Justia Health Law Opinion Summaries

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The issue presented for the New Mexico Supreme Court’s review centered on the executive branch’s authority to impose business restrictions during a pandemic. Specifically, the Court was asked to address: (1) whether Petitioners were authorized to restrict or close businesses when necessary for the protection of public health; and (2) whether the renewed temporary closure of indoor dining at restaurants and breweries, mandated by a July 13, 2020, emergency public health order (July Order), was arbitrary and capricious. With respect to the first question the Supreme Court held, consistent with its opinion in Grisham v. Reeb, 2020-NMSC-___, (S-1-SC-38336, Nov. 5, 2020), that Petitioners were so authorized. With respect to the second question, the Court held that the July Order’s temporary closure of indoor dining was not arbitrary and capricious. View "Lujan Grisham v. Romero" on Justia Law

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The Ninth Circuit affirmed the district court's grant of summary judgment for HHS in an action brought by plaintiff, challenging HHS's denial of his claim for reimbursement from the Medicare program for services that he provided covered patients. The Supreme Court recently reaffirmed that a reviewing court should defer to an agency's reasonable interpretation of ambiguous regulations in Kisor v. Wilkie, 139 S. Ct. 2400 (2019).The panel agreed with the district court that the governing regulation, 42 C.F.R. 424.520(d), is genuinely ambiguous and that the agency's interpretation is reasonable. In this case, section 424.520(d) does not specify whether a certification submitted to reactivate billing privileges constitutes a "Medicare enrollment application" that triggers a new effective date. The panel concluded that the Board's interpretation of section 424.520(d) merits Auer deference and controls this case. Therefore, plaintiff's reactivation request was "a Medicare enrollment application," and its filing date of August 31, 2015 is the effective date of his billing privileges. The panel also agreed with the district court that its review was appropriately confined to the administrative record the agency produced and that the agency was not required to supplement the record. View "Goffney v. Becerra" on Justia Law

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In this special action challenging the trial court's ruling that Defendant's due process rights required disclosure of the victim's privileged records for in-camera review, the Supreme Court held that the trial court did not err in ordering in-camera review.Defendant was charged with second-degree murder for killing M.S., his girlfriend. Before trial, Defendant moved to compel Magellan Hospital to disclose for in-camera review M.S.'s privileged mental health records. The trial court ruled that Defendant's due process rights required dislosure of the privileged records for in-camera review. M.S.'s siblings filed a special action under Arizona's Victims' Bill of Rights challenging the ruling. The court of appeals granted relief, concluding that there was not a substantial probability that the records contained information critical to Defendant's justification defense. The Supreme Court vacated the court of appeals' opinion and affirmed the trial court's judgment, holding that a record of M.S.'s purported mental illness would be material to Defendant's justification defense. View "R.S. v. Honorable Peter A. Thompson" on Justia Law

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The Supreme Court affirmed in part and reversed in part the judgment of the circuit court compelling Plaintiff to arbitrate his claims of wrongful death and negligence against Signature HealthCARE of East Louisville, holding that arbitration was required on all claims.To secure his father's admittance into Signature, a long-term care facility, Plaintiff signed an arbitration agreement as his father's authorized representative. After his father died, Plaintiff brought a negligence and wrongful death claim against Signature. Signature filed a motion to compel arbitration. The trial court denied the motion. The court of appeals reversed in part, holding that Plaintiff's wrongful death claim was arbitrable because he signed the arbitration agreement in his individual capacity. The Supreme Court affirmed in part and reversed in part, holding that both Plaintiff's individual claims and that claims he brought as the representative of his father's estate were subject to arbitration. View "LP Louisville East, LLC v. Patton" on Justia Law

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CMA and others filed suit against Aetna, seeking among other claims, an injunction for alleged violations of the Unfair Competition Law (UCL; Bus. & Prof. Code, section 17200). The trial court found that CMA lacked standing under the UCL because it was not directly injured by Aetna's policy.The Court of Appeal affirmed the trial court's grant of Aetna's motion for summary judgment, concluding that the body of law permitting an association to bring a nonclass representative action does not bestow standing upon CMA to seek an injunction against Aetna under the UCL, whether or not CMA individually suffered injury in fact and lost money or property. The court also concluded that CMA's evidence that it diverted substantial resources to assist its physician members who were injured by Aetna's policy did not create a material disputed fact as to whether CMA itself suffered injury in fact and lost money or property. The court explained that an association must sustain direct economic injury to itself and not just its members to bring a UCL claim. Furthermore, evidence that an association diverted resources to investigate its members' claims of injury and advocate for their interests is not enough to show standing under the UCL. In this case, the federal authorities CMA cites are neither binding on this court nor instructive. View "California Medical Ass'n v. Aetna Health of California, Inc." on Justia Law

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Plaintiff, a Nevada physician who treats patients covered by Medicare, filed suit seeking an injunction compelling the contractor that administers Medicare in his region to change the method of evaluating his claims. The district court granted the injunction.The Ninth Circuit vacated the preliminary injunction, concluding that the Medicare statute permits a court to review only claims that have been presented to the agency. The panel explained that, because this case does not involve a claim that was presented to the agency, the district court lacked subject matter jurisdiction. Accordingly, the panel remanded to the district court with instructions to dismiss the complaint for lack of jurisdiction. View "Odell v. U.S. Department of Health & Human Services" on Justia Law

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Plaintiffs, a group of nursing homes that participate in both the Medicare and Medicaid programs, challenge the legality of DHS's Final Rule permitting survey teams conducting certain inspections of nursing homes not to include a registered nurse. The district court dismissed plaintiffs' claims, brought under the Medicare and Medicaid Acts, for lack of subject-matter jurisdiction based on claim-channeling and jurisdiction-stripping provisions governing claims arising under the Medicare Act.The Second Circuit reversed, concluding that the district court has jurisdiction under 28 U.S.C. 1331 over plaintiffs' claim arising under the Medicaid Act, which does not incorporate the same claim-channeling and jurisdiction-stripping provisions as the Medicare Act. The court explained that the Medicare Act's review provisions do not preclude plaintiffs from challenging the Final Rule in federal court because their challenge is independently rooted in the Medicaid Act. Furthermore, plaintiffs' Medicaid Act claim is not inextricably intertwined with a Medicare Act claim for benefits or compliance determination, and the government's policy rationale does not support claim channeling and jurisdiction stripping in this case. Accordingly, the court remanded for further proceedings. View "Avon Nursing & Rehabilitation v. Becerra" on Justia Law

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The Supreme Court affirmed the order of the circuit court vacating the finding of the West Virginia Department of Health and Human Resources of maltreatment by Respondent as to her son, holding that the circuit court correctly determined that the conduct engaged in by the lay representative of the West Virginia Department of Health and Human Resources (DHHR) constituted the unauthorized practice of law.The circuit court concluded (1) the decision of the administrative law judgment upholding the DHHR's finding of maltreatment was erroneous because it was not supported by a witness with personal knowledge and was based upon inadmissible DHHR records; and (2) the administrative hearing before DHHR's board of review was conducted in an unlawful manner because DHHR's non-lawyer representative engaged in the unauthorized practice of law. The Supreme Court affirmed, holding that the circuit court did not err in concluding that the administrative proceedings were based upon unlawful procedure brought about by DHHR's lay representative engaging in the unauthorized practice of law. View "W. Va. Department of Health and Human Resources v. C.P." on Justia Law

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The Supreme Court reversed the order of the county court purporting to discharge the Office of Public Guardian (OPG) and appoint the ward's parents as successor coguardians over their objection, holding that the parents had standing to appeal and that the Public Guardianship Act, Neb. Rev. Stat. 30-4101 to 30-4118, did not permit the discharge of the OPG.Nicholas was an adult with severe mental illness who was in need of a guardian. His parents served as his court-appointed coguardians until they petitioned to have the OPG appointed as Nicholas's guardian pursuant to the Act. The county court appointed the OPG as Nicholas's guardian, but OPG later filed a motion for discharge, asserting that Nicholas's parents should be named successor guardians. After a hearing, the court granted the OPG's motion for discharge and directed that Nicholas's parents be appointed his successor coguardians. The Supreme Court reversed, holding that the OPG failed to prove that its services were no longer necessary, and therefore, the county court erred in discharging the OPG under section 30-4117. View "In re Guardianship of Nicholas H." on Justia Law

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A patient sued a hospital, arguing the hospital violated the Alaska Health Care Decisions Act (HCDA) when it temporarily assumed decision-making authority over his medical care while he was incapacitated and treated him without his consent or that of his parents, whom he had previously authorized to make medical decisions on his behalf if he were rendered incompetent or incapacitated. The hospital argued it was entitled to immunity under the HCDA because it held a good faith belief that the patient’s parents lacked authority to make medical decisions for him, based on conduct that convinced health care providers at the hospital that the parents were not acting in the patient’s best interest. The superior court agreed with the hospital and granted its summary judgment motion, concluding that the immunity provisions applied. The superior court concluded the hospital was entitled to immunity because its doctors had acted in good faith and in accordance with generally accepted medical standards. In a matter of first impression for the Alaska Supreme Court, it determined the superior court overlooked the requirement for specific good faith as to the authority or lack thereof of the patient’s surrogate or agent. The grant of summary judgment was reversed and the matter remanded for further proceedings. View "Bohn v. Providence Health & Srvs - Washington" on Justia Law