Justia Health Law Opinion Summaries

In 2011 Wisconsin reduced subsidies for the Wisconsin Care Program, which funds grants for organizations administering programs for disabled persons who live in group homes. The plaintiffs are developmentally disabled and suffered the largest cuts. Persons who had received smaller payments bore smaller cuts. For some (frail elderly) per capita payments increased. Plaintiffs claim that making larger absolute cuts for persons whose care is most expensive violated the Rehabilitation Act and the Americans with Disabilities Act and that reduction in payments increases the risk that they will be moved from group homes to institutions. The district judge noted that states have waived sovereign immunity with respect to the Rehabilitation Act, as a condition to receiving federal funds. The Supreme Court has held that the portions of the ADA that are not designed to implement disabled persons’ constitutional rights cannot be used to override states’ sovereign immunity. The district court concluded that the relevant provisions of the ADA do not concern the Constitution and that other claims were premature because no plaintiff has been moved to an institution. The Seventh Circuit affirmed, noting that without information about care provided to other disabled persons, there is no useful theory of discrimination. View "Amundson v. WI Dep't of Health Servs." on Justia Law

In the 1980s, the owners bought the Cottonwood seasonal campground in Cedar Grove, Indiana. Each of 50-80 campsites has a water spigot and sewer hookup for recreational vehicles. The property also has two restrooms with working toilets, sinks, and showers. In 1998, the Environmental Protection Agency (EPA) issued an Administrative Order under the Safe Drinking Water Act, 42 U.S.C. 300g-3(b), (g), finding that Cottonwood operated as a public water system and was required to sample its water system, and to notify any individuals who use the property of its past failure to monitor the water system. The owners tested the water only sporadically over the following years. They denied that the water system constituted a public water system under SDWA because the water spigots are marked as “Non-Potable,” so users would know that water is not provided for human consumption. The district court entered summary judgment, finding violation of SDWA. The Seventh Circuit dismissed an appeal, finding that the owners had not raised any of their appellate arguments in the district court. View "United States v. Ritz" on Justia Law

The Black Lung Benefits Act, 30 U.S.C. 901, originally included a “15-year presumption” that total pulmonary or respiratory impairment of a coal worker with 15 years of experience in the mines was due to pneumoconiosis (black lung). Congress removed this presumption in 1981, but in 2010 revived the presumption for claims filed after January 1, 2005, still pending on or after March 23, 2010. Bailey, employed by Consolidation Coal for 26 years, also smoked cigarettes for many years. He was diagnosed with chronic obstructive pulmonary disease and sought benefits. Three claims were considered during the interval when the 15-year presumption was withdrawn. Two were denied, and he withdrew a third. For his current claim, filed in 2007, three doctors agreed that Bailey is totally disabled by COPD. Because of the rejected claims, Bailey was required to show a change in condition. An ALJ, using the 15-year presumption, held that Bailey can now establish pneumoconiosis caused in part by coal dust exposure, two elements deficient in earlier claims, and awarded benefits. The Benefits Review Board affirmed. The Seventh Circuit affirmed. The ALJ correctly applied the 15-year presumption, addressed evidence relating to Bailey’s health and smoking history, and delivered a rational decision, supported by substantial evidence. View "Consolidation Coal Co. v. Dir., Office of Workers Comp. Programs" on Justia Law

From 1981 to 1989, Schultz worked painting equipment, floors, walls, ceilings, and pipes at AMC company plants. In 2005 he was diagnosed with acute myeloid leukemia (AML). He died 2006. His wife sued paint companies, alleging that the companies produced or distributed the paint Schultz used at work and that benzene from the paints caused his disease. She offered reports from two experts: Stewart, an industrial hygienist, who reconstructed Schultz’s work with the paints to quantify his benzene exposure, and Gore, an oncologist, who testified that benzene is generally known to cause AML and specifically was a substantial factor in the development of Schultz’s disease. The district court granted the companies summary judgment on the ground that Gore’s testimony was scientifically unreliable; without that evidence, Schultz had no way of linking his disease to the paints. The Seventh Circuit reversed in part, holding that the district court erred in excluding Gore’s testimony. View "Schultz v. Glidden Co." on Justia Law

In 1987, Kenseth underwent surgical gastric banding, covered by her insurer. About 18 years later Dr. Huepenbecker, advised another operation for severe acid reflux and other problems resulting from the first surgery. Her employer provided insurance through Dean, a physician-owned integrated healthcare system, specifically excluding coverage for “surgical treatment or hospitalization for the treatment of morbid obesity” and services related to a non-covered benefit or service. Plan literature refers coverage questions to the customer service department. Huepenbecker worked at a Dean-owned clinic, scheduled surgery at a Dean-affiliated hospital, and instructed Kenseth to call her insurer. Kenseth spoke with a customer service representative, who stated that Dean would cover the procedure. After the surgery, Dean declined coverage. Kenseth was readmitted for complications. Dean denied coverage for the second hospitalization. Kenseth pursued internal appeals to obtain payment of the $77,974 bill before filing suit under ERISA, 29 U.S.C. 1001, and Wisconsin law. The district court granted Dean summary judgment. The Seventh Circuit affirmed as to estoppel and pre-existing condition claims, but remanded concerning breach of fiduciary duty. After the district court again entered summary judgment for Dean, the Supreme Court decided Cigna v. Amara, clarifying relief available for a breach of fiduciary duty in an ERISA action. The Seventh Circuit remanded, stating that Kenseth has a viable claim for equitable relief. View "Kenseth v. Dean Health Plan, Inc." on Justia Law

Natale,a vascular surgeon, was compensated by Medicare for repairing a patient’s aortic aneurysm. Another doctor reviewed the post-surgical CT scan, which did not match the procedure Natale described in his operative reports. After an investigation, Natale was indicted for health care fraud related to his Medicare billing, mail fraud, and false statements related to health care. A jury acquitted Natale on the fraud counts but convicted him of making false statements, 18 U.S.C. 1035. The trial court used jury instructions that seemingly permitted conviction for false statements completely unrelated to Medicare reimbursement. The Seventh Circuit affirmed, finding the error harmless, but clarified that under the statute, even conviction for false statements made in connection with items or services still must relate to a “matter involving a health care benefit program.” View "United States v. Natale" on Justia Law

Basden was hired as a PTI dispatcher in 2007, subject to an attendance policy that did not differentiate between absences for medical reasons and other absences. Basden had two absentee incidents in 2007. In January 2008, Basden became dizzy and fell in her home. A CT scan suggested that she might have multiple sclerosis. She was considered to have five absence incidents following her fall, prompting a verbal warning. Absences in April were treated as a sixth incident, resulting in a written warning. She began to feel numbness in her hands she asked to be relieved of assignments that required additional typing. The company moved her back to dispatcher, but eventually returned her to the typing duties. At her request, Basden was moved to a part-time position. Basden was absent again in May and was suspended for three days. Her request for leave was denied and she did not return to work. Her employment was terminated. In her suit under the Americans With Disabilities Act and the Family and Medical Leave Act, the district court found that Basden had failed to establish a prima facie right to the protection of either statute and granted PTI summary judgment. The Seventh Circuit affirmed. View "Basden v. Prof'l Transp., Inc." on Justia Law

Under the Federal Mine Safety & Health Act of 1977, the Secretary of Labor protects the health and safety of miners, acting through the Federal Mine Safety and Health Administration (MSHA). Regulations under the Act require mine operators to report all mine-related injuries and illnesses suffered by employees. In 2010, MSHA acted on a new and broader interpretation and informed 39 mine operators that they would be required to permit MSHA inspectors to review employee medical and personnel records during inspections. Two operators refused to provide the records. MSHA issued citations and imposed penalties. An ALJ and the Review Commission found that the demands and enforcement were lawful under 30 U.S.C. 813(h) and 30 C.F.R. 50.41. Mine employees intervened to raise personal privacy challenges. The Seventh Circuit denied a petition for review, rejecting arguments that MSHA does not have authority for the requirement; that 30 C.F.R. 50.41 is not a reasonable interpretation of the Act and was not properly promulgated; that the requirement infringes operators’ Fourth Amendment right not to be searched without a warrant; that the demands violate the miners’ Fourth Amendment privacy rights in their medical records; and that penalties imposed for noncompliance violate the operators’ Fifth Amendment due process rights. View "Bickett v. Fed. Mine Safety & Review Comm'n" on Justia Law

Cloe started working for the City of Indianapolis in 2007 as an Unsafe Buildings/Nuisance Abatement Project Manager. In 2008, she was diagnosed with multiple sclerosis, a chronic, incurable neurological disorder that rendered her disabled and significantly impaired her day-to-day life. In 2009, the city terminated her, ostensibly for poor performance. Cloe sued under the Americans with Disabilities Act, 42 U.S.C. 12101, alleging that the city discriminated against her because of her disability; failed to reasonably accommodate her disability; and retaliated against her for requesting accommodations. The district court granted summary judgment in favor of the city. The Seventh Circuit affirmed with respect to the reasonable accommodation claims, but reversed on the discrimination and retaliation claims, noting “suspicious timing, ambiguous statements oral or written, and other bits and pieces from which an inference of retaliatory intent might be drawn.” View "Cloe v. City of Indianapolis" on Justia Law

In 2008, Pepper, then 54 years old, applied for Supplemental Security Disability Insurance Benefits, alleging that she became unable to work in November 1998 as a result of numerous physical and mental impairments. The alleged onset date was later amended to October 2002, when Pepper last worked. Extensive medical records show that Pepper sought treatment for numerous health concerns over the years. At various times, Pepper has been assessed as having ongoing neck pain and limited range of motion in her neck, degenerative disc disease in her spine, left knee problems, migraine headaches, problems with her vision, diabetes, asthma, mitral valve prolapse, sciatica, dyslipidemia, hyperglycemia, hypertension, allergic rhinitis, obesity, plantar fasciitis in her left heel, caregiver stress, and depression. An ALJ denied the claim and the district court affirmed. The Seventh Circuit affirmed, rejecting arguments that the ALJ erred when addressing Pepper’s residual function capacity and that the ALJ’s credibility determination was inadequately supported and patently wrong. Substantial evidence supported denial of benefits. View "Pepper v. Astrue" on Justia Law