Justia Health Law Opinion Summaries

The Supreme Court reversed the decision of the court of appeals reversing the judgment of the trial court concluding that Acuity, an insurer, did not owe Masters Pharmaceutical, Inc. a duty to defend it in the several lawsuits brought by cities and counties in three states (the governments) for losses caused by the opioid epidemic, holding that Acuity did not owe Masters a duty to defend.Cities and counties in West Virginia, Michigan, and Nevada brought the underlying lawsuits against Masters, a wholesale distributor of pharmaceutical products, including prescription opioids, alleging that Masters's conduct contributed to the opioid epidemic. Acuity filed an action for a declaratory judgment that it owed no duty to defend or indemnify Masters in the underlying suits. The trial court granted summary judgment for Acuity. The court of appeals reversed. At issue was whether the governments sought damages for their own economic losses and not "damages because of bodily injury." The Supreme Court reversed, holding (1) the governments did not seek "damages because of bodily injury"; and (2) therefore, Acuity did not owe Masters a duty to defend it in the underlying suits. View "Acuity v. Masters Pharmaceuticals, Inc." on Justia Law

The Ninth Circuit reversed in part and vacated in part the district court’s grant of Defendants’ motion to dismiss, and remanded for further proceedings, in an action in which federally-qualified health centers operating in Arizona and their membership organization alleged that the Arizona Health Care Cost Containment System, which administers Arizona’s Medicaid program, and its director violated 42 U.S.C. Section 1396a(bb) and binding Ninth Circuit precedent by failing or refusing to reimburse Plaintiffs for the services of dentists, podiatrists, optometrists, and chiropractors.   First, the panel held that the court’s precedent in California Ass’n of Rural Health Clinics v. Douglas (“Douglas”), 738 F.3d 1007 (9th Cir. 2013), established that FQHC services are a mandatory benefit under Section 1396d(a)(2)(C) for which Plaintiffs have a right to reimbursement under Section 1396a(bb) that is enforceable under 42 U.S.C. Section 1983. The panel rejected Defendants’ interpretation of Section 1396d(a)(2)(C)’s phrase “which are otherwise included in the plan” as applying to both the phrases “FQHC services” and “other ambulatory services offered by a [FQHC.]” The panel, therefore, rejected Defendants’ assertion that Section 1396d(a)(2)(C) only required states to cover FQHC services that are included in the state Medicaid plan.   The panel recognized that Douglas held that the mandatory benefit of “FQHC services” under § 1396d(a)(2)(C) includes “services furnished by . . . dentists, podiatrists, optometrists, and chiropractors” as well as doctors of medicine and osteopathy. The panel held that Arizona’s categorical exclusion of adult chiropractic services violated the unambiguous text of the Medicaid Act as interpreted in Douglas. View "AACHC V. AHCCCS" on Justia Law

Over ten years ago, Prince Kurtiss Cheatham fled criminal custody after he heard nonexistent voices that led him to believe his life was in danger. After being returned to custody, he again attempted to escape after again hearing nonexistent voices because of untreated schizoaffective disorder. He was charged based on these events and, after being found not guilty by reason of insanity, was committed to a state hospital. Since that time, Cheatham took medications that largely subdued his mental health symptoms but have not resolved his symptoms entirely. Shortly before Cheatham’s anticipated release from hospital custody, the local district attorney sought to extend his commitment under Penal Code section 1026.5. After two psychologists testified at trial that Cheatham met the statute's criteria, a jury found the district attorney had proved the facts necessary to extend Cheatham’s commitment. On appeal, Cheatham argued: (1) the evidence at trial was insufficient to support the jury’s findings; and (2) the district attorney should be barred from trying the matter again under double jeopardy principles. Although he acknowledged these principles generally applied only in criminal matters, he contended they also applied in proceedings to extend a section 1026.5 commitment per 1026.5(b)(7). After review, the Court of Appeal agreed with Cheatham on both points: because of the lack of evidence supporting the required showing, the Court found the evidence insufficient to support a commitment extension under section 1026.5. Further, the Court found that, on remand, the district attorney could not again attempt to extend Cheatham’s commitment. The trial court’s order extending Cheatham’s commitment was reversed and the trial court directed to dismiss the petition to extend the commitment. View "California v. Cheatham" on Justia Law

Illinois, Cook County Health and Hospitals System, Chicago, and Naperville each issued an order, policy, or directive requiring certain employees to vaccinate or regularly test for COVID-19. Employees who failed to comply would be subject to disciplinary action, including possible termination. Three district judges denied motions for preliminary injunctions against those vaccine mandates.Consolidating the appeals, the Seventh Circuit affirmed. Rejecting a claim that the regulations violated the plaintiffs’ constitutional right to substantive due process by interfering with their rights to bodily autonomy and privacy, the court stated that the plaintiffs failed to provide facts sufficient to show that the challenged mandates abridge a fundamental right and did not provide a textual or historical argument for their constitutional interpretation. The district judge properly applied the rational basis standard. The plaintiffs established the efficacy of natural immunity and pointed out some uncertainties associated with the COVID-19 vaccines but did not establish that the governments lack a “reasonably conceivable state of facts” to support their policies. Without specifying the process that was due, how it was withheld, and evidence for the alleged protected interest, the plaintiffs’ procedural due process claims fail. The court also rejected free exercise claims and claims under the Illinois Health Care Right of Conscience Act. View "Troogstad v. City of Chicago" on Justia Law

Section 1557 of the Patient Protection and Affordable Care Act prohibits health care programs that receive federal funds from discriminating against patients on the basis of sex. Section 1557 incorporates Title IX’s definition of prohibited sex discrimination. The Secretary of HHS has authority to issue regulations to implement Section 1557.In May 2016, HHS issued a rule interpreting Section 1557’s prohibition of “discrimination on the basis of sex.” Plaintiffs claimed the rule violated the Administrative Procedure Act (APA) by defining “sex discrimination” inconsistently with Title IX. Initially, the district court issued a nationwide preliminary injunction and ultimately granted summary judgment to Plaintiffs but denied permanent injunctive relief. Significant litigation followed.In this case, HHS argues that any challenge to the 2016 Rule is now moot because the district court already vacated the parts of the rule that violated the APA, and because the 2020 Rule rescinded the 2016 Rule. The Fifth Circuit agreed. View "Franciscan Alliance v. Becerra" on Justia Law

Several states challenged the portion of the vaccine mandate as it pertains to employees who work on or in connection with a covered contract, or share a workplace with another employee who does. The district court determined that Plaintiffs were entitled to a preliminary injunction.On appeal, the Eleventh Circuit agreed with the district court that Plainitffs were likely to prevail on the merits. However, the court also found that the injunction’s nationwide scope was too broad. Thus, the Eleventh Circuit affirmed the district court’s order to the extent that it enjoins federal agencies from enforcing the mandate against the plaintiffs and to the extent that it bars the federal government from considering a bidder’s compliance with the mandate when deciding whether to grant a contract to a plaintiff or to a nonparty bidder. However, the Eleventh Circuit vacated the remaining portion of the preliminary injunction. View "State of Georgia, et al v. President of the United States, et al" on Justia Law

The Mississippi Division of Medicaid (DOM) and Yalobusha County Nursing Home (YNH) disputed four costs submitted for reimbursement by YNH in its fiscal year 2013 Medicaid cost report. The DOM appealed a Chancery Court’s judgment ordering the DOM to reverse the four adjustments at issue. Because the DOM correctly interpreted the appropriate statutes and because its decisions were supported by substantial evidence, the Mississippi Supreme Court reversed the chancery court’s order and rendered judgment reinstating the decisions of the DOM. View "Mississippi Division of Medicaid v. Yalobusha County Nursing Home" on Justia Law

Defendants 1 and 2 are siblings and were indicted on substantive counts of health care fraud, conspiracy to commit health care fraud, money laundering, and conspiracy to commit money laundering related to their activities running a "pill mill." The District Court precluded evidence that Defendant 1 provided good care to his patients. The court also precluded evidence proffered by Defendant 2 (the younger sibling) that it is part of the Nigerian culture to defer to older siblings' decisions. Following their convictions, Defendant's challenged the court's evidentiary rulings as well as the sufficiency of the evidence.The Eleventh Circuit affirmed Defendants' convictions, rejecting all claims of error. The court also determined that the evidence was sufficient to support their convictions. View "USA v. Patrick Emeka Ifediba, et al" on Justia Law

Plaintiffs, a transgender youth, their parents, and two healthcare professionals, sought to enjoin Arkansas Act 626, which prohibits healthcare professionals from providing gender transition procedures to any individual under the age of 18 or from referring any such individual to any healthcare professional for gender transition procedures. The district court enjoined the Act, and the State appealed.The Eighth Circuit held that because a minor's sex at birth determines whether or not the minor can receive certain types of medical care under the law, Act 626 discriminates on the basis of sex. Thus, to be valid, the Act must be supported by an exceedingly persuasive justification. The Eighth Circuit determined that the Act prohibits medical treatment that conforms with the recognized standard of care for adolescent gender dysphoria and that the purpose of the Act is not to ban a treatment but to ban an outcome the State deems undesirable. Thus, the district court did not err in granting an injunction. View "Dylan Brandt v. Leslie Rutledge" on Justia Law

Plaintiffs, the heirs and executor of the estate of Viviana Ruscitto, filed complaints seeking compensatory and punitive damages on numerous counts after Ruscitto’s death from leiomyosarcoma, a rare cancer that cannot be reliably diagnosed preoperatively, following the hysterectomy she underwent at defendant Valley Hospital with the use of a power morcellation device. Ruscitto sought treatment for uterine fibroids from defendant Howard Jones, a gynecologic surgeon at the hospital with whom Ruscitto met four times before she underwent surgery. Approximately six months before Ruscitto’s surgery, the FDA issued a Safety Communication discouraging the use of power morcellation. Valley Hospital administrators and Dr. Jones exchanged emails about the continued use of power morcellation. They considered factors including that “without the morcellator these cases would be open instead of laparoscopic, which “increases morbidity”; the fact that “the numbers at Valley” did not support the “1 sarcoma in 350 operations” number suggested by the FDA; and the role of informed consent. A “power morcellation group” was convened to draft an informed consent form. A form was prepared and approved by the legal department but was never implemented or used prior to Ruscitto’s surgery. One month after her surgery, the FDA issued an updated communication explicitly warning against the use of power morcellators in the majority of cases. Valley Hospital then discontinued use of the power morcellation device. Plaintiffs brought claims against several defendants, including Dr. Jones and the Valley Hospital administrators, and defendants sought partial summary judgment dismissing the punitive damages claim. The trial court denied the motions, and the Appellate Division denied leave to appeal. The New Jersey Supreme Court concluded a reasonable jury could not find by clear and convincing evidence that punitive damages were warranted based on the facts of this case, and partial summary should have been granted. View "Rivera v. Valley Hospital, Inc." on Justia Law