Justia Health Law Opinion Summaries

Indiana’s 2015 Vapor Pens and E-Liquid Act regulates the manufacture and distribution of vapor pens and the liquids used in e-cigarettes, Ind. Code 7.1-7- 1-1. The Act has extraterritorial reach and imposed detailed requirements of Indiana law on out-of-state manufacturing operations. It purported to regulate the design and operation of out-of-state production facilities, including requirements for sinks, cleaning products, and even the details of contracts with outside security firms and the qualifications of those firms’ personnel. The Seventh Circuit reversed dismissal of a challenge to the Act. Imposing these Indiana laws on out-of-state manufacturers violates the dormant Commerce Clause. Indiana has ample authority to regulate in-state commerce in vapor pens, e-liquids, and e-cigarettes to protect the health and safety of its residents, by prohibiting sales to minors and requiring child-proof packaging, ingredient labeling, and purity. The requirements for in-state production facilities pose no inherent constitutional problems. Indiana may not, however, try to achieve its health and safety goals by directly regulating out-of-state factories and commercial transactions. View "Legato Vapors, LLC v. Cook" on Justia Law

Flambeau adopted an employee wellness program, requiring its employees, as a condition of receiving employer-subsidized health insurance, to fill out a medical questionnaire and to undergo biometric testing. One employee did not meet those requirements in time for the 2012 benefit year;, he and his family were briefly without health insurance. He filed a complaint with the Equal Employment Opportunity Commission, which filed suit, arguing that Flambeau’s requirement violated the Americans with Disabilities Act (ADA) ban on involuntary medical examinations, 42 U.S.C. 12112(d)(4). The district court dismissed; the Seventh Circuit affirmed. The court declined to address whether wellness programs are exempt from the limits on medical examinations because the ADA does not “restrict … [an] organization … administering the terms of a bona fide benefit plan that are based on underwriting risks, classifying risks, or administering such risks that are based on or not inconsistent with State law” or the EEOC argument that this insurance safe harbor does not apply to wellness programs. The court held that the relief the EEOC sought is either unavailable or moot. The employee resigned before suit was filed. He did not incur damages as a result of Flambeau’s policy and is not entitled to punitive damages. Flambeau abandoned its wellness program requirements for reasons unrelated to the litigation. View "Equal Employment Opportunity Commission v. Flambeau, Inc." on Justia Law

Advocate Health Care and NorthShore University HealthSystem operate hospital networks in Chicago’s northern suburbs. They propose to merge. The Clayton Act forbids asset acquisitions that may lessen competition in any “section of the country,” 15 U.S.C. 18. The Federal Trade Commission and the state sought an injunction, pending the Commission’s consideration of the issue. To identify a relevant geographic market where anticompetitive effects of the merger would be felt, plaintiffs relied on the “hypothetical monopolist test,” which asks what would happen if a single firm became the sole seller in a proposed region. If such a firm could profitably raise prices above competitive levels, that region is a relevant geographic market. The Commission’s expert economist chose an 11-hospital candidate region and determined that it passed the hypothetical monopolist test. The district court denied a preliminary injunction, finding that the plaintiffs had not demonstrated a likelihood of success on the merits, but stayed the merger pending appeal. The Seventh Circuit reversed; the geographic market finding was clearly erroneous. The evidence was not equivocal: most patients prefer to receive hospital care close to home and insurers cannot market healthcare plans to employers with employees in Chicago’s northern suburbs without including some of the merging hospitals in their networks. The district court rejected that evidence because of some patients’ willingness to travel for care; its analysis erred by overlooking the market power created by the remaining patients’ preferences (the “silent majority” fallacy). View "FTC v. Advocate Health Care Network" on Justia Law

O.B., two years old, has Down Syndrome, lung disease, and cardiac abnormalities. He is ventilator‐dependent and cannot digest take oral nutrition. O.B. is the named plaintiff in a class action against the Illinois Department of Healthcare and Family Services, alleging violation of the Medicaid Act. The Act defines “medical assistance” as including “early and periodic screening, diagnostic, and treatment services [EPSDT] … for individuals … under the age of 21,” 42 U.S.C. 1396d(a)(4)(B), and requires "reasonable promptness." EPSDT services include “private duty nursing services,” so that the child lives at home. When he was nine months old, the Department approved $19,718 monthly to pay nurses for up to 18 hours a day to care for O.B. at home. It took his parents almost a year to obtain home‐nursing staff so that O.B. could go home. The district judge certified a class of Illinois children who have been approved for home nursing but who have not been able to hire nurses. The judge ordered the Department to “take immediate and affirmative steps to arrange directly or through referral . . . in‐home shift nursing services.” The Seventh Circuit affirmed, noting that Congress has clarified that where the Act refers to the provision of services, a participating state is required to provide (or ensure the provision of) services, not merely pay for them and that O.B.’s in-hospital care cost four times what home nursing would cost. View "O. B. v. Norwood" on Justia Law

O’Connor-Spinner, age 47, suffers from depression and several physical impairments, including degenerative disk disease, bilateral carpal tunnel syndrome, sleep apnea, “restrictive lung disease,” and obesity. Several times since 2001 she has applied for Disability Insurance Benefits and Supplemental Security Income. In 2010, the Seventh Circuit invalidated the Social Security Administration’s denial of her 2004 request for benefits, noting that the ALJ had not asked a testifying vocational expert to assess how O’Connor-Spinner’s employment prospects would be affected by her moderate limitation on concentration, persistence, and pace, and had ignored a psychologist’s opinion that O’Connor-Spinner also faces a moderate limitation on her ability to accept instructions from, and respond appropriately to, supervisors. On remand, a different ALJ contradicted his colleague and declared that O’Connor-Spinner’s depression is not, and never was a severe impairment. The Seventh Circuit again vacated and remanded, stating that the medical evidence contradicts the ALJ’s assertion. The court noted symptoms including recurring agitation, impulsivity, fatigue, crying spells, and two or three “explosive episodes” weekly involving violent behavior and memory blackouts. View "O'Connor-Spinner v. Colvin" on Justia Law

In 2005, D.U., then three years old, was severely injured in a car accident. She qualified for Wisconsin Medicaid services on financial grounds and was provided extensive medical care until August 2013. After a change in family circumstances, D.U. no longer qualified on financial grounds. Wisconsin continued to provide the same services under its “Katie Beckett Program,” which funds Medicaid benefits for children who are otherwise ineligible because of the assets or income of their parents, 42 U.S.C. 1396a(e)(3). The state noted that D.U., whose condition had substantially improved over the years, was “borderline” for meeting the criteria to qualify for private duty nursing care and later informed D.U. and her father that D.U. no longer qualified for those services. D.U.filed a new request for 70 hours per week of private duty nursing and submitted additional information, but the request was denied. D.U. did not appeal the denial, but sought a preliminary injunction. The district court concluded that the evidence that D.U. submitted in support of her request for injunctive relief failed to demonstrate a likelihood of success on the merits. The Seventh Circuit affirmed, holding that D.U. failed to demonstrate that she will suffer irreparable harm if the injunction is denied. View "D. U. v. Rhoades" on Justia Law

In 2012, Illinois enacted legislation requiring prior approval for reimbursement for more than four prescriptions for one Medicaid patient within a 30‐day period. 305 ILCS 5/5‐5.12(j). Ciarpaglini is an Illinois Medicaid recipient and suffers from chronic conditions, including bipolar disorder, attention deficit hyperactivity disorder, panic disorder, and generalized anxiety disorder. Doctors have prescribed at least seven medications to manage these conditions. Ciarpaglini alleges that after the prior‐approval requirement took effect, he could not, at least at times, obtain medications he needed and that he has contemplated committing suicide, committing petty crimes so that he would be jailed, or checking himself into hospitals just to get medications. He challenged the requirement under federal Medicaid law, the Americans with Disabilities Act, the Rehabilitation Act, and the Constitution. Illinois subsequently moved Ciarpaglini from the general fee‐for‐service Medicaid program to a new managed care program, under which the requirement does not apply. The district court dismissed the matter as moot. The Seventh Circuit remanded, finding insufficient evidence to determine whether the claims were moot, given Ciarpaglini’s stated desire to move to another county and the lack of information about whether the change in his program was individual or part of a change in policy. View "Ciarpaglini v. Norwood" on Justia Law

Dr. Liu, an Asian woman, began working at Stroger Hospital in 1984. Liu says that, beginning in 2003, her supervisors sent a disproportionate number of her cases to review committees as compared to white male colleagues. In 2004, Liu treated a 19-year-old with appendicitis non-operatively and the patient suffered a heart attack, resulting in a clash between Liu and administration regarding her preference for non-operative treatment. After several incidents involving her refusal to conform to policy and to treat appendicitis surgically, her supervisor suspended Liu’s surgical privileges and limited her to “low complexity” cases. The Peer Review Committee investigated several cases and recommended that the suspension continue until Liu completed counseling, “with the goals of gaining insight into her problems, accepting responsibility.” The Executive Medical Staff concurred. in 2010, Liu was terminated because, during the proceedings, she accessed patient records to try to support her position, violating HIPAA and the Hospital System Privacy Policy. The Seventh Circuit affirmed summary judgment, rejecting Liu’s claims under Title VII, 42 U.S.C. 2000e-2(a) & 2000e-3(a), and 42 U.S.C. 1981. Liu presented only sparse evidence of animus based on her race, sex, and national origin, none of it linked to the challenged decisions, and did not create a genuine dispute of fact as to whether the stated reasons for discipline were honest. View "Liu v. Cook County, Ill." on Justia Law

Stark worked at GM for over 10 years as a yard driver. Her back pain started in 2000, when she underwent her first of three surgeries. She has been diagnosed with degenerative disc disease, nerve root irritation, moderate-to-severe spinal stenosis, and possible radiculopathy. Stark underwent numerous nonsurgical treatments for pain, including epidural spinal injections and a nerve root block, with a regimen of Neurontin, Darvocet, Celebrex, Oxycocone, Avinza, physical exercises, and physical therapy. Stark’s pain control was “fair-to-poor.” She stopped working in 2009. A doctor assessed that Stark could do light physical demand activities based on her full range of motion and ability to squat, kneel, and walk. A medical consultant estimated that Stark occasionally could lift or carry 20 pounds and sit for about 6 hours in an 8-hour day. At a 2012 hearing, Stark testified to a “tremendous amount of pain every day.” She could no longer take narcotic pain relievers because of a hepatitis C diagnosis. An ALJ denied benefits, finding that “the objective evidence does not substantiate the extreme symptoms and limitations to which she testified” and that her testimony regarding daily activities “demonstrates a level of daily function not inconsistent with light work activity.” The Seventh Circuit reversed, finding the credibility analysis flawed. View "Stark v. Colvin" on Justia Law

In 2003 Tipton Hospital awarded Babchuk medical staff privileges and gave his professional corporation an exclusive contract to provide radiology services. In 2012 Tipton cancelled both his medical privileges and his corporation’s contract. In Babchuk’s suit under 42 U.S.C. 1983, the district judge granted summary judgment in favor of all defendants, reasoning that the plaintiffs had failed to prove they had a federally protected property interest in Dr. Babchuk’s hospital privileges or in the contract between his professional corporation and the hospital. The Seventh Circuit affirmed, finding that the conduct of which Babchuk complained was not state action and, therefore, not actionable under 42 U.S.C. 1983. The fact that some of Tipton’s revenues are siphoned off to the state university that owns it does not make the hospital a state actor. The university may well exert pressure direct and indirect on Tipton, just as federal and state governments in manifold ways exert pressure on private institutions. “Government is omnipresent; that doesn’t make all employees of private entities state actors.“ View "Babchuk v. IN Univ. Health, Inc" on Justia Law