Justia Health Law Opinion Summaries

The hospital, located in Philadelphia, received a reclassification into the New York City area, which would sizably increase the hospital’s Medicare reimbursements due to that area’s higher wage index, 42 U.S.C. 1395ww(d). Although a statute makes such reclassifications effective for three fiscal years, the agency updated the geographical boundaries for the New York City area before the close of that period and reassigned the hospital to an area in New Jersey with an appreciably lower wage index. The hospital successfully sued three agency officials in the Eastern District of Pennsylvania.The Third Circuit vacated and remanded for dismissal. The Medicare Act, 42 U.S.C. 1395oo(f)(1), channels reimbursement disputes through administrative adjudication as a near-absolute prerequisite to judicial review. The hospital did not pursue its claim through administrative adjudication before suing in federal court. By not following the statutory channeling requirement, the hospital has no valid basis for subject-matter jurisdiction. View "Temple University Hospital, Inc. v. Secretary United States Department of Health & Human Services" on Justia Law

The 2010 Patient Protection and Affordable Care Act required most Americans to obtain minimum essential health insurance coverage and imposed a monetary penalty upon most individuals who failed to do so; 2017 amendments effectively nullified the penalty. Several states and two individuals sued, claiming that without the penalty, the Act’s minimum essential coverage provision, 26 U.S.C. 5000A(a), is unconstitutional and that the rest of the Act is not severable from section 5000A(a).The Supreme Court held that the plaintiffs lack standing to challenge section 5000A(a) because they have not shown a past or future injury fairly traceable to the defendants’ conduct enforcing that statutory provision. The individual plaintiffs cited past and future payments necessary to carry the minimum essential coverage; that injury is not “fairly traceable” to any “allegedly unlawful conduct” of which they complain, Without a penalty for noncompliance, section 5000A(a) is unenforceable. To find standing to attack an unenforceable statutory provision, seeking only declaratory relief, would allow a federal court to issue an impermissible advisory opinion.The states cited the indirect injury of increased costs to run state-operated medical insurance programs but failed to show how that alleged harm is traceable to the government’s actual or possible enforcement of section 5000A(a). Where a standing theory rests on speculation about the decision of an independent third party (an individual’s decision to enroll in a program like Medicaid), the plaintiff must show at the least “that third parties will likely react in predictable ways.” Nothing suggests that an unenforceable mandate will cause state residents to enroll in benefits programs that they would otherwise forgo. An alleged increase in administrative and related expenses is not imposed by section 5000A(a) but by other provisions of the Act. View "California v. Texas" on Justia Law

In the lawsuit underlying these consolidated writ proceedings, the People of the State of California, by and through the Santa Clara County Counsel, the Orange County District Attorney, the Los Angeles County Counsel, and the Oakland City Attorney, filed an action against defendants— various pharmaceutical companies involved in the manufacture, marketing, distribution, and sale of prescription opioid medications. The People alleged the defendants made false and misleading statements as part of a deceptive marketing scheme designed to minimize the risks of opioid medications and inflate their benefits. This scheme, the People alleged, caused a public health crisis in California by dramatically increasing the number of opioid prescriptions, the use and abuse of opioids, and opioid-related deaths. These proceedings pertained to a discovery dispute after several of the defendants served subpoenas on two nonparty counties, petitioners County of Los Angeles and County of Alameda, seeking records of patients in various county programs, including individual prescription data and individual patient records related to substance abuse treatment. After petitioners and the Johnson & Johnson defendants engaged in various informal and formal means to attempt to resolve the dispute, the superior court issued a discovery order granting the Johnson & Johnson defendants’ motions to compel production of the records. The Court of Appeal concluded petitioners established that the superior court’s order threatened a serious intrusion into the privacy interests of the patients whose records were at issue: the Johnson & Johnson defendants failed to demonstrate their interests in obtaining “such a vast production of medical information” outweighed the significant privacy interests that the nonparty petitioners identified. Accordingly, the Court granted petitioners’ writ petitions and directed the superior court to vacate its order compelling production of the requested documents, and to enter a new order denying Johnson & Johnson defendants’ motions to compel. View "County of Los Angeles v. Superior Ct." on Justia Law

The Supreme Court affirmed the decisions of the circuit court in these consolidated cases, holding that the West Virginia Health Care Authority's interpretation of the State Health Plan Home Health Services Standards was not arbitrary or capricious and was entitled to judicial deference pursuant to Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc. 467 U.S. 837 (1984).The Standards governed the Authority's consideration of applications from entities and individuals seeking to provide home health care services in a particular county. The Standards included a methodology for determining whether there was an unmet need for such services in the county. Petitioners argued that unmet need could not be established unless the evidence showed that at least 229 individuals in the subject county were in need of home health care services. Respondents countered that the Standards required the new applicant to demonstrate a need at or beyond the 229 average usage figure. The circuit court concluded that the Authority did not err. The Supreme Court affirmed, holding that the Authority did not exceed its constitutional or statutory authority and its decision was not arbitrary or capricious. View "Amedisys West Virginia, LLC v. Personal Touch Home Care of W. Va., Inc." on Justia Law

The Supreme Court vacated the portions of the emergency order issued by Janel Heinrich, in her capacity as a local health officer of Public Health of Madison and Dane County, restricting or prohibiting in-person instruction in all schools in Dane County for grades 3-12, holding that those portions were unlawful and unenforceable and are hereby vacated.The disputed order was issued in an effort to decrease the spread of COVID-19. Petitioners - students - brought three cases challenging Heinrich's authority to issue the emergency order, contending that the order exceeded her statutory authority under Minn. Stat. 252.03, violated Petitioners' fundamental right to the free exercise of religioun under Wis. Const. art. I, 18, and violated parents' fundamental right to direct the upbringing and education of their children under Wis. Const. art. I, 1. The Supreme Court consolidated the cases and held (1) local health officers do not have the statutory power to close schools under section 252.03; and (2) the order infringed Petitioners' fundamental right to the free exercise of religion guaranteed in the Wisconsin Constitution. View "St. Ambrose Academy, Inc. v. Parisi" on Justia Law

Linda Black sustained second-degree burns on her back while undergoing electrotherapeutic treatment at Superior Physical Therapy (“SPT”). Black’s treatment was performed by Bart McDonald, a licensed physical therapist and the sole owner of SPT. Black brought a product liability claim against the manufacturer and seller of the self- adhesive carbon electrode pads used during her treatment. The manufacturer moved for summary judgment on the grounds that Black was unable to prove that the electrode pads were defective or that the injuries Black sustained were proximately caused by its negligence. The district court ruled that: (1) McDonald’s conclusory statements that the electrode pads were defective were inadmissible because he was not a qualified expert; (2) the doctrine of res ipsa loquitur did not apply to Black’s case; and (3) Black’s prima facie case failed because there was evidence of abnormal use of the electrode pads and other reasonable secondary causes that could have contributed to Black’s injury. The district court granted summary judgment in favor of the manufacturer. Finding no reversible error, the Idaho Supreme Court affirmed the district court’s decision. View "Black v. DJO Global" on Justia Law

The plaintiffs retired from the Louisville Metropolitan police department and received free health insurance, administered by Kentucky Retirement Systems. Kentucky initially paid all of their healthcare costs. After the officers turned 65, Medicare became the primary payer, leaving Kentucky to cover secondary expenses. Each officer came out of retirement, joining county agencies different from the ones they served before retiring. They became eligible for healthcare benefits in their new positions. Kentucky notified them that federal law “mandate[d]” that it “cannot offer coverage secondary to Medicare” for retirees “eligible to be on [their] employer’s group health plan” as “active employees.” Some of the officers then paid for insurance through their new employers; others kept their retirement insurance by quitting or going part-time. The officers sued.The district court granted summary judgment to the officers, ordered Kentucky to reinstate their retirement health insurance, and awarded the officers some of the monetary damages requested. The Sixth Circuit affirmed. The officers have a cognizable breach-of-contract claim. Under Kentucky law, the Kentucky Retirement Systems formed an “inviolable contract” with the officers to provide free retirement health insurance and to refrain from reducing their benefits, then breached that contract. The Medicare Secondary Payer Act of 1980 did not bar Kentucky from providing Medicare-eligible police officers with state retirement insurance after they reentered the workforce and became eligible again for employer-based insurance coverage, 42 U.S.C. 1395y. View "River City Fraternal Order of Police v. Kentucky Retirement Systems" on Justia Law

M&K Construction (M&K) appealed a workers’ compensation court’s order (the Order) making it reimburse plaintiff Vincent Hager for the ongoing costs of the medical marijuana he was prescribed after sustaining a work-related injury while employed by M&K. Specifically, M&K contends that New Jersey’s Jake Honig Compassionate Use Medical Cannabis Act was preempted as applied to the Order by the federal Controlled Substances Act (CSA). Compliance with the Order, M&K claims, would subject it to potential federal criminal liability for aiding-and-abetting or conspiracy. M&K also claimed medical marijuana was not reimbursable as reasonable or necessary treatment under the New Jersey Workers’ Compensation Act (WCA). Finally, M&K argued that it fit within an exception to the Compassionate Use Act and was therefore not required to reimburse Hager for his marijuana costs. After review, the New Jersey Supreme Court determined: (1) M&K did not fit within the Compassionate Use Act’s limited reimbursement exception; (2) Hager presented sufficient credible evidence to the compensation court to establish that the prescribed medical marijuana represents, as to him, reasonable and necessary treatment under the WCA; and (3) the Court interpretsed Congress’ appropriations actions of recent years as suspending application of the CSA to conduct that complied with the Compassionate Use Act. As applied to the Order, the Court thus found the Act was not preempted and that M&K did not face a credible threat of federal criminal aiding-and-abetting or conspiracy liability. M&K was ordered to reimburse costs for, and reasonably related to, Hager’s prescribed medical marijuana. View "Hager v. M&K Construction" on Justia Law

Two women were hospitalized following psychiatric emergencies. In each instance hospital staff petitioned the superior court for an order authorizing hospitalization for evaluation, and the superior court granted the order. But the women were not immediately transported for evaluation because no beds were available at Alaska Psychiatric Institute (API). Each woman eventually moved for a review hearing to determine whether continued detention in a hospital was proper; in each case the superior court allowed continued detention. The women were finally transported to API more than 14 calendar days after their initial detentions. On appeal they argued their continued detention before being moved to API for evaluation violated their due process rights. The Alaska Supreme Court agreed, vacating the superior court order in each case: “We conclude there was no reasonable relation between the limited purpose of the evaluation orders and the extended duration of the respondents’ confinements. The State’s unreasonably lengthy detentions of Mabel and Sarah violated their substantive due process rights.” View "In the Matter of the Necessity for the Hospitalization of: Sarah D. & Mabel B." on Justia Law

Abbott Laboratories and Abbott Laboratories, Inc. (collectively, "Abbott"), petitioned the Alabama Supreme Court for a writ of mandamus to direct the Mobile Circuit Court to dismiss all claims asserted by the Mobile County Board of Health and the Family Oriented Primary Health Care Clinic (collectively, "Mobile Health") against Abbott on the basis that those claims are barred by the rule of repose or by the applicable statute of limitations. Mobile Health alleged that Abbott had participated in the marketing of a specific prescription drug, OxyContin. Mobile Health alleged that this marketing campaign "precipitated" an "opioid crisis" in the United States, and specifically in Alabama, because it caused an astronomical increase in the use of opioids by patients who quickly became dependent upon the drugs. Mobile Health asserted that it brought this action because of the burdens it had to bear as a result of the "opioid epidemic." The Alabama Supreme Court concluded the applicable statutes of limitations barred Mobile Health's claims against Abbott. Therefore, the Court granted Abbott's petition for a writ of mandamus, and directed the circuit court to enter an order dismissing Mobile Health's claims against Abbott. View "Ex parte Abbott Laboratories and Abbott Laboratories, Inc." on Justia Law