Justia Health Law Opinion Summaries

Mark R. Schmidt, a workers' compensation attorney, sustained a work-related injury while loading files into a trial bag. His treatment included pain management with medications like OxyContin and Oxycodone. To avoid increasing his medication dosage, his physician, Dr. Murphy, prescribed CBD oil. Schmidt purchased CBD oil and lotion over the counter and used them as directed. He sought reimbursement from his employer, Schmidt, Kirifides and Rassias, PC, for the CBD oil costs, which the employer refused, arguing that CBD oil is not a pharmaceutical drug.A Workers' Compensation Judge (WCJ) granted Schmidt's penalty petition, ordering the employer to reimburse him for the CBD oil costs. The Workers' Compensation Appeal Board (Board) reversed this decision, stating that Schmidt did not follow the necessary rules for reimbursement and that CBD oil is not a "supply" under the Workers' Compensation Act (WCA) due to the lack of FDA approval. The Commonwealth Court reversed the Board's decision, concluding that CBD oil is a "medicine" or "supply" under the WCA and that Schmidt, not being a provider, was not required to submit standard billing forms for reimbursement.The Supreme Court of Pennsylvania reviewed the case and held that any item prescribed by a health care provider as part of a treatment plan for a work-related injury falls within the meaning of "medicines and supplies" under Section 306(f.1)(1)(i) of the WCA. The court also held that the cost containment provisions of the WCA and related regulations do not apply to claimants who are not providers. Therefore, Schmidt was entitled to reimbursement for the CBD oil costs, and the Commonwealth Court's order was affirmed. View "Schmidt v. Schmidt, Kirifides & Rassias" on Justia Law

Dr. Omar Almusa, a licensed medical physician and surgeon in Pennsylvania, unlawfully distributed hydrocodone between 2014 and 2018. He pleaded guilty to unlawful dispensing and distributing a controlled substance, conspiracy to distribute, and health care fraud. In 2019, he was sentenced to 24 months in prison followed by three years of supervised release. Consequently, the State Board of Medicine automatically suspended his medical license for at least ten years, effective August 15, 2019.Almusa did not appeal the suspension. In 2020, the General Assembly enacted Act 53, redefining how licensing boards consider criminal offenses, specifying that only drug trafficking offenses (involving at least 100 grams of a controlled substance) warrant automatic suspension. Almusa's offense did not meet this threshold. In 2021, Almusa petitioned for reinstatement of his license, arguing that Act 53 should apply to his case, allowing him to seek reinstatement without waiting ten years.The Board denied his petition, stating that Act 53 did not apply retroactively to suspensions imposed before its enactment. The Commonwealth Court affirmed the Board's decision, interpreting the suspension and reinstatement as a single action requiring a ten-year suspension period.The Supreme Court of Pennsylvania reversed the Commonwealth Court's decision. It held that automatic suspension and reinstatement are separate actions under the Medical Practice Act. The Court found that Act 53, effective December 28, 2020, applies to reinstatement proceedings initiated after this date. Since Almusa's offense did not qualify as drug trafficking under Act 53, the ten-year waiting period did not apply to his reinstatement petition. The Court concluded that Almusa was entitled to have his reinstatement petition considered under the new law. View "Almusa v. State Board of Medicine" on Justia Law

In the case at hand, a group of reproductive health centers and Planned Parenthood affiliates in Pennsylvania challenged the constitutionality of sections of the Pennsylvania Abortion Control Act and corresponding regulations which prohibit the use of state Medicaid funds for abortions except in cases of rape, incest, or to avert the death of the mother. The petitioners argued that the exclusion of abortion from Medicaid coverage violated the Equal Rights Amendment and equal protection provisions of the Pennsylvania Constitution.The Supreme Court of Pennsylvania held that the health centers had standing to bring the lawsuit on behalf of their patients who are enrolled in or eligible for aid under Pennsylvania's Medical Assistance program but whose abortions are not covered because of the exclusion. The court further held that the Commonwealth Court erred in permitting individual members of the Pennsylvania Senate and House of Representatives to intervene in the case.The Supreme Court of Pennsylvania reversed the Commonwealth Court's order dismissing the petition for review. The court concluded that the providers' petition for review was legally sufficient to survive demurrer. The court noted that its precedent may have misstated the breadth of the exclusion and remanded the case to the Commonwealth Court for further proceedings consistent with its opinion. The court did not rule on the constitutionality of the challenged provisions. View "Allegheny Reprod. Health v. PA DHS" on Justia Law

During their employment with Dialysis Clinic, Inc. (DCI), the Doctors maintained staff privileges and worked at Washington Hospital. In 2013, Alyssa McLaughlin was admitted to the Hospital and received treatment from, among other medical staff, the Doctors, Kathryn Simons, M.D., Anne F. Josiah, M.D., Thomas Pirosko, D.O., and Ashely Berkley, D.O. At some point during or after that treatment, McLaughlin sustained severe and permanent neurological injuries. Attributing those injuries to negligence in her treatment, McLaughlin and her husband, William McLaughlin (collectively, the McLaughlins), initiated an action against the Doctors, the Hospital, and the other physicians noted above who were responsible for her care. The issue this case presented for the Pennsylvania Supreme Court's review centered on whether, as a matter of law, the Hospital could seek contribution and/or indemnity from DCI for negligence committed by DCI’s employees (the Doctors). The trial and superior courts both concluded that, although traditional principles of contribution and indemnity did not apply cleanly these particular circumstances, equitable principles of law permitted the Hospital to seek both contribution and indemnity from DCI. As a result, the trial court denied DCI’s motion for summary relief, and the superior court affirmed. The Supreme Court was unanimous in finding that, if the Hospital and DCI were determined to be vicariously liable for the negligence of the Doctors, the law permitted the Hospital to seek contribution from DCI. The Court was evenly divided on the question of whether the Hospital could also seek indemnification from DCI. Given the decision on contribution and inability to reach a decision on indemnity, the superior court was affirmed on those questions. View "McLaughlin v. Nahata, et al." on Justia Law

The underlying dispute before the Pennsylvania Supreme Court in this case involved the adequacy of state funding for community participation support ("CPS") services, which were designed to help individuals with autism or intellectual disabilities live independently. The primary issue on appeal related to the exhaustion requirement. The Pennsylvania Department of Human Services ("DHS") issued ODP Announcement 19-024, indicating it intended to change the rate structure for CPS services provided under the Home and Community Based Services (“HCBS”) waivers. Petitioners filed an action for declaratory and injunctive relief, challenging the legality of the new fee schedule and alleged the new reimbursement rates were too low to sustain the provision of CPS services to eligible recipients. Pertinent here, the Commonwealth Court agreed with one of DHS' preliminary objections that Petitioners failed to exhaust their administrative remedies, as required by case precedent, before seeking judicial review. The court acknowledged a narrow exception to the exhaustion requirement whereby a court may consider the merits of a claim for declaratory or injunctive relief if a substantial constitutional question is raised and the administrative remedy is inadequate. It clarified, however, that the exception only applied where the plaintiff raises a facial constitutional challenge to the statute or regulation in question, as opposed to its application in a particular case. Here, the court concluded, the Petitioners were attacking the fee schedule in the Final Notice, which was produced by application of the legal authority cited in that notice, and not advancing a facial constitutional challenge. The court also found Petitioners failed to demonstrate the administrative remedy was inadequate. The Supreme Court affirmed the Commonwealth Court’s order insofar as it sustained the preliminary objection asserting that the Petitioners failed to exhaust their administrative remedies, and dismissed the Petition as to those parties. The order was vacated in all other respects, and the matter was remanded for further proceedings. View "Rehabilitation & Community Providers Association, et al. v. Dept. Human Svcs" on Justia Law

The Pennsylvania Supreme Court granted expedited review of this direct appeal to decide whether the Commonwealth Court erred in concluding that Acting Secretary of Health Alison Beam (“the Secretary”) lacked the power under existing law and Department of Health regulations to require individuals to wear facial coverings while inside Pennsylvania’s schools as a means of controlling the spread of COVID-19. Having determined that the Secretary exceeded her authority in issuing that directive, by per curiam order on December 10, 2021, the Court affirmed the lower court’s decision nullifying the mandate, and published this opinion expounding on its reasoning. View "Corman, J., et al. v. Beam" on Justia Law

In late 2015, decedent Cody Albert (“Cody”) and his childhood friend, Zachary Ross (“Zachary”) struggled with substance abuse issues. At that time, Zachary’s mother, April Kravchenko, was suffering from multiple myeloma for which her doctors prescribed her several opiate pain medications, which she filled at a small, independent pharmacy in Scranton called Sheeley’s Drug Store. Kravchenko and her sister Debra Leggieri worried Zachary would try to pick up (and use) Kravchenko’s pain medication from Sheeley’s while Kravchenko was in the hospital. To prevent this, Leggieri called Sheeley’s and placed a restriction on who could pick up Kravchenko’s prescriptions. Zachary called Sheeley’s one day pretending to be his mother, and asked about refilling her OxyContin prescription. Donato Iannielli, owner-pharmacist Lori Hart’s father, and the prior owner of Sheeley’s, was the pharmacist on-duty at the time, and told “Kravchenko” that her OxyContin prescription could not be filled yet, but that she had a prescription for fentanyl patches ready to be picked up. “Kravchenko” told Iannielli that she wanted to send her son to pick up the patches, but stated that he did not have a driver’s license or other form of identification. Iannielli told the caller that this would not be a problem, since he personally knew and would recognize Zachary. Cody then drove Zachary to Sheeley’s, where Zachary picked up Kravchenko’s medication even though, according to Zachary, the pharmacy receipt explicitly stated, “[d]o not give to son.” On the drive back to Zachary’s house, Cody at some point consumed fentanyl from one of the patches, smoked marijuana, and then fell asleep on the once inside the house. Later that night, Zachary tried to wake Cody up, but he was unresponsive. Cody was later pronounced dead at a hospital. Zachary eventually pleaded guilty to involuntary manslaughter and multiple drug offenses in connection with Cody’s overdose. The question in this appeal was whether claims brought against the pharmacy on behalf of the decedent who overdosed on illegally obtained prescription drugs was barred by the doctrine of in pari delicto. Because the Pennsylvania Supreme Court concluded that the trial court correctly applied the in pari delicto doctrine, judgment was affirmed. View "Albert v. Sheeley's Drug Store, et al." on Justia Law

The Bureau of Workers’ Compensation Fee Review Hearing Office (“Hearing Office”) concluded that, in the fee review setting, a non-treating healthcare provider, like a pharmacy, could not challenge a utilization review (“UR”) determination that medications prescribed by a treating healthcare provider, such as a physician, but dispensed by the non-treating entity, were unreasonable and unnecessary for the treatment of a claimant’s work-related injury. The Commonwealth Court affirmed the Hearing Office’s order. However, after reaching this result, the intermediate court held that for UR procedures occurring in the future, when an employer, insurer or an employee requests UR, non-treating providers, such as pharmacies, had to be afforded notice and an opportunity to establish their right to intervene in the UR proceedings. While the Pennsylvania Supreme Court affirmed the Commonwealth Court’s result, it rejected its prospective holding that non-treating healthcare providers had to be given notice and an opportunity to intervene in UR proceedings. View "Keystone Rx v. Bureau. of Workers' Compensation" on Justia Law

This discretionary appeal concerned discovery in a medical negligence lawsuit in which the patient suffered complications following surgery at a hospital. The issue was whether certain portions of the hospital’s credentialing file for the doctor who performed the surgery were protected from discovery. The hospital claimed protection under the Peer Review Protection Act and the federal Health Care Quality Improvement Act. The Supreme Court held: (1) a hospital’s credentials committee qualified as a “review committee” for purposes of Section 4 of the Peer Review Protection Act to the extent it undertakes peer review; and (2) the federal Health Care Quality Improvement Act protects from disclosure the responses given by the National Practitioner Data Bank to queries submitted to it – and this protection exists regardless of any contrary aspect of state law. The order of the Superior Court was reversed insofar as it ordered discovery of the NPDB query responses. It was vacated in all other respects and the matter was remanded for further proceedings. View "Leadbitter v. Keystone, et al." on Justia Law

In 2018, B.W. went to his primary car provider’s office for “anxiety” and “agitation.” The provider’s notes reflect B.W. discussed making “credible threats of violence against a co-worker.” The provider recommended inpatient treatment, “involuntary if necessary.” B.W. made no threats to the provider’s staff. The provider certified B.W. needed involuntary examination and treatment, and B.W. was transported to another hospital for such examination. The hospital evaluator noted B.W. was “homicidal toward a co-worker,” and was “severely mentally disabled and in need of treatment.” B.W. was involuntarily committed and released after 72 hours. Thereafter, B.W. petitioned to expunge his mental health record, averring there was no basis for the involuntary commitment. A trial court found it undisputed B.W. made threats to harm his co-worker. Though he made no “act in furtherance” of his threats, the court concluded the medical evaluators’ records reflecting B.W.’s statement he would “strangle his co-worker the next time he saw” that person, was sufficient to support B.W. was a clear and present danger to others. The Pennsylvania Supreme Court considered whether the superior court erred in ordering the expungement of B.W.’s records on grounds that the trial court’s conclusion was wrong. The Supreme Court determined the records contained sufficient facts to prove B.W. made a threat to harm another person, and acted in furtherance of that threat, which the physicians found credible. Accordingly, judgment was reversed. View "In Re: B. W., Appeal of: Blair Dept Human Services" on Justia Law