Justia Health Law Opinion Summaries

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The Supreme Judicial Court reversed the decision of the trial court dismissing this case alleging that a Massachusetts assisted living residence's (ALR) charge to new residents of an upfront "community fee" violated the security deposit statute, Mass. Gen. Laws ch. 186, 15B, holding that if an ALR charges upfront fees that are not used to fund distinct assisted living services, it does so in violation of section 15B. Plaintiff alleged that the community fee, which was intended to cover upfront administrative costs, move-in assistance, an initial service coordination plan, and a replacement reserve for building improvements, violated section 15B because it exceeded the upfront costs allowed by the statute. Defendant filed a motion to dismiss, arguing that ALRs are not subject to section 15B. The trial court granted the motion to dismiss. The Supreme Judicial Court remanded this case, holding (1) ALRs may institute upfront charges beyond those permitted by Mass. Gen. Laws ch. 186, 15B(1)(b) to the extent those charges correspondent to the distinct services enumerated in Mass. Gen. Laws ch. 19D, 13 or to other services specifically designed for ALRs; and (2) further factual development was required to determine whether the fee at issue here was permissibly charged and used for services distinct to ALRs. View "Ryan v. Mary Ann Morse Healthcare Corp." on Justia Law

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Mary Thomas awoke, paralyzed, after surgery. She filed a medical malpractice suit against Dr. Adam Lewis, who performed the surgery, claiming her injuries stemmed from two neurosurgeries performed by Dr. Lewis. Thomas also filed suit against Jackson Neurosurgery Clinic and Central Mississippi Medical Center based on vicarious liability. Thomas’s medical malpractice claims were based on an alleged failure of Dr. Lewis to manage Thomas’s mean arterial blood pressure during the first surgery and Dr. Lewis’s decision to perform the second surgery. However, the issue on appeal involved the reliability of expert testimony under Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993). Thomas’s expert, neurosurgeon Dr. Neil Wright, claimed that Dr. Lewis had failed to provide the proper standard of care and, in turn, caused Thomas’s injuries. However, Dr. Lewis argued that Dr. Wright’s opinions were not reliable because they were inconsistent with medical literature. The trial court agreed, struck Dr. Wright’s opinions, and granted partial summary judgment in favor of Dr. Lewis with regard to the first surgery. The trial court also ruled that Dr. Wright could testify to negligence regarding the second surgery. The trial court allowed Thomas to proceed on claims related to the second surgery. Dr. Wright admitted that the decision to perform the second surgery was a judgment call and that he failed to testify that making the decision to proceed with a second surgery was a breach of the standard of care. The trial court considered the evidence and found that Mary Thomas had failed to offer admissible proof from which a reasonable juror could find that Dr. Lewis deviated from a professional standard of care. The trial court directed a verdict in favor of Dr. Lewis, Jackson Neurosurgery Clinic, and Central Mississippi Medical Center, and Thomas appealed. Finding no reversible error, the Mississippi Supreme Court affirmed. View "Thomas v. Lewis" on Justia Law

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Three out of every five hospitals use Ciox, a medical records provider, which processed 4.3 million pages per day in 2018. Ciox is subject to the 1996 Health Insurance Portability and Accountability Act (HIPAA), 110 Stat. 1936. Department of Health and Human Service fee-limit provisions prohibit Ciox from charging patients more than “reasonable, cost-based fee[s]” for their records. Tennessee’s Medical Records Act (TMRA), prevents hospitals from charging patients more than the “reasonable costs for copying and the actual costs of mailing [their] records.” The named Plaintiffs worked with law firms to request their medical records from Tennessee hospitals. Ciox serviced those requests. Plaintiffs filed a class action, accusing Ciox of charging them more than what HIPAA regulations and TMRA allow. HIPAA does not authorize a private cause of action, so the Plaintiffs cited common-law causes of action: negligence, negligence per se, unjust enrichment, and breach of implied-in-law contract. The district court dismissed the TMRA claim but granted class certification and later granted Ciox summary judgment The Sixth Circuit affirmed. Tennessee's common law is no substitute for the private right of action that Congress refused to create in HIPAA. TMRA’s fee limits unambiguously do not apply to medical-records providers. Plaintiffs cannot prove the existence of any common-law duty or legal contract. Because the court did not send notice to absentee class members, the decision binds only the named Plaintiffs. View "Faber v. Ciox Health, LLC" on Justia Law

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Danielle B., a 73-year-old woman who suffers from schizoaffective disorder, was involuntarily committed for 30 days. Her illness led to repeated hospitalizations and temporary improvements with the help of medication. But upon release she has deteriorated after stopping the medication. As a result she has had housing problems and incidents involving police due to her behavior, leading to more hospitalization. Since the 1980s she had been admitted to Alaska Psychiatric Institute (API) 30 times. The last such admission she appealed, arguing the State failed to prove that there were no less restrictive alternatives than commitment. Because the court did not err by finding clear and convincing evidence that there was no less restrictive alternative, the Alaska Supreme Court affirmed the court’s order committing her for involuntary treatment. View "D.B. v. Alaska" on Justia Law

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In 2011-2012, Godofsky was a doctor at a “pill mill,” the Central Kentucky Bariatric and Pain Management clinic. The clinic accepted payment by only cash (later by debit card), at $300 for the first visit and $250 per visit thereafter, and did not give change. The clinic had thousands of dollars in cash on hand every day, so the manager was armed with a handgun and patrolled the clinic with a German Shepherd. The clinic scheduled multiple “patients” at the same time, every 15 minutes, and was often open until after 10:00 p.m. The clinic received hundreds of “patients” per day, many of whom had traveled long distances and waited for hours for a few minutes with a doctor who would then provide a prescription for a large amount of opioids, usually oxycodone. The Sixth Circuit affirmed Godofsky’s conviction for prescribing controlled substances, 21 U.S.C. 841(a), and the below-guidelines 60-month prison term and $500,000 fine, upholding the trial court’s refusal to use a jury instruction titled “Good Faith,” which would have instructed the jurors that his “good intentions” were enough for his acquittal or, rather, that the prosecutor had to prove that he had not personally, subjectively, believed that the oxycodone prescriptions would benefit his patients. View "United States v. Godofsky" on Justia Law

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After an employee of Excel was killed when a scaffold he was constructing collapsed into Galveston Bay, OSHA conducted an investigation into the incident and issued Excel a number of safety citations. Excel contested the issuance of the citation charging the company with a serious violation of a regulation which required Excel to ensure the presence of a "lifesaving skiff" at all jobsites where employees were required to work over water. The ALJ upheld the Commission's decision declining to conduct further review, and Excel petitioned for review. The Fifth Circuit denied Excel's petition for review, holding that Excel repeatedly failed to preserve the affirmative defense of infeasibility, and the ALJ did not abuse its discretion by determining that it would have been prejudicial to the Secretary to allow Excel to pursue its infeasibility defense. Even if Excel had not abandoned its infeasibility defense, Excel had not met its burden of proving that it was entitled to the defense on the merits. Finally, the court held that the ALJ's conclusion that the absence of a skiff exposed Excel's employees to a substantial probability of death or serious injury was amply supported by the record. View "Excel Modular Scaffold & Leasing Co. v. Occupational Safety and Health Review Commission" on Justia Law

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The DC Circuit affirmed the district court's partial grant of summary judgment to HHS. Determining that the appeal was not moot, the court held that the district court correctly declined to grant plaintiff equitable relief. The court held that, after properly channeling a single claim for "medical and other health services" benefits, a Medicare beneficiary can not obtain prospective equitable relief mandating that HHS recognize his treatment as a covered Medicare benefit in all future claim determinations. In this case, plaintiff's real problem was with Novitas and, to the extent he wanted the Secretary to instruct Novitas to cover his treatments, he could not do so through the claim appeal process. View "Porzecanski v. Azar" on Justia Law

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Tennessee family medicine physicians, mostly in rural areas, received increased Medicaid payments in 2013-2014. In 2015 Tennessee’s Medicaid agency, TennCare, brought an administrative action to “recoup” an average of more than $100,000 per physician, alleging that the physicians had not met the 60-percent requirement of the Final Medicaid Payment Rule. Under 42 U.S.C. 13961(a)(13(C), a state plan for medical assistance must provide payment for primary care services furnished in 2013 and 2014 by a physician with a primary specialty designation of family medicine, general internal medicine, or pediatric medicine at a specified rate; “primary specialty designation” was interpreted to mandate that the physician either show board certification in that specialty or that 60 percent of her recent Medicaid billings were for certain primary care services. The Sixth Circuit affirmed summary judgment in favor of the physicians, declaring the Rule invalid. The Centers for Medicare and Medicaid Services interpreted “a physician with a primary specialty designation” to have different meanings in parallel provisions of the Affordable Care Act although the context was the same. There is no 60-percent-of-billings requirement in 42 U.S.C. 1396a(a). The phrase “a physician with a primary specialty designation” means in section 1396a(a) the same thing that the agency said it means in section 1395l(x): a physician who has himself designated, as his primary specialty, one of the specialties recited in those provisions. View "Averett v. United States Department of Health & Human Services" on Justia Law

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The Supreme Court denied the writ of prohibition sought by the West Virginia Regional Jail Authority (WVRJA) seeking to have the Court prohibit the circuit court from enforcing its order denying the WVRJA's motion to dismiss Bobbi Bryant's complaint against it as time barred, holding that WVRJA failed to demonstrate that the circuit court's order was clearly erroneous. The WVRJA moved to dismiss Bryant's complaint on the sole basis that the claims asserted against it were barred by the applicable statute of limitations. The circuit court found that because the statute of limitations was appropriately tolled as to the co-defendant and because Bryant alleged a civil conspiracy cause of action the statute of limitation as to the co-defendant was imputed to the WVRJA. The WVRJA then filed a petition for writ of prohibition with the Supreme Court. The Supreme Court denied the petition, holding that the circuit court did not commit clear legal error in denying WVRJA's motion to dismiss the complaint as time barred, based on the applicable statute of limitations, such that a writ of prohibition is warranted. View "State ex rel. Regional Jail Authority v. Honorable Carrie Webster" on Justia Law

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Respondent R.M. appealed a circuit court order that renewed his involuntary admission to New Hampshire Hospital for the purpose of allowing him to remain on a conditional discharge for a period of five years. Respondent was a 30-year-old man who had been hospitalized on multiple occasions as a result of schizophrenia. When respondent doesn't take his prescribed anti-psychotic medication, he becomes paranoid, violent, and suicidal. In addition, he experienced hallucinations, paranoid delusions, and difficulties with impulse control and exhibited “a serious level of aggression.” Respondent was first hospitalized in 2010 after voicing suicidal ideation, stating that he would be “better off dead.” Pertinent here, was admitted on an emergency basis again in February 2015 due to concerns of suicidal threats, incapacity, and his paranoid belief that people were conspiring against him. In early March 2019, a few weeks before the respondent’s three-year conditional discharge was set to expire, the local community mental health center filed a petition to renew his conditional discharge. On appeal, respondent challenged the sufficiency of the evidence and argued the five-year renewal was not the least restrictive treatment option. Finding no reversible error, the New Hampshire Supreme Court affirmed. View "In re R.M." on Justia Law