Justia Health Law Opinion Summaries

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The Fifth Circuit denied a petition for review of the Commission's determination that Sanderson violated various regulations of the Department of Labor's Occupational Safety and Health Administration (OSHA). The court held that the ALJ's determination that the compressor cutouts and the emergency stops are subject to the mechanical integrity program was not an abuse of discretion or otherwise contrary to law; the ALJ's determination that Sanderson failed to rebut the presumption of exposure to a hazard was not an abuse of discretion or otherwise contrary to law; and the Secretary bore his burden with respect to all elements of a violation regarding Items 5a and 5b. View "Sanderson Farms, Inc. v. Occupational Safety and Health Review Commission" on Justia Law

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This matter arose from alleged violations of the Health Care Consumer Billing and Disclosure Protection Act (“Balance Billing Act” or “Act”). The Louisiana Supreme Court granted certiorari review to resolve the question of whether a patient’s claims against a contracted healthcare provider for an alleged violation of La. R.S. 22:1874(A)(1) were delictual in nature. The consolidated lawsuits in this matter were filed by Matthew DePhillips and Earnest Williams, individually and on behalf of putative classes, against Hospital District No. 1 of Tangipahoa Parish d/b/a North Oaks Medical Center/North Oaks Health System (“North Oaks”). In February, 2011, Williams was injured in a motor vehicle accident. He sought emergency medical treatment from North Oaks. At the time of the accident, Williams was insured under an insurance policy administered by Louisiana Health Service & Indemnity Company d/b/a Blue Cross and Blue Shield of Louisiana (“BCBS”). North Oaks is a contracted healthcare provider with BCBS pursuant to a certain Member Provider Agreement (the “MPA”) between North Oaks and BCBS. After Williams’ treatment, North Oaks filed a claim with BCBS, and BCBS paid a discounted rate on the claims as provided by the MPA. Thereafter, North Oaks sought to collect from Williams by filing a medical lien against his liability insurance claim for the full and undiscounted charges. Williams alleged that North Oaks filed this lien despite being a contracted healthcare provider with BCBS and despite its legal and contractual requirements to accept the insurance as payment in full. The trial court denied the exceptions of no right of action for breach of contract and prescription, but granted the North Oaks’ exception of no cause of action for claims arising before the effective date of the Balance Billing Act. The court of appeal granted writs in part, finding DePhillips did not have a right of action to assert a claim for breach of the MPA, as he was neither a party nor a third-party beneficiary to that agreement. The appellate court denied North Oaks’ writ application insofar as it related to the trial court’s denial of its exception of prescription. After review, the Supreme Court determined plaintiff's claims were delictual in nature, subject a one-year prescriptive period. View "DePhillips v. Hospital Service Dist. No. 1 of Tangipahoa Parish d/b/a North Oaks Medical Center et al." on Justia Law

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In this case requiring the Supreme Court to determine the scope of the authority of the Wisconsin Department of Health Services (DHS) to recoup payments made to Medicaid service providers the Supreme Court held that DHS does not have the authority to enforce its recoupment policy. Plaintiffs, Kathleen Papa and Professional Homecare Providers, Inc. (collectively, PHP), challenged DHS's recoupment policy as it had been enforced against PHP nurses to recover payments made for services they provided to Medicaid patients. PHP claimed that DHS recoups payments nurses earned and received for their Medicaid services because the nurses' supporting records contained documentation shortcomings. The Supreme Court held (1) DHS may recoup Medicaid payments from service providers only in cases where DHS cannot verify certain facts; and (2) DHS's recoupment policy exceeds its authority. View "Papa v. Wisconsin Department of Health Services" on Justia Law

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The Patient Protection and Affordable Care Act of 2010 (ACA) requires covered employers to provide women with “preventive care and screenings” without cost-sharing requirements and relies on Preventive Care Guidelines “supported by the Health Resources and Services Administration” (HRSA) to define “preventive care and screenings,” 42 U.S.C. 300gg–13(a)(4). Those Guidelines mandate that health plans cover all FDA-approved contraceptive methods. When the Federal Departments incorporated the Guidelines, they gave HRSA the discretion to exempt religious employers from providing contraceptive coverage. Later, the Departments promulgated a rule accommodating qualifying religious organizations, allowing them to opt out of coverage by self-certifying that they met certain criteria to their health insurance issuer, which would then exclude contraceptive coverage from the employer’s plan and provide participants with separate payments for contraceptive services without any cost-sharing requirements. In its 2014 “Hobby Lobby” decision, the Supreme Court held that the contraceptive mandate substantially burdened the free exercise of closely-held corporations with sincerely held religious objections. In a later decision, the Court remanded challenges to the self-certification accommodation so that the parties could develop an approach that would accommodate employers’ concerns while providing women full and equal coverage. The Departments then promulgated interim final rules. One significantly expanded the church exemption to include an employer that objects, based on its sincerely held religious beliefs, to coverage or payments for contraceptive services. Another created an exemption for employers with sincerely held moral objections to providing contraceptive coverage. The Third Circuit affirmed a preliminary nationwide injunction against the implementation of the rules. The Supreme Court reversed. The Departments had the authority under the ACA to promulgate the exemptions. Section 300gg–13(a)(4) states that group health plans must provide preventive care and screenings “as provided for” in comprehensive guidelines, granting HRSA sweeping authority to define that preventive care and to create exemptions from its Guidelines. Concerns that the exemptions thwart Congress’ intent by making it significantly harder for women to obtain seamless access to contraception without cost-sharing cannot justify supplanting that plain meaning. “It is clear ... that the contraceptive mandate is capable of violating the Religious Freedom Restoration Act.” The rules promulgating the exemptions are free from procedural defects. View "Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania" on Justia Law

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The Supreme Court reversed the decision of the court of appeals affirming the order of the district court that non-homestead life estates should not be included in Marvin Schmalz's assets, holding that the term "individual" in Minn. Stat. 256B.056, subd. 4a applies only to the applicant for medical assistance. Esther Schmalz was living at a long-term-care facility when she submitted an application for medical assistance for long-term-care benefits. As part of the assessment of her husband Marvin's assets, Renville County Human Services (RCHS) included Marvin's portion of several non-homestead life estate interests that he and Esther owned. Esther appealed, arguing that the life estates should not be included in the total amount of assets that Marvin may retain. The human services judge concluded that RCHS properly denied Esther's application for medical assistance based on the inclusion of the life estate assets owned by Marvin. The Commissioner of Minnesota Department of Human Services adopted the human services judge's recommendation. The district court concluded that the non-homestead life estates should not be included in Marvin's assets, ruling that the term "individual" in section 256B.056, subd. 4a included Marvin. The Supreme Court reversed, holding that an "individual" in the statute refers to the medical assistance applicant and not a community spouse. View "In re Schmalz" on Justia Law

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On March 6, 2020, in response to the COVID-19 pandemic, Pennsylvania Governor Tom Wolf issued a Proclamation of Disaster Emergency (“Proclamation”) pursuant to 35 Pa.C.S. 7301(c), a provision of the Emergency Management Services Code. This Proclamation activated many emergency resources. Days later, the Governor issued an order closing businesses that were not considered life-sustaining. Four Pennsylvania businesses and one individual challenged the Governor's Order, alleging that it violated the Emergency Management Services Code and various constitutional provisions. On April 13, 2020, in an exercise of its King’s Bench jurisdiction, the Pennsylvania Supreme Court ruled that the Governor’s order complied with both the statute and Commonwealth Constitution. On June 3, 2020, the Governor renewed the Proclamation for an additional ninety days. June 9, 2020, the Pennsylvania House of Representatives adopted a concurrent resolution to order the Governor to terminate the disaster emergency. The matter reached a loggerhead and went again before the Supreme Court. The Court issued an opinion stating "we find it necessary to make clear what this Court is, and is not, deciding in this case. We express no opinion as to whether the Governor’s response to the COVID-19 pandemic constitutes wise or sound policy. Similarly, we do not opine as to whether the General Assembly, in seeking to limit or terminate the Governor’s exercise of emergency authority, presents a superior approach for advancing the welfare of our Commonwealth’s residents." Instead, the Court decided here a narrow legal question: whether the Pennsylvania Constitution and the Emergency Services Management Code permitted the General Assembly to terminate the Governor’s Proclamation of Disaster Emergency by passing a concurrent resolution, without presenting that resolution to the Governor for his approval or veto. To this, the Supreme Court responded "no": "because the General Assembly intended that H.R. 836 terminate the Governor’s declaration of disaster emergency without the necessity of presenting that resolution to the Governor for his approval or veto, we hold, pursuant to our power under the Declaratory Judgments Act, that H.R. 836 is a legal nullity." View "Wolf v. Scarnati" on Justia Law

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In July 2010, L.M. was born at full-term and developed normally for six months. In February 2011, L.M. received childhood vaccines, including the diphtheria-tetanus-acellular pertussis vaccination. By that evening, L.M. had a fever, was lethargic, had poor muscle tone, and would not eat., Any disturbance caused L.M. to scream. L.M. began to have several seizures a day. At seven years of age, L.M. could crawl and walk with the assistance of a walker. She had a poorly coordinated grasp, suffered cortical visual impairments, and was nonverbal, though she could use a few signs to express ideas such as “yes,” and “no.” Testing revealed that L.M. had a genetic mutation. In a claim under the National Vaccine Injury Compensation Program, L.M. alleged that the vaccinations administered to L.M. in February 2011, significantly aggravated L.M.’s pre-existing condition under two alternative theories. The Special Master denied the petition, finding that L.M.’s genetic mutation was “the most compelling explanation for her predisposition to develop a seizure disorder.” The Federal Circuit affirmed the denial of an “on-table” claim, finding no support for an argument that most encephalopathies do not become acute until after vaccination. The court vacated and remanded the denial of an “off-table” claim, which requires determining whether the child’s receipt of vaccinations significantly aggravated her seizure disorder in the face of an underlying genetic mutation. View "Sharpe v. Secretary of Health and Human Services" on Justia Law

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Darby notified her Childvine supervisor that she had been diagnosed with breast cancer and was scheduled for a double mastectomy. Mayhugh expressed doubt about whether Childvine would allow Darby to remain employed when her surgery date fell within her 90-day probationary period. Darby moved the procedure to the day after her probationary period expired. Darby’s request to use her vacation and sick time to recover from the procedure was approved. When Darby returned to work, with a medical release, she learned that Childvine had sent a letter of termination effective on the last day of her probationary period because of an “unpleasant” attitude, dress code violations, and “being unable to work.” Darby filed suit under the Americans with Disabilities Act (ADA), noting that she was never disciplined for behavior issues. In reviewing Darby’s medical records, Childvine learned that Darby was never diagnosed with cancer; she had a family history of cancer and the BRCA1 “pre-cancerous genetic mutation.” The district court stated that the definition of physical impairment does not include a condition that might lead to cancer, and dismissed the case. The Sixth Circuit reversed. Darby plausibly alleged that her impairment substantially limits her normal cell growth as compared to the general population due to both the BRCA1 gene and a medical diagnosis of abnormal epithelial cell growth serious enough to warrant a double mastectomy. View "Darby v. Childvine, Inc." on Justia Law

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The Supreme Court affirmed the judgment of the circuit court declaring section 11.800 of House Bill No. 2011 (HB2011) invalid, holding that there was a direct conflict between the language of Mo. Rev. Stat. 208.153.2 and 208.152.1(6), (12) requiring the MO HealthNet Division of the Missouri Department of Social Services to pay its authorized providers for covered physicians' services and family planning provided to Medicaid-eligible individuals and the language of section 11.800 prohibiting MO HealthNet from doing so. Planned Parenthood of the St. Louis Region and Reproductive Health Services of Planned Parenthood (Planned Parenthood) was an authorized provider of physicians' services and family planning because it had an agreement with MO HealthNet to do so. MO HealthNet informed Planned Parenthood that it could not reimburse Planned Parenthood for those services during the fiscal year 2019 due to section 11.800, which stated that "No funds shall be expended to any abortion facility...." The circuit court concluded that section 11.800 of HB2011 violated Mo. Const. Art. III, 23 because it amended substantive law. The Supreme Court affirmed, holding (1) section 11.800 was invalid because article III, section 23 prohibits using an appropriation bill to amend a substantive statute; and (2) the circuit court properly severed that provision from the remainder of HB2011. View "Planned Parenthood of St. Louis Region v. Department of Social Services, Division of Medical Services" on Justia Law

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The Supreme Court held that equitable tolling can lessen the otherwise strict time limit on the availability of writs of administrative mandate under Cal. Gov't Code 11523. The State Department of Public Health (the Department) imposed a fine on Saint Francis Memorial Hospital when it learned that doctors left a surgical sponge in a patient during a surgery. The Department later denied Saint Francis's request for reconsideration. Eleven days after the Department denied reconsideration but forty-one days after being served with the Department's final decision Saint Francis filed a petition for a writ of administrative mandate.The Department demurred on the ground that the petition was untimely under section 11523. The superior court sustained the Department's demurrer, reasoning that Saint Francis's petition was time-barred and that Saint Francis's mistake about the availability of reconsideration was not a sufficient basis to excuse a late filing. The court of appeal affirmed. The Supreme Court vacated the court of appeal's judgment, holding (1) equitable tolling may apply to petitions filed under section 11523; and (2) because the court of appeal didn't address equitable tolling's third element, the case is remanded for further proceedings. View "Saint Francis Memorial Hospital v. State Department of Public Health" on Justia Law