Justia Civil Procedure Opinion Summaries

The Supreme Court held that because Plaintiff's state-law claims were based on allegations that his father's health maintenance organization (HMO) plan and healthcare services administrator that managed his father's benefits (collectively, Defendants) breached state-law duties that incorporated and duplicated standards established under Medicare Part C, Part C's preemption provision preempted them.Plaintiff brought this action alleging a state statutory claim under the Elder Abuse Act and common law claims of negligence and wrongful death for the alleged maltreatment of his father, a Medicare Advantage (MA) enrollee who died after being discharged from a skilled nursing facility. Plaintiff alleged that the MA HMO and healthcare services administrator breached a duty to ensure his father received skilled nursing benefits to which he was entitled under his MA plan. Defendants demurred, arguing that the claims were preempted by Part C's preemption provision. The trial court sustained the demurrers, and the court of appeal affirmed. The Supreme Court affirmed, holding that because Plaintiff's state-law claims were based on allegations that Defendants breached state-law duties that incorporate and duplicate standards established under Part C, the claims were expressly preempted. View "Quishenberry v. UnitedHealthcare, Inc." on Justia Law

In 2014, decedent Aaron Martineau, age 28, arrived at the McKenzie-Willamette Hospital emergency room, complaining of sudden onset chest pain, shortness of breath, and other symptoms. He was seen by a physician assistant and by a physician, defendant Gary Josephsen, M.D.; both worked for defendant Doctor’s Emergency Room Corporation, P.C. (collectively, the ER defendants). Defendants did not adequately review the x-ray or refer decedent for further imaging or other tests to rule out or confirm the presence of serious cardiovascular or cardiopulmonary conditions. Instead, they diagnosed him with noncardiac chest pain and discharged him from the hospital. Approximately 24 hours after being discharged, decedent died from an aortic dissection in his heart. In this wrongful death action, two issues were presented for the Oregon Supreme Court's review: (1) whether the trial court erred when it instructed the jury that physicians “are not negligent merely because their efforts were unsuccessful” and that a physician “does not guarantee a good result by undertaking to perform a service;” and (2) whether plaintiff had alleged a lost chance claim under Oregon’s survival statute, ORS 30.075, that was separately cognizable from her wrongful death claim under ORS 30.020. The trial court dismissed plaintiff’s lost chance claim before trial. Later, when submitting the wrongful death claim to the jury at the close of trial, the court included the challenged instruction—which was taken from Uniform Civil Jury Instruction (UCJI) 44.03 at defendants’ request—in its instructions to the jury. After the jury returned a verdict in defendants’ favor, plaintiff appealed, and the Court of Appeals reversed, concluding the trial court had erred in dismissing plaintiff’s lost chance claim and by including UCJI 44.03 in the jury instructions. After its review, the Supreme Court concluded plaintiff did not allege a lost chance claim that was cognizable under Oregon law, and, further, the trial court did not err when it included UCJI 44.03 in the jury instructions. The Court therefore reversed the Court of Appeals and affirmed the trial court. View "Martineau v. McKenzie-Willamette Medical Center" on Justia Law

Third-Party Plaintiff Dynasty Healthcare, LLC, a medical billing firm, claimed that a Medicare Administrative Contractor (“MAC”) negligently processed and misclassified the enrollment and payment application of one of Dynasty’s clients, a medical services supplier, and that. As a result, the client was underpaid for providing Medicare services. When the client sued Dynasty for the error, Dynasty sued the MAC, blaming it for the error. The district court dismissed Dynasty’s claims for lack of subject matter jurisdiction because Dynasty failed to pursue administrative channels through the United  States Department of Health and Human Services before seeking judicial review. At issue on appeal is whether Dynasty’s claims “arise under” the Medicare Act, such that the administrative channeling requirement set forth in 42 U.S.C. 14 Section 405(h) applies; and second, if so, whether the district court nonetheless had jurisdiction based on a narrow exception to the  Medicare Act’s jurisdiction stripping provision recognized in Shalala v. Illinois Council on Long Term Care, Inc.   The Second Circuit affirmed. The court concluded that the claims arise under the Medicare Act and that the Illinois Council exception does not apply to these claims. The court explained that Dynasty is not entitled to the exception because Retina’s financial interests in the claims alleged in this case were aligned with Dynasty’s interests at all relevant times, and Retina had both the incentive and the ability to seek administrative review. That Retina pursued a different course is irrelevant to the court's analysis under Illinois Council’s “objective inquiry.” View "Dynasty Healthcare, LLC v. Nat'l Gov't Services, Inc." on Justia Law

In the winter of 2020, the Secretary of Health and Human Services (HHS) determined that the threat posed by the novel SARS-CoV-2 virus constituted a public health emergency. The CDC published the rule at issue—the Requirement for Persons to Wear Masks While on Conveyances and at Transportation Hubs, 86 Fed. Reg. 8025-01 (Feb. 3, 2021) (“Mandate”). Plaintiffs initiated this litigation, arguing that the Mandate was unlawful under the Administrative Procedure Act, 5 USC Section 706(2) (APA), and unconstitutional under non-delegation and separation-of-powers tenets.   The Eleventh Circuit vacated the district court’s judgment and instructed the district court to dismiss the case as moot. The court explained that it found Plaintiffs’ contention that there is a reasonable expectation that the CDC will issue another nationwide mask mandate for all conveyances and transportation hubs to be speculative. Conjectures of future harms like these do not establish a reasonable expectation that a mask mandate from the CDC will reissue. Further, the court reasoned that there is no “reasonable expectation or a demonstrated probability that the same controversy will recur involving the same complaining party.” View "Health Freedom Defense Fund, et al v. President of the United States, et al" on Justia Law

Plaintiff (and IVYR PLLC, doing business as Par Retina) sued Wolfe Clinic, P.C. (and three of its owner-physicians). Plaintiff alleged that the Clinic monopolized or attempted to monopolize the vitreoretinal care market. On the merits, the district court initially dismissed the monopolization, fraudulent inducement, and recission claims while remanding the remaining state law claims. In an amended judgment, the district court denied Plaintiff’s motion to amend the complaint and affirmed the dismissal of the monopolization claims, but declined to exercise supplemental jurisdiction, dismissing all state law claims.   The Eighth Circuit affirmed. The court held that the district court did not abuse its discretion by denying Plaintiff’s motion to amend the complaint. The information in the amended complaint was previously available to Plaintiff and should have been pleaded before the judgment was entered. Plaintiff was on notice of the deficiencies in his complaint when the Clinic filed its motion to dismiss. Despite this, Plaintiff inexcusably delayed filing the Rule 59(e) motion—waiting over five months after the motion to dismiss was filed and almost a month after the district court dismissed the complaint. The court ultimately held that Plaintiff failed to plead a plausible claim for monopolization or attempted monopolization because he did not allege a relevant geographic market. View "George Par v. Wolfe Clinic, P.C." on Justia Law

Eight South Florida hospitals dutifully provided out-of-network emergency treatment to numerous Cigna customers. When Cigna reimbursed the hospitals just 15% of what they had charged, the hospitals sued, accusing Cigna of paying less than the “community” rate. As proof, the hospitals showed that they normally receive five times as much for the care they provided here. In response, Cigna asserted that the hospitals’ data proved nothing because, it insisted, the relevant “community” necessarily includes more than just the eight plaintiff hospitals. The district court agreed and granted Cigna summary judgment.   The Eleventh Circuit reversed. The court explained that even if the relevant “community” here extends beyond the eight plaintiff hospitals, their receipts alone are enough to create a genuine factual dispute about what the “community” rates are. The court reasoned that to survive summary judgment, a plaintiff needn’t present evidence that compels a single, airtight inference—just evidence that allows a reasonable one. The court explained that the way to rebut an inference allegedly skewed by limited data is to add data. And Cigna can do just that—at trial. If it can show there that most other providers in the “community” charge less than the plaintiff hospitals do, then it may well debunk the hospitals’ estimate. But unless and until that happens, it remains the case that a reasonable jury could conclude that the eight plaintiff hospitals’ rates reflect the prevailing community rate—and thus that Cigna shortchanged them. View "North Shore Medical Center, Inc., et al v. Cigna Health and Life Insurance Company" on Justia Law

The Federally Supported Health Centers Assistance Act (“FSHCAA”) provides that health centers receiving funding under Section 330 of the Public Health Service Act (“PHSA”) may be deemed Public Health Service (“PHS”) employees. Plaintiffs alleged that Defendants violated their duty to report a court-ordered Lane County Mental Health patient’s refusal to comply with the terms of his probation. Plaintiffs alleged they were injured as a result of Defendants’ failure to report a patient’s repeated failures to comply with his mental health treatment plan. Defendants contended that they were entitled to Section 233 immunity. The district court held that Section 233 immunity did not apply to Defendants and remanded to state court.   The Ninth Circuit reversed the district court’s order remanding to state court Plaintiffs’ action alleging negligence and wrongful death claims against federally funded community health centers and their employees (“Defendants”), and remanded to the district court to enter an order substituting the United States as the defendant and deeming the action as one brought under the Federal Tort Claims Act. The panel first addressed whether there was jurisdiction to review the district court’s remand order. Ordinarily, a remand order is not reviewable on appeal, except for cases removed pursuant to 28 U.S.C. Section 1442. The panel agreed with Defendants that Section 233 immunity did not turn on who brings the claim, but rather on whether the conduct giving rose to the claim arose out of the Defendants’ performance of “medical, surgical, dental or related functions.” View "SAM FRIEDENBERG, ET AL V. LANE COUNTY, ET AL" on Justia Law

Middle schooler A.K. struggled with suicidal ideation for many years and attempted suicide numerous times, resulting in frequent emergency room visits and in-patient hospitalizations. A.K.’s physicians strongly recommended she enroll in a residential treatment facility to build the skills necessary to stabilize. Despite these recommendations and extensive evidence in the medical record, United Behavioral Health (“United”) denied coverage for A.K.’s stay at a residential treatment facility beyond an initial three month period. Her parents appealed United’s denial numerous times, requesting further clarification, and providing extensive medical evidence, yet United only replied with conclusory statements that did not address the evidence provided. As a result, A.K.’s parents brought this lawsuit contending United violated its fiduciary duties by failing to provide a “full and fair review” of their claim for medical benefits. Both sides moved for summary judgment, and the district court ruled against United. The issue this case presented for the Tenth Circuit's review was whether United arbitrarily and capriciously denied A.K. medical benefits and whether the district court abused its discretion in awarding A.K. benefits rather than remanding to United for further review. The Court ultimately concluded United did act arbitrarily and capriciously in not adequately engaging with the opinions of A.K.’s physicians and in not providing its reasoning for denials to A.K.’s parents. The Court also concluded the district court did not abuse its discretion by awarding A.K. benefits outright. View "D.K., et al. v. United Behavioral Health, et al." on Justia Law

Alabama Somerby, LLC, d/b/a Brookdale University Park IL/AL/MC; Brookdale Senior Living, Inc.; and Undrea Wright (collectively, Brookdale) appealed a circuit court's order denying their motion to compel arbitration of the claims asserted against them by plaintiff, L.D., as the next friend of her mother, E.D. Brookdale operated an assisted-living facility for seniors ("the nursing home") in Jefferson County, Alabama; Wright was the administrator of the nursing home. In March 2022, L.D. filed on E.D.'s behalf, a complaint against Brookdale and Wright and others, asserting various tort claims and seeking related damages premised on allegations that, following her admission to the nursing home, E.D. had been subjected to multiple sexual assaults both by other residents and by an employee of Brookdale. The Brookdale defendants jointly moved to compel arbitration of L.D.'s claims against them or, alternatively, to dismiss the action without prejudice to allow those claims to proceed via arbitration. Following a hearing, the trial court, denied the motion seeking to dismiss the action or to compel arbitration. The Brookdale defendants timely appealed, asserting that the trial court had erred by failing to order arbitration. The Alabama Supreme Court concluded the Brookdale defendants established that an agreement providing for arbitration existed and that the agreement affected interstate commerce. The trial court erred in denying the Brookdale defendants' request to compel arbitration. The Supreme Court reversed the trial court's order and remanded the case for further proceedings. View "Alabama Somerby, LLC, et al. v. L.D." on Justia Law

Victor Chin, M.D., and Sportsmed Orthopedic Specialists, P.C. (collectively "the Sportsmed defendants"), were defendants in an action brought by their patient, Malik Woodard. Woodard alleged that, against his wishes, Dr. Chin obtained records of Woodard's prior psychological treatment. The Sportsmed defendants sought mandamus relief from: (1) the circuit court's order denying their motion to change venue based on the Alabama Medical Liability Act and the Alabama Medical Liability Act of 1987 (collectively "AMLA"); and (2) the court's order prohibiting them from using the psychological records (and certain related documents) in the case and requiring them to return or destroy those records and documents ("the protective order"). As to the venue order, the Alabama Supreme Court denied the petition because the Sportsmed defendants did not argue that the complaint did not support an inference that Dr. Chin had no medical reason for obtaining the psychological records. As to the protective order, the Supreme Court denied the petition because the Sportsmed defendants did not demonstrate that the order was subject to mandamus review. View "Ex parte Victor Chin, M.D., and Sportsmed Orthopedic Specialists, P.C." on Justia Law