Justia Health Law Opinion Summaries

Articles Posted in US Court of Appeals for the Sixth Circuit
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In 2021, Tennessee enacted a statute that vaccination, masking, and quarantine decisions: “A local health entity or official, mayor, governmental entity, or school does not have the authority to quarantine a person or private business for purposes of COVID-19,” and “a school or a governing body of a school shall not require a person to wear a face mask while on school property” unless various conditions are met. Before seeking accommodation under its terms, eight minor students with disabilities filed suit, alleging that the legislation violated the Americans with Disabilities Act (ADA), 42 U.S.C. 12101m Section 504 of the Rehabilitation Act, 29 U.S.C. 794, the Equal Protection Clause, and the Supremacy Clause. The district court granted a preliminary injunction with respect to sections of the Act concerning face coverings for schools and provisions that prohibit local health officials and schools from making quarantining decisions as they relate to public schools.While acknowledging that the case is moot, the Sixth Circuit dismissed it for lack of jurisdiction. The plaintiffs’ argument that they are injured because the Act categorically violates the ADA amounts to an overly generalized grievance. They do not seek redress for a completed violation of a legal right; they seek only prospective relief to protect against future violations. Their injuries are not fairly traceable to any defendant, so no remedy applicable to those defendants (be it an injunction or a declaration) would redress the alleged injuries. View "R. K. v. Lee" on Justia Law

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In 1985, Messing, an attorney, obtained a long-term disability (LTD) insurance policy through Provident. Beginning in 1994, Messing struggled with depression. In 1997, Messing was hospitalized for his depression for more than three weeks. Provident began paying LTD benefits but later initiated a dispute. Messing's subsequent lawsuit settled in 2000 with Provident resuming payments. In 2018, Provident sought proof, beyond Messing’s own certifications, that he was unable to work as an attorney. Messing’s treating psychiatrist, Dr. Franseen, submitted a report diagnosing Messing with “Major Depressive Disorder, recurrent, minimal to mild,” and noting that Messing had stopped using medications to treat his depression in 2012 “and ha[d] been stable for the most part since then.” Franseen refused to render an opinion as to whether Messing could return to work. Provident had Dr. Lemmen interview Messing. Lemmen concluded, “[t]here is no objective evidence that [Messing] would not be able to practice as an attorney, should he desire to do so.” Messing appealed the termination of his benefits, providing affidavits from attorneys and a report from a third psychiatrist, Callaghan.The Sixth Circuit affirmed the denial of Provident’s claim for reimbursement of benefits it had paid but reversed with respect to the termination of benefits. Messing has proven that he remains unable to return to work as an attorney. Improvements in Messing’s health do not necessarily mean he can return to working as a full-time personal injury attorney. Dr. Callaghan noted Messing’s progress is likely attributable to his abstention from practicing law. View "Messing v. Provident Life & Accident Insurance Co." on Justia Law

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Head Start is a federal program that funds early childhood education for low-income children and provides other resources and education to the children’s families. Michigan Head Start grantees challenged the COVID-19 vaccine mandate for Head Start program staff, contractors, and volunteers imposed by an interim final rule of the Department of Health and Human Services. The district court denied a preliminary injunction.The Sixth Circuit denied an injunction pending appeal. The plaintiffs have not shown that they will likely prevail on the merits. HHS likely did not violate the Administrative Procedure Act when it promulgated the vaccine requirement through an interim final rule instead of notice-and-comment rulemaking, 5 U.S.C. 553(b)(B). That rule contains ample discussion of the evidence in support of a vaccine requirement and the justifications for the requirement, 86 Fed. Reg. 68,055-059. HHS likely has the statutory authority to issue a vaccine requirement for Head Start program staff, contractors, and volunteers under 42 U.S.C. 9836a(a)(1)(A), (E). The risk that unvaccinated staff members could transmit a deadly disease to Head Start children—who are ineligible for the COVID-19 vaccine due to their young age—is “a threat to the health” of the children. The court noted HHS’s history of regulating the health of Head Start children and staff. View "Livingston Educational Service Agency v. Becerra" on Justia Law

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Dr. Paulus was prosecuted for healthcare fraud. Government consultants reviewed 496 of Paulus’s procedures and concluded that 146 (about 30%) were unnecessary. King’s Daughters Medical Center (KDMC) consultants also reviewed a random selection of Paulus’ procedures. Three experts at trial concluded that Paulus overstated his patients’ arterial blockage and inserted medically unnecessary stents. A jury convicted Paulus. After remand, before sentencing, the government disclosed to Paulus for the first time the “Shields Letter,” stating that when KDMC faced previous legal trouble, it hired independent experts to review 1,049 of Paulus’s cases; they flagged about 7% of his procedures as unnecessary. The defense viewed this evidence as exculpatory and consistent with diagnostic differences of opinion. Before trial, the district court had held that the information was inadmissible and that the parties “[we]re not to disclose” any information about the KDMC Review to Paulus.The Sixth Circuit vacated Paulus’s convictions and remanded, finding that the Shields Letter was material to Paulus’s defense and that failure to disclose it violated Paulus’s “Brady” rights. On remand, the government subpoenaed KDMC for additional information regarding the study referenced in the Shields Letter. KDMC objected, citing the attorney-client, work-product, and settlement privileges. The government filed a motion to compel, which was granted. KDMC sought a writ of mandamus. The Sixth Circuit denied KDMC’s petition. KDMC’s disclosure of some information regarding its experts’ study waived its privilege over the related, undisclosed information now being sought. View "In re: King's Daughters Health System, Inc." on Justia Law

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Under the “individual mandate” within the Patient Protection and Affordable Care Act of 2010, non-exempt individuals must either maintain a minimum level of health insurance or pay a “penalty,” 26 U.S.C. 5000A, the “shared responsibility payment” (SRP). The McPhersons did not maintain health insurance for part of 2017, and Juntoff did not maintain health insurance in any month in 2018. They did not pay their SRP obligations. In each of their Chapter 13 bankruptcy cases, the IRS filed proofs of claim and sought priority treatment as an “excise/income tax”: for Juntoff, $1,042.39, and for the McPhersons, $1,564.The bankruptcy court confirmed their plans, declining to give the IRS claims priority as a tax measured by income. The Bankruptcy Appellate Panel reversed. DIstinguishing the Sebelius decision in which the Supreme Court determined that the SRP constituted a “penalty” for purposes of an Anti-Injunction Act analysis and a “tax” under a constitutionality analysis, the Panel concluded that the SRP is not a penalty but a tax measured by income. It is “calculated as a percentage of household income, subject to a floor based on a specified dollar amount and a ceiling based on the average annual premium the individual would have to pay for qualifying private health insurance.” View "In re: Juntoff" on Justia Law

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Doctors Hills, Alqsous, Elrawy, and Al-Madani were convicted of offenses connected to their employment at a publicly-owned Cuyahoga County hospital, MetroHealth, which receives federal funds. Hills solicited and received bribes from Alqsous, Al-Madani, and Elrawy in exchange for favorable treatment with respect to their employment. Alqsous, Al-Madani, and Sayegh solicited and/or accepted bribes from applicants to MetroHealth’s dental residency program. Hills and an unindicted business partner operated OHE to provide training for dentists with discipline or performance issues. Some of OHE’s business was accomplished using MetroHealth personnel, equipment, or facilities without permission or compensation. Hills received and Alqsous and Al-Madani offered or paid kickbacks for referrals to private clinics. There were recordings of discussions concerning warning a resident to stay quiet, preparing 1099 forms to hide the kickbacks, and telling a grand jury witness to “forget” seeing envelopes of cash. Hills also arranged for his attorney to receive extensive dental work without charge and assigned MetroHealth residents to work at a private clinic.The district court imposed aggregate terms of imprisonment of: 188 months (Hills), 151 months (Alqsous), and 121 months (Al-Madani). They were also ordered to pay restitution, some jointly and severally, in amounts approaching $1 million. The Sixth Circuit affirmed, rejecting challenges to the sentences, the loss calculation, the sufficiency of the evidence, the jury instructions, the denial of a motion to suppress, and other procedural rulings. View "United States v. Alqsous" on Justia Law

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Tiwari and Sapkota sought to establish a home healthcare company that would focus on serving Nepali-speaking individuals in the Louisville area. Kentucky restricts the number of such companies that may serve each county. When the Commonwealth denied their certificate-of-need application, Tiwari and Sapkota filed suit, claiming that the regulation violates their Fourteenth Amendment right to earn a living, serving only the illegitimate end of protecting incumbent home healthcare companies from competition, and lacking a rational basis.The Sixth Circuit affirmed summary judgment, upholding the requirement. Economic regulations, even those affecting an individual’s liberty to work in a given area, are subject to “rational basis” review. While expressing skepticism about certificate-of-need laws, the court concluded that a legislator could plausibly believe that the regulation has a rational connection to increasing cost efficiency, improving quality of care, and improving the healthcare infrastructure in place. View "Tiwari v. Friedlander" on Justia Law

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Tomei went to Parkwest Hospital after he injured his foot and leg. He is deaf and communicates using American Sign Language. He asked for an interpreter. Parkwest never provided one. Medical staff gave him an antibiotic and ibuprofen and sent him home. Days later he went to the emergency room, where doctors determined he had blood clots in his leg. Parkwest offered only to connect Tomei with an off-site interpreter via webcam. The connection was so glitchy that Tomei could not effectively communicate. After surgery, Tomei could not tell the medical staff that he was still experiencing pain. Tomei was sent home. Tomei’s family doctor sent him to the University of Tennessee Medical Center, where interpreters helped him through a second surgery. Ultimately, doctors amputated nearly one-third of his leg. About 15 months after he was first denied an interpreter, Tomei sued under section 1557 of the Patient Protection and Affordable Care Act (ACA).The Sixth Circuit rejected an argument that the suit was untimely under Tennessee’s one-year statute of limitations for personal injury suits. Unless federal law provides otherwise, a civil action “arising under” a federal statute enacted after December 1, 1990, is subject to a four-year statute of limitations. 28 U.S.C. 1658(a). Tomei brought his discrimination claim under the ACA—not the Rehabilitation Act. No statute or regulation explicitly sets a statute of limitations for violating the ACA’s discrimination bar. View "Tomei v. Parkwest Medical Center" on Justia Law

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The 1949 Federal Property and Administrative Services Act is intended to facilitate the “economical and efficient” purchase of goods and services on behalf of the federal government, 40 U.S.C. 101. In November 2021, the Safer Federal Workforce Task Force, under the supposed auspices of the Act, issued a “Guidance” mandating that employees of federal contractors in “covered contract[s]” with the federal government become fully vaccinated against COVID-19. Ohio, Kentucky, and Tennessee and Ohio sheriffs’ offices sued, alleging that the Property Act does not authorize the mandate, that the mandate violates other federal statutes, and that its intrusion upon traditional state prerogatives raises federalism and Tenth Amendment concerns.The district court enjoined enforcement of the mandate throughout the three states and denied the federal government’s request to stay the injunction pending appeal. The Sixth Circuit denied relief. The government has established none of the showings required to obtain a stay. The government is unlikely to succeed on claims that the plaintiffs lack standing and the plaintiffs likely have a cause of action under the Administrative Procedure Act. The court noted the plaintiff’s concerns about disruptions to the supply chain if workers leave their jobs rather than receiving vaccinations and also stated: Given that expansive scope of the Guidance, the interpretive trouble is not figuring out who’s “covered”; the difficult issue is understanding who, based on the Guidance’s definition of “covered,” could possibly not be covered. View "Commonwealth of Kentucky v. Biden" on Justia Law

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In November 2021, 5he Occupational Safety and Health Administration (OSHA), the federal agency tasked with assuring a safe and healthful workplace, issued an Emergency Rule on COVID-19 Vaccination and Testing, 86 Fed. Reg. 61402. The rule does not require anyone to be vaccinated but allows covered employers—employers with 100 or more employees—to determine for themselves how best to minimize the risk of contracting COVID-19 in their workplaces. Employers may require unvaccinated workers to wear a mask on the job and test for COVID-19 weekly; they can require workers to do their jobs exclusively from home. Workers who work exclusively outdoors are exempt. The next day, the Fifth Circuit stayed the rule pending judicial review; it renewed that decision in an opinion issued on November 12. Under 28 U.S.C. 2112(a)(3), petitions challenging the rule, filed in Circuits across the nation, were consolidated into the Sixth Circuit, which dissolved the stay issued by the Fifth Circuit. The language of its enabling act plainly authorizes OSHA to act on its charge “to assure safe and healthful working conditions for the nation’s workforce and to preserve the nation’s human resources.” OSHA’s issuance of the rule is not a transformative expansion of its regulatory power, The factors regarding irreparable injury weigh in favor of the government and the public interest. View "In re: MCP No. 165, Occupational Safety and Health Admin., Interim Final Rule: COVID19 Vaccination and Testing, 86 Fed. Reg. 61402" on Justia Law