Justia Health Law Opinion Summaries

This appeal concerned the implementation of a federally-assisted Medicaid program by the Commonwealth of Puerto Rico, represented by its Secretary of Health. This was the sixth time the First Circuit Court of Appeals considered issues related to a dispute between the Commonwealth and several federally qualified health centers (FQHCs). The FQHCs here took to federal courts their claims for reimbursement payments owed to them under the Medicaid program. The district court, among other things, set a formula in place by way of a preliminary injunction that calculated payments the Commonwealth owed the FQHCs for providing Medicaid services. The First Circuit (1) concluded the formula that the district court endorsed in its preliminary injunction was not sufficiently supported by the factual record, and therefore, the Court remanded for further reformulation; (2) affirmed the district court's denial of the FQHCs' request for indemnification from debts owed to third party managed care organizations; and (3) affirmed the district court's determination that the Eleventh Amendment precludes a federal court from imposing a judgment for money damages upon the Commonwealth to make payments for periods predating the date of the district court's preliminary injunction. View "Consejo de Salud De La Communidad de Playa de Ponce, Inc. v. Gonzalez-Feliciano" on Justia Law

Plaintiff’s employment was terminated after she exhausted 12 weeks of medical leave and did not return to work. The employer had received a certification of health care provider indicating that she was "not incapacitated" and was "able to perform [her] job" on a normal work schedule with "no heavy lifting." The district court entered summary judgment in favor of her former employer on her claims of retaliation in violation of the Family and Medical Leave Act, 29 U.S.C. 2601-2654, and disability discrimination in violation of Massachusetts law, Mass. Gen. L. ch. 151B. The First Circuit affirmed. View "Henry v. United Bank" on Justia Law

In 1998, the city purchased a house, built before 1978, to provide storage. The seller provided a lead paint inspection report, based on a 1996 inspection, indicating the presence of lead-based paint. When the city sold the house in 2003, it provided a blank, pre-printed, standard lead-based paint disclosure form, which the buyer and his agent signed. The agent informed the buyer that the city would complete the form later. The city never completed the form nor did it turn over the 1996 report. The buyer moved into the home with his family. In 2008, tests taken at his son's two-year physical revealed an elevated blood lead level. The state of New Hampshire performed an inspection, which revealed lead-based paint hazards. In 2010, more than six years after the purchase, the buyer sued under 42 U.S.C. 4852d, which requires disclosure of lead-based paint hazards in sales of homes built before 1978. He alleged that he had received an estimate of approximately $126,000 to perform abatement. The district court granted summary judgment in favor of the city based on a three-year limitations period. The First Circuit affirmed. The claim accrued when the city failed to disclose. View "Randall v. Laconia, NH" on Justia Law

A doctor filed a qui tam action under the False Claims Act, 31 U.S.C. 3729, against Brigham and Women's Hospital, Massachusetts General Hospital and doctors, claiming violation of the Act by including false statements in a grant application, concerning neurodegenerative illness associated with aging, submitted to the National Institute on Aging in the National Institutes of Health, an agency of the U.S. Department of Health and Human Services, and that defendants, knowing of the falsity, failed to take corrective action. The district court granted defendants summary judgment. The First Circuit vacated. The district court abused its discretion by excluding or failing to consider certain expert testimony and erred by failing to consider statements of the parties and experts as required by the summary judgment standard. The dispute was not about which scientific protocol produces results that fall within an acceptable range of "accuracy" or whether re-measurements, the basis for preliminary scientific conclusions, were "accurate" insofar as they fall within a range of results accepted by qualified experts, but whether there was intentional falsification. View "Jones v. Brigham & Women's Hospital" on Justia Law

Plaintiff's doctor prescribed, for shoulder pain, sulindac, a non-steroid anti-inflammatory, under the brand-name Clinoril; her pharmacist dispensed generic sulindac. She developed a hypersensitivity reaction, toxic epidermal necrolysis, with which the outer skin layer on a patient's body has deteriorated, been burned off or turned into an open wound. Plaintiff spent 70 days at Massachusetts General Hospital, more than 50 in its burn unit, with 60-65 percent of her skin affected. Her "truly horrific" injuries include permanent near-blindness. Her claims against the manufacturer included breach of warranty, fraud, and negligence, and products liability claims: design defect, failure to warn, and manufacturing defect. By trial, the remaining theory of design defect was narrowed to a claim that sulindac's risks outweighed its benefits making it unreasonably dangerous to consumers, despite the FDA having never withdrawn its statutory "safe and effective" designation. A jury awarded $21.06 million in compensatory damages. The First Circuit affirmed, rejecting claims including that the district court misunderstood New Hampshire law on design defect claims; that such claims as to generic drugs are preempted under federal law; that causation was not proved; and that damages were excessive and required a new trial. .View "Bartlett v. Mut. Pharm. Co., Inc." on Justia Law

Plaintiffs are a dissident group, within a larger class of medical patient consumers in a case alleging fraud in overcharging for the medication Lupron. The patients, along with insurers and private health care providers, obtained a $150 million settlement agreement that was approved by the district court, of which $40 million was allocated to consumers. That agreement provided that if there were unclaimed monies from the $40 million consumer settlement pool after full recovery to consumer plaintiffs, all unclaimed funds would go into a cy pres fund to be distributed at the discretion of the trial judge. Dissident plaintiffs appealed distribution of the $11.4 million cy pres fund to the Dana Farber/Harvard Cancer Center and the Prostate Cancer Foundation for work on the treatment of the diseases for which Lupron is prescribed. They have already recovered more than 100% of their actual damages. The First Circuit affirmed. After expressing concern about distribution of such funds by judges and adding an audit requirement, the court noted the importance of avoiding windfalls for plaintiffs who have already been fully compensated. View "Rohn v. Dana Farber/Harvard Cancer Ctr." on Justia Law

Named plaintiffs sought to represent potential classes of hospital employees, some covered by collective bargaining agreements and others not, claiming that they were deprived of compensation for work performed during meal breaks, before and after shifts, and during training sessions. One case asserted only state law tort and regulatory claims; the other raised claims under the Fair Labor Standards Act, 29 U.S.C. 206-207, and the Employee Retirement Income Security Act, 29 U.S.C.1059(a)(1), 1104(a)(1). The district court dismissed. The First Circuit affirmed in part. The state law claims were properly removed to federal court and were preempted because many were dependent on the terms of a collective bargaining agreement. The federal law claims, dismissed for failure to identify specific employers, were remanded to permit amendment. View "Cavallaro v. UMass Mem'l Health Care,Inc." on Justia Law

Plaintiffs, seeking to represent a class, alleged failure to compensate them for work performed during their meal break and before and after shifts, and for time spent attending training sessions, in violation of the Fair Labor Standards Act, 29 U.S.C. 206-207; the Employee Retirement Income Security Act, 29 U.S.C. 1059(a)(1), 1104(a)(1); and the Racketeer Influenced and Corrupt Organizations Act, 18 U.S.C. 1962, 1964(c). The district court held that the FLSA claim was deficiently pled, and that this was fatal to the complaint because the ERISA and RICO claims were derivative of the FLSA claim. The court found the allegation of under-compensation insufficient, given the lack of any information on plaintiffs' approximate weekly wages and hours worked, or even an allegation that they had worked in excess of 40 hours in any workweek. The First Circuit vacated. The allegations were insufficient under the FLSA, but plaintiffs should be permitted to amend. View "Pruell v. Caritas Christi" on Justia Law

In 2003, the New Hampshire Department of Health and Human Services and a certified class of Medicaid-eligible children reached a settlement agreement and proposed a consent decree that outlined the Department's obligations to provide dental services to Medicaid-enrolled children in accordance with federal law. The district court approved the Decree in 2004. Between 2007 and 2010, the district court denied four motions alleging that the Department was not in compliance. The First Circuit affirmed, upholding the district court's requirement that the Class to file a motion for contempt to enforce the Decree; denial of a 2010 motion for contempt; denial of a request for an evidentiary hearing in 2010; and holding the Class to a clear and convincing burden of proof on its 2010 motion to modify or extend the Decree.

Plaintiff, who suffers epilepsy, began working as a part-time kitchen assistant in 1999. His episodes would cause him to leave work three to six times each year, but generally he just stepped back and resumed work after the episode passed. He was denied a full-time position, filed a complaint with the EEOC, and obtained a right-to-sue letter. The court rejected his suit under the Americans With Disabilities Act, 42 U.S.C. 12101, Title VII, and 42 U.S.C. 1983. The First Circuit affirmed, concluding that plaintiff was not substantially limited in his ability to work or in other work activities, within the meaning of the ADA,.