Justia Health Law Opinion Summaries

Victor Chin, M.D., and Sportsmed Orthopedic Specialists, P.C. (collectively "the Sportsmed defendants"), were defendants in an action brought by their patient, Malik Woodard. Woodard alleged that, against his wishes, Dr. Chin obtained records of Woodard's prior psychological treatment. The Sportsmed defendants sought mandamus relief from: (1) the circuit court's order denying their motion to change venue based on the Alabama Medical Liability Act and the Alabama Medical Liability Act of 1987 (collectively "AMLA"); and (2) the court's order prohibiting them from using the psychological records (and certain related documents) in the case and requiring them to return or destroy those records and documents ("the protective order"). As to the venue order, the Alabama Supreme Court denied the petition because the Sportsmed defendants did not argue that the complaint did not support an inference that Dr. Chin had no medical reason for obtaining the psychological records. As to the protective order, the Supreme Court denied the petition because the Sportsmed defendants did not demonstrate that the order was subject to mandamus review. View "Ex parte Victor Chin, M.D., and Sportsmed Orthopedic Specialists, P.C." on Justia Law

The 2005 Medicare amendment, launching prescription drug coverage, raised concerns that patient assistance plans could violate the Anti-Kickback Statute, 42 U.S.C. 1320a-7b, and the False Claims Act, 31 U.S.C. 3729, by effectively rewarding doctors and patients for choosing particular drugs. Astellas subsequently launched Xtandi, used to treat metastatic prostate cancer. Priced at $7,800 per month, Xtandi prescriptions were covered by Medicare up to about $6,000 per month. Astellas made contributions to two patient assistance plans. An Astellas marketing executive encouraged both plans to create special funds to provide co-pay assistance for only androgen receptor inhibitors like Xtandi and a few other medications. Astellas donated to the new funds but stopped after contributing about $27 million. Astellas continued contributing to broader prostate cancer funds.The Department of Justice began investigating; the Astellas marketing executive acknowledged that he had “hoped” and “expected” that the contributions would produce financial benefits for Astellas but that Astellas had made no efforts to calculate “a return on investment.” Astellas settled with the government for $100 million--$50 million for “restitution” to the government. Astellas sought indemnification from liability insurers, including Federal, which denied coverage.The Seventh Circuit affirmed summary judgment for Astellas. Under Illinois law, a party may not obtain liability insurance for genuine restitution it owes the victim of its intentional wrongdoing, but a party may obtain insurance for compensatory damages. In cases of ambiguity, Illinois favors settlements and freedom of contract. Federal wrote its insurance policy to try to extend coverage to the limit of what Illinois law would allow. Federal did not carry its burden of showing that the portion of the settlement payment for which Astellas seeks coverage is uninsurable restitution. View "Astellas US Holding, Inc. v. Federal Insurance Co." on Justia Law

The Supreme Court affirmed the decision of the court of appeals reversing the circuit court's issuance of an injunction compelling Aurora Health Care, Inc. to administer Ivermectin to Petitioner's uncle (Patient), holding that the circuit court abused its discretion in issuing the injunction without analyzing Petitioner's reasonable probability of success on the merits.Patient was in Aurora's care when he tested positive for COVID-19. Petitioner, who held health care power of attorney for Patient, received a prescription for Ivermectin from a retired OB/GYN, but Aurora declined to effect the prescription. Thereafter, Petitioner bright a complaint seeking declaratory and injunctive relief. The circuit court issued an order compelling Aurora immediately to enforce the prescription and administer Ivermectin to Patient. The court of appeals reversed. The Supreme Court affirmed, holding that the circuit court erroneously exercised its discretion by issuing the temporary injunction without referencing any basis demonstrating that Petitioner had a reasonable probability of success on the merits of "some type of legal claim." View "Gahl v. Aurora Health Care, Inc." on Justia Law

Appellants Crestwood Behavior Health, Inc. (Crestwood), West Anaheim Extended Care and Extended Care Hospital of Westminster (West Anaheim), and Royale Health Care Center dba South Coast Post Acute (South Coast) (together, appellants) operated skilled nursing facilities serving beneficiaries of the California Medical Assistance Program (Medi-Cal). Respondent Department of Health Care Services (the Department) administered Medi-Cal. As relevant here, the Department also administered the “Skilled Nursing Facility Quality and Accountability Supplemental Payment System” (QASP), which authorized supplemental payments, over and above Medi-Cal reimbursement rates, to skilled nursing facilities meeting certain performance standards. Consolidated appeals challenged the Department’s method for calculating QASP payments. Appellants argued they did not receive all the QASP payments to which they were entitled and blame the alleged underpayment to the Department’s practice of excluding certain Medi-Cal days—known as “special treatment program days” or “STP days”—from its calculations. They sought writs of mandate directing the Department to include STP days in the calculation of QASP payments. The Court of Appeal concurred with the trial court that appellants failed to identify an appropriate basis for writ relief. Appellants sued under Welf. & Inst. Code Section 14170 (a)(1), which did not impose a mandatory or ministerial duty on the Department that could support the issuance of a writ of mandate. And the Court found appellants did not show any abuse of discretion by the Department. Accordingly, the trial court judgment was affirmed. View "Crestwood Behavioral Health, Inc. v. Baass" on Justia Law

Bridges and Cunningham filed a putative class action, alleging that Blackstone (the owner of Ancestry.com) violated Section 30 of Illinois’s 1998 Genetic Information Privacy Act, which provides that no person or company “may disclose or be compelled to disclose the identity of any person upon whom a genetic test is performed or the results of a genetic test in a manner that permits identification of the subject of the test,” 410 ILCS 513/30(a). Both plaintiffs had purchased DNA testing products from Ancestry and submitted saliva samples for genetic sequencing years earlier. Blackstone subsequently purchased Ancestry in a “control acquisition”— an all-stock transaction. Because Ancestry had allegedly paired the plaintiffs’ genetic tests with personally identifiable information—including names, emails, and home addresses—Bridges and Cunningham maintained that Blackstone, as part of acquiring Ancestry, had compelled the disclosure of their genetic identities in violation of Section 30.The Seventh Circuit affirmed the dismissal of the suit for failure to state a claim. The complaint focusing exclusively on Blackstone’s acquisition of Ancestry did not adequately allege any compulsory disclosure. View "Bridges v. Blackstone, Inc." on Justia Law

President Biden invoked his authority under the Federal Property and Administrative Services Act of 1949 (“Procurement Act”) to direct federal agencies to include in certain contracts a clause requiring covered contractor employees to follow COVID-19 safety protocols, including vaccination requirements, in order for employees to be eligible to work on federal government projects. Plaintiffs sued to enjoin the vaccination mandate. This lawsuit revolved around four documents that comprise the Contractor Mandate: the Executive Order, the Task Force Guidance, the Office of Management and Budget Determination, and the Federal Acquisition Regulatory Council Guidance. The district court granted a permanent injunction against the Contractor Mandate, effective in any contract that either involved a party domiciled or headquartered in Arizona and/or was performed “principally” in Arizona.   The Ninth Circuit reversed the district court’s order granting a permanent injunction and dissolved the injunction. First, the panel held the Major Questions Doctrine—which requires that Congress speak clearly if it wishes to assign to an agency decisions of vast economic and political significance—did not apply. Second, the panel held that even if the Major Questions Doctrine applied, it would not bar the Contractor Mandate because the Mandate is not a transformative expansion of the President’s authority under the Procurement Act. Third, the panel held that the Contractor Mandate fell within the President’s authority under the Procurement Act. Fourth, the panel held that the nondelegation doctrine and state sovereignty concerns did not invalidate the Contractor Mandate. Finally, the panel held that the Contractor Mandate satisfied the Office of Federal Procurement Policy Act’s procedural requirements. View "KRISTIN MAYES, ET AL V. JOSEPH BIDEN, ET AL" on Justia Law

Plaintiff, MSP Recovery Claims, Series LLC (“MSP”) appealed from the district court’s judgment dismissing for lack of standing its putative class action against Defendant Hereford Insurance Company (“Hereford”) and denying leave to amend. MSP has brought several lawsuits around the country seeking to recover from insurance companies that allegedly owe payments to Medicare Advantage Organizations (“MAOs”) under the Medicare Secondary Payer Act (the “MSP Act”). In the putative class action brought here, MSP charges Hereford with “deliberate and systematic avoidance” of Hereford’s reimbursement obligations under the MSP Act.   The Second Circuit affirmed. The court concluded that MSP lacked standing because its allegations do not support an inference that it has suffered a cognizable injury or that the injury it claims is traceable to Hereford. The court also concluded that the district court did not abuse its discretion when it denied MSP leave to amend based on MSP’s repeated failures to cure. The court explained that the plain language of Section 111 provides that when a no-fault insurance provider such as Hereford reports a claim pursuant to Section 111, it does not thereby admit that it is liable for the claim. The statutory context of the section’s reporting obligation and the purpose of the reporting obligation confirms the correctness of this interpretation. Because MSP’s argument that the payments made by EmblemHealth are reimbursable by Hereford rests entirely on its proposed interpretation of Section 111, MSP has not adequately alleged a “concrete” or “actual” injury or that the injury it alleges is fairly traceable to Hereford. View "MSP v. Hereford" on Justia Law

Plaintiffs Clearview Realty Ventures, LLC, JHM HIX Keene, LLC, VIDHI Hospitality, LLC, NAKSH Hospitality, LLC, 298 Queen City Hotel, LLC, ANSHI Hospitality, LLC, 700 Elm, LLC, Bedford-Carnevale, LLC, and Carnevale Holdings, LLC, owned commercial real estate on which they operated hotels, some of which offered restaurant services along with banquet or function facilities. They contended that the COVID-19 pandemic was a “natural disaster” and that their buildings were “damaged” within the meaning of RSA 76:21, I. Plaintiffs sought relief from the New Hampshire municipalities involved: the Cities of Laconia, Keene, and Manchester, and the Town of Bedford. After denial of their applications, they appealed to the superior court in the applicable county. Observing that there were thirteen separate lawsuits pending in six counties, they then filed an assented-to motion for interlocutory transfer without ruling and motion to consolidate to allow the coordinated transfer of the common questions of law to the New Hampshire Supreme Court. In this interlocutory transfer without ruling, the Supreme Court was asked to determine: (1) whether, for purposes of RSA 76:21, the COVID-19 pandemic constituted a “natural disaster”; and (2) if so, whether the buildings owned by the plaintiffs were “damaged” by COVID-19 such that they were “not able to be used for [their] intended use” within the meaning of RSA 76:21, I. The Court answered the second question in the negative. View "Clearview Realty Ventures, LLC v. City of Laconia; et al." on Justia Law

The Supreme Court reversed the oral pronouncement issued by the district court waiving Appellant's right to be physically present at his commitment hearing and the findings of fact, conclusions of law, and order of commitment issued by the district court, holding that the court committed reversible error by waiving Appellant's right to physically appear.The State filed a petition for involuntary commitment of Appellant supported by a mental health evaluation. Appellant advised the court that he desired to be present in-person at the commitment hearing. At the time of the hearing, however, counsel represented that he wished to waive Appellant's appearance and instead have him appear via two-way video conferencing due to improper behavior. The district court granted counsel's request and permitted him to appear via two-way video communication. The district court subsequently committed Appellant to the Montana State Hospital and authorized the use of involuntary medication. The Supreme Court reversed, holding that the statutory requirements for waiver of physical presence at the commitment hearing were not met. View "In re J.D.L." on Justia Law

Betty Smith brought a negligence and wrongful death lawsuit against Belhaven Senior Care, LLC (Belhaven), a nursing home facility in which her mother Mary Hayes had resided shortly before Hayes’s death. Belhaven sought to compel arbitration, citing the arbitration provision in the nursing home admissions agreement Smith signed when admitting her mother. The trial judge denied arbitration, finding that Smith lacked the legal authority to bind her mother to the agreement. Belhaven appealed. The nursing home’s primary argument on appeal was that under the Health-Care Decisions Act (“the Act”), Smith acted as a statutory healthcare surrogate. So in signing the nursing home admission agreement, Smith had authority to waive arbitration on her mother’s behalf. In addition, Belhaven puts forth arguments of direct-benefit estoppel and third-party beneficiary status. The Mississippi Supreme Court affirmed, finding that while Hayes did suffer from some form of dementia, when admitted to the nursing home, she was neither evaluated by a physician nor was she determined to lack capacity. Indeed, her “Admission Physician Orders” were signed by a nurse practitioner. It was not until eleven days later that a physician evaluated Hayes. "And even then, the physician did not deem she lacked capacity. In fact, Belhaven puts forth no evidence that—at any time during her stay of more than a year at Belhaven—any physician ever determined Hayes lacked capacity." The Court determined Belhaven failed to prove the strict requirements of the surrogacy statute to rebut this presumption. Furthermore, the Court found Belhaven’s direct-benefit estoppel and third-party beneficiary arguments were lacking: because Belhaven contends that Hayes was incapacitated, she could not knowingly seek or obtain benefits from the agreement. "Nor does Smith’s largely negligence-based lawsuit seek to enforce the contract’s terms or require determination by reference to the contract. So Smith is not estopped from pursuing these claims." View "Belhaven Senior Care, LLC, et al. v. Smith, et al." on Justia Law