Justia Health Law Opinion Summaries

Most people eligible for Medicaid benefits are “categorically needy” because their income falls below a threshold of eligibility. People with higher income but steep medical expenses are “medically needy” once they spend enough of their own assets to qualify, 42 U.S.C. 1396a(a)(10). Plaintiffs contend that medical expenses they incurred before being classified as “medically needy” should be treated as money spent on medical care, whether or not those bills have been paid, which would increase Illinois's payments for their ongoing care.The Seventh Circuit affirmed the dismissal of their suit. Medicaid is a cooperative program through which the federal government reimburses certain expenses of states that abide by the program’s rules. Medicaid does not establish anyone’s entitlement to receive particular payments. The federal-state agreement is not enforceable by potential beneficiaries. Plaintiffs bypassed their administrative remedies and do not have a judicial remedy under 1396a(r)(1)(A). Section 1396a(a)(8) provides that a state’s plan must provide that all individuals wishing to apply for medical assistance under Medicaid shall have the opportunity to do so and that assistance shall be furnished with reasonable promptness to all eligible individuals; some courts have held that this requirement can be enforced in private suits. If such a claim were available, it would fail. Plaintiffs are receiving benefits. The court also rejected claims under the Americans with Disabilities Act, 42 U.S.C. 12131–34, and the Rehabilitation Act, 29 U.S.C. 794. Plaintiffs receive more governmental aid than nondisabled persons. View "Nasello v. Eagleson" on Justia Law

The Supreme Court extended an August 27, 2020 order for first circuit criminal matters, which was extended pursuant to a September 11, 2020 order, until November 16, 2020, determining that changing conditions wrought by the COVID-19 pandemic required flexibility and vigilance regarding the need to protect the health and safety of court users and Judiciary personnel.In July 2020, there was a surge of COVID-19 cases in Hawaii, included cases in community correctional centers and facilities, particularly at the O'ahu Community Correctional Center. As a result, the time requirements for preliminary hearings under Haw. R. Pen. P. (HRPP) 5(c)(3) was impacted. In August 2020, the Supreme Court entered an order providing that the first circuit may temporarily extend the time requirements for preliminary hearings no longer than reasonably necessary to protect public health and safety. In September, the order was extended. Because the transports of custody defendants from all O'ahu correctional facilities remained suspended and the exponential number of citations issued for Haw. Rev. Stat. ch. 127A violations remained high, the Supreme Court extended the August order for first circuit criminal matters until November 16, 2020. View "In re Judiciary’s Response to COVID-19 Outbreak" on Justia Law

The 2009 Family Smoking Prevention and Tobacco Control Act (TCA) allows the FDA to regulate tobacco products. Tobacco products that were not on the market in February 2007 or that were modified after that date must obtain premarket authorization. The 2016 “Deeming Rule” subjected cigars, pipe tobacco, and electronic nicotine delivery systems to the TCA; about 25,000 existing products became subject to 21 U.S.C. 387j(a). The FDA planned to stagger compliance periods for deemed tobacco products.In 2018, public health organizations challenged FDA “guidance” issued under the TCA. The Maryland district court granted them summary judgment. Compliance deadlines had passed but the court concluded that it could impose a deadline because the case presented extraordinary circumstances. The court ordered the FDA to require that premarket applications be filed within 10 months (May 2020) but declined to require enforcement actions. The FDA issued new guidance in January 2020, stating that it intended to prioritize enforcement of the premarket-review requirements for e-cigarettes beginning in May 2020. Before the Fourth Circuit ruled, the district court amended its injunction, in light of the pandemic, to require that applications be submitted by September 2020. The FDA revised its guidance accordingly. The Fourth Circuit dismissed the appeal.An e-cigarette trade organization sought a declaration that FDA’s deadline was unlawful agency action under the APA in the Eastern District of Kentucky, arguing the FDA’s brief and an attached declaration motivated the Maryland court to impose that deadline, which significantly accelerated the original FDA deadline. The Sixth Circuit affirmed that the plaintiffs lacked standing. The Maryland court’s injunction was independent of the FDA’s brief and declaration; the allegedly unauthorized court submissions do not form a plausible legal basis for an injunction against subsequent, independently-caused FDA enforcement proceedings. View "Vapor Technology Association v. United States Food and Drug Administration" on Justia Law

In 2005, the Georgia Department of Community Health (Department) promulgated a rule, commonly known as the “Psychiatric Rule” (“the Rule”), that required hospitals to obtain a Certificate of Need (“CON”) “prior to the establishment of a new or the expansion of an existing acute care adult psychiatric and/or substance abuse inpatient program,” and defined “expansion” as “the addition of beds to an existing CON-authorized or grandfathered psychiatric and/or substance abuse inpatient program.” The issue this case presented for the Georgia Supreme Court's review centered on whether the Department could, through the Rule, require a licensed hospital with a psychiatric/substance-abuse program authorized by a CON, to obtain an additional CON to redistribute inpatient beds in excess of those identified in its CON to operate a psychiatric/substance-abuse program, but within its total licensed bed capacity. In UHS of Anchor, L.P. v. Department of Community Health, 830 SE2d 413 (2019), the Court of Appeals held that the Department could. The Supreme Court determined the appellate court erred in that conclusion, and reversed. "The General Assembly’s delegation of legislative authority to the Department to promulgate rules as part of its administration of the CON program does not include the authority to define additional new institutional health services requiring a CON, beyond those listed in OCGA 31-6-40 (a)." View "Premier Health Care Investments, LLC v. UHS of Anchor, LP" on Justia Law

During the certificate of need (CON) application process, applicant ACTD, LLC (operator of the Green Mountain Surgery Center (GMSC), a for-profit multi-specialty ambulatory surgery center), indicated that it initially planned to offer surgical services in five identified specialties. After the CON was issued, applicant notified the Board that in addition to these five specialties, it planned to offer plastic surgery and ophthalmology procedures. The Board chose to review these changes and, after hearing, issued a decision clarifying that the original CON was limited in scope to the five specialties applicant had identified in its application, and that the proposed addition of plastic surgery and ophthalmology procedures was a nonmaterial change to the project. The Board concluded that applicant had demonstrated a need for greater access to plastic surgery and ophthalmology procedures currently performed in a hospital setting and approved the addition of these services. However, it rejected applicant’s proposal to offer ophthalmology procedures already available at another ambulatory surgery center nearby. The Board also extended applicant’s implementation reporting period for two additional years. Applicant argued on appeal of the Board's decision that the Board improperly restricted the scope of the CON and lacked the power to extend the reporting requirement. Finding that the Board acted within its authority, the Vermont Supreme Court affirmed its decision. View "In re ACTD LLC, d/b/a The Green Mountain Surgery Center" on Justia Law

Plaintiffs filed suit alleging that defendants entered into an illegal referral and kickback scheme in which USC paid below-market rates for hospitalist services from Concord, and Concord self-referred patients to Elevate, which shared ownership with Concord. Plaintiffs further alleged that when Plaintiff Alborzi complained to management at Verdugo Hills Hospital about the illegal scheme, the hospital stopped referring patients to him and eventually dissolved the on-call panel in retaliation.The Court of Appeal held that the trial court erred by sustaining the demurrer because plaintiffs were not required to exhaust judicial remedies before asserting the causes of action they have alleged here. The court also found that plaintiffs' complaint alleged sufficient facts to support causes of action for violations of Health and Safety Code section 1278.5 and Business and Professions Code section 17200, et seq., and therefore the demurrer should have been overruled as to those claims. The court further found that plaintiffs' cause of action for violation of Government Code section 12653 failed to allege sufficient facts to state a cause of action, but leave to amend was warranted. Finally, the court found that plaintiffs have abandoned the three causes of action they did not address on appeal. Accordingly, the court reversed the judgment and remanded the action with directions. View "Alborzi v. University of Southern California" on Justia Law

Wendy and Janet Norman alleged that Xytex Corporation, a sperm bank, sold them human sperm under false pretenses about the characteristics of its donor, and that the child conceived with that sperm once born suffered from a variety of impairments inherited from the sperm donor. The Court of Appeals affirmed the dismissal of all but one of the Normans’ claims on the basis of Etkind v. Suarez, 519 SE2d 210 (1999), and Atlanta Obstetrics & Gynecology Group v. Abelson, 398 SE2d 557 (1990). The Georgia Supreme Court granted review, and held that claims arising from the very existence of the child were barred, but claims arising from specific impairments caused or exacerbated by defendants’ alleged wrongs could proceed, as could other claims that essentially amounted to ordinary consumer fraud. Therefore, the Court affirmed in part, reversed in part, and remanded the case for further proceedings. View "Norman et al. v. Xytex Corp., et al." on Justia Law

The Georgia Supreme Court granted certiorari to the Court of Appeals in five consolidated appeals to address two discrete issues – one related to pleading vicarious liability, and the other related to vicarious liability and apportionment. In 2009, Shannon Trabue suffered a catastrophic brain injury resulting from pulmonary edema leading to full cardiac arrest within days of giving birth to her daughter at Northside Hospital in Atlanta. At the hospital, Shannon was treated by physician-employees of AWS, including Dr. Stanley Angus and Dr. Rebecca Simonsen. Kenneth Trabue (husband) and the bank serving as his wife’s conservator (Plaintiffs) later filed a medical malpractice action naming as defendants only Dr. Angus and Atlanta Women’s Specialists, LLC (AWS), although the complaint contained allegations regarding Dr. Simonsen’s conduct and alleged that AWS was vicariously responsible for the acts and omissions of both Dr. Angus and Dr. Simonsen. The complaint did not allege any independent acts of negligence on the part of AWS. The issues the appellate court presented for the Supreme Court's review were: (1) whether the Court of Appeals erred in holding that plaintiffs sufficiently pled a claim for vicarious liability against AWS based on Dr. Simonsen's conduct; and (2) whether the appellate court erred in holding that, to obtain apportionment of damages with regard to the negligence of Dr. Simonsen, the defendants were required to comply with OCGA 51-12-33 (d) by filing a pretrial notice of nonparty fault? The Supreme Court answered both questions in the negative and affirmed the Court of Appeals’ judgment. View "Atlanta Womens Specialists, LLC et al. v. Trabue et al." on Justia Law

QHG of Enterprise, Inc., d/b/a Medical Center Enterprise ("QHG"), appealed a circuit court's judgment awarding Amy Pertuit ("Amy") $5,000 in compensatory damages and $295,000 in punitive damages. Leif Pertuit ("Leif") had been married to Deanna Mortensen; they had one child, Logan. Leif and Mortensen divorced in 2007. At some point, Mortensen was awarded sole physical custody of Logan, and Leif was awarded visitation. Leif later married Amy, a nurse. At the time of their marriage, Leif and Amy resided in Mobile, Alabama, and Mortensen resided in Enterprise. Eventually, tensions arose between Leif and Mortensen regarding the issue of visitation. In March 2014, Mortensen began sending text messages to Leif accusing Amy of being addicted to drugs. Around that time, Mortensen visited the attorney who had represented her in divorce from Leif. Mortensen expressed concern that Logan was in danger as a result of the visitation arrangement and asked her attorney to assist with obtaining a modification of Leif's visitation. In April 2014, Mortensen contacted Dr. Kathlyn Diefenderfer, a physician whom QHG employed as a hospitalist at Medical Center Enterprise. Mortensen had been Dr. Diefenderfer's patient, and Dr. Diefenderfer's son played sports with Logan. Mortensen informed Dr. Diefenderfer that Logan was scheduled to ride in an automobile with Amy from Enterprise to Mobile for Leif's visitation and expressed concern regarding Amy's ability to drive, given her belief that Amy was using drugs and had lost her nursing license. Dr. Diefenderfer used a hospital computer to check on Amy's drug prescriptions. After reviewing that information,Dr. Diefenderfer told Mortensen: "All I can tell you is I would not put my son in the car." Mortensen went back to her attorney, informing him that Dr. Diefenderfer had acquired the necessary proof of Amy's drug use. Amy received a copy of the modification petition, and was convinced her private health information had been obtained in violation of HIPAA, and filed complaints to the Enterprise Police Department, the US Department of Health and Human Services, the Alabama Bar Association, and the Alabama Board of Medical Examiners. A grand jury indicted Mortensen and Dr. Diefenderfer, which were later recalled, but the two entered diversion agreements with the district attorney's office. Amy then filed suit alleging negligence and wantonness, violation of her right to privacy, the tort of outrage and conspiracy. The Alabama Supreme Court determined the trial court erred by denying QHG's motion for a judgment as a matter of law with respect to Amy's asserted theories of respondeat superior; ratification; and negligent and wanton training, supervision, and retention because there was not substantial evidence indicating that QHG was liable to Amy as a consequence of Dr. Diefenderfer's conduct under any of those theories. The trial court's judgment awarding Amy $5,000 in compensatory damages and $295,000 in punitive damages was reversed, and judgment rendered in favor of QHG. View "QHG of Enterprise, Inc., d/b/a Medical Center Enterprise v. Pertuit" on Justia Law

Regina Hannah appealed the grant of summary judgment in favor of Michael Naughton, M.D.; Michael Naughton, M.D., Ph.D., LLC; Terisa Thomas, M.D., and and Terisa A. Thomas, M.D., P.C. (collectively, "the defendants"), on Hannah's claims alleging medical malpractice. In 2005, Hannah was seen by Dr. Thomas, a board-certified general surgeon, for a female health-care examination. Hannah was 32 years old at the time, and complained of fatigue, weight gain, heavy menstrual cycles, cramping, and painful sexual relations. Hannah also reported a significant family medical history of cervical cancer and stated that she was fearful of getting cancer. Hannah stated that her mother, grandmother, and sister had suffered from cervical cancer. Dr. Thomas ordered a number of tests, including a pelvic ultrasound and a Pap smear. Dr. Thomas received the results of Hannah's Pap smear, which indicated an "abnormal" result: "Epithelial Cell Abnormality. Atypical Squamous Cells Cannot Exclude High Grade Squamous Intraepithelial Lesion (HSIL)." Dr. Thomas stated that this was not a diagnosis of cancer but, rather, that she considered it an abnormal finding indicative of an "increased risk" of cancer. Dr. Thomas related to Dr. Naughton that she had a patient she wanted to refer to him for a second opinion following an abnormal Pap smear. Dr. Naughton testified that Hannah chose the most aggressive option for treatment, specifically stating that she wanted "it all out:" a hysterectomy, including her ovaries. Dr. Naughton had Hannah execute a "surgical-awareness" form indicating that she accepted full responsibility for her decision to have the surgery. Hannah underwent surgery; there was no indication of any diagnosis of cervical cancer mentioned in the surgical record. Hannah's surgery was completed without complication. Hannah would have one more follow up appointment with Dr. Naughton; she also met with Dr. Thomas. Frustrated with a lack of response from additional calls to Dr. Naughton's office, Hannah consulted with Dr. Max Austin, a gynecologic oncologist. After review of her medical records, Dr. Austin told Hannah she "never had nor did she have cervical cancer." Hannah then filed suit against Drs. Thomas and Naughton, alleging they breached their standard of care by falsely informing her she had cervical cancer based on the abnormal Pap-smear, and by advising her to undergo a hysterectomy. The Alabama Supreme Court found no reversible error in the trial court's judgment and affirmed it. View "Hannah v. Naughton, M.D., et al." on Justia Law