Justia Health Law Opinion Summaries
QHG of Enterprise, Inc., d/b/a Medical Center Enterprise v. Pertuit
QHG of Enterprise, Inc., d/b/a Medical Center Enterprise ("QHG"), appealed a circuit court's judgment awarding Amy Pertuit ("Amy") $5,000 in compensatory damages and $295,000 in punitive damages. Leif Pertuit ("Leif") had been married to Deanna Mortensen; they had one child, Logan. Leif and Mortensen divorced in 2007. At some point, Mortensen was awarded sole physical custody of Logan, and Leif was awarded visitation. Leif later married Amy, a nurse. At the time of their marriage, Leif and Amy resided in Mobile, Alabama, and Mortensen resided in Enterprise. Eventually, tensions arose between Leif and Mortensen regarding the issue of visitation. In March 2014, Mortensen began sending text messages to Leif accusing Amy of being addicted to drugs. Around that time, Mortensen visited the attorney who had represented her in divorce from Leif. Mortensen expressed concern that Logan was in danger as a result of the visitation arrangement and asked her attorney to assist with obtaining a modification of Leif's visitation. In April 2014, Mortensen contacted Dr. Kathlyn Diefenderfer, a physician whom QHG employed as a hospitalist at Medical Center Enterprise. Mortensen had been Dr. Diefenderfer's patient, and Dr. Diefenderfer's son played sports with Logan. Mortensen informed Dr. Diefenderfer that Logan was scheduled to ride in an automobile with Amy from Enterprise to Mobile for Leif's visitation and expressed concern regarding Amy's ability to drive, given her belief that Amy was using drugs and had lost her nursing license. Dr. Diefenderfer used a hospital computer to check on Amy's drug prescriptions. After reviewing that information,Dr. Diefenderfer told Mortensen: "All I can tell you is I would not put my son in the car." Mortensen went back to her attorney, informing him that Dr. Diefenderfer had acquired the necessary proof of Amy's drug use. Amy received a copy of the modification petition, and was convinced her private health information had been obtained in violation of HIPAA, and filed complaints to the Enterprise Police Department, the US Department of Health and Human Services, the Alabama Bar Association, and the Alabama Board of Medical Examiners. A grand jury indicted Mortensen and Dr. Diefenderfer, which were later recalled, but the two entered diversion agreements with the district attorney's office. Amy then filed suit alleging negligence and wantonness, violation of her right to privacy, the tort of outrage and conspiracy. The Alabama Supreme Court determined the trial court erred by denying QHG's motion for a judgment as a matter of law with respect to Amy's asserted theories of respondeat superior; ratification; and negligent and wanton training, supervision, and retention because there was not substantial evidence indicating that QHG was liable to Amy as a consequence of Dr. Diefenderfer's conduct under any of those theories. The trial court's judgment awarding Amy $5,000 in compensatory damages and $295,000 in punitive damages was reversed, and judgment rendered in favor of QHG. View "QHG of Enterprise, Inc., d/b/a Medical Center Enterprise v. Pertuit" on Justia Law
Hannah v. Naughton, M.D., et al.
Regina Hannah appealed the grant of summary judgment in favor of Michael Naughton, M.D.; Michael Naughton, M.D., Ph.D., LLC; Terisa Thomas, M.D., and and Terisa A. Thomas, M.D., P.C. (collectively, "the defendants"), on Hannah's claims alleging medical malpractice. In 2005, Hannah was seen by Dr. Thomas, a board-certified general surgeon, for a female health-care examination. Hannah was 32 years old at the time, and complained of fatigue, weight gain, heavy menstrual cycles, cramping, and painful sexual relations. Hannah also reported a significant family medical history of cervical cancer and stated that she was fearful of getting cancer. Hannah stated that her mother, grandmother, and sister had suffered from cervical cancer. Dr. Thomas ordered a number of tests, including a pelvic ultrasound and a Pap smear. Dr. Thomas received the results of Hannah's Pap smear, which indicated an "abnormal" result: "Epithelial Cell Abnormality. Atypical Squamous Cells Cannot Exclude High Grade Squamous Intraepithelial Lesion (HSIL)." Dr. Thomas stated that this was not a diagnosis of cancer but, rather, that she considered it an abnormal finding indicative of an "increased risk" of cancer. Dr. Thomas related to Dr. Naughton that she had a patient she wanted to refer to him for a second opinion following an abnormal Pap smear. Dr. Naughton testified that Hannah chose the most aggressive option for treatment, specifically stating that she wanted "it all out:" a hysterectomy, including her ovaries. Dr. Naughton had Hannah execute a "surgical-awareness" form indicating that she accepted full responsibility for her decision to have the surgery. Hannah underwent surgery; there was no indication of any diagnosis of cervical cancer mentioned in the surgical record. Hannah's surgery was completed without complication. Hannah would have one more follow up appointment with Dr. Naughton; she also met with Dr. Thomas. Frustrated with a lack of response from additional calls to Dr. Naughton's office, Hannah consulted with Dr. Max Austin, a gynecologic oncologist. After review of her medical records, Dr. Austin told Hannah she "never had nor did she have cervical cancer." Hannah then filed suit against Drs. Thomas and Naughton, alleging they breached their standard of care by falsely informing her she had cervical cancer based on the abnormal Pap-smear, and by advising her to undergo a hysterectomy. The Alabama Supreme Court found no reversible error in the trial court's judgment and affirmed it. View "Hannah v. Naughton, M.D., et al." on Justia Law
Bloom v. Azar
Plaintiff, a Medicare beneficiary who uses a Continuous Glucose Monitoring device (CGM) to manage his Type I diabetes, sought Medicare coverage to offset the costs associated with his CGM. After the Medicare Appeals Council rejected plaintiff's requests for coverage, he challenged the adverse decisions in federal court. The district court concluded that two of the three challenged decisions failed to meet the $1,500 amount-in-controversy threshold for federal court jurisdiction and that the Medicare Act did not permit plaintiff to cure the jurisdictional deficiency by aggregating the three separate amounts.The Second Circuit held, based on the text of the statute and reinforced by its regulatory and legislative history, that the Medicare Act does not prohibit plaintiff from aggregating his claims for the first time in district court. Therefore, the district court erred in refusing to let plaintiff aggregate his claims to satisfy the Act's amount-in-controversy requirement. The court vacated the district court's judgment and remanded for further proceedings. View "Bloom v. Azar" on Justia Law
Sahara Health Care, Inc. v. Azar
The Fifth Circuit affirmed the district court's grant of the government's motion to dismiss Sahara's suit for injunctive relief in a Medicare recoupment case, holding that the government provided Sahara adequate process. Applying the Mathews factors, the court held that the sufficiency of the current procedures and the minimal benefit of the live hearing weighs so strongly against Sahara that its due process claim fails. In this case, Sahara received some procedure, chose to forego additional protections, and cannot demonstrate the additional value of the hearing it requests. The court also held that Sahara failed to state a claim for ultra vires actions under 42 U.S.C. 1395ff. View "Sahara Health Care, Inc. v. Azar" on Justia Law
In re Guardianship of D.E.
In February 2020, the 79-year-old ward was a patient at a hospital in Lebanon, New Hampshire. At that time, the hospital filed a petition to appoint a guardian over the ward’s person and estate. The hospital alleged a guardianship was necessary because the ward “has persistent cognitive impairment due to an anoxic brain injury and a major [neurocognitive] disorder,” which “renders him unable to provide for his personal needs for health care, food, clothing, shelter and safety” or to “manage his finances or estate.” The court held a hearing in March at which only the ward’s adult children were present. The ward’s children testified that, in October 2019, when their father was in the intensive care unit, they executed a “Do Not Resuscitate” (DNR) order for him. The ward had no DNR order previously. When the ward’s condition improved and he was transferred to a medical ward, he specifically told his children that he wanted the DNR order removed. Based upon the evidence at the March hearing, the court found that the ward was incapacitated and that a guardianship was necessary as a means of providing for his “continuing care ... and for the prudent management of [his] property and financial affairs.” The court limited the guardian’s authority to execute either a DNR order or an order limiting life-sustaining treatment. In August 2020, the guardian moved for a hearing to ask the court to remove the limitations on her authority regarding the ward’s medical care. The guardian averred that the ward, who now resided in a nursing home, was in need of dialysis but had refused dialysis on three occasions, and refused future treatment. The guardian asserted that, by declining to resume dialysis, “the ward himself has decided to stop his own life sustaining treatment,” and that “without having a DNR order in place and without anyone else having the ability to sign [one],” it will be “quite problematic and painful for the ward.” The ward’s attorney informed the court that the ward was “very clear that he did not want a DNR Order.” Upon interlocuroty transfer without a ruling from the circuit court, the New Hampshire Supreme Court accepted review of issues arising from the ward's guardianship. The Court determined that although the ward had a guardian to make health care decisions on his behalf, the trial court had limited the guardian’s authority to withhold life-sustaining treatment, including whether to execute a DNR order on his behalf. "Under these circumstances, given the ward’s lack of capacity to make health care decisions generally, and assuming that he does not have a valid and unrevoked living will or an authorized agent under a durable power of attorney for health care, the process for appointing a surrogate, as described in RSA 137-J:34-:37, applies. ... Accordingly, it does not appear that at this time, a DNR order may be executed on his behalf by his health care providers." View "In re Guardianship of D.E." on Justia Law
Southcentral Foundation v. Alaska Native Tribal Health Consortium
The Ninth Circuit reversed the district court's dismissal for lack of standing of a tribal health organization's action seeking declaratory relief regarding alleged violations of a federal law concerning the provision of health services to Alaska Natives. The panel held that SCF alleges an injury in fact sufficient to confer Article III standing in two distinct ways: first, that ANTHC infringed SCF's governance and participation rights under Section 325 of the Department of the Interior and Related Agencies Appropriations Act of 1998 by delegating the full authority of the fifteen-member Board to the five-person Executive Committee; and second, that ANTHC erected informational barriers in the Code of Conduct and Disclosure Policy that deprived SCF of its ability to exercise effectively its governance and participation rights. The panel remanded for further proceedings. View "Southcentral Foundation v. Alaska Native Tribal Health Consortium" on Justia Law
Burchell v. Faculty Physicians & Surgeons etc.
In 2014, plaintiff-respondent Keith Burchell underwent what was supposed to be a simple, outpatient procedure to remove a small mass in his scrotum for testing. His surgeon, Dr. Gary Barker, discovered that the mass was more extensive than expected, believing the mass was malignant. Without consulting either Burchell (who was under anesthesia) or the person Burchell had designated as his medical proxy, Barker removed the mass from both the scrotum and the penis, a different and substantially more invasive procedure than had been contemplated. Burchell suffered serious side effects, some of which are permanent and irreversible. The mass turned out to be benign. Burchell brought suit, alleging professional negligence and medical battery. A jury returned a verdict for Burchell on both causes of action, awarding him $4 million in past noneconomic damages and $5.25 million in future noneconomic damages against Dr. Barker and defendant-appellant Faculty Physicians & Surgeons of the Loma Linda University School of Medicine (FPS). On appeal, FPS argued the award of noneconomic damages should have been reduced to the $250,000 limit on such damages in “any action for injury against a health care provider based on professional negligence” provided by Civil Code section 3333.2(a), part of the Medical Injury Compensation Reform Act of 1975 (MICRA). In the alternative, FPS argued the award of noneconomic damages was excessive and the product of improper argument by Burchell’s counsel, so the Court of Appeal should reverse and remand for new trial unless Burchell accepts a reduction of the award to an amount we deem reasonable. Finally, FPS argued Burchell’s offer to compromise pursuant to Code of Civil Procedure section 998 was invalid, so the award of expert witness fees and prejudgment interest should also be reversed. After review, the Court of Appeal rejected FPS' first two arguments, but concurred that Burchell’s section 998 offer was invalid, and therefore reversed the award of expert witness fees and prejudgment interest. View "Burchell v. Faculty Physicians & Surgeons etc." on Justia Law
Dane v. UnitedHealthcare Insurance Co.
The Second Circuit affirmed the district court's dismissal, based on Federal Rule of Civil Procedure 12(b)(6), of plaintiff's amended complaint alleging that defendants violated Connecticut and District of Columbia law in entering into a licensing agreement with respect to a group plan for Medicare supplement insurance. Plaintiff claimed that defendants' royalty fee arrangement constituted an unlawful "premium rebate" in violation of Connecticut and District of Columbia anti-rebating insurance laws.The court held that plaintiff did not state an unlawful rebate claim under Connecticut or D.C. law because he failed to plausibly allege any ascertainable loss or injury as a result of his purchase of Medicare supplement insurance ("Medigap") or the AARP royalty fee. Likewise, the court held that plaintiff failed to plausibly allege a cognizable claim based on his purchase of Medigap insurance through the AARP-UnitedHealthcare plan. In regard to plaintiff's consumer protection claims, he failed to show any concrete and particularized injury because he paid only the regulator-approved rate and received the Medigap insurance he contracted for. Finally, plaintiff failed to plausibly allege the requisite elements for his remaining common law claims and his statutory theft claim under Connecticut law. View "Dane v. UnitedHealthcare Insurance Co." on Justia Law
State Farm v. Spine Care Delaware
A superior court determined State Farm Mutual Auto Insurance Company and State Farm Fire and Casualty Company’s (collectively, “State Farm”) payment practices with Spine Care Delaware, LLC (“SCD”) for medical fees incurred by its Personal Injury Protection (“PIP”) insureds in connection with covered multi-injection spine procedures contravened 21 Del. C. 2118(a)(2). When State Farm received SCD’s charges for a multi-injection procedure performed on one of its PIP insureds, it unilaterally applied a Multiple Payment Reduction (“MPR”) to the charges for injections after the first injection in a manner consistent with Medicare guidelines, paying SCD less than what it charged. SCD sought a declaration that State Farm's application of its MPRs was inconsistent with section 2118(a)(2)’s requirement of reasonable compensation for covered medical expenses, and sought a declaration that State Farm had to pay SCD any reasonable amount charged for PIP-related medical expenses, without applying MPRs. Both parties then moved for summary judgment. The superior court held that State Farm failed to show that the MPR reductions correlated to reasonable charges for the multiple-injection treatments, and thus contravened section 2118(a)(2). On appeal, State Farm contended the superior court incorrectly placed the burden of proof on State Farm to demonstrate that its application of MPRs was reasonable, and that SCD failed to meet its burden of demonstrating that State Farm’s application of MPRs was a failure to pay reasonable and necessary expenses under the statute. Alternatively, State Farm argued that even if it had the burden of proof, it satisfied that burden. The Delaware Supreme Court agreed with State Farm's first premise, that the superior court erred in assigning State Farm the burden of proof. Judgment was reversed and the matter remanded for further proceedings. View "State Farm v. Spine Care Delaware" on Justia Law
Greenbrier Hospital, LLC v. Azar
Federal regulations establish a compensation formula for the payment of certain health care providers—a formula that changes once a year. However, each formula takes effect on January 1 and runs until January 1 of the following year. On January 1, two competing formulas purport to apply, making it unclear which one governs: the new one, or the one from the preceding year.The Fifth Circuit affirmed the district court's grant of summary judgment to the government, holding that the context of the rule makes clear that the court should construe the 2005 rule to give effect to the new formula, and not the formula from the preceding year, when presented with a cost report that begins on January 1. View "Greenbrier Hospital, LLC v. Azar" on Justia Law