Hospital sought full tax refunds in relation to Hospital's attempt to reclassify certain services from either "inpatient" or "outpatient" hospital services to "physicians' services" for purposes of the West Virginia Health Care Provider Tax Act. The Office of Tax Appeals denied Hospital's request, and the circuit court affirmed. In seeking to reclassify items of overhead as "physicians' services," Hospital focused on its use of certain billing codes that were required by federal law. The Tax Commission argued that Hospital's reliance on these billing codes to identify what qualifies as "physicians' services" under the Act was misplaced. The Supreme Court affirmed, holding that the overhead items at issue did not qualify as "physicians' services" under the Act. View "Wheeling Hosp., Inc. v. Lorensen" on Justia Law
Posted in: Government & Administrative Law, Health Law, Tax Law, West Virginia Supreme Court of Appeals
Nancy Belcher was the designated health care surrogate of decedent Beulah Wyatt. Belcher signed an arbitration agreement that was presented to her when she sought to admit Wyatt to the McDowell Nursing and Rehabilitation Center (McDowell Nursing). Wyatt died after living ten months in the nursing home. Lelia Baker subsequently filed a wrongful death suit against McDowell Nursing alleging that its negligent care of Wyatt caused and/or contributed to her death. McDowell Nursing filed a motion to dismiss and to enforce the arbitration agreement. The circuit court denied the motion and concluded that the agreement was unenforceable because Belcher did not have the authority to waive Wyatt's right to a jury trial. The Supreme Court denied McDowell Nursing's subsequent request for a writ of prohibition to prevent the circuit court from enforcing its order, holding that Belcher, as a health care surrogate, did not have the authority to enter the arbitration agreement because it was not a health care decision and was not required for Wyatt's receipt of nursing home services from McDowell Nursing. View "State ex rel. AMFM, LLC v. Circuit Court (King)" on Justia Law
In the instant case, the Supreme Court was once again asked to consider whether medical protective orders are valid and enforceable to limit the dissemination and retention of medical records obtained through discovery. Such orders had been entered in lawsuits filed by plaintiffs seeking compensation for the injuries they sustained in motor vehicle accidents caused by other motorists. Repeatedly, the insurers from whom such compensation had been sought requested the West Virginia Supreme Court, the United States Supreme Court, and a federal district court to invalidate these protective orders as burdensome, restrictive, and/or unconstitutional. Each time the reviewing Court examined these medical protective orders, it upheld the order as substantively valid and enforceable as a proper exercise of the issuing court's supervisory authority over discovery. In the instant case, the Court again declined insurance companies' invitation to invalidate the subject medical protective orders, finding that the insurance companies' arguments were insufficient to overturn precedent. View "State ex rel. State Farm Mut. Auto. Ins. Co. v. Circuit Court" on Justia Law
After Plaintiff learned his confidential medical and psychological information at St. Mary's Medical Center had been improperly accessed, Plaintiff filed several state-law claims against St. Mary's. The circuit court granted St. Mary's 12(b)(6) motion to dismiss Plaintiff's state-law claims based upon its conclusion that the claims were preempted by the federal Health Insurance Portability and Accountability Act (HIPAA). In addition, St. Mary's asserted a cross assignment of error arguing that the circuit court erred by finding that Plaintiff's claims did not fall under the West Virginia Medical Professional Liability Act (MPLA) and concluding, therefore, that Plaintiff was not required to file a notice of claim and screening certificate of merit. The Supreme Court (1) reversed the circuit court's order insofar as it granted St. Mary's 12(b)(6) motion to dismiss based upon its conclusion that Plaintiff's state-law claims were preempted by HIPAA, holding that Plaintiff's state-law claims for the wrongful disclosure of his medical and personal health information were not preempted by HIPAA; and (2) affirmed the order to the extent it found Plaintiff's claims did not fall under the MPLA. Remanded. View "R.K. v. St. Mary's Med. Ctr., Inc." on Justia Law
Infant was born with severe brain damage. Respondent, Infant's mother, on behalf of Infant, applied for and received Medicaid benefits from the West Virginia Department of Health and Human Resources (DHHR). Respondent later filed a medical malpractice lawsuit on behalf of Infant. Subsequently, Respondent petitioned the circuit court for approval of the settlement, requesting that Medicaid not be reimbursed. DHHR intervened. The court granted the motion of Respondent for allocation of the $3,600,000 settlement, holding that, pursuant to Arkansas Department of Health and Human Services v. Ahlborn, a proportional reduction of DHHR's recovery was required based on the ratio of the settlement to the "full value" of the case among the various damages categories. Using this allocation method, the court reduced DHHR's statutory reimbursement from the requested amount of $289,075 to $79,040 and directed that the net settlement proceeds be placed in a special needs trust for the benefit of Infant. The Supreme Court reversed in part and affirmed in part, holding (1) a $500,000 cap on noneconomic damages was applicable in this case; and (2) under the formula applied in Ahlborn, the DHHR was entitled to approximately $98,080, less its pro rata share of attorney's fees and costs. Remanded. View "In re E.B." on Justia Law
Posted in: Government & Administrative Law, Health Law, Medical Malpractice, Public Benefits, West Virginia Supreme Court of Appeals
Petitioner, the executrix of the estate of Henry Cline, filed a complaint against Respondent, Dr. Kiren Kresa-Reahl, alleging that Respondent negligently failed to advise the decedent of the availability of certain medications to treat his stroke. Prior to filing her complaint, Petitioner refused to provide a pre-suit screening certificate of merit pursuant to the pre-suit requirements of the Medical Professional Liability Act. Petitioner asserted that her claim fell within the exception to such requirements as an "informed consent" claim. The circuit court disagreed, ruling that Petitioner's complaint did not state a recognized informed consent claim and that, therefore, her failure to provide a screening certificate of merit warranted dismissal without prejudice. The Supreme Court affirmed, holding that the trial court did not err in applying the plain language of the statute and caselaw in dismissing the case without prejudice. View "Cline v. Kresa-Reahl " on Justia Law
Respondent, who had a diagnosis of autism with obsessive compulsive disorder traits and hyperactive traits, had participated for several years in the federal Mentally Retarded / Developmentally Delayed Home and Community-Based Waiver Program, which provided in-home and community-based services for persons with mental retardation or a delayed development condition. The state Department of Health and Human Resources (DHHR) subsequently terminated Respondent's benefits. The circuit court reversed the DHHR's decision based on the DHHR's failure to present evidence that Respondent's condition had improved since he first began receiving benefits. DHHR appealed, arguing that the circuit court erred in placing the burden of proof on it rather than on Respondent. The Supreme Court affirmed, holding (1) when the DHHR seeks to reduce or terminate benefits that a claimant is receiving under the Waiver Program, the DHHR has the burden of proof to show a change in circumstances warranting such action, and therefore, the circuit court did not err in determining that the DHHUR had the burden to show some medical improvement in Respondent's condition; and (2) the circuit court did not abuse its discretion in finding that the DHHR had failed to meet its burden of proof.
Petitioner, who had a diagnosis of severe autism, had been participating in the federal Mentally Retarded / Developmentally Delayed Home and Community-Based Waiver Program, which provided in-home and community-based services for persons with mental retardation or a delayed development condition. The state Department of Health and Human Resources (DHHR) terminated Petitioner's benefits after determining that Petitioner did not demonstrate substantial adaptive deficits in three or more major life areas. A hearing officer upheld the DHHR's decision. The circuit court affirmed without holding any further proceedings. The Supreme Court reversed, holding that the trial court committed error by failing to make an independent review of Petitioner's eligibility for participation in the Waiver Program. Remanded.
In three cases consolidated for review, the facts were similar. A person was admitted to a nursing home, and a family member signed an admission agreement containing an arbitration clause. After the person died, a family member filed suit against the nursing home, alleging the nursing home negligently caused injuries leading to the person's death. The nursing home sought to dismiss the lawsuit and compel the family member to participate in binding arbitration. The family members asserted the arbitration clauses were unenforceable, alleging (1) the clauses violated the West Virginia Nursing Home Act, and (2) were unconscionable under the common law. After reviewing the relevant laws, the Supreme Court held that (1) the Nursing Home Act, which states any that waiver by a nursing home resident of his right to sue for injuries sustained in a nursing home shall be void as contrary to public policy, is preempted by the Federal Arbitration Act; and (2) in the context of pre-injury nursing home admission agreements, where a personal injury or wrongful death occurred after the signing of the contract, arbitration clauses are unenforceable to compel arbitration of a dispute concerning negligence that results in a personal injury or wrongful death.
In two consolidated original jurisdiction actions, petitioners Mylan, Inc., Mylan Pharmaceuticals, Inc., and Mylan Technologies, Inc. sought writs of prohibition in two actions pending in the circuit court of Kanawha County. In each action, the circuit court denied a motion filed by petitioners to dismiss the case on the basis of forum non conveniens. Petitioners filed a petition for a writ of prohibition, asserting that each of the circuit judges erred in applying the forum non conveniens statute, W. Va. Code 56-1-1a, and seeking to prohibit the circuit court from refusing to dismiss their actions. In a show cause order, the Supreme Court held that the circuit court erred in failing to make findings of fact and conclusions of law regarding the eight factors listed for consideration in Section 56-1-1a. The Court, therefore, granted the writs and remanded the actions.
Posted in: Contracts, Health Law, Injury Law, Products Liability, West Virginia Supreme Court of Appeals