Articles Posted in Health Care Law

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Twenty California counties were plaintiffs in this petition for writ of mandate and complaint for declaratory and injunctive relief against defendants the State and its pertinent officials (DHCS and DMH). In their petition, the Counties alleged that a DHCS 2009 Memorandum and a DMH 2010 Letter were invalid. Under federal Medicaid law, the federal government did not pay for services to IMD patients between the ages of 21 and 65. In 1999, California added a state-only Medi-Cal benefit by enacting Welfare and Institutions Code section 14053.1. The section provided that the State would pay for "ancillary outpatient services" for IMD patients within the federal IMD exclusion. The specific focus of this appeal involved two Assembly Bills: No. 2877 (1999-2000 Reg. Sess.) and No. 430 (2000-2001 Reg. Sess.) that concerned subsequent sunsetting legislation regarding section 14053.1. Assembly Bill 2877 (enacted in 2000) sought to extend the original sunset provision an additional year, and Assembly Bill 430 (enacted in 2001) sought to eliminate the sunset provision altogether, thereby making section 14053.1 effective indefinitely. The counties argued the memorandum and letter were: (1) inconsistent with section 14053.1; and (2) they constituted underground regulations adopted in violation of the state Administrative Procedures Act (Gov. Code, 11340.5, subd. (a)). The Counties similarly sought a writ/injunction prohibiting the State from applying them against the Counties. The trial court denied the Counties' petition for writ of mandate and complaint for injunctive relief, and issued a declaratory judgment in favor of the State. The court concluded that the subsequent sunsetting amendments (Assem. Bills 2877 & 430) were void because they were enacted after the statute had already sunset by its own terms in 2000. Thus, in the absence of section 14053.1, the State did not promulgate an underground regulation by issuing the DHCS 2009 Memorandum and the DMH 2010 Letter and ancillary outpatient services for Medi-Cal eligible IMD patients within the federal IMD exclusion. The Court of Appeal concluded that section 14053.1 remained a valid law, and that 14053.1's presence in the California statutes was not the result of a legislative amendment to a repealed act. The Counties' petition for writ of mandate and complaint for declaratory and injunctive relief was granted: the DHCS 2009 Memorandum and the DMH 2010 Letter contravened section 14053.1 and were therefore invalid. The State was enjoined from applying them. The judgment of the trial court was reversed. View "Colusa County v. Douglas" on Justia Law

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The Louisiana Supreme Court granted this writ application to determine whether a plaintiff had a private right of action for damages against a health care provider under the Health Care and Consumer Billing and Disclosure Protection Act. Plaintiff Yana Anderson alleged that she was injured in an automobile accident caused by a third party. She received medical treatment at an Ochsner facility. Anderson was insured by UnitedHealthcare. Pursuant to her insurance contract, Anderson paid premiums to UnitedHealthcare in exchange for discounted health care rates. These reduced rates were available pursuant to a member provider agreement, wherein UnitedHealthcare contracted with Ochsner to secure discounted charges for its insureds. Anderson presented proof of insurance to Ochsner in order for her claims to be submitted to UnitedHealthcare for payment on the agreed upon reduced rate. However, Ochsner refused to file a claim with her insurer. Instead, Ochsner sent a letter to Anderson’s attorney, asserting a medical lien for the full amount of undiscounted charges on any tort recovery Anderson received for the underlying automobile accident. Anderson filed a putative class action against Ochsner, seeking, among other things, damages arising from Ochsner’s billing practices. Upon review of the matter, the Supreme Court found the legislature intended to allow a private right of action under the statute. Additionally, the Court found an express right of action was available under La. R.S. 22:1874(B) based on the assertion of a medical lien. View "Anderson v. Ochsner Health System" on Justia Law

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Two estates filed separate wrongful death actions against two acute care hospitals alleging violations of Arizona’s Adult Protective Services Act (APSA). The trial court granted summary judgment for the hospitals, concluding that APSA does not apply to acute care hospitals. The court of appeals reversed, ruling that the APSA subjects acute care hospitals to potential liability. The Supreme Court vacated the opinion of the court of appeals and remanded, holding that the APSA does apply to acute care hospitals because they provide care to vulnerable adults and are not expressly exempted by the statutory language of Ariz. Rev. Stat. 46-455(B). View "Wyatt v. Vanguard Health Sys., Inc." on Justia Law

Posted in: Health Care Law

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The issues this case presented to the Supreme Court both arose from the Georgia Department of Community Health's ("DCH's") granting of an application for a Certificate of Need ("CON") to develop an outpatient ambulatory surgery service in East Cobb County to Kennestone Hospital, Inc. Kennestone's application was eventually approved by the DCH after the service was determined to be "part of a hospital" pursuant to Ga. Comp. R. & Regs. r. 111-2-2-.40 (1) (a). Northside Hospital, Inc. opposed the CON and sought administrative review of the DCH's initial decision. After the appeal was unsuccessful, Northside then filed a petition for judicial review with the superior court. The superior court reversed the DCH's decision to grant the CON on the basis that the "case-by-case" provision in Ga. Comp. R. & Regs. r. 111-2-2-.40 (1) (a) was unconstitutionally vague. The Court of Appeals upheld the superior court's determination. "The gist of the Rule is to afford a less stringent review for ambulatory surgery service proposals that are 'part of a hospital.' [. . .] the final sentence of the Rule cannot be read in isolation from the other language contained in it. Thus, contrary to Northside's contentions, the Rule is not unconstitutionally vague on its face, and the Court of Appeals was incorrect to conclude otherwise." View "Georgia Dept. of Community Health v. Northside Hospital, Inc." on Justia Law

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Ector Manuel Savala-Quintero sustained injuries when he jumped through the fourth-story window of room in the Wabaunsee County jail where he had been placed by sheriff officials during an investigation. The University of Kansas Hospital Authority sued the Board of Wabaunsee County Commissioners for reimbursement of the medical expenses incurred in its treatment of Savala-Quintero. The district court granted summary judgment in favor of the County. The Court of Appeals reversed. The Supreme Court reversed the Court of Appeals, holding that the County was not obligated to pay the medical expenses of Savala-Quintero because, although Savala-Quintero was temporarily detained at the county jail, he was not a prisoner committed to or held in the jail at the time he was injured.View "Univ. of Kan. Hosp. Auth. v. Bd. of Comm’rs " on Justia Law

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The South Carolina Supreme Court answered certified two questions from the U.S. District Court for the District of South Carolina. The case concerned supplemental health insurance policies, which differ from ordinary health insurance policies in both purpose and operation. The questions were: (1) whether the definition of "actual charges" contained within S.C. Code Ann. 38-71-242 be applied to insurance contracts executed prior to the statute's effective date; and (2) whether the South Carolina Department of Insurance could mandate the application of "actual charges" to policies already inexistence on the statute's effective dates by prohibiting an insurance company from paying claims absent the application of that definition. The South Carolina Supreme Court answered both questions "no." View "Kirven v. Central States" on Justia Law

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Jai Medical Systems Managed Care Organization, Inc. (JaiMCO) is an entity that contracts with health care providers to provide health care services to patients enrolled in the State Medicaid program. Dr. Steven Bennett participated as a specialty care provider in the network of JaiMCO. Petitioner chose Dr. Bennett to treat a bunion on her foot that was causing her pain. After Dr. Bennett performed surgery to remove the bunion Petitioner developed gangrene, and her foot had to be partially amputated. Petitioner sought to hold JaiMCO liable for Dr. Bennett’s negligence on a theory of apparent agency, asserting that JaiMCO created the appearance that Dr. Bennett was its agent and that she reasonably relied on that appearance. A jury returned a verdict in Petitioner’s favor. The court of special appeals reversed, determining that the evidence was insufficient to support the verdict. The Court of Appeals affirmed, holding (1) a managed care organization may be vicariously liable for the negligence of a network physician under a theory of apparent agency; but (2) even if Petitioner subjectively believed Dr. Bennett was an employee of JaiMCO, the belief was not reasonable under the facts of this case.View "Bradford v. Jai Med. Sys. Managed Care Org., Inc." on Justia Law

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In 2011, the Bullitt County Board of Health enacted a Regulation that prohibited tobacco smoke in all enclosed public places, among other places, and placed additional restrictions regarding tobacco use on smoking-regulated businesses and regulated places. Appellants filed a petition for declaration of rights against the Board, arguing that the Board had exceeded its authority by enacting a substantive law without proper enabling legislation. The trial court agreed with Appellants and held that the Regulation was invalid. The court of appeals reversed, determining that the Regulation was valid and a proper exercise of the Board’s statutory authority. The Supreme Court reversed, holding that the Board exceeded its statutory authority in adopting the Resolution, and therefore, the Resolution was invalid and unenforceable.View "Bullitt Fiscal Court v. Bullitt County Bd. of Health" on Justia Law

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Christiana Anaya suffered from uncontrolled diabetes, which left her susceptible to serious infections. She went to the Toppenish Community Hospital with a urinary tract infection. Blood test results revealed Ms. Anaya had a yeast infection. The lab called Ms. Anaya's primary care facility (the Yakima Valley Farm Workers Clinic) where Respondent Dr. Mark Sauerwein was covering for Ms. Anaya's usual provider. Sauerwein was concerned about the lab results. Due to the serious nature of a blood infection, the doctor decided that if Ms. Anaya was feeling ill, she should come in immediately for treatment. If she was feeling better, it was more likely that the test result was a false positive, a common occurrence in microbiology labs. Dr. Sauerwein used the complete clinical picture available to him to conclude that the lab result was a false positive resulting from contamination but had the nurse contact Mrs. Anaya to move her next appointment up to the following week. Dr. Sauerwein did not tell Mrs. Anaya about the test result. The lab positively identified candida glabrata as the yeast in Ms. Anaya's blood. An infection of glabrata in the blood is serious. Lab microbiologists entered this information into Ms. Anaya's medical record but did not notify Dr. Sauerwein, the Clinic, or anyone else about the positive test result. Before Ms. Anaya's next visit to the Clinic, her condition worsened. Ms. Anaya went to Yakima Memorial Hospital where she was prescribed amphotericin B, which is highly toxic to the kidneys. Given the compromised state of Ms. Anaya's kidneys from her diabetes, a health care provider would not normally prescribe amphotericin B until positively identifying glabrata. Unfortunately, the amphotericin B treatment came too late to stop the infection from spreading to the internal organs. Ms. Anaya died at age 32 of cardiac arrest, deprivation of oxygen to the brain, and fungal sepsis; all stemming from type II diabetes mellitus. Mr. Anaya Gomez, as personal representative of Ms. Anaya's estate, filed suit against Dr. Sauerwein and the Clinic for malpractice. Three weeks before the jury trial, the estate moved to add a claim for failure to obtain informed consent. At the close of Mr. Anaya's case, the defense moved for judgment as a matter of law on the informed consent claim. The trial judge granted the motion and dismissed the informed consent claim, arguing that case law precluded the claim in misdiagnosis cases. The jury then found Dr. Sauerwein did not breach any duty owed to Ms. Anaya. After its review, the Supreme Court concluded that when a health care provider rules out a particular diagnosis based on the patient's clinical condition-including test results, medical history, presentation upon physical examination, and any other circumstances surrounding the patient's condition that are available to the provider the provider may not be liable for informed consent claims arising from the ruled out diagnosis. The Court affirmed the appellate court, which affirmed the trial court's judgment. View "Gomez v. Sauerwein" on Justia Law

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Dorothy Douglas died from severe dehydration not long after leaving Heartland Nursing Home, where she stayed for nineteen days. Plaintiff, individually and on behalf of Douglas’s estate, brought claims of negligence, violations of the West Virginia Nursing Home Act (NHA), and breach of fiduciary duty against Defendants, several corporate entities related to Heartland. After a jury trial, Plaintiff was awarded $11.5 million in compensatory damages and $80 million in punitive damages. The Supreme Court reversed in part, holding (1) the circuit court erred in concluding that the NHA was not governed by the Medical Professional Liability Act (MPLA), and due to a lack of evidence that the pre-suit requirements of the MPLA were met, the claim is dismissed and the accompanying $1.5 million award is vacated; (2) the circuit court erred in recognizing a breach of fiduciary duty claim against a nursing home, and therefore, the claim is dismissed and the accompanying $5 million award is vacated; and (3) the punitive damages award is reduced proportionate to the reduction in compensatory damages. Remanded.View "Manor Care Inc. v. Douglas" on Justia Law