Justia Health Law Opinion Summaries

The case involves the interpretation of Administrative Code of the City of New York § 12-126, which mandates that New York City pay the full cost of health insurance coverage for active employees, retirees, and their dependents, up to a specified cap. The dispute centers on whether the City is required to pay up to the statutory cap for any health insurance plan it offers or just one plan. Petitioners argue that the City must pay for any plan offered, while the City contends it only needs to pay for one plan and any additional plans are subject to collective bargaining agreements.The Supreme Court of New York County granted a preliminary injunction preventing the City from enforcing an opt-out date for a new Medicare Advantage plan and later permanently enjoined the City from passing any costs of the current plan to retirees, except where costs exceed the statutory cap. The court did not determine the exact statutory cap but suggested that the cost of the Senior Care plan did not exceed it. The Appellate Division affirmed the Supreme Court's decision, agreeing that the City must pay the full cost, up to the statutory cap, for any health insurance plan it offers to retirees.The Court of Appeals of New York affirmed the Appellate Division's decision, holding that § 12-126 requires the City to pay up to the statutory cap for each health insurance plan it offers to employees and retirees. The court did not address the issue of how the statutory cap should be determined for Medicare-eligible retirees, as the City had not preserved this question for review. The court concluded that the legislative history supported the interpretation that the City must pay for any plan it offers, aligning with the intent to provide a choice of health insurance plans to employees and retirees. View "Matter of NYC Org. of Pub. Serv. Retirees, Inc. v Campion" on Justia Law

In 2006, an individual was convicted of first-degree sexual abuse and later subjected to civil management under New York's Mental Hygiene Law due to a "mental abnormality." Initially confined, he was released to a strict and intensive supervision and treatment (SIST) program in 2016. In 2019, he violated SIST conditions by tampering with an alcohol monitoring bracelet, leading to his temporary confinement based on a psychologist's evaluation and a probable cause finding by the court.The Supreme Court initially found probable cause to believe he was a "dangerous sex offender requiring confinement" and ordered his detention pending a final hearing. He filed a habeas corpus petition, arguing that the statutory scheme violated procedural due process by not providing an opportunity to be heard at the probable cause stage. The Supreme Court denied the petition, and the Appellate Division converted the proceeding to a declaratory judgment action, ultimately declaring the statute constitutional.The New York Court of Appeals reviewed the case and upheld the lower court's decision. The court held that the statutory scheme under Mental Hygiene Law § 10.11 (d) (4) appropriately balances individual and state interests. It concluded that the statute provides sufficient procedural safeguards, including a prompt judicial probable cause determination and a full hearing within 30 days, to mitigate the risk of erroneous confinement. The court found that the petitioner failed to demonstrate that the statute is unconstitutional either on its face or as applied to him. The order of the Appellate Division was affirmed without costs. View "People ex rel. Neville v Toulon" on Justia Law

Michele Rawlins, a former school principal and member of the Teachers' Retirement System of the City of New York (TRS), was diagnosed with post-traumatic stress disorder (PTSD) following a series of incidents involving a disgruntled food-service worker. The worker's behavior left Rawlins feeling threatened and harassed, leading to her inability to perform her job responsibilities. The final incident occurred in April 2019, when the worker, who had been transferred to another location, entered the school and demanded to speak with Rawlins, insisting she had his "belt and wallet." Rawlins interpreted the worker's remarks as having "sexual overtones" and felt she was being stalked. She left the school building and never returned to work following the incident.Rawlins applied for accidental disability retirement benefits (ADR) from the TRS, but her application was denied. The TRS Medical Board determined that she did not sustain an accident in the work setting and that "purposeful conduct by coworkers giving rise to a disabling injury is not an accident within the meaning of the pension statute." Rawlins reapplied for ADR, but the Board maintained its previous determination. Rawlins then commenced a CPLR article 78 proceeding to annul the Board's determination. The Supreme Court denied the petition and dismissed the proceeding, stating that the Board's determination had a rational basis. The Appellate Division affirmed the Supreme Court's decision, and Rawlins was granted leave to appeal.The Court of Appeals affirmed the lower courts' decisions. The court held that substantial evidence supported the Board's determination that Rawlins' injury was not caused by an "accident" within the meaning of the statutory scheme. The court declined to adopt a rule that "purposeful conduct by coworkers" can never be the basis for an award of ADR. Instead, the court stated that when a member's disability is alleged to have resulted from the intentional acts of any third party, the relevant question continues to be whether the injury-causing event was sudden, unexpected, and outside the risks inherent in the work performed. View "Matter of Rawlins v Teachers' Retirement Sys. of the City of N.Y." on Justia Law

The case involves the Roman Catholic Diocese of Albany and other entities, who provide medical insurance plans to their employees. They challenged a regulation by the Department of Financial Services, which requires New York employer health insurance policies that provide hospital, surgical, or medical expense coverage to include coverage for medically necessary abortion services. The plaintiffs argued that the exemption for "religious employers" was too narrow, violating the First Amendment rights of certain types of religiously affiliated employers who do not meet the terms of the exemption.The case began in 2016, raising a federal Free Exercise Claim that was similar to a previous case, Catholic Charities of Diocese of Albany v Serio. The lower courts dismissed the plaintiffs' complaints based on the principle of stare decisis, and the Appellate Division affirmed on the same ground. The plaintiffs appealed to the Supreme Court of the United States, which remanded the case to the Appellate Division to reconsider in light of a recent decision, Fulton v Philadelphia.On remand, the Appellate Division held that Serio was still good law and affirmed its previous decision that neither the medically necessary abortion regulation nor the "religious employer" exemption as defined violated the Free Exercise Clause. The Court of Appeals agreed, stating that under Fulton, both the regulation itself and the criteria delineating a "religious employer" for the purposes of the exemption are generally applicable and do not violate the Free Exercise Clause. The court concluded that the "religious employer" exemption survives the general applicability tests delineated in Fulton, and therefore, the Appellate Division order should be affirmed. View "Roman Catholic Diocese of Albany v Vullo" on Justia Law

The case involves a dispute over the adjusted Medicaid reimbursement rates for for-profit residential health care facilities in New York. The New York State Department of Health and its Commissioner, in response to a legislative mandate, eliminated a component known as the "residual equity reimbursement factor" from the computation formula used to set these rates. This change was part of a broader effort to reduce Medicaid costs in the state. The petitioners, 116 for-profit nursing homes, challenged this adjustment, arguing that it was retroactively applied and violated their rights under the Public Health Law and the Equal Protection Clause.The Supreme Court partially granted the petitioners' motion for a preliminary injunction against enforcement of the clause pending a final determination of the proceeding. It also partially granted the respondents' motion for summary judgment, dismissing the petitioners' claims that the adjusted rates were not "reasonable and adequate to meet costs" under the Public Health Law and violated their equal protection rights. However, the court found that the adjusted rates were improperly applied retroactively. The Appellate Division affirmed the Supreme Court's decision.The New York Court of Appeals, in its review, held that the Department of Health did not violate the legislature's intent when it announced the recalculated rates for services provided on or after April 2, 2020. The court found that the legislature clearly expressed its intent for the elimination clause to be applied without delay, and that the initial implementing ratemaking was not subject to the usual 60-day advance notice requirement. The court also rejected the petitioners' claims that the adjusted rates were not "reasonable and adequate to meet costs" and violated their equal protection rights. The court modified the order of the Appellate Division in accordance with its opinion and, as so modified, affirmed it. View "In re Aaron Manor Rehabilitation & Nursing Ctr., LLC v Zucker" on Justia Law

The Court of Appeals accepted a question certified by the United States Court of Appeals for the Second Circuit and answered that no provide cause of action exists for violations of New York Public Health Law 18(2)(e).Plaintiff filed a complaint alleging that Defendant, a hospital, violated section 18(2)(3) by charging her $1.50 per page for paper copies of her medical records. The district court concluded that no private right of action existed under section 18(2)(e) and therefore granted Defendant's motion to dismiss. On appeal, the Second District concluded that there was insufficient precedent to resolve the issue of whether a private right of action existed. After applying the factors set forth in Sheehy v. Big Flats Community Day, 73 NY2d 629 (1989), the Court of Appeals concluded that no private cause of action exists for violations of section 18(2)(e). View "Ortiz v. Ciox Health LLC" on Justia Law

The Court of Appeals affirmed the order of the Appellate Division, holding that, under N.Y. C.P.L.R. 3122(a)(2), the Comptroller of the State of New York's subpoenas to a medical provider seeking patients' records in carrying out the Comptroller's obligation to audit payments to private companies that provide health care to beneficiaries of a state insurance program need not be accompanied by written patient authorizations.Petitioner, a professional corporation engaged in the practice of plastic surgery, was served with a subpoena duces tecum requesting the names and addresses of certain patients. Petitioner commenced this special proceeding to quash the subpoena, arguing that under C.P.L.R. 3122(a)(2) it was not obligated to respond to the subpoena. Supreme Court granted the petition and quashed the subpoena. The Appellate Division reversed. The Court of Appeals affirmed, holding that the requirements set out in C.P.L.R. 3122(a)(2) apply only to subpoenas duces tecum served after the commencement of an action, and therefore, the statute does not require that the Comptroller's subpoenas be accompanied by written patient authorizations. View "Plastic Surgery Group, P.C. v. Comptroller of the State of New York" on Justia Law

The Court of Appeals answered in the negative a question certified to it by the United States Court of Appeals for the Second Circuit asking whether N.Y. Pub. Health Law 230(11)(b) creates a private right of action for bad faith and malicious reporting to the Office of Professional Medical Conduct, holding that there is not indication that the legislature intended to create a private right of action in section 230(11)(b).Plaintiff, a surgeon, treated four injured patients insured by Defendant and submitted claims to Defendant in connection with each patient. Defendant later filed complaints with the Office of Professional Medical Conduct (OPMC) alleging insurance fraud. After OPMC declined to impose discipline against Plaintiff, Plaintiff commenced this action asserting that Defendant's complaints lacked a good-faith basis in violation of section 230(11)(b) and interposed a separate caused of action for defamation. Defendant moved to dismiss the complaint, arguing that section 230(11)(b) does not imply a private right of action. The federal district court granted the motion. On appeal, the Second Circuit certified the above question to the Court of Appeals. The Court of Appeals held that the statutory text and legislative history of the statute do not imply a legislative intent to create a right of action under section 230(11)(b). View "Haar v. Nationwide Mutual Fire Insurance Co." on Justia Law

In this insurance dispute involving an insurer withholding payments to a medical service corporation improperly controlled by nonphysicans the Court of Appeals ruled that the trial court did not err in declining to give a charge requiring the jury to find fraudulent intent or conduct "tantamount to fraud" in order to reach a verdict in favor of the insurers.Plaintiff Andrew Carothers, M.D., P.C., a professional service corporation, filed multiple collection actions against insurance carriers seeking to recover unpaid claims of assigned first-party no-fault insurance benefits. The jury found that Defendants had proved that Plaintiff was "fraudulently incorporated" and that Carothers did not engage in the practice of medicine. Plaintiff appealed, arguing that the court erred in failing to give a jury instruction on "the traditional elements of common-law fraud and fraudulent intent. The Appellate Division affirmed. The Court of Appeals affirmed, holding that the court's instructions to the jury were proper. View "Carothers v. Progressive Insurance Co." on Justia Law

The Court of Appeals held that N.Y. Mental Hyg. Law 33.13, which protects the confidentiality of the clinical records of patients and clients as maintained by facilities licensed or operated by the Office of Mental Health or the Office for People with Developmental Disabilities, does not require automatic sealing of the entire court record of all proceedings involving insanity acquittees who have dangerous mental disorders within the meaning of N.Y. Crim. Proc. Law (CPL) 330.20.Defendant, an insanity acquittee, was found to have a dangerous mental disorder as defined by CPL 330.20(1)(c) and was committed to the custody of the Commissioner for the Office for People with Developmental Disabilities. Supreme Court denied Defendant’s motion to seal the entire court record in his case, finding that the documents related to the legal proceedings rather than Defendant’s treatment. The Appellate Division modified. The Court of Appeals affirmed, holding that the legislature provided no automatic sealing requirement of an entire court record in either CPL 330.20 or the Mental Hygiene Law for an insanity acquittee, and Defendant cited no authority for such an obligation. View "In re James Q." on Justia Law