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Filed 3/25/04IN THE SUPREME COURT OF CALIFORNIA COVENANT CARE, INC., et al.,
Petitioners, S098817v. Ct. App. 2/1 B145406THE SUPERIOR COURT OF LOS ANGELES COUNTY, Los Angeles CountyRespondent; Super. Ct. No. LC041017
LOURDES M. INCLAN et al.,
Real Parties in Interest. ___________________________________ )We granted review in this matter to resolve a conflict among the Courts ofAppeal as to whether the procedural prerequisites to seeking punitive damages inan action for damages arising out of the professional negligence of a health careprovider, codified at Code of Civil Procedure section 425.13, subdivision (a)(section 425.13(a)), apply to punitive damage claims in actions alleging elderabuse subject to heightened civil remedies under the Elder Abuse and DependentAdult Civil Protection Act (Welf. & Inst. Code, § 15600 et seq.) (Elder Abuse Actor Act). The Court of Appeal concluded section 425.13(a) does not apply. Weagree, finding nothing in the text, legislative history, or purposes of either section425.13(a) or the Elder Abuse Act to suggest the Legislature intended to affordhealth care providers that act as elder custodians, and that egregiously abuse the1elders in their custody, the special protections against exemplary damages theyenjoy when accused of negligence in providing health care. Accordingly, weaffirm the judgment of the Court of Appeal.Background1Lourdes M. Inclan and Juan C. Inclan (plaintiffs) sued Covenant CareCalifornia, Inc., and Covenant Care, Inc. (defendants), for damages caused bydefendants’ care and treatment of their father, Juan A. Inclan (decedent), duringthe approximately eight weeks that decedent, an elder,2 resided at defendants’skilled nursing facility in Los Angeles. More than two years after filing theirinitial complaint, plaintiffs moved for leave to file a fourth amended complaint. Intheir proposed fourth amended complaint, plaintiffs sought damages, including“general damages for pain and suffering according to proof,” for willfulmisconduct, intentional infliction of emotional distress, constructive fraud, fraud,battery, false imprisonment, elder abuse, and wrongful death. They also soughtpunitive damages.Plaintiffs’ fourth amended complaint contained detailed and specific factualallegations of elder abuse. Specifically, plaintiffs alleged that decedent sufferedfrom Parkinson’s disease. Plaintiffs contracted with a managed care organizationto oversee decedent’s care, to act within plaintiffs’ directives, and to informplaintiffs of any change in decedent’s condition or other situation requiring theirattention. The managed care organization, however, assumed rights and usurped1 Plaintiffs’ motions for judicial notice, filed on January 30, 2002, and onMay 1, 2002, respectively, are denied. (Mangini v. R. J. Reynolds Tobacco Co.(1994) 7 Cal.4th 1057, 1064.) Defendants’ motion for judicial notice, filed onNovember 20, 2001, is granted.2 “ ‘Elder’ means any person residing in this state, 65 years of age or older.”(Welf. & Inst. Code, § 15610.27.)2powers over decedent neither contemplated nor agreed to by decedent or plaintiffs.The managed care organization, sometimes in conspiracy with defendants,admitted and ordered the discharge of decedent, without his consent, from varioushealth care facilities, including a convalescent hospital owned and operated bydefendants, and “withh[e]ld essential care, treatment and medical services fromdecedent including . . . food, fluids, medicine, and basic nursing care includingbasic palliative care.”Plaintiffs alleged that defendants conspired and otherwise “acted withmalice and oppression” in moving and treating decedent in order to maximizerevenue from the Medicare and Medicaid programs and to avoid regulatorypenalties for noncompliance with certain federal and state regulations. At onepoint, decedent was compelled to transfer to defendants’ skilled nursing facility.At that facility, defendants provided decedent only with hospice services anddeprived him of skilled nursing services to which he was legally entitled.Decedent’s subsequent injury and death flowed in part from defendants’ actions.While decedent was at defendants’ nursing facility, plaintiffs furtheralleged, defendants knew he was suffering from Parkinson’s disease and wasunable to care for his personal needs. Defendants nevertheless failed to providedecedent with proper care, nutrition, hydration, and medication. Defendants’conduct was in conscious disregard of decedent’s rights and safety. Decedent wasleft in his bed, unattended and unassisted, for excessively long periods. Althoughdecedent increasingly could not feed or hydrate himself, he was for long periodsnot provided assistance with these activities. As a result, decedent wasinadequately stimulated, became malnourished, and lost much of his body weight.Decedent was left in his excrement for long periods; he developed ulcers on hisbody that exposed muscle and bone and became septic; and he also becameseverely dehydrated.3As decedent deteriorated, he manifested signs and symptoms of starvation,dehydration, neglect, and abuse. Plaintiffs alleged that defendants deliberatelyfailed to report such symptoms, neglect, and abuse to public authorities as theywere legally required to do. Moreover, defendants misrepresented decedent’scondition and failed to inform plaintiffs of his true condition, thus concealing hisdeterioration from plaintiffs.When decedent was transferred out of defendants’ nursing facility toanother facility (where he died approximately a week later), plaintiffs alleged,decedent was in such condition that without immediate intervention andaggressive care he would surely die from the effects of starvation, dehydration,and infection. Decedent, however, was not transferred to an acute care facilitybut, rather, to a 24-hour care setting where, without any care for his acute needs,he languished and deteriorated further. As a direct and proximate result ofdefendants’ neglect and abuse, decedent sustained personal injury, includingsevere emotional distress, and died.Plaintiffs filed their motion for leave to file the fourth amended complaintclaiming punitive damages on May 14, 1999. Defendants opposed the motion,arguing that under section 425.13(a), which requires such a motion be “filedwithin two years after the complaint or initial pleading is filed,” this was too late.The trial court granted plaintiffs’ motion, ruling plaintiffs were not required tocomply with section 425.13(a) because the causes of action alleged in the fourthamended complaint “go beyond mere or simple professional negligence.” TheCourt of Appeal summarily denied defendants’ petition for writ relief, and wedenied review.Subsequent to the trial court’s ruling, a different district of the Court ofAppeal issued an opinion in Community Care & Rehabilitation Center v. SuperiorCourt (2000) 79 Cal.App.4th 787 (Community Care). The court in Community4Care held that section 425.13(a) applies to elder abuse actions in which punitivedamages are sought, “whenever the gravamen of an action is professionalmalfeasance—that is, malfeasance in the provision of health care services.”(Community Care, supra, at p. 797.) Defendants moved the trial court forreconsideration in light of Community Care, but the court denied the motion.The Court of Appeal again denied defendants’ petition for writ relief.Rejecting Community Care, the Court of Appeal ruled that plaintiffs’ elder abuseclaim was exempt from “the procedural hurdles created by section 425.13.” Wegranted review.DiscussionAs originally enacted in 1982, the Elder Abuse Act establishedrequirements and procedures for mandatory and nonmandatory reporting to localagencies of elder abuse, as defined,3 and the abuse of other dependent adults. TheAct also addressed local agency investigation and criminal prosecution of suchcases. (See Stats. 1982, ch. 1184, § 3, p. 4223.) The Act continues to containsuch provisions. (See generally Welf. & Inst. Code, § 15600 et seq.)43 “ ‘Abuse of an elder or a dependent adult’ means either of the following:[¶] (a) Physical abuse, neglect, financial abuse, abandonment, isolation, abduction,or other treatment with resulting physical harm or pain or mental suffering.[¶] (b) The deprivation by a care custodian of goods or services that are necessaryto avoid physical harm or mental suffering.” (Welf. & Inst. Code, § 15610.07.)4 Although “[s]ubsequent amendment refined the 1982 enactment, . . . thefocus remained on reporting abuse and using law enforcement to combat it.[Citation.] Also, Penal Code section 368 was enacted, making it [a criminaloffense] for, among other things, a custodian of an elder or dependent adult towillfully cause or permit various types of injury.” (Delaney v. Baker (1999) 20Cal.4th 23, 33.)5In 1991, in order “to enable interested persons to engage attorneys to takeup the cause of abused elderly persons and dependent adults” (Welf. & Inst. Code,§ 15600, subd. (j)), the Legislature added Welfare and Institutions Code section15657 to the Act. That section makes available, to plaintiffs who prove especiallyegregious elder abuse to a high standard, certain remedies “in addition to all otherremedies otherwise provided by law” (Welf. & Inst. Code, § 15657). Specifically,a plaintiff who proves “by clear and convincing evidence” that a defendant isliable for physical abuse, neglect, or financial abuse (as these terms are defined inthe Act), and that the defendant has been guilty of “recklessness, oppression,fraud, or malice” in the commission of such abuse, may recover attorney fees andcosts. (Id., subd. (a), incorporating by reference Welf. & Inst. Code, §§ 15610.30,15610.57, 15610.63.)5 On the same conditions, a plaintiff who brings suit as thepersonal representative of a deceased elder is partially relieved of the limitation ondamages in a decedent’s action imposed by Code of Civil Procedure section5 In its entirety, Welfare and Institutions Code section 15657 provides:“Where it is proven by clear and convincing evidence that a defendant is liable forphysical abuse as defined in Section 15610.63, neglect as defined in Section15610.57, or financial abuse as defined in Section 15610.30, and that thedefendant has been guilty of recklessness, oppression, fraud, or malice in thecommission of this abuse, in addition to all other remedies otherwise provided bylaw: [¶] (a) The court shall award to the plaintiff reasonable attorney’s fees andcosts. The term ‘costs’ includes, but is not limited to, reasonable fees for theservices of a conservator, if any, devoted to the litigation of a claim brought underthis article. [¶] (b) The limitations imposed by Section 337.34 [sic: should be377.34] of the Code of Civil Procedure on the damages recoverable shall notapply. However, the damages recovered shall not exceed the damages permittedto be recovered pursuant to subdivision (b) of Section 3333.2 of the Civil Code.[¶] (c) The standards set forth in subdivision (b) of Section 3294 of the Civil Coderegarding the imposition of punitive damages on an employer based upon the actsof an employee shall be satisfied before any damages or attorney’s fees permittedunder this section may be imposed against an employer.”6377.34 and thus may recover damages up to $250,000 for emotional distresssuffered by the decedent prior to death. (Welf. & Inst. Code, § 15657, subd. (b).)Section 425.13(a) provides, in relevant part, that “[i]n any action fordamages arising out of the professional negligence of a health care provider, noclaim for punitive damages shall be included” unless the plaintiff “within twoyears after the complaint or initial pleading is filed or not less than nine monthsbefore the date the matter is first set for trial, whichever is earlier” files a motiondemonstrating a “substantial probability” he or she will prevail on the claim.6 Thequestion presented is whether plaintiffs’ elder abuse claim is one “arising out ofthe professional negligence of a health care provider” for the purposes of section425.13(a). We have not previously addressed whether a plaintiff seeking6 In its entirely, section 425.13 provides: “(a) In any action for damagesarising out of the professional negligence of a health care provider, no claim forpunitive damages shall be included in a complaint or other pleading unless thecourt enters an order allowing an amended pleading that includes a claim forpunitive damages to be filed. The court may allow the filing of an amendedpleading claiming punitive damages on a motion by the party seeking the amendedpleading and on the basis of the supporting and opposing affidavits presented thatthe plaintiff has established that there is a substantial probability that the plaintiffwill prevail on the claim pursuant to Section 3294 of the Civil Code. The courtshall not grant a motion allowing the filing of an amended pleading that includes aclaim for punitive damages if the motion for such an order is not filed within twoyears after the complaint or initial pleading is filed or not less than nine monthsbefore the date the matter is first set for trial, whichever is earlier. [¶] (b) For thepurposes of this section, ‘health care provider’ means any person licensed orcertified pursuant to Division 2 (commencing with Section 500) of the Businessand Professions Code or licensed pursuant to the Osteopathic Initiative Act, or theChiropractic Initiative Act, or licensed pursuant to Chapter 2.5 (commencing withSection 1440) of Division 2 of the Health and Safety Code; and any clinic, healthdispensary, or health facility, licensed pursuant to Division 2 (commencing withSection 1200) of the Health and Safety Code. ‘Health care provider’ includes thelegal representatives of a health care provider.”7heightened remedies under the Elder Abuse Act must comply with section 425.13in order to claim punitive damages.Plaintiffs assert that our reasoning in Delaney v. Baker, supra, 20 Cal.4th23 (Delaney), precludes application of section 425.13 to Elder Abuse Act causesof action. In Delaney, we held unanimously that a cause of action seeking theAct’s heightened remedies for reckless, oppressive, fraudulent, or malicious elderabuse is not based on “professional negligence” within the meaning of Welfareand Institutions Code section 15657.2,7 a section of the Act that excludes from itspurview causes of action based on such negligence. (Delaney, supra, at pp. 29-32.) Our rationale, which we derived from the language and history of the Act,was that the Legislature intended section 15657.2 to clarify “that the actsproscribed [by the Act] do not include acts of simple professional negligence, butrefer to forms of abuse or neglect performed with some state of culpability greaterthan mere negligence.” (Delaney, supra, at p. 32.)Observing that the relevant language in section 425.13 (“arising out of theprofessional negligence of a health care provider”) is similar to the Welfare andInstitutions Code section 15657.2 language we construed in Delaney (“based onthe health care provider’s alleged professional negligence”), plaintiffs argue weshould rule here, as we did there, that causes of action against health careproviders that otherwise come within the scope of the Elder Abuse Act are not7 In its entirety, Welfare and Institutions Code section 15657.2 provides:“Notwithstanding this article, any cause of action for injury or damage against ahealth care provider, as defined in Section 340.5 of the Code of Civil Procedurebased on the health care provider’s alleged professional negligence, shall begoverned by those laws which specifically apply to those professional negligencecauses of action.”8within the meaning of the section 425.13 language. (Delaney, supra, 20 Cal.4th atp. 32.)Factually, as noted, plaintiffs alleged their decedent suffered bodily injury,pain, and suffering (including severe emotional distress) at defendants’ hands.More specifically, plaintiffs alleged decedent’s injuries were caused bydefendants’ willful misconduct in violation of the Elder Abuse Act, consisting infraudulent business practices, intentional infliction of emotional distress, batteryupon, and false imprisonment of decedent. In describing defendants’ abuse ofdecedent, plaintiffs specifically alleged despicable and deceptive businesspractices, as well as other unlawful conduct by defendants, some of whichconstituted conspiracy and all of which was reckless, intentional, deliberate, orknowing. Plaintiffs also alleged that in abusing decedent, defendants consciouslydisregarded his rights and safety, acting with fraud, oppression, and malice.In its ordinary sense, “professional negligence” is failure to exercise“ ‘knowledge, skill, and care ordinarily employed by members of the profession ingood standing.’ ” (Delaney, supra, 20 Cal.4th at p. 31.) Hence, such misconductas plaintiffs alleged—intentional, egregious elder abuse—cannot be described asmere “professional negligence” in the ordinary sense of those words. But asdefendants point out, in light of our prior pronouncements respecting section425.13(a), that fact is not necessarily dispositive. (See Central Pathology ServiceMedical Clinic, Inc. v. Superior Court (1992) 3 Cal.4th 181, 191-192 (CentralPathology).)In Central Pathology, a patient sued a physician and a laboratory, allegingthey failed to notify her she was developing cancer when a pap smear thephysician performed and sent to the laboratory for analysis revealed the presenceof abnormal cells. (Central Pathology, supra, 3 Cal.4th at p. 185.) The patient’sinitial complaint was for negligence in the provision of medical services, but she9moved to amend it to add causes of action for fraud and intentional infliction ofemotional distress and to seek punitive damages in connection with those claims.Construing section 425.13(a)’s reference to “any action for damages arising out ofthe professional negligence of a health care provider,” we concluded the statuteapplied to the proposed additional intentional tort causes of action, as well as tothe ordinary negligence causes of action already contained in the complaint.(Central Pathology, supra, at p. 192.) Were we to hold otherwise, we reasoned,“injured patients seeking punitive damages in an action involving professionalnegligence could readily assert that their health care providers committed anintentional tort” and thus by “artful pleading” effectively “annul the protectionafforded [health care providers] by that section.” (Id. at p. 191.)Relying primarily on Central Pathology, defendants argue in effect thateven egregious elder abuse arises out of professional negligence (§ 425.13(a))when such abuse is “directly related to the professional services provided”(Central Pathology, supra, 3 Cal.4th at p. 191) by a health care provider.Defendants acknowledge that, on its face, section 425.13(a) applies only to causesof action arising from negligence, and that in Delaney we distinguished between“professional negligence” and statutory elder abuse. Nevertheless, defendantspoint out, health care providers can at once be subject to liability under the ElderAbuse Act and protected by section 425.13(a)’s restrictions on the pleading ofpunitive damages. Because Central Pathology’s broad phrasing potentiallysupports this possibility and Delaney does not expressly bar it, defendants urgethat we declare it to be the law.Notwithstanding the parties’ focus on Central Pathology and Delaney,resolution of the issue here is not simply an exercise in conforming our result toour previous phraseology. Judicial precedent on similar facts may be relevant, but“[e]stablishing terminological uniformity throughout our codified law is less10important than discerning ‘ “the intent of the Legislature so as to effectuate thepurpose” ’ of each individual statute.” (Delaney, supra, 20 Cal.4th at p. 42.)Ultimately, “the ascertainment of legislative intent is the paramount principle ofstatutory interpretation.” (In re Michael G. (1988) 44 Cal.3d 283, 289.) For thefollowing reasons, we agree with the Court of Appeal that section 425.13’slimitations on actions for damages arising out of professional negligence(§ 425.13(a)) were not meant to burden those who pursue the cause of abusedelderly persons (Welf. & Inst. Code, § 15600, subd. (j)) under the Elder AbuseAct.Plain language. First, nothing in the text of either section 425.13(a) or theElder Abuse Act suggests the Legislature meant to link the two statutes. Whilesection 425.13 by its terms applies only to causes of action arising out of“negligence” (§ 425.13(a)), every cause of action seeking the Act’s heightenedcivil remedies, by definition, arises out of “recklessness, oppression, fraud, ormalice” (Welf. & Inst. Code, § 15657). The earlier enacted section 425.13(a), ofcourse, contains no reference to the Elder Abuse Act or to elder abuse; neitherdoes the subsequently enacted Act contain any reference to section 425.13(a).It is true that statutory elder abuse includes “neglect as defined in Section15610.57” (Welf. & Inst. Code, § 15657), which in turn includes negligent failureof an elder custodian “to provide medical care for [the elder’s] physical andmental health needs” (id., § 15610.57, subd. (b)(2)). But as we explained inDelaney, “neglect” within the meaning of Welfare and Institutions Code section15610.57 covers an area of misconduct distinct from “professional negligence.”As used in the Act, neglect refers not to the substandard performance of medicalservices but, rather, to the “failure of those responsible for attending to the basicneeds and comforts of elderly or dependent adults, regardless of their professionalstanding, to carry out their custodial obligations.” (Delaney, supra, 20 Cal.4th at11p. 34.) Thus, the statutory definition of neglect speaks not of the undertaking ofmedical services, but of the failure to provide medical care. (Ibid.) Notably, theother forms of abuse, as defined in the Act—physical abuse and fiduciary abuse(Welf. & Inst. Code, § 15657)—are forms of intentional wrongdoing also distinctfrom “professional negligence.” (Delaney, supra, at p. 34.)As we determined in Delaney, if the neglect (or other abuse) is reckless ordone with oppression, fraud, or malice, “then the action falls within the scope of[Welfare and Institution Code] section 15657 and as such cannot be consideredsimply ‘based on . . . professional negligence’ . . . . That only these egregious actswere intended to be sanctioned under section 15657 is further underscored by thefact that the statute requires liability to be proved by a heightened ‘clear andconvincing evidence’ standard.” (Delaney, supra, 20 Cal.4th at p. 35.)Because in Delaney we were construing the term “professional negligence”as used in the Elder Abuse Act, our actual holding did not impinge on the holdingof Central Pathology that professional negligence within the meaning of section425.13 can encompass intentional torts. (Central Pathology, supra, 3 Cal.4th atp. 192.) Nevertheless, our conclusion that the Legislature intended the ElderAbuse Act to sanction only egregious acts of misconduct distinct fromprofessional negligence contravenes any suggestion that, in defining elder abuse toinclude failure to provide medical care, the Legislature intended that health careproviders, alone among elder custodians, would enjoy under the Act theprocedural protections they enjoy when sued for negligence in their professionalhealth care practice. (See Delaney, supra, 20 Cal.4th at p. 35 [discussing theanomaly of such a result].)Legislative history. Second, nothing in the legislative history of eithersection 425.13(a) or the Elder Abuse Act suggests the Legislature meant to linkthe two statutes. Our past pronouncements succinctly describe the relevant12history. (See Central Pathology, supra, 3 Cal.4th at pp. 189-190; Delaney, supra,20 Cal.4th at pp. 31-34.)Section 425.13 was added to the Code of Civil Procedure in 1987. “Asoriginally enacted, the section was not limited to medical malpractice. The statuteprovided, ‘No claim for punitive damages against a health care provider shall beincluded in a complaint or other pleading unless the court enters an order allowingan amended pleading that includes a claim for punitive damages to be filed.’(Stats. 1987, ch. 1498, § 7, p. 5782.) The next year the Legislature amended thesection by incorporating former section 425.13 into new subdivision (a) of thatsection and by altering the first sentence to read, ‘In any action for damagesarising out of the professional negligence of a health care provider, no claim forpunitive damages shall be included . . . .’ (Stats. 1988, ch. 1205, § 1, p. 4028.)”(Central Pathology, supra, 3 Cal.4th at pp. 188-189, italics omitted.)The Legislature enacted the Elder Abuse Act’s heightened civil damageremedies for egregious elder abuse three years later, in 1991. (Stats. 1991, ch.774, § 3, p. 3477 [enacting Sen. Bill No. 679 (1991-1992 Reg. Sess.].) As werecounted in Delaney, in the 1991 amendments to the Act, the Legislature shiftedthe focus in protecting vulnerable and dependent adults from reporting abuse andusing law enforcement to combat it, “to private, civil enforcement of laws againstelder abuse and neglect. ‘[T]he Legislature declared that “infirm elderly personsand dependent adults are a disadvantaged class, that cases of abuse of thesepersons are seldom prosecuted as criminal matters, and few civil cases are broughtin connection with this abuse due to problems of proof, court delays, and the lackof incentives to prosecute these suits.” ([Welf. & Inst. Code,] § 15600, subd. (h),added by Stats. 1991, ch. 774, § 2.) . . . As was stated in the Senate RulesCommittee’s analysis of Senate Bill No. 679, ‘in practice, the death of the victimand the difficulty in finding an attorney to handle an abuse case where attorneys13fees may not be awarded, impedes many victims from suing successfully. [¶] Thisbill would address the problem by: . . . authorizing the court to award attorney’sfees in specified cases; [and by] allowing pain and suffering damages to beawarded when a verdict of intentional and reckless abuse was handed down afterthe abused elder dies.’ (Sen. Rules Com., Analysis of Sen. Bill No. 679 (1991-1992 Reg. Sess.) as amended May 8, 1991, p. 3.)” (Delaney, supra, 20 Cal.4th atp. 33.)As we determined in Central Pathology, the legislative history of section425.13 demonstrates that the Legislature’s intent in enacting the statute was toprotect health care providers (or practitioners) only in their professional capacityas providers; there was no intent to protect them in any other capacity. (CentralPathology, supra, 3 Cal.4th at p. 189; see also id. at p. 190.) Without question,health care provider and elder custodian “capacities” are conceptually distinct.“Health care provider” means any person licensed or certified pursuant tospecified licensing provisions and any licensed clinic, health dispensary, or healthfacility and their legal representatives. (§ 425.13, subd. (b).) Neglectful elderabuse, by contrast, as noted, is “the failure of those responsible for attending to thebasic needs and comforts of elderly or dependent adults, regardless of theirprofessional standing, to carry out their custodial obligations.” (Delaney, supra,20 Cal.4th at p. 34, italics added.)Moreover, the legislative history of the Elder Abuse Act “indicates thatthose who enacted the statute thought that the term ‘professional negligence,’ . . .within the meaning of [Welfare and Institutions Code] section 15657.2, wasmutually exclusive of the abuse and neglect specified in [Welfare and InstitutionsCode] section 15657” as actionable under the Act. (Delaney, supra, 20 Cal.4th atp. 30.) As we have noted, the Legislature apparently concluded that the highstandard imposed by section 15657—clear and convincing evidence of (i) liability14and (ii) recklessness, malice, oppression or fraud—adequately protects health careproviders from liability under the statute for acts of simple or even grossnegligence. (Delaney, supra, at p. 32.) We are not authorized to gainsay thatlegislative judgment.8Defendants argue the Legislature’s failure expressly to exempt Elder Abuseactions from section 425.13 obliges us to construe the section as including suchactions. In support, they contend that elder abuse, when committed by a healthcare provider, is “an injury that is directly related to the professional servicesprovided by a health care provider acting in its capacity as such” (CentralPathology, supra, 3 Cal.4th at p. 191). Defendants’ argument fails on threecounts.First, the rules of statutory construction defendants invoke—viz., thatpresumably the Legislature knew how to create an exemption if it wished to do soand that courts generally may not insert what the Legislature has omitted from astatute (see California Fed. Savings & Loan Assn. v. City of Los Angeles (1995) 11Cal.4th 342, 349)—have no application unless one assumes, at the outset, thefacial applicability of section 425.13. But section 425.13(a), which references“professional negligence,” is not facially applicable to claims for heightened civilremedies under the Elder Abuse Act, which entail “recklessness, oppression,fraud, or malice” (Welf. & Inst. Code, § 15657, subd. (a)).Second, elder abuse as defined in the Act, even when committed by ahealth care provider, is not an injury that is “directly related” to the provider’s8 As we conclude the Legislature did not intend section 425.13 to apply tocauses of action seeking heightened remedies under the Elder Abuse Act, we donot reach the additional question raised by plaintiffs whether all defendants wereor are health care providers entitled to invoke the protection of section 425.13.15professional services. That statutory elder abuse may include the egregiouswithholding of medical care for physical and mental health needs is notdeterminative. As a failure to fulfill custodial duties owed by a custodian whohappens also to be a health care provider, such abuse is at most incidentally relatedto the provider’s professional health care services.That is, claims under the Elder Abuse Act are not brought against healthcare providers in their capacity as providers but, rather, against custodians andcaregivers that abuse elders and who may or may not, incidentally, also be healthcare providers. Statutorily, as well as in common parlance, the function of ahealth care provider is distinct from that of an elder custodian, and “the fact thatsome health care institutions, such as nursing homes, perform custodial functionsand provide professional medical care” (Delaney, supra, 20 Cal.4th at p. 34, italicsadded) does not mean that the two functions are the same.Third, the Legislature did not have the benefit of our 1992 opinion inCentral Pathology either when it limited section 425.13(a) to damage actionsarising out of the professional negligence of a health care provider (Stats. 1988,ch. 1205, § 1, p. 4028) or three years later when it added heightened civil remediesto the Elder Abuse Act (Stats. 1991, ch. 774, § 3, p. 3475). Accordingly,regardless of its language, Central Pathology affords no basis for concluding theLegislature intended its reference in section 425.13(a) to “professional negligence”to encompass elder abuse, let alone as yet uncreated statutory causes of action forelder abuse committed with recklessness, oppression, fraud, or malice (Welf. &Inst. Code, § 15657). Nor does the opinion afford any basis for deeming theLegislature to have intended, when adding heightened civil remedies as an16incentive to the prosecution of elder abuse actions, that section 425.13(a) restrictthe availability of those remedies.9Statutory purposes. The fundamental legislative purposes underlying theElder Abuse Act, on the one hand, and section 425.13, on the other, would not bepromoted were we to link the two regimes. Indeed, such linkage actually wouldundermine the purposes of the Elder Abuse Act.“The purpose of the [Act was] essentially to protect a particularlyvulnerable portion of the population from gross mistreatment in the form of abuseand custodial neglect.” (Delaney, supra, 20 Cal.4th at p. 33.) To this end, theLegislature added to the Act heightened civil remedies for egregious elder abuse,seeking thereby “to enable interested persons to engage attorneys to take up thecause of abused elderly persons and dependent adults.” (Welf. & Inst. Code,§ 15600, subd. (j).) To burden such causes with section 425.13’s proceduralrequirements when claims are made for punitive damages would undermine theLegislature’s intent to foster such actions by providing litigants and attorneys withincentives to bring them.Defendants concede that application of section 425.13 would precludeplaintiffs’ punitive damage claim but, they maintain, only because plaintiffs9 With respect to section 425.13(a), in fact, the presumption would be to thecontrary. “At the time Senate Bill No. 679 was enacted, the terms ‘arising out ofprofessional negligence’ and ‘based on professional negligence’ had been quitenarrowly construed.” (Delaney, supra, 20 Cal.4th at p. 42, fn. 8, citing inter aliaBommareddy v. Superior Court (1990) 222 Cal.App.3d 1017, 1024 [whichinterpreted § 425.13(a) as excluding intentional torts]; Flores v. Natividad MedicalCenter (1987) 192 Cal.App.3d 1106, 1114-1116 [which interpreted the phrase“based on professional negligence” in the Medical Injury Compensation ReformAct (MICRA) to exclude failure to summon medical care pursuant to Gov. Code,§ 845.6].)17delayed filing their motion for punitive damages until more than two years afterthey filed suit. Nevertheless, making it more difficult for Elder Abuse Actplaintiffs to plead punitive damages would, as a general matter, likely diminish thewillingness of attorneys to undertake such cases on a contingency basis. (SeeWelf. & Inst. Code, § 15600, subd. (h) [reciting Legislature’s observation whenenacting Elder Abuse Act that “few civil cases are brought in connection with thisabuse due to . . . the lack of incentives to prosecute such suits”].)Section 425.13(a) “was enacted amid concern over routine inclusion ofsham punitive damages claims in medical malpractice actions. The statuteapparently seeks to alleviate this problem by shifting to the plaintiff the proceduralburden that would otherwise fall on the defendant to remove a ‘frivolous’ or‘unsubstantiated’ claim early in the suit.” (College Hospital, Inc. v. SuperiorCourt (1994) 8 Cal.4th 704, 717; see also id. at p. 719 [motion required by§ 425.13(a) “operates like a demurrer or motion for summary judgment in‘reverse’ ”].) More specifically, section 425.13(a) “was designed to address twoproblems. First, the Legislature sought in all cases to require greater certainty ofthe propriety of imposing punitive damages by requiring clear and convincingevidence of fraud, malice, or oppression and by modifying the definition of maliceto include despicable, willful conduct. [¶] Second, because it was concerned thatunsubstantiated claims for punitive damages were being included in complaintsagainst health care providers, the Legislature sought to provide additionalprotection by establishing a pretrial hearing mechanism by which the court woulddetermine whether an action for punitive damages could proceed.” (CentralPathology, supra, 3 Cal.4th at p. 189.)Applying section 425.13 to Elder Abuse Act causes of action would notsignificantly heighten the “certainty of the propriety of imposing punitivedamages” (Central Pathology, supra, 3 Cal.4th at p. 189), because a plaintiff18prosecuting a claim for heightened civil remedies under the Elder Abuse Act isrequired in any event to plead and to prove by clear and convincing evidence“recklessness, oppression, fraud, or malice” (Welf. & Inst. Code, § 15657). Thus,with or without application of section 425.13(a), a health care provider sued forviolating the Elder Abuse Act must defend against allegations of egregiousconduct.Neither would applying section 425.13 to Elder Abuse Act causes of actionafford health care providers significant additional protection against the type ofunsubstantiated claims for punitive damages that concerned the Legislature whenit enacted section 425.13(a). As we have noted, the fundamental problem section425.13 seeks to address arises because the kinds of negligent acts supporting amalpractice cause of action might also support a cause of action for an intentionaltort, such that plaintiffs might through artful pleading “sidestep” the section byincluding an intentional tort cause of action in a negligence action and therebyannul the protection the Legislature intended to afford health care providers in themedical malpractice context. (Central Pathology, supra, 3 Cal.4th at pp. 191,192.) No analogous threat looms here; praying for punitive damages in an actionbased on a violation of the Elder Abuse Act does not substantively transform theaction as does adding an intentional tort claim in a malpractice action. While“minimally culpable defendants are often charged with intentional torts” (FarWest Financial Corp. v. D & S Co. (1988) 46 Cal.3d 796, 830 (conc. & dis. opn.of Eagleson, J.)) supporting punitive damage claims, elder abuse triggering theAct’s heightened remedy provisions entails by its nature egregious conduct.(Welf. & Inst. Code, §§ 15657, 15610.30, 15610.57, 15610.63.) And while in themedical malpractice context “there may be considerable overlap of intentional andnegligent causes of action” (Central Pathology, supra, at p. 192), no such overlapoccurs in the Elder Abuse Act context, where the Legislature expressly has19excluded ordinary negligence claims from treatment under the Act (Welf. & Inst.Code, § 15657.2; Delaney, supra, 20 Cal.4th at p. 30).10In order to obtain the Act’s heightened remedies, a plaintiff must allegeconduct essentially equivalent to conduct that would support recovery of punitivedamages. (Compare Welf. & Inst. Code, § 15657 [requiring “clear and convincingevidence that a defendant is liable for” elder abuse and “has been guilty ofrecklessness, oppression, fraud, or malice in the commission of the abuse”] withCiv. Code, § 3294, subd. (a) [requiring “clear and convincing evidence” that thedefendant has been guilty of oppression, fraud, or malice].) Accordingly, thatplaintiffs in an Elder Abuse Act action may, on appropriate proof (Civ. Code,§ 3294, subd. (a)), recover punitive damages entails no danger directly analogousto the danger that exists when “ ‘punitive damages may be awarded on what istraditionally considered a negligence cause of action’ ” (Central Pathology, supra,3 Cal.4th at p. 190).Section 425.13(a) also contains timing requirements, including therequirement at issue in this case that any motion under the statute be “filed withintwo years after the complaint or initial pleading is filed . . . .” The purpose of thisrequirement is to provide a health care provider with adequate notice of a punitivedamages claim, as well as to prevent “last minute” insertion of punitive damagesissues into a case that has been prepared for trial without consideration of such,and past the time when positions and discovery issues have become fixed.10 In so noting, we have no occasion to decide whether or on what theory aplaintiff may be able to obtain common law remedies for ordinary negligence thatalso constitutes neglect as defined in the Elder Abuse Act. (See, e.g., Norman v.Life Care Centers of America, Inc. (2003) 107 Cal.App.4th 1233, 1242-1243, rev.den. Aug. 13, 2003.)20(Goodstein v. Superior Court (1996) 42 Cal.App.4th 1635, 1642.) As discussed,however, in any Elder Abuse Act action issues of egregious conduct are bydefinition always present, so a defendant has the relevant notice from the outset.Judicial precedent. To the extent we are presented in this case with thenecessity of choosing between application of Central Pathology’s holding to factsonly at its outer reaches and Delaney’s well-documented understanding of theElder Abuse Act’s subject matter and purposes, we choose the latter.Where the gravamen of an action is violation of the Elder Abuse Act,Central Pathology’s rationale for applying section 425.13 to the common lawintentional torts at issue in that case does not obtain. In contrast with CentralPathology, this case cannot be resolved by application of the principle “that astatute should not be interpreted in a manner that would lead to absurd results”(Central Pathology, supra, 3 Cal.4th at p. 191), because neither of the possibleresults—i.e., that section 425.13 applies to Elder Abuse Act claims or that it doesnot—is absurd. Thus, in declining to apply section 425.13, the courts below didnot by implication “render the statute virtually meaningless” (Central Pathology,supra, at p. 191). Central Pathology itself guarantees that, notwithstanding ouraffirmance of the Court of Appeal’s judgment in this case, section 425.13 willcontinue to apply to a broad range of intentional torts typically pled in medicalmalpractice cases. (See Central Pathology, supra, at p. 184.)Defendants fail to acknowledge the factual aspects of Central Pathologythat qualify its holding, including that the case addressed common law causes ofaction for fraud and intentional infliction of emotional distress that arose in themedical malpractice context. (Central Pathology, supra, 3 Cal.4th at pp. 185,21192.)11 While Central Pathology thus speaks to situations in which claims forpunitive damages are, as a factual matter, “predicated on mere negligence or aconscious disregard of the rights or safety of others” in which intentional torts arenevertheless alleged (Central Pathology, supra, at p. 191), its rationale does notextend to situations, as here, in which a claim for punitive damages accompaniesallegations of a statutory violation, proof of which will require clear andconvincing evidence the defendant has been guilty of recklessness, oppression,fraud, or malice in the commission of physical, neglectful, or financial elder abuse.(See Welf. & Inst. Code, §§ 15657, 15610.30, 15610.57, 15610.63.)In light of the general rule that statutory causes of action must be pleadedwith particularity (Lopez v. Southern Cal. Rapid Trans. Dist. (1985) 40 Cal.3d780, 795), a rule plaintiffs’ fourth amended complaint satisfies, we cannotconclude, as we concluded in Central Pathology when considering section425.13’s application to common law intentional torts, that the Legislature intendedthe statute to apply in an action under the Elder Abuse Act.11 It is axiomatic that an unnecessarily broad holding is “informed and limitedby the fact[s]” of the case in which it is articulated. (Cassista v. CommunityFoods, Inc. (1993) 5 Cal.4th 1050, 1061; see generally id. at p. 1057; Thor v.Superior Court (1993) 5 Cal.4th 725, 743.)22DispositionThe judgment of the Court of Appeal is affirmed.12WERDEGAR,J.WE CONCUR:GEORGE, C. J.KENNARD, J.BAXTER, J.BROWN, J.MORENO, J.RYLAARSDAM, J.P.T.*12 To the extent it is inconsistent with our opinion here, Community Care &Rehabilitation Center v. Superior Court, supra, 79 Cal.App.4th 787, isdisapproved.* Associate Justice of the Court of Appeal, Fourth Appellate District,Division Three, assigned by the Chief Justice pursuant to article VI, section 6 ofthe California Constitution.23See next page for addresses and telephone numbers for counsel who argued in Supreme Court.Name of Opinion Covenant Care v. Superior Court__________________________________________________________________________________Unpublished OpinionOriginal AppealOriginal ProceedingReview Granted XXX 89 Cal.App.4th 928Rehearing Granted__________________________________________________________________________________Opinion No. S098817Date Filed: March 25, 2004__________________________________________________________________________________Court: SuperiorCounty: Los AngelesJudge: Richard B. Wolfe__________________________________________________________________________________Attorneys for Appellant:Horvitz & Levy, Julie L. Woods, David S. Ettinger; Even, Crandall, Wade, Lowe & Gates, Randolph M.Even & Associates, Randolph M. Even and Stephanie Charles for Petitioners.Hooper, Lundy & Bookman, Mark E. Reagan and Mark A. Johnson for California Association of HealthFacilities as Amicus Curiae on behalf of Petitioners.Hanson, Bridgett, Marcus, Vlahos & Rudy, Paul A. Gordon and Michelle L. Sullivan for CaliforniaAssociation of Homes and Services for the Aging as Amicus curiae on behalf of Petitioners.Fred J. Hiestand for Californians Allied for Patient Protection and the Civil Justice Association ofCalifornia as Amici Curiae on behalf of Petitioners.Thelen Reid & Priest, Curtis A. Cole, Kenneth R. Pedroza and E. Todd Chayet for California MedicalAssociation, California Dental Association and California Healthcare Association as Amici Curiae onbehalf of Petitioners.__________________________________________________________________________________Attorneys for Respondent:No appearance for Respondent.Houck & Balisok, Russell S. Balisok, Steven Wilheim, Patricia L. Canner; Law Office of Carol S. Jimenezand Carol S. Jimenez for Real Parties in Interest.Peter G. Lomhoff for California Advocates for Nursing Home Reform, Inc., as Amicus Curiae on behalf ofRespondent and Real Parties in Interest.Wilkes & McHugh, Stephen M. Garcia, David T. Bamberger; Robinson, Calcagnie & Robinson and SharonJ. Arkin for Consumer Attorneys of California as Amicus Curiae on behalf of Real Parties in Interest.24Counsel who argued in Supreme Court (not intended for publication with opinion):David S. EttingerHorvitz & Levy15760 Ventura Blvd., 18th FloorEncino, CA 91436-3000(818) 995-0800Curtis A. ColeThelen Reid & Priest333 South Grand Avenue, Suite 3400Los Angeles, CA 90071-3193(213) 621-9800Russell S. BalisokHouck & Balisok535 North Brand Boulevard, Suite 501Glendale, CA 91203(818) 506-789025