Justia Health Law Opinion Summaries

The trial court properly dismissed two of Petitioners’ counts against Respondent seeking damages for injuries one of the petitioners allegedly sustained while staying at one of Respondent’s facilities because these two counts alleged medical injuries within the Health Claims Act (HCA). Therefore, Petitioners were required to file those claims in the Health Care Alternative Dispute Resolute Office (ADR Office) as a condition precedent to their circuit court action. Petitioners’ remaining negligence count should survive because it did not allege a breach of professional standard of care such that it must be filed in the ADR Office. Petitioners’ counts sounding in contract, consumer protection, and loss of consortium also survived dismissal. View "Davis v. Frostburg Facility Operations, LLC" on Justia Law

The Idaho Supreme Court answered a certified question of Idaho law from the United States District Court for the District of Idaho. The question certified centered on whether, for purposes of the dispute in this lawsuit, the terms ‘state board of correction’ as used in Idaho Code 20-237B(1) and ‘department of correction’ as used in Idaho Code § 20-237B(2), included privatized correctional medical providers under contract with the Idaho Department of Correction. The Court answered the question certified in the negative. View "In Re: Pocatello Hospital, LLC v. Corazon, LLC" on Justia Law

The right of an incompetent defendant to raise defenses in a proceeding pursuant to Conn. Gen. Laws ch. 123A, 15, which allows incompetent persons who are unable to stand trial for qualifying sex offenses to be deemed sexually dangerous based on the commission of those offenses, includes that of a lack of criminal responsibility.The Supreme Judicial Court reversed the trial judge’s denial of Defendant’s motion to admit expert testimony that he was not criminally responsible for his criminal acts and the judge’s allowance of the Commonwealth’s motion to preclude the testimony, holding that the statute allows incompetent defendants to raise any defenses that they could raise in a criminal trial, including that of a lack of criminal responsibility. View "Commonwealth v. Curran" on Justia Law

Dr. Erdle was arrested for possession of cocaine. He successfully completed drug treatment under a deferred entry of judgment program. Before completion of his drug program and dismissal of his criminal matter, the Medical Board filed an accusation. Erdle argued that he could not be disciplined because the action was based entirely on information obtained from his arrest record. Penal Code 1000.4 provides that “[a] record pertaining to an arrest resulting in successful completion of a pretrial diversion program shall not ... be used in any way that could result in the denial of any employment, benefit, license, or certificate.” Business and Professions Code section 492, however, states: “Notwithstanding any other provision of law, successful completion of any diversion program under the Penal Code . . . shall not prohibit" disciplinary action by specific agencies, "notwithstanding that evidence of that misconduct may be" in an arrest record. The ALJ concluded that section 492 permits discipline but that arrest records should not be permitted at the hearing; that testimony by the arresting officer was allowable; and that cause for discipline existed. The court of appeal held that section 492 creates a blanket exemption from the restrictions contained in section 1000.4 for licensing decisions made by the specified healing arts agencies. View "Medical Board of California v. Superior Court" on Justia Law

Appellant BCBSM, Inc. (“Blue Cross”) denied respondent James Linn’s insurance claim because the requested treatment was not considered medically necessary under the parties’ health-plan contract. After Blue Cross denied the claim, an external-review entity determined that the treatment was, in fact, medically necessary for Linn’s condition. Blue Cross paid the claim, but Linn and his wife sued Blue Cross for breach of contract. The district court granted summary judgment for Blue Cross, concluding that the treatment was not medically necessary under the contract’s plain terms and that Blue Cross fulfilled its contractual obligations when it paid for the treatment following the external review. The court of appeals reversed. Because the Minnesota Supreme Court concluded: (1) external-review decisions were independent determinations of medical necessity that did not supersede contractual definitions of medical necessity; and (2) the health-plan contract plainly excluded coverage for Linn’s claim for treatment, the Court reversed. View "Linn v. BCBSM, Inc." on Justia Law

Erie is a Chicago “Federally Qualified Health Center” (FQHC), 42 U.S.C. 254b (2012). FQHCs rely heavily on federal grants and Medicaid reimbursement. Erie Employees are federal employees under the Federal Tort Claims Act, 42 U.S.C. 233(a). Erie was founded as a project between Northwestern Memorial Hospital (NMH) and Erie Neighborhood House in 1957. NMH provides financial support and technical assistance, but Erie physicians seeking NMH privileges are required to apply for them. In 2005, Yarbrough went to the Erie after searching for a clinic that would not require insurance coverage. Yarbrough was informed that she would have her ultrasounds done at Northwestern and would likely deliver her baby at NMH. Based upon information she received during the visit, Yarbrough believed that Erie and NMH were the same entity. Yarbrough sued NMH. based on her daughter’s premature birth, alleging medical negligence. The Illinois Supreme Court answered a certified question: A hospital cannot be held vicariously liable under the doctrine of apparent agency set forth in Gilbert v. Sycamore, for the acts of the employees of an unrelated, independent clinic that is not a party to the litigation. Yarbrough sought treatment at Erie but looks to impose liability on NMH. Erie is neither owned nor operated by NMH. While Erie receives some charitable assistance from NMH, it relies heavily on federal money. Erie does not utilize the Northwestern name, Northwestern-related branding, or Northwestern’s trademark purple color. View "Yarbrough v. Northwestern Memorial Hospital" on Justia Law

The DC Circuit reversed the district court's grant of summary judgment in favor of Clarian in an action challenging the legality of HHS's decision to set forth certain policies regarding the means of calculating reimbursements for Medicare providers in an instruction manual without engaging in notice and comment rulemaking. The court held that the Manual instructions embodied a general statement of policy, not a legislative rule, setting forth HHS's enforcement priorities; policy statements did not establish binding norms; they were not "rules" that must be issued through notice and comment rulemaking; nor were the instructions subject to the Medicare Act's independent notice and comment requirement because they did not establish or change a substantive legal standard. Therefore, neither the Administrative Procedure Act nor the Medicare Act required that the Manual instructions be established by regulation. View "Clarian Health West, LLC v. Hargan" on Justia Law

The district court granted Dana-Farber partial summary judgment, agreeing that Dana-Farber was entitled to full reimbursement of Medicare's share of a tax paid and vacating the Board's decision. At issue was the Board's interpretation of two regulations expounding upon the statutory directive to reimburse only reasonable costs actually incurred. The DC Circuit reversed the district court's judgment, holding that the Board's interpretation was reasonable and Dana-Farber failed to show otherwise — much less that the interpretation violated the Administrative Procedure Act — and thus the court appropriately deferred to it. View "Dana Farber Cancer Institute v. Hargan" on Justia Law

Certain policy and procedures of the Newtown Police Department did not impose a ministerial duty on the department’s officers to search Stanley Lupienski, an individual suffering from auditory hallucinations and shortness of breath, when they took him into custody pursuant to Conn. Gen. Stat. 17a-503(a).The Supreme Court affirmed the judgment of the trial court granting summary judgment in favor of the Town of Newtown, holding (1) the arrest section of the Department’s policy applies only in the context of criminal arrest and does not apply in the context of civil mental health custody, which is governed by section 17a-503(a); and (2) Lupienski was not subject to mandatory search under the Department’s prisoner transportation section of the policy because the transportation policy does not apply to those under custody pursuant to section 17a-503(a). View "Hull v. Town of Newtown" on Justia Law

Plaintiff Lisa Wilson appealed dismissal of her complaint seeking damages against defendants, University of Alabama Health Services Foundation, P.C. ("UAHSF"); Carla Falkson, M.D.; Tina Wood, M.D.; Ravi Kumar Paluri, M.D.; and Mollie DeShazo, M.D., based on the tort of outrage. Wilson's complaint alleged that, in late 2011, her elderly mother, Elizabeth Monk Wilson ("Elizabeth"), was diagnosed with and underwent treatment for colon cancer. According to Wilson, before the onset of Elizabeth's illness, Elizabeth had executed an advanced health-care directive that "instruct[ed] ... caregivers to use all available means to preserve [Elizabeth's] life" and further named Wilson as Elizabeth's health-care proxy "in the event [Elizabeth] became 'too sick to speak for' herself." Elizabeth subsequently suffered a recurrence of her cancer. In August 2015, she was admitted to the University of Alabama at Birmingham Hospital, a facility operated by UAHSF. In her complaint, Wilson alleged that, while Elizabeth was in the hospital, she was treated by the doctors. She further alleged that the doctors made numerous and repeated tactless comments to Elizabeth and Wilson about Elizabeth's condition and her impending death, and to the effect that she was wasting resources by being in the hospital instead of dying at home. Wilson's complaint alleged a single claim for damages "for the tort of outrage, and for the tort of intentional infliction of emotional distress" and sought compensatory and punitive damages. Wilson sought to hold UAHSF vicariously liable for the alleged conduct of the doctors, which conduct, she alleged, occurred within the line and scope of the doctors' employment with UAHSF. The Alabama Supreme Court determined the trial court's holding that the tort of outrage "is limited to three situations" was an incorrect statement of law: the tort can be viable outside the context of the above-identified circumstances and has previously been held to be so viable. The Court therefore reversed the trial court's judgment and remanded the case for further proceedings where the trial court should, under the standard appropriate for a motion to dismiss under Rule 12(b)(6), determine whether the alleged conduct was "so extreme in degree as to go beyond all possible bounds of decency and be regarded as atrocious and utterly intolerable in a civilized society." View "Wilson v. University of Alabama Health Services Foundation, P.C." on Justia Law