Jill M. Bishop v. Smith Ranch Nursing & Rehabilitation Center, et al.

Defendants’ demurrer to the Third Cause of Action is sustained with leave to amend. Defendants’ motion to strike is granted with leave to amend.

Allegations in Plaintiff’s Complaint

Plaintiff was admitted to Defendant Smith Ranch Nursing & Rehabilitation Center, erroneously sued as Smith Ranch Skilled Nursing & Rehabilitation Center (“Smith Ranch”), on February 9, 2025, for skilled nursing and rehabilitation services to recover from a sacral fracture. On February 13, 2025, Plaintiff experienced severe abdominal pain and was transferred to the Emergency Department at Defendant Novato Community Hospital (“NCH”). While attempting to use a commode in the emergency room, Plaintiff slipped and braced herself against the commode, striking her chest and ribs. She immediately complained of rib pain. A chest X-ray was performed and she returned to Smith Ranch that same day.

Over the next few days at Smith Ranch, Plaintiff’s condition deteriorated significantly. Her abdominal pain worsened, she experienced severe distention, and she did not have a bowel movement for four days. Despite Plaintiff’s and her son’s repeated requests for medical attention on February 19, 2025, nursing staff at Smith Ranch failed to provide timely intervention. The son called the nurses’ station and it rang more than 10 times with no answer. Staff told Plaintiff’s son that the decision to call 911 was up to him.

Plaintiff’s son called 911 and Plaintiff was transported by ambulance to NCH. Upon her arrival of NCH, Plaintiff presented with tachycardia and critically low oxygen saturation. CT imaging revealed a massive hepatic subcapsular hematoma, a liver laceration, internal bleeding with hemoperitoneum, and a new nondisplaced rib fracture. Blood tests showed severe blood loss. Plaintiff required 70 minutes of critical care for trauma and shock, a blood transfusion, and an emergency transfer to Marin General Hospital Trauma Unit for multiple surgeries.

Plaintiff sustained severe and permanent injuries.

The First Cause of Action against all defendants alleges medical negligence, the Second Cause of Action against all defendants alleges general negligence, and the Third Cause of Action against Smith Ranch and Defendants Life Generations Healthcare LLC, erroneously sued as Generations HC, LLC (“Generations”) alleges elder abuse and neglect.1 In her Third Cause of Action, Plaintiff alleges that Smith Ranch and Generations are liable based on the following conduct: (1) failing to provide adequate medical care for Plaintiff’s physical health needs on February 19, 2025, (2) failing to protect Plaintiff from health and safety hazards, including the hazard presented by her deteriorating medical condition and the development of a lifethreatening internal hemorrhage, (3) failing to respond to Plaintiff’s repeated requests for medical attention and pain relief on February 19, 2025, (4) failing to answer telephone calls from Plaintiff's son who was attempting to obtain medical care for his mother, (5) failing to promptly assess Plaintiff's medical condition when her son reported she was in severe pain with significant abdominal distention, (6) instructing Plaintiff, who had a recent sacral fracture and 50% weightbearing restriction, to “get up and move around” before providing medical treatment, (7) telling Plaintiff she “needed to follow protocol” and handing her papers to read while she was in severe medical distress, (8) abdicating responsibility for medical decision-making by repeatedly telling Plaintiff’s family member that the decision to call 911 was “up to him,” (9) failing to call for emergency medical services or arrange emergency transport despite signs of medical crisis, (10) failing to provide adequate assistance with personal hygiene and dignity, leaving Plaintiff “half naked” without blankets while she was in severe distress and regurgitating, (11) failing to provide adequate nursing care, monitoring, and assessment following Plaintiff’s return from the emergency department on February 13, 2025, (12) failing to recognize warning signs of serious internal injury, including worsening abdominal pain and distention over multiple days, (13) failing to maintain adequate staffing levels to respond to resident needs and emergency situations, (14) failing to implement and enforce policies and procedures to protect residents from foreseeable medical emergencies, and (15) failing to provide the medical care, supervision, and protection that a reasonable skilled nursing facility would provide to a 72-year-old patient with known osteoporosis, recent fractures, multiple medical comorbidities, and documented fall risk.

Smith Ranch and Generations (“Defendants”) demur to the Third Cause of Action.

Demurrer

Standard

“The function of a demurrer is to test the sufficiency of the complaint as a matter of law, and it raises only a question of law.” (Holiday Matinee, Inc. v. Rambus, Inc. (2004) 118 Cal.App.4th 1413, 1420.) A complaint “ordinarily is sufficient if it alleges ultimate rather than evidentiary facts” (Doe v. City of Los Angeles (2007) 42 Cal.4th 531, 550), but the plaintiff must set forth the essential facts of his or her case “with reasonable precision and with particularity sufficient to acquaint [the] defendant with the nature, source and extent” of the plaintiff’s claim.

1 On May 28, 2026, Plaintiff dismissed the Second Cause of Action as to Smith Ranch and Generations.

(Doheny Park Terrace Homeowners Assn., Inc. v. Truck Ins. Exchange (2005) 132 Cal.App.4th 1076, 1099 [citation and internal quotations omitted].) Legal conclusions are insufficient. (Id. at 1098–1099; Doe, 42 Cal.4th at 551, fn. 5.) The court “assume[s] the truth of the allegations in the complaint, but do[es] not assume the truth of contentions, deductions, or conclusions of law.” (California Logistics, Inc. v. State of California (2008) 161 Cal.App.4th 242, 247.)

Discussion

Defendants demur to the Third Cause of Action for elder abuse on the ground that at best, Plaintiff pleads a cause of action for professional negligence arising out of a single isolated event on a single day in February 2025. They contend that the specific facts alleged do not support Plaintiff’s allegations of neglect and recklessness.

A cause of action for elder abuse and neglect arises out of the Elder Abuse and Dependent Adult Civil Protection Act (the “Act”), found in Welfare & Institutions Code Section 15600 et seq. The Act contains certain enhanced remedies for a plaintiff who proves abuse of an elder. Specifically, a plaintiff who proves by clear and convincing evidence both that a defendant is liable for physical abuse, neglect or financial abuse, and that the defendant is guilty of recklessness, oppression, fraud, or malice in the commission of such abuse, may recover attorney fees and costs. (Worsham v.

O’Connor Hospital (2024) 226 Cal.App.4th 331, 335.) “Recklessness is a subjective state of culpability greater than simple negligence, which has been described as a deliberate disregard of the high degree of probability that an injury will occur. [citations.] Recklessness, unlike negligence, involves more than inadvertence, incompetence, unskillfulness, or a failure to take precautions but rather rises to the level of a conscious choice of a course of action . . . with knowledge of the serious danger to others involved in it.” (Fenimore v.

Regents of the University of California (2016) 245 Cal.App.4th 1339, 1347 [internal quotations omitted].) “[T]he Act does not provide liability for simple or gross negligence by health care providers.” (Ibid.)

The term “neglect” is defined in Section 15610.57 as including “[t]he negligent failure of any person having the care or custody of an elder or a dependent adult to exercise that degree of care that a reasonable person in a like position would exercise.” (Wel. & Inst. Code § 15610.57(a).) “Neglect includes, but is not limited to, all of the following: (1) Failure to assist in personal hygiene, or in the provision of food, clothing, or shelter. (2) Failure to provide medical care for physical and mental health needs . . . (3) Failure to protect from health and safety hazards. (4) Failure to prevent malnutrition or dehydration . . .” (Wel. & Inst.

Code § 15610.57(a).) “[S]everal factors . . . must be present for conduct to constitute neglect within the meaning of the Elder Abuse Act and thereby trigger the enhanced remedies available under the Act. The plaintiff must allege (and ultimately prove by clear and convincing evidence) facts establishing that the defendant: (1) had responsibility for meeting the basic needs of the elder or dependent adult, such as nutrition, hydration, hygiene or medical care; (2) knew of conditions that made the elder or dependent adult unable to provide for his or her own basic needs; and (3) denied or withheld goods or services necessary to meet the elder or dependent adult’s basic needs, either with knowledge that injury was substantially certain to befall the elder or dependent adult (if the plaintiff alleges oppression, fraud or malice) or with conscious disregard of the high probability of such injury (if the plaintiff alleges recklessness) . . . the facts constituting the neglect and establishing the causal link between the neglect and the injury must be pleaded with particularity, in accordance with the pleading rules governing statutory claims.” (Carter v.

Prime Healthcare Paradise Valley LLC (2011) 198 Cal.App.4th 396, 406-407 [citations and internal quotations omitted].)

“‘[N]eglect’ within the meaning of Welfare and Institutions Code section 15610.57 covers an area of misconduct distinct from ‘professional negligence.’ As used in the Act, neglect refers not to the substandard performance of medical services but, rather, to the ‘failure of those responsible for attending to the basic needs and comforts of elderly or dependent adults, regardless of their professional standing, to carry out their custodial obligations.’ Thus, the statutory definition of ‘neglect’ speaks not of the undertaking of medical services, but of the failure to provide medical care.” (Covenant Care, Inc. v. Superior Court (2004) 32 Cal.4th 771, 783 [citations omitted] [emphasis in original].)

Defendants argue that Plaintiff’s allegations sound in professional negligence, not elder abuse, because they center on deficiencies in medical assessment, monitoring, treatment, and intervention and arise from the rendition of skilled nursing skills rather than the denial of basic custodial needs. As a result, Defendants argue, these allegations fall outside of the scope of “neglect” and enhanced remedies under the Act. Plaintiff argues that she adequately alleges neglect because she alleges that a custodial facility failed to respond to a known, obvious, worsening medical emergency.

Here, the Complaint essentially alleges that Defendants failed to provide adequate medical attention to her on February 19, when she was in medical distress, and told her son on February 19 that it was up to him whether to call 911. The remainder of Plaintiff’s allegations are generally legal conclusions and language from Section 15610.57, without specific facts to support those allegations. There are no specific allegations that Defendants failed to assist in personal hygiene or provide food, shelter or clothing, that Defendants failed to provide or denied medical care that Defendants themselves should or could have provided, or that Defendants failed to protect Plaintiff from any particular health and safety hazards.

Plaintiff does not allege what medical care or treatment could or should have been provided by Defendants but was not. With respect to Plaintiff’s allegations about the six days preceding February 19th, she does not allege what Defendants knew about any particular condition Plaintiff was in or what Defendants could or should have done differently during those six days. Plaintiff merely alleges that her condition worsened over that time frame and that Defendants failed to provide timely intervention on February 19th despite Plaintiff’s son’s requests that day. (See Complaint, ¶¶ 16, 17.)

Facts supporting an elder abuse claim must be alleged with particularity. (Covenant Care, 32 Cal.4th at p. 790; Carter, 198 Cal.App.4th at p. 407.)

Plaintiff’s Complaint is not like the complaint in Fenimore, supra, upon which Plaintiff relies. In Fenimore, the plaintiffs sued the defendant hospital after their family member, George, fell and suffered a hip injury and never recovered. When George was admitted to the hospital, the hospital was told that George suffered from multiple conditions including dementia and Alzheimer’s disease, had a history of wandering that led to numerous falls, and that he had been transferred from another facility on a 5150 hold and was an extreme fall risk.

The hospital was also aware that George required 24 hour supervision, assistance with ambulation and transferring, safety devices to prevent accidents, interventions to prevent further falls, and assistance with daily activities. Just minutes after entering the hospital, George was left unattended and fell. The hospital tried to conceal the fall from the family, giving them conflicting stories, and did not adequately assess George after the fall. An x-ray was taken after staff indicated leg pain on his record and noted George was wincing when bending forward and lifting his knee.

George was not walking at the time. The hospital did not notify George’s family of his change in condition or need for evaluation. Six days after the fall, after he had been transferred for other reasons, x-rays revealed that George had a left hip fracture. He had surgery on his hip but passed away a few months later.

The plaintiffs alleged that the hospital failed to assess George’s fall risk and implement an adequate plan of care for him, complete with interventions or other measures to prevent him from falling such as hip guards or devices to prevent patients from falling out of a wheelchair. The plaintiffs also alleged that the hospital violated several sections of the California Code of Regulations applicable to acute psychiatric hospitals, such as regulations requiring proper staff training, a written patient care plan, and a sufficient number of staff on hand for the safety of patients.

The plaintiffs alleged that these regulatory violations caused injury to George and that the hospital acted with reckless disregard for the health and safety of George and other residents. The plaintiffs further alleged that the hospital had a pattern and practice of understaffing and undertraining its staff to cut costs, which foreseeably resulted in the abuse and neglect of its residents, and consciously chose not to increase staff numbers or increase training. The hospital knew that insufficient staff in number and competency would lead to it not meeting patients’ needs and injuries to patients would be inevitable.

The plaintiffs alleged that had there been sufficient staff, George would have received proper supervision and assistance and would not have suffered his injuries.

The Fenimore court held that George’s initial fall and the hospital’s reaction to that fall, and the treatment of George’s hip, was possibly incompetence or unskillfulness but not recklessness. However, the allegations that the hospital’s regulatory violations constituted elder abuse were sufficient to survive the hospital’s demurrer. Specifically, the allegations that the hospital had a pattern and knowing practice of improperly understaffing to cut costs, and had the hospital been staffed sufficiently, George would have been properly supervised and would not have suffered injury. (Id. at pp. 1348-1349.)

The court noted that the plaintiffs “alleged more than a simple understaffing here. The FAC identified the staffing regulation the Hospital allegedly violated and suggested a knowing pattern of violating it constituted recklessness.” (Id. at p. 1350.) The court concluded that “[r]eckless understaffing might be neglectful under the Act even if it is not a fundamental failure to provide medical care.” (Id. at p. 1351.)

Thus in Fenimore, there were detailed allegations in the complaint identifying specific staffing regulations for acute psychiatric hospitals that had been violated, that there was a knowing pattern to violate those regulations to cut costs, and that the violations of those regulations caused injury to George. In contrast, Plaintiff’s Complaint here only generally alleges that Defendants “negligently provid[ed] inadequate levels of nursing care and staffing” (¶25), negligently supervised staff (¶26), “[f]ailed to maintain adequate staffing levels to respond to resident needs and emergency situations” (¶49m), and had “inadequate staffing, failure to implement emergency response protocols, and culture of prioritizing administrative procedures over patient safety” (¶51).

There are insufficient facts alleged to support these allegations. For example, Plaintiff does not identify any regulations or rules that require a certain level of staffing, the staffing that existed at the time Plaintiff was there, or the staffing that Plaintiff contends should have existed at the time.

The demurrer is sustained on the ground that Plaintiff fails to plead sufficient facts to support her allegations of neglect and recklessness. Because the demurrer is sustained on this basis, the Court does not address Defendants’ additional arguments in support of their demurrer.

Motion to Strike

Defendants move to strike Plaintiff’s requests for enhanced remedies (Complaint, p. 14:20-24) on the ground that Plaintiff has failed to allege a cause of action for elder abuse. As the Court has sustained the demurrer to that case of action, the Court also grants the motion to strike.

All parties must comply with Marin County Superior Court Local Rules, Rule 2.10(B) to contest the tentative decision. Parties who request oral argument are required to appear in person or remotely by ZOOM. Regardless of whether a party requests oral argument in accordance with Rule 2.10(B), the prevailing party shall prepare an order consistent with the announced ruling as required by Marin County Superior Court Local Rules, Rule 2.11.

The Zoom appearance information for August, 2026 is as follows: https://marin-courts-ca-gov.zoomgov.com/j/1615487764?pwd=Ob4B5J7LLKcpnkxzJjjEOSHNzEGafG.1 Meeting ID: 161 548 7764 Passcode: 502070

If you are unable to join by video, you may join by telephone by calling (669) 254-5252 and using the above-provided passcode. Zoom appearance information may also be found on the Court’s website: https://www.marin.courts.ca.gov