What is the test for exhaustion of administrative remedies in medical malpractice cases?

Third, courts have required "exhaustion of `external' administrative remedies in a variety of public contexts." (Rojo, supra, 52 Cal.3d at p. 87, 276 Cal.Rptr. 130, 801 P.2d 373.) In such cases, although the legislative intent to resort in the first instance to administrative remedies is not entirely clear, courts have required exhaustion when they "have expressly or implicitly determined that the administrative agency possesses a specialized and specific body of expertise in a field that particularly equips it to handle the subject matter of the dispute. Typical of these is Karlin v. Zalta (1984) 154 Cal.App.3d 953, 201 Cal.Rptr. 379, involving a physician's class action for equitable relief and damages arising out of defendant insurers' alleged charging of excessive malpractice insurance premium rates.... [] [T]he court held plaintiffs were required to exhaust their administrative remedies under the McBride Act (Ins.Code, 1850-1860.3). Citing the `factual complexities' of medical malpractice insurance ratemaking and the McBride Act's `pervasive and self-contained system of administrative procedure' for monitoring rates and relevant market conditions, the court determined the excessive-rates issue was a matter `singularly within the technical competence of the Insurance Commissioner through the enlistment of agency resources.' (154 Cal.App.3d at p. 983, 201 Cal.Rptr. 379.) In these circumstances, the court held, `it is indispensable that the expertise of the insurance commissioner and the agency's staff be initially engaged to make such review.'" (Rojo, supra, 52 Cal.3d at p. 87, 276 Cal.Rptr. 130, 801 P.2d 373.)