Justia Health Law Opinion Summaries
In re Involuntary Treatment of K.
The Supreme Judicial Court dismissed as moot Appellant's appeal from a judgment entered by the superior court ordering the involuntary medical treatment of Appellant, holding that because Appellant was no longer subject to the court's involuntary treatment order, this appeal was moot. Appellant was arrested and charged with burglary and theft by unauthorized taking. While Appellant was in preconviction detention at the mental health unit of the Maine State Prison (MSP) the Department of Corrections filed an application pursuant to Me. Rev. Stat. 34-A, 3049 seeking the involuntary medication of Appellant. The court entered an ex parte order granting the emergency application and permitting the immediate medication of Appellant for a period of 120 days. Appellant appealed. The Supreme Judicial Court dismissed the appeal as moot, holding that because Appellant was no longer at the mental health unit of the MSP and the involuntary treatment order had expired, the appeal was moot and no exceptions to the mootness doctrine applied. View "In re Involuntary Treatment of K." on Justia Law
Dougherty v. Roseville Heritage Partners
In January 2017, plaintiffs Lori Dougherty and Julie Lee's 89-year-old father passed away while living in Somerford Place, an elder residential care facility owned and operated by defendants Roseville Heritage Partners, Somerford Place, LLC, Five Star Quality Care, Inc., and Five Star Quality Care-Somerford, LLC. In July 2017, plaintiffs sued defendants, alleging elder abuse and wrongful death based upon the reckless and negligent care their father received while residing in defendants’ facility. Defendants appealed the trial court’s denial of their motion to compel arbitration and stay the action, contending the arbitration agreement did not contain any unconscionable or unlawful provisions. Alternatively, defendants argued the court abused its discretion by invalidating the agreement as a whole, rather than severing the offending provisions. The Court of Appeal found the arbitration agreement at issue here was "buried within the packet at pages 43 through 45," and "[b]ased on the adhesiveness of the agreement, and the oppression and surprise present," the Court concluded the trial court properly found the Agreement was imposed on a “take it or leave it” basis and evinced a high degree of procedural unconscionability. Under the sliding scale approach, only a low level of substantive unconscionability was required to render the arbitration agreement unenforceable. Likewise, the Court concurred that the arbitration agreement was substantively unconscionable, "particularly given the accompanying evidence of procedural unconscionability." The Court found no abuse of discretion in the trial court's declination to sever the offending provisions of the agreement, rather than invalidate the entire agreement. View "Dougherty v. Roseville Heritage Partners" on Justia Law
Amrhein v. eClinical Works, LLC
The First Circuit affirmed the judgment of the district court finding that Plaintiffs, patients whose healthcare providers used eClinicalWorks, LLC (ECW) software to record and store their medical records, lacked standing to bring this case, holding that, without further injury, Plaintiffs lacked standing to bring this case. Plaintiffs were the estates of two deceased patients whose medical records were kept and stored by healthcare providers using ECW. Plaintiffs alleged that ECW's system was riddled with bugs that showed healthcare providers false and incomplete data about patients' medical problems and treatments and that ECW hid the glitches from government regulators. Plaintiffs brought several state common-law claims and sought to represent a class of millions of other similarly-situated patients. The district court dismissed the case under Fed. R. Civ. P. 12(b)(1). The First Circuit affirmed, holding that the arguments as presented sought redress based on a moot risk of misdiagnosis or mistreatment that no statute or common-law claim makes suable. Therefore, Plaintiffs lacked standing to bring this case. View "Amrhein v. eClinical Works, LLC" on Justia Law
Winter v. Gardens Regional Hospital & Medical Center, Inc.
The Ninth Circuit reversed the district court's dismissal of a qui tam action brought by relator under the False Claims Act, alleging that defendants submitted, or caused to be submitted, Medicare claims falsely certifying that patients' inpatient hospitalizations were medically necessary. After determining that it had jurisdiction, the panel held that a plaintiff need not allege falsity beyond the requirements adopted by Congress in the FCA, which primarily punishes those who submit, conspire to submit, or aid in the submission of false or fraudulent claims. The panel wrote that Congress imposed no requirement of proving "objective falsity," and the panel had no authority to rewrite the statute to add such a requirement. The panel held that a doctor’s clinical opinion must be judged under the same standard as any other representation. The panel explained that a doctor, like anyone else, can express an opinion that he knows to be false, or that he makes in reckless disregard of its truth or falsity. Therefore, a false certification of medical necessity can give rise to FCA liability. The panel also held that a false certification of medical necessity can be material because medical necessity is a statutory prerequisite to Medicare reimbursement. View "Winter v. Gardens Regional Hospital & Medical Center, Inc." on Justia Law
Vicksburg Healthcare, LLC v. Mississippi Dept. of Health & Wound Care Management, LLC
The Mississippi State Department of Health entered a final order approving a Certificate of Need for Wound Care Management, LLC, d/b/a MedCentris for the “[p]rovision of [d]igital [s]ubtraction [a]ngiography (DSA) services (Limb Salvage Program).” Vicksburg Healthcare, LLC, d/b/a Merit Health River Region, a hospital in Vicksburg that opposed the certificate of need, appealed the Department’s statutorily affirmed decision pursuant to Mississippi Code Section 41-7-201(2) (Rev. 2018). After considering the record and issues presented, the Mississippi Supreme Court entered an order on its own motion requiring supplemental briefing regarding whether Section 41-7-201(2), as amended, governed the appeal process pertaining to facilities established for the private practice, either independently or by incorporated medical groups of physicians. The Supreme Court held that River Region lacked the right to petition the chancery court for review of the certificate of need under Section 41-7-201(2). Accordingly, the Supreme Court dismissed the case and remanded it to the Hinds County Chancery Court for further proceedings. View "Vicksburg Healthcare, LLC v. Mississippi Dept. of Health & Wound Care Management, LLC" on Justia Law
Sandoval v. UNUM Life Insurance
The insured, Brenda Sandoval, submitted a claim to her insurer, Unum Life Insurance Company of America, which initially paid benefits but then terminated them. The termination of benefits led Sandoval to sue Unum for: (1) a common-law tort (bad faith breach of insurance contract); (2) a statutory tort (unreasonable conduct under Colo. Rev. Stat. sec. 10-3-1115 to 1116); and (3) breach of contract. The district court granted Unum’s motion for partial summary judgment on the tort claims. The contract claim went to trial, where the jury rendered a verdict for Sandoval. The district court later denied Unum’s motion for judgment as a matter of law. Sandoval appealed the grant of Unum’s motion for partial summary judgment, and Unum cross-appealed the denial of its motion for judgment as a matter of law. After review, the Tenth Circuit affirmed the award of partial summary judgment on the tort claims because Unum conducted a reasonable investigation. On the contract claim, the Court also affirmed the denial of Unum’s motion for judgment as a matter of law: the policy contained two alternative tests for a disability, and the evidence permitted a reasonable finding that Sandoval had satisfied at least one of these definitions. View "Sandoval v. UNUM Life Insurance" on Justia Law
Reinaas v. Saul
Until 2010, Reinaas, now in his mid‐fifties, worked as a machine operator. He injured his spine and tore his rotator cuff on the job, and underwent two neck fusion surgeries. Reinaas planned to return to work but continued to suffer from severe headaches (treated with hydrocodone), shoulder pain, and a decreased range of motion. A neurologist diagnosed him with cervicogenic headaches, and his family doctor diagnosed “long term nuchal headaches” and “[p]ermanent pain syndrome post cervical fusion.” Dr. Bodeau, a Mayo Clinic occupational physician, opined that Reinaas could not return to his factory job and suggested surgical intervention. In 2013, Reinaas had shoulder surgery and attended physical therapy; he took naproxen and Vicodin for pain. Reinaas applied for social security disability benefits. Benefits were denied after state‐retained physicians reviewed his records and concluded that Reinaas’s accounts of his symptoms were not fully credible. Dr. Bodeau opined that Reinaas had “deteriorated significantly” and was “highly unlikely to successfully regain employment at any physical demand level.” The ALJ concluded that Reinaas was not disabled. In determining Reinaas’s residual functional capacity, the ALJ afforded great weight to the opinions of the two non‐examining physicians and gave little weight to Dr. Bodeau’s opinion, explaining that Bodeau lacked knowledge of Social Security disability rules and that his report was based on subjective complaints of questionable credibility. The Seventh Circuit vacated. Substantial evidence does not support the ALJ’s decision to discount the treating physician’s opinion and the ALJ did not adequately evaluate Reinaas’s subjective complaints. View "Reinaas v. Saul" on Justia Law
Williams v. Dimensions Health Corp.
Plaintiff filed suit against the hospital, alleging that it violated the Emergency Medical Treatment and Active Labor Act (EMTALA) by failing to properly screen him and stabilize his condition. The Fourth Circuit adopted the requirement of a good faith admission and held that a party claiming an admission was not in good faith must present evidence that the hospital admitted the patient solely to satisfy its EMTALA standards with no intent to treat the patient once admitted and then immediately transferred the patient. The court held that plaintiff failed to point to evidence that creates a genuine issue of material fact as to this high standard. Furthermore, plaintiff failed to point to any evidence in support of his theory that the hospital admitted plaintiff to improperly hoard him in order to garner his premium insurance benefits. View "Williams v. Dimensions Health Corp." on Justia Law
Graham v. CIOX Health, LLC
Mo. Rev. Stat. Section 191.227.1 permits health care providers to charge patients who request their medical records a "search" fee when there are no responsive medical records to be found. The Eighth Circuit affirmed the district court's dismissal of the action and dismissed movants' appeal of the denial of their motion to intervene as moot. The court rejected plaintiff's claim that CIOX's practice of charging a fee for unsuccessful records searches violated the Missouri statute. View "Graham v. CIOX Health, LLC" on Justia Law
Susie v. Family Health Care of Siouxland, P.L.C.
The Supreme Court affirmed the judgment of the district court granting summary judgment for Defendants on Plaintiffs' medical malpractice claims, holding that Plaintiffs failed to set forth specific facts showing a prima facie case of causation and lost chance of survival. Sharon Susie lost her right arm and eight of her toes due to a disorder known as necrotizing fasciitis. Sharon and her husband (together, Plaintiffs) filed a negligence claim against Defendants seeking damages for the amputation of Sharon's arm and other injuries. Plaintiffs alleged that Defendants were negligent because Sharon's condition was not properly diagnosed and treatment was not timely commenced and that Defendants' actions resulted in the lost chance to save Sharon's arm and toes from amputation. The district court granted summary judgment for Defendants. The Supreme Court affirmed, holding that summary judgment was properly granted because Plaintiffs failed to set forth specific facts showing a prima facie case of causation and lost chance of survival. View "Susie v. Family Health Care of Siouxland, P.L.C." on Justia Law