Justia Health Law Opinion SummariesArticles Posted in New Hampshire Supreme Court
Appeal of Andrew Panaggio
Petitioner Andrew Panaggio appealed a New Hampshire Compensation Appeals Board (Board) determination that respondent, CNA Insurance Company (the insurer), could not be ordered to reimburse him for his purchase of medical marijuana because such reimbursement would have constituted aiding and abetting his commission of a federal crime under the federal Controlled Substances Act (CSA). When Panaggio appealed the insurer’s denial to the New Hampshire Department of Labor, a hearing officer agreed with the insurer. Panaggio appealed the hearing officer’s decision to the Board, which unanimously found that his use of medical marijuana was reasonable and medically necessary. Nonetheless, the Board upheld the insurer’s refusal to reimburse Panaggio, concluding that “the carrier is not able to provide medical marijuana because such reimbursement is not legal under state or federal law.” The New Hampshire Supreme Court surmised the issue on appeal raised a question of federal preemption, "which is essentially a matter of statutory interpretation and construction." Although it was an issue of first impression for the New Hampshire Court, other courts considered whether the CSA preempted a state order requiring reimbursement of an employee’s purchase of medical marijuana. Panaggio reasoned that “[b]ecause New Hampshire law unambiguously requires the insurer to pay for the claimant’s medically related treatment,” an insurer that reimburses a claimant for the purchase of medical marijuana acts without the volition required by the federal aiding and abetting statute. The insurer asserted Panaggio’s argument leads to an absurd result, observing that “[c]onflict preemption applies because state law requires what federal law forbids.” The New Hampshire Supreme Court ultimately concluded the CSA did not make it illegal for an insurer to reimburse an employee for his or her purchase of medical marijuana. "[A] Board order to reimburse Panaggio does not interfere with the federal government’s ability to enforce the CSA. Regardless of whether the insurer is ordered to reimburse Panaggio for his medical marijuana purchase, the federal government is free to prosecute him for simple possession of marijuana under the CSA." Under these circumstances, the Court concluded the “high threshold” for preemption “is not met here.” The Board's decision was reversed and the matter remanded for further proceedings. View "Appeal of Andrew Panaggio" on Justia Law
In re Guardianship of D.E.
In February 2020, the 79-year-old ward was a patient at a hospital in Lebanon, New Hampshire. At that time, the hospital filed a petition to appoint a guardian over the ward’s person and estate. The hospital alleged a guardianship was necessary because the ward “has persistent cognitive impairment due to an anoxic brain injury and a major [neurocognitive] disorder,” which “renders him unable to provide for his personal needs for health care, food, clothing, shelter and safety” or to “manage his finances or estate.” The court held a hearing in March at which only the ward’s adult children were present. The ward’s children testified that, in October 2019, when their father was in the intensive care unit, they executed a “Do Not Resuscitate” (DNR) order for him. The ward had no DNR order previously. When the ward’s condition improved and he was transferred to a medical ward, he specifically told his children that he wanted the DNR order removed. Based upon the evidence at the March hearing, the court found that the ward was incapacitated and that a guardianship was necessary as a means of providing for his “continuing care ... and for the prudent management of [his] property and financial affairs.” The court limited the guardian’s authority to execute either a DNR order or an order limiting life-sustaining treatment. In August 2020, the guardian moved for a hearing to ask the court to remove the limitations on her authority regarding the ward’s medical care. The guardian averred that the ward, who now resided in a nursing home, was in need of dialysis but had refused dialysis on three occasions, and refused future treatment. The guardian asserted that, by declining to resume dialysis, “the ward himself has decided to stop his own life sustaining treatment,” and that “without having a DNR order in place and without anyone else having the ability to sign [one],” it will be “quite problematic and painful for the ward.” The ward’s attorney informed the court that the ward was “very clear that he did not want a DNR Order.” Upon interlocuroty transfer without a ruling from the circuit court, the New Hampshire Supreme Court accepted review of issues arising from the ward's guardianship. The Court determined that although the ward had a guardian to make health care decisions on his behalf, the trial court had limited the guardian’s authority to withhold life-sustaining treatment, including whether to execute a DNR order on his behalf. "Under these circumstances, given the ward’s lack of capacity to make health care decisions generally, and assuming that he does not have a valid and unrevoked living will or an authorized agent under a durable power of attorney for health care, the process for appointing a surrogate, as described in RSA 137-J:34-:37, applies. ... Accordingly, it does not appear that at this time, a DNR order may be executed on his behalf by his health care providers." View "In re Guardianship of D.E." on Justia Law
In re Guardianship of L.N.
Respondent L.N. appealed a circuit court order denying a motion to authorize removal of life support filed by her guardian. In 2018, tests indicated that L.N. had suffered a stroke. L.N. was 69 years old at the time of the orders on appeal, and had “enjoyed a full, active, independent life” prior to her stroke on September 12. Thereafter, L.N. remained in the hospital on a ventilator to assist with breathing and a nasal-gastric tube for nutrition and hydration. L.N.’s attorney informed the court in a motion for expedited hearing that “[a]fter consulting with personnel, it has been indicated that [L.N.] will probably not survive the massive stroke which precipitated this hospitalization, but there is no one with authority to act.” There was no evidence that L.N. had previously executed either a living will or a durable power of attorney for healthcare. M.C., a former co-worker, was ultimately appointed as guardian. Based upon conversations, the guardian’s sense was that L.N. “would want to be allowed to have a natural death.” Notwithstanding testimony by L.N.’s caregivers and guardian, the trial court concluded that, “in cases of doubt, the Court must assume that the patient would choose to defend life” and did “not find that [L.N.] - under the facts in this case - would choose to have life support removed and a natural death process to occur.” On appeal, L.N. argues that the probate court erred in determining that “it had jurisdiction to make a determination as to the appropriateness, or lack thereof, of the removal of life support in the case of a patient who was in a persistent vegetative state” where “no party challeng[ed] the proposed removal.” She further argued that, even if the court had the authority to exercise its discretion in this matter, its findings were unsupported by the testimony. The New Hampshire Supreme Court reversed the order denying authority to remove life support and vacated, in part, the order appointing the guardian: “Because any limitation on the guardian’s RSA 464-A:25, I(d) authority after the October 17 hearing was not supported by the statutorily-required finding that it was “desirable for the best interests of [L.N.],” RSA 464-A:25, II, we vacate that limitation. Without that limitation, the guardianship order’s grant of the ‘right and authority to determine if refusal should be made or consent should be given to any medical or other professional care, counseling, treatment, or service’ constitutes a general grant of authority that includes the authority to withdraw life-sustaining treatment in appropriate circumstances.” View "In re Guardianship of L.N." on Justia Law
In re R.M.
Respondent R.M. appealed a circuit court order that renewed his involuntary admission to New Hampshire Hospital for the purpose of allowing him to remain on a conditional discharge for a period of five years. Respondent was a 30-year-old man who had been hospitalized on multiple occasions as a result of schizophrenia. When respondent doesn't take his prescribed anti-psychotic medication, he becomes paranoid, violent, and suicidal. In addition, he experienced hallucinations, paranoid delusions, and difficulties with impulse control and exhibited “a serious level of aggression.” Respondent was first hospitalized in 2010 after voicing suicidal ideation, stating that he would be “better off dead.” Pertinent here, was admitted on an emergency basis again in February 2015 due to concerns of suicidal threats, incapacity, and his paranoid belief that people were conspiring against him. In early March 2019, a few weeks before the respondent’s three-year conditional discharge was set to expire, the local community mental health center filed a petition to renew his conditional discharge. On appeal, respondent challenged the sufficiency of the evidence and argued the five-year renewal was not the least restrictive treatment option. Finding no reversible error, the New Hampshire Supreme Court affirmed. View "In re R.M." on Justia Law
Appeal of Panaggio
Petitioner Andrew Panaggio appealed a decision of the New Hampshire Compensation Appeals Board (board). Petitioner suffered a work-related injury to his lower back in 1991; a permanent impairment award was approved in 1996 and in 1997, he received a lump sum settlement. Petitioner continued to suffer ongoing pain as a result of his injury and has experienced negative side effects from taking prescribed opiates. In 2016, the New Hampshire Department of Health and Human Services determined that Panaggio qualified as a patient in the therapeutic cannabis program, and issued him a New Hampshire cannabis registry identification card. Panaggio purchased medical marijuana and submitted his receipt to the workers’ compensation insurance carrier for reimbursement. The respondent-carrier, CNA Insurance Company, denied payment on the ground that “medical marijuana is not reasonable/necessary or causally related” to his injury. The board denied his request for reimbursement from the respondent.On appeal, Panaggio argued the board erred in its interpretation of RSA 126-X:3, III, and when it based its decision in part on the fact that possession of marijuana is illegal under federal law. The New Hampshire Supreme Court reversed in part and remanded for further proceedings. Specifically, the Court determined that because the board found that Panaggio’s use of medical marijuana was reasonable, medically necessary, and causally related to his work injury, the board erred when it determined the insurance carrier was prohibited from reimbursing Panaggio for the costs of purchasing medical marijuana. The Court determined that because the board’s order failed to sufficiently articulate the law that supported the board’s legal conclusion and failed to provide an adequate explanation of its reasoning regarding federal law, it was impossible for the Court to discern the grounds for the board’s decision sufficient for it to conduct meaningful review. Accordingly, the case was remanded to the board for a determination of these issues in the first instance. View "Appeal of Panaggio" on Justia Law
Alward v. Johnston
This appeal arose from the dismissal of a medical malpractice action filed by plaintiff Nicole Alward against defendants Emery Johnston, M.D., Gary Fleischer, M.D., Tung Thuy Nguyen, M.D., Elliot Hospital, and Southern New Hampshire Medical Center. Following a second back surgery, plaintiff consulted with two different attorneys about a potential medical malpractice claim. Ultimately, both attorneys advised the plaintiff that they were unwilling to represent her in a medical malpractice action against the treating physicians and hospitals. As a result, plaintiff believed that her potential claim had no value. Plaintiff then consulted with a bankruptcy attorney, Mark Cornell, in April 2015. She informed Cornell about her potential medical malpractice claim and that other attorneys had declined to pursue it. When Cornell drafted the plaintiff’s petition for chapter 7 bankruptcy, he did not list the potential medical malpractice claim on the plaintiff’s schedule of assets. Cornell also failed to advise plaintiff that she needed to disclose this potential claim to the bankruptcy trustee. At her ex-husband’s suggestion, in February 2016, plaintiff consulted with a third law firm, Swartz & Swartz, P.C., which agreed to represent her and pursue the medical malpractice claim. Plaintiff filed the underlying medical malpractice action against defendants in June 2016. The bankruptcy court issued its order discharging her case in July 2016. In October, defendants moved to dismiss the medical malpractice action, arguing plaintiff should have been judicially estopped from pursuing her medical malpractice claim because she failed to disclose it on her schedule of assets in the bankruptcy case. Plaintiff immediately consulted with new bankruptcy counsel, who moved to reopen her bankruptcy case to "administer a potential asset" and appoint a new trustee. The bankruptcy court granted the motion and appointed a new trustee. Plaintiff then resisted defendants' motion to dismiss, which was denied by the trial court. The trial court ultimately dismissed the case, holding plaintiff was judicially estopped from bringing her medical malpractice claim. The New Hampshire Supreme Court concluded the trial court erred in applying judicial estoppel to this matter, reversed and remanded for further proceedings. View "Alward v. Johnston" on Justia Law
Appeal of Dao Nguyen
Petitioner Dao Nguyen appealed a New Hampshire Board of Barbering, Cosmetology, and Esthetics (Board) decision, suspending her personal license as a manicurist and revoking the shop license for Nail Care. In 2013, Board inspector Beulah Green conducted a routine inspection of Nail Care, finding numerous violations of the Board Administrative Rules (Rules), including two foot spas that were not disinfected properly, no record of cleaning for two foot spas, five tables that were not sanitized, numerous implements that were either not sanitized and disinfected properly or not discarded or disposed of properly, multiple “credo” blades, and the use of nail drills that are not manufactured for use on the natural nail (improper nail drills). For these violations, Green imposed a fine of $4,158. In the next few years, Green conducted additional inspections, and again found multiple, repeat violations of the Rules. Noting the repeated violations and the “blatant disregard” that the petitioner demonstrated towards the Rules, the Board suspended petitioner’s personal license for five years, revoked her shop license for Nail Care, and ordered her to pay all outstanding fines owed to the Board within 90 days. The Board also ruled that, if the petitioner’s license is reinstated, it will be subject to a three-year probationary period. Finding the Board’s decision was supported by substantial, credible evidence, the New Hampshire Supreme Court affirmed the Board’s decision. View "Appeal of Dao Nguyen" on Justia Law
New Hampshire v. Actavis Pharma, Inc.
The State of New Hampshire moved to enforce administrative subpoenas served on defendants Actavis Pharma, Inc., Endo Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Purdue Pharma L.P., and Teva Pharmaceuticals USA, Inc. The State was investigating defendants’ role in allegedly causing health care providers to prescribe opioids to treat chronic pain. Defendants resisted, arguing the Office of the Attorney General’s (OAG) engagement of outside counsel was unlawful. In addition, defendants moved for a protective order, seeking to “bar the Attorney General from engaging contingent fee counsel to: (a) participate in or assume responsibility for any aspect of the State’s investigation of alleged violations of the Consumer Protection Act . . . ; or (b) participate in or assume responsibility for any subsequent enforcement action pertaining to alleged CPA violations.” Defendants argued that the OAG’s fee agreements with the firm Cohen Milstein: (1) violated RSA 21-G:22 and :23 (2012) (amended 2016); (2) violated New Hampshire common law; (3) were ultra vires because the OAG did not comply with RSA 7:12 (2013) (amended 2016) or :6-f (Supp. 2016); (4) violated the doctrine of separation of powers; (5) violated the New Hampshire Rules of Professional Conduct; and (6) violated due process under the New Hampshire and United States Constitutions. The State replied that an objection to the Attorney General’s use of outside counsel was not appropriate justification for refusing to comply with lawful subpoenas, and that defendants lacked standing to raise that complaint. The trial court denied the State’s motion to enforce the subpoenas and granted the defendants’ motion for a protective order “to the extent that the OAG and Cohen Milstein’s contingency fee agreement is invalid.” The trial court determined that the defendants had demonstrated standing to bring their claims, that the fee agreement was void, and therefore denied the State’s motion to enforce the subpoenas on that basis. The New Hampshire Supreme Court concluded defendants lacked standing to challenge the outside counsel agreement. It reversed and remanded the matter for further proceedings. View "New Hampshire v. Actavis Pharma, Inc." on Justia Law
Exeter Hospital, Inc. v. Steadfast Insurance Company
In this declaratory judgment proceeding, petitioner Exeter Hospital, Inc. (Exeter) appealed a superior court order denying its motion for partial summary judgment as to the amount at which coverage was triggered under an umbrella policy (the policy) issued to Exeter by respondent Steadfast Insurance Company (Steadfast). In the spring of 2012, an outbreak of Hepatitis C infections among patients serviced by Exeter’s cardiac catheterization lab led investigators to discover that a technician had spread the virus to patients “through a clandestine drug diversion scheme.” The technician allegedly injected certain drugs into his body by way of intravenous needles, then reused the needles on patients, thereby infecting them with the virus. Numerous lawsuits were lodged against Exeter by affected patients. Exeter was primarily insured through a Self-Insurance Trust Agreement (SIT), which provided professional liability coverage in the amount of $1 million per medical incident, with a $4 million annual aggregate cap. Exeter also maintained the policy with Steadfast, which provided excess health care professional liability coverage. Steadfast maintained that it would pay damages only in excess of the $100,000 retained limit for each medical incident. Exeter filed this proceeding, seeking a declaration that it was not required to pay $100,000 retained limit per claim. The trial court interpreted the term “applicable underlying limit” as being a variable amount “dependent on the actual coverage remaining under [the] other [limits of] insurance,” here, the limits of the SIT. Because Exeter had paid out the limits of the SIT, the court found that the “applicable underlying limit” was zero, thereby rendering the $100,000 retained limit greater than the “applicable underlying limit.” Thus, the court determined that, pursuant to “Coverage A,” Steadfast was required “to pay damages in excess of $100,000 for each medical incident.” Exeter sought reconsideration of the court’s order, which the court denied. Although the New Hampshire Supreme Court did not agree with every underlying argument pressed by Exeter, it concluded that its overall argument regarding the interpretation of Coverage A was reasonable, and the trial court therefore erred in granting partial summary judgment as to the terms of Coverage A. View "Exeter Hospital, Inc. v. Steadfast Insurance Company" on Justia Law
Appeal of Northridge Environmental, LLC
Respondents Northridge Environmental, LLC and Arch Insurance Company (carrier), appealed a decision of the New Hampshire Compensation Appeals Board (CAB) granting a request by petitioner John Nicholson for reimbursement for home health care services provided to him by his wife, Angela Nicholson. Petitioner was seriously injured on the job while working for Northridge. After a period of hospitalization, petitioner was discharged but prescribed medication and follow-up care, which included home health services. Following the petitioner’s release from the hospital, he had multiple open wounds that required daily cleaning, and he “needed 24/7 care, due to balance problems, short term memory loss, and inability to perform certain regular activities of daily living.” Although petitioner’s wife did not have any formal medical training, she provided the required care, including cleaning his wounds, bathing him, dressing him, aiding him in the use of the bathroom, helping him move around, and constantly supervising him. Petitioner sought reimbursement at a rate of $15 per hour, 16 hours per day, between the date of his release from the hospital, and June 4, 2012, the date of the Department of Labor (DOL) hearing. The DOL denied the request for reimbursement. On remand to the CAB, respondents argued that because petitioner’s wife did not fall within the definition of a “health care provider” as used in RSA 281-A:2, XII-b (2010), her services were not reimbursable. Petitioner conceded that his wife was not a “doctor, chiropractor, or rehabilitation provider” as listed in RSA 281-A:2, XII-b, but he still asserted that her services were, nonetheless, reimbursable. The CAB first concluded that petitioner was entitled to reimbursement for his wife’s services. Regarding the amount of reimbursement, the CAB observed that petitioner’s wife offered inexact dates, times, and durations of various treatments that she provided and also lacked written records of her care. Nonetheless, the CAB concluded that it was reasonable to reimburse the petitioner for 12 hours per day at $15 per hour for the period between August 25, 2010, and June 4, 2012. The parties filed motions for reconsideration, which were denied. Finding no reversible error in the CAB's decision, the Supreme Court affirmed. View "Appeal of Northridge Environmental, LLC" on Justia Law