Justia Health Law Opinion Summaries

In this case regarding conservatorships authorized by the Lanterman-Petris-Short (LPS) Act for persons gravely disabled by a mental disorder or chronic alcoholism the Supreme Court held that, for purposes of the right against compelled testimony, those facing an LPS conservatorship due to an inability to care for themselves are sufficiently similar to persons found not guilty of crimes by reason of insanity (NGIs) that equal protection principles require the government to justify its disparate treatment of these proposed conservatees.The Contra Costa County Public Guardian petitioned for an LPS conservatorship on the ground that Appellant was gravely disabled. Appellant requested a jury trial and objected to giving compelled testimony.The court overruled the petition. Appellant was called to testify during trial. The jury found Appellant gravely disabled, and the court appointed the Public Guardian as conservator. On appeal, Appellant challenged the order compelling his testimony. The court of appeals held that LPS conservatives and similarly situated with NGIs for the purposes of NGI extension proceedings but that the error in compelling Appellant's testimony was harmless. The Supreme Court affirmed, holding (1) traditional LPS conservatees are similarly situated with NGI’s for purposes of the right against compelled testimony; but (2) a remand was not appropriate in this case. View "In re Conservatorship of Eric B." on Justia Law

The First Circuit affirmed the decision of the district court denying motion for a preliminary injunction sought by Appellants, then-employees of Mass General Brigham, Inc. (MGB), to stop their employer's application of its mandatory COVID-19 vaccination policy to them, holding that the district court did not err.In November 2021, Appellants bought this action. The district court denied a preliminary injunction. Appellants then noticed an appeal and also sought emergency injunctive relief from the First Circuit. The First Circuit held that they had not met the requirements for an injunction pending appeal. Now that the merits of Appellants' appeal were before the Court, the First Circuit affirmed the denial of a preliminary injunction, holding that the district court correctly denied relief. View "Together Employees v. Mass General Brigham Inc." on Justia Law

The Court of Appeals answered a certified question of law by concluding that the then-Chief Judge Mary Ellen Barbara of the Court of Appeals acted within her authority and consistently with the Maryland Constitution when she issued an administrative order temporarily tolling statutes of limitations under Maryland law with respect to civil actions during the COVID-19 pandemic.On April 24, 2020, the Chief issued an administrative order that temporarily tolled statutes in civil cases during the state of emergency created by the COVID-19 pandemic. In a commercial dispute between the parties in this case, the timeliness of certain claims and the diversity jurisdiction of the federal court depended on the validity of the Chief Justice's administrative tolling order and whether the order violated the Maryland Declaration of Rights. The Court of Appeals held that the Chief Justice acted within her authority when she issued the administrative tolling order concerning the timeliness of the complaints filed in Maryland during the pandemic. View "Murphy v. Liberty Mutual Insurance Co." on Justia Law

Hospitals provided emergency medical services to members of the county’s health plan, which is licensed and regulated by the state Department of Managed Health Care under the Knox-Keene Health Care Service Plan Act, Health & Saf. Code 1340. The county reimbursed the Hospitals for $28,500 of a claimed $144,000. The Hospitals sued, alleging breach of an implied-in-fact or implied-in-law contract. The trial court rejected the county’s argument that it is immune from the Hospitals’ suit under the Government Claims Act (Gov. Code 810).The court of appeal reversed. The county is immune from common law claims under the Government Claims Act and the Hospitals did not state a claim for breach of an implied-in-fact contract. The county does not contest its obligation to reimburse the Hospitals for the reasonable and customary value of the services; the issue is what remedies may be pursued against the county when the reasonableness of the reimbursement is disputed. The Knox-Keene Act provides alternative mechanisms to challenge the amount of emergency medical services reimbursements. A health care service plan has greater remedies against a private health care service plan than it does against a public entity health care service plan, a result driven by the Legislature broadly immunizing public entities from common law claims and electing not to abrogate that immunity in this context. View "County of Santa Clara v. Superior Court" on Justia Law

Respondent K.C. appealed a circuit court decision ordering her to involuntary admission to the New Hampshire Hospital (NHH) for a two-year period, to be discharged when clinically appropriate. On appeal, respondent contended NHH presented insufficient evidence at the hearing to support the circuit court’s order. Respondent was diagnosed with bipolar I disorder with manic, psychotic features. She had contacted police in the previous year 300-400 times, believing someone was hacking her phone and “rerouting her to people in black ops.” She had two active protective orders preventing her from contacting her ex-husband and another man, and there was outstanding criminal complaints from her violating those orders. Respondent was admitted to NHH, whereupon she was evaluated by psychiatrists, and the decision was ultimately made to have her committed. Finding no reversible error in the circuit court’s order, the New Hampshire Supreme Court affirmed, finding the evidence presented at respondent’s hearing was sufficient on which to have her involuntarily committed. View "In re K.C." on Justia Law

Plaintiff suffered from back and neck pain for years, and her doctor concluded that surgery would help her relieve her symptoms. After surgery, her insurance provider, Central States, denied her claim. Central States made this determination pursuant to a provision of the plan stating that covered individuals “shall not be entitled to payment of any charges for care, treatment, services, or supplies which are not medically necessary or are not generally accepted by the medical community as Standard Medical Care, Treatment, Services or Supplies.” Central States came to this conclusion based on an independent medical review (IMR) of Plaintiff’s claim, conducted by a physician board-certified in general surgery. Plaintiff filed suit under the Employee Retirement Income Security Act (“ERISA”), and Defendant appealed the district court’s ruling.The Fourth Circuit found that Central States failed to disclose to their IMR physician the medical records that would have been pertinent to his analysis. The court noted that it did not conclude that Central States acted in bad faith or deliberately withheld documentation. But intent aside, Central States owes plan participants a “deliberate, principled reasoning process.” Further, while plan trustees enjoy a good measure of discretion in determining what is “medically necessary” under the terms of the plan, they may not abuse that discretion by employing processes that lead to unreasoned conclusions or by affixing extratextual requirements. The court held that because Central States had ample chance to review Plaintiff’s claim, the district court did not abuse its discretion by awarding benefits outright. View "Dorothy Garner v. Central States, Southeast and Southwest Areas" on Justia Law

The Supreme Court reversed in part and affirmed in part the decision of the district court granting summary judgment for Meritain Health, Inc., and dismissing David Peterson's claims against Meritain, holding that there were genuine issues of material fact as to some of Peterson's claims.Peterson, an insured under a hospital's health benefit plan, brought this action against the hospital and Meritain Health, Inc., the third-party administrator of the plan, alleging several claims arising from the denial of his claims for health insurance coverage. The district court granted Meritain's motion for summary judgment. The Supreme Court reversed in part and remanded the case, holding that there were genuine issues of material fact regarding Peteron's breach of contract claim, his third-party beneficiary claim, and his claim for breach of the covenant of good faith and fair dealing. View "Peterson v. Meritain Health, Inc." on Justia Law

Dual Diagnosis Treatment Center, Inc., d/b/a Sovereign Health of San Clemente, and its owner, Tonmoy Sharma, (collectively Sovereign) appealed the trial court's denial of Sovereign's motion to compel arbitration of claims asserted by Allen and Rose Nelson for themselves and on behalf of their deceased son, Brandon. The Nelsons alleged a cause of action for wrongful death, and on behalf of Brandon, negligence, negligence per se, dependent adult abuse or neglect, negligent misrepresentation, and fraud. According to the complaint, despite concluding that 26-year-old "Brandon requires 24 hour supervision ... at this time" after admitting him to its residential facility following his recent symptoms of psychosis, Sovereign personnel allowed him to go to his room alone, where he hung himself with the drawstring of his sweatpants. The trial court denied Sovereign's motion to compel arbitration because: (1) the court found Sovereign failed to meet its burden to authenticate an electronic signature as Brandon's on Sovereign's treatment center emollment agreement; and (2) even assuming Brandon signed the agreement, it was procedurally and substantively unconscionable, precluding enforcement against Brandon or, derivatively, his parents. Sovereign challenged the trial court's authentication and unconscionability findings. Finding no reversible error, the Court of Appeal affirmed the trial court's judgment. View "Nelson v. Dual Diagnosis Treatment Center" on Justia Law

Dr. Paulus was prosecuted for healthcare fraud. Government consultants reviewed 496 of Paulus’s procedures and concluded that 146 (about 30%) were unnecessary. King’s Daughters Medical Center (KDMC) consultants also reviewed a random selection of Paulus’ procedures. Three experts at trial concluded that Paulus overstated his patients’ arterial blockage and inserted medically unnecessary stents. A jury convicted Paulus. After remand, before sentencing, the government disclosed to Paulus for the first time the “Shields Letter,” stating that when KDMC faced previous legal trouble, it hired independent experts to review 1,049 of Paulus’s cases; they flagged about 7% of his procedures as unnecessary. The defense viewed this evidence as exculpatory and consistent with diagnostic differences of opinion. Before trial, the district court had held that the information was inadmissible and that the parties “[we]re not to disclose” any information about the KDMC Review to Paulus.The Sixth Circuit vacated Paulus’s convictions and remanded, finding that the Shields Letter was material to Paulus’s defense and that failure to disclose it violated Paulus’s “Brady” rights. On remand, the government subpoenaed KDMC for additional information regarding the study referenced in the Shields Letter. KDMC objected, citing the attorney-client, work-product, and settlement privileges. The government filed a motion to compel, which was granted. KDMC sought a writ of mandamus. The Sixth Circuit denied KDMC’s petition. KDMC’s disclosure of some information regarding its experts’ study waived its privilege over the related, undisclosed information now being sought. View "In re: King's Daughters Health System, Inc." on Justia Law

Plaintiff, a hospice provider, challenges the Centers for Medicare and Medicaid Services (“CMS”) methodology, contending that it violates both the Medicare statute and the Budget Control Act and that CMS did not follow the required administrative procedures for adopting it.According to Plaintiff, the sequestration methodology violated the statute and the regulation by adding back the sequestration reduction withheld from the preliminary disbursements into the equation, such that — for overpayment purposes — funds the providers did not actually receive were being counted against them. Plaintiff contends that CMS was required to use the net payments methodology instead of the sequestration methodology.The court held that the regulations and guidance do not support Plaintiff’s contention that the statute unambiguously requires the net payments methodology. Reasoning that section 1395f(i)(2)(A) does not mandate any one methodology for applying the aggregate cap. Further, the plain meaning of the statute gives no instruction as to how overpayments should be calculated, the court concludes the statute is “silent . . . with respect to the specific issue” of what methodology CMS must use in applying the aggregate cap. Further, because the Secretary’s chosen methodology comports with the statutory text, purpose, and operation, Plaintiff has not shown that the Board’s decision was “arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law.” Thus, the court affirmed the district court’s grant of summary judgment to the Secretary and denial of summary judgment to Plaintiff. View "Gentiva Health Services, Inc. v. Becerra" on Justia Law