Justia Health Law Opinion Summaries

The Commonwealth of Kentucky initiated a lawsuit against several pharmacy benefit managers (PBMs) and related entities, asserting that these firms contributed to the opioid crisis in Kentucky by conspiring with drug manufacturers to increase opioid supply. Kentucky alleged the PBMs negotiated with drug companies to give opioids preferred placement on formularies in exchange for rebates and fees, thus violating state consumer protection laws and creating a public nuisance. The PBMs served both federal and commercial clients, including federal workers under the Federal Employees Health Benefits Act, TRICARE members, and Veterans Health Administration beneficiaries.Following removal of the case to the United States District Court for the Eastern District of Kentucky by the PBMs under the federal officer removal statute (28 U.S.C. § 1442), Kentucky sought to remand the case to state court, arguing its complaint disclaimed liability for conduct undertaken at the direction of federal officers. The district court granted Kentucky’s motion to remand.The United States Court of Appeals for the Sixth Circuit reviewed the district court’s decision de novo. Relying on its prior decision in Ohio ex rel. Yost v. Ascent Health Services, LLC, and similar decisions from other circuits, the Sixth Circuit determined the PBMs acted under federal officers when administering federal health benefits and that Kentucky’s claims related to conduct performed under federal supervision. The court found the PBMs had raised colorable federal defenses, including immunity and preemption under federal statutes governing federal health plans, TRICARE, ERISA, and Medicare Part D. The court concluded that Kentucky’s complaint targeted indivisible conduct relating to federal duties, so the PBMs met the requirements for removal under § 1442. The Sixth Circuit reversed the district court’s remand order and remanded the case for further proceedings. View "Commw. of Ky. v. Express Scripts, Inc." on Justia Law

A medical provider specializing in reconstructive surgery, which is out-of-network for the health plans administered by the defendant insurers, obtained more than $3 million in awards through the No Surprises Act’s (“NSA”) independent dispute resolution (“IDR”) process. Despite statutory requirements, the insurers did not pay the IDR award amounts. The provider brought a lawsuit seeking a declaration that the insurers owed it the IDR award amounts and had violated the NSA by failing to pay. The insurers argued that the provider’s claims were invalid, in part due to alleged fraudulent billing practices.The United States District Court for the Southern District of New York reviewed the provider’s complaint and granted the insurers’ motion to dismiss for failure to state a claim. The district court concluded that the NSA does not contain either an express or implied private right of action to enforce IDR awards, and the Declaratory Judgment Act does not provide an independent cause of action for such enforcement.The United States Court of Appeals for the Second Circuit reviewed the district court’s decision de novo. The Second Circuit held that the NSA does not provide an implied private right of action for providers to enforce payment awards obtained through the IDR process. The court found that the structure and text of the NSA delegate enforcement authority to federal agencies and states, reflecting Congressional intent that enforcement be handled administratively rather than through private litigation. The court also rejected the provider’s argument that the Declaratory Judgment Act provided a basis for relief. Accordingly, the Second Circuit affirmed the district court’s dismissal of the provider’s complaint. View "East Coast Advanced Plastic Surgery, LLC v. Cigna Health and Life Insurance Company" on Justia Law

The case centers on a challenge to a state law enacted in 2023, which prohibits health care providers from administering certain types of gender-affirming medical treatments to minors, including puberty blockers and cross-sex hormones, for the purpose of aligning a minor’s sex with their gender perception when inconsistent with their biological sex. Exceptions exist for minors with medically verifiable disorders of sex development and for those already receiving such treatments prior to the law’s effective date. Three minors, their parents, and a physician, Dr. Casas, who treats minors with gender dysphoria, initiated legal proceedings seeking declaratory and injunctive relief, arguing the law violates the North Dakota Constitution.The District Court of Burleigh County reviewed the case. It dismissed the minor plaintiffs and their parents for lack of standing, based on its interpretation that the law did not apply to minors receiving treatment before the effective date. The court found Dr. Casas had standing to pursue certain claims, including equal protection and personal autonomy on behalf of his patients, but not parental rights claims. After a seven-day trial and extensive evidence, the court concluded the law responded to legitimate concerns regarding the risks and effectiveness of gender-affirming treatments for minors and determined the statute did not violate constitutional guarantees of equal protection or personal autonomy. The court denied declaratory and injunctive relief, but clarified the law’s exception for ongoing treatment.On appeal, the Supreme Court of North Dakota addressed only whether the statute’s prohibition on gender-affirming medication for minors violates Article I, §§ 1 or 21 of the state constitution. The court held that minors do not have a fundamental right to a particular course of medical treatment under Article I, § 1. It further found the law does not classify based on sex or transgender status and is subject to rational basis review. The statute was deemed rationally related to the state’s legitimate interest in protecting minors’ health and welfare. The court affirmed the district court’s denial of relief. View "T.D. v. Wrigley" on Justia Law

A physician who practiced at Corona Regional Medical Center alleged that the hospital and three individual doctors conspired to defame him, destroy his professional reputation, and summarily suspended his admitting privileges under false pretenses. He claimed these actions were motivated by competitive and financial interests, and that the hospital and defendants orchestrated a campaign using fabricated internal reports to target him, resulting in financial and emotional harm. The physician entered into an agreement with the hospital to lift his suspension, subject to several conditions, and avoided having the suspension reported to the California Medical Board. His wife separately claimed loss of consortium due to the defendants’ actions.The Superior Court of Riverside County reviewed the case and granted summary judgment for the defendants. The court found that the physician had failed to exhaust the administrative remedies available to him through the hospital’s peer review process before suing for damages. The trial court also partially granted the defendants’ motion for attorney fees based on a provision in the hospital’s bylaws, but denied fees against the wife, and reduced the fee amounts for certain attorneys.The Court of Appeal of the State of California, Fourth Appellate District, Division Two, affirmed the judgment and the postjudgment order. The court held that the physician did not establish he was excused from exhausting his administrative remedies, as the agreement to lift his suspension was conditional and did not provide the maximum relief available through the peer review process. The court also upheld the attorney fee award to defendants under the bylaws, finding the fee provision valid and not preempted by statute, and concluded that the trial court correctly denied fees against the wife and for certain attorney billing records. View "Sujan v. UHS Corona" on Justia Law

During the COVID-19 pandemic, Dr. Scott Jensen, a physician and former Minnesota state senator, publicly voiced opposition to vaccine mandates and business closures. As a Republican candidate for governor in 2022, he became the subject of 18 complaints alleging he spread misinformation and endangered public health. The Minnesota Board of Medical Practice initiated four investigations, each requiring Jensen to respond and cooperate fully, including providing documents and hiring legal counsel. One investigation lasted over a year and demanded an in-person conference. Jensen claims these investigations caused him to spend substantial time and money, self-censor his public statements, and decline speaking engagements due to fear of professional repercussions.The United States District Court for the District of Minnesota dismissed Jensen’s amended complaint for lack of standing, finding his allegations “too conclusory” and lacking specific instances of chilled speech or imminent enforcement threats. The court determined he did not demonstrate injury sufficient to invoke federal jurisdiction, thus preventing further review of his constitutional claims seeking damages and injunctive relief.The United States Court of Appeals for the Eighth Circuit reviewed the dismissal. It found that Jensen’s general factual allegations of time, money spent, and self-censorship—the chilling effect—were sufficient to establish standing at the pleading stage. The court concluded that both monetary harms and reasonable self-censorship due to credible threats of enforcement constituted concrete and particularized injuries. The appellate court held that Jensen had standing to pursue his claims for damages and injunctive relief. The judgment of the district court was reversed and the case remanded for further proceedings on the merits. View "Jensen v. Minn. Bd. of Medical Practice" on Justia Law

A church in Washington State challenged the validity of two state laws: the Reproductive Parity Act, which requires health insurance carriers to include coverage for all federally approved contraceptives and, if maternity care is covered, for abortions; and a longstanding conscience statute, which allows employers to object to purchasing coverage for specific healthcare services on religious or moral grounds. The church, as an employer providing health insurance to its employees, argued that these laws forced it to provide, pay for, or facilitate access to abortion and certain contraceptives in violation of its religious beliefs and right to religious autonomy.The United States District Court for the Western District of Washington found that the church had standing to sue, but granted summary judgment in favor of the state defendants on the merits, concluding that the challenged laws did not violate the Free Exercise Clause or church autonomy doctrine. Both sides appealed. Previously, the Ninth Circuit vacated the district court’s judgment for lack of standing, but after the Supreme Court’s decision in Diamond Alternative Energy, LLC v. EPA, 606 U.S. 100 (2025), it vacated its own opinion and reheard the case.The United States Court of Appeals for the Ninth Circuit held that the church had Article III standing, as the laws caused it to facilitate abortion indirectly. Assuming, without deciding, that the laws burdened the church’s religious exercise, the court concluded that the laws are neutral and generally applicable. Therefore, rational basis review applied, and the church conceded the laws met that standard. The court affirmed summary judgment for the state defendants, holding that the laws do not violate the Free Exercise Clause or the church autonomy doctrine. View "CEDAR PARK ASSEMBLY OF GOD OF KIRKLAND, WASHINGTON V. KUDERER" on Justia Law

A man with a lengthy history of severe mental illness, homelessness, and repeated hospitalizations was admitted multiple times to the Alaska Psychiatric Institute (API), most recently seeking shelter during winter. He has diagnoses including schizoaffective disorder, traumatic brain injury, and polysubstance dependence, and has frequently been barred from local shelters and facilities due to his behavior. After his admission in early 2024, API staff observed his acute psychosis, noncompliance with outpatient treatment, and declining condition. There was discussion of a possible discharge plan involving relocation to live with family in Arizona, but concerns were raised about his ability to safely travel, the sufficiency of supports available there, and his own reluctance to leave Alaska.The Superior Court of the State of Alaska, Third Judicial District, Anchorage, first granted a 30-day involuntary commitment and authorization for administration of psychotropic medication, then later extended the commitment for 90 days. At the 90-day hearing, testimony indicated that less restrictive alternatives, including discharge to family, were considered but not feasible at that time. The court also approved a renewed petition for involuntary medication after finding that the man lacked the capacity to make informed medical decisions and had not previously, while competent, expressed a clear wish to refuse such medication. The man did not file timely objections to the master’s findings.The Supreme Court of the State of Alaska reviewed the case under the plain error standard, given the absence of objections below. The court held that while it was a clear error for the superior court to proceed without confirming whether the man was advised of the option for voluntary treatment, this mistake was not obviously prejudicial because the record indicated he would not have accepted voluntary admission. The Supreme Court also found no plain error in the lower court’s conclusions that no less restrictive alternative was available and that the requirements for involuntary medication were satisfied. The superior court’s orders were affirmed. View "In re Necessity for the Hospitalization of Derius L." on Justia Law

An individual Nebraska resident, voter, and taxpayer sought declaratory and injunctive relief challenging the constitutionality of two medical cannabis laws enacted by voter-approved initiatives in the November 2024 general election. He named as defendants the Governor, other state officials, members of the Nebraska Medical Cannabis Commission, and the sponsors of the initiatives. The plaintiff alleged the laws violated the federal Supremacy Clause, improperly delegated regulatory authority in violation of Nebraska’s separation of powers, and were otherwise unconstitutional. He further claimed public officials and agencies would expend state funds and resources to implement these laws, and that this expenditure was unlawful.Previously, before the laws passed, the same individual brought a preelection challenge to the legal sufficiency of the initiative petitions in the District Court for Lancaster County. That challenge was rejected, and the Nebraska Supreme Court affirmed. After the election, he filed a new action in the same district court, seeking to enjoin the Governor from certifying the measures. The district court denied his request for a temporary restraining order. Once the laws were certified and enacted, he amended his complaint several times, ultimately alleging taxpayer standing, standing for a matter of great public concern, and standing under a Nebraska statute governing initiative challenges. The defendants moved to dismiss, contending he lacked standing.The Nebraska Supreme Court reviewed the district court’s dismissal de novo. The Supreme Court held that the plaintiff lacked standing to bring the suit. Specifically, it concluded he did not have taxpayer standing, as his allegations of incidental expenditures and government employee time spent implementing the laws did not amount to illegal expenditures sufficient to confer standing under Nebraska law. The Court also found he did not qualify for any exception for matters of great public concern. The order dismissing his complaint without prejudice was affirmed. View "Kuehn v. Pillen" on Justia Law

While incarcerated at a North Carolina women’s correctional facility, the plaintiff learned she was pregnant and, due to her history of opioid use disorder, was prescribed medication for opioid withdrawal (MOUD) under a prison policy that restricted such treatment to pregnant inmates. When she went into labor, she was transported to the hospital and was shackled at various stages during labor, delivery, and her return to prison. After giving birth, the facility denied her further MOUD because she was no longer pregnant, instead providing a short course of alternative pain medication. She experienced significant withdrawal symptoms as a result. The plaintiff brought claims against various prison officials, alleging violations of the Eighth Amendment for the shackling and for denial of MOUD, as well as disability discrimination under the Americans with Disabilities Act and the Rehabilitation Act.The United States District Court for the Eastern District of North Carolina granted summary judgment to all defendants, finding no constitutional violations and that qualified immunity protected the officials. It also concluded that the plaintiff was not discriminated against under federal disability law because the MOUD program was limited to pregnant inmates.On appeal, the United States Court of Appeals for the Fourth Circuit affirmed in part, vacated in part, and remanded. The Fourth Circuit held that, as to certain officials, there was a genuine dispute of fact regarding whether shackling the plaintiff during labor and postpartum, without evidence of a security or flight risk, violated the Eighth Amendment. The court also held that the denial of MOUD following pregnancy, pursuant to a categorical policy, could constitute deliberate indifference to serious medical needs under the Eighth Amendment, and that summary judgment was inappropriate for the medical officials involved. The court further vacated the lower court’s disposition of the plaintiff’s ADA and Rehabilitation Act claims, remanding for further proceedings. Summary judgment for other defendants was affirmed. View "Edwards v. Witherspoon" on Justia Law

An individual incarcerated at a California state prison suffers from a spinal condition causing severe pain and limited mobility, and also experiences incontinence. For nearly a year, prison staff provided him with adult diapers as a medical accommodation. However, after a transfer to a different housing unit, his access to these supplies was abruptly terminated, and his requests for reinstatement were denied for almost five months. During this period, he was forced to soil himself and his environment, resulting in humiliation and distress, despite repeated written and verbal requests for accommodation.He filed a lawsuit in the United States District Court for the Northern District of California, alleging violations of the Americans with Disabilities Act (ADA) and the Eighth Amendment. The district court granted summary judgment in favor of the California Department of Corrections and Rehabilitation (CDCR) and other defendants, concluding he was not entitled to relief under the ADA because it found no evidence of discrimination due to his disability and determined his claims for injunctive relief were moot once supplies were reinstated.On appeal, the United States Court of Appeals for the Ninth Circuit reversed the district court’s summary judgment as to the ADA claim. The appellate court held that a reasonable jury could find the plaintiff is disabled under the ADA due to his spinal condition and incontinence, that he was denied meaningful access to toileting and hygiene services because of his disabilities, and that this denial was because of his disabilities. The court further found there was sufficient evidence to create a triable issue as to whether CDCR acted with deliberate indifference, a necessary element for damages. The panel also clarified that a public entity is not excused from ADA obligations merely because an accommodation is not deemed medically necessary. The case was remanded for further proceedings, including consideration of standing for injunctive relief. View "ADOM V. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION" on Justia Law