Justia Health Law Opinion Summaries

Before the South Carolina Supreme Court in this appeal was the trial court's dismissal of respondent Jeanne Beverly's claims pursuant to Rule 12(b)(6) of the South Carolina Rules of Civil Procedure. Beverly brought claims against Grand Strand Regional Medical Center, LLC. Blue Cross Blue Shield of South Carolina (BCBS) was a mutual insurance company that provided health insurance coverage through Member Benefits Contracts to its Members. Beverly was a BCBS Member. In 2005, Grand Strand and BCBS entered into a contract labeled "Institutional Agreement." The Institutional Agreement contained a clause entitled, "No Third Party Beneficiaries," that provided in part, "This Agreement is not intended to, and shall not be construed to, make any person or entity a third party beneficiary." Grand Strand and BCBS were the only parties to the Institutional Agreement. Grand Strand made two promises to BCBS in the Institutional Agreement that Beverly contended created rights she and other BCBS Members could enforce. Beverly was injured in an automobile accident on September 6, 2012. The same day, she received health care services at a Grand Strand emergency room for injuries she sustained in the accident. Beverly alleges she provided Grand Strand proof of her status as a BCBS Member. Some time later, Beverly received a bill directly from Grand Strand for $8,000. Beverly alleges the $8,000 bill does not reflect the discount Grand Strand promised in the Institutional Agreement. Beverly filed this action on behalf of herself and a class of similarly situated BCBS Members who were denied the right to have their bills processed and discounted according to Grand Strand's promises in the Institutional Agreement. The primary question before the Supreme Court was whether the "no beneficiary" clause in the Institutional Agreement overrode an otherwise manifestly clear purpose of the contracting parties to provide a direct benefit to non-contracting parties. "Mindful that we are reviewing a Rule 12(b)(6) dismissal order—not an order on the merits—we hold it does not." The Supreme Court affirmed the court of appeals' opinion reversing the 12(b)(6) dismissal. The case was remanded to circuit court for discovery and trial. View "Beverly v. Grand Strand Regional Medical Center, LLC" on Justia Law

Relatives of Saldana, who died from COVID-19 at Glenhaven nursing home, sued Glenhaven in California state court, alleging state-law causes of action. Glenhaven removed the case to federal court. The Ninth Circuit affirmed a remand to state court,The district court lacked jurisdiction under the federal officer removal statute, 28 U.S.C. 1442, because Glenhaven did not act under a federal officer or agency’s directions when it complied with mandatory directives from the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and the Department of Health and Human Services.The claims were not completely preempted by the Public Readiness and Emergency Preparedness Act, which provides immunity from suit when the HHS Secretary determines that a threat to health constitutes a public health emergency, but provides an exception for an exclusive federal cause of action for willful misconduct. A March 2020 declaration under the Act provided "liability immunity for activities related to medical countermeasures against COVID-19.” The Act does not displace non-willful misconduct claims related to the public health emergency, nor did it provide substitute causes of action. The federal scheme was not so comprehensive that it entirely supplanted state law claims.The district court did not have jurisdiction under the embedded federal question doctrine, which applies if a federal issue is necessarily raised, actually disputed, substantial, and capable of resolution in federal court without disrupting the federal-state balance approved by Congress. View "Saldana v. Glenhaven Healthcare LLC" on Justia Law

The Supreme Court affirmed the judgment of the district court granting the governor's request to dismiss this lawsuit challenging the Governor's August 2020 public health disaster proclamation that temporarily required taverns and bars in six counties to close, holding that this case was moot.Six establishments brought this action seeking an injunction that would block the order of Governor Kimberly K. Reynolds, which was issued during the COVID-19 pandemic, on the grounds that it exceeded her statutory and constitutional authority. After the Governor rescinded her order, the district court granted the Governor's request to dismiss the lawsuit as moot. The Supreme Court affirmed, holding that this case was moot and that no mootness exception applied. View "Riley Drive Entertainment I, Inc. v. Reynolds" on Justia Law

Tiwari and Sapkota sought to establish a home healthcare company that would focus on serving Nepali-speaking individuals in the Louisville area. Kentucky restricts the number of such companies that may serve each county. When the Commonwealth denied their certificate-of-need application, Tiwari and Sapkota filed suit, claiming that the regulation violates their Fourteenth Amendment right to earn a living, serving only the illegitimate end of protecting incumbent home healthcare companies from competition, and lacking a rational basis.The Sixth Circuit affirmed summary judgment, upholding the requirement. Economic regulations, even those affecting an individual’s liberty to work in a given area, are subject to “rational basis” review. While expressing skepticism about certificate-of-need laws, the court concluded that a legislator could plausibly believe that the regulation has a rational connection to increasing cost efficiency, improving quality of care, and improving the healthcare infrastructure in place. View "Tiwari v. Friedlander" on Justia Law

The Supreme Court affirmed the judgment of the circuit court denying the petition for a permanent writ of prohibition filed by the Missouri Department of Health and Senior Services, holding that the circuit court did not err in denying the writ.After the Department denied the applications filed by Kings Garden Midwest LLC seeking two medical marijuana cultivation facility licenses Kings Garden requested that the Department provide complete and unreacted copies of successful cultivation license applications in discovery. The administrative hearing commission (AHC) granted the motion to compel. The Department filed a petition for a writ of prohibition seeking to bar enforcement of the AHC's order. The circuit court denied the writ. The Supreme Court affirmed, holding that because the plain language of allows confidential information to be used for purposes of appealing the Department's decision to deny a license, the AHC did not err in sustaining Kings Garden's motion to compel. View "State ex rel. Department of Health & Senior Services v. Slusher" on Justia Law

The Supreme Court affirmed the judgment of the trial court in favor of Defendants in this action alleging that Boston Scientific Corporation's sale of its Obtryx Transobturator Mid-Urethral Sling System (Obtryx) violated the Connecticut Product Liability Act, Conn. Gen. Stat. 52-572m et seq., holding that there was no error.The named plaintiff alleged that the Obtryx, a transvaginal mesh sling implanted in women to treat stress urinary incontinence, injured her in various ways after it was implanted in her. Plaintiffs brought claims against Boston Scientific and the named plaintiff's gynecologist and medical practice, alleging violations of the Act, negligence sounding in informed consent, and misrepresentation. The trial court granted the medical defendants' motion for summary judgment. The case proceeded to trial against Boston Scientific, and the jury returned a verdict in its favor. The Supreme Court affirmed, holding that the trial court (1) did not err in granting summary judgment for the medical defendants on the informed consent and misrepresentation claims; and (2) properly declined to instruct the jury on the reasonable alternative design prong of the risk-utility test. View "Fajardo v. Boston Scientific Corp." on Justia Law

Respondent, C.R. (ward) appealed a circuit court order appointing a guardian over her person, arguing that petitioner New Hampshire Hospital (NHH) failed to prove beyond a reasonable doubt that she was incapacitated. She also argued the trial court’s findings of incapacity exceeded the scope of the pleadings and evidence at trial, thereby depriving her of notice and an opportunity to be heard. The ward suffered from schizoaffective disorder, and, in November 2020, was involuntarily admitted to NHH for a two-year period. NHH obtained emergency treatment authorization to provide the ward with psychiatric medication without her consent, and although her condition improved, the medication caused side effects that required a reduction in dosage. The ward declined to take any medication to treat the side effects or any alternative medication that would not cause the side effects. The emergency treatment authorization expired on January 4, 2021. In the two weeks before the February 2021 guardianship proceeding, the ward started exhibiting worsening thoughts that people were trying to target her, and her mood fluctuated more, spurring concerns that the current medication was insufficient. NHH filed the guardianship petition at issue here, alleging that, the guardianship was necessary. The New Hampshire Supreme Court concluded the evidence presented at trial was sufficient for the trial court to have found the ward “is likely to suffer substantial harm due to an inability to provide for [her] personal needs for food, clothing, shelter, health care or safety or an inability to manage . . . her property or financial affairs.” Further, the Court found there was support in the record for the trial court's finding that guardianship was the least restrictive intervention for the ward. The Court found that the guardianship petition informed the ward the trial court could “impose additional orders as a result of the hearing,” but it did not inform her that NHH was asking the court to find her incapable of exercising her rights to marry or divorce, make a will or waive a will’s provisions, hold or obtain a motor vehicle operator’s license, initiate/defend/settle lawsuits, or make decisions concerning educational matters or training. Under these circumstances, the Supreme Court held that the ward did not receive the notice contemplated by RSA 464-A:5, I, as to those rights. Therefore, the Court vacated the guardianship order to the extent that it deprived her of those rights. The Court otherwise affirmed the order appointing a guardian over the person of the ward and remanded. View "In re Guardianship of C.R." on Justia Law

Appellant Dameron Hospital Association (Dameron) required patients or their family members to sign Conditions of Admissions (COAs) when Dameron provided the patients’ medical care. The COAs at issue in this case contained language that assigned to Dameron direct payment of uninsured and underinsured motorist (UM) benefits and medical payment (MP) benefits that would otherwise be payable to those patients under their automobile insurance policies. Dameron treated five of California State Automobile Association Inter-Insurance Bureau's ("CSAA") insureds for injuries following automobile accidents. Those patients had UM and/or MP coverage as part of their CSAA coverage, and Dameron sought to collect payment for those services from the patients’ UM and/or MP benefits at Dameron’s full rates. Instead of paying to Dameron the lesser of either all benefits due to the patients under their UM and MP coverage, or Dameron’s full charges, CSAA paid portions of those benefits directly to the patients which left balances owing on some of Dameron’s bills. Dameron sued CSAA to collect UM and MP benefits it contended CSAA owed Dameron under the assignments contained in the COAs. The trial court concluded that Dameron could not enforce any of the assignments contained in the COAs and entered judgment in CSAA’s favor following CSAA’s successful motion for summary judgment. The Court of Appeal held Dameron could not collect payment for emergency services from the UM or MP benefits due to patients that were covered under health insurance policies. Further, the Court held: (1) the COA forms were contracts of adhesion; (2) it was not within the reasonable possible expectations of patients that a hospital would collect payments for emergency care directly out of their UM benefits; and (3) a trier of fact might find it was within the reasonable expectations of patients that a hospital would collect payments for emergency care directly out of their MP benefits. Accordingly, the Court concluded Dameron could not maintain causes of action to collect MP or UM benefits due to four of the five patients directly from CSAA. However, consistent with this opinion, the trial court could consider whether an enforceable assignment of MP benefits was made by one adult patient. View "Dameron Hospital Assn. v. AAA Northern Cal. etc." on Justia Law

Prior to her death, Eyvon Ambrose (decedent) had become entirely dependent upon others for her basic care needs. Defendants Oroville Hospital d/b/a Golden Valley Home Health and Oroville Hospital, agreed to provide decedent in-home nursing services for wound care for a pressure injury to her left ischium or buttock. Defendants provided such in-home wound care on six occasions in July 2015 and four additional occasions in October 2015. According to real parties in interest (plaintiffs), decedent’s wound worsened, she sustained additional wounds, she was hospitalized, and she ultimately died from her wound and complications. Plaintiffs filed the underlying actions against defendants alleging a number of causes of action. Defendant’s writ petition and arguments related solely to plaintiff’s cause of action to recover under the Elder Abuse and Dependent Adult Civil Protection Act for defendants’ alleged neglect which, they asserted, was committed with recklessness, oppression, fraud, or malice. Therefore, plaintiffs asserted entitlement to enhanced remedies under the Elder Abuse Act. They sought no other relief in their petition. Defendants moved for summary judgment or, in the alternative, summary adjudication, asserting they did not have a substantial caretaking or custodial relationship with the decedent, a prerequisite for recovery for neglect under the Elder Abuse Act. They further asserted that a reasonable jury could not find them guilty of forms of abuse or neglect rising to the level of recklessness. The trial court denied defendants’ motion. To the Court of Appeal, Defendants sought a preemptory writ of mandate directing the trial court to vacate its denial of their motion for summary adjudication and to grant the motion. The Court concluded that, in opposition to defendants’ prima facie showing of entitlement to summary adjudication on plaintiffs’ Elder Abuse Cause of action based on the absence of a substantial caretaking or custodial relationship, plaintiffs failed to raise a triable issue of material fact. The Court therefore issued the requested writ. View "Oroville Hospital v. Superior Court" on Justia Law

Class members are Medicare Part A beneficiaries who are formally admitted to a hospital as "inpatients" before their subsequent reclassification as outpatients receiving "observation services." Plaintiffs filed suit alleging that the Secretary violated their due process rights by declining to provide them with an administrative review process for the reclassification decision. The district court entered an injunction ordering the creation of such a process.The Second Circuit affirmed, concluding that the named plaintiff had standing by demonstrating that they suffered a financial injury as a result of being reclassified as receiving observations services; the failure of the Secretary to provide an appeals process for the reclassification decision implicates the same set of concerns—namely, a loss of Part A coverage—for both the named plaintiffs and the absent class members; and the litigation incentives are sufficiently aligned so that the named plaintiffs can properly assert claims on behalf of those class members who will be hospitalized in the future. The court also concluded that the district court properly certified the plaintiff class and that the class satisfies the commonality and typicality requirements. Furthermore, the plaintiff class was properly certified under Federal Rule of Civil Procedure 23(b)(2).The court concluded that the district court did not clearly err by finding that plaintiffs' due process rights are violated by the current administrative procedures available to Medicare beneficiaries. In this case, plaintiffs have demonstrated that the Secretary violates their due process rights when utilization review committees reclassify them from inpatients to those receiving observation services without providing a mechanism to appeal that decision. View "Barrows v. Becerra" on Justia Law