Justia Health Law Opinion Summaries

A resident of Puerto Rico suffered work-related injuries in 1994, resulting in permanent total disability. His employer and its insurance carrier were ordered to provide medical care under Section 7 of the Longshore and Harbor Workers’ Compensation Act, as extended by the Defense Base Act. In 2019, a Puerto Rico-licensed physician recommended medical cannabis-infused edibles to treat the petitioner’s chronic pain. The petitioner sought reimbursement for these products from the employer’s insurance carrier, which denied the request.The petitioner then asked the United States Department of Labor’s Office of Administrative Law Judges to order reimbursement, arguing that medical cannabis was a reasonable and necessary treatment. The Administrative Law Judge denied the request, finding that marijuana’s classification as a Schedule I substance under the Controlled Substances Act (CSA) meant it could not have an accepted medical use under federal law. On appeal, the Department of Labor Benefits Review Board affirmed this decision by a 2-1 vote, agreeing that reimbursement was barred by the CSA and rejecting arguments that recent federal appropriations riders or executive actions altered the federal legal status of marijuana.On further appeal, the United States Court of Appeals for the Second Circuit reviewed the case. The court held that because marijuana remains a Schedule I substance under the CSA, it cannot be considered a reasonable and necessary medical expense for purposes of reimbursement under the Longshore and Harbor Workers’ Compensation Act. The court found that neither appropriations riders nor recent executive or legislative actions had changed marijuana’s federal classification or its legal status under the Act. Therefore, the court denied the petition for review. View "Garcia v. Department of Labor" on Justia Law

A man was convicted by a Michigan state jury for delivering oxycodone to a friend, resulting in her death from a drug overdose. The evidence showed that the man and the deceased had a longstanding relationship, and after her release from jail, he purchased 40 Percocet pills—containing oxycodone and acetaminophen—and spent time with her at a hotel where she died. Medical experts found oxycodone in her blood and acetaminophen in her urine, both components of Percocet, and testified that oxycodone was a substantial factor in causing her death.After his conviction, the defendant sought a new trial in the Michigan courts, arguing that his trial counsel was ineffective for two reasons: failing to investigate an “acetaminophen-based” defense (that the absence of acetaminophen in the blood meant the deceased had not consumed Percocet), and failing to call an expert witness to challenge the prosecution’s case on causation. The trial court held a hearing and ultimately rejected these claims. The Michigan Court of Appeals affirmed, and the Michigan Supreme Court denied further review.The United States District Court for the Eastern District of Michigan then denied the defendant’s petition for habeas corpus, and the case was appealed to the United States Court of Appeals for the Sixth Circuit. The Sixth Circuit held that, under the highly deferential standards of the Antiterrorism and Effective Death Penalty Act (AEDPA), the state courts did not unreasonably apply clearly established Supreme Court law or make unreasonable determinations of fact in rejecting the ineffective assistance claims. The court further held that counsel’s strategic decisions were not objectively unreasonable and that the alleged failures did not prejudice the outcome of the trial. The Sixth Circuit affirmed the denial of habeas relief. View "DeBruyn v. Douglas" on Justia Law

A patient was hospitalized after contracting COVID-19 and, as his condition worsened, was transferred between several hospitals in Kentucky and Indiana. During his treatment, he was intubated, placed on a ventilator, and medically immobilized. While under this care, he developed a severe bed sore that progressed to necrotizing fasciitis. Despite ongoing treatment, he ultimately died, with his death certificate listing multiple causes including cardiopulmonary arrest and sepsis. His estate claimed that negligence in the treatment of the bed sore caused his death and filed a proposed medical malpractice complaint against more than eighty healthcare providers.The case began when the estate filed its complaint with the Indiana Department of Insurance, while a medical-review panel was being requested. Before the panel was constituted, the providers moved for summary judgment in Vanderburgh Superior Court, arguing they were immune from liability under Indiana’s Healthcare Immunity Act, Premises Immunity Act, and the federal PREP Act. The trial court granted summary judgment for the providers, finding that statutory immunity applied and that the court, not the medical-review panel, could decide the immunity issue. The estate appealed, and the Indiana Court of Appeals reversed, holding that the question of immunity required expert input from the medical-review panel, especially regarding causation.The Indiana Supreme Court granted transfer, vacating the Court of Appeals’ decision. It held that the trial court could make a preliminary determination on statutory immunity without waiting for a medical-review panel’s opinion, since the facts relating to the connection between the patient’s COVID-19 treatment and his injury were undisputed for summary judgment purposes. The court further held that the providers were immune from civil liability under both state and federal law, as the patient’s injuries arose from treatment provided in response to the COVID-19 emergency. The court affirmed summary judgment for the providers. View "Estate of Waggoner v. Anonymous Health System, Inc." on Justia Law

The City of Boston, along with its Public Health Commission and Housing Authority, brought suit against two pharmacy benefit managers (PBMs), OptumRx and Express Scripts, alleging that the PBMs had worked with opioid manufacturers to misrepresent the risks of opioid drugs. The City claimed that this conduct violated Massachusetts public nuisance law and resulted in harm to the City. The PBMs removed the case to federal court and argued that the suit was untimely because it was brought after the three-year statute of limitations had expired. The City responded by asserting that its complaint sufficiently alleged a continuing nuisance and that the statute of limitations should be tolled due to the PBMs’ fraudulent concealment of their wrongdoing.The United States District Court for the District of Massachusetts granted the PBMs’ motion to dismiss, finding that the City either knew or should have known of its injuries and of the PBMs’ alleged role before 2021, based on public records and prior litigation, and thus failed to file suit within the statutory period. The district court further ruled that the City had not adequately pled a continuing nuisance, as it did not allege any specific, recent unlawful acts within the limitations period, and rejected the City’s claim of fraudulent concealment, determining that the City had the means to discover the facts needed for its claim. The district court also denied a motion by the PBMs to disqualify the City's law firm, Motley Rice.On appeal, the United States Court of Appeals for the First Circuit affirmed both the dismissal of the City’s state law claim and the denial of the motion to disqualify Motley Rice. The court held that the action was time-barred and that the City had not met the requirements for tolling the statute of limitations or for pleading a continuing nuisance under Massachusetts law. View "The City of Boston v. OptumRx, Inc." on Justia Law

The case centers on a dispute involving a pharmaceutical company founded by the plaintiff, who also served as its CEO. The plaintiff obtained investment from a Canadian entity controlled by one of the defendants, who later became a director. The company entered into a profitable licensing agreement for a drug, and the plaintiff claims he was personally entitled to 30% of the profits based on an oral agreement. The investor and his affiliates, however, allege that the plaintiff wrongfully diverted corporate assets by taking this share. After disagreements arose, the investor replaced himself and another director on the board with officers from his own affiliates, who began investigating the alleged diversion. In response, the plaintiff initiated litigation, asserting that the investigation was a breach of fiduciary duty and that the investor and his affiliates acted in bad faith for their own benefit.Previously, the Court of Chancery of the State of Delaware was asked to consider several claims, including breach of fiduciary duty, civil conspiracy, and tortious interference against the investor, his affiliates, and the two new directors. The investor’s affiliate moved to dismiss for lack of personal jurisdiction, and the court found it had no jurisdiction over the affiliate. The court also examined whether it had jurisdiction over the investor for claims other than those related to his service as a director, finding it did not because the complaint failed to state a viable claim against him in that capacity.In the present decision, the Court of Chancery held that it lacked personal jurisdiction over the investor’s affiliate and over the investor in his non-director capacities, dismissing those claims without prejudice. The court further dismissed with prejudice the breach of fiduciary duty and conspiracy claims against the directors and the investor in his director capacity, finding no viable claims were stated. However, the court allowed the plaintiff’s claim for a declaratory judgment regarding his right to the profits from the drug to proceed against the company, provided an amended complaint is filed naming the company as a proper defendant. View "MacLaughlan v. Einheiber" on Justia Law

Law enforcement responded to an incident where the defendant, after brandishing a machete and robbing a 76-year-old man of his car, led police on a dangerous high-speed chase. He drove on the wrong side of major roads and ignored traffic signals before being apprehended. At the time, he had deliberately stopped taking prescribed mental health medication. He was charged with robbery of an elderly person, grand larceny of a motor vehicle, and driver evading or failing to stop for a police signal in a manner endangering others.A jury in the Second Judicial District Court in Washoe County found him not guilty by reason of insanity (NGRI) for the robbery and grand larceny counts but guilty but mentally ill (GBMI) for the driver-evading count. Following the verdicts, the district court ordered a mental health evaluation and held a hearing pursuant to NRS 175.539. The defendant argued that the court was required to commit him to a forensic mental health facility for treatment before sentencing on the GBMI conviction, or at minimum, impose probation conditioned on such treatment. The district court rejected this argument, concluding that the statutes did not require commitment before sentencing and that it retained discretion to impose a prison sentence for the GBMI conviction, with treatment during incarceration and civil commitment following release if necessary.On appeal, the Supreme Court of Nevada affirmed the district court’s judgment. The Court held that Nevada statutes do not specify the sequence of civil commitment and criminal sentencing in cases with both NGRI acquittals and a GBMI conviction. Therefore, the district court retains discretion to sentence a defendant to prison for a GBMI conviction, with appropriate mental health treatment during incarceration, and to order evaluation for civil commitment after release. Probation is not mandatory in split-verdict cases. The judgment of conviction was affirmed. View "SILVANUS VS. STATE" on Justia Law

Michael Hickson, who had become severely disabled following cardiac arrest and anoxic brain injury in 2017, was hospitalized multiple times for recurring infections but recovered from several serious episodes. In June 2020, while hospitalized for pneumonia, sepsis, and suspected COVID-19, his doctors at St. David’s Healthcare assessed him as having a 70% chance of survival. Despite this, he was placed on hospice care and a do-not-resuscitate order was issued, with medical staff indicating that his inability to walk or talk equated to a poor quality of life. Life-sustaining treatment, including food and fluids, was withdrawn, even as his condition temporarily improved. Michael’s family, led by his wife Melissa Hickson, sought answers and attempted to visit him, but were repeatedly denied access and information. Michael ultimately passed away, and subsequent public statements by the hospital disclosed protected health information and cast aspersions on Melissa’s fitness as a guardian.The United States District Court for the Western District of Texas dismissed or granted summary judgment in favor of the defendants on all claims, including disability discrimination under § 504 of the Rehabilitation Act and § 1557 of the ACA, § 1983 claims, state-law medical negligence, informed consent, wrongful death, and intentional infliction of emotional distress. The plaintiffs objected to the recommendations for dismissal of the disability discrimination and § 1983 claims; the district court overruled these objections and dismissed those claims with prejudice. The remaining state-law claims were later resolved on summary judgment.Upon de novo review, the United States Court of Appeals for the Fifth Circuit held that disability discrimination claims based on alleged denial of medical treatment solely due to disability are cognizable and may proceed. The court also vacated and remanded the dismissals of the informed consent and intentional infliction of emotional distress claims, but affirmed dismissal of the § 1983 claims and other state-law claims. View "Hickson v. St. David's Healthcare Partnership" on Justia Law

A young man, referred to as Jared, was charged with battery to a law enforcement officer after an incident in which he threatened his family and police, and struck an officer. Following his arrest, concerns about Jared’s mental health led to a competency evaluation. He was diagnosed with schizophrenia and found incompetent to stand trial. While initially taking prescribed medication inconsistently in jail, Jared later refused medication in a mental health institution, resulting in disruptive and aggressive behavior. The State, through a Department of Health Services doctor, sought and obtained a Milwaukee County Circuit Court order for involuntary medication to restore Jared’s competency for trial.On appeal, Jared challenged the involuntary medication order, arguing that neither the statutory requirements under Wisconsin law nor the constitutional standards articulated in Sell v. United States were met. The Wisconsin Court of Appeals reversed, finding the circuit court’s findings on both the statutory and Sell factors clearly erroneous and concluding that the State had not sufficiently established any of the four Sell factors necessary for involuntary medication.The Supreme Court of Wisconsin reviewed the case to clarify the standard of appellate review for each of the Sell factors and to determine whether the circuit court’s application of those factors and the statutory requirements was correct. The Supreme Court held that the question of whether an important governmental interest exists (Sell factor one) is reviewed de novo, while the remaining three Sell factors (significant furtherance of the interest, necessity, and medical appropriateness) are findings of fact reviewed for clear error. The Supreme Court found that the State’s interest in prosecuting Jared was important and not sufficiently diminished by special circumstances. It further held that the lower court’s findings on the remaining Sell factors and the statutory requirements were not clearly erroneous. The Supreme Court reversed the Court of Appeals, reinstating the circuit court’s order for involuntary medication. View "State v. J. D. B." on Justia Law

The defendant operated two companies that provided durable medical equipment, both of which were enrolled as Medicare providers under the names of her mother and nephew. The defendant orchestrated a scheme where patient information was used to submit fraudulent claims for unnecessary medical equipment and repairs, with the assistance of other employees and marketers. Over a ten-year period, the companies submitted more than $24 million in claims, of which Medicare paid approximately $13 million.The United States District Court for the Central District of California presided over the case. The defendant was indicted and, after a second trial, convicted by a jury of conspiracy to launder monetary instruments, healthcare fraud, and aggravated identity theft under 18 U.S.C. § 1028A(a)(1), based on the use of her relatives’ names during the commission of health care fraud. The district court sentenced her to a total of 180 months in custody, including a mandatory consecutive two-year term for aggravated identity theft. The defendant appealed her convictions for aggravated identity theft.The United States Court of Appeals for the Ninth Circuit reviewed the case. The main issue on appeal was whether the use of her relatives’ names constituted aggravated identity theft under the standard clarified in Dubin v. United States, 599 U.S. 110 (2023). The Ninth Circuit held that the government failed to show that the use of the relatives’ names was “at the crux” of the fraud—meaning that the use itself was fraudulent or deceitful and critical to the scheme’s success, as required by Dubin. The court vacated the defendant’s sentence for aggravated identity theft and remanded the case to the district court for resentencing. The healthcare fraud and other convictions were not in dispute. View "USA V. MOTLEY" on Justia Law

A man was admitted to a long-term healthcare facility by his wife, who signed all required admission documents, including an arbitration agreement. The arbitration agreement stated that all disputes related to the facility’s care would be resolved by binding arbitration, but it was not a condition of admission or continued care. After the man’s death, his wife, individually and on behalf of his wrongful death beneficiaries, sued the facility and two nurses, alleging improper care and treatment resulting in his death.The defendants moved to compel arbitration, contending there was a valid agreement and that the wife had the authority to enter into it as her husband’s healthcare surrogate, since he allegedly lacked capacity at admission. The wife countered that there had been no proper determination of her husband’s incapacity at the time of admission and, regardless, that signing an arbitration agreement was not a healthcare decision. The Hinds County Circuit Court denied the motion to compel arbitration, relying on precedent holding that a healthcare surrogate’s authority is limited to healthcare decisions, and that an arbitration agreement is not a healthcare decision unless it is an essential part of receiving care. The court found that, since arbitration was not a condition of admission or care, the wife lacked authority to bind her husband.On appeal, the Supreme Court of Mississippi reviewed the denial de novo. The Court reaffirmed that under Mississippi law, a surrogate’s authority extends only to healthcare decisions, and an arbitration agreement is only such a decision if required for admission or care. Because the arbitration agreement in this case was not a condition of admission or care, the wife lacked authority to execute it. The Supreme Court of Mississippi affirmed the trial court’s denial of the motion to compel arbitration and to stay proceedings, holding the arbitration agreement invalid and unenforceable. View "Manhattan Nursing and Rehabilitation Center, LLC v. Hawkins" on Justia Law