Justia Health Law Opinion Summaries

by
Bellin brought a putative class action under 42 U.S.C. 1983, alleging that managed long-term care plans (MLTCs) that contract with New York State violate Medicaid beneficiaries’ due process rights by denying them the right to appeal an MLTC’s initial determination of the personal care services hours the MLTC will provide the beneficiary if they choose to enroll with the MLTC. Bellin also alleged that beneficiaries are entitled to this appeal right, and to notice of the right, under federal statutory and constitutional law. Bellin brought her claims against ElderServe, an MLTC that she alleges denied her these rights, and Zucker, in his official capacity as Commissioner of the New York State Department of Health, for his alleged failure to enforce these asserted rights.The Second Circuit affirmed the dismissal of Bellin’s federal law claims on the grounds that the relevant federal statutes do not provide Medicaid beneficiaries a right to appeal initial personal care services hours determinations. The court vacated the dismissal of Bellin’s Fourteenth Amendment due process claims; Bellin plausibly alleged a constitutionally protected property interest in the determination of her personal care services hours. View "Bellin v. Zucker" on Justia Law

by
Connecticut Governor Ned Lamont and the state's Commissioner of the Department of Emergency Services and Public Protection James Rovella appeal from the district court's order granting a preliminary injunction ordering that the Governor repeal, in light of the COVID-19 pandemic, a provision to suspend collection of fingerprints in connection with applications for authorization to obtain firearms. The injunction also ordered that the Governor repeal that provision of the executive order and that the DESPP Commissioner resume fingerprinting services at that agency.The Second Circuit vacated the preliminary injunction and concluded that: (1) with respect to the individual plaintiffs, the preliminary injunction motion became moot in the district court; and (2) CCDL lacked organizational standing. Because the motion was moot and CCDL lacked standing, the district court had no jurisdiction to issue the preliminary injunction. View "Connecticut Citizens Defense League, Inc. v. Lamont" on Justia Law

by
Talevski, living with dementia, was a patient at Valparaiso Care, a state-run Indiana nursing facility. His wife filed suit under 42 U.S.C. 1983 for violations of the Federal Nursing Home Reform Act (FNHRA), 42 U.S.C. 1396r, which establishes the minimum standards of care to which nursing-home facilities must adhere in order to receive federal funds in the Medicaid program. Some of the requirements relate to residents’ rights, including two cited by Talevski, the right to be free from chemical restraints imposed for purposes of discipline or convenience rather than treatment and the right not to be transferred or discharged unless certain criteria are met.The district court dismissed the action, finding that FNHRA does not provide a private right of action that may be redressed under 42 U.S.C. 1983. The Seventh Circuit reversed. The section 1983 remedy broadly encompasses violations of federal statutory as well as constitutional law. The court noted the express rights-creating language in the statute and that FNHRA is not the type of comprehensive enforcement scheme, incompatible with individual enforcement. The right protected by the statute is not so vague and amorphous that its enforcement would strain judicial competence. View "Talevski v. Health and Hospital Corp. of Marion County" on Justia Law

by
The primary issue in consolidated appeals was the scope of an automobile insurance policy’s arbitration provision. Two insureds with identical Allstate Insurance Company medical payments and uninsured/underinsured motorist (UIM) insurance coverage settled with their respective at-fault drivers for applicable liability insurance policy limits and then made medical payments and UIM benefits claims to Allstate. Allstate and the insureds were unable to resolve the UIM claims and went to arbitration as the policy required. The arbitration panels initially answered specific questions submitted about the insureds’ accident-related damages. At the insureds’ requests but over Allstate’s objections, the panels later calculated what the panels believed Allstate ultimately owed the insureds under their medical payments and UIM coverages and issued final awards. Allstate filed superior court suits to confirm the initial damages calculations, reject the final awards as outside the arbitration panels’ authority, and have the court determine the total amounts payable to the insureds under their policies. The judge assigned to both suits affirmed the final arbitration awards; Allstate appealed both decisions. The Alaska Supreme Court determined the arbitration panels had no authority to determine anything beyond the insureds’ damages arising from their accidents and because Allstate withheld its consent for the panels to determine anything else, the Court reversed the superior court’s decisions and judgments. The Supreme Court also reversed some aspects of the superior court’s separate analysis and rulings on legal issues that the panels improperly decided. Given (1) the arbitration panels’ damages calculations and (2) the Supreme Court's clarification of legal issues presented, the cases were remanded for the superior court to determine the amount, if any, Allstate had to pay each insured under their medical payments and UIM coverages. View "Allstate Insurance Company v. Harbour" on Justia Law

by
Saunders worked as a bus attendant for the Washington, D.C., school system, helping students with special needs and those in wheelchairs on and off the bus. On January 7, 2014, she slipped and fell on ice at work, suffering a hip contusion and back pain. Saunders never returned to work but filed a disability claim with the Social Security Administration six months after her fall. She obtained multiple opinions from Dr. Williams, her generalist, and Dr. Liberman, her neurologist. Saunders received disability benefits from the Washington, D.C., workers’ compensation board.After Saunders’s federal disability claims were denied an ALJ held a hearing and concluded that she was not disabled. The ALJ gave “some” weight to certain medical opinions but “no weight” to others, including Dr. Lieberman’s opinion that Saunders was permanently disabled. The ALJ placed considerable weight on the vocational expert’s testimony and found that someone with Saunders’s functional capacity could perform her past work as generally performed in the national economy. The district court affirmed. The D.C. Circuit remanded. The ALJ erroneously failed to consider certain medical opinions, particularly those of Saunders’s treating physician. View "Saunders v. Kijakazi" on Justia Law

by
Indian Health Services (IHS) previously provided health care to the federally recognized Tribe through a clinic in McDermitt, Nevada, and an emergency medical services program. Federal law entitles members of other tribes also to receive care at the clinic. In 2016, the Tribe notified IHS of its intent to assume responsibility for the clinic and part of the EMS program. The Tribe requested about $603,000 annually to provide medical care at the clinic. IHS awarded only about $53,000. The parties disputed whether the Tribe was entitled to all the funds that IHS previously had spent on the clinic or whether the agency could withhold the portion of those funds to benefit members of another tribe. IHS allocates generally funding among health care programs according to the number of eligible users living in the tribe's assigned. IHS funded the clinic to benefit the Tribe and the nearby Winnemucca Tribe. IHS argued that it could not include Winnemucca’s “tribal share” of clinic funding without that tribe’s consent. The parties disputed the treatment of third-party income from Medicare and Medicaid, which the Tribe now collects directly. The Tribe assumed full control of the clinic, filed suit, and obtained summary judgment.The D.C. Circuit reversed. The Indian Self-Determination and Education Assistance Act, 25 U.S.C. 5321(a), did not permit withholding of the amount budgeted as benefitting members of the second tribe but did permit withholding an amount equal to the Medicare and Medicaid reimbursements. View "Fort McDermitt Paiute and Shoshone Tribe v. Becerra" on Justia Law

by
The Supreme Court affirmed in part and vacated in part the judgment of the circuit court rejecting Plaintiffs' claims challenging the refusal by the Department of Social Services (DSS) to provide MO HealthNet coverage, holding that the circuit court erred in declaring Mo. Const. art. IV, 36(c) constitutionally invalid.Plaintiffs, three Missourians eligible for MO HealthNet coverage under article IV, section 36(c), brought this action challenging the DSS's refusal to provide coverage on the grounds that the General Assembly failed to appropriate adequate funding. The circuit court rejected the claims, finding that the ballot initiative that enacted article IV, section 36(c) violated Mo. Const. art. III, 51, which prohibits initiatives from appropriating money without creating revenue to fund the initiative. The Supreme Court affirmed in part and vacated in part the circuit court's judgment, holding (1) article IV, section 36(c) does not appropriate money and does not remove the General Assembly's discretion in appropriating money to MO HealthNet; and (2) therefore, the circuit court erred in concluding that article IV, section 36(c) violates article III, section 51. View "Doyle v. Tidball" on Justia Law

by
After a Tessier's employee was modifying a hole cover on the roof of an unfinished building when the cover collapsed and he fell 22 feet to the floor below, OSHA issued a citation against Tessier's under 29 C.F.R. 1926.501(b)(4)(i), for failing to protect its employees from falling through holes.The Eighth Circuit denied the petition for review filed by Tessier's, concluding that substantial evidence supported the ALJ's conclusion that the employees had removed a one-foot-by-three-foot section of the cover before it collapsed and, in doing so, exposed a hole. Because this hole was not covered and was more than six feet above the second floor, Tessier's was required to protect its employees from falling by means of an alternative form of fall protection, which it had not done. Therefore, the ALJ did not err in concluding that Tessier's had committed the violation. View "Tessier's, Inc. v. Secretary of Labor" on Justia Law

by
Antonia Nyman was renting a backyard cottage to Dan Hanley when the COVID-19 pandemic began. She sought to evict Hanley and gave him 60 days’ notice of her intention to move into the unit herself. Due to this unprecedented pandemic, Washington Governor Jay Inslee temporarily halted most evictions, but not for landlords seeking to occupy the unit personally. A federal eviction moratorium imposed by the United States Centers for Disease Control and Prevention (CDC) also temporarily halted some evictions, but not for tenants who have violated a contractual obligation (with certain specified exceptions). The issue this case presented for the Washington Supreme Court's review centered on whether Hanley violated a contractual obligation by holding over in his unit after his lease expired by its terms. Based on undisputed facts before us, the Court held that he did. "While the CDC order may be more protective than Washington’s eviction proclamation in some instances, it does not apply here. Accordingly, we affirm the trial court and lift the stay of the writ of restitution." View "Nyman v. Hanley" on Justia Law

by
The Family Smoking Prevention and Tobacco Control Act amended the Federal Food, Drug, and Cosmetic Act to establish a comprehensive regulatory scheme for tobacco products, defined as “any product made or derived from tobacco that is intended for human consumption, including any component, part, or accessory of a tobacco product,” 21 U.S.C. 321(rr)(1). The 2016 FDA "Deeming Rule" deemed all products that meet the Act’s definition of “tobacco product,” including any “component” and “part” but excluding any “accessory” of those products, to be subject to the Act. Premarket review by FDA was required before the introduction into interstate commerce of any “new tobacco product.” FDA adopted “staggered compliance periods” for premarket review requirements of newly deemed products that were being marketed as of the Rule’s effective date. FDA also promulgated a separate rule addressing the assessment of user fees for manufacturers and importers of cigars and pipe tobacco.The D.C. Circuit affirmed summary judgment in favor of FDA on five Administrative Procedure Act challenges to the Deeming Rule concerning its implementation of the premarket review requirements, underlying cost-benefit analysis, and classification of a pipe as a “component or part” of a tobacco product subject to regulation, and an APA challenge to the User Fees Rule. View "Cigar Association of America v. United States Food and Drug Administration" on Justia Law