Justia Health Law Opinion Summaries

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

A mental health patient lived in a forty-unit apartment building and repeatedly told his doctors and therapists he would kill an unnamed “neighbor.” He ultimately carried out his threat, killing an individual who lived in his building, a few doors away from his own apartment. In subsequent wrongful death litigation filed by the victim’s mother, the providers argued they had no duty to warn anyone about their patient’s threats because he never expressly identified a specific victim. The trial court rejected this argument and denied the providers’ motion for summary judgment, allowing the case to proceed to trial. On appeal, the Superior Court agreed, and finding no reversible error, the Pennsylvania Supreme Court affirmed. View "Maas v. Univ. of Pittsburgh Med. Ctr." on Justia Law

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

At issue before the Pennsylvania Supreme Court was a challenge to a local judicial district’s policy prohibiting the use of medical marijuana by individuals under court supervision, such as probationers. Relevant here, the applicable statutory authority, the Pennsylvania Medical Marijuana Act, contained an immunity provision protecting patients from government sanctions. In September 2019, the 52nd Judicial District -- comprised of the Lebanon County Court of Common Pleas (the “District”) -- announced a “Medical Marijuana Policy” under the issuing authority of the president judge. The Policy prohibited “the active use of medical marijuana, regardless of whether the defendant has a medical marijuana card, while the defendant is under supervision by the Lebanon County Probation Services Department.” Petitioners were individuals under the supervision of the Lebanon County probation agency who filed suit in the Commonwealth Court's original jurisdiction to challenge the validity of the Policy in light of the MMA's immunity provision. Separately, Petitioners filed an application for special relief in the nature of a preliminary injunction. Soon thereafter, the Commonwealth Court proceeded, sua sponte, to transfer the case to this Court, concluding that it lacked jurisdiction to grant the requested relief. The District then filed its response in this Court opposing preliminary injunctive relief. It claimed, among other things, that Petitioners were unlikely to prevail on the merits, arguing, inter alia, that the General Assembly didn’t intend the MMA to override the courts’ ability to supervise probationers and parolees. After review, the Pennsylvania Supreme Court granted Petitioners' request for declaratory and injunctive relief. The Policy was deemed to be contrary to the immunity accorded by the MMA, and as such, should not be enforced. "[N]othing impedes a revocation hearing or other lawful form of redress, where there is reasonable cause to believe that a probationer or other person under court supervision has possessed or used marijuana in a manner that has not been made lawful by the enactment." View "Gass et al. v. 52nd Judicial District" on Justia Law

This matter came from two separate lawsuits commenced in the Pennsylvania courts of common pleas which were subsequently removed to federal district courts on the basis of diversity jurisdiction, and thereafter consolidated for disposition by the United States Court of Appeals for the Third Circuit. Appellee William Scott was covered by an automobile insurance policy issued by Appellant Travelers Commercial Insurance Company. Appellee Samantha Sayles was covered by an automobile policy issued by Appellant Allstate Insurance Company. Allstate’s policy contained a clause, similar to the one in Scott’s policy, providing that, in order to receive first-party medical benefits, the insured had to submit to mental and physical examinations by physicians selected by the insurance company at the company’s behest before medical benefits were paid. Both appellees were injured in separate car accidents, and their respective insurance companies refused to pay their medical bills. The United States Court of Appeals for the Third Circuit certified a question of Pennsylvania law to the Pennsylvania Supreme Court: Does an automobile insurance policy provision, which required an insured seeking first-party medical benefits under the policy to submit to an independent medical exam whenever the insurer requires and with a doctor selected by the insurer, conflict with 75 Pa.C.S. Section 1796(a) of the Pennsylvania Motor Vehicle Financial Responsibility Law (“MVFRL”), such that the requirement was void as against public policy? After review, the Supreme Court concluded that the provision indeed conflicted with Section 1796(a), and was void as against public policy. View "Sayles. v. Allstate Ins Co." on Justia Law