Justia Health Law Opinion Summaries

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

Bloomington, Indiana (population 90,000) is in a metropolitan statistical area with a population near 200,000. From Bloomington, one can drive an hour and ten minutes to Indianapolis (population 865,000); two hours to Evansville (population 120,000); two hours to Louisville (population 620,000); or two and a half hours to Cincinnati, (population 300,000). Dr. Vasquez arrived in Bloomington in 2006, opened an independent vascular‐surgery practice, and obtained admitting privileges at Bloomington Hospital, Monroe Hospital, and the Indiana Specialty Surgery Center. He performed more than 95% of his inpatient procedures at Bloomington Hospital. In 2010, IU Health acquired Bloomington Hospital. In 2017, IU Health acquired Premier Healthcare, an independent physician group based in Bloomington. Vasquez alleges that, because of the acquisition, IU Health employs 97% of primary care providers (PCPs) in Bloomington and over 80% of PCPs in the region. Vasquez’s alleged that IU Health launched “a systematic and targeted scheme” to ruin his reputation and practice because of Vasquez’s commitment to independent practice. IU Health's employees cast aspersions on his reputation. IU Health revoked Vasquez’s Bloomington admitting privileges.Vasquez brought claims under Sherman Act, 15 U.S.C. 2, and Clayton Act, section 18. The Seventh Circuit reversed the dismissal of his suit. Vasquez’s accounts of how a hypothetical monopolist could dominate Bloomington’s vascular‐ surgery market suffice for the pleading stage; the complaint presents a plausible account under which his suit is timely. View "Vasquez v. Indiana University Health, Inc" on Justia Law

The Supreme Court affirmed the order and judgment of the circuit court in this case concerning whether local health officers may lawfully issue public health orders, holding that local health officers have statutory authority to issue orders and that no state law preempted the local health ordinance in question.At issue was Dane County Ordinance 46.40 regarding the prevention, suppression, and control of communicable diseases. Plaintiffs bought this action against the County and the Health Department and its director challenging their authority to issue and enforce such orders. The circuit court granted summary judgment against Plaintiffs' claims. The Supreme Court affirmed, holding (1) Wis. Stat. 252.03 grants local health officers the authority to issue public health orders; (2) the ordinance at issue, which makes such orders enforceable by civil citations, was not preempted by state law; and (3) a local health officer's authority to issue enforceable public health orders pursuant to section section 252.03 and ordinance 46.40 does not run afoul of constitutional separation of powers principles. View "Becker v. Dane County" on Justia Law

The First Circuit denied an emergency stay sought by Plaintiffs of a disclosure order in this challenge to the Maine vaccine mandate for healthcare workers as it stood on October 19, 2021, holding that Plaintiffs were not entitled to the stay.For this first ten months of this case Plaintiffs were allowed to proceed under pseudonyms. Upon a motion by intervenor press/media organizations, the district court ordered Plaintiffs to file an amended complaint identifying by name the individual plaintiffs, finding that Plaintiffs did not meet their burden of rebutting the presumption against parties proceeding under pseudonyms. Plaintiffs filed an appeal from the disclosure order and sought an emergency stay of that order until resolution of their appeal on the merits. The First Circuit denied the stay, holding that the public interest and the media intervenors' interests weighed in favor of denying the stay due to the presumption of public access. View "Does v. Mills" on Justia Law

Jody arrived at the Indiana University Health emergency room with severe abdominal pain. Doctors determined she needed emergency surgery to remove a dying portion of her intestine. Because they believed (incorrectly) that the problem stemmed from earlier gastric bypass surgery, they transferred her to another facility to be operated on by the bariatric surgeon who had performed the bypass. Jody died two days later. Her husband sued, alleging that IU’s failure to operate on Jody violated its obligation under the federal Emergency Medical Treatment and Labor Act to “stabilize” Jody when it decided to transfer her without first performing the laparotomy and removing the ischemic portions of her intestine, 42 U.S.C. 1395dd(b)(1)(A).The Seventh Circuit affirmed the summary judgment rejection of the suit. The Act authorizes pre-stabilization transfer where one of two triggering conditions is satisfied and the transfer is “appropriate.” No reasonable jury could conclude that IU did not satisfy both requirements. A physician certified that “[b]ased upon the information available to [him] at the time of transfer, … the medical benefits reasonably expected from the provision of appropriate medical treatment at another facility outweigh the increased risks to [Jody] … from undertaking the transfer.” The court cited the “Treatment Act’s narrow purpose as an anti-dumping law rather than a federal cause of action for medical malpractice.” View "Martindale v. Indiana University Health Bloomington, Inc." on Justia Law