Justia Health Law Opinion Summaries

The First Circuit affirmed in part and reversed in part in this case brought against three Maine government officials in their official capacities (collectively, the State) and several healthcare providers (the Providers) by Plaintiffs, seven healthcare workers whose employment was vaccinated after they refused to accept COVID-19 vaccination (collectively, the Providers), holding that the court erred in dismissing certain claims.In 2021, under the "Mandate," Maine required certain healthcare facilities to ensure that their non-remote workers were vaccinated against COVID-19. Plaintiffs alleged that their sincerely-held religious beliefs prevented them from receiving any of the available COVID-19 vaccines and requested that their employers, the Providers, exempt them from the vaccination requirement. The Providers refused and terminated Plaintiffs' employment. Plaintiffs brought this suit alleging several claims. The district court dismissed the complaint in its entirety. The First Circuit reversed in part, holding that the district court (1) did not err in dismissing Plaintiffs' claims brought under Title VII of the Civil Rights Act of 1964; but (2) erred in dismissing Plaintiffs' claims for relief under the Free Exercise and Equal Protection Clauses. View "Lowe v. Mills" on Justia Law

Eight South Florida hospitals dutifully provided out-of-network emergency treatment to numerous Cigna customers. When Cigna reimbursed the hospitals just 15% of what they had charged, the hospitals sued, accusing Cigna of paying less than the “community” rate. As proof, the hospitals showed that they normally receive five times as much for the care they provided here. In response, Cigna asserted that the hospitals’ data proved nothing because, it insisted, the relevant “community” necessarily includes more than just the eight plaintiff hospitals. The district court agreed and granted Cigna summary judgment.   The Eleventh Circuit reversed. The court explained that even if the relevant “community” here extends beyond the eight plaintiff hospitals, their receipts alone are enough to create a genuine factual dispute about what the “community” rates are. The court reasoned that to survive summary judgment, a plaintiff needn’t present evidence that compels a single, airtight inference—just evidence that allows a reasonable one. The court explained that the way to rebut an inference allegedly skewed by limited data is to add data. And Cigna can do just that—at trial. If it can show there that most other providers in the “community” charge less than the plaintiff hospitals do, then it may well debunk the hospitals’ estimate. But unless and until that happens, it remains the case that a reasonable jury could conclude that the eight plaintiff hospitals’ rates reflect the prevailing community rate—and thus that Cigna shortchanged them. View "North Shore Medical Center, Inc., et al v. Cigna Health and Life Insurance Company" on Justia Law

Plaintiff was employed by Defendant and, as a condition of employment, was required to get a flu vaccine. Plaintiff sought an exemption based on a medically recognized contraindication, presenting a doctor's note that recommended she avoid the vaccine based on her history of cancer and general allergies. However, neither of these was a medically recognized contraindication, and Defendant terminated her employment.Plaintiff filed suit under the FEHA for disability discrimination. The trial court granted summary judgment in Defendnat's favor, plaintiff appealed.The Second Appellate District affirmed, finding that Defendant did not engage in disability discrimination and that Defendant's reason for terminating Plaintiff's employment was legitimate and lacked pretext. Further, the court rejected Plaintifff's retaliation claim. View "Hodges v. Cedars-Sinai Medical Center" on Justia Law

The Federally Supported Health Centers Assistance Act (“FSHCAA”) provides that health centers receiving funding under Section 330 of the Public Health Service Act (“PHSA”) may be deemed Public Health Service (“PHS”) employees. Plaintiffs alleged that Defendants violated their duty to report a court-ordered Lane County Mental Health patient’s refusal to comply with the terms of his probation. Plaintiffs alleged they were injured as a result of Defendants’ failure to report a patient’s repeated failures to comply with his mental health treatment plan. Defendants contended that they were entitled to Section 233 immunity. The district court held that Section 233 immunity did not apply to Defendants and remanded to state court.   The Ninth Circuit reversed the district court’s order remanding to state court Plaintiffs’ action alleging negligence and wrongful death claims against federally funded community health centers and their employees (“Defendants”), and remanded to the district court to enter an order substituting the United States as the defendant and deeming the action as one brought under the Federal Tort Claims Act. The panel first addressed whether there was jurisdiction to review the district court’s remand order. Ordinarily, a remand order is not reviewable on appeal, except for cases removed pursuant to 28 U.S.C. Section 1442. The panel agreed with Defendants that Section 233 immunity did not turn on who brings the claim, but rather on whether the conduct giving rose to the claim arose out of the Defendants’ performance of “medical, surgical, dental or related functions.” View "SAM FRIEDENBERG, ET AL V. LANE COUNTY, ET AL" on Justia Law

The Supreme Court affirmed in part and reversed in part the judgment of the circuit court denying the motion for partial summary judgment brought by the Estate of Robert T. Lynch as to its action against Kevin Lynch and entering judgment as a matter of law for Kevin on his counterclaim for conversion, holding that remand was required.The Estate sued Kevin alleging claims for fiduciary fraud, conversion, breach of fiduciary duty, and elder exploitation. Kevin filed a counterclaim alleging conversion, among other claims. After the circuit court denied the Estate's motion for partial summary judgment on its claims against Kevin the court entered judgment as a matter of law for Kevin on his counterclaim. The Supreme Court (1) reversed as to the Estate's claims involving two payable-on-death CDs Kevin deposited in his individual account and directed that, on remand, the circuit court shall enter judgment as a matter of law for compensatory damages plus prejudgment interest on the Estate’s claims for breach of fiduciary duty and conversion; (2) ruled that the Estate's claim for punitive damage on the reversed portion of the judgment was an open question on remand; and (3) otherwise affirmed. View "Estate of Lynch v. Lynch" on Justia Law

The Plan is a nonprofit health care service plan subject to Health & Safety Code 1340, including the Parity Act, under which: “Every health care service plan contract . . . that provides hospital, medical, or surgical coverage shall provide coverage for the diagnosis and medically necessary treatment of severe mental illness of a person of any age, and of serious emotional disturbances of a child . . . under the same terms and conditions applied to other medical conditions.”Plaintiffs alleged that the Plan violates the Parity Act by “deterring members from obtaining one-on-one mental health therapy without making individualized determinations … encouraging ‘group’ therapy, without making individualized determinations" where similar practices are not followed in the treatment of physical health conditions. An Unruh Civil Rights Act claim alleged that the Plan intentionally discriminated against persons with mental disabilities or conditions. The court granted the Plan summary judgment.The court of appeal affirmed the rejection of one plaintiff’s individual claims; the Plan is not liable for the acts of its subsidiary by whom the plaintiff’s coverage was issued. The court otherwise reversed. On an Unfair Competition Law claim, the court failed to consider how the Plan’s conduct undermines its contractual promises of covered treatment in violation of the Parity Act. On the Unruh claim, triable issues of fact exist as to whether the plaintiffs were denied medically necessary treatment as a result of intentional discrimination. View "Futterman v. Kaiser Foundation Health Plan, Inc." on Justia Law

Middle schooler A.K. struggled with suicidal ideation for many years and attempted suicide numerous times, resulting in frequent emergency room visits and in-patient hospitalizations. A.K.’s physicians strongly recommended she enroll in a residential treatment facility to build the skills necessary to stabilize. Despite these recommendations and extensive evidence in the medical record, United Behavioral Health (“United”) denied coverage for A.K.’s stay at a residential treatment facility beyond an initial three month period. Her parents appealed United’s denial numerous times, requesting further clarification, and providing extensive medical evidence, yet United only replied with conclusory statements that did not address the evidence provided. As a result, A.K.’s parents brought this lawsuit contending United violated its fiduciary duties by failing to provide a “full and fair review” of their claim for medical benefits. Both sides moved for summary judgment, and the district court ruled against United. The issue this case presented for the Tenth Circuit's review was whether United arbitrarily and capriciously denied A.K. medical benefits and whether the district court abused its discretion in awarding A.K. benefits rather than remanding to United for further review. The Court ultimately concluded United did act arbitrarily and capriciously in not adequately engaging with the opinions of A.K.’s physicians and in not providing its reasoning for denials to A.K.’s parents. The Court also concluded the district court did not abuse its discretion by awarding A.K. benefits outright. View "D.K., et al. v. United Behavioral Health, et al." on Justia Law

Alabama Somerby, LLC, d/b/a Brookdale University Park IL/AL/MC; Brookdale Senior Living, Inc.; and Undrea Wright (collectively, Brookdale) appealed a circuit court's order denying their motion to compel arbitration of the claims asserted against them by plaintiff, L.D., as the next friend of her mother, E.D. Brookdale operated an assisted-living facility for seniors ("the nursing home") in Jefferson County, Alabama; Wright was the administrator of the nursing home. In March 2022, L.D. filed on E.D.'s behalf, a complaint against Brookdale and Wright and others, asserting various tort claims and seeking related damages premised on allegations that, following her admission to the nursing home, E.D. had been subjected to multiple sexual assaults both by other residents and by an employee of Brookdale. The Brookdale defendants jointly moved to compel arbitration of L.D.'s claims against them or, alternatively, to dismiss the action without prejudice to allow those claims to proceed via arbitration. Following a hearing, the trial court, denied the motion seeking to dismiss the action or to compel arbitration. The Brookdale defendants timely appealed, asserting that the trial court had erred by failing to order arbitration. The Alabama Supreme Court concluded the Brookdale defendants established that an agreement providing for arbitration existed and that the agreement affected interstate commerce. The trial court erred in denying the Brookdale defendants' request to compel arbitration. The Supreme Court reversed the trial court's order and remanded the case for further proceedings. View "Alabama Somerby, LLC, et al. v. L.D." on Justia Law

The Supreme Court dismissed this direct appeal brought by the Iowa Department of Human Services (HDS) from a district court ruling requiring Iowa's Medicaid program to pay for sex reassignment surgery for two transgender adults and affirmed the denial of fees on cross-appeal, holding that the appeal was moot.Petitioners, adult transgender Iowans who were denied preauthorization for sex reassignment surgeries through the Medicaid program, appealed their managed care organization's denial of coverage to DHS. DHS affirmed the denials. The district court reversed, concluding that Iowa Code 216.7(3), an amendment to the Iowa Civil Rights Act (ICRA) violated the guarantee of equal protection under the Iowa Constitution. DHS appealed, but, thereafter, agreed to pay for Petitioners' surgeries. The Supreme Court dismissed the direct appeal as moot and affirmed the district court's order denying any fee award, holding that the court erred in denying Petitioners' request for attorney fees. View "Vasquez v. Iowa Dep't of Human Services" on Justia Law

In an interlocutory appeal, multiple hotel operators challenged a superior court’s orders in a suit against defendants, multiple insurance underwriters, all relating to the denial of coverage during the COVID-19 world health pandemic. Plaintiffs owned and operated twenty-three hotels: four in New Hampshire, eighteen in Massachusetts, and one in New Jersey. Plaintiffs purchased $600 million of insurance coverage from defendants for the policy period from November 1, 2019 to November 1, 2020. With the exception of certain addenda, the relevant language of the policies was identical, stating in part that it “insures against risks of direct physical loss of or damage to property described herein . . . except as hereinafter excluded.” For periods of time, pursuant to governors’ orders, hotels in each of the three states were permitted to provide lodging only to vulnerable populations and to essential workers. These essential workers included healthcare workers, the COVID-19 essential workforce, and other workers responding to the COVID-19 public health emergency. Beginning in June 2020, plaintiffs’ hotels were permitted to reopen with a number of restrictions on their business operations. Plaintiffs, through their insurance broker, provided notice to defendants they were submitting claims in connection with losses stemming from COVID-19. Plaintiffs sued when these claims denied, arguing that the potential presence of the virus triggered business loss provisions in their respective policies. To this, the New Hampshire Supreme Court disagreed, finding that “[w]hile the presence of the virus might affect how people interact with one another, and interact with the property, it does not render the property useless or uninhabitable, nor distinctly and demonstrably altered.” View "Schleicher & Stebbins Hotels, LLC, et al. v. Starr Surplus Lines Insurance Co., et al." on Justia Law