Justia Health Law Opinion Summaries

The Supreme Court vacated the judgment of the court of appeals affirming the denial by the court of common pleas of Appellants' motion to dismiss concluding that immunity from liability afforded to mental-health providers under Ohio Rev. Code 2305.51 did not apply in this case, holding that the trial court's order denying Appellants' motion to dismiss was not a final, appealable order, and therefore, the court of appeals lacked jurisdiction to issue its judgment.In overruling Appellants' motion to dismiss the trial court concluded that immunity from liability afforded to mental-health providers under section 2305.51 did not apply in this case. The court of appeals affirmed, rejecting Appellants' argument that the trial court erred in holding that Appellants were not entitled to statutory immunity under section 2305.51. The Supreme Court vacated the court of appeals' judgment, holding that the appellate court lacked jurisdiction where the trial court's entry denying Appellants' motion to dismiss was not a final, appealable order. View "Stewart v. Solutions Community Counseling & Recovery Centers, Inc." on Justia Law

In this COVID-19 pandemic-related case, the Seventh Circuit vacated in part the judgment of the district court granting Loyola University of Chicago's motion to dismiss this complaint brought by Plaintiffs, three undergraduate students, for breach of contract and unjust enrichment, holding that Plaintiffs pled enough to withstand dismissal for failure to state a claim and that Plaintiffs were entitled to leave to amend to save their alternative claim for unjust enrichment.As a result of the pandemic, Loyola suspended all in-person instruction during the Spring 2020 semester, curtailed access to campus facilities, and moved all instruction online. Plaintiffs brought a putative class action lawsuit against Loyola, arguing that the decision to shut down Loyola's campus deprived them of promised services, such as in-person instruction and access to on-campus facilities, in exchange for tuition and fees. The district court granted Loyola's motion to dismiss for failure to state a claim. The Seventh Circuit reversed in part, holding (1) Plaintiffs sufficiently pled a claim for breach of an implied contract under Illinois law; and (2) Plaintiffs adequately pled an unjust enrichment claim in the alternative. View "Gociman v. Loyola University of Chicago" on Justia Law

A man appealed superior court orders authorizing his commitment for mental health treatment and the involuntary administration of psychotropic medication, arguing the superior court relied on erroneous facts to find that he was gravely disabled and that the court did not adequately consider the constitutional standards established in Myers v. Alaska Psychiatric Institute before authorizing medication. Because the evidence supported the court’s finding that the man was gravely disabled, the Alaska Supreme Court affirmed the commitment order. But the Supreme Court vacated the medication order because the court’s analysis of the Myers factors was not sufficient. View "In the Matter of the Necessity for the Hospitalization of: Jonas H." on Justia Law

In this case involving licenses to operate a retail marijuana dispensary the Supreme Judicial Court affirmed in part and reversed in part the judgment of the Land Court judge ordering the issuance of a special permit to Plaintiff and the issuance of a second injunction, holding that the second injunction exceeded the permissible scope of the judge's authority.After denying Plaintiff's application for a special permit license to operate a recreational marijuana establishment in the City of Taunton the City granted a special permit to a different applicant. Plaintiff filed a complaint challenging the denial of its special permit application. The Land Court judge found the City's denial of Plaintiff's special permit application was arbitrary and capricious and enjoined the City from conducting previously-scheduled licensing proceedings to consider applications from nonparties seeking licenses to operate medical marijuana dispensaries and from issuing any of the four licenses to the pending applicants. A single justice vacated the preliminary injunction. The Supreme Judicial Court vacated the portion of the judgment concerning the city council's licensing hearings and otherwise affirmed, holding that the injunction exceeded the scope of the judge's authority but that the judge did not err in determining that the City's denial was arbitrary and legally untenable. View "Bask, Inc. v. Municipal Council of Taunton" on Justia Law

This case involved a medical-malpractice suit brought by Jalena and Brian Taylor against Jalena’s OB/GYN, Dr. Donielle Daigle, and her clinic, Premier Women’s Health, PLLC. In 2017, Jalena was admitted to Memorial Hospital of Gulfport in active labor preparing to give birth. After pushing for two and a half hours, the baby’s head became lodged in the mother’s pelvis, and it was determined that a caesarean section was necessary. Following delivery of the child, Jalena’s blood pressure dropped, and her pulse increased. The nurses worked to firm Jalena’s uterus post delivery, but she continued to have heavy clots and bleeding. Jalena was given a drug to tighten the uterus, and an OR team was called to be on standby in the event surgery became necessary. Dr. Daigle called the OR team off after Jalena’s bleeding was minimal, and her uterus remained completely firm. But Jalena’s heart rate remained extremely elevated. Dr. Daigle allowed Jalena to go back to her room, and she checked her again, and the uterus was firm. A minute or two later, Jalena sat up and felt a gush of blood. Dr. Daigle prepared to perform a hysterectomy, There was still bleeding from the cervical area, which doctors decided they needed to amputate. Even after doing so, there was still bleeding because of a laceration extending into the vagina. When the vagina was sutured and incorporated into the repair of the vaginal cuff, the bleeding finally stopped. The Taylors allege that Dr. Daigle failed to adequately treat Jalena and, as a result, she cannot have any more children. A five-day jury trial was held in January 2021, and the jury returned a twelve-to-zero verdict in favor of Dr. Daigle and Premier. On appeal, the Taylors argued the trial court committed reversible error by: (1) refusing to grant their cause challenges of patients of Dr. Daigle and Premier, thus failing to give them a right to a fair and impartial jury; and (2) failing to find a deviation from the standard of care for failing to perform a proper inspection of a genital tract laceration. The Mississippi Supreme Court affirmed the jury verdict because it was reached on factual evidence in favor of Dr. Daigle and Premier by an impartial jury. "All twelve of the jurors agreed on the verdict, and the verdict was not against the overwhelming weight of the evidence. It should not be disturbed." View "Taylor v. Premier Women's Health, PLLC, et al." on Justia Law

The Louisiana Independent Pharmacies Association (“LIPA”) sued Express Scripts on behalf of its members, seeking a declaratory judgment on whether La. Rev. Stat. Ann. Sections 22:1860.1 and 46:2625 are preempted by Medicare Part D.1 Express Scripts moved to dismiss LIPA’s request for declaratory judgment regarding the reimbursement provision for failure to state a claim, see Fed. R. Civ. P. 12(b)(6), on the basis that Medicare Part D preempts the reimbursement provision for prescriptions covered by Part D plans The district court concluded, however, that Express Scripts failed “to meet its burden of showing preemption or any other basis for dismissal.” Express Scripts moved to certify the order denying its motion to dismiss for interlocutory appeal under 28 U.S.C. Section1292(b). The district court granted certification,   The Fifth Circuit vacated the district court’s order concluding that the court lacks both federal question and diversity jurisdiction. The court explained that here, LIPA seeks a declaration that Express Scripts’ state law and related contractual obligation to reimburse LIPA’s member pharmacies for the provider fee is not preempted by federal law. Applying the well-pleaded complaint rule requires the court to imagine a hypothetical coercive lawsuit brought by Express Scripts against LIPA’s member pharmacies. But none is conceivable, thus, because Express Scripts has no possible ground for a coercive lawsuit, no federal question arises for purposes of jurisdiction in LIPA’s declaratory judgment case. Accordingly, the court concluded that LIPA must make the same showing to satisfy the amount in controversy requirement. View "LA Indep Pharmacies v. Express Scripts" on Justia Law

Various actors in the Medicare Advantage program assigned claims for failure to pay or reimburse medical expenses owed under the Medicare Secondary Payer Act to Plaintiffs—MSP Recovery Claims, Series LLC; MSPA Claims 1, LLC; and MAO-MSO Recovery II LLC, Series PMPI, (collectively, “MSP Recovery”). MSP Recovery then asserted those claims against Metropolitan General Insurance Company, Metropolitan Casualty Insurance Company, Metropolitan Group Property & Casualty Insurance Company, Metlife Auto & Home Group, and Metropolitan P&C Insurance Company (collectively, “Defendants”).   The district court dismissed MSP Recovery’s claims because the complaint failed to show that Defendants had a “demonstrated responsibility” to reimburse MSP Recovery’s assignors for the medical expenses at issue. The Eleventh Circuit held that at this procedural stage MSP Recovery’s complaint plausibly alleged that Defendants had a demonstrated responsibility to pay the claims, and the court, therefore reversed and remanded this case to the district court for further proceedings consistent with this opinion.   The court explained that the district court found that it would not consider Exhibit A, which was attached to and referenced by incorporation in the factual allegations of MSP Recovery’s complaint. Because “documents attached to a complaint or incorporated in the complaint by reference can generally be considered by a federal court in ruling on a motion to dismiss under Rule 12(b)(6),” the court concluded that the district court erred in failing to consider whether the complaint and Exhibit A, taken together, plausibly alleged that Defendants’ responsibility to pay had been demonstrated prior to suit. View "MSP Recovery Claims, Series LLC, et al v. Metropolitan General Insurance Company, et al" on Justia Law

In 2016, the Secretary of Health and Human Services (“HHS”) issued a final rule that implemented The Protecting Access to Medicare Act of 2014 (“PAMA” or “Act”), definition of “applicable laboratory” (“2016 Rule”). The American Clinical Laboratory Association (“ACLA”) filed a lawsuit challenging the 2016 Rule as arbitrary and capricious under the Administrative Procedure Act (“APA”) on the basis that it depresses Medicare reimbursement rates by excluding most hospital laboratories from PAMA’s reporting requirements. ACLA contended that because hospital laboratories tend to charge higher prices than standalone laboratories, their exclusion from reporting obligations results in an artificially low weighted median.   On remand, the parties cross-moved for summary judgment. The district court declined to reach the merits of ACLA’s APA challenge to the 2016 Rule, based on its determination that the Secretary had issued a new rule (“2018 Rule”) that superseded the 2016 Rule and mooted ACLA’s lawsuit.   The DC Circuit concluded that the case is not moot. Accordingly, the court reversed the district court’s dismissal for lack of subject matter jurisdiction and reached the merits of ACLA’s APA claim. The court explained that the 2016 Rule is arbitrary and capricious because the agency “failed to consider an important aspect of the problem.” The court wrote that PAMA provides that an applicable laboratory “means a laboratory that” receives “a majority” of its Medicare revenues from the Physician Fee Schedule or Clinical Laboratory Fee Schedule. Thus, hospital laboratories that provide outreach services may, in some instances, constitute “applicable laboratories” under PAMA. View "American Clinical Laboratory Association v. Xavier Becerra" on Justia Law

Appellant sought the dismissal of most of the counts of his indictment and a new trial on the remaining counts. In his view, the indictment failed to allege a convergence between the deceived entity, CareFirst, and those deprived of property— which, in Appellant’s view, were his clients. In other words, he claimed that the indictment did not allege that he defrauded CareFirst of any of its own property. He argued instead that the indictment and trial improperly relied on evidence that he defrauded his small business clients by overcharging them for health insurance premiums. He also brought a number of evidentiary challenges.   The DC Circuit affirmed Appellant’s conviction and sentence. The court wrote that there is no convergence problem in this case. The indictment alleged that Appellant defrauded CareFirst, causing it to lose money. That is the same fraud that the government proved at trial. The differential between the falsely lowered premiums that Appellant tricked CareFirst into charging and those he billed his clients represented, at least in part, property fraudulently taken from CareFirst. That price difference also helped to show Appellant profit motive for the fraud, and demonstrated that he was neither acting as a Robin Hood nor at the behest of his clients to help reduce their premiums. None of Appellant’s other challenges on appeal succeed. View "USA v. Tarek Abou-Khatwa" on Justia Law

The plaintiff alleged that after being treated at the defendant’s emergency room, he was billed an evaluation and management services (EMS) fee in addition to the charges for individual items of service and treatment. His total charges of $4,593 (before discounts) included the undisclosed EMS Fee of $2,811. He argued that the EMS Fee was charged to patients simply for being seen in the emergency room and is not visibly posted on signage in or around emergency rooms or at its registration windows/desks.The court of appeal affirmed the dismissal of his third amended complaint, alleging violation of the Consumers Legal Remedies Act (CLRA) (Civ. Code 1750). The court noted that another division of the court of appeals recently held that identical allegations do not state a cause of action under the CLRA. The plaintiff acknowledged the hospital’s compliance with California’s “Payers’ Bill of Rights,” Health and Safety Code 1339.50, by listing the EMS Fee in its chargemaster, which is published on defendant’s website. There is no duty to make an additional disclosure of the EMS Fee in light of the public policy reflected in federal and state statutes that emergency room care be provided to patients without delay or questioning about their ability to pay. View "Saini v. Sutter Health" on Justia Law