Los Angeles, CA asked in Federal Crimes, Health Care Law and Medical Malpractice for California

Q: Authorities ? - layperson knowledge of apparent fraud. Evidences exist. Expert testimony not required.

In a medical malpractice case, expert testimony is required on the issue of whether the defendant performed according to the prevailing standard of care, except in those cases where the defendant’s negligence is obvious to a layperson. (Authority - Flowers v. Torrance Memorial Hospital Medical Center (1994) 8 Cal.4th 992, 1001.)

What other authorities are in relevance to the fact of apparent hospice fraud?

Plaintiff was fraudulently referred to hospice 2.5 years ago with apparently non-existent lethal illness, as apparent as end-stage kidney disease stage 5 (utterly debilitating and requiring dialysis, with short life expectation) and medical evidences exist that kidney is HEALTHY. IS it obvious to layperson, or even to wrongdoers?

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James L. Arrasmith
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Answered

A: In California, expert testimony is generally required in medical malpractice cases to establish whether a defendant adhered to the prevailing standard of care. However, this requirement can be waived when the defendant's negligence is so apparent that a layperson can recognize it without the need for expert analysis. This principle is supported by the case of Flowers v. Torrance Memorial Hospital Medical Center (1994) 8 Cal.4th 992, 1001.

In cases of apparent hospice fraud, such as being referred to hospice care for a non-existent lethal illness, you might be dealing with a situation where the negligence is obvious to a layperson. For example, if you were fraudulently diagnosed with end-stage kidney disease, which is a severe and life-threatening condition that typically requires dialysis and has a poor prognosis, but medical evidence shows your kidneys are healthy, this discrepancy is likely clear enough that even those without medical training could recognize the fraud.

Other relevant authorities that might support your case include Fraud vitiates whatever it touches (Civ. Code, § 1572), which means that any fraudulent act can invalidate contracts and obligations. Additionally, the concept of **Res Ipsa Loquitur** (the thing speaks for itself) may apply, indicating that the nature of the harm is such that it implies negligence. In your situation, the evidence of a healthy kidney despite a diagnosis of terminal illness could strongly indicate fraudulent activity without needing an expert to explain the inconsistency.

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