Justia Health Law Opinion Summaries

Several minors diagnosed with gender dysphoria, their parents, and a physician challenged an Oklahoma law (SB 613) that prohibits healthcare providers from administering gender transition procedures—including puberty blockers and cross-sex hormones—to individuals under eighteen. The law defines these procedures as medical or surgical interventions intended to affirm a minor’s gender identity when it differs from their biological sex. The statute does not ban mental health counseling or certain other medical treatments. The plaintiffs, all affected by the law’s restrictions, argued that SB 613 violated their constitutional rights.The United States District Court for the Northern District of Oklahoma denied the plaintiffs’ request for a preliminary injunction, finding they had not demonstrated a likelihood of success on the merits of their claims. The plaintiffs appealed this decision to the United States Court of Appeals for the Tenth Circuit. While the appeal was pending, the Tenth Circuit paused proceedings to await the Supreme Court’s decision in United States v. Skrmetti, which addressed a similar Tennessee law.The United States Court of Appeals for the Tenth Circuit affirmed the district court’s denial of a preliminary injunction. The court held that SB 613 does not violate the Equal Protection Clause because it classifies based on age and medical use, not sex or transgender status, and is subject to rational basis review. The court found Oklahoma’s interest in the health and welfare of minors provided a rational basis for the law. The court also rejected the substantive due process claim, concluding that there is no fundamental right for parents to access gender transition procedures for their children, and that the law is rationally related to a legitimate state interest. The court found no evidence of invidious discriminatory intent by the legislature. View "Poe v. Drummond" on Justia Law

Several chambers of commerce, including regional and national organizations, brought a lawsuit on behalf of their pharmaceutical-manufacturer members challenging the constitutionality of the Drug Price Negotiation Program established by the Inflation Reduction Act of 2022. This federal program authorizes the Secretary of Health and Human Services to negotiate prices for certain high-expenditure drugs sold to Medicare and Medicaid. Among the plaintiffs’ members were AbbVie Inc. and its subsidiary Pharmacyclics LLC, manufacturers of a drug selected for the first round of negotiations. Notably, Pharmacyclics joined the Dayton and Ohio Chambers only after the litigation began, while AbbVie had longstanding membership in several chambers.The United States District Court for the Southern District of Ohio reviewed the case after the government moved to dismiss, arguing that the Dayton Chamber lacked associational standing and that venue was therefore improper. The district court allowed limited discovery and permitted the plaintiffs to amend their complaint. Ultimately, the district court dismissed the case, holding that the regional chambers’ purposes were not sufficiently related to the interests at stake in the lawsuit, and thus they lacked associational standing. The court also found that, without standing for the Dayton and Ohio Chambers, venue in the Southern District of Ohio was improper and declined to transfer the case.The United States Court of Appeals for the Sixth Circuit affirmed the district court’s judgment. The Sixth Circuit held that the interests asserted in the lawsuit were not germane to the purposes of the Dayton, Ohio, or Michigan Chambers, as their regional missions were too remote from the national pharmaceutical issues at stake. The court further concluded that, with no plaintiff residing in the district, venue was improper. The judgment of dismissal for improper venue was therefore affirmed. View "Dayton Area Chamber of Commerce v. Kennedy" on Justia Law

The case concerns a defendant who, after being excluded from Medicare and Medicaid as part of a civil False Claims Act settlement, purchased a Medicare-participating home healthcare company using an alias and forged documents. The company then submitted hundreds of fraudulent claims to Medicare, resulting in over $2.7 million in payments for services that were never provided. The defendant transferred the proceeds to India, where they remain unrecovered. During the criminal investigation, the defendant also attempted to prevent a former employee from testifying by impersonating another person and making false reports to U.S. authorities, which led to the employee’s visa being denied.A grand jury in the United States District Court for the Eastern District of Michigan indicted the defendant on charges including health care fraud, money laundering, conspiracy, aggravated identity theft, and witness tampering. The trial was delayed, and shortly before it began, the defendant’s counsel experienced internal conflict, leading to motions to withdraw and requests for a mistrial, all of which the district court denied. During trial, the defense sought to call a surprise witness, an unindicted co-conspirator, on the last day. The district court excluded this witness, citing a violation of a discovery order and concerns about delay, prejudice, and the likelihood the witness would invoke the Fifth Amendment.On appeal, the United States Court of Appeals for the Sixth Circuit reviewed whether the district court violated the defendant’s constitutional rights by excluding the witness, denying counsel’s motion to withdraw, and excluding the defendant from an in-chambers conference. The Sixth Circuit held that the exclusion of the witness did not violate the Sixth Amendment, as the district court reasonably balanced the defendant’s right to present a defense against countervailing interests, and the defendant failed to show what exculpatory evidence the witness would have provided. The court also found no abuse of discretion in denying the motion to withdraw and no reversible error in excluding the defendant from the conference. The Sixth Circuit affirmed the district court’s judgment. View "United States v. Pancholi" on Justia Law

A nonprofit substance abuse treatment facility in Kent, Connecticut, challenged the state’s approval of a competitor’s application to establish a similar facility in the same town. The competitor, Birch Hill Recovery Center, LLC, applied for a certificate of need from the Department of Public Health. The plaintiff was granted intervenor status in the administrative proceedings, allowing it to participate in hearings and present evidence. After public hearings, a hearing officer recommended denying Birch Hill’s application, but the Department and Birch Hill later entered into a settlement agreement that approved the application with certain conditions.The plaintiff appealed the Department’s decision to the Superior Court, arguing that the approval was an abuse of discretion, especially given the hearing officer’s earlier recommendation. The defendants moved to dismiss the appeal, contending that the plaintiff was not aggrieved by the decision and thus lacked standing. The Superior Court initially dismissed the appeal on the ground that the settlement agreement was not a final decision. The Appellate Court affirmed this dismissal. However, the Connecticut Supreme Court later held that the settlement agreement was a final decision and remanded the case for further proceedings. On remand, the Superior Court again dismissed the appeal, this time concluding that the plaintiff was not statutorily or classically aggrieved and therefore lacked standing.The Supreme Court of Connecticut affirmed the dismissal, holding that the plaintiff was neither statutorily nor classically aggrieved by the Department’s decision. The Court explained that mere economic competition resulting from governmental action does not confer standing in administrative appeals unless the relevant statute expressly protects competitors’ interests. The Court found that the applicable statute, General Statutes (Rev. to 2017) § 19a-639 (a), did not create such an exception. The plaintiff’s status as an intervenor and its participation in the administrative process did not, by themselves, establish a specific, personal, and legal interest sufficient for standing. View "High Watch Recovery Center, Inc. v. Dept. of Public Health" on Justia Law

Lonnie Parker, a licensed medical practitioner, was found guilty by a jury of distributing oxycodone and promethazine HCl with codeine solution in a manner unauthorized by the Controlled Substances Act. The case began when an individual named N.C. was pulled over for reckless driving, found impaired, and later died in custody. The DEA suspected Parker of operating a "pill mill" and seized patient records from his clinic. An expert reviewed these records and found that Parker had prescribed controlled substances inappropriately.The United States District Court for the Western District of Arkansas sentenced Parker to 87 months’ imprisonment. Parker appealed, arguing that the evidence was insufficient to support his convictions, the jury instructions were improper, and the district court committed procedural error in sentencing. The district court had calculated Parker’s base offense level by including uncharged prescriptions as relevant conduct, resulting in a total offense level of 30 and an advisory sentencing guidelines range of 108 to 135 months. The court varied downwards to 87 months.The United States Court of Appeals for the Eighth Circuit reviewed the case. The court found that the evidence was sufficient to support Parker’s convictions, as the expert testimony provided enough basis for the jury to conclude that Parker prescribed controlled substances without a legitimate medical purpose. The court also found no plain error in the jury instructions, noting that the instructions as a whole clarified the requirements for criminal conduct. Finally, the court determined that any potential error in calculating the quantity of controlled substances for sentencing was harmless, as the district court stated it would have imposed the same sentence regardless. The Eighth Circuit affirmed the judgment of the district court. View "United States v. Parker" on Justia Law

The defendant, a visiting nurse, was charged with two counts of aggravated felonious sexual assault (AFSA) and four counts of misdemeanor sexual assault (MSA) based on events that allegedly occurred while he was providing care to the victim. The charges included allegations under RSA 632-A:2, I(g)(1) (sexual assault by medical provider) and I(i) (sexual assault by surprise). The victim was over the age of 13 at the time of the alleged assaults.The defendant notified the court of his intention to assert a consent defense under RSA 626:6, I. The State moved to preclude this defense, leading to substantial pre-trial litigation. The trial court directed the parties to prepare an interlocutory appeal statement, which was approved and transferred to the Supreme Court of New Hampshire.The Supreme Court of New Hampshire reviewed three questions: whether consent is a defense under RSA 632-A:2, I(g)(1); whether RSA 632-A:2, I(g)(1) is unconstitutionally vague and overbroad; and whether consent is a defense under RSA 632-A:2, I(i). The court held that consent is not a defense under RSA 632-A:2, I(g)(1) because the Nurse Practice Act (NPA) prohibits sexual conduct between nurses and patients, making such conduct professionally unethical or unacceptable. The court also found that RSA 632-A:2, I(g)(1) is not unconstitutionally vague.Regarding RSA 632-A:2, I(i), the court concluded that consent cannot be a legal defense because if the defendant admitted to causing sexual contact through concealment or surprise, it would inherently mean the victim did not consent. However, the defendant may present evidence of the victim's consent to support his theory of the case, allowing the factfinder to evaluate the credibility of the evidence.The court answered all three questions in the negative and remanded the case for further proceedings consistent with its opinion. View "State v. Allore" on Justia Law

A skilled nursing facility accepted a new resident who was receiving Medicaid benefits. The resident's husband was designated as her authorized representative. Nearly two years later, the Department of Human Services (DHS) terminated the resident's Medicaid benefits due to excess assets. Both the resident and her husband were incapacitated, and the resident's public guardian submitted a new Medicaid application, which was denied. The nursing facility continued to care for the resident without compensation until her death. The facility later sought an administrative hearing to challenge the eligibility decision, but the request was denied because the facility was not an authorized representative and the appeal was late.The circuit court and the Intermediate Court of Appeals (ICA) affirmed the denial, holding that the nursing home lacked standing to challenge the eligibility determination under Hawai'i Revised Statutes (HRS) § 346-12, which limits appeals to the applicant or recipient. The courts concluded that the nursing home did not have a close relationship with the resident for third-party standing purposes.The Supreme Court of the State of Hawai'i reviewed the case and disagreed with the lower courts regarding standing. The court held that skilled nursing facilities have constitutionally protected property interests in compensation for medical services performed for residents based on DHS eligibility determinations. The court ruled that these facilities have due process rights under the Hawai'i Constitution, including notice and the opportunity to appeal Medicaid eligibility determinations when the beneficiary is incapacitated and no authorized representative is available or willing to appeal. The court vacated the ICA's judgment and the circuit court's order, remanding the case for a new administrative hearing on the merits of the resident's Medicaid eligibility. View "In re FT" on Justia Law

Nikko Cerrone, a sixteen-year-old, received the Gardasil HPV vaccine, Flumist influenza vaccine, and Hepatitis A vaccine on October 7, 2015. He later reported decreased stamina and blood in his stools, leading to a diagnosis of ulcerative colitis (UC) in March 2016. He received a second HPV vaccine dose in February 2016 and a third in June 2016, with no documented reaction to the third dose.Cerrone filed a petition for compensation under the National Vaccine Injury Compensation Program, claiming the vaccines caused his UC. The Chief Special Master of the National Vaccine Injury Compensation Program denied his claim, finding that Cerrone failed to prove causation by a preponderance of the evidence. The Court of Federal Claims upheld this decision.The United States Court of Appeals for the Federal Circuit reviewed the case. The court affirmed the lower court's decision, agreeing that Cerrone did not meet the burden of proof required under the Vaccine Act. The court found that the special master correctly applied the legal standards and that the findings were not arbitrary or capricious. The court noted that the special master found the respondent's experts more credible and persuasive than Cerrone's experts. The court also upheld the special master's conclusion that the evidence did not support a proximate temporal relationship between the vaccinations and the onset of UC. The decision of the Court of Federal Claims was affirmed. View "CERRONE v. HHS " on Justia Law

The Grand Traverse Band of Ottawa and Chippewa Indians and its employee welfare plan (the Plan) alleged that Blue Cross Blue Shield of Michigan (Blue Cross) breached fiduciary duties under ERISA and related duties under Michigan state law. The Tribe claimed that Blue Cross submitted false claims, causing the Tribe to overpay for hospital services. The Tribe also alleged violations of the Michigan Health Care False Claims Act (HCFCA) and sought to amend its complaint to include additional facts.The United States District Court for the Eastern District of Michigan dismissed the Tribe’s ERISA and common-law fiduciary duty claims as time-barred, granted summary judgment to Blue Cross on the HCFCA claim, and denied the Tribe’s motion for leave to amend its complaint a second time. The court found that the Tribe had actual knowledge in 2009 that it was not receiving Medicare-Like Rates (MLR) and thus the claims were time-barred. The court also concluded that Blue Cross was not directly governed by the MLR regulations, and therefore, the Tribe could not prove a violation of the HCFCA based on Blue Cross’s failure to apply MLR.The United States Court of Appeals for the Sixth Circuit affirmed the district court’s decisions. The appellate court agreed that the Tribe’s fiduciary duty claims were time-barred because the Tribe knew in 2009 that it was not receiving MLR. The court also upheld the summary judgment on the HCFCA claim, finding that the MLR regulations did not apply to Blue Cross. Additionally, the court found no error in the district court’s denial of the Tribe’s motion for leave to amend its complaint, as the proposed amendments would not have cured the deficiencies in the ERISA claim. View "Grand Traverse Band of Ottawa & Chippewa Indians v. Blue Cross Blue Shield of Michigan" on Justia Law

M.R., an inmate serving a prison sentence for racketeering, experienced significant health issues, including balance problems and difficulty writing. In August 2020, he was diagnosed with a malignant brain tumor and underwent surgery in January 2021. By November 2022, M.R. was wheelchair-bound with residual neurological deficits. In February 2023, M.R. applied for compassionate release under the Compassionate Release Act (CRA). The New Jersey Department of Corrections (DOC) designated two physicians to review his medical records, who provided conflicting diagnoses regarding his terminal condition status. The DOC ultimately denied M.R. a Certificate of Eligibility for compassionate release.M.R. appealed the DOC's decision, and in August 2023, the Appellate Division remanded the case for reevaluation due to the conflicting medical opinions. The physicians provided updated reports, now uniformly concluding that M.R. did not suffer from a terminal condition or permanent physical incapacity, again relying solely on M.R.'s electronic medical records. The DOC reaffirmed its denial of the Certificate of Eligibility. The Appellate Division later affirmed the DOC's decision, concluding that the CRA does not require physical examinations and that the denial was not arbitrary, capricious, or unreasonable.The Supreme Court of New Jersey reviewed the case, focusing on whether the CRA and its implementing regulation require physical examinations for compassionate release applications. The Court held that the CRA does not mandate physical examinations for medical diagnoses. However, the Court found the DOC's decision to deny M.R. a Certificate of Eligibility in August 2023 to be arbitrary, capricious, and unreasonable. The Court emphasized the need for contemporaneous and comprehensive medical evaluations to support such decisions and reversed the Appellate Division's judgment. View "M.R. v. New Jersey Department of Corrections" on Justia Law