## Facts

- California’s Hereditary Disorders Act authorized a statewide newborn screening program administered by the State Department of Health Services (Department), generally requiring testing of newborns unless parents objected on religious grounds.
- Sierra Creason was born October 20, 1990; shortly after birth, her blood specimen was collected and tested by a state-contracted laboratory for certain disorders, including congenital hypothyroidism.
- The Department’s protocol at the time triggered parental notification based on elevated thyroid-stimulating hormone (TSH) levels associated with typical congenital hypothyroidism.
- Sierra had congenital hypothyroidism, but her screening results reflected abnormally low hormone counts rather than elevated TSH; under the protocol, her parents were not notified of any abnormality.
- In April 1991, Sierra was diagnosed with congenital hypothyroidism; plaintiffs alleged delayed diagnosis and treatment caused serious, permanent injury.
- Plaintiffs alleged the Department negligently (1) set improper cutoff values and testing procedures and (2) failed to timely report abnormal results to physicians and parents.
- The trial court sustained the Department’s demurrer without leave to amend and dismissed the action; the Court of Appeal reversed; the California Supreme Court granted review.

## Issues

1. Whether the Hereditary Disorders Act imposed a mandatory duty, enforceable under Government Code § 815.6, requiring the Department to adopt accurate standards for testing for and reporting congenital hypothyroidism, such that breach could support public-entity liability.
2. If an enforceable mandatory duty existed, whether the California Tort Claims Act nonetheless immunized the State/Department from liability, including under Government Code §§ 820.2 and 855.6.

## Decision

- The California Supreme Court reversed the Court of Appeal and reinstated dismissal.
- The court held the Hereditary Disorders Act did not impose a “mandatory duty” under Government Code § 815.6 to select particular testing thresholds or reporting protocols for congenital hypothyroidism.
- Alternatively, even if a mandatory duty could be inferred, the Department would be immune under the Tort Claims Act because the challenged conduct involved discretionary policy decisions and fell within statutory immunities for examination/diagnosis/reporting failures.

## Legal Principles

- Government Code § 815.6 liability requires an enactment that clearly commands a specific, ministerial act; general statutory direction to operate a program, without prescribing how to perform it, does not create a mandatory duty.
- Where a statute leaves the manner of implementation to agency judgment (including technical choices such as test selection, cutoff values, and notification criteria), those choices are discretionary rather than ministerial for § 815.6 purposes.
- Government Code § 820.2 provides immunity for acts or omissions resulting from discretionary policy decisions by public employees, and this immunity extends to the public entity where applicable.
- Government Code § 855.6 immunizes public entities and employees from liability for injuries caused by failure to perform, or negligent performance of, an examination for the purpose of determining whether an individual has a disease or condition, including failures to diagnose or report.

## Conclusion

The court held that the newborn screening statute did not impose a sufficiently specific, non-discretionary duty to support public-entity liability for the Department’s screening thresholds and notification procedures, and that, in any event, discretionary-decision immunity and the examination/diagnosis/reporting immunity barred the claims.


Creason v. Dep’t of Health Servs., 957 P.2d 1323 (Cal. 1998)