A Hospital brought this lawsuit against a TennCare managed care organization (MCO), alleging that the MCO had not paid the Hospital all it was due for emergency services provided to the MCO’s TennCare enrollees. The MCO counterclaimed, seeking recovery of alleged overpayments made pursuant to the TennCare regulations. Thereafter, the MCO filed a motion for partial summary judgment, arguing that the Uniform Administrative Procedures Act (UAPA) required the Hospital to exhaust its administrative remedies by bringing its claims before TennCare prior to filing suit. The trial court agreed and dismissed the Hospital’s complaint and the MCO’s counterclaim for lack of subject matter jurisdiction. The Supreme Court reversed, holding (1) the UAPA requires exhaustion of administrative remedies in this matter to the extent that resolution of the parties’ claims would require the trial court to render a declaratory judgment concerning the validity or applicability of TennCare regulations; but (2) while the UAPA prohibits the trial court from rendering such declaratory relief absent exhaustion of administrative remedies, it does not address claims for damages. Remanded to the trial court with directions to hold the parties’ damage claims in abeyance pending resolution of administrative proceedings regarding the validity or applicability of the TennCare regulations at issue. View "Chattanooga-Hamilton County Hosp. Auth. v. UnitedHealthcare Plan of the River Valley, Inc." on Justia Law
Plaintiffs filed this action against Defendant, a licensed clinical social worker, alleging negligence, negligence per se, and intentional infliction of emotional distress for providing counseling services for their minor daughter without their consent. Defendant filed a motion to dismiss based on Plaintiffs’ failure to comply with the pre-suit notice and certificate of good faith requirements of the Tennessee Health Care Liability Act (“THCLA”). Plaintiffs responded that their claims were not subject to the THCLA’s procedural requirements because their claims sounded in ordinary negligence. The trial court dismissed all of Plaintiffs’ claims, concluding that the THCLA encompassed Plaintiffs’ claims because they related to the provision of “health care services” by a “health care provider.” The Court of Appeals vacated the trial court’s order and remanded, concluding that the trial court erred by failing to apply the Supreme Court’s analysis in determining if Plaintiffs’ claims sounded in ordinary negligence or health care liability. The Supreme Court reversed the Court of Appeals, holding (1) the Tennessee Civil Justice Act of 2011, which amended the THCLA, statutorily abrogated the Court’s decision in Estate of French; and (2) Plaintiff’s complaint was subject to the THCLA, which required them to provide pre-suit notice and a certificate of good faith. View "Ellithorpe v. Weismark" on Justia Law
Decedent died following complications that arose when she received anesthesia. Decedent's husband (Plaintiff) filed suit against various health care providers, including Defendant, which contracted with the hospital to provide anesthesia services to its obstetric patients. Plaintiff alleged that Defendant was vicariously liable for the negligent acts of its corporate owner and president, a medical doctor, who was on call the night Decedent received the anesthesia but refused to come to the hospital to administer the anesthesia. Defendant failed to raise the statute of repose as a defense to the vicarious liability claim. After a jury trial, the trial court set aside the verdict for Defendants and granted a new trial. Defendant then moved to amend its answer to assert a repose defense and to dismiss the case based on the statute of repose. The trial court denied Defendant's motions, ruling that Defendant had waived the statute of repose defense. The Supreme Court affirmed, holding that Defendant failed to timely raise the statute of repose as an affirmative defense. View "Pratcher v. Methodist Healthcare Memphis Hosps." on Justia Law
Plaintiffs filed a claim against a county hospital (Hospital) alleging that the negligence of the hospital and its employees caused the death of their son. The claim was filed fifteen months after Plaintiffs' son's death. Hospital, a governmental entity, filed a motion to dismiss, arguing that the claim was filed outside the one-year statute of limitations of the Governmental Tort Liability Act (GTLA). Plaintiffs argued that their complaint was timely filed because Tenn. Code Ann. 29-26-121(c) extends the GTLA statute of limitations by 120 days. The trial court denied Hospital's motion to dismiss but granted an interlocutory appeal. The court of appeals affirmed the denial of the motion to dismiss. The Supreme Court reversed, holding that the 120-day extension provided by section 29-26-121(c) did not apply to Plaintiffs' claim brought under the GTLA. Remanded for entry of an order dismissing the complaint. View "Cunningham v. Williamson County Hosp. Dist." on Justia Law
When the nursing staff at the assisted living facility where Mable Farrar lived did not give Farrar an over-the-counter medicine for constipation as often as her doctor had prescribed, Farrar became constipated. Thereafter, Farrar's doctor notified the staff at the facility to give Farrar three to four enemas each day. A facility nurse gave Farrar only two enemas in three days. Farrar subsequently died of a perforated colon. Farrar's daughters filed a wrongful death action against the nurse who gave the enemas, the director of nursing at the facility, the owner of the facility, and the facility's management company. The jury found the management company fifty percent at fault based on its failure to provide sufficient personnel at the facility. The court of appeals reversed the jury verdict against the management company, finding that there was no material evidence that staffing deficiencies proximately caused Farrar's death. The Supreme Court reversed the court of appeals and reinstated the jury verdict, holding that material evidence supported the jury's finding that the management company's conduct was a substantial factor in causing Farrar's death. Remanded for review of the award of punitive damages. View "Wilson v. Americare Sys., Inc." on Justia Law
The Tennessee Board of Medical Examiners suspended Dr. Joseph Rich's medical license for one year and imposed other conditions after finding that, among other things, the physician had violated Tenn. Code Ann. 63-6-214(b)(1)(4) and (12). The chancery court affirmed the Board's judgment. The court of appeals reversed because the Board failed to articulate the applicable standard of care in its deliberations. The Supreme Court (1) held that the Board was required by Tenn. Code Ann. 63-6-214(g) to articulate the applicable standard of care in its deliberations; (2) vacated the ruling of the trial court to the extent that it affirmed the Board's decision that Rich had violated sections 63-6-214(b)(1)(4) and (12); (3) vacated the judgment of the court of appeals to the extent it reversed the Board's findings that Rich violated sections 63-6-214(b)(1)(4) and (12); and (4) rather than reversing the Board's findings of violations, remanded the matter to the Board with instructions to conduct deliberations based on the existing record and articulate the applicable standard of care as required by the statute.
Posted in: Government & Administrative Law, Health Law, Professional Malpractice & Ethics, Tennessee Supreme Court
At issue in this case was the applicable standard that courts should use in determining whether a medical expert is qualified to testify as an expert witness in a medical malpractice case. Donna Shipley filed a medical malpractice action against two doctors and a hospital, alleging various claims for medical negligence. The trial court granted the hospital and one doctor summary judgment. After disqualifying Shipley's medical experts, the trial court granted summary judgment to the remaining defendant, Dr. Williams, and dismissed Shipley's case. The court of appeals upheld the trial court's decision to disqualify Shipley's medical experts but reversed the grant of summary judgment on Shipley's negligence claims. The Supreme Court (1) reversed the trial court's judgment disqualifying Shipley's medical experts; (2) reversed the judgment of the court of appeals in part and reinstated summary judgment in Dr. Williams' favor on one of Shipley's negligence claims; and (3) vacated the trial court's order granting summary judgment on Shipley's remaining claims. Remanded.
Employee injured his shoulder while working for Employer. After Employee returned to work, he filed a claim for workers' compensation benefits. Employee and Employer settled Employee's claim. The settlement stated that the award of vocational disability benefits to which the parties agreed was not based on the medical impairment rating of either the treating physician or Employee's independent medical examiner. After Employee was laid off, he sought reconsideration of his benefits. The chancery court awarded additional permanent disability benefits based on an impairment rating computed from the percentage of permanent partial disability reflected in the settlement. Employer appealed. At issue was whether the chancery court erred in declining to apply any of three impairment ratings assigned by physicians after the original settlement. The Supreme Court affirmed, holding (1) a court's reconsideration of a workers' compensation award is limited to a determination of additional permanent partial disability based on the employee's impairment rating at the time of the initial award or settlement, and therefore, the chancery court properly computed the medical impairment rating; and (2) the award was not excessive.
Posted in: Government & Administrative Law, Health Law, Labor & Employment Law, Tennessee Supreme Court
Employee injured her right shoulder in the course of her employment with Employer. Employee received medical treatment, during which time she continued to work for Employer. Employee filed a complaint in chancery court seeking workers' compensation benefits from her Employer. At trial, the parties contested the extent of Employee's anatomical impairment and permanent disability. The medical evidence at trial consisted of the testimony of two physicians, and through their testimony, the parties introduced Employee's medical records generated by other treating physicians. The physicians assigned varying degrees of impairment to the body as whole. The trial court eventually chose the evaluating physician's impairment, who assigned a seventeen percent impairment, and awarded Employee 25.5 percent permanent partial disability to the body as a whole. Employer appealed, arguing that the evaluating physician's rating did not comply with the American Medical Association Guides and that the award was therefore excessive. The Supreme Court affirmed, holding that the trial court did not abuse its discretion by accepting the evaluating physician's impairment rating as the basis of the disability award.
After Employee sustained an injury, he filed a worker's compensation action against Employer. The result was a court-approved workers' compensation settlement. Employee's authorized treating physician later recommended medical treatment. After Employer's utilization review provider denied approval of the proposed treatment, Employer filed a motion for an independent medical examination, pursuant to Tenn. Code Ann. 50-6-204(d)(1), which is required if reasonable. The trial court found Employer's request to be unreasonable and denied the motion. On appeal, the Special Workers' Compensation Appeals Panel reversed the judgment of the trial court, holding (1) Employer had good faith reasonable basis for questioning both the causation and the necessity of the proposed treatment and for filing a motion for a physical examination of Employee; and (2) the trial court abused its discretion in finding that Employer's request for a medical examination of Employee was unreasonable. Remanded.