Justia Health Law Opinion Summaries

Plaintiffs Luther C. Parente and Eric L. Stewart sued the Rhode Island Department of Corrections (RIDOC) and its staff for failing to properly treat their preexisting medical conditions. They alleged various federal and state constitutional, statutory, and common law bases for relief, including a claim under the Rhode Island Civil Rights Act of 1990 (RICRA). The plaintiffs claimed that RIDOC's medical and correctional staff failed to meet their medical needs, resulting in harm and discrimination.The United States District Court for the District of Rhode Island denied RIDOC's motion for summary judgment on Eleventh Amendment grounds as to the RICRA claim. The district court held that Rhode Island's general waiver of sovereign immunity under the State Tort Claims Act applied to RICRA claims, reasoning that discrimination actions under RICRA sounded in tort. RIDOC appealed this decision, arguing that the district court erred in holding that violations of civil rights under RICRA were subject to the general waiver of Eleventh Amendment immunity.The United States Court of Appeals for the First Circuit reviewed the case and determined that there was a "special reason" to certify the underlying state-law issue to the Rhode Island Supreme Court. The appellate court noted that the question of whether RICRA claims are "actions of tort" under the State Tort Claims Act is a matter of state law that has not been definitively resolved by the Rhode Island Supreme Court. Therefore, the First Circuit certified the question to the Rhode Island Supreme Court to determine whether discrimination claims under RICRA are covered by the general waiver of sovereign immunity under the State Tort Claims Act. The First Circuit retained jurisdiction over the issue pending resolution of the certified question. View "Parente v. Lefebvre" on Justia Law

James Lowe appealed a decision by Workforce Safety and Insurance (WSI) regarding the denial of his request for continued opioid medication exceeding 90 Morphine Milligram Equivalents (MME) daily. Lowe argued that WSI abused its discretion in denying his request for approval of the medication.The District Court of McKenzie County, Northwest Judicial District, reviewed the case and affirmed WSI's decision. The court found that WSI had not acted arbitrarily, unreasonably, or capriciously in its decision-making process. The court also noted that Lowe's medical provider had not provided sufficient documentation to support the medical necessity for exceeding the 90 MME limit, as required by the new law effective July 1, 2022.The Supreme Court of North Dakota reviewed the case and upheld the lower court's decision. The court found that WSI had conducted a full review of Lowe's request and had properly applied the guidelines governing long-term opioid pain management. The court concluded that WSI did not abuse its discretion in denying Lowe's request for continued opioid medication in excess of 90 MME daily. The court affirmed the district court judgment affirming the managed care binding dispute resolution decision by WSI. View "Lowe v. Workforce Safety and Insurance" on Justia Law

The case involves a class action lawsuit filed by transgender women prisoners in Illinois, who allege that the Illinois Department of Corrections (IDOC) has been deliberately indifferent to their gender dysphoria, a serious medical condition. The plaintiffs seek injunctive relief to ensure timely evaluations and treatments, including hormone therapy, gender-affirming surgery, and appropriate support for social transitioning.The United States District Court for the Southern District of Illinois initially issued a preliminary injunction on February 7, 2022, which was intended to address the plaintiffs' claims. The court later issued further injunctions to supplement and modify the terms. However, more than a year and a half after the preliminary injunction was issued, the district court retroactively labeled it as a permanent injunction and issued a final judgment consistent with the February 7, 2022 decision. The defendants appealed several injunctions and a finding of civil contempt by the district court.The United States Court of Appeals for the Seventh Circuit reviewed the case and found that the district court's attempt to retroactively transform the preliminary injunction into a permanent one was not authorized. The appellate court held that under the Prison Litigation Reform Act (PLRA), the preliminary injunction issued on February 7, 2022, expired 90 days later, on May 8, 2022. Consequently, the appellate court vacated all existing injunctions and remanded the case for further proceedings consistent with its opinion. The court also dismissed the portion of the appeal challenging the finding of contempt, as the district court had not yet imposed any sanctions, which are necessary to establish appellate jurisdiction. View "Monroe v. Bowman" on Justia Law

The case involves Planned Parenthood and two physicians challenging the Idaho Attorney General's interpretation of Idaho Code § 18-622(1), which criminalizes performing or attempting to perform an abortion and imposes professional licensing penalties on healthcare providers who assist in performing or attempting to perform an abortion. The Attorney General issued an opinion letter stating that the statute prohibits medical providers from referring patients to out-of-state abortion providers. Plaintiffs argued that this interpretation violates their First Amendment rights by preventing them from providing information about abortion services in other states.The United States District Court for the District of Idaho granted a preliminary injunction, preventing the Attorney General from enforcing his interpretation of the statute. The court found that the plaintiffs had standing, the case was ripe and not moot, and the Attorney General was a proper defendant under Ex parte Young. The court held that the plaintiffs were likely to succeed on the merits of their First Amendment claim and would suffer irreparable harm without an injunction.The United States Court of Appeals for the Ninth Circuit affirmed the district court's decision. The Ninth Circuit held that the plaintiffs had established Article III standing, as they demonstrated a credible threat of prosecution under the Attorney General's interpretation. The case was deemed ripe and not moot despite the Attorney General's withdrawal of the opinion letter, as the withdrawal did not disavow the interpretation. The court also held that the Attorney General was a proper defendant under Ex parte Young due to his authority to assist in the enforcement of the statute. The Ninth Circuit agreed with the district court that the plaintiffs were likely to succeed on the merits of their First Amendment claim and affirmed the preliminary injunction. The request for reassignment to a different district judge was denied. View "PLANNED PARENTHOOD GREAT NORTHWEST, HAWAII, ALASKA V. LABRADOR" on Justia Law

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