Justia Health Law Opinion Summaries

The Supreme Court held that a reimbursement cap imposed by the Tennessee Department of Finance and Administration's Division of TennCare, the state agency tasked with administering the federal Medicaid program in Tennessee, was a "rule" within the meaning of the Uniform Administrative Procedures Act that should have been promulgated through the notice-and-comment process.Emergency Medical Care Facilities, P.C., a corporation compromised of private healthcare professionals who provide emergency-department services to TennCare enrollees, brought this action against TennCare alleging that TennCare's decision to impose a $50 cap on the amount that Emergency Medical and other healthcare professionals could recover from TennCare for certain treatment provided to TennCare enrollees was a rule and that TennCare violated the Tennessee Uniform Administrative Procedures act (UAPA) by implementing the cap without rulemaking. The chancery court granted summary judgment in favor of Emergency Medical. The court of appeals reversed, concluding that the $50 cap fell within the so-called "internal-management exception" to the UAPA. The Supreme Court reversed, holding that the $50 cap was a rule under the UAPA and should have been promulgated through notice-and-comment rulemaking. View "Emergency Medical Care Facilities, P.C. v. Division of Tenncare" on Justia Law

The Supreme Court reversed the judgments of the court of appeals and the trial court concluding that the Health Care Liability Act, Tenn. Code Ann. 29-26-101 to -122, did not apply to Plaintiffs' medical battery and intentional misrepresentation claims, holding that Plaintiffs' claims fell within the definition of a "healthcare liability action" under the Act.Plaintiffs sued a doctor and his medical practice alleging medical battery and intentional misrepresentation. Defendants filed a motion to dismiss on the grounds that Plaintiffs did not comply with the Act's pre-suit notice and filing requirements. The trial court agreed, ruling that Defendants' misrepresentations were made before they rendered any health care services and therefore did not relate to the provision of health care services. The court of appeals affirmed. The Supreme Court reversed, holding that the Act applied to Plaintiffs' claims. View "Cooper v. Mandy" on Justia Law

The Supreme Court held that the Tennessee Consumer Protection Act of 1977, Tenn. Code Ann. 47-18-101 to -132, applies to health care providers when they are acting in their business capacities and that Plaintiffs, who were consumers of medical services, may state a claim under the Act against the hospitals for conduct arising out of the hospitals' business practices.Plaintiffs received hospital medical services for injuries received in car accidents. The hospitals did not bill Plaintiffs' health insurance companies but, rather, filed hospital liens against Plaintiffs' claims for damages arising from the accidents. The liens were for the entire amount of the hospital bills and were not reduced for Plaintiffs' health insurance benefits. Plaintiffs brought this lawsuit, alleging that the filing of the discounted hospital liens was unlawful under the Act. The trial court dismissed the case for failure to state a cause of action. The court of appeals affirmed, concluding that the underlying transaction did not fit within the Act's definition of a "consumer transaction" as defined by the Act. The Supreme Court reversed, holding that Plaintiffs stated a cause of action under the Act. View "Franks v. Sykes" on Justia Law

The Supreme Court affirmed the judgment of the trial court dismissing Plaintiffs' health care liability action as time-barred, holding that Plaintiffs were not entitled to the 120-day extension of the statute of limitations due to their noncompliance with Tenn. Code Ann. 29-26-121 (section 121).Before Plaintiffs filed a health care liability action Plaintiffs attempted to comply with section 121 by notifying Defendants of their intent to file suit. Plaintiffs subsequently voluntarily nonsuited their lawsuit. Less than one year later, Plaintiffs filed a second lawsuit alleging the same health care liability claims against Defendants. To establish the timeliness of the second lawsuit, Plaintiffs relied on the savings statute. Defendants filed a motion to dismiss, arguing that Plaintiffs' pre-suit notice was not substantially compliant with section 121, and therefore, Plaintiffs were not entitled to the 120-day extension of the statute of limitations so that their first lawsuit was not timely filed. Therefore, Defendants argued, Plaintiffs' second lawsuit was untimely. The trial court dismissed the lawsuit. The Supreme Court affirmed the dismissal, holding (1) Plaintiffs failed to establish either substantial compliance or extraordinary cause to excuse their noncompliance with section 121; and (2) therefore, Plaintiffs could not rely on the one-year savings statute to establish the timeliness of their lawsuit. View "Martin v. Rolling Hills Hospital, LLC" on Justia Law

The Supreme Court held a doctor who was permitted to practice medicine in Tennessee under a statutory licensure exemption but was not licensed to practice in Tennessee or a contiguous state during the year before the date of the alleged injury or wrongful conduct does not meet the requirements of Tenn. Code Ann. 29-26-115(b) to testify as an expert witness in a health care liability action.Plaintiff brought this action against Thomas Killian, M.D. and Frist Cardiology, PLLC (collectively, Defendants) alleging that Defendants' negligent conduct caused her husband's death. Plaintiff named Dr. Jason A. Rytlewski as the expert witness who would testify that Dr. Killian deviated from the applicable standard of care in his treatment of the decedent. Defendants moved for summary judgment, asserting that Dr. Rytlewski did not have a medical license in Tennessee or a contiguous state the year before the decedent's heart procedure, as required by section 29-26-115(b). In response, Plaintiff explained that Dr. Rytlewski had been granted an exemption allowing him to practice medicine without a medical license. The trial court allowed Dr. Rytlewski's testimony. The Supreme Court reversed, holding that Dr. Rytlewski was not qualified to testify as an expert as an expert witness in this health care liability case. View "Young v. Frist Cardiology, PLLC" on Justia Law

The Supreme Court vacated the qualified protective order entered by the trial court in this case, holding that Tenn. Code Ann. 29-26-121(f) is unconstitutional as enacted to the limited extent that it divests trial courts of their inherent discretion over discovery and that the statute can be elided to make it permissive and not mandatory upon trial courts.Plaintiff filed this healthcare liability wrongful death lawsuit on behalf of the decedent alleging that Defendant's negligent treatment of the decedent resulted in the decedent's death. During discovery, Defendants filed a motion for a qualified protective order pursuant to section 29-26-121(f), which allows defense counsel to conduct ex parte interviews with patients' non-party treating healthcare providers in a healthcare liability lawsuit. In response, Plaintiff argued that the statute is unconstitutional because it deprives the trial court of its inherent authority over court proceedings. The trial court entered a written qualified protective order allowing the interviews. The Supreme Court vacated the qualified protective order, holding (1) section 29-26-121(f) impermissibly intrudes on the authority of the judiciary over procedural matters; and (2) the unconstitutional portion of the statute may be elided, and the statute as elided is constitutional. View "Willeford v. Klepper" on Justia Law

In this healthcare liability action, the Supreme Court affirmed the decision of the trial court denying Plaintiffs' motion to alter or amend after concluding that Plaintiffs' sole expert witness was not competent to testify on causation and granting summary judgment to Defendant, holding that the trial court's decision was within the range of acceptable alternative dispositions of the motion to alter or amend.In Plaintiffs' motion to alter or amend Plaintiffs proffered causation testimony from a new expert witness. The trial court denied the motion. The court of appeals reversed, concluding that the trial court abused its discretion. The Supreme Court reversed the decision of the court of appeals and reinstated the judgment of the trial court, holding that the court of appeals erred in holding that the trial court's denial of Plaintiffs' motion to alter or amend was an abuse of discretion because the trial court's decision was within the parameters of the court's sound discretion. View "Harmon v. Hickman Community Healthcare Services, Inc." on Justia Law

In this case alleging health care liability claims, the trial court erred by allowing Plaintiff to amend her complaint after the expiration of the statute of limitations to substitute as a defendant a health care provider to which Plaintiff had not sent pre-suit notice.The Supreme Court reversed the decisions of the trial court and court of appeals, holding that Plaintiff did not comply with the mandatory pre-suit notice provision of the Tennessee Health Care Liability Act, Tenn. Code Ann. 29-26-121(a)(1), because she did not give written pre-suit notice of the potential claim to the health care provider she later sought to substitute as a defendant after the expiration of the statute of limitations. View "Runions v. Jackson-Madison County General Hospital District" on Justia Law

A potential plaintiff who provides pre-suit notice to one potential defendant is not required under Tenn. Code Ann. 29-26-121(a)(2)(E) to provide the single potential defendant with a HIPAA-compliant medical authorization.Plaintiff sent a pre-suit notice of her healthcare liability claim to a single healthcare provider and included a medical authorization. Dr. Radwan Khuri moved to dismiss the case, asserting that Plaintiff had failed to povide a HIPAA-compliant medical authorization under section 29-26-121(a)(2)(E). The trial court granted Dr. Khuri’s motion and dismissed the complaint, concluding that the authorization provided by Plaintiff did not substantially comply with HIPAA or with the requirements of section 29-26-121(a)(2)(E) and that Defendant was prejudiced by Plaintiff’s deficient authorization. The court of appeals affirmed. The Supreme Court reversed and remanded the case to the trial court for further proceedings, holding that a HIPAA-compliant medical authorization was not required in this case because Plaintiff’s pre-suit notice was sent to a single provider. View "Bray v. Khuri" on Justia Law

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