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WSHB Case Update: California Court of Appeal Holds Admission Of Department Of Public Health Nursing Home Citation Was An Abuse Of Discretion

July 22, 2013

Nevarrez v. San Marino Skilled Nursing and WEllness Centre et al.
2013 WL 2436633
Filed June 5, 2013


In this decision, the Second District Court of Appeal concluded the trial court abused its discretion by admitting into evidence a “class A” citation and a statement of deficiencies issued by the Department of Public Health (DPH).


Patient Nevarez filed the underlying action, seeking damages on theories of negligence, elder abuse, and violation of the Patient’s Bill of Rights. The plaintiff fell nine times within a two month period while under the care of defendant San Marino Skilled Nursing & Wellness Centre. In connection with the ninth fall, the DPH issued a class A citation and statement of deficiencies, based on violations of federal regulations. The DPH citation also included the nursing home’s plan of corrections, the investigator’s review of Nevarez’s records, and the investigator’s conclusions about the fall.

Defendant’s efforts to keep the citation out of evidence were rejected by the trial court. When it became apparent the actual DPH investigator would not testify, defendant also argued it would be prejudiced by the admission of the citation because it would be denied the opportunity to cross-examine the investigator regarding his qualifications and findings. The trial court ultimately overruled the objection and admitted the citation into evidence. The citation was the cornerstone of plaintiff counsel’s closing argument. The jury subsequently ruled in favor of the plaintiff.

The appeal followed, with the key issue being whether the lower court abused its discretion in admitting the class A citation and a statement of deficiencies issued by the DPH against the defendant.


The trial court abused its discretion in admitting the citation into evidence because the record was void of any indication that the court balanced the probative value of the citation against the danger of undue prejudice or jury confusion. In fact, the Court of Appeal agreed with the defendant and held that the citation was largely used to confuse the jury into believing the negligence issues were already established by the citation. Compounding the situation was the fact the citation contained the investigator’s conclusions and opinions, which were not solely or primarily based upon his observations. For all of these reasons, the Court of Appeal concluded the citation contained information that was untrustworthy, likely to confuse the jury and, as such, prejudicial.


This case stands for the proposition that before a citation issued by DPH may be utilized to establish negligence or elder abuse, the court must balance the probative value of the citation against the danger of undue prejudice or jury confusion. Here, the Court of Appeal was concerned the citation was being offered, essentially, as an endorsement by the government of the plaintiff’s case against the defendant nursing home. However, the Court’s opinion also suggests that so long as the trial judge balances the probative value and the prejudicial effect of such a citation, it may be admissible in other cases.


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