Justia Health Law Opinion Summaries

A man with a lengthy history of severe mental illness, homelessness, and repeated hospitalizations was admitted multiple times to the Alaska Psychiatric Institute (API), most recently seeking shelter during winter. He has diagnoses including schizoaffective disorder, traumatic brain injury, and polysubstance dependence, and has frequently been barred from local shelters and facilities due to his behavior. After his admission in early 2024, API staff observed his acute psychosis, noncompliance with outpatient treatment, and declining condition. There was discussion of a possible discharge plan involving relocation to live with family in Arizona, but concerns were raised about his ability to safely travel, the sufficiency of supports available there, and his own reluctance to leave Alaska.The Superior Court of the State of Alaska, Third Judicial District, Anchorage, first granted a 30-day involuntary commitment and authorization for administration of psychotropic medication, then later extended the commitment for 90 days. At the 90-day hearing, testimony indicated that less restrictive alternatives, including discharge to family, were considered but not feasible at that time. The court also approved a renewed petition for involuntary medication after finding that the man lacked the capacity to make informed medical decisions and had not previously, while competent, expressed a clear wish to refuse such medication. The man did not file timely objections to the master’s findings.The Supreme Court of the State of Alaska reviewed the case under the plain error standard, given the absence of objections below. The court held that while it was a clear error for the superior court to proceed without confirming whether the man was advised of the option for voluntary treatment, this mistake was not obviously prejudicial because the record indicated he would not have accepted voluntary admission. The Supreme Court also found no plain error in the lower court’s conclusions that no less restrictive alternative was available and that the requirements for involuntary medication were satisfied. The superior court’s orders were affirmed. View "In re Necessity for the Hospitalization of Derius L." on Justia Law

An individual Nebraska resident, voter, and taxpayer sought declaratory and injunctive relief challenging the constitutionality of two medical cannabis laws enacted by voter-approved initiatives in the November 2024 general election. He named as defendants the Governor, other state officials, members of the Nebraska Medical Cannabis Commission, and the sponsors of the initiatives. The plaintiff alleged the laws violated the federal Supremacy Clause, improperly delegated regulatory authority in violation of Nebraska’s separation of powers, and were otherwise unconstitutional. He further claimed public officials and agencies would expend state funds and resources to implement these laws, and that this expenditure was unlawful.Previously, before the laws passed, the same individual brought a preelection challenge to the legal sufficiency of the initiative petitions in the District Court for Lancaster County. That challenge was rejected, and the Nebraska Supreme Court affirmed. After the election, he filed a new action in the same district court, seeking to enjoin the Governor from certifying the measures. The district court denied his request for a temporary restraining order. Once the laws were certified and enacted, he amended his complaint several times, ultimately alleging taxpayer standing, standing for a matter of great public concern, and standing under a Nebraska statute governing initiative challenges. The defendants moved to dismiss, contending he lacked standing.The Nebraska Supreme Court reviewed the district court’s dismissal de novo. The Supreme Court held that the plaintiff lacked standing to bring the suit. Specifically, it concluded he did not have taxpayer standing, as his allegations of incidental expenditures and government employee time spent implementing the laws did not amount to illegal expenditures sufficient to confer standing under Nebraska law. The Court also found he did not qualify for any exception for matters of great public concern. The order dismissing his complaint without prejudice was affirmed. View "Kuehn v. Pillen" on Justia Law

While incarcerated at a North Carolina women’s correctional facility, the plaintiff learned she was pregnant and, due to her history of opioid use disorder, was prescribed medication for opioid withdrawal (MOUD) under a prison policy that restricted such treatment to pregnant inmates. When she went into labor, she was transported to the hospital and was shackled at various stages during labor, delivery, and her return to prison. After giving birth, the facility denied her further MOUD because she was no longer pregnant, instead providing a short course of alternative pain medication. She experienced significant withdrawal symptoms as a result. The plaintiff brought claims against various prison officials, alleging violations of the Eighth Amendment for the shackling and for denial of MOUD, as well as disability discrimination under the Americans with Disabilities Act and the Rehabilitation Act.The United States District Court for the Eastern District of North Carolina granted summary judgment to all defendants, finding no constitutional violations and that qualified immunity protected the officials. It also concluded that the plaintiff was not discriminated against under federal disability law because the MOUD program was limited to pregnant inmates.On appeal, the United States Court of Appeals for the Fourth Circuit affirmed in part, vacated in part, and remanded. The Fourth Circuit held that, as to certain officials, there was a genuine dispute of fact regarding whether shackling the plaintiff during labor and postpartum, without evidence of a security or flight risk, violated the Eighth Amendment. The court also held that the denial of MOUD following pregnancy, pursuant to a categorical policy, could constitute deliberate indifference to serious medical needs under the Eighth Amendment, and that summary judgment was inappropriate for the medical officials involved. The court further vacated the lower court’s disposition of the plaintiff’s ADA and Rehabilitation Act claims, remanding for further proceedings. Summary judgment for other defendants was affirmed. View "Edwards v. Witherspoon" on Justia Law

An individual incarcerated at a California state prison suffers from a spinal condition causing severe pain and limited mobility, and also experiences incontinence. For nearly a year, prison staff provided him with adult diapers as a medical accommodation. However, after a transfer to a different housing unit, his access to these supplies was abruptly terminated, and his requests for reinstatement were denied for almost five months. During this period, he was forced to soil himself and his environment, resulting in humiliation and distress, despite repeated written and verbal requests for accommodation.He filed a lawsuit in the United States District Court for the Northern District of California, alleging violations of the Americans with Disabilities Act (ADA) and the Eighth Amendment. The district court granted summary judgment in favor of the California Department of Corrections and Rehabilitation (CDCR) and other defendants, concluding he was not entitled to relief under the ADA because it found no evidence of discrimination due to his disability and determined his claims for injunctive relief were moot once supplies were reinstated.On appeal, the United States Court of Appeals for the Ninth Circuit reversed the district court’s summary judgment as to the ADA claim. The appellate court held that a reasonable jury could find the plaintiff is disabled under the ADA due to his spinal condition and incontinence, that he was denied meaningful access to toileting and hygiene services because of his disabilities, and that this denial was because of his disabilities. The court further found there was sufficient evidence to create a triable issue as to whether CDCR acted with deliberate indifference, a necessary element for damages. The panel also clarified that a public entity is not excused from ADA obligations merely because an accommodation is not deemed medically necessary. The case was remanded for further proceedings, including consideration of standing for injunctive relief. View "ADOM V. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION" on Justia Law

A biotechnology company developed a gene therapy for two hereditary blood disorders, which may negatively affect patients’ fertility. To address potential deterrence due to fertility concerns, the company created a program offering up to $70,000 for fertility services to patients receiving the therapy. The program was initially limited to privately insured patients, as the company was concerned it might violate federal healthcare statutes if extended to federally insured patients. To clarify the legality, the company requested an advisory opinion from the Department of Health and Human Services (HHS), arguing that the program did not violate relevant statutes and, alternatively, qualified for statutory exceptions.After significant delays and exchanges, HHS issued an unfavorable advisory opinion, concluding the program violated both the Anti-Kickback Statute (AKS) and the Beneficiary Inducement Statute (BIS), and denied immunity from enforcement. The company sued HHS and its officials in the United States District Court for the District of Columbia, challenging both the advisory opinion and the regulations governing timing for advisory opinions. The district court granted summary judgment to HHS, finding that the program violated the AKS and deferring to HHS’s reasoning regarding the BIS exception, while dismissing the challenge to the timing regulations as moot after the opinion was issued.On appeal, the United States Court of Appeals for the District of Columbia Circuit reviewed the district court’s decision de novo. The court affirmed summary judgment for HHS regarding the AKS, holding that the program constituted prohibited remuneration intended to induce patients to purchase the therapy. However, it reversed as to the BIS, finding HHS’s determination arbitrary and capricious due to its failure to explain why the statutory exception did not apply. The court also held that the company had standing to challenge HHS’s timing regulations and that those regulations unlawfully evaded the statutory deadline. The judgment was affirmed in part, reversed in part, and remanded. View "Vertex Pharmaceuticals Inc. v. HHS" on Justia Law

A woman brought her nearly two-year-old son to a hospital in Lincoln, Nebraska, where he was found with multiple injuries, including bruises, swelling, and a fractured leg. Subsequent medical examinations revealed further injuries, such as broken ribs, a lung contusion, brain swelling, and ultimately, the child died from his injuries. The mother, who had left the child in the care of her boyfriend and others, admitted to noticing symptoms and injuries over a period of weeks but did not seek medical care, citing reasons such as believing the injury was minor and fear of involvement with Child Protective Services. Evidence at trial included interviews, witness testimony, text messages, and internet searches indicating the mother was aware of the child’s worsening condition.The District Court for Lancaster County reviewed the case and presided over a jury trial. The jury found the mother guilty of intentional child abuse resulting in death, intentional child abuse resulting in serious bodily injury, and possession with intent to deliver or delivery of a controlled substance near a school. The court denied pretrial motions to exclude certain photographic evidence and sentenced her to consecutive prison terms totaling 70 years to life for the most serious charges, and additional years for the drug offense.The Nebraska Supreme Court examined claims of insufficient evidence, improper admission of photographs, ineffective assistance of counsel, and excessive sentencing. Applying the appropriate standards of review, the court held that there was sufficient evidence for the convictions, the photographs were relevant and not unduly prejudicial, and the sentences were within statutory limits and not an abuse of discretion. Claims of ineffective assistance were rejected as either unsupported or not prejudicial. The court affirmed the judgment of the district court. View "State v. Cook" on Justia Law

A healthcare administrator at a Mississippi correctional facility, who had served in that role for many years, was employed by a new contractor after it obtained the healthcare services contract for the facility. The administrator became concerned that a prison physician was providing inadequate care and might be impaired by drugs, reporting these concerns to her employer and recommending the physician’s termination. Despite those reports, the physician remained employed after a brief administrative leave. Later, the administrator was notified her employment would be terminated because the employer required all administrators to be registered nurses, and she did not meet that requirement.After her termination, the administrator filed suit in the Sunflower County Circuit Court, alleging wrongful termination and tortious interference. She argued her firing was due to her refusal to participate in denying adequate medical care and her repeated reports about the physician’s performance and possible drug use. The employer denied these allegations, and moved for summary judgment, asserting that she was an at-will employee and had not reported conduct subject to criminal penalties as required under the public-policy exceptions recognized in McArn v. Allied Bruce-Terminix Co., Inc. The circuit court granted summary judgment for the employer, finding that her claims did not implicate criminal conduct and thus did not fall within McArn’s exceptions.The Supreme Court of Mississippi reviewed the case de novo. It held that the administrator failed to show a genuine issue of material fact that she was discharged for refusal to participate in or for reporting criminal conduct, as required under McArn. The Court further clarified that Swindol v. Aurora Flight Sciences Corp. did not expand McArn beyond criminal conduct. Accordingly, the Supreme Court of Mississippi affirmed the circuit court’s grant of summary judgment in favor of the employer. View "Knighten v. VitalCore Health Strategies, LLC" on Justia Law

Jessica Stuart was convicted of health care fraud and using false identification after she falsely claimed to be a Board-Certified Behavioral Analyst, rendering services to children with autism and causing significant financial losses to her employer and Medicaid. Her criminal history included multiple instances of fraud and larceny, such as issuing bad checks, stealing from individuals with whom she resided, and manipulating payments for personal gain. After serving her sentence, Stuart’s supervised release was marked by additional violations, including failing to make restitution payments, moving without approval, committing new frauds involving food stamps and unemployment benefits, and failing to report police contact.The United States District Court for the District of Connecticut initially sentenced Stuart to incarceration and supervised release. When she violated conditions of her supervised release, the court, now presided over by Judge Nagala, imposed a new special condition authorizing the Probation Office to notify third parties—including employers, potential employers, and others to whom Stuart might pose a risk—of her criminal history and past conduct. Stuart objected, arguing the condition improperly delegated judicial authority to the Probation Office by granting it sole discretion to determine who qualifies as a third party at risk.The United States Court of Appeals for the Second Circuit reviewed the challenge. Applying an abuse of discretion standard and reviewing legal questions de novo, the court held that the district court had sufficiently limited the Probation Office’s discretion. The condition was found permissible because it was rooted in Stuart’s varied and opportunistic risk profile, and the court had provided enough guidance to constrain arbitrary use of delegated authority. The Probation Office’s role was determined to be execution, not imposition, of the condition. Accordingly, the Second Circuit affirmed the judgment of the district court. View "United States v. Stuart" on Justia Law

A physician brought a lawsuit on behalf of the United States under the False Claims Act (FCA), alleging that her employer and associated healthcare entities knowingly submitted false diagnosis codes to Medicare in order to obtain inflated payments. The case proceeded for several years. In February 2024, the defendants sought judgment on the pleadings or dismissal, arguing that the FCA’s qui tam provisions—which allow private individuals (relators) to sue on behalf of the government—violated the Constitution’s Appointments Clause, Take Care Clause, and Vesting Clause.The United States District Court for the Middle District of Florida granted the defendants’ motion, concluding that the qui tam provisions violated the Appointments Clause. The district court reasoned that relators are “officers of the United States” because they exercise significant federal authority and occupy a continuing position established by law, but are not appointed by the President as required by Article II. The court dismissed the case, finding the relator lacked authority to proceed on behalf of the United States, and did not address the other constitutional arguments.On appeal, the United States Court of Appeals for the Eleventh Circuit reviewed the district court’s constitutional analysis de novo. The Eleventh Circuit disagreed with the lower court’s conclusion, holding that relators under the FCA are not officers of the United States because they do not occupy a continuing position established by law. The court explained that relators’ roles are temporary, personal, and lack a continuing emolument or transferable duties. Therefore, the FCA’s qui tam provisions do not violate the Appointments Clause. The Eleventh Circuit vacated the district court’s dismissal and remanded the case for consideration of the remaining constitutional arguments. View "Zafirov v. Florida Medical Associates, LLC" on Justia Law

Several plaintiffs challenged a New Jersey law requiring any doctor who wishes to provide telemedicine services to a patient located in New Jersey to first obtain a license from the state’s Board of Medical Examiners. The plaintiffs included two physicians licensed outside New Jersey and three New Jersey residents who wanted to receive virtual medical consultations from those doctors. The doctors argued that New Jersey’s licensing requirement placed an undue burden on their ability to provide telemedicine services, especially since they were already licensed in their home states. The patients and a parent also raised claims based on their rights to receive medical advice and direct their child’s care.The United States District Court for the District of New Jersey dismissed all the plaintiffs’ claims for failure to state a claim. The court held that the licensing requirement did not violate the First Amendment, the dormant Commerce Clause, the Privileges and Immunities Clause, or substantive due process. The plaintiffs appealed, maintaining that the law, as applied, unconstitutionally restricted their right to free speech and imposed excessive burdens on interstate medical practice.The United States Court of Appeals for the Third Circuit affirmed the District Court’s dismissal of all claims, with one modification. The Third Circuit held that requiring a medical license to provide telemedicine services is a content-based restriction on speech, but such regulations have a long tradition and thus do not warrant strict scrutiny. Instead, the law survives intermediate scrutiny because the burdens imposed are not substantial compared to New Jersey’s interest in ensuring competent medical care. The court further held that the law does not violate the dormant Commerce Clause or the Privileges and Immunities Clause, as it applies equally to all doctors regardless of their state of residence. The court also found that the plaintiff asserting a substantive due process right lacked standing, and that claim was ordered dismissed without prejudice for lack of jurisdiction. View "MacDonald v. President NJ State Board of Medical Examiners" on Justia Law