Justia Health Law Opinion Summaries

Minton, a transgender man diagnosed with gender dysphoria, sued under the Unruh Civil Rights Act, Civil Code 51(b), which guarantees “full and equal accommodations, advantages, facilities, privileges, or services in all business establishments of every kind.” Minton’s physician, Dr. Dawson, scheduled Minton's hysterectomy at Mercy, which is part of Dignity Health. Minton told a Mercy nurse that he is transgender. The following day, Mercy notified Dawson that the procedure was canceled. Mercy’s president, Ivie, informed Dawson that she would “never” be allowed to perform Minton's hysterectomy at Mercy because it was “part of a course of treatment for gender dysphoria, as opposed to any other medical diagnosis.” At Ivie's suggestion, Dawson was able to get emergency admitting privileges at Methodist Hospital, a non-Catholic Dignity hospital about 30 minutes away. Dawson performed Minton’s hysterectomy at Methodist three days later. Dignity argued that as a Catholic hospital, Mercy is bound to follow its facially neutral “Ethical and Religious Directives for Catholic Health Care Services” issued by the U.S. Conference of Catholic Bishops, which prohibit direct sterilization and require that bodily and functional integrity be preserved. The court of appeal reversed the dismissal of Minton’s complaint. Without determining the right of Dignity to provide its services in such cases at alternative facilities, the complaint alleges that Dignity initially failed to do so and that the subsequent rectification of its denial, while likely mitigating plaintiff’s damages, did not extinguish his discrimination claim. View "Minton v. Dignity Health" on Justia Law

The Department of Justice filed suit against the State of Florida, seeking declaratory and injunctive relief under Title II of the Americans with Disabilities Act (ADA) and 28 C.F.R. 35.130(d). The Department alleged that Florida was failing to meet its obligations under Title II by unnecessarily institutionalizing hundreds of children with disabilities in nursing facilities. The Department also alleged that Florida's Medicaid policies and practices placed other children who have "medically complex" conditions, or who are "medically fragile," at risk of unnecessary institutionalization. The Eleventh Circuit held that the Attorney General has a cause of action to enforce Title II of the ADA. The court held that when Congress chose to designate the "remedies, procedures, and rights" in section 505 of the Rehabilitation Act, which in turn adopted Title VI, as the enforcement provision for Title II of the ADA, Congress created a system of federal enforcement. The court also held that the express statutory language in Title II adopts federal statutes that use a remedial structure based on investigation of complaints, compliance reviews, negotiation to achieve voluntary compliance, and ultimately enforcement through "any other means authorized by law" in the event of noncompliance. Therefore, courts have routinely concluded that Congress's decision to utilize the same enforcement mechanism for Title II as the Rehabilitation Act, and therefore Title VI, demonstrates that the Attorney General has the authority to act "by any other means authorized by law" to enforce Title II, including initiating a civil action. Accordingly, the court reversed the district court's judgment and remanded. View "United States v. State of Florida" on Justia Law

University of Pittsburgh Medical Center includes 20 hospitals. Its more than 2,700 doctors are employed by Medical Center subsidiaries. Each surgeon had a base salary and an annual Work-Unit quota. Every medical service is worth a certain number of Work Units, which are one component of Relative Value Units (RVUs). RVUs are the units that Medicare uses to measure how much a medical procedure is worth. The surgeons were rewarded or punished based on how many Work Units they generated. The number of Work Units billed by the Neurosurgery Department more than doubled in 2006-2009. The relators accuse the surgeons of artificially boosting their Work Units: The surgeons said they acted as assistants on surgeries and as teaching physicians when they did not and billed for procedures that never happened. They did surgeries that were medically unnecessary or needlessly complex. Most of the surgeons reported total Work Units that put them in the top 10% of neurosurgeons nationwide. Whenever a surgeon did a procedure at one of the hospitals, the Medical Center billed for hospital and ancillary services. The United States intervened in a suit as to the physician services claims, settling those claims for $2.5 million. It declined to intervene in the hospital services claims. The Third Circuit reversed the dismissal of those claims. The relators adequately pleaded violations of the Stark Act, 42 U.S.C. 1395nn(b)(4), which forbids hospitals to bill Medicare for certain services when the hospital has a financial relationship with the doctor who requested those services. It is likely that the surgeons' pay is so high that it must take referrals into account. Stark Act exceptions work like affirmative defenses; the burden lies with the defendant, even under the False Claims Act, 31 U.S.C. 3729(a)(1)(A). View "United States v. University of Pittsburgh Medical Center" on Justia Law

In a case of first impression for the Alaska Supreme Court, at issue was the use of electroconvulsive therapy (ECT) to a catatonic, non-consenting patient. In March 2017, police officers found Lucy G. in an Anchorage parking lot, wet and shivering. She was taken to a local hospital, where she initially exhibited “agitated, self-harming, and disoriented” behaviors requiring sedation for her and the staff’s safety. Lucy, who was calm but unresponsive by the end of the day, was diagnosed as catatonic. Hospital staff also noted her prior schizophrenia diagnosis and psychotropic medication prescriptions, as well as hospitalization the prior month. After a petition by hospital staff, the superior court authorized Lucy’s hospitalization for an involuntary commitment evaluation. She would ultimately be diagnosed with catatonia, involuntarily committed for 30 days, and given psychotropic medication and involuntary ECT. At the superior court hearing, the parties agreed that constitutional standards established in Myers v. Alaska Psychiatric Institute, 138 P.3d 238 (Alaska 2006) for ordering involuntary, non-emergency administration of psychotropic medication also applied to involuntary ECT. The patient argued there should have been heightened standards for ordering involuntary ECT and that, in any event, the superior court’s Myers analysis was legally deficient. The Alaska Supreme Court held that the superior court did not plainly err by applying the existing Myers constitutional standards to authorize involuntary ECT to the non-consenting patient. The Court also held the superior court made sufficient findings related to each relevant, contested mandatory Myers factor. Therefore, the Court surmised these findings supported the court’s involuntary ECT order. View "In the Matter of the Necessity of the Hospitalization of Lucy G." on Justia Law

The Ninth Circuit granted the Secretary's petition for review of the Commission's decision interpreting a provision of the Respiratory Protection Standard promulgated under the Occupational Safety and Health Act of 1970. The panel adopted the Secretary's interpretation of section 1910.134(d)(1)(iii) of the Act to require covered employers to evaluate the respiratory hazards at their workplaces whenever there is the "potential" for overexposure of employees to contaminants, in order to determine whether respirators are "necessary to protect the health" of employees. The panel explained that the text, structure, purpose, and regulatory history of the Standard all point in the same direction as the Secretary's interpretation. View "Secretary of Labor v. Seward Ship's Drydock, Inc." on Justia Law

After three former AseraCare employees alleged that AseraCare had a practice of knowingly submitting unsubstantiated Medicare claims in violation of the False Claims Act, the Government intervened and filed the operative complaint. The Eleventh Circuit held that a clinical judgment of terminal illness warranting hospice benefits under Medicare cannot be deemed false, for purposes of the False Claims Act, when there is only a reasonable disagreement between medical experts as to the accuracy of that conclusion, with no other evidence to prove the falsity of the assessment. However, the court held that the Government should have been allowed to rely on the entire record, not just the trial record, in making its case that disputed issues of fact, beyond just the difference of opinion between experts, existed sufficient to warrant denial of the district court’s post-verdict sua sponte reconsideration of summary judgment on the falsity question. Accordingly, the court affirmed in part and remanded in part. View "United States v. Aseracare, Inc." on Justia Law

Plaintiff-relator Matthew Omlansky, by virtue of knowledge gleaned as a state employee involved with the Medi-Cal program, brought this qui tam action in the name of the State of California alleging that defendant Save Mart Supermarkets (Save Mart) had violated the False Claims Act in its billings to Medi-Cal for prescription and nonprescription medications, charging a higher price than cash customers paid in violation of 2009 statutory provisions capping Medi-Cal charges at a provider’s usual and customary price (“statutory cap”). Per the trial court, the gist of the alleged fraud upon Medi-Cal, Save Mart generally offered a lower price for medications to cash customers, and would also match a lower price that a competitor was offering (although it appears from an exhibit to the complaint that the latter applied only to prescriptions), but did not apply these discounts from its list prices in the billings it submitted to Medi-Cal. The State declined to intervene. The trial court sustained a demurrer to the original complaint because all of the alleged violations occurred during a period when the 2009 statutory cap was subject to a federal injunction. Plaintiff then filed an essentially identical amended complaint. The only significant change was an allegation in paragraph 45 that Save Mart’s billing practices favoring cash customers continued from December 2016 to March 2017 after the expiration of the injunction, specifying six examples of “illegal pricing.” The court sustained Save Mart’s demurrer to this pleading as to two of the six grounds raised, and denied leave to amend. It entered a judgment of dismissal. Plaintiff timely appealed, but the Court of Appeal concurred with the grounds for the trial court’s ruling, thereby affirming dismissal of Plaintiff’s complaint. View "Omlansky v. Save Mart Supermarkets" on Justia Law

Defendant, a 24-hour skilled nursing facility, appealed an order denying its petition to compel arbitration of claims asserting negligent or willful misconduct, elder abuse, and wrongful death filed against it by decedent’s daughter as successor in interest and individually. The trial court found the successor claims were not arbitrable because no arbitration agreement existed between decedent and defendant, given defendant’s failure to prove daughter had authority to sign the agreement on decedent’s behalf. The court further found the arbitration agreement was unenforceable against daughter individually on grounds of unconscionability. Finding no reversible error, the Court of Appeal affirmed the trial court order. View "Lopez v. Bartlett Care Center, LLC" on Justia Law

Cameo Williams, Sr. was a veteran of the United States Army, who spent his entire service stateside - never overseas or in combat. But for years, based on false statements about combat service, he obtained VA benefits for combat-related PTSD. The issue presented for the Tenth Circuit Court of Appeals in this case was whether it mattered about Williams’ lies about overseas service to obtain his PTSD benefits. The Court rejected Williams’s argument that his lie was not material under 18 U.S.C. 1001(a)(2), as well as his two challenges to evidentiary rulings. View "United States v. Williams" on Justia Law

Appellees Augustus Feleccia and Justin Resch were student athletes who played football at Lackawanna Junior College (Lackawanna), a nonprofit junior college. Lackawanna had customarily employed two athletic trainers to support the football program. The Athletic Director, Kim Mecca, had to fill two trainer vacancies in the summer of 2009. She received applications from Kaitlin Coyne, and Alexis Bonisese. At the time she applied and interviewed for the Lackawanna position, Coyne had not yet passed the athletic trainer certification exam, and was therefore not licensed by the Board. Bonisese was also not licensed, having failed the exam on her first attempt, and still awaiting the results of her second attempt when she applied and interviewed for the Lackawanna position. Nevertheless, Lackawanna hired both Coyne and Bonisese in August 2009 with the expectation they would serve as athletic trainers, pending receipt of their exam results, and both women signed “athletic trainer” job descriptions. After starting their employment at Lackawanna, Coyne and Bonisese both learned they did not pass the athletic trainer certification exam. Mecca retitled the positions held by Coyne and Bonisese from “athletic trainers” to “first responders.” However, neither Coyne nor Bonisese executed new job descriptions, despite never achieving the credentials included in the athletic trainer job descriptions they did sign. Appellants were also aware the qualifications of their new hires was called into question by their college professors and clinic supervisors. In 2010, appellees participated in the first day of spring contact football practice, engaging in a variation of the tackling drill known as the “Oklahoma Drill.” While participating in the drill, both Resch and Feleccia suffered injuries. Resch attempted to make a tackle and suffered a T-7 vertebral fracture. Resch was unable to get up off the ground and Coyne attended to him before he was transported to the hospital in an ambulance. Later that same day, Feleccia was injured while attempting to make his first tackle, experiencing a “stinger” in his right shoulder, i.e., experiencing numbness, tingling and a loss of mobility in his right shoulder. Bonisese attended Feleccia and cleared him to continue practice “if he was feeling better.” In this discretionary appeal arising from the dismissal of appellees’ personal injury claims on summary judgment, the Pennsylvania Supreme Court considered whether the superior court erred in: (1) finding a duty of care; and (2) holding a pre-injury waiver signed by student athletes injured while playing football was not enforceable against claims of negligence, gross negligence, and recklessness. After careful review, the Court affirmed the superior court’s order only to the extent it reversed the trial court’s entry of summary judgment on the claims of gross negligence and recklessness. The Case was remanded back to the trial court for further proceedings. View "Feleccia v. Lackawanna College, et al." on Justia Law