Justia Health Law Opinion Summaries

D&G, a Medicare service provider for nursing homes and homebound individuals, filed suit against the H.H.S. Secretary in federal court seeking repayment of recouped funds, which then amounted to $4,136,258.19 in principal and $593,294.54 in accrued interest. The district court dismissed D&G's case for lack of subject matter jurisdiction, holding that there was no federal court jurisdiction pursuant to 42 U.S.C. 405(g), as applied to Medicare appeals by 42 U.S.C. 1395ff(b)(1)(A).The Fifth Circuit held that "effectuations" of final agency decisions when sought to liquidate the amount of repayment owed, are reviewable under 42 U.S.C. 405(g) as continuous aspects of the initial, properly exhausted, administrative decision. The court concluded that the district court had jurisdiction under section 405(g) to resolve this dispute because "effectuations" are inextricably intertwined with the initial exhausted agency action. Therefore, the district court committed reversible error when it granted the Secretary' motion to dismiss. Furthermore, the Secretary's attempted reopening of the "effectuation" was untimely and the purported reopening was void ab initio. The court reversed and remanded for further proceedings. View "D&G Holdings, LLC v. Becerra" on Justia Law

Pacheco received Depo-Provera injections from NeighborCare, a federally-qualified community health center. Depo-Provera is a highly effective contraceptive that requires injections every 11-13 weeks. Pacheco visited NeigborCare in September 2011, for an “on-time” injection. A NeighborCare employee instead injected Pacheco with a flu vaccine. Pacheco alleges that she did not consent to a flu shot and did not learn that she received a flu shot instead of her scheduled injection until she called NeighborCare for her next injection. Pacheco's child, S.L.P., was born with epilepsy and bilateral perisylvian polymicrogyria, which contributes to neurological delays.The district court found that Rodriguez failed to meet the minimum standard of care and that the unwanted pregnancy, birth, and medical expenses associated with S.L.P.'s condition were foreseeable consequences caused by the negligence and awarded $10,042,294.81.The Ninth Circuit noted that the negligently performed procedure here was not “intended to prevent the birth of a defective child,” but to “prevent the birth of an unwanted child,” so this case lies outside the duty imposed on healthcare providers to assume responsibility when they encumber parents’ rights by failing to adequately complete procedures to prevent the births of defective children. The court certified the question to the Washington Supreme Court: Under claims for wrongful birth or wrongful life, does Washington law allow extraordinary damages for costs associated with raising a child with birth defects when defendants negligently provided contraceptive care even though plaintiffs did not seek contraceptives to prevent conceiving a child later born with birth defects? View "Pacheco v. United States" on Justia Law

A man with severe mental illness stabbed his parents during a psychotic episode and was subsequently committed to a psychiatric hospital. He appealed that commitment order. Before the commitment hearing, he stopped taking prescribed medications, leading hospital staff to petition for permission to administer medication involuntarily. The court granted the medication petition as well as a revised petition requesting a higher dose. He also appealed the order authorizing involuntary administration of medication. Finding the superior court did not err in its finding there was no less restrictive alternative to confinement, or that the court did not err petitioner lacked capacity to give or withhold consent to psychotropic medication, the Alaska Supreme Court affirmed both orders. View "In the Matter of the Necessity for the Hospitalization of: Mark V." on Justia Law

In this qui tam action, after the jury found that Pinellas violated the False Claims Act and that the United States sustained damages, the district court trebled the damages and imposed statutory minimum penalties of $1,177,000 ($5,500 for each of the 214 violations).The Eleventh Circuit affirmed in part and reversed in part. The court upheld the district court's admission of Exhibit 24 where Pinellas failed to argue that the admission of the evidence constituted plain error. The court concluded that there was sufficient evidence for the jury to have found that, had Medicare known of Pinellas's misrepresentations, it would not have paid the refiled reimbursement claims. Furthermore, viewed in the light most favorable to the verdict, the evidence on scienter is not overwhelmingly in favor of Pinellas. Therefore, the jury's decision stands. The court also upheld the jury's findings on damages where the court concluded that the proper measure of damages in this case is the difference between what the United States paid and what it would have paid had Pinellas' claims been truthful. The court rejected the remaining challenges to the jury's verdict. The court further concluded that the monetary award imposed does not violate the Excessive Fines Clause. Finally, the court dismissed Pinellas' appeal as to the allocation of the monetary award between Ms. Yates and the United States. View "Yates v. Pinellas Hematology & Oncology, P.A." on Justia Law

The Pennsylvania Supreme Court granted expedited review of this direct appeal to decide whether the Commonwealth Court erred in concluding that Acting Secretary of Health Alison Beam (“the Secretary”) lacked the power under existing law and Department of Health regulations to require individuals to wear facial coverings while inside Pennsylvania’s schools as a means of controlling the spread of COVID-19. Having determined that the Secretary exceeded her authority in issuing that directive, by per curiam order on December 10, 2021, the Court affirmed the lower court’s decision nullifying the mandate, and published this opinion expounding on its reasoning. View "Corman, J., et al. v. Beam" on Justia Law

In late 2015, decedent Cody Albert (“Cody”) and his childhood friend, Zachary Ross (“Zachary”) struggled with substance abuse issues. At that time, Zachary’s mother, April Kravchenko, was suffering from multiple myeloma for which her doctors prescribed her several opiate pain medications, which she filled at a small, independent pharmacy in Scranton called Sheeley’s Drug Store. Kravchenko and her sister Debra Leggieri worried Zachary would try to pick up (and use) Kravchenko’s pain medication from Sheeley’s while Kravchenko was in the hospital. To prevent this, Leggieri called Sheeley’s and placed a restriction on who could pick up Kravchenko’s prescriptions. Zachary called Sheeley’s one day pretending to be his mother, and asked about refilling her OxyContin prescription. Donato Iannielli, owner-pharmacist Lori Hart’s father, and the prior owner of Sheeley’s, was the pharmacist on-duty at the time, and told “Kravchenko” that her OxyContin prescription could not be filled yet, but that she had a prescription for fentanyl patches ready to be picked up. “Kravchenko” told Iannielli that she wanted to send her son to pick up the patches, but stated that he did not have a driver’s license or other form of identification. Iannielli told the caller that this would not be a problem, since he personally knew and would recognize Zachary. Cody then drove Zachary to Sheeley’s, where Zachary picked up Kravchenko’s medication even though, according to Zachary, the pharmacy receipt explicitly stated, “[d]o not give to son.” On the drive back to Zachary’s house, Cody at some point consumed fentanyl from one of the patches, smoked marijuana, and then fell asleep on the once inside the house. Later that night, Zachary tried to wake Cody up, but he was unresponsive. Cody was later pronounced dead at a hospital. Zachary eventually pleaded guilty to involuntary manslaughter and multiple drug offenses in connection with Cody’s overdose. The question in this appeal was whether claims brought against the pharmacy on behalf of the decedent who overdosed on illegally obtained prescription drugs was barred by the doctrine of in pari delicto. Because the Pennsylvania Supreme Court concluded that the trial court correctly applied the in pari delicto doctrine, judgment was affirmed. View "Albert v. Sheeley's Drug Store, et al." on Justia Law

The Bureau of Workers’ Compensation Fee Review Hearing Office (“Hearing Office”) concluded that, in the fee review setting, a non-treating healthcare provider, like a pharmacy, could not challenge a utilization review (“UR”) determination that medications prescribed by a treating healthcare provider, such as a physician, but dispensed by the non-treating entity, were unreasonable and unnecessary for the treatment of a claimant’s work-related injury. The Commonwealth Court affirmed the Hearing Office’s order. However, after reaching this result, the intermediate court held that for UR procedures occurring in the future, when an employer, insurer or an employee requests UR, non-treating providers, such as pharmacies, had to be afforded notice and an opportunity to establish their right to intervene in the UR proceedings. While the Pennsylvania Supreme Court affirmed the Commonwealth Court’s result, it rejected its prospective holding that non-treating healthcare providers had to be given notice and an opportunity to intervene in UR proceedings. View "Keystone Rx v. Bureau. of Workers' Compensation" on Justia Law

In November 2021, 5he Occupational Safety and Health Administration (OSHA), the federal agency tasked with assuring a safe and healthful workplace, issued an Emergency Rule on COVID-19 Vaccination and Testing, 86 Fed. Reg. 61402. The rule does not require anyone to be vaccinated but allows covered employers—employers with 100 or more employees—to determine for themselves how best to minimize the risk of contracting COVID-19 in their workplaces. Employers may require unvaccinated workers to wear a mask on the job and test for COVID-19 weekly; they can require workers to do their jobs exclusively from home. Workers who work exclusively outdoors are exempt. The next day, the Fifth Circuit stayed the rule pending judicial review; it renewed that decision in an opinion issued on November 12. Under 28 U.S.C. 2112(a)(3), petitions challenging the rule, filed in Circuits across the nation, were consolidated into the Sixth Circuit, which dissolved the stay issued by the Fifth Circuit. The language of its enabling act plainly authorizes OSHA to act on its charge “to assure safe and healthful working conditions for the nation’s workforce and to preserve the nation’s human resources.” OSHA’s issuance of the rule is not a transformative expansion of its regulatory power, The factors regarding irreparable injury weigh in favor of the government and the public interest. View "In re: MCP No. 165, Occupational Safety and Health Admin., Interim Final Rule: COVID19 Vaccination and Testing, 86 Fed. Reg. 61402" on Justia Law

Joanne R., a conservatee subject to a conservatorship under the Lanterman-Petris-Short (LPS) Act, contends that the trial court provided her an inadequate jury trial waiver advisement and improperly induced her to waive her right to a jury trial by stating she could either have a court trial that day or a jury trial nine months later.The Court of Appeal concluded that, although it is concerned by the delay in providing conservatees jury trials during the COVID-19 pandemic, there was no violation of Joanne's statutory right to a jury trial. However, the court cautioned the superior court that a nine-month delay for a conservatee to have a jury trial where the conservatorship would otherwise end in a year, absent a health emergency, raises serious constitutional concerns in light of the significant liberty interests at stake. The court urged the superior court to dedicate the necessary additional resources to LPS jury trials so that conservatees may exercise their right to a jury trial in a timely manner. The court noted that failure to do so likely violates a conservatee's constitutional right to due process. View "Stusser v. Joanne R." on Justia Law

The Court of Appeals held that an administrative law judge (ALJ) with the Maryland Office of Administrative Hearings erred in declining Petitioner's request to be represented by counsel at an administrative hearing regarding the approval to give Petitioner forced medication, holding that the ALJ erred.Petitioner, a patient at a psychiatric institution, refused to take prescribed psychotropic medication. After a panel approved forced medication, Petitioner requested a hearing. On the day of the hearing, Petitioner asked for counsel. The ALJ treated the request for counsel as a request for a postponement, concluding that there was not good cause to postpone the hearing, and convened the hearing with Petitioner unrepresented. The Court of Appeals reversed, holding (1) under the plain language of HG 10-708 an individual possesses a right to counsel upon request; (2) an on-the-record waiver colloquy of the kind required in a criminal case is unnecessary, but there must be verification that the individual has knowingly and voluntarily waived the right to counsel and elected to proceed without representation; and (3) the ALJ erred in declining Petitioner's request to be presented by counsel at the administrative hearing. View "Mercer v. Thomas B. Finan Center" on Justia Law