Justia Health Law Opinion Summaries

In consolidated appeals, defendants appealed the denial of their motions for judgment on the pleadings where plaintiffs brought a diversity suit to enforce California Civil Code 2527 and 2528, which required defendants to supply the results of bi-annual studies of California's pharmacies' retail drug pricing for private uninsured customers to their clients, who were third-party payors such as insurance companies and self-insured employer groups. At issue was whether the court was bound by the Erie doctrine to follow the state appellate court decisions striking down section 2527 and if not, whether section 2527 violated the First Amendment or the California Constitution's free speech provision. The court held that the Erie doctrine did not require it to follow the state appellate court decisions and that section 2527 did not unconstitutionally compel speech under either the United States or California Constitutions. Accordingly, the court affirmed the judgment.

Appellant, a medicare provider, appealed its notice of program reimbursement for the fiscal year ending in 2001 to the Provider Reimbursement Review Board ("Board"), which dismissed the appeal because appellant missed its deadline to file a preliminary position paper. After the Board denied appellant's motion for reinstatement of its appeal, appellant filed the current action and subsequently appealed from the district court's order granting summary judgment for appellee. The court affirmed summary judgment and held that the Board's Instructions requiring dismissal of claims due to failure to timely submit preliminary position papers did not violate the Medicare Act, 42 U.S.C. 1395, and the Board's dismissal of appellant's claim was neither arbitrary or capricious.

Plaintiff applied at age 51 for supplemental security income based on disability. At issue was whether the administrative law judge ("ALJ") erred by failing to develop the record adequately and should have requested more explanation from two of plaintiff's treating physicians at the Department of Veterans Affairs ("VA"). The court held that the ALJ's failure to assist plaintiff in developing the record by getting his disability determination into the record was probably likely to have been prejudicial because the court gave VA disability determinations great weight. Therefore, the court remanded under sentence four of 42 U.S.C. 405(g), concluding that "the agency erred in some respect in reaching a decision to deny benefits."

Plaintiffs, two non-profit organizations, sought injunctive and declaratory relief to remedy the delays in the provision of mental health care and adjudication of service-connected death and disability compensation claims by the Department of Veterans Affairs ("VA"). At issue was whether these delays violated veterans' due process rights to receive the care and benefits they were guaranteed by statute for harms and injuries sustained while serving our country. While the court affirmed the district court's ruling, with respect to various claims for specific forms of relief under the Administrative Procedures Act ("APA"), 5 U.S.C. 500 et. seq., that the APA prevented the court from granting veterans the statutory relief they sought, the court reversed the district court's ruling on plaintiffs' constitutional claims and held that the VA's failure to provide adequate procedures for veterans facing prejudicial delays in the delivery of mental health care violated the Due Process Clause of the Fifth Amendment. The court further held that the district court erred in concluding that it lacked jurisdiction to review plaintiffs' due process challenge to delays and procedural deficiencies in the compensation claims adjudication system and that it erroneously denied plaintiffs' the relief to which they were entitled under the Due Process Clause.