Justia Health Law Opinion Summaries

A California-based psychologist, Dr. Rick Q. Wilson, was investigated by the Drug Enforcement Administration (DEA) for potential violations of the Controlled Substances Act. The DEA issued an administrative subpoena to obtain Wilson's medical, prescription, and billing records. Wilson challenged the subpoena on statutory, constitutional, and privacy grounds.The district court initially dismissed the United States' petition to enforce the subpoena, finding it violated the Health Insurance Portability and Accountability Act (HIPAA) and the Fourth Amendment. However, upon reconsideration, the court granted the United States' motion to amend the petition and enforce a narrowed version of the subpoena.On appeal, the United States Court of Appeals for the Tenth Circuit affirmed the district court's decision. The court found that the modified subpoena complied with HIPAA, was not unreasonably burdensome under the Fourth Amendment, and did not violate Wilson's Fifth Amendment privilege against self-incrimination due to the required-records exception. The court held that the subpoena was issued within the DEA's authority, was relevant to the DEA's investigation, and was not unreasonably broad or burdensome. The court also found that the records requested fell within the required-records exception to the Fifth Amendment's privilege against self-incrimination. View "United States v. Wilson" on Justia Law

The case involves the Department of Children, Youth, and Families (DCYF) in Rhode Island, which was held in contempt by the Family Court for failing to place a minor, N.D., in a residential facility appropriate for her level of need. N.D., a teenager with severe mental health issues, was under the temporary custody of DCYF. Despite the court's order, DCYF was unable to find an appropriate in-state or out-of-state placement for N.D. due to her high level of need and the lack of available facilities. The Court Appointed Special Advocate (CASA) filed a motion to adjudge DCYF in contempt for this failure.The Family Court found DCYF in contempt, rejecting DCYF's defense that it was unable to comply with the court's order. The court imposed a contempt sanction of $1,000 per day until N.D. was placed in an appropriate facility, with the sanction to be placed in a trust for N.D.'s benefit. DCYF appealed this decision.The Supreme Court of Rhode Island vacated the order of the Family Court. The Supreme Court found that while DCYF was in technical violation of the Family Court's order, it had demonstrated that it was literally unable to comply because an appropriate placement for N.D. was not presently within its power. The court noted the lack of appropriate facilities for girls with N.D.'s level of need in Rhode Island, staffing issues, and an increase in mental health problems among adolescents. The case was remanded to the Family Court for further proceedings. View "In re N.D." on Justia Law

The case revolves around a minor, A.L., who developed immune thrombocytopenic purpura after receiving the DTaP, Hib, and MMR vaccines. Her parents, Victoria and Kevin Leming, filed a petition for compensation under the National Childhood Vaccine Injury Act (the “Vaccine Act”), alleging that the vaccines caused A.L.'s condition. The Lemings argued that A.L.'s condition met the "surgical intervention" severity requirement of the Vaccine Act, as she was hospitalized for two weeks and underwent a bone marrow aspiration and biopsy.The Court of Federal Claims initially ruled that the Lemings could not establish by a preponderance of the evidence that A.L. satisfied the “surgical intervention” severity requirement. The court held that the bone marrow aspiration and biopsy performed on A.L. was purely diagnostic and did not qualify as a "surgical intervention" under the Vaccine Act. On appeal, the case was reassigned to another special master who requested the Lemings offer more evidence to address the “residual effects” prong of the severity requirement. The Lemings failed to prove that A.L. suffered from the “residual effects” of the vaccine injury for more than six months.The United States Court of Appeals for the Federal Circuit reversed the lower court's decision. The appellate court held that the term “surgical intervention,” as used in the Vaccine Act, requires a surgical act or measure, either diagnostic or therapeutic, taken to prevent harm to a patient or to improve the health of a patient. The court found that the bone marrow aspiration and biopsy performed on A.L. was a surgical intervention as it was a surgical act taken to improve the health of and prevent harm to A.L. The case was remanded for further proceedings consistent with this opinion. View "LEMING v. HHS " on Justia Law

The Supreme Court of the State of Delaware considered an appeal from a decision of the Superior Court regarding the adoption of a Medicare Advantage Plan for State retirees by the State Employee Benefits Committee (SEBC). The Superior Court had found that the SEBC's decision was subject to the requirements of Delaware’s Administrative Procedures Act (APA), granted a motion to stay the implementation of the Medicare Advantage Plan, and required the State to maintain its retirees’ Medicare Supplement Plan. The Superior Court also denied the plaintiffs' application for attorneys’ fees.The Supreme Court of the State of Delaware disagreed with the lower court's ruling. It found that the SEBC's decision to adopt a Medicare Advantage Plan was not a "regulation" as defined by the APA. The court reasoned that the decision did not meet the APA's definition of a regulation because it was not a "rule or standard," nor was it a guide for the decision of future cases. Therefore, the Superior Court did not have jurisdiction to stay the implementation of the plan. The Supreme Court reversed the decision of the Superior Court.On cross-appeal, the plaintiffs argued that the Superior Court erred by refusing to grant their application for attorneys’ fees. However, the Supreme Court found this argument moot because fee shifting is available only against a losing party in favor of a prevailing party. Since the Supreme Court reversed the decision below, fee shifting was foreclosed. View "DeMatteis v. RISE Delaware, Inc." on Justia Law

The case involves two defendants, Christopher Yates and Shawn Connelly, who were convicted for conspiring to distribute methamphetamine. The conspiracy operated out of Macomb, Illinois, and lasted thirteen months, from January 2019 to February 2020. Yates supplied the methamphetamine, initially purchasing the drugs from an unknown source in Joliet, Illinois, with alleged Mexican cartel connections. After the arrest of that supplier, Yates sought out a new source. Connelly was among the distributors.The United States District Court for the Central District of Illinois sentenced both defendants. Yates argued that the government failed to prove the purity of all the methamphetamine involved in the conspiracy, having only tested a small, unrepresentative amount. Connelly argued that the court should not have relied on his coconspirators’ statements to calculate the total drug weight, and that the full weight was not reasonably foreseeable to him. The district court rejected both arguments and sentenced Yates to 168 months in prison and Connelly to 188 months’ imprisonment.On appeal, the United States Court of Appeals for the Seventh Circuit vacated Yates’s sentence and remanded the case. The court found that the government did not provide reliable evidence to support the district court's finding that the conspiracy involved at least 737.1 grams of “ice” methamphetamine. Therefore, Yates was entitled to resentencing. However, the court affirmed Connelly’s sentence, finding that the district court did not err in its calculation of the total drug weight attributable to him. View "United States v. Connelly" on Justia Law

The plaintiff, Ryan S., filed a class action lawsuit against UnitedHealth Group, Inc. and its subsidiaries (collectively, “UnitedHealthcare”) under the Employee Retirement Income Security Act of 1974 (“ERISA”). He alleged that UnitedHealthcare applies a more stringent review process to benefits claims for outpatient, out-of-network mental health and substance use disorder (“MH/SUD”) treatment than to otherwise comparable medical/surgical treatment. Ryan S. asserted that by doing so, UnitedHealthcare violated the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (“Parity Act”), breached its fiduciary duty, and violated the terms of his plan.The district court granted UnitedHealthcare’s motion to dismiss under Federal Rule of Civil Procedure 12(b)(6) based primarily on its conclusions that Ryan S. failed to allege that his claims had been “categorically” denied and insufficiently identified analogous medical/surgical claims that he had personally submitted and UnitedHealthcare had processed more favorably.The United States Court of Appeals for the Ninth Circuit reversed in part and affirmed in part the district court’s judgment. The panel concluded that Ryan S. adequately stated a claim for a violation of the Parity Act. The panel explained that an ERISA plan can violate the Parity Act in different ways, including by applying, as Ryan S. alleged here, a more stringent internal process to MH/SUD claims than to medical/surgical claims. The panel also concluded that Ryan S. alleged a breach of fiduciary duty. However, as Ryan S. failed to identify any specific plan terms that the alleged practices would violate, the panel affirmed the dismissal of his claims based on a violation of the terms of his plan. The case was remanded for further proceedings. View "Ryan S. v. UnitedHealth Group, Inc." on Justia Law

The case involves the Idaho Department of Health and Welfare's (the Department) action to set aside a transfer of real property from two Medicaid recipients, Robert Gilbert and Juanita Gilbert, to their five grandchildren. The Department had provided Robert and Juanita with Medicaid benefits totaling over $140,000. In 2005, Robert and Juanita executed two quitclaim deeds transferring their interest in real property to themselves and their grandchildren. After their deaths, the Department filed an action to set aside the two quitclaim deeds, alleging that the estates did not receive adequate consideration for the transfer of their interests in the real property. One of the grandchildren, Earle L. Beason, argued that the Department’s action was barred by the statute of limitations and that Robert and Juanita received adequate consideration for their interests in the property.The District Court of the Seventh Judicial District of the State of Idaho granted the Department’s motion for summary judgment and entered a judgment in favor of the Department setting aside the quitclaim deeds. The court concluded that the Department’s action was timely and that the Department had demonstrated the absence of a genuine issue of material fact regarding adequate consideration. Earle L. Beason appealed the decision.The Supreme Court of the State of Idaho affirmed the district court’s decision. The court held that the Department’s action was timely filed pursuant to Idaho Code section 5-224, the catch-all statute of limitation, which provides a four-year limitation period when an action for relief is not otherwise provided for. The court also affirmed the district court’s grant of summary judgment in favor of the Department because Earle L. Beason did not establish a genuine issue of material fact regarding adequate consideration. View "Idaho Department of Health and Welfare v. Beason" on Justia Law

The case involves Vanda Pharmaceuticals, a drug manufacturer, and the Centers for Medicare & Medicaid Services (CMS). Vanda challenged a 2020 regulation by CMS that expanded the definition of a "line extension" drug under the Medicaid Drug Rebate Program. This program requires drug manufacturers to reimburse Medicaid if they increase their prices faster than inflation. A "line extension" drug, which is a new formulation of an existing drug, can also be liable for price increases of the original drug. Vanda argued that the regulation expanded the definition of a line extension beyond what the Medicaid statute permitted.Previously, the district court granted summary judgment to CMS, disagreeing with Vanda's argument. The court held that the agency's regulation was within the bounds of the Medicaid statute.The United States Court of Appeals for the Fourth Circuit affirmed the district court's decision. The court found that the agency's definitions of "line extension" and "new formulation" were within the Medicaid statute's ambit. It also held that the agency's interpretation of the oral-solid-dosage-form requirement was not contrary to law. The court rejected Vanda's argument that the agency's rulemaking process was arbitrary and capricious, finding that the agency had reasonably considered the relevant issues and explained its decision. View "Vanda Pharmaceuticals, Inc. v. Centers for Medicare & Medicaid Services" on Justia Law

The case involves Adree Edmo, a transgender woman incarcerated in Idaho, who sued the State of Idaho, private prison company Corizon, and individual prison officials for failing to provide her with adequate medical care, including gender-confirmation surgery. Edmo alleged violations of the Eighth Amendment, the Fourteenth Amendment’s Equal Protection Clause, the Affordable Care Act, the Americans with Disabilities Act, and negligence under Idaho law. The district court granted an injunction on Edmo’s Eighth Amendment claim and ordered the defendants to provide her with adequate medical care, including gender-confirmation surgery. The court denied preliminary injunctive relief on Edmo’s Fourteenth Amendment and ACA claims because the record had not been sufficiently developed.The district court's decision was appealed, and the injunction was stayed. The Ninth Circuit Court of Appeals affirmed the district court’s decision except as it applied to five defendants in their individual capacities. After the Supreme Court denied a writ of certiorari, the parties engaged in settlement negotiations that led to Edmo voluntarily dismissing the remainder of her claims. The district court awarded Edmo $2,586,048.80 for attorneys’ fees incurred up until the injunction became permanent and all appeals were resolved.The Ninth Circuit Court of Appeals reversed in part, affirmed in part, and vacated in part the district court’s award of attorneys’ fees to Edmo. The court held that Edmo was entitled to fees incurred litigating her successful Eighth Amendment claim. However, the court found that the district court erred in calculating the lodestar amount to include fees incurred litigating unsuccessful claims advanced in the complaint, even if those claims were premised on the same facts that supported Edmo’s Eighth Amendment claim. The court also held that the district court did not err by applying an enhancement to the lodestar amount given that Edmo’s counsel operated under extraordinary time pressure and that the customary fee for counsel’s services is well above the PLRA cap. The case was remanded for recalculation of the lodestar amount to include only fees incurred litigating Edmo’s successful claim against the defendants who remained in the case. View "Edmo v. Corizon, Inc." on Justia Law

In 2019, MO CANN Do, Inc. (MCD) applied for a medical marijuana cultivation license in Missouri. However, the Department of Health and Senior Services (DHSS) rejected MCD's application as it failed to include a certificate of good standing demonstrating its authorization to operate as a business in Missouri. An administrative hearing commission upheld DHSS's decision, and MCD appealed to the circuit court, which also affirmed the decision.The Supreme Court of Missouri found that MCD's application did not meet the minimum standards for licensure, as it failed to provide a certificate of good standing from the Secretary of State, as required by DHSS's regulations. MCD argued that its certificate of incorporation satisfied the standard requiring proof of authorization to operate as a business in Missouri, but the Court disagreed, stating that the regulatory language was unambiguous and the certificate of good standing was a specific requirement.MCD further argued that DHSS waived the certificate of good standing requirement by failing to specify it in the deficiency letter sent to MCD. The Court rejected this argument, stating that DHSS never affirmatively waived the deficiencies in MCD's application.Lastly, MCD claimed that DHSS should be estopped from denying its application based on the missing certificate of good standing due to its failure to notify MCD of this specific deficiency. The Court denied this claim, stating that it is generally inappropriate to estop governmental agencies tasked with administrating licensure in highly regulated industries, which include the marijuana industry. In conclusion, the Supreme Court of Missouri affirmed the circuit court’s judgment. View "MO CANN Do, Inc. vs. Missouri Department of Health and Senior Services" on Justia Law