Justia Health Law Opinion SummariesArticles Posted in U.S. 6th Circuit Court of Appeals
Island Creek KY Mining v. Ramage
Ramage, born in 1933, worked for Island Creek for 28 years, five years underground and 23 years on the surface. In 2007 he sought black lung benefits. While the claim was pending, Congress revived a statutory rebuttable presumption that a coal miner who worked in an underground coal mine for 15 years and suffers from a total respiratory or pulmonary disability is presumed to be totally disabled due to pneumoconiosis, 30 U.S.C. 921(c)(4), applicable to pending claims filed after January 1, 2005. The ALJ noted that x-rays did not show pneumoconiosis, that Ramage could not complete a pulmonary function test due to a tracheostomy, and that arterial blood-gas studies were qualifying under the federal standards. The ALJ summarized the medical opinions of five doctors, including one who emphasized that it was impossible to distinguish between the damage due to coal dust as opposed to the damage due to smoking. The ALJ awarded benefits and the Benefits Review Board affirmed. The Sixth Circuit denied a petition for review, holding that the ALJ’s determinations were reasoned and reasonable and that the legislative provisions creating the presumption are self-executing.View "Island Creek KY Mining v. Ramage" on Justia Law
United States v. Volkman
Volkman, an M.D. and a Ph.D. in pharmacology from University of Chicago, was board-certified in emergency medicine and a “diplomat” of the American Academy of Pain Management. Following lawsuits, he had no malpractice insurance and no job. Hired by Tri-State, a cash-only clinic with 18-20 patients per day, he was paid $5,000 to $5,500 per week. After a few months, pharmacies refused to fill his prescriptions, citing improper dosing. Volkman opened a dispensary in the clinic. The Ohio Board of Pharmacy issued a license, although a Glock was found in the safe where the drugs were stored. Follow-up inspections disclosed poorly maintained dispensary logs; that no licensed physician or pharmacist oversaw the actual dispensing process; and lax security of the drug safe. Patients returned unmarked and intermixed medication. The dispensary did a heavy business in oxycodone. A federal investigation revealed a chaotic environment. Cup filled with urine were scattered on the floor. The clinic lacked essential equipment. Pills were strewn throughout the premises. Months later, the owners fired Volkman, so he opened his own shop. Twelve of Volkman’s patients died. Volkman and the Tri-State owners were charged with conspiring to unlawfully distribute a controlled substance, 21 U.S.C. 841(a)(1); maintaining a drug-involved premises, 21 U.S.C. 856(a)(1); unlawful distribution of a controlled substance leading to death, 21 U.S.C. 841(a)(1) and 841(b)(1)(C), and possession of a firearm in furtherance of a drug-trafficking crime, 18 U.S.C. 24(c)(1) and (2). The owners accepted plea agreements and testified against Volkman, leading to his conviction on most counts, and a sentence of four consecutive terms of life imprisonment. The Sixth Circuit affirmed. View "United States v. Volkman" on Justia Law
Eden Foods, Inc v. Sebelius
The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, collectively, the Affordable Care Act require that most businesses employing 50 or more individuals provide female employees with health-insurance coverage that includes, at no cost to the employee, “such additional preventive care and screenings . . . as provided for in comprehensive guidelines supported by the Health Resources and Services Administration.” 42 U.S.C. 300gg-13(a)(4). Those guidelines require plans to cover “[a]ll Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for women with reproductive capacity.” Eden Foods, Inc., and Potter sought an injunction to prevent federal agencies from enforcing that mandate against them. They contend that offering such contraceptive services to the employees of Eden Foods would substantially burden the plaintiffs’ religious beliefs and contravene protections under the Religious Freedom Restoration Act, 42 U.S.C. 2000bb–2000bb-4 (RFRA). The district court denied relief. The Sixth Circuit affirmed. A for-profit corporation is not a “person” capable of religious exercise as intended by RFRA and individual shareholders/owners of a corporation have no standing to challenge provisions of laws that the corporation must obey. View "Eden Foods, Inc v. Sebelius" on Justia Law
S. Rehab. Grp. v. Sec’y of Health & Human Servs.
Southern Rehabilitation Group and its medical director sued the Secretary of Health and Human Services and past and present Medicare contractors, seeking review of the Secretary’s final decision on 6,200 claims for Medicare reimbursement. The district court remanded so that the Secretary could pay the disputed amount. After payment, the case returned to the district court, which concluded that the claims for payment were moot and dismissed remaining constitutional and statutory claims as barred by jurisdictional provisions of the Medicare Act. The court also held that plaintiffs did not show that they were eligible to collect interest on their claims and that it did not have jurisdiction over 8,900 other claims that plaintiffs alleged were still in the administrative process. The Sixth Circuit affirmed summary judgment to defendants on plaintiffs’ federal and state law claims and on the 8,900 claims still in the administrative process, but reversed summary judgment on plaintiffs’ claims for interest. The Secretary could not rely on her unreasonable interpretation of the “clean-claims” statute as a basis for summary judgment concerning interest. View "S. Rehab. Grp. v. Sec'y of Health & Human Servs." on Justia Law
Autocam Corp. v. Sebelius
Kennedy family members own a controlling interest in corporate entities that comprise Autocam. John Kennedy is Autocam’s CEO. The companies are for-profit manufacturers in the automotive and medical industries and have 661 employees in the U.S. The Kennedys are practicing Roman Catholics and profess to “believe that they are called to live out the teachings of Christ in their daily activity and witness to the truth of the Gospel,” which includes their business dealings. Regulations under the Patient Protection and Affordable Care Act of 2010 (ACA), 124 Stat. 119, require that Autocam’s health care plan cover, without cost-sharing, all FDA-approved contraceptive methods, sterilization, and patient education and counseling for enrolled female employees. Autocam and the Kennedys claim that compliance with the mandate will force them to violate their religious beliefs, in violation of the Religious Freedom Restoration Act, 42 U.S.C. 2000bb. The district court denied their motion for a preliminary injunction. The Sixth Circuit affirmed for lack of standing. Recognition of rights for corporations under the Free Speech Clause 20 years after RFRA’s enactment does not require the conclusion that Autocam is a “person” that can exercise religion for purposes of RFRA. View "Autocam Corp. v. Sebelius" on Justia Law
VanDiver v. Prison Health Servs., Inc.
Vandiver filed a pro se civil action against Prison Health Services (PHS) and five medical professionals, alleging that the defendants violated and are continuing to violate his Eighth Amendment rights by deliberate indifference to the health care needs associated with his serious chronic conditions, including Hepatitis C and diabetes and that as a result, he has undergone partial amputations of his feet and suffered visual impairment. He claimed that he is at risk of further injury, including additional amputations, coma, and death. He acknowledged having previously filed three complaints that were dismissed as frivolous. The district court denied his application to proceed in forma pauperis, applying the three-strikes rule, 28 U.S.C. 1915(g). The Sixth Circuit reversed and remanded, holding that alleging a danger of serious physical injury as a result of being presently denied adequate medical treatment for a chronic illness satisfies the imminent-danger exception to the three-strikes rule. Allegations of incremental harm culminating in serious physical injury may present a danger equal to that of an injury that occurs all at once. View "VanDiver v. Prison Health Servs., Inc." on Justia Law
Srouder v. Dana Light Axle Mfg., LLC
In 2006 White began working at a job that required him to lift parts weighing between 20 and 75 pounds. White was considered a good worker, but had consistent attendance problems. Between January 26, 2009, and September 24, 2009, White called in 19 absences for reasons, including emergency vacation leave, vacation leave, unpaid leave, and Family Medical Leave Act leave. White took FMLA leave in 2009 due to gout and unrelated back and foot pain. In September 2009, White began suffering complications related to abdominal surgeries following a 1995 car accident. On September 25, White’s surgeon scheduled his surgery for October 7. According to the employer, White did not use the word hernia and only indicated that he might be having surgery soon. White and his employer dispute whether he submitted paperwork concerning a restriction on lifting. White missed several more days and failed to call in, in violation of company policy, and was terminated. The district court entered summary judgment in favor of the employer. The Sixth Circuit affirmed. The FMLA expressly permits an employer to enforce its “usual and customary notice and procedural requirements for requesting leave,” 29 C.F.R. 825.302(d). View "Srouder v. Dana Light Axle Mfg., LLC" on Justia Law
Kinds v. OH Bell Tel. Co.
Kinds was assaulted and threatened by her live-in boyfriend. She requested time off to find a new place to live, but did not have vacation time available and was not eligible for Family and Medical Leave Act leave because she had worked less than 1,250 hours for her employer during the previous 12 months, 29 U.S.C. 2611(2)(A). The company granted her one week of discretionary leave. She returned to work for about a month, after which she was eligible for FMLA leave. She applied for leave the following day and returned part-time about two months later. Her employer notified the administrator of its short-term disability insurance plan. Three weeks into her leave, a licensed independent social worker diagnosed Kinds as having a severe depression episode. Following approval of disability benefits for part of Kinds’s absence, her employer approved the period after her diagnosis for FMLA leave and asked Kinds to submit medical certification for the period that was not approved. Neither Kinds nor her healthcare providers timely submitted documentation. After an extension, the employer denied FMLA leave, determined that Kinds’s absence during the period at issue was unexcused, and terminated Kinds’s employment. The district court dismissed her FMLA lawsuit. The Sixth Circuit affirmed. View "Kinds v. OH Bell Tel. Co." on Justia Law
Pipefitters Local 636 Ins. Fund v. Blue Cross & Blue Shield of MI
The Fund is a multi-employer trust fund under the Taft-Hartley Act, 29 U.S.C. 186, and the Employee Retirement Income Security Act, 29 U.S.C. 1001. Blue Cross is a Michigan non-profit corporation; its enabling statute authorizes the State Insurance Commissioner to require it to pay a cost transfer of one percent of its “earned subscription income” to the state for use to pay costs beyond what Medicare covers. In 2002 the Fund converted to a self-funded plan, and entered into an Administrative Services Contract with Blue Cross, which states that Blue Cross is not the Plan Administrator, Plan Sponsor, or fiduciary under ERISA; its obligations are limited to processing and paying claims. In 2004 the Fund sued, claiming that Blue Cross breached ERISA fiduciary duties by imposing and failing to disclose a cost transfer subsidy fee to subsidize coverage for non-group clients. The fee was regularly collected from group clients. Self-insured clients were not always required to pay it. Following a first remand, the district court granted class certification and granted the Fund summary judgment. On a second remand, the court again granted judgment on the fee imposition claim and awarded damages of $284,970.84 plus $106,960.78 in prejudgment interest. The Sixth Circuit affirmed. View "Pipefitters Local 636 Ins. Fund v. Blue Cross & Blue Shield of MI" on Justia Law
Peabody Coal Co. v. Dir., Office of Workers’ Comp.
Brigance worked as a coal miner for 20 years, until he stopped working in 1994 because of shortness of breath, which prevented him from obtaining other employment. Brigance obtained Kentucky state black lung benefits, which expired after about eight years. Brigance sought federal benefits under the Black Lung Benefits Act. An administrative law judge held that the claim was not barred by the Act’s three-year statute of limitations, 30 U.S.C. 932(f). The Benefits Review Board affirmed an award of benefits. The Sixth Circuit reversed. Brigance admitted that he had a medical determination of total disability (pneumoconiosis) seven years before filing his claim. View "Peabody Coal Co. v. Dir., Office of Workers' Comp." on Justia Law