Justia Health Law Opinion Summaries

Dr. Fares Jeries Rabadi, a licensed physician in California, had his certificate of registration to dispense controlled substances revoked by the Drug Enforcement Administration (DEA). The DEA initiated an investigation into Rabadi in April 2018 due to his high-risk prescribing practices. In March 2020, the DEA issued an Order to Show Cause and Immediate Suspension of Registration, alleging that Rabadi issued numerous prescriptions for controlled substances outside the usual course of professional practice and not for a legitimate medical purpose to seven individuals. Rabadi requested a hearing before an administrative law judge (ALJ), which took place in September 2020. The ALJ found Rabadi's testimony not credible and recommended revoking his registration. The DEA Administrator adopted the ALJ's recommendations with minor modifications and revoked Rabadi's registration.Rabadi petitioned for review, arguing that the DEA's revocation was invalid because DEA ALJs are unconstitutionally insulated from removal by two layers of "for-cause" protections. The United States Court of Appeals for the Ninth Circuit reviewed the case. The court held that Rabadi's argument failed under Decker Coal Co. v. Pehringer, which found similar ALJ removal protections constitutional. The court noted that DEA ALJs perform purely adjudicatory functions, Congress does not mandate the use of ALJs for DEA hearings, and DEA ALJ decisions are reviewed de novo by the DEA Administrator, who is removable at will by the President.Rabadi also argued that the DEA Administrator's order was arbitrary and capricious. The court rejected this argument, finding that the Administrator properly ignored Rabadi's unsupported defense regarding high dosages of prescribed drugs and appropriately analyzed the public interest factors, including Rabadi's lack of a conviction record. The Ninth Circuit denied Rabadi's petition for review, upholding the DEA Administrator's order. View "RABADI V. USDEA" on Justia Law

Charles Leonhardt, a pretrial detainee at the Big Horn County Jail, suffered from back pain and was eventually diagnosed with two lower back infections after being transported to a hospital. He sued Big Horn County Sheriff Ken Blackburn, Jail Captain Debbie Cook, unnamed detention officers, the Big Horn County Sheriff’s Office, and the Jail, alleging negligence and deliberate indifference under the Fourteenth Amendment.The District Court of Big Horn County granted summary judgment to the defendants on both claims. The court found that Sheriff Blackburn had fulfilled his duty to arrange for medical care by contracting with Midway Medical Clinic, which provided medical services to inmates. The court also determined that the actions of Sheriff Blackburn, Captain Cook, and the detention officers were reasonable and did not proximately cause Mr. Leonhardt’s injuries. Additionally, the court found no evidence of deliberate indifference to Mr. Leonhardt’s medical needs, as the defendants ensured he received timely medical care.The Wyoming Supreme Court reviewed the case and affirmed the district court’s decision. The court held that there was no genuine dispute of material fact regarding the negligence claim, as the defendants acted reasonably and provided Mr. Leonhardt with access to medical care. The court also found no evidence that the defendants were aware of and disregarded an excessive risk to Mr. Leonhardt’s health, thus failing to meet the subjective component of a deliberate indifference claim. Consequently, the court affirmed the summary judgment in favor of the defendants on both the negligence and Fourteenth Amendment deliberate indifference claims. View "Leonhardt v. Big Horn County Sheriff's Office" on Justia Law

The case involves the Hawai‘i Disability Rights Center (HDRC), which represents individuals with developmental disabilities, including children with autism. HDRC alleges that the Hawai‘i Departments of Education (DOE) and Human Services (DHS) unlawfully deny students with autism access to Applied Behavioral Analysis (ABA) therapy during school hours, even when medically necessary. DOE provides ABA services only if deemed educationally relevant, and DHS does not provide ABA services during school hours, even if medically necessary and covered by Medicaid or private insurance.The United States District Court for the District of Hawaii granted summary judgment in favor of DOE and DHS, holding that HDRC's failure to exhaust administrative procedures under the Individuals with Disabilities Education Act (IDEA) was fatal to all its claims, including those under the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act, and the Medicaid Act. The court concluded that HDRC, as a protection and advocacy organization, must ensure that parents of its constituents exhaust the IDEA’s administrative process.The United States Court of Appeals for the Ninth Circuit reviewed the case. The court held that HDRC, as Hawai‘i’s designated protection and advocacy system, can pursue administrative remedies under the IDEA and is therefore bound by the IDEA’s administrative exhaustion requirement for its own claim. However, HDRC need not ensure that parents of individual children with autism exhaust their individual IDEA claims. The court found that HDRC did not exhaust its administrative remedies, and no exceptions to IDEA exhaustion applied.The Ninth Circuit also held that HDRC was not required to exhaust the IDEA’s administrative procedures before bringing its claims under the ADA, Section 504, and the Medicaid Act. The court concluded that HDRC’s non-IDEA claims do not allege the denial of a free appropriate public education (FAPE) and therefore do not require exhaustion under the IDEA. The court affirmed in part, reversed in part, and remanded the case. View "HAWAI'I DISABILITY RIGHTS CRT. V. KISHIMOTO" on Justia Law

A healthcare consulting firm, Core Finance Team Affiliates, LLC (Core), provided data services to three Maine hospitals (the Hospitals) to support their claims for federal reimbursement for Medicare-eligible patients. Core's services included adjustments to the Hospitals' internal data, specifically annual hourly wage data and occupational mix survey (OMS) data. The Maine Hospital Association entered into a contract with Core, which included a contingent fee for OMS services. The Hospitals used Core's data but refused to pay the contingent fee, leading Core to file a complaint for breach of contract and unjust enrichment.The Superior Court (Cumberland County) held a jury trial on the breach of contract claim, resulting in a verdict for the Hospitals, finding they were not contractually obligated to pay the contingent fee for OMS services. Subsequently, the Business and Consumer Docket (Duddy, J.) held a bench trial on the unjust enrichment claim, awarding Core $566,582.25 based on the increased federal reimbursement the Hospitals received due to Core's services. The court ruled that the Hospitals waived the issue of quantum meruit by not pleading it as an affirmative defense.The Maine Supreme Judicial Court reviewed the case and vacated the judgment. The court held that the trial court erred in awarding restitution for unjust enrichment without first addressing the adequacy of a quantum meruit claim. The court emphasized that quantum meruit, a legal remedy, should be considered before unjust enrichment, an equitable remedy. The court also found that the award exceeded the amount Core would have received under the proposed contract and was improperly based on the Hospitals' increased federal reimbursement rather than the market value of Core's services. The case was remanded for entry of judgment in favor of the Hospitals. View "Core Finance Team Affiliates, LLC v. Maine Medical Center" on Justia Law

In 2013, Dr. Johnathan Slone began working as a general surgeon at El Centro Regional Medical Center (Center) on a locum tenens basis. Despite not being board-certified, he was granted full staff privileges in January 2015. In April 2016, Slone became an employee of the Imperial Valley MultiSpecialty Medical Group (IVMSMG) and later entered into a contract with Community Care IPA (IPA) to provide healthcare administrative services. In July 2017, Slone was informed by the Center that he had until July 2020 to become board-certified. Subsequently, he resigned from IVMSMG and began working full-time for IPA. In September 2017, the Center suspended his privileges for failing to complete medical records, and by March 2018, his suspension was deemed a voluntary resignation.Slone filed a fourth amended complaint in February 2021, alleging that the Center retaliated against him in violation of Health and Safety Code section 1278.5 after he reported concerns about patient care. The case proceeded to a bench trial solely on this cause of action. The Superior Court of Imperial County found in favor of the Center, concluding that Slone did not suffer retaliation and had not proven any economic or noneconomic damages.The Court of Appeal, Fourth Appellate District, Division One, reviewed the case. The court affirmed the lower court's judgment, holding that Slone did not carry his burden on appeal. The court found substantial evidence supporting the trial court's findings that the Center did not retaliate against Slone for his complaints about patient care. The court also upheld the trial court's findings that Slone voluntarily resigned from his surgical practice to pursue a career as a medical administrator and did not suffer any economic or noneconomic damages as a result of the alleged retaliation. View "Slone v. El Centro Regional Medical Center" on Justia Law

The case involves a billing dispute between a group of emergency room physicians (plaintiff) and an insurance company (defendant). The dispute centers on the interpretation of Connecticut’s surprise billing law, which aims to protect insured individuals from high medical bills when they receive emergency care from out-of-network providers. The plaintiff contends that the law requires the defendant to fully reimburse them for emergency services and then collect any applicable cost-sharing amounts (deductibles, copayments) from the insured. The defendant argues that it can deduct the insured’s cost-sharing amounts from the reimbursement it pays to the plaintiff.The United States District Court for the District of Connecticut dismissed the plaintiff’s stand-alone claims under the surprise billing law, concluding that the law does not create a private right of action. The court then certified three questions to the Connecticut Supreme Court: (1) whether a CUTPA claim can be maintained for conduct that violates the surprise billing law but not CUIPA, (2) whether the surprise billing law requires insurers to fully reimburse providers and then collect cost-sharing amounts from insureds, and (3) whether the defendant’s practice of deducting cost-sharing amounts from reimbursements violates the surprise billing law.The Connecticut Supreme Court held that Connecticut law does not recognize a cause of action under CUTPA for conduct that violates the surprise billing law but is not identified as an unfair insurance practice under CUIPA. The court also held that the surprise billing law does not require insurers to fully reimburse providers and then collect cost-sharing amounts from insureds. Instead, insurers can deduct the insured’s cost-sharing amounts from the reimbursement paid to the provider. Finally, the court concluded that the defendant’s practice of deducting cost-sharing amounts from reimbursements does not violate the surprise billing law. View "NEMS, PLLC v. Harvard Pilgrim Health Care of Connecticut, Inc." on Justia Law

A federal inmate, Dustin Rowland, developed a hernia after a pretrial detention fight. A physician deemed the hernia "reducible and stable," recommending non-surgical treatments. Rowland, desiring surgery, utilized the Bureau of Prisons' (BOP) Administrative Remedial Program, which involves a four-step grievance process. His initial requests were denied, but a later appeal led to approval for a surgical consultation. However, Rowland's final appeal was denied for procedural reasons, and he did not correct the deficiency. He eventually received surgery but filed a lawsuit claiming deliberate indifference to his medical needs, seeking damages under Bivens, injunctive relief for post-operative care, and a negligence claim under the Federal Tort Claims Act (FTCA).The United States District Court for the District of Colorado dismissed Rowland's Bivens claim, granted summary judgment against his injunctive relief claim for failure to exhaust administrative remedies, and dismissed the FTCA claim for lack of subject matter jurisdiction due to non-exhaustion. Rowland's motion for reconsideration was also denied.The United States Court of Appeals for the Tenth Circuit reviewed the case. The court affirmed the district court's dismissal of the Bivens claim, noting that Rowland's case presented a new context not covered by previous Bivens cases and that the BOP's Administrative Remedial Program provided an adequate alternative remedy. The court also upheld the summary judgment on the injunctive relief claim, as Rowland failed to exhaust administrative remedies specifically for post-operative care. Lastly, the court affirmed the dismissal of the FTCA claim, emphasizing the jurisdictional requirement of exhausting administrative remedies before filing suit. The court found no abuse of discretion in the district court's denial of Rowland's Rule 60(b) motion for reconsideration. View "Rowland v. Matevousian" on Justia Law

Chad Sheller, as the personal representative of the estate of his son Daniel Elias Sheller, sought attorneys' fees after voluntarily dismissing a Vaccine Act petition. Daniel passed away at two months old, two days after receiving several vaccinations. Sheller filed for compensation under the National Childhood Vaccine Injury Compensation Program, relying on the "Triple Risk Model" of vaccine-triggered sudden infant death syndrome (SIDS) proposed by Dr. Douglas Miller. This model had previously been accepted in another case, Boatmon v. Secretary of Health & Human Services.The Special Master denied Sheller's request for attorneys' fees, concluding that the Triple Risk Model did not provide a reasonable basis for the claim. The United States Court of Federal Claims affirmed this decision. The Special Master also struck certain medical articles from the record, which were submitted after the petition was dismissed, deeming them irrelevant.The United States Court of Appeals for the Federal Circuit reviewed the case. The court found that the Special Master abused his discretion by not considering whether the Triple Risk Model was a reasonable basis at the time of filing, given its prior acceptance in the Boatmon case. The court noted that the model was plausible and had succeeded before another special master, making it a reasonable basis for the petition when filed. The court also found that the Special Master did not abuse his discretion in striking the medical articles, as he assessed their relevance appropriately.The Federal Circuit vacated the decision and remanded the case for the Special Master to determine, in his discretion, whether attorneys' fees should be granted, considering the Vaccine Act's objective of maintaining access to qualified legal assistance. View "SHELLER v. HHS " on Justia Law

Annette McEachin, a human resources manager, was seriously injured in a car accident in 2017 and subsequently filed a disability claim with Reliance Standard Life Insurance Company. Reliance approved her for long-term disability benefits, which were later extended after another car accident worsened her condition. McEachin underwent multiple surgeries and treatments for her physical injuries and also received treatment for mental health issues, including depression and anxiety, exacerbated by her son's suicide in 2019. Reliance paid her benefits for nearly four years but stopped payments in April 2021, concluding that her physical health had improved sufficiently for her to return to work.The United States District Court for the Eastern District of Michigan found that McEachin no longer had a physical disability as of April 2021 but ruled that her mental health disabilities entitled her to two more years of benefits. Both parties appealed the decision. Reliance argued that the district court misinterpreted the insurance policy, while McEachin contended that her physical disabilities persisted beyond April 2021.The United States Court of Appeals for the Sixth Circuit reviewed the case. The court held that McEachin's physical disabilities alone justified her disability benefits until April 2021, meaning the 24-month mental health limitation did not apply until then. The court affirmed the district court's finding that McEachin's physical disabilities no longer rendered her totally disabled as of April 2021. However, the court vacated the district court's decision regarding the mental health benefits and remanded the case to consider whether McEachin's post-April 2021 medical evidence could toll the 24-month mental health limitation period, potentially extending her eligibility for benefits beyond April 2023. View "McEachin v. Reliance Standard Life Ins. Co." on Justia Law

Kyle John Schober was convicted of possessing a controlled substance with intent to deliver after a traffic stop revealed marijuana, THC extract, and cocaine in his vehicle. He was sentenced to one-to-fifteen years imprisonment, suspended in favor of five years of probation, with conditions including drug treatment and random drug screens.Schober later obtained a medical cannabis identification card under the West Virginia Medical Cannabis Act and sought to modify his probation conditions to allow the use of medical cannabis. The Circuit Court of Berkeley County denied his initial motion, finding insufficient evidence of a valid PTSD diagnosis and treatment. Schober filed a renewed motion with additional documentation, but the court again denied the motion, questioning the validity of his medical cannabis card and finding that his use of cannabis would not support his rehabilitation or community safety.The Supreme Court of Appeals of West Virginia reviewed the case and affirmed the lower court's decision. The court held that the West Virginia Cannabis Act does not supersede West Virginia Code § 62-12-9, which allows courts to impose conditions on probation, including prohibiting the use of marijuana. The court found no conflict between the statutes and concluded that probation conditions can restrict otherwise lawful conduct to support rehabilitation and public safety. Additionally, the court noted that Schober's possession of marijuana would violate federal law, specifically the Controlled Substances Act, and thus violate the conditions of his probation under West Virginia Code § 62-12-9(a)(1). View "State of West Virginia v. Schober" on Justia Law