Justia Health Law Opinion Summaries

In this case, a group of healthcare providers (Providers) sued the insurer Sanford Health Plan, Inc. (SHP) for excluding them from participating in some of its health benefit plans. The Providers argued that according to South Dakota’s “Any Willing Provider” law (SDCL 58-17J-2), they had the right to participate as panel providers in all of SHP's plans. The law stipulates that a health insurer cannot block patient choice by excluding a willing and qualified healthcare provider from its panel of providers if the provider is within the geographic coverage area of the health benefit plan. The circuit court determined that the law did not permit SHP to exclude a qualified and willing healthcare provider from participating in every health benefit plan it offered, granting summary judgment in favor of the Providers.The Supreme Court of the State of South Dakota affirmed the circuit court's decision. It interpreted the law as plan-specific, meaning an insurer may not exclude any willing and fully qualified provider from any of its plans or from any tier within a plan. It also clarified that an insurer may still exclude providers from plans if they do not meet the statutory requirements for participation as a panel provider. The court concluded that, according to the law, SHP could not exclude the Providers from participating in its TRUE Plan or Tier 1 of the PLUS Plan, thus affirming the circuit court's granting of summary judgment in favor of the Providers. View "Orthopedic Institute v. Sanford Health Plan, Inc." on Justia Law

In Oklahoma, a woman suffering from various progressive, degenerative diseases executed an advance directive instructing that her life not be extended by life-sustaining treatment, including artificially administered nutrition and hydration. Later, she was hospitalized and a PEG tube was inserted to provide artificially administered nutrition and hydration, contrary to the terms of her advance directive. The woman's sister and children disagreed on whether to keep the PEG tube in place or follow the instructions in the advance directive. The Supreme Court of the State of Oklahoma held that an incapacitated or incompetent person retains the legal right to revoke their advance directive and that revocation of an advance directive must be proven by clear and convincing evidence. The court affirmed the decision of the lower court, which had found that the woman had not revoked her advance directive and that the insertion of the PEG tube violated the terms of her advance directive. View "IN RE GUARDIANSHIP OF L.A.C." on Justia Law

In the case before the United States Court of Appeals For the Eighth Circuit, the defendant, Kaycee Heard, appealed his 180-month sentence for involvement in a drug-trafficking conspiracy that transported oxycodone and fentanyl pills from Michigan to North Dakota for distribution. Heard pleaded guilty to conspiring to distribute and possess with intent to distribute controlled substances, and his sentence exceeded his Guidelines range of 135 to 168 months. Heard's appeal centered around three key claims: the district court miscalculated his criminal history score, wrongly applied a Guidelines enhancement for his role in the conspiracy, and issued an unreasonable sentence.The Court of Appeals rejected all three of Heard's claims. First, the court found that the district court was correct to assess a criminal history point for a two-year probation term Heard served under Michigan’s Holmes Youthful Trainee Act. Despite Heard's argument that this sentence should not have counted towards his criminal history score as no conviction was entered and the underlying charges were dismissed, the Appeals Court ruled that Heard's admission of guilt by pleading guilty meant the probation term was correctly counted as a "prior sentence".Second, the Appeals Court upheld the district court's application of a three-level enhancement for Heard's role in the conspiracy, finding that Heard had exhibited sufficient managerial or supervisory authority to warrant this enhancement. The court pointed to evidence that Heard had recruited co-conspirators, used a co-conspirator’s apartment as a stash house, directed a co-conspirator to travel to get pills for distribution, and received proceeds from the pills’ sale.Finally, the court found Heard's sentence to be both procedurally and substantively reasonable. The district court had varied up from the Guidelines range based on Heard's conduct in pretrial detention, including his participation in a prison riot and assaults on two inmates. The Appeals Court found no clear error in the district court's determination that Heard had participated in the riot, and concluded that the 180-month sentence was within the realm of reasonableness given Heard's drug trafficking and pretrial detention misconduct. The court also rejected Heard's claim that his sentence created unwarranted disparities with his co-conspirators, stating that the need to avoid unwarranted sentence disparities refers to national disparities, not differences among co-conspirators. The court therefore affirmed the district court’s judgment. View "United States v. Heard" on Justia Law

The plaintiff, Dr. Misty Blanchette Porter, had been a staff physician at Dartmouth-Hitchcock Medical Center (DHMC) since 1996. She specialized in reproductive medicine and was highly regarded in her field. In November 2015, Dr. Porter developed a medical condition that required her to take a medical leave of absence and subsequently work reduced hours. In 2017, DHMC decided to close the Reproductive Endocrinology and Infertility Division (REI) where Dr. Porter worked and terminate her employment. Dr. Porter claimed that her termination was due to her disability and her whistleblowing activity, in violation of the Americans with Disabilities Act (ADA), the Rehabilitation Act, and the laws of Vermont and New Hampshire.The United States Court of Appeals for the Second Circuit found that the district court erred in granting summary judgment to DHMC. The court found that there was direct evidence that the decision to terminate Dr. Porter's employment was based, in whole or in part, on her disability. The court also found that a jury could reasonably infer that Dr. Edward Merrens, the chief decision-maker in the termination, was aware of Dr. Porter's whistleblowing activity. The case was affirmed in part, vacated and remanded in part. View "Porter v. Dartmouth-Hitchcock Medical Center" on Justia Law

The case revolves around Windy Hill Hospital's request to change from a long-term care hospital to a short-term care hospital in Georgia, without obtaining a new Certificate of Need (CON) from the Department of Community Health. The case addresses two preliminary questions: whether a CON confers a private right or a public right on a hospital, and the proper framework for interpreting the Department's CON regulations.The Supreme Court of Georgia held that a CON confers a private right as it provides the individual, usually a corporate entity, with the right to operate a particular kind of hospital. This is because the right to use one's property in a particular way is a traditional property right. The Court also clarified the framework for interpreting administrative rules, stating that courts may defer to an agency's interpretation of its own rule only if the rule's meaning is ambiguous. In this case, the Court did not definitively determine if the Court of Appeals had applied this framework correctly in interpreting the Department's regulations relevant to this case.The case was remanded to the Court of Appeals for further proceedings consistent with this opinion, without deciding several other issues that could be dispositive of this case. The Court did not rule on whether Windy Hill Hospital ever held a CON to operate as a long-term care hospital, whether the hospital's 1996 correspondence with the State Health Planning Agency constituted a "CON process", and whether any rights purportedly conferred by a CON ultimately vested. View "KENNESTONE HOSPITAL, INC. v. EMORY UNIVERSITY" on Justia Law

A pregnant inmate, Lidia Lech, filed a lawsuit against several healthcare providers and staff at the Western Massachusetts Regional Women's Correctional Center (WCC), alleging that they ignored her serious medical symptoms and denied her requests to go to the hospital, resulting in the stillbirth of her baby. The district court permitted most of Lech's claims to proceed to trial, but granted summary judgment in favor of one of the correctional officers. The jury returned a verdict in favor of the defense. On appeal, the United States Court of Appeals for the First Circuit found that the district court abused its discretion in two evidentiary rulings. The first error was allowing the defense to use Lech's recorded phone calls to impugn her character for truthfulness. The second error was excluding testimony from Lech's friend, which would have corroborated her version of events. The court concluded that at least one of these evidentiary rulings was not harmless, vacated the jury verdict, and remanded for a new trial against most of the defendants. However, the court affirmed the district court's grant of summary judgment to the correctional officer, as well as the jury verdict in favor of one of the medical providers. View "Lech v. Von Goeler" on Justia Law

The case involves Joel Smithers, who was a doctor of osteopathy and was convicted on 861 counts associated with his opioid prescription practices. He was sentenced to a total of 480 months in prison. Smithers was charged under 21 U.S.C. § 841(a)(1), which makes it unlawful for any person knowingly or intentionally to manufacture, distribute, or dispense a controlled substance without authorization. Authorization is defined by Drug Enforcement Agency regulations as a prescription issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice. Following his conviction, the Supreme Court in Ruan v. United States clarified the mens rea required to convict someone of unauthorized dispensing or distributing of a controlled substance. The United States Court of Appeals for the Fourth Circuit found that, in light of the Ruan decision, Smithers' jury instructions were incorrect, and the errors were not harmless. Therefore, the court vacated the convictions and remanded the case to the district court for a new trial. View "United States v. Joel Smithers" on Justia Law

In the case before the Court of Appeal of the State of California First Appellate District Division Four, the plaintiffs, thousands of individuals who suffered adverse effects from the use of a prescription drug, TDF, made by Gilead Life Sciences, Inc., brought a claim of negligence and fraudulent concealment against Gilead. The plaintiffs alleged that while Gilead was developing TDF, it discovered a similar, but chemically distinct and safer potential drug, TAF. However, Gilead allegedly decided to defer development of TAF because it was concerned that the immediate development of TAF would reduce its financial return from TDF. Gilead sought summary judgment on the ground that in order to recover for harm caused by a manufactured product, the plaintiff must prove that the product was defective. The trial court denied Gilead's motion for summary judgment in its entirety.In reviewing this case, the appellate court held that the trial court was correct to deny Gilead's motion for summary judgment on the negligence claim. The court reasoned that a manufacturer's duty of reasonable care can extend beyond the duty not to market a defective product. The court found that the factual basis of the plaintiffs' claim was that Gilead knew TAF was safer than TDF, but decided to defer development of TAF to maximize its profits. The court held that if Gilead's decision to postpone development of TAF indeed breached its duty of reasonable care to users of TDF, then Gilead could potentially be held liable.However, the appellate court reversed the trial court's decision regarding plaintiffs' claim for fraudulent concealment. The court concluded that Gilead's duty to plaintiffs did not extend to the disclosure of information about TAF, as it was not available as an alternative treatment for HIV/AIDS at the time the alleged concealment occurred. Consequently, the court granted in part and denied in part Gilead's petition for a writ of mandate, directing the superior court to vacate its order denying Gilead's motion for summary judgment and to enter a new order denying summary adjudication of the negligence claim but granting summary adjudication of the fraudulent concealment claim. View "Gilead Tenofovir Cases" on Justia Law

A group of current and former inmates, or their representatives, filed a class action lawsuit against Kate Brown, the Governor of Oregon, and Patrick Allen, the Director of the Oregon Health Authority, claiming that the state's COVID-19 vaccine rollout plan, which prioritized corrections officers over inmates, violated their Eighth Amendment rights. The defendants moved to dismiss the claim, asserting immunity under the Public Readiness and Emergency Preparedness (PREP) Act. The district court denied the motion, and the defendants appealed.The United States Court of Appeals for the Ninth Circuit reversed the district court's decision, finding that the defendants were immune from liability for the vaccine prioritization claim under the PREP Act. The court held that the statutory requirements for PREP Act immunity were met because the "administration" of a covered countermeasure includes prioritization of that countermeasure when its supply is limited. The court further concluded that the PREP Act's provisions extend immunity to persons who make policy-level decisions regarding the administration or use of covered countermeasures. The court also held that the PREP Act provides immunity from suit and liability for constitutional claims brought under 42 U.S.C. § 1983, even if those claims are federal constitutional claims. View "MANEY V. BROWN" on Justia Law

In this case, the appellant, Barni A., appealed against an order from the District Court in Lewiston, Maine, terminating her parental rights to her older child. The child was born prematurely with a genetic abnormality that led to several medical issues, including tumors on his brain, leading to seizures and affecting his executive functioning, vision, and visual processing. The child qualified for 24/7 private nursing care under Maine's Medicaid program, MaineCare, but never received it. Barni A. argued that the State of Maine's failure to provide the child with the required care resulted in the trial court erroneously finding her unfit because she could not address her child's complicated medical needs.The Maine Supreme Judicial Court agreed with Barni A., stating that the trial court's findings did not address important issues that needed to be answered before determining whether the record supports a finding by clear and convincing evidence that she is unfit. The court noted that the child's right to full-time private nursing care under federal and state law had not been provided by the Department of Health and Human Services, and this failure affected the mother's ability to care for the child. The court further explained that while the mother had made significant progress in dealing with her personal challenges, her visitation time with the child was substantially limited, and she was never afforded the assistance necessary to care for her child.The court therefore vacated the judgment and remanded the matter to the trial court, instructing it to consider whether the mother has an intellectual disability, whether the mother is or would be unfit regardless of the Department's failure to meet its MaineCare obligation regarding skilled nursing care, and whether there is an alternative to termination of the mother's parental rights that meets the best interest of the child. View "In re Child of Barni A." on Justia Law