mandatory, or both. (Ironridge Global IV, Ltd. v. ScripsAmerica, Inc. (2015) 238 Cal.App.4th 259, 265, fn. 4.) A prohibitory injunction is one that "that requires no action and merely preserves the status quo." (Daly v. San Bernardino County Bd. of Supervisors (2021) 11 Cal.5th 1030, 1035 (Daly).) A mandatory injunction "requires] the defendant to take affirmative action." (Ibid.)
The distinction may be significant here, because mandatory preliminary injunctions are "scrutinized even more closely on appeal: """The judicial resistance to injunctive relief increases when the attempt is made to compel the doing of affirmative acts. A preliminary mandatory injunction is rarely granted, and is subject to stricter review on appeal."' [Citation.] The granting of a mandatory injunction pending trial '"is not permitted except in extreme cases where the right thereto is clearly established.'"'" (City of Corona v. AMG Outdoor Advertising, Inc. (2016) 244 Cal.App.4th 291, 299 (Corona).)
"'The principles upon which mandatory and prohibitory injunctions are granted do not materially differ. The courts are perhaps more reluctant to interpose the mandatory writ, but in a proper case it is never denied.'" (Ryland Mews Homeowners Assn. v. Munoz (2015) 234 Cal.App.4th 705, 712, fn. 4.)
The parties, not surprisingly, dispute whether the injunction sought here is prohibitory or mandatory. "Like many distinctions in the law, the distinction between a mandatory and a prohibitory injunction sometimes proves easier to state than to apply." (Daly, supra, 11 Cal.5th at p. 1041.) Indeed, "in some cases an order that appears facially mandatory may prove to be prohibitory 'in essence and effect.'" (Id. at p. 1047.) "The substance of the injunction, not the form, determines whether it is mandatory or prohibitory." (Davenport v. Blue Cross of California (1997) 52 Cal.App.4th 435, 447 (Davenport).)
Recognizing the difficulty in distinguishing between mandatory and prohibitory injunctions, our Supreme Court has identified "certain benchmarks that help guide the inquiry." (Daly, supra, 11 Cal.5th at p. 1042.) It explained that an injunction is typically mandatory if the requested relief would change "the position of the parties at the time the injunction [is] entered." (Id. at p. 1044.) For example, a real property tear-down order, an order requiring a defendant to hire or fire someone, and an order requiring the defendant to perform an act in breach of his or her contractual obligations to a third party all constitute mandatory injunctions. (Id. at pp. 1042-1044 [collecting cases]; see also Davenport, supra, 52 Cal.App.4th at pp. 446-448 [despite being worded in prohibitory way, injunction ordering insurer to authorize and pay for insured's medical treatment was mandatory in effect]; Shoemaker v. County of Los Angeles (1995) 37 Cal.App.4th 618, 625, fn. 4 [injunction ordering county to restore plaintiff to his administrative position was "undoubtedly mandatory in nature"; "it altered the status quo because [he] had already been removed from those positions when the trial court issued its order"].)
Prohibitory injunctions, by comparison, maintain the status quo and restrain improper conduct. (Daly, supra, 11 Cal.5th at p. 1041; see, e.g., Oiye, supra, 211 Cal.App.4th at p. 1048 [order that defendant not encumber, transfer, or divest his assets was prohibitory, not mandatory]; People ex rel. Brown v. iMergent, Inc. (2009) 170 Cal.App.4th 333, 342 [injunction restraining defendants' continued violation of the Seller Assisted Marketing Plan Act was prohibitory, not mandatory]; Youngblood v. Wilcox (1989) 207 Cal.App.3d 1368, 1372, fn. 1 [order restraining country club from interfering with lifetime members' use and enjoyment of club benefits was prohibitory, not mandatory].)
Following Daly's guidance, we conclude Plaintiffs' requested relief here is mandatory in nature, notwithstanding their reference to "preserv[ing] the status quo," because it would require affirmative action by CalOptima and would in fact change the status quo that existed when Plaintiffs' motion was filed on February 9.
Plaintiffs assert the status quo should be measured at the time they filed their lawsuit (pre-contract termination), not at the time they filed their motion (post-contract termination). We disagree. The Supreme Court has noted that in some cases, when determining whether the status quo is changed by the injunction, courts have measured the status quo not at the time of the injunction, but rather from the "'"last actual peaceable, uncontested status which preceded the pending controversy."'" (Daly, supra, 11 Cal.5th at p. 1045; see, e.g., United Railroads v. Superior Court (1916) 172 Cal. 80, 87, and later cases.) However, the court explained this alternative baseline applies only where the injunctive order aims to prevent injury from future continued conduct; it does not apply where, as here, the injunction calls for the performance of an affirmative act as a remedy for a past violation. (Daly, at p. 1046; see also Weil, et al., Cal. Practice Guide: Civil Procedure Before Trial (The Rutter Guide 2024) ¶ 9:531.)
The mandatory nature of the injunction becomes apparent when one considers what CalOptima would be required to do if ordered to "retain" the now-cancelled network contracts with the Prime Hospitals as requested. Not only would CalOptima be required to enter into new contracts with the Prime Hospitals, it also would need to prepare notices to members informing them about the change; to seek DHCS approval of the draft notice, a process that could take up to sixty days; to have the new notices translated into seven mandatory languages once approved; to mail the notices to members (which would cost thousands of dollars in postage); to re-educate employees and reimplement processes and tools in various departments; to update its software and other systems to enable billing; and to revise and republish its Health Provider Directory.
Plaintiffs nonetheless insist they seek a prohibitory injunction "to restrain CalOptima from continuing to violate its obligations to include safety-net providers in its network and to maintain an adequate network of providers." This argument fails as a practical matter because CalOptima cannot restore the Prime Hospitals to its network by declaring it to be so. The network has been altered; its restoration would require substantial affirmative effort. Looking at the substance of the desired order rather than its form, the injunction sought is mandatory in nature.
In denying Plaintiffs' motion for preliminary injunction, the trial court found that issuing an injunction is not procedurally appropriate because the Prime Hospital contracts had already been terminated, and because an injunction cannot prohibit a completed act. (See Huntingdon Life Sciences, Inc. v. Stop Huntingdon Animal Cruelty USA, Inc. (2005) 129 Cal.App.4th 1228, 1266 [injunctive relief lies only to prevent threatened injury and has no application to wrongs that have been completed].) We disagree. Plaintiffs' motion did not seek to prevent the termination of the contracts; rather, it sought, in essence, to reinstate the already terminated contracts.
III.
Analysis
Because Plaintiffs seek a mandatory injunction, their appeal is subject to stricter review, and we must affirm the trial court's order denying their motion unless they establish this is an extreme case where the right to mandatory injunctive relief is clear. (Corona, supra, 244 Cal.App.4th at p. 299; Davenport, supra, 52 Cal.App.4th at p. 448.) The record on appeal does not support such a finding.
A. Likelihood of Prevailing on the Merits
We first consider Plaintiffs' likelihood of prevailing. We must determine whether the trial court abused its discretion in concluding Plaintiffs did not demonstrate a likelihood of prevailing on the merits and whether substantial evidence supports its related factual findings.
Below and on appeal, Plaintiffs advance three theories to support their petition: (1) CalOptima's alleged breach of its contractual obligation to include in its network any willing safety-net provider, (2) CalOptima's allegedly arbitrary decision to terminate its contracts with the Prime Hospitals, and (3) CalOptima's alleged failure to provide an adequate network. Although we believe it is possible Plaintiffs may ultimately prevail on one or more of those theories, we find no abuse of discretion by the trial court in concluding that Plaintiffs did not demonstrate a likelihood of prevailing.
First, we are not convinced based on this record that CalOptima breached its contractual obligations by terminating its contracts with the Prime Hospitals. Although the DHCS contract requires CalOptima to offer a contract to and include in its network any safety-net provider that is willing to contract (§§ 3.1.8.A and 5.2.3.H), that contract also provides that CalOptima must give DHCS 60 days' notice of its intent to terminate a contract with a safety-net provider (§ 3.1.8.B). The existence of the latter provision suggests CalOptima may terminate such contracts. Indeed, DHCS itself approved the termination, which confirms our belief that termination of a contract with a safety-net provider is at least theoretically possible.
Nor are we persuaded, based on the record before us, that CalOptima's decision to terminate the Prime Hospitals was arbitrary. In opposing the motion, CalOptima presented evidence that its decision was based on its determination that only 1.5 percent of its members had used the Prime Hospitals in the past year, 98.6 percent of those visits were to the emergency departments (which are unaffected by the contract terminations), and terminating the contracts would enable CalOptima "to operationally align its overall healthcare delivery network."
Although the trial court did not address this argument in its minute order, we can infer from its denial of Plaintiffs' motion that it found the argument unpersuasive. In any event, "[w]e review the trial court's decision, not its reasoning." (Loy, supra, 85 Cal.App.5th at p. 406.)
Whether Plaintiffs showed that CalOptima's network is now inadequate to ensure proper care of its patients is a closer call. Plaintiffs maintain CalOptima's post-termination network is no longer adequate because (1) many members have lost access to primary and specialty care that they could only obtain from the Prime Hospitals; (2) CalOptima is unable to effectuate the post-stabilization transfers that are now needed as a result of the Prime Hospitals' out-of-network status on a timely basis, which means members are forced to wait unreasonable amounts of time to obtain necessary post-stabilization care; (3) as a result of these delays, members face increased risk of medical complications; (4) members are increasingly leaving the Prime Hospitals against medical advice, which necessarily creates further health risks; and (5) CalOptima's members are being funneled into already strained and overburdened hospitals.
To support these contentions, Plaintiffs submitted the declarations of several Prime Hospital doctors, who recounted recent instances where CalOptima members who sought treatment at the Prime Hospitals' emergency departments suffered "agonizing" delays while awaiting post-stabilization transfers to other hospitals, many of which lacked the capacity to accept the transfers. CalOptima objected to much of this evidence, asserting it lacked foundation and was based on speculation. The trial court largely sustained CalOptima's objections and found Plaintiffs had failed to submit admissible evidence that CalOptima's network was inadequate to ensure proper care.
We review the trial court's evidentiary rulings for abuse of discretion. (Loy, supra, 85 Cal.App.5th at p. 406.) Applying that highly deferential standard, even if another judge might have ruled differently on certain issues, we cannot say the court's rulings exceeded the bounds of reason.
In any event, an allegedly erroneous evidentiary ruling requires reversal only if there is a reasonable probability that Plaintiffs would have obtained a more favorable result in the absence of the error. (Twenty-Nine Palms Enterprises Corp. v. Bardos (2012) 210 Cal.App.4th 1435, 1449.) In this case, given our conclusion discussed below on the balancing of the competing interests, we cannot say Plaintiffs' evidence on the network's alleged inadequacy, if admitted, would have established a clear right to mandatory injunctive relief. (See Cohen, supra, 40 Cal.3d at p. 287 [appellate court may affirm order denying preliminary injunction if it finds trial court abused its discretion as to only one factor].)
B. Balancing the Interests
Finally, we consider whether the trial court abused its discretion in balancing the interests here. Again, we find no error.
Substantial evidence supports the trial court's decision not to afford great weight to Plaintiffs' anticipated harms. CalOptima presented evidence that suggested a small percentage of CalOptima members were treated at the Prime Hospitals during the previous year, and nearly all of those visits were for emergency care (which is not affected by the contract terminations). CalOptima also presented evidence that there are multiple other in-network hospitals within a few miles of the Prime Hospitals at which CalOptima members can receive non-emergency care. The evidence also supports the trial court's implicit finding that requiring CalOptima to renew its contracts with the four Prime Hospitals would have a significant impact on CalOptima, both in terms of administrative labor and expense.
Plaintiffs note the trial court's minute order did not discuss CalOptima's claimed harms or how those purported harms stacked against Plaintiffs' harms, and on that basis assert the court applied the wrong standard in balancing the harms. We cannot agree. Although Plaintiffs are correct that the court's order fails to discuss the harms to CalOptima, the order does correctly state that the court was tasked with weighing "the relative harm to the parties from the issuance or nonissuance of the injunction." We can infer from the court's ruling that it considered the relative harm to CalOptima and found that harm outweighed the harm to Plaintiffs. (See Loy, supra, 85 Cal.App.5th at p. 406 [we draw inferences in favor of implicit and explicit factual findings, and "[w]e review the trial court's decision, not its reasoning"].)
C. A Final Word
For all these reasons, we find no abuse of discretion in the trial court's refusal to issue a mandatory injunction; we therefore affirm the trial court's orders.
We deny CalOptima's request for judicial notice because the material involved is largely irrelevant.
This ruling should not be construed to suggest we are unsympathetic to CalOptima members who have been negatively impacted by the contract terminations. Nor should this opinion be interpreted as a signal from this court that we believe Plaintiffs cannot ultimately prevail on the merits of their claims. "The . . . den[ial] of a preliminary injunction does not constitute an adjudication of the ultimate rights in controversy." (Cohen, supra, 40 Cal.3d at p. 286.)
DISPOSITION
The orders are affirmed. In the interests of justice, each party will bear its own costs on appeal. (Cal. Rules of Court, rule 8.278(a)(5).)
WE CONCUR: O'LEARY, P. J. MOORE, J.