Justia Health Law Opinion Summaries

In this case, the plaintiffs, a minor and her parents, sued their health insurer, Premera Blue Cross, for denying coverage for the minor’s stay in a wilderness therapy program, claiming that the denial violates mental health parity laws. The plaintiffs also alleged breach of contract, insurance bad faith, and violation of the Consumer Protection Act.The Supreme Court of the State of Washington held that the plaintiffs’ breach of contract claim based on alleged violation of federal parity laws does not form a viable common law action. The Court found that the plaintiffs failed to show that a violation of federal parity law would give rise to a viable common law action for breach of contract.Furthermore, the Court held that the breach of contract action based on Premera's alleged violation of state parity laws could not succeed based on the statutory language that was in place at the time.However, the Court did affirm the lower court’s finding that the plaintiffs were not required to produce evidence of objective symptomatology to support their insurance bad faith claim for emotional distress damages. Consequently, the case was remanded to the trial court for further proceedings on the bad faith and Consumer Protection Act claims. View "P.E.L. v. Premera Blue Cross" on Justia Law

The Supreme Court of Missouri reversed a lower court's judgment in a negligence case involving a hospital and an individual who was shot on the hospital's property. The plaintiff, Steven Harner, had sued Mercy Hospital Joplin, alleging the hospital had breached its duty to protect him from the criminal acts of a third person on its property. The case revolved around the "known third person exception" to the general rule that businesses have no duty to protect invitees from the criminal acts of third parties. According to this exception, a duty may arise when a person known to be violent is present on the premises, or an individual is present who has conducted himself so as to indicate danger, and sufficient time exists to prevent injury. The court found that the defendant, Mercy Hospital, could not have reasonably foreseen that the third person in question, who had committed a non-violent theft on the premises prior to the shooting, would suddenly become violent. As such, the court held that Mercy Hospital did not owe a duty of care to Harner under the known third person exception and reversed the lower court's judgment. The case was remanded for further proceedings. View "Harner vs. Mercy Hospital Joplin" on Justia Law

The Supreme Court of Missouri ruled in favor of three employees of a medical facility, Jayla Ruiz Morales, John Kimani, and Valarie Johnson, who were sued for wrongful death by the legal guardian of a patient, Ronald Scheer. Scheer, a resident at the St. Louis Developmental Disabilities Treatment Center-St. Charles Habilitation Center, died after his wheelchair's belt constricted his breathing. The employees were accused of failing to adequately supervise Scheer, failing to ensure that his wheelchair's seatbelt and pelvic harness were properly fastened, among other allegations. The employees argued that they were entitled to official immunity, a doctrine that protects public officials from liability for acts of negligence committed during the course of their official duties. The lower court rejected this argument and the employees sought a writ of prohibition from the Supreme Court of Missouri.The Supreme Court of Missouri held that the employees were entitled to official immunity. The court found that the tasks they were required to perform were not ministerial (routine or mundane tasks) but required discretion. Tasks such as checking on the patient, repositioning him, and using a seat belt and pelvic harness required the employees to use judgment to determine if Scheer needed additional care, and if so, what care to be administered. Therefore, these tasks were not ministerial and the employees were entitled to official immunity. The court made its preliminary writ of prohibition permanent, barring the lower court from taking further action in the case. View "State ex rel. Jayla Ruiz-Morales v. Alessi" on Justia Law

A case involving Lebanon County Employees' Retirement Fund and Teamsters Local 443 Health Services & Insurance Plan, as plaintiffs-appellants, and Steven H. Collis, Richard W. Gochnauer, Lon R. Greenberg, Jane E. Henney, M.D., Kathleen W. Hyle, Michael J. Long, Henry W. McGee, Ornella Barra, D. Mark Durcan, and Chris Zimmerman, as defendants-appellees, was heard by the Supreme Court of the State of Delaware. The plaintiffs, shareholders in AmerisourceBergen Corporation, brought a derivative complaint against the directors and officers of the Corporation alleging that they failed to adopt, implement, or oversee reasonable policies and practices to prevent the unlawful distribution of opioids. The plaintiffs claimed that this led to AmerisourceBergen incurring liability exceeding $6 billion in a 2021 global settlement related to the Company's role in the opioid epidemic. The Court of Chancery of the State of Delaware initially dismissed the complaint, basing its decision on a separate federal court finding that AmerisourceBergen had complied with its anti-diversion obligations under the Controlled Substances Act. However, the Supreme Court of the State of Delaware reversed the Court of Chancery's dismissal of the complaint, ruling that the lower court had erred in considering the federal court's findings as it changed the date at which demand futility should be considered and violated the principles of judicial notice. The case was remanded for further proceedings. View "Lebanon County Employees' Retirement Fund v. Collis" on Justia Law

Former executives of medical device manufacturer Acclarent, Inc., William Facteau and Patrick Fabian, were found guilty of multiple misdemeanor violations of the Federal Food, Drug, and Cosmetic Act (FDCA) for commercially distributing an adulterated and misbranded medical device. They appealed their convictions, claiming First Amendment violations, due process violations, and insufficiency of evidence. The United States Court of Appeals for the First Circuit rejected all of these claims and affirmed the convictions. The court held that the use of promotional speech as evidence of a device's intended use did not implicate the First Amendment. The court also found that the term "intended use" was not unconstitutionally vague and that Facteau and Fabian had fair warning of the conduct prohibited under the FDCA. Finally, the court found that the evidence was sufficient to support the convictions and that Fabian's fine did not violate the Eighth Amendment. View "United States v. Facteau" on Justia Law

In the case, a defendant, Mario Rodriguez, was charged with several felonies, each carrying a maximum sentence exceeding two years. In 2018, Rodriguez was found mentally incompetent to stand trial and committed to a state hospital. After a certificate indicating his restoration to competency was filed within the two-year time limit, Rodriguez was returned to court. However, due to COVID-19 restrictions, his hearing to confirm his competency did not take place within the two-year period. Rodriguez sought to dismiss the charges against him, claiming the time for commitment had run out.The Supreme Court of California held that under the relevant statutes, the time between the filing of a certificate of restoration of mental competency and the court's ruling on that certificate counts towards the two-year maximum commitment period mandated by section 1370(c)(1) of the California Penal Code. Therefore, the filing of a certificate of restoration does not end the period of mental incompetency commitment.The court sent the case back to the Court of Appeal to decide whether the two-year limit was exceeded in this case, and if so, what remedy Rodriguez might be entitled to. The court did not decide whether Rodriguez was entitled to the remedy of dismissal he sought, or whether and how the issue of tolling may affect Rodriguez's entitlement to any relief. View "Rodriguez v. Super. Ct." on Justia Law

In the case concerning the estate of Frances R. Mason, the Supreme Judicial Court of Massachusetts ruled on two key issues. First, it considered whether the Massachusetts Medicaid program, MassHealth, could enforce a lien (known as a TEFRA lien) against a member's property after the member's death. The Court concluded that, under Massachusetts law, MassHealth can only enforce such a lien if the property is sold during the member's lifetime. Therefore, MassHealth could not enforce its lien against Mason's property, which was not sold until after her death. This ruling is a restriction on MassHealth's ability to recover Medicaid benefits paid.Second, the Court addressed the timing of MassHealth's claim for recovery of Medicaid benefits paid on Mason's behalf. The Court concluded that the three-year statute of repose of the Massachusetts Uniform Probate Code (MUPC) does not apply retroactively to bar MassHealth's claim against the estate of a member who died prior to the effective date of the MUPC. Accordingly, MassHealth's claim against Mason's estate, which was filed nearly nine years after her death, was not barred by the MUPC's three-year statute of repose.The facts of the case were as follows: Frances R. Mason was a recipient of Medicaid benefits from MassHealth. From January to August 2008, MassHealth paid for her care in a residential nursing facility. In May 2008, MassHealth imposed a TEFRA lien against Mason's home, as she was expected to be permanently institutionalized in the facility. Mason died in August 2008 without the property having been sold. MassHealth filed a claim to recover the Medicaid benefits paid for Mason's care in August 2018, after the executor of Mason's will had opened formal probate proceedings in June 2017.The disposition by the Court was to affirm the order of the Probate and Family Court judge insofar as it struck MassHealth's lien against Mason's home, and to reverse the order insofar as it dismissed MassHealth's claim against her estate. The case was remanded for further proceedings consistent with the Court's opinion. View "In re Estate of Mason" on Justia Law

In 2017, Donald Winkler received a Tdap vaccination after stepping on rusted metal. Soon after, he developed symptoms of Guillain-Barré Syndrome (GBS), a type of acute monophasic peripheral neuropathy. Winkler filed a petition for relief under the National Vaccine Injury Compensation Program, asserting the Tdap vaccine caused his GBS. However, the Special Master denied his claim, and this decision was upheld by the United States Court of Federal Claims. Winkler appealed to the United States Court of Appeals for the Federal Circuit.The appellate court affirmed the lower court's decision. The court noted that GBS is not listed as a covered condition for Tdap vaccines, so Winkler had to prove that his GBS was actually caused by the Tdap vaccination. The court applied the three-prong test set forth in Althen v. Secretary of Health and Human Services, requiring Winkler to show a medical theory causally connecting the vaccination and the injury, a logical sequence of cause and effect showing that the vaccination was the reason for the injury, and a proximate temporal relationship between vaccination and injury.The Special Master found that Winkler had not established the second Althen prong, as he failed to provide preponderant evidence of a logical sequence of cause and effect. The court disagreed with Winkler's argument that the Special Master erred by requiring him to disprove that he suffered from a Campylobacter jejuni infection, a known trigger for GBS, stating that Winkler mischaracterized his burden of proof. The court further stated that Winkler failed to establish a prima facie case of causation of his GBS by the Tdap vaccine, not that he failed to disprove evidence of an infection. Therefore, the court affirmed the Special Master's holding that Winkler failed to prove causation of GBS by the Tdap vaccine by preponderant evidence. View "WINKLER v. HHS " on Justia Law

In this case handled by the Supreme Court of Texas, the parents of two children, Kate Cox and Justin Cox, along with their doctor, Dr. Damla Karsan, filed a suit to challenge the enforcement of Texas laws that prohibit abortion. Mrs. Cox was about 20 weeks pregnant with a baby diagnosed with trisomy 18, a serious genetic disorder. The suit sought to apply a medical-necessity exception provided in the Texas law, which allows an abortion if a woman's life is threatened or she faces a serious risk of substantial impairment of a major bodily function due to her pregnancy.The court, in its decision, clarified that the exception to the abortion prohibition is based on the reasonable medical judgment of a doctor, not a court. It was noted that Dr. Karsan presented a "good faith belief" that Mrs. Cox meets the exception's requirements but did not assert that her belief meets the objective standard of "reasonable medical judgment."The court held that judges lack the authority to broaden the statutory exception by interpreting it and held the trial court erred in applying a different, lower standard instead of requiring reasonable medical judgment. The court emphasized that the exception requires a doctor's decision whether a pregnant woman’s complications pose the required risks.The court conditionally granted relief and directed the trial court to vacate the temporary restraining order that had restrained the Attorney General from enforcing the abortion laws against Dr. Karsan and others related to the case, based solely on the verified pleading. The court also noted that nothing in their opinion prevents a physician from acting if, in that physician’s reasonable medical judgment, they determine that the pregnant woman has a life-threatening physical condition. View "IN RE STATE OF TEXAS" on Justia Law

In this case heard before the United States Court of Appeals for the Fourth Circuit, the plaintiff, Daniella Easterbrook, appealed the denial of her application for disability benefits by the Social Security Administration. Easterbrook, who has suffered from persistent back pain since 2011, argued that the Administrative Law Judge (ALJ) failed to provide a "good reason," supported by substantial evidence, for not giving adequate weight to the opinions of her treating physician, Dr. John Kim.The court agreed with Easterbrook, stating that the ALJ erred in not applying the "treating source rule" to Dr. Kim's opinions and not providing a sufficient justification for giving his opinions less weight. The court noted that Dr. Kim's opinions were well-supported by medically acceptable clinical and laboratory diagnostic techniques and were consistent with the substantial evidence in the record.The court also found that the ALJ's reasons for discounting Dr. Kim's opinions, such as Easterbrook's decision not to undergo certain treatments, were inappropriate and did not constitute "good reasons." The court stated that a patient's refusal to pursue a specific type of medical treatment does not automatically call into question the severity of her pain.As a result, the court reversed the Commissioner's decision and remanded the case for a determination consistent with its opinion. View "Easterbrook v. Kijakazi" on Justia Law