Justia Health Law Opinion Summaries

Bryn Mawr Chicago nursing home, a Medicaid provider, is subject to Illinois Department of Public Health (IDPH) inspections. In 2010, IDPH inspected the facility following allegations that a resident had been sexually assaulted. Bryn Mawr was eventually cited for three deficiencies, 42 C.F.R. 488.301, two based on sexual abuse and one based on failure to sufficiently monitor a resident. Bryn Mawr challenged the findings by Informal Dispute Resolution, which involved exchange of written information without a live hearing. IDPH simultaneously conducted internal review and found that the deficiencies based on allegations of sexual abuse were not sufficiently supported by credible evidence, but the third party upheld the deficiency findings. Ultimately IDPH maintained the deficiency findings. Meanwhile, Bryn Mawr also engaged in a parallel process to “correct” deficiencies. At the follow-up inspection, IDPH determined that the deficiencies had been corrected, so that remedies would not be imposed. IDPH passed the deficiency findings on to the Centers for Medicare and Medicaid Services, which published them on its website and factored them into its 5-Star Rating System. Bryn Mawr’s rating was supposed to fall from five to four stars because of the deficiencies, but CMS mistakenly reduced it to two stars. Regardless of a partial correction, Bryn Mawr was displeased that it had not had the opportunity to challenge the findings at a hearing and sued to compel a hearing. The district court granted summary judgment to defendants. The Seventh Circuit affirmed. View "Bryn Mawr Care, Inc. v. Sebelius" on Justia Law

In 2008, Shields, an Illinois prisoner was lifting weights and ruptured the pectoralis tendon in his left shoulder. Although he received some medical attention, he did not receive the prompt surgery needed for effective treatment. Due to oversights and delays by those responsible for his medical care, too much time passed for surgery to do any good. He has serious and permanent impairment that could have been avoided. After his release from prison, Shields filed suit under 42 U.S.C. 1983, alleging that several defendants were deliberately indifferent to his serious medical needs and violated his rights under the Eighth Amendment to the Constitution. The district court granted summary judgment in favor of the defendants. The Seventh Circuit affirmed, reasoning that Shields was the victim not of any one person’s deliberate indifference, but of a system of medical care that diffused responsibility for his care to the point that no single individual was responsible for seeing that he timely received the care he needed. As a result, no one person can be held liable for any constitutional violation. Shields’ efforts to rely on state medical malpractice law against certain private defendants also failed. View "Shields v. IL Dep't of Corrs." on Justia Law

In 2006 Buechel was incarcerated at FCI-Greenville federal correctional institution, where he contracted Methicillin-Resistant Staphylococcus aureus, (MRSA), a staph infection resistant to certain antibiotics. Buechel was hospitalized for more than 40 days and was left with serious and permanent damage to his heart and lungs. He sued under the Federal Tort Claims Act, 28 U.S.C. 1346(b), alleging that his injuries were caused by the prison’s negligence. The district court issued a pretrial order that limited Buechel’s negligence claim to a theory that he contracted MRSA from contact with one fellow inmate, in the prison laundry in July 2006, or more generally as a result of sloppy procedures in handling infected prison laundry. After a bench trial, the court held that Buechel had not proved that he contracted MRSA from either the inmate or the laundry procedures and entered judgment in favor of the government. The Seventh Circuit affirmed the finding that Buechel failed to prove that he contracted MRSA from the inmate or as a result of inadequate laundry procedures, but vacated and remanded for consideration of a broader theory. Buechel’s administrative claim and complaint presented a broader theory that the prison was negligent more generally in its failure to adhere to its MRSA-containment policies.View "Buechel v. United States" on Justia Law

The Affordable Care Act, 42 U.S.C. 300gg-13(a)(4), requires health insurance providers (including third party administrators) to cover certain preventive services without cost to the insured, including, “with respect to women … preventive care and screenings,” including all FDA-approved contraceptive methods, sterilization, and patient education for women with reproductive capacity. The University of Notre Dame self‐insures employees’ medical expenses; Meritain administers the employee health plan. For students’ medical needs, Notre Dame has a contract with Aetna. Because Catholic doctrine forbids the use of contraceptives, Notre Dame has never paid for contraceptives for employees or permitted Aetna to insure the expense of contraceptives. Because of those religious objections and the Religious Freedom Restoration Act, 42 U.S.C. 2000bb‐1(a), the government created a religious exemption, 45 C.F.R. 147.130(a)(1)(iv)). New regulations enlarged the exemption, so that Notre Dame came within its scope. To exercise its right to opt out of paying for coverage for contraceptives, the university completed a form that alerts insurers that Notre Dame is not going to pay, so they will have to pay. The government will reimburse at least 110 percent of the third‐party administrator’s costs and Aetna can expect to recoup its costs from savings on pregnancy medical care. Several months after the regulations were promulgated, the University unsuccessfully sought a preliminary injunction. The Seventh Circuit affirmed, noting that the University had not indicated exactly what it wanted enjoined at this stage. The insurance companies were not parties, and, therefore, could not be enjoined from providing the required coverage. A religious institution has no right to prevent other institutions from engaging in acts that merely offend the institution and the University has complied by completing the required form. View "Univ. of Notre Dame v. Sebelius" on Justia Law

Charlie has Type 1 diabetes, managed with an insulin pump, a personal diabetes manager, and a continuous glucose monitor. Before Charlie entered kindergarten, his parents worked with the school district to develop a “504 plan” to enable him to attend public school. Charlie’s plan incorporated doctor’s orders for how insulin doses and snacks would be administered at school; required his school to train three “Diabetes Personnel;” and that all staff members who would interact with Charlie be given general training about diabetes. The school hired a licensed nurse, to perform Charlie’s care and held one general training session and one session specific to Charlie’s equipment, attended by almost all staff who would interact with Charlie. In Charlie’s second year, the parents complained to the Department of Education that the school was violating the 504 plan by failing to have three Trained Diabetes Personnel and refusing to allow the nurse to adjust insulin doses on a case-by-case basis. A mediated agreement required the school to conduct training for three nurses and generally required the school to follow the 504 plan. The parents continued to be dissatisfied and moved Charlie to a private school with no medically trained staff and no formal plan for his diabetes care. The district court rejected their suit under the Rehabilitation Act, 29 U.S.C. 794, and the Americans with Disabilities Act, 42 U.S.C. 12132. The Seventh Circuit affirmed, finding neither intentional discrimination nor failure to reasonably accommodate Charlie’s diabetes.View "CTL v. Ashland Sch. Dist." on Justia Law

Chhibber, an internist, operated a walk‐in medical office on the south side of Chicago. For patients with insurance or Medicare coverage, Chhibber ordered an unusually high volume of diagnostic tests, including echocardiograms, electrocardiograms, pulmonary function tests, nerve conduction studies, carotid Doppler ultrasound scans and abdominal ultrasound scans. Chhibber owned the equipment and his staff performed the tests. He was charged with eight counts of making false statements relating to health care matters, 18 U.S.C. 1035, and eight counts of health care fraud, 18 U.S.C. 1347. The government presented witnesses who had worked for Chhibber, patients who saw him, and undercover agents who presented themselves to the Clinic as persons needing medical services. Chhibber’s former employees testified that he often ordered tests before he even arrived at the office, based on phone calls with staff. Employees performed the tests themselves with little training, and the results were not reviewed by specialists; normally, the tests were not reviewed at all. Chhibber was convicted of four counts of making false statements and five counts of health care fraud. The Seventh Circuit affirmed, rejecting challenges to evidentiary rulings. View "United States v. Chhibber" on Justia Law

In 2004 Spurling began working for C&M as a packer assigned to the third (night) shift. In 2009, she began to experience decreased consciousness and alertness, for which she received several disciplinary warnings. Spurling received a Final Warning/Suspension in February 2010 after she left her work site to use the restroom and did not return for more than 20 minutes. After her suspension, Spurling met with her manager and supervisors and indicated that her sleep issues were caused by a prescribed medication; she produced a note to the same effect. Spurling continued to experience difficulty remaining conscious at work and received a Final Warning/Suspension, Spurling informed human resources that her performance issues might be related to a medical condition. Although her doctor indicated that she had a disability, C&M concluded that she did not and terminated her employment. The district court entered summary judgment in favor of C&M, rejecting claims of violation of the Americans with Disabilities Act and of the Family and Medical Leave Act. The Seventh Circuit reversed in part. Spurling established disputed issues of material facts as to whether C&M failed to properly engage in the interactive process required by the ADA, but did not provide sufficient notice to establish a claim under the FMLA.View "Spurling v. C&M Fine Pack, Inc." on Justia Law

Dalton worked in coal mine jobs from 1957 until 1991 and was exposed to substantial coal and rock dust. He developed trouble breathing; he quit his job and was never employed again. In 1999 Dalton sought benefits under the Black Lung Benefits Act, 30 U.S.C. 901‐45. In 2003, an ALJ awarded benefits, finding that Dalton was a “miner,” that Frontier was the “responsible operator,” and that Dalton had established clinical pneumoconiosis, based on the opinions of pulmonary experts, but could not determine the date of onset of total disability, so Dalton’s benefits began in 1999. The Board vacated, finding that the ALJ had not properly evaluated CT scans. The ALJ again awarded benefits beginning in 1999. In 2007, the case was again remanded. A new ALJ reweighed the evidence and ordered benefits to begin in 1999. Dalton died in 2007. The ALJ denied a motion by Dalton’s children to substitute as claimant. The Board dismissed an appeal and a cross‐appeal. The District Director returned the case to its third ALJ, who allowed the children’s motion, modified the date for commencement of benefits to 1991, and awarded attorneys’ fees and expenses. The Board vacated with respect to the onset date. The Seventh Circuit remanded for entry of the 1991 onset date, rejecting a claim that the children lacked standing. Substantial evidence supported the ALJ’s finding that 1991 marked the time of onset for Dalton’s total disability on account of pneumoconiosis. View "Dalton v. Office of Workers' Compensation Programs" on Justia Law

In 2013, the Governor of Wisconsin signed into law a statute that prohibits a doctor, under threat of heavy penalties, from performing an abortion unless he has admitting privileges at a hospital no more than 30 miles from the clinic in which the abortion is performed. Wis. Stat. 253.095(2). Planned Parenthood and others challenged the law under 42 U.S.C. 1983. The district court entered a preliminary injunction against enforcement of the law. The Seventh Circuit affirmed. The court noted that the seven doctors affected by the law had applied for, but after five months, had not been granted, admitting privileges; that all Wisconsin abortion clinics already have transfer agreements with local hospitals to facilitate transfer of clinic patients to the hospital emergency room. A hospital emergency room is obliged to admit and to treat a patient requiring emergency care even if the patient is uninsured, 42 U.S.C. 1395dd(b)(1). Had enforcement of the law, with its one-weekend deadline for compliance, not been stayed, two of the state’s four abortion clinics would have had to shut down and a third clinic would have lost the services of half its doctors. View "Planned Parenthood of WI v. Van Hollen" on Justia Law

Garcia, previously a construction worker and then age 40, applied for social security disability benefits in 2010, claiming abdominal pain caused by cirrhosis of the liver, severe low platelet count, hepatitis C, and an umbilical hernia, all of which had been diagnosed by several physicians that year. All were caused or exacerbated by alcoholism, but he stopped drinking and alcoholism is no longer a “contributing factor” barring him from obtaining disability benefits, 42 U.S.C. 423(d)(2)(C). An ALJ ruled that Garcia is capable of doing limited sedentary work. The district court affirmed. The Seventh Circuit reversed, noting that Garcia would be a candidate for a liver transplant, but was not on the list because he was too sick for surgery. His platelet count was too low to for even a liver biopsy. Garcia has been repeatedly hospitalized and treated for pain with morphine and other opium derivatives, with limited success. He has lupus, anemia, colitis, anxiety and other psychological problems, and chronic fatigue. One physician described Garcia’s condition as “chronic and terminal.” The court stated that Garcia is “one of the most seriously disabled applicants for social security disability benefits whom we’ve encountered in many years … We are surprised that the Justice Department would defend such a denial.” View "Garcia v. Colvin" on Justia Law