Justia Health Law Opinion Summaries

The case involves Bristol SL Holdings, Inc., the successor-in-interest to Sure Haven, Inc., a defunct drug rehabilitation and mental health treatment center, and Cigna Health and Life Insurance Company and Cigna Behavioral Health, Inc. Bristol alleged that Sure Haven's calls to Cigna verifying out-of-network coverage and seeking authorization to provide health services created independent contractual obligations. Cigna, however, denied payment based on fee-forgiving, a practice prohibited by the health plans. Bristol brought state law claims for breach of contract and promissory estoppel against Cigna.The district court initially dismissed Bristol’s claims, but the Ninth Circuit Court of Appeals reversed the dismissal, holding that Bristol had derivative standing to sue for unpaid benefits as Sure Haven’s successor-in-interest. On remand, the district court granted Cigna’s motion for summary judgment, ruling that the Employee Retirement Income Security Act of 1974 (ERISA) preempted Bristol’s state law claims.On appeal, the Ninth Circuit Court of Appeals affirmed the district court's decision. The court held that Bristol’s state law claims were preempted by ERISA because they had both a “reference to” and an “impermissible connection with” the ERISA plans that Cigna administered. The court reasoned that Bristol’s claims were not independent of an ERISA plan because they concerned the denial of reimbursement to patients who were covered under such plans. The court also held that allowing liability on Bristol’s state law claims would interfere with nationally uniform plan administration, a central matter of plan administration. View "Bristol SL Holdings, Inc. v. Cigna Health and Life Insurance Co." on Justia Law

The Supreme Court of Texas reviewed a case involving the State of Texas, Ken Paxton in his official capacity as Attorney General of Texas, the Texas Medical Board, and Stephen Brint Carlton in his official capacity as Executive Director of the Texas Medical Board (collectively, the State) against a group of women and physicians. The plaintiffs challenged the constitutionality of Texas's abortion laws, specifically the Human Life Protection Act, which generally prohibits performing an abortion except when a pregnant woman has a life-threatening physical condition that poses a risk of death or serious physical impairment unless an abortion is performed.The case reached the Supreme Court of Texas as a direct appeal from a temporary injunction issued by the 353rd District Court, Travis County, Texas, which halted the enforcement of Texas's abortion laws in various circumstances. The State contested the injunction, arguing that the plaintiffs lacked standing, the State had sovereign immunity, and the current Texas law permitting life-saving abortion was not more limiting than the Texas Constitution permits.The Supreme Court of Texas held that one of the plaintiffs, Dr. Damla Karsan, had standing to challenge the Attorney General’s enforcement of the Human Life Protection Act against her. The court also concluded that the Declaratory Judgments Act waives the State’s immunity for a claim that a statute violates the state constitution. The court further clarified that under the Human Life Protection Act, a woman with a life-threatening physical condition and her physician have the legal authority to proceed with an abortion to save the woman’s life or major bodily function, in the exercise of reasonable medical judgment and with the woman’s informed consent. The court concluded that Dr. Karsan had not demonstrated that the part of the Human Life Protection Act that permits life-saving abortion is narrower than the Texas Constitution allows. As a result, the court vacated the lower court's injunction order. View "State v. Zurawski" on Justia Law

In 2019, Emily Wheeler, a property owner, was charged with various violations of the Los Angeles Municipal Code related to unlicensed cannabis activity on her property. Wheeler, who was 85 years old and had no criminal record, claimed she had no knowledge of the illegal activity. The trial court dismissed the charges against her, citing her age, clean record, and lack of knowledge about the illegal activity on her property. The People appealed the dismissal, arguing that the trial court erred in considering Wheeler's lack of knowledge because the charges were strict liability offenses.The appellate division of the superior court reversed the dismissal, agreeing with the People that the trial court should not have considered Wheeler's lack of knowledge. The appellate division reasoned that since the charges were strict liability offenses, Wheeler's lack of knowledge was not mitigating. Wheeler then petitioned the Court of Appeal for a writ of mandate to affirm the trial court's dismissal, but the Court of Appeal affirmed the appellate division's decision.The Supreme Court of California reversed the Court of Appeal's judgment. The Supreme Court held that a trial court has discretion to consider a defendant's lack of knowledge when deciding whether to dismiss charges in furtherance of justice under Penal Code section 1385, even for strict liability offenses. The Supreme Court reasoned that the nature of the charged offense and a defendant's minimal culpability can be relevant considerations for a section 1385 dismissal. The Supreme Court remanded the case to the Court of Appeal with instructions to issue a writ of mandate directing the appellate division to affirm the trial court's dismissal. View "Wheeler v. Appellate Division of Superior Court" on Justia Law

Wade T. Hamilton, a pediatric cardiologist, recommended a patient for a cardiac MRI scan but warned her that due to her COVID-19 vaccination, which he claimed included "magnets and heavy metals", it would be unsafe for her to enter an MRI machine. The patient's mother reported Hamilton's statements to the nurse practitioner who had referred the patient to Hamilton, leading to a report being filed against Hamilton with the Board of Licensure in Medicine. The Board, in response, opened a complaint proceeding and demanded that Hamilton undergo a neuropsychological evaluation.Hamilton challenged the Board's order in the Superior Court, arguing that the Board had overstepped its authority and violated his rights to due process and free speech. However, the Superior Court denied his petition and ruled in favor of the Board. Shortly before this decision, Hamilton's medical license in Maine expired and he did not renew it.The Maine Supreme Judicial Court dismissed Hamilton's appeal as nonjusticiable, stating that there had been no final agency action and that the challenged order was moot because Hamilton had allowed his medical license to lapse. The court also noted that Hamilton's challenge to the order directing the evaluation was fully reviewable at the conclusion of the complaint proceedings, making his petition premature. Furthermore, since Hamilton was no longer licensed in Maine, the Board no longer had authority to pursue his evaluation. The court vacated the judgment and remanded the case to the Superior Court for dismissal of the petition for judicial review as nonjusticiable. View "Hamilton v. Board of Licensure in Medicine" on Justia Law

The case involves Lorain Ann Stiffler, who applied for disability insurance benefits under the Social Security Act, claiming disability due to attention deficit hyperactivity disorder, depression, a mood disorder, right knee problems, and a processing disorder. Her application was initially denied and denied again upon reconsideration. Dr. Khosh-Chashm, who diagnosed Stiffler with major depressive disorder, concluded that she had extreme mental functioning limitations and lacked the cognitive and communicative skills required for gainful employment. However, state agency medical consultants Dr. Goldberg and Dr. Bilik disagreed, concluding that Stiffler was not disabled but had moderate limitations on her ability to carry out detailed instructions, maintain concentration, work with others, make simple work-related decisions, and complete a normal workday and workweek.The Administrative Law Judge (ALJ) affirmed the denial of Stiffler's application for disability benefits. The ALJ rejected Dr. Khosh-Chashm's opinion, finding it unsupported by and inconsistent with the medical evidence and Stiffler's significant daily activities. The ALJ also found no conflict between the testimony of the vocational expert and the Dictionary of Occupational Titles (DOT), concluding that Stiffler could work as a marking clerk, mail clerk, or laundry worker.The United States Court of Appeals for the Ninth Circuit affirmed the district court's judgment, which had upheld the ALJ's decision. The court found substantial evidence supporting the ALJ's evaluation of Dr. Khosh-Chashm's medical opinion and concluded that there was no conflict between Stiffler's limitation to "an environment with few workplace changes" and the DOT's Reasoning Level 2. View "STIFFLER V. O'MALLEY" on Justia Law

The case involves four plaintiffs who took docetaxel, a chemotherapy drug, as part of their treatment for early-stage breast cancer and subsequently suffered permanent chemotherapy-induced alopecia (PCIA). The plaintiffs allege that the manufacturers of the drug, Hospira, Inc., Hospira Worldwide, LLC, and Accord Healthcare, Inc., violated state law by failing to warn them that docetaxel could cause PCIA.The case was initially heard in the United States District Court for the Eastern District of Louisiana, where the defendants moved for summary judgment on the basis that the plaintiffs' state law failure-to-warn claims were preempted by federal law. The district court denied the motion, and the defendants appealed.The United States Court of Appeals for the Fifth Circuit was tasked with determining whether federal law preempts the plaintiffs' state law failure-to-warn claims against the defendant drug manufacturers. The court found that the district court had erred in its interpretation of what constitutes "newly acquired information" under the changes-being-effected (CBE) regulation, which allows manufacturers to file a supplemental application with the FDA and simultaneously implement a labeling change before obtaining FDA approval. The court held that the district court failed to enforce the requirement that newly acquired information must "reveal risks of a different type or greater severity or frequency than previously included in submissions to FDA."The court vacated the district court's judgment on the plaintiffs' failure-to-warn claims and remanded the case for further consideration of one outstanding issue: whether the Bertrand Abstract, a scientific study, constituted "newly acquired information" that revealed a greater risk of PCIA than previously known. If the Bertrand Abstract does not meet this standard, the court held that the defendants would not be liable to the plaintiffs on their state law failure-to-warn claims. View "Hickey v. Hospira" on Justia Law

Seth Lookhart, a dentist, was convicted of numerous crimes related to a fraudulent scheme that endangered his patients' health and safety. The scheme involved unnecessary sedation of patients to fraudulently bill Alaska’s Medicaid program, overcharging it by more than $1.6 million. Lookhart also stole $412,500 from a business partner. His reckless sedation practices nearly resulted in the loss of two patients' lives. He was arrested in April 2017 and convicted on 46 charges in January 2020, leading to a sentence of 20 years in prison with eight years suspended.Following Lookhart's convictions, the Division of Corporations, Business and Professional Licensing sought to revoke his dental license. Lookhart agreed to the facts of the accusation but argued that revocation was not an appropriate sanction. The administrative law judge (ALJ) disagreed, stating that Lookhart's misconduct was more severe than any prior case and that revocation was the clear and obvious sanction. The Board of Dental Examiners adopted the ALJ's decision.Lookhart appealed to the superior court, arguing that the Board's decision was inconsistent with its prior decisions. The court disagreed, stating that the Board had wide discretion to determine appropriate sanctions and that no prior case was comparable to Lookhart's. The court affirmed the Board's decision. Lookhart then appealed to the Supreme Court of the State of Alaska.The Supreme Court affirmed the lower court's decision. It held that the Board of Dental Examiners did not abuse its discretion by revoking Lookhart's license. The court found that none of the Board's prior licensing cases involved misconduct of the scope and severity in this case, so there was no applicable precedent to limit the Board's exercise of its discretion. View "Lookhart v. State of Alaska, Board of Dental Examiners" on Justia Law

A teacher, who was involved in a car accident caused by a third party, sustained serious injuries. The teacher was covered under his employer’s self-insured healthcare plan, which stipulates that the employer has a right of reimbursement for medical expenses if a covered person receives a separate settlement. The employer paid for the teacher’s medical expenses and the teacher also received $500,000 in settlements from two separate insurers. The teacher requested that the employer waive its right to reimbursement twice, but the employer never agreed. Two years after the teacher notified the employer of his insurance settlements, the employer requested reimbursement and later sued him for breach of contract.The Superior Court of the State of Alaska granted summary judgment to the employer on the issue of whether the teacher breached the contract to reimburse the employer. The employer then moved for summary judgment on the amount of damages, providing an affidavit from its Plan Administrator and a claims ledger. The teacher opposed the motion, providing his own affidavit and a self-created spreadsheet in support of his argument that some of the medical costs paid by the employer were not associated with the accident. The court granted the employer’s motion for summary judgment on contract damages.The Supreme Court of the State of Alaska affirmed the lower court’s summary judgment order regarding breach of contract, but held that the teacher raised a genuine dispute of material fact regarding damages. Therefore, the Supreme Court reversed and remanded the lower court’s summary judgment order regarding contract damages. View "Fischer v. Kenai Peninsula Borough School District" on Justia Law

Michele Rawlins, a former school principal and member of the Teachers' Retirement System of the City of New York (TRS), was diagnosed with post-traumatic stress disorder (PTSD) following a series of incidents involving a disgruntled food-service worker. The worker's behavior left Rawlins feeling threatened and harassed, leading to her inability to perform her job responsibilities. The final incident occurred in April 2019, when the worker, who had been transferred to another location, entered the school and demanded to speak with Rawlins, insisting she had his "belt and wallet." Rawlins interpreted the worker's remarks as having "sexual overtones" and felt she was being stalked. She left the school building and never returned to work following the incident.Rawlins applied for accidental disability retirement benefits (ADR) from the TRS, but her application was denied. The TRS Medical Board determined that she did not sustain an accident in the work setting and that "purposeful conduct by coworkers giving rise to a disabling injury is not an accident within the meaning of the pension statute." Rawlins reapplied for ADR, but the Board maintained its previous determination. Rawlins then commenced a CPLR article 78 proceeding to annul the Board's determination. The Supreme Court denied the petition and dismissed the proceeding, stating that the Board's determination had a rational basis. The Appellate Division affirmed the Supreme Court's decision, and Rawlins was granted leave to appeal.The Court of Appeals affirmed the lower courts' decisions. The court held that substantial evidence supported the Board's determination that Rawlins' injury was not caused by an "accident" within the meaning of the statutory scheme. The court declined to adopt a rule that "purposeful conduct by coworkers" can never be the basis for an award of ADR. Instead, the court stated that when a member's disability is alleged to have resulted from the intentional acts of any third party, the relevant question continues to be whether the injury-causing event was sudden, unexpected, and outside the risks inherent in the work performed. View "Matter of Rawlins v Teachers' Retirement Sys. of the City of N.Y." on Justia Law

An inmate, Timothy Finley, who suffers from severe psychiatric disorders, was placed in a heavily restrictive cell in administrative segregation for approximately three months by prison officials. Finley brought a case against the deputy wardens, Erica Huss and Sarah Schroeder, alleging violations of the Eighth Amendment and his right to procedural due process, as well as disability-discrimination claims under the Americans with Disabilities Act and the Rehabilitation Act.The district court granted summary judgment to Huss and Schroeder on all claims. On appeal, the United States Court of Appeals for the Sixth Circuit affirmed the lower court's decision on Finley’s procedural due process and statutory discrimination claims. However, the court reversed the lower court's decision on Finley’s Eighth Amendment claim, finding that he presented sufficient evidence to find that the deputy wardens violated his clearly established rights. The court remanded the case for further proceedings on the Eighth Amendment claim. View "Finley v. Huss" on Justia Law