Justia Health Law Opinion Summaries

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The Court of Appeals reversed the judgments of the Court of Special Appeals and circuit court dismissing D.L.'s petition for judicial review challenging her involuntary admission to a facility operated by Sheppard Pratt Health Systems, Inc. as moot based on her release from Sheppard Pratt, holding that D.L. faced collateral consequences as a result of her involuntary admission, and therefore, her appeal was not moot. An ALJ involuntarily admitted D.L. to Sheppard Pratt. After she was released, D.L. petitioned for judicial review. The circuit court granted Sheppard Pratt's motion to dismiss on grounds of mootness because D.L. had already been released from the facility. The Court of Special Appeals affirmed. The Court of Appeals reversed, holding that D.L. was subject to collateral consequences stemming from her involuntary admission, and therefore, the circuit court erred in dismissing the case as moot. View "D.L. v. Sheppard Pratt Health System Inc." on Justia Law

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A group of children's hospitals that receive Disproportionate Share Hospital (DSH) payments under the Medicaid Act filed suit challenging the Secretary's promulgation of a regulation defining "costs incurred" in furnishing hospital services to low income patients (the 2017 Rule). The DC Circuit reversed the district court's decision vacating the 2017 Rule and reinstated it, holding that the rule did not exceed the Secretary's statutory authority under the Medicaid Act and rejecting plaintiffs' reasons for why the statute did not grant the Secretary authority to require that payments by Medicare and private insurers be considered in calculating a hospital's "costs incurred;" the 2017 Rule is consistent with the statute's context and purpose, both of which suggest DSH payments are meant to assist those hospitals that need them most by covering only those costs for which DSH hospitals are in fact uncompensated; and the 2017 Rule was not a product of arbitrary and capricious reasoning. View "Children's Hospital Association of Texas v. Azar" on Justia Law

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The Supreme Court dismissed this petition for extraordinary relief asserting that the actions of Governor Gary R. Herbert, Lieutenant Governor Spencer J. Cox, and the Utah Legislature in replacing a citizens' initiative approved by Utah voters that legalized medical cannabis and replacing the initiative with H.B. 3001 were unconstitutional, holding that some of Petitioners' arguments failed on the merits and that the remainder of the petition did not comply with Rule 19 of the Utah Rules of Appellate Procedure. The day H.B. 3001 passed, some of the Petitioners filed a referendum application with the Lieutenant Governor that would have allowed H.B. 3001 to be put to a vote of the people. The Lieutenant Governor denied the petition because he determined one of the referendum sponsors did not meet the applicable statutory requirements and because the Utah House of Representatives and the Utah Senate passed the bill by a supermajority, which made the bill referendum-proof. Petitioners subsequently brought this petition. The Supreme Court dismissed the petition, holding (1) the Governor did not effectively veto Provision 2, and the Two-Thirds Provisions of the Utah Constitution and Utah Code applied to the legislation here; and (2) the rest of the petition is dismissed without prejudice for failure to comply with Rule 19. View "Grant v. Governor Gary R. Herbert" on Justia Law

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This case presented a narrow issue of whether respondent Michelle Rouillard in her capacity as director of California’s Department of Managed Health Care (Department) violated the California Administrative Procedure Act (APA) when she sent letters to seven health care service plans directing them to comply with California law in their coverage of abortion services. The issue reduced to whether a “voluntary” abortion was a “medically necessary” procedure that health care service plans were required to cover. The letters told the recipients that health care plans could not limit or exclude coverage for termination of pregnancies. Petitioner Missionary Guadalupanas of the Holy Spirit, Inc., claimed that by sending out the letters interpreting “basic health care services” to include abortions, respondent ignored the APA rulemaking process. The Court of Appeal concluded petitioner’s argument set forth a false dichotomy between a “voluntary” service and a “medically necessary” health care service, which health care plans were required to cover under California Code of Regulations, title 28, section 1300.67."This false assumption led petitioner to the flawed conclusion that the Department’s letters were for the purpose of clarifying an ambiguity in the statute, and that compliance with the rulemaking procedures of the APA was necessary." The Court determined the application of the regulation to the facts of this case was unambiguous, and the Department was not required to comply with the APA. View "Missionary Guadalupanas of the Holy Spirit v. Rouillard" on Justia Law

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ACLA filed suit alleging that the Secretary's final ruling implementing the Protecting Access to Medicare Act's (PAMA) definition of "applicable laboratory" unlawfully excluded most hospital laboratories from PAMA's reporting requirements. The district court dismissed the complaint for lack of subject matter jurisdiction. As a preliminary matter, the DC Circuit held that ACLA had standing. In view of PAMA's text, its structure, and the distinct nature of the processes of data collection and establishment of payment rates, the court could not conclude that the bar against reviewing the "establishment of payment amounts" also prevents its review of the rule setting up a new and detailed process for collecting data on market rates that private insurers pay to laboratories. Because the statute is "reasonably susceptible" to this interpretation, the court held that it does not bar judicial review of the Secretary's rule establishing the parameters of data collection under 42 U.S.C. 1395m-1(a). Finally, the court rejected ACLA's claim that the Secretary's rule was ultra vires. Accordingly, the court reversed the district court's holding on subject matter jurisdiction and remanded for further proceedings. View "American Clinical Laboratory Assoc. v. Azar" on Justia Law

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The owners and operators of a skilled nursing facility contended the trial court erred when it denied their petition to compel arbitration. They attempted to enforce arbitration in this action for elder abuse and wrongful death brought by a decedent through her husband as successor in interest, her husband individually, and their children. Appellants claimed the successor had signed the arbitration agreements as the decedent’s authorized agent. The trial court determined that although the successor did not sign the agreements as the decedent’s agent, he expressly bound himself to arbitrate all claims he held individually and as the successor in interest. As a result, the decedent’s claim for elder abuse and the husband’s individual claim for wrongful death were subject to arbitration. However, the court denied the petition because the children’s claims were not subject to arbitration, and allowing the arbitration and the litigation to proceed concurrently could result in inconsistent findings of fact and law. Finding no reversible error in the trial court’s judgment, the Court of Appeal affirmed. View "Valentine v. Plum Healthcare Group, LLC" on Justia Law

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Health and Safety Code section 1418.8 concerns nursing home residents who lack the capacity to make their own health care decisions and are without family members or other legal surrogates. The superior court held that the statute, on its face, violates due process under the California Constitution by failing to require notice to residents of a physician’s predicate determinations that the patient lacks capacity, has no surrogate decision-maker, needs a recommended medical intervention, and has a right to judicial review; was never intended to authorize interdisciplinary team (IDT) decision-making for administration of antipsychotic medication, and violates due process, as applied, when used to authorize such drugs; and violates the patient’s privacy rights and is unconstitutional as applied to decisions regarding end of life withdrawal of care. The court of appeal reversed, construing the statute to uphold its constitutionality rather than enjoining its use, and directing the superior court to enter a modified judgment, requiring nursing homes to adopt additional procedures. Written and oral notice must be provided to every resident for whom section 1418.8 is invoked, of any determination of the resident’s incapacity; any determination that no surrogate decision-maker is available; any proposed medical intervention; the fact that a decision will be made by the IDT; the resident’s right to have a patient representative participate in IDT decision-making; and the resident’s right to judicial review of IDT decisions. Except in emergency circumstances, no medical treatment decision by an IDT on behalf of a resident may be implemented until the resident has been given a reasonable opportunity to seek judicial review. Except in emergency circumstances, every IDT must include a patient representative, and where the resident has no family or friend willing to serve, someone unaffiliated with the nursing home must serve as the patient representative. The IDT process may be used to authorize the administration of antipsychotic medications and for decisions to create or change physician orders for life-sustaining treatment, DNRs or comfort care orders, and to transfer patients to hospice care. View "California Advocates for Nursing Home Reform v. Smith" on Justia Law

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The Fifth Circuit denied Southern Hens' petition for review of the ALJ's determination that the poultry processing plant committed two violations of occupational safety standards after an employee suffered a serious injury when her hand got caught in a machine's moving parts. The court upheld the ALJ's decision with regard to the lockout violation because Southern Hens lacked the sort of established work rule required for the "unpreventable employee misconduct" defense; upheld that machine-guarding standard and adopted the reasonably predictable standard, holding that there was substantial evidence that employee injury from the hazard was reasonably predictable; and upheld the penalties for the lockout violation and the machine-guarding violation. View "Southern Hens, Inc. v. Occupational Safety and Health Review Commission" on Justia Law

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The Affordable Care Act (ACA) mandates that women’s health insurance cover preventive health care. Health Resources and Services Administration guidelines indicate that preventative health care includes contraceptive care. Nonprofit religious entity employers could invoke "the Accommodation," which permits employers to send self-certification forms to their insurance issuers to exclude contraceptive coverage from the group health plan while providing payments for contraceptive services for plan participants and beneficiaries, separate from the group health plan, without the imposition of cost sharing, premium, fee, or other charge on plan participants or beneficiaries or on the eligible organization or its plan. Following Supreme Court decisions concerning ACA, the Accommodation was extended to for-profit entities that are not publicly traded, are majority-owned by a relatively small number of individuals, and that object to providing contraceptive coverage based on the owners’ religious beliefs. The district court entered a preliminary injunction, prohibiting the rule’s enforcement nationwide. The Third Circuit affirmed, reasoning that the agencies did not follow the Administrative Procedures Act and that the regulations are not authorized under the ACA or required by the Religious Freedom Restoration Act. Sates will face unredressable financial consequences from subsidizing contraceptive services, providing funds for medical care associated with unintended pregnancies, and absorbing medical expenses arising from decreased use of contraceptives for other health conditions. The current Accommodation does not substantially burden employers’ religious exercise and its extension is not necessary to protect a legally-cognizable interest. The public interest favors minimizing harm to third-parties by ensuring that women who may lose ACA-guaranteed contraceptive coverage. View "Pennsylvania v. President of the United States" on Justia Law

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In May 2009 Jesse Collens, then 21 years old, was permanently injured in a bicycle accident that left him a C-1 quadriplegic, paralyzed from the neck down, and dependent on a ventilator to breathe. In December 2009 he contracted with Maxim Healthcare Services, a national healthcare corporation with a home healthcare division, to provide his nursing care. In late 2011 issues arose between Collens and Maxim over the company’s management of his care. These issues escalated, and in early March 2012, Alaina Adkins, Maxim’s Alaska office manager, met with Collens to discuss his main concerns with Maxim’s services. The following business day, Adkins emailed various members of Maxim’s legal and administrative staff about one of the issues Collens had raised. Internal concerns surfaced about the legal compliance of the staff working with Collens. In an email responding to the report, Maxim’s area vice president wrote, “We are in dangerous territory right now with the liability of this case and we are going to have to seriously consider discharge.” Collens’s care plan was subject to routine recertification every 60 days; Maxim’s Alaska Director of Clinical Services visited Collens’s house to complete the review necessary for this recertification, noting “discharge is not warranted.” Concurrent to the recertification, Adkins requested Maxim’s legal department provide her a draft discharge letter for Collens. The draft letter stated the discharge had been discussed with Collens’s physician and care coordinator and that they agreed with the discharge decision. But in fact neither approved the discharge. The draft letter also included a space for names of other entities that could provide the care needed by the patient. Adkins noted in an email to the legal department, “We already know that there are no providers in our area that provide this type of service.” The discharge letter she eventually delivered to Collens filled in the blank with four agency names. Adkins delivered and read aloud the discharge letter at Collens’s home on March 30. Collens sued Maxim and Adkins for breach of contract, fraudulent misrepresentation, unfair and deceptive acts and practices under Alaska’s Unfair Trade Practices and Consumer Protection Act (UTPA), and intentional infliction of emotional distress (IIED). The superior court ruled for Collens on all his claims and entered a $20,379,727.96 judgment against Adkins and Maxim, which included attorney’s fees. Maxim and Adkins appealed, arguing that: (1) they were not liable under the UTPA; (2) the superior court erred in precluding their expert witnesses from testifying at trial; (3) the court’s damages award was excessive; and (4) the court’s attorney’s fee award was unreasonable. The Alaska Supreme Court agreed the superior court’s attorney’s fee award was unreasonable, but on all other issues it affirmed the superior court’s decision. View "Maxim Healthcare Services, Inc. v. Collens" on Justia Law