Justia Civil Procedure Opinion Summaries

Plaintiff sued Adventist Health System/West and Hanford Community Hospital (collectively, Hospital), for a violation of the Consumer Legal Remedies Act (CLRA; Civ. Code, Sec. 1750 et seq.) and declaratory relief.Plaintiff received emergency treatment and services at Hospital’s emergency room in Hanford. The emergency room did not contain a posted notice or warning that a substantial EMS Fee would be added to Plaintiff’s bill on top of the individual charges for each item of treatment and services provided to her. Plaintiff alleged Hospital engaged in a deceptive practice when it did not disclose its intent to charge her a substantial emergency room EMS Fee.Hospital moved for judgment on the pleadings, which the trial court granted. The court found that although Plaintiff’s pleading adequately alleges Hospital failed to disclose facts that were known exclusively by Hospital and were not reasonably accessible to Plaintiff, the court concluded Plaintiff’s conclusory allegation that she relied on the failure to disclose the EMS Fee and thereafter received treatment at the Hospital does not plead the element of reliance with sufficient particularity.In an unpublished part of the opinion, the court concluded Plaintiff has not carried her burden of demonstrating the trial court erred when it denied her leave to file a third amended complaint. Thus, the court affirmed the judgment. View "Torres v. Adventist Health System/West" on Justia Law

Plaintiff filed a lawsuit in state court, alleging state law claims arising from SelectHealth’s administration of her deceased husband’s Medicare Advantage ("MA") plan and his death. SelectHealth removed the action to federal court on the basis of diversity jurisdiction.The court first considered whether Plaintiff’s claims must be exhausted through the Medicare Act’s administrative review scheme. The court concluded that Plaintiff’s claims were not subject to the SSA’s exhaustion requirement because the dispute was not whether Plaintiff’s husband received a favorable outcome from the internal benefits determination process but rather whether he should have received the services earlier.Next, the court held that Plaintiff’s claim that SelectHealth breached a duty to process her husband’s October 7, 2016 appeal was expressly preempted. The court reasoned that the Medicare Act preempted those claims, regardless of whether they would be inconsistent with federal regulations. The court also held that the Medicare Act also preempted Plaintiff’s claims based on SelectHealth’s alleged breach of duty to investigate properly her husband’s August 23, 2016 preauthorization request for consultation and testing at the Medical Center in Phoenix, Arizona.The court concluded that a state law claim based on a duty to process claims for benefit in a timely manner is preempted by the Part C regulations that set forth the timeframes for initial determinations and reconsideration decisions. The court affirmed the district court’s summary judgment in favor of SelectHealth because the Medicare Act’s express preemption provision barred her claims. View "NAOMI AYLWARD V. SELECTHEALTH, INC." on Justia Law

Johnson & Johnson, Ethicon, Inc., and Ethicon US, LLC (collectively, Ethicon) appealed after a trial court levied nearly $344 million in civil penalties against Ethicon for willfully circulating misleading medical device instructions and marketing communications that misstated, minimized, and/or omitted the health risks of Ethicon’s surgically-implantable transvaginal pelvic mesh products. The court found Ethicon committed 153,351 violations of the Unfair Competition Law (UCL), and 121,844 violations of the False Advertising Law (FAL). The court imposed a $1,250 civil penalty for each violation. The Court of Appeal concluded the trial court erred in just one respect: in addition to penalizing Ethicon for its medical device instructions and printed marketing communications, the court penalized Ethicon for its oral marketing communications, specifically, for deceptive statements Ethicon purportedly made during one-on-one conversations with doctors, at Ethicon-sponsored lunch events, and at health fair events. However, there was no evidence of what Ethicon’s employees and agents actually said in any of these oral marketing communications. Therefore, the Court of Appeal concluded substantial evidence did not support the trial court’s factual finding that Ethicon’s oral marketing communications were likely to deceive doctors. Judgment was amended to strike the nearly $42 million in civil penalties that were imposed for these communications. View "California v. Johnson & Johnson" on Justia Law

In 2012, United Healthcare of Mississippi (United) entered into provider agreements with Mississippi’s fourteen Community Mental Health Centers (CMHCs) to provide Medicaid services under the Division of Medicaid’s (DOM’s) managed care program. From 2012 until 2019, United paid the CMHCs an agreed upon amount for Medicaid services - 100 percent of the medicaid fee schedule rates. In July 2019, United unilaterally imposed a 5 percent rate cut, retroactive to January 1, 2019, and later demanded that the CMHCs refund 5 percent of all payments made from July 1, 2018, through December 31, 2018, all of which totaled more than $1 million. The CMCHs demanded that United immediately cease and desist from the 5 percent rate cut and recoupments. When United refused, the CMHCs filed a Complaint for Damages and Injunctive Relief, specifically requesting, inter alia, a preliminary injunction. United responded with a motion to compel arbitration and to stay the proceedings. After a two-day evidentiary hearing, the circuit court denied United’s motion to compel arbitration, granted the CMHCs’ request for injunctive relief, and issued a preliminary injunction. The limited issues presented to the Mississippi Supreme Court were whether the trial court properly enjoined United from imposing a 5 percent rate cut and whether the trial court erred by denying arbitration. After review, the Supreme Court affirmed the trial court’s decision to grant a preliminary injunction and to deny the motion to compel arbitration. View "United Healthcare of Mississippi Inc. et al. v. Mississippi's Community Mental Health Commissions, et al." on Justia Law

The Supreme Court held that a technical defect in personal service on a ward does not drive the probate court of subject-matter jurisdiction or personal jurisdiction over the ward where the ward is personally served and participates in the proceedings through counsel without objection.Petitioner, the daughter of Mauricette and James Fairley, asked the Supreme Court to void all orders entered in a guardianship proceeding in which Mauricette acted as James's guardian for the final three years of his life. Specifically, Petitioner alleged that personal service on her father by a private process server was insufficient to vest jurisdiction in the probate court because Chapter 1051 of the Estates Code requires a proposed ward to personally be served by a sheriff, constable, or other elected officeholder. The Supreme Court denied relief, holding that Petitioner failed to establish that any deficiency with respect to the method of personal service rose to the level of a violation of due process. View "In re Guardianship of Fairley" 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

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

Two cases were consolidated for the Mississippi Supreme Court's review. In the first appeal, Singing River MOB, LLC (MOB), argued that the leases between itself and Singing River Health System (SRHS) and the lease between Jackson County, Mississippi (County), and SRHS were valid and that the chancery court erred by finding the leases invalid under Mississippi’s “minutes rule.” In the second appeal, Jackson County and SRHS contended the chancery court erred by fashioning its own equitable relief as a result of the first ruling. MOB also raised its own objection as to the manner in which the equitable relief was fashioned. After careful review, the Supreme Court affirmed and remanded the partial summary-judgment order as to the first appeal (No. 2019-IA-01630-SCT); however, the Court reversed and remanded that order as to the second appeal (No. 2019-IA-01653-SCT). View "Singing River MOB, LLC v. Jackson County" on Justia Law

Tomei went to Parkwest Hospital after he injured his foot and leg. He is deaf and communicates using American Sign Language. He asked for an interpreter. Parkwest never provided one. Medical staff gave him an antibiotic and ibuprofen and sent him home. Days later he went to the emergency room, where doctors determined he had blood clots in his leg. Parkwest offered only to connect Tomei with an off-site interpreter via webcam. The connection was so glitchy that Tomei could not effectively communicate. After surgery, Tomei could not tell the medical staff that he was still experiencing pain. Tomei was sent home. Tomei’s family doctor sent him to the University of Tennessee Medical Center, where interpreters helped him through a second surgery. Ultimately, doctors amputated nearly one-third of his leg. About 15 months after he was first denied an interpreter, Tomei sued under section 1557 of the Patient Protection and Affordable Care Act (ACA).The Sixth Circuit rejected an argument that the suit was untimely under Tennessee’s one-year statute of limitations for personal injury suits. Unless federal law provides otherwise, a civil action “arising under” a federal statute enacted after December 1, 1990, is subject to a four-year statute of limitations. 28 U.S.C. 1658(a). Tomei brought his discrimination claim under the ACA—not the Rehabilitation Act. No statute or regulation explicitly sets a statute of limitations for violating the ACA’s discrimination bar. View "Tomei v. Parkwest Medical Center" on Justia Law

Through a bankruptcy proceeding, Bristol became the successor-in-interest to Haven, an accredited mental-health and substance-abuse treatment center that regularly serviced patients insured by Cigna. Bristol alleged that Cigna violated the Employee Retirement Income Security Act of 1974 (ERISA) and state law by denying Haven’s claims for reimbursement for services provided. Haven was out-of-network for Cigna’s insureds. The district court dismissed Bristol’s ERISA claim, as an assignee of a healthcare provider, for lack of derivative standing, or lack of authority to bring a claim under ERISA, 29 U.S.C. 1132(a)(1)(B).The Ninth Circuit reversed. Under ERISA, a non-participant health provider cannot bring claims for benefits on its own behalf but must do so derivatively, relying on its patients’ assignments of their benefits claims. Other assignees also may have derivative standing if extending standing would align with the goal of ERISA. Refusing to allow derivative standing for Bristol would create serious perverse incentives that would undermine the goal of ERISA. Denying derivative standing to health care providers would harm participants or beneficiaries because it would discourage providers from becoming assignees and possibly from helping beneficiaries who were unable to pay up-front. View "Bristol SL Holdings, Inc. v. Cigna Health and Life Insurance Co." on Justia Law