Justia Civil Procedure Opinion Summaries

The Government of Puerto Rico sued several pharmaceutical benefit managers (PBMs) and pharmaceutical manufacturers in the Commonwealth of Puerto Rico Court of First Instance. The Commonwealth alleged that the PBMs, including Express Scripts and Caremark, schemed to unlawfully inflate insulin prices through rebate negotiations and price setting. The PBMs removed the case to federal court under 28 U.S.C. § 1442(a)(1), arguing that they acted under federal authority in negotiating rebates and setting drug prices, and that the lawsuit related to their federal service.The United States District Court for the District of Puerto Rico remanded the case back to the Court of First Instance. The district court found that the Commonwealth's disclaimer, which stated that it was not seeking relief related to any federal program or contract, effectively excluded any claims upon which the PBMs could base removal under § 1442(a)(1). The district court concluded that the PBMs could not claim they acted under federal authority for their non-federal PBM services and that dividing the work done for federal and non-federal clients was possible.The United States Court of Appeals for the First Circuit reversed the district court's decision. The appellate court held that the disclaimer did not prevent removal because Caremark's rebate negotiations for federal and non-federal clients were indivisible. The court found that Caremark acted under federal authority when negotiating rebates for FEHBA plans and possessed a colorable federal defense under FEHBA's express preemption provision. The court concluded that the disclaimer did not eliminate the possibility that the Commonwealth would recover for Caremark's official acts, thus justifying removal under § 1442(a)(1). The case was remanded to the district court with instructions to return it to federal court. View "Government of Puerto Rico v. Express Scripts, Inc." on Justia Law

The appellant, a federal prisoner serving a twenty-two-year sentence, has a history of filing numerous lawsuits regarding his prison conditions. In this case, he sought to proceed in forma pauperis (IFP) under the Prison Litigation Reform Act (PLRA) despite having three prior cases dismissed as frivolous, malicious, or for failure to state a claim. He claimed imminent danger of serious physical injury due to worsening glaucoma and alleged that prison officials denied him necessary medical treatment and incited other inmates to assault him.The United States District Court for the District of Columbia denied his motion to proceed IFP, finding that he did not demonstrate imminent danger of serious physical injury. The court dismissed his case without prejudice. The appellant then appealed this decision.The United States Court of Appeals for the District of Columbia Circuit reviewed the case. The court disagreed with the District Court's assessment regarding the appellant's glaucoma, finding that the appellant's allegations of being denied necessary medical treatment for his worsening glaucoma did place him under imminent danger of serious physical injury. Consequently, the court granted the appellant's motion to proceed IFP and reversed the District Court's denial of his motion, allowing his complaint to be docketed.However, the court also found that some of the appellant's claims were frivolous, particularly those against high-ranking officials such as the United States Attorney General and members of the United States Senate Judiciary Committee. These claims were dismissed under the PLRA's mandate to dismiss frivolous claims. The court's decision allowed the appellant to proceed with his claims related to his medical treatment and alleged assaults but dismissed the frivolous claims against the aforementioned officials. View "Owlfeather-Gorbey v. Avery" on Justia Law

Aletha Porcaro was admitted to The Heights of Summerlin, a skilled nursing facility, for rehabilitation after surgery. Upon her discharge, she contracted COVID-19 and died eight days later. Her daughter, Rachelle Crupi, filed a lawsuit against The Heights and its parent companies, alleging that they failed to implement effective COVID-19 safety protocols. The claims included negligence, wrongful death, and other related causes of action.The Heights removed the case to federal court, which remanded it back to state court. In state court, The Heights moved to dismiss the case, arguing that the federal Public Readiness and Emergency Preparedness Act (PREP Act) and Nevada’s Emergency Directive 011 granted them immunity from Crupi’s claims. The district court dismissed the professional negligence claim but allowed the other claims to proceed.The Heights then petitioned the Supreme Court of Nevada for a writ of mandamus, seeking to dismiss the remaining claims based on the same immunity arguments. The Supreme Court of Nevada reviewed the petition and concluded that the PREP Act does not apply to a lack of action or failure to implement COVID-19 policies. The court also determined that Directive 011 does not grant immunity to health care facilities, as it applies to individual medical professionals, not facilities.The Supreme Court of Nevada denied the petition for a writ of mandamus, holding that neither the PREP Act nor Directive 011 provided immunity to The Heights for the claims brought by Crupi. The court affirmed the district court’s decision to allow the remaining claims to proceed. View "The Heights of Summerlin, LLC v. District Court" on Justia Law

The case involves the National Infusion Center Association (NICA) and other plaintiffs challenging the constitutionality of the Drug Price Negotiation Program established by the Inflation Reduction Act. This program requires the Department of Health and Human Services (HHS) to negotiate drug prices with manufacturers, setting a "maximum fair price" between 40% and 75% of the market price. Manufacturers who do not comply face significant fines or must withdraw from Medicare coverage entirely.The United States District Court for the Western District of Texas dismissed NICA's lawsuit for lack of subject-matter jurisdiction. The district court reasoned that NICA's claims had to be "channeled" through HHS as required by 42 U.S.C. § 405, which mandates that claims arising under the Medicare Act be decided by the relevant agency before being brought to federal court. The district court also dismissed the remaining plaintiffs due to improper venue without NICA.The United States Court of Appeals for the Fifth Circuit reviewed the case and found that NICA had standing based on both economic and procedural injuries. The court determined that NICA's claims did not arise under the Medicare Act but rather under the Inflation Reduction Act, and thus did not require channeling through HHS. The court held that the district court had subject-matter jurisdiction over NICA's claims and reversed the lower court's dismissal, remanding the case for further proceedings. View "Natl Infusion Center v. Becerra" on Justia Law

Dignity Health, operating as French Hospital Medical Center, filed a complaint against orthopedic surgeon Troy I. Mounts, M.D., and his corporation to recover an advance paid under their Physician Recruitment Agreement. Mounts filed a cross-complaint alleging retaliation for his complaints about patient care quality, interference with his economic opportunities, and unlawful business practices. Dignity responded with an anti-SLAPP motion to strike the cross-complaint, which the trial court initially denied. The appellate court reversed this decision and remanded the case for further consideration.Upon remand, the trial court concluded that Mounts had not demonstrated a probability of prevailing on his claims. The court found that Dignity's actions were protected by the litigation privilege, the common interest privilege, and were barred by the statute of limitations. Consequently, the court granted Dignity's motion to strike the cross-complaint and ordered Mounts to pay Dignity's attorney fees and costs.The California Court of Appeal, Second Appellate District, Division Six, reviewed the case. The court affirmed the trial court's decision, holding that all of Mounts' claims were based on conduct protected by the litigation privilege (Civil Code § 47, subd. (b)) and the common interest privilege (Civil Code § 47, subd. (c)). The court also found that Dignity's actions were immune under federal law (42 U.S.C. § 11137) and that some claims were barred by the statute of limitations. The appellate court upheld the trial court's orders granting the motion to strike and awarding attorney fees to Dignity. View "Dignity Health v. Mounts" on Justia Law

Elizabeth Holt, a former insurance agent for Medicare Medicaid Advisors, Inc. (MMA), alleged that MMA and several insurance carriers (Aetna, Humana, and UnitedHealthcare) violated the False Claims Act (FCA). Holt claimed that MMA engaged in fraudulent practices, including falsifying agent certifications and violating Medicare marketing regulations, which led to the submission of false claims to the Centers for Medicare and Medicaid Services (CMS).The United States District Court for the Western District of Missouri dismissed Holt's complaint. The court found that no claims were submitted to the government, the alleged regulatory violations were not material to CMS’s contract with the carriers, and the complaint did not meet the particularity standard required by Federal Rule of Civil Procedure 9(b). The court also denied Holt's motion for reconsideration, which introduced a fraudulent inducement theory and requested leave to amend the complaint.The United States Court of Appeals for the Eighth Circuit reviewed the case. The court affirmed the district court's dismissal, agreeing that Holt's allegations did not meet the materiality requirement under the FCA. The court applied the materiality standard from Universal Health Services, Inc. v. United States ex rel. Escobar, considering factors such as whether the government designated compliance as a condition of payment, whether the violations were minor or substantial, and whether the government continued to pay claims despite knowing of the violations. The court found that the alleged violations did not go to the essence of CMS’s contract with the carriers and were not material to the government's payment decisions.The Eighth Circuit also upheld the district court's denial of Holt's motion for reconsideration and request to amend the complaint, concluding that adding a fraudulent inducement claim would be futile given the immateriality of the alleged violations. View "United States ex rel. Holt v. Medicare Medicaid Advisors" on Justia Law

O.L.K. was admitted to Montana State Hospital in January 2022 following a disturbance at a mental health treatment center. The petition for involuntary commitment was based on an evaluation by Michale McLean, LCSW, which included observations and reports from medical staff and law enforcement. O.L.K. had been brought to the hospital twice in one day for aggressive behavior, including threatening his therapist and threatening to burn down the treatment center. During his second hospital visit, he made several threatening statements, including threats to kill someone.The Fourth Judicial District Court, Missoula County, appointed Shannon McNabb, a Licensed Clinical Professional Counselor, to evaluate O.L.K. McNabb testified that O.L.K. exhibited disorganized and delusional behavior and diagnosed him with Bipolar I disorder. She relied on various records, including the St. Patrick’s Report, and testified about O.L.K.’s threats and delusional statements. The District Court overruled hearsay objections raised by O.L.K.’s attorney, admitting the St. Patrick’s Report under the medical records exception. The court found that O.L.K. presented an imminent risk to others and committed him to Montana State Hospital for up to 90 days.The Supreme Court of the State of Montana reviewed the case and affirmed the District Court’s decision. The Supreme Court held that while the District Court erred in admitting the St. Patrick’s Report as a hearsay exception, there was substantial admissible evidence from McNabb’s testimony to support the finding of an overt act. The court concluded that O.L.K.’s statements to McNabb, which included threats to kill someone, were sufficient to demonstrate an imminent threat of injury to others. The decision to commit O.L.K. was therefore upheld. View "In re O.L.K." on Justia Law

In a juvenile wardship proceeding, the minor's counsel declared a doubt about the minor's competency to stand trial. Consequently, the juvenile court suspended the proceedings and referred the minor for a competency evaluation. The court's protocol mandated the disclosure of the minor's mental health records to the court-appointed expert for evaluation. The minor objected, citing the psychotherapist-patient privilege under California Evidence Code section 1014. The court overruled the objection and ordered the disclosure, prompting the minor to file a writ petition challenging this decision.The Contra Costa County Superior Court overruled the minor's objection, stating that Welfare and Institutions Code section 709 permits the compelled disclosure of all available records, including mental health records, for competency evaluations. The court also referenced Evidence Code section 1025, which it interpreted as allowing such disclosures in competency proceedings. The minor's request for a stay to seek appellate review was denied, leading to the filing of the writ petition.The California Court of Appeal, First Appellate District, reviewed the case. The court held that Evidence Code section 1016 renders the psychotherapist-patient privilege inapplicable in juvenile competency proceedings once the minor's counsel declares a doubt about the minor's competency. The court reasoned that the issue of the minor's mental or emotional condition is tendered by the minor through their counsel, thus falling under the patient-litigant exception to the privilege. The court denied the minor's writ petition and dissolved the partial stay of the juvenile court's order. View "T.M. v. Superior Court" on Justia Law

The plaintiffs, Medicare beneficiaries with chronic illnesses, rely on home health aides for essential care. They allege that Medicare-enrolled providers have either refused to provide in-home care or offered fewer services than entitled, attributing this to the policies of the Secretary of Health and Human Services. They sought systemwide reforms through a lawsuit.The United States District Court for the District of Columbia dismissed the plaintiffs' complaint for lack of Article III standing. The court found that the plaintiffs failed to plausibly allege that their requested relief would redress any harm. The court noted that the injuries were caused by private home health agencies (HHAs) not before the court and that it was speculative whether enjoining the Secretary would change the HHAs' behavior. The court also found the plaintiffs' requested relief too general, making it difficult to evaluate its potential impact.The United States Court of Appeals for the District of Columbia Circuit reviewed the case and affirmed the district court's dismissal. The appellate court held that the plaintiffs failed to demonstrate redressability, a key component of standing. The court noted that the plaintiffs' injuries stemmed from the independent choices of private HHAs, and it was speculative that the requested injunctions would prompt these agencies to change their behavior. The court emphasized that the plaintiffs did not provide sufficient evidence to show that the Secretary's enforcement policies were a substantial factor in the HHAs' decisions. Consequently, the plaintiffs lacked standing to bring the suit, and the dismissal for lack of jurisdiction was affirmed. View "Johnson v. Becerra" on Justia Law

Eva Mae Givens applied for Medicaid assistance in Washington, D.C., but the District miscalculated her copay, requiring her to pay an extra $2,000 per month. Givens requested an administrative hearing to contest the miscalculation, but D.C. did not provide a timely hearing as required by federal law. Givens then filed a lawsuit under 42 U.S.C. § 1983, seeking injunctive and declaratory relief for a fair hearing and monetary damages for the overpayments. While the case was pending, D.C. held a hearing, corrected the miscalculation, and sent back-payments to the nursing homes, but not to Givens. Givens passed away shortly after the hearing.The United States District Court for the District of Columbia dismissed the case with prejudice, ruling that the claims were moot because D.C. had provided the hearing and corrected the miscalculation. The court also held that Givens failed to state a claim for relief. Givens' children, who sought to be substituted as plaintiffs, appealed the decision.The United States Court of Appeals for the District of Columbia Circuit reviewed the case. The court affirmed the dismissal of the fair-hearing claims as moot but noted that the dismissal should have been without prejudice. The court found that the calculation claim was not moot because Givens had not received compensation for the overpayments she made. However, the court held that the calculation claim failed to plausibly allege a violation of federal rights under § 1983, as Givens did not identify a specific municipal policy or custom that caused the miscalculation.The appellate court vacated the district court's order dismissing the case with prejudice and remanded the case. The district court was instructed to dismiss the moot fair-hearing claims without prejudice and to either dismiss the calculation claim without prejudice or provide a detailed explanation for a dismissal with prejudice. View "Givens v. Bowser" on Justia Law