Justia Health Law Opinion Summaries

The Federal Trade Commission found that a merger between a health system and a hospital violated the Clayton Act, 15 U.S.C. 18. Plaintiffs sought treble damages and certification of a class of patients and third-party payors who allegedly paid higher prices for care. Under FRCP 23(b)(3), a class may be certified only if questions of law and fact common to members predominate over questions affecting only individuals in the class. Plaintiffs proposed to rely on economic and statistical methods used by the FTC and defendant's economic experts to analyze antitrust impact. The "difference-in-differences" method estimates price increases resulting from exercise of market power rather than from other factors. The district court denied certification, concluding that the expert had not shown that his methodology could address impact on a class-wide basis. The Seventh Circuit granted interlocutory appeal, vacated, and remanded. Although plaintiffs' expert initially believed that the health system did increase prices uniformly across all services, he acknowledged that it might not have done so, and explained how his methodology could show impact to the class despite such complications. The degree of uniformity the court demanded is not required; "it is important not to let a quest for perfect evidence become the enemy of good evidence."

A medical provider filed proofs of claim in about 3,200 bankruptcy cases, 2003-2008, listing the debtors' medical treatment information. The filings were public and available on the docket. Debtors filed class action suits under a statute that allows individuals to sue if their health care records are disclosed without permission, Wis. Stat. 146.84. The bankruptcy judge granted the provider summary judgment. The Seventh Circuit dismissed and remanded for lack of jurisdiction. Bankruptcy judges lack authority under Article III of the Constitution to enter final judgments on claims that constitute "the stuff of the traditional actions at common law." The debtors' claims are based on a state law that is "independent of the federal bankruptcy law" and not necessarily resolvable by a ruling on the creditor’s proof of claim in bankruptcy.

Plaintiff injured his back while working for defendant. Following worker's compensation leave, he returned to work as a long-haul driver and worked without incident for two years. With the birth of his child, he asked to switch to a city route. After the switch, plaintiff began having problems with his back and asked to switch back, but the collective bargaining agreement did not allow another change within a year, so the request was denied. He took medical leave, but sought to return to work as a long-haul driver, presenting a medical release which limited him to "road driver work" and "limited dock work." Defendant would not allow plaintiff to return, saying that it needed clarification on medical restrictions and that he could not return to work as a driver unless he received a medical release without restrictions. The district court granted employer summary judgment in a suit under the Americans with Disabilities Act, 42 U.S.C. 12102(2). The Seventh Circuit affirmed. Plaintiff is not substantially limited in the major life activity of working because he is capable of long-haul driving; at most, he is unable to work as a city driver because it involves short hauls and dock work that requires him to frequently load and unload cargo.

Medicare Part A reimburses hospitals according to a Prospective Payment System (42 U.S.C. 1395ww(d), which uses a predetermined formula to calculate reimbursement for each patient discharge without regard to the actual cost incurred. The formula includes the average hourly wage of the employees in the geographic region, including paid lunch hours. Hospitals objected to the practice because some hospitals give paid lunch breaks, which depresses the average area hourly wage and, in turn, their Medicare reimbursements. The district court granted summary judgment for the government. The Seventh Circuit affirmed, reasoning that counting all paid hours, for the sake of administrative simplicity, is not arbitrary.

An inmate began suffering from pain in his groin after an injury in 2004. Staff at the prison health unit recognized that his pain was caused by an inguinal hernia but gave him only mild pain medication. The inmate complained and was examined by a doctor who pushed the hernia back into his abdomen and refused a request for surgery. For several months the condition worsened, with a visible bulge and pain, but medical staff continued to refuse surgery. The inmate filed suit under 42 U.S.C. 1983. The district court dismissed prior to service. The Seventh Circuit reversed with respect to the physicians and remanded for determination of whether their response to more than two years of complaints has been blatantly inappropriate in the face of the inmate's pain and the risk the worsening hernia poses to his present and future health.

Defendant was the pharmacy director of a medical center and had influence over decisions concerning which drugs to stock. Levato was the local business manager of a pharmaceutical company. Levato agreed to pay defendant $18,000 not to switch away from his company's drug, and made computer entries recording nine nonexistent speeches given by defendant for the pharmaceutical company; defendant later received another $14,000 for more fictitious speeches. After investigation by an FDA agent, Levato and defendant were indicted. Levato plead guilty and testified against defendant. Defendant was convicted of solicitation and receipt of kickbacks and sentenced to 22 months in prison. The Seventh Circuit affirmed. Memoranda prepared by the Department of Health and Human Services, discovered by the prosecution after trial, did not constitute exculpatory material withheld by the prosecution. The court noted that the documents would have strengthened the prosecution case.

Plaintiff had previously worked for the employer before being hired as a full-time employee in 2005. When budget cuts necessitated layoffs, plaintiff thought his job was secure until he requested leave for surgery and was let go. The district court entered summary judgment for employer on claims under the Family and Medical Leave Act, which guarantees employees 12 workweeks of leave for serious health conditions, including the knee surgery plaintiff had, 29 U.S.C. 2612(a)(1). The Seventh Circuit reversed. Because there was evidence from which a jury could infer that termination was based on the leave request, summary judgment was inappropriate. A memo made by a supervisor, for purposes of discussing the termination with the employer's attorney, did not fit within the crime-fraud exception and is protected by attorney-client privilege.

In attempting to enroll his infant daughter, a covered employee failed to complete parts of the form indicating whether the child resided with employee, was dependent upon employee for more than 50 percent support and maintenance, and whether the child qualified to be claimed as a tax exemption on employee's federal tax return. The plan made several inquiries before sending a notice that coverage was denied. The employee did not appeal. The plan sued under the Employee Retirement Income Security Act , 29 U.S.C. 1001, to recover $472,357.84 paid to the medical college and $1,199,538.58 paid to the hospital on behalf of the child. The district court dismissed. The Seventh Circuit affirmed dismissal of the ERISA claim. The plan reserves the right to recover against "covered persons" if it has paid them or any other party on their behalf. Neither the treating entities nor the child are covered persons. Because the plan is not implicated, state law claims were not preempted; the court reversed dismissal of those claims. Plaintiffs' position was not unreasonable; the district court abused its discretion in awarding attorney fees.

A newborn suffered severe brain damage because doctors failed to promptly diagnose and treat an infection contracted at his 2003 birth. He was born prematurely and certain tests, normally done during pregnancy, were not performed by the federally-subsidized clinic where the mother received care. The clinic and its doctors are deemed federal employees under the Federally Supported Health Centers Assistance Act, 42 U.S.C. 233(g)-(n), and shielded from liability under the Federal Tort Claims Act. In 2005 the parents filed suit in state court and, in 2006, HHS denied an administrative claim for damages. Within six months of the denial the case was removed to federal court. In 2010, the district court held that the claim was filed within the two year statute of limitations under the FTCA (28 U.S.C. 2401(b)) and awarded more than $29 million in damages against the government. The Seventh Circuit affirmed. A claim only accrues when a plaintiff obtains sufficient knowledge of the government-related cause of his injury; the plaintiffs were reasonably diligent.

In 2001 plaintiff received prenatal care from a clinic that receives federal funds. Its physicians and the clinic are deemed federal employees for purposes of malpractice liability, so that the United States could be substituted as a party to a suit. 28 U.S.C. 2679(d)(1); claims would be governed by the Federal Tort Claims Act, and neither would face liability. For complex situations, the clinic contracted with UIC for specialists. Plaintiff's baby died following a difficult delivery. She sued the clinic, its doctor, the delivery hospital, and two UIC physicians who assisted. The U.S. Department of Health and Human Services denied claims for damages. The district court entered summary judgment for the UIC doctors under the Illinois Good Samaritan Act, which shields physicians who provide "emergency care without fee to a person," 745 ILCS 49/25, but declined to dismiss the case against the government, which had been substituted for the clinic. The Seventh Circuit reversed, first holding that the district court had derivative jurisdiction. Although the salaried UIC doctors did not receive a direct financial benefit from the delivery, their employer billed the clinic for services. There was evidence that one doctor submitted a billing form with respect to the delivery; the other made a "bad faith" decision not to bill.