Justia Civil Procedure Opinion Summaries

Defendant-respondent Inland Empire Health Plan (IEHP) was a health care service plan subject to the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act). It contracted with certain medical groups and providers to provide medical care at reduced costs to eligible beneficiaries of the California Medical Assistance Program (Medi-Cal or Medicaid) who were enrolled with IEHP. Plaintiffs-appellants Allied Anesthesia Medical Group, Inc., and Upland Anesthesia Medical Group were groups of doctors who provided anesthesia services to IEHP’s enrollees for elective, nonemergency surgeries. Plaintiffs had no provider contract with IEHP; however, they had exclusive agreements with the hospitals. Plaintiffs were paid at the Medi-Cal fee schedule rate. In this case, plaintiffs claimed IEHP should have paid them at the reasonable and customary value rate for their services instead of the Medi-Cal fee schedule rate, and requested a declaratory judgment based solely upon the Knox-Keene Act and the Claims Settlement Practices regulation. IHEP demurred on several grounds, including: (1) the cause of action for breach of implied-in-fact contract fails to sufficiently plead “mutual assent” and “legal consideration”; and (2) the cause of action for breach of contract (third party beneficiary) failed to allege how plaintiffs were the express, intended third party beneficiaries of any contract between IEHP and the California Department of Health Care Services. The trial court agreed with IEHP, sustained its demurrer without leave to amend, and entered judgment. Plaintiffs appealed, maintaining IEHP was obligated to pay them the reasonable and customary value rate for their services to IEHP’s enrollees. To this the Court of Appeal disagreed and affirmed the trial court. View "Allied Anesthesia Medical Group v. Inland Empire Health Plan" on Justia Law

Zelda Sheppard appealed a superior court’s affirmance of an Industrial Accident Board (“IAB” or “Board”) decision granting Allen Family Foods’ (“Employer”) Petition for Review (“Petition”). The IAB determined that Sheppard’s prescribed narcotic pain medications were no longer compensable. Sheppard sought to dismiss the Petition at the conclusion of Employer’s case-in-chief during the IAB hearing, arguing that the matter should have been considered under the utilization review process. After hearing the case on the merits, the IAB disagreed, holding that Employer no longer needed to compensate Sheppard for her medical expenses after a two-month weaning period from the narcotic pain medications. On appeal, Sheppard argued the IAB erred as a matter of law when it denied Sheppard’s Motion to Dismiss Employer’s Petition because Employer failed to articulate a good faith change in condition or circumstance relating to the causal relationship of Sheppard’s treatment to the work injury. Accordingly, Sheppard argued that the Employer was required to proceed with the utilization review process before seeking termination of her benefits. The Delaware Supreme Court determined the IAB’s decision was supported by substantial evidence, therefore the superior court’s decision was affirmed. View "Sheppard v. Allen Family Foods" on Justia Law

The Supreme Court affirmed the judgment of a panel of the court of appeals dismissing an appeal in this temporary commitment case on the grounds that the appeal was moot, holding that "public interest exception" to mootness applied.After a hearing, the trial court found E.F. was gravely disabled and entered a temporary commitment order allowing for her emergency detention. While E.F.'s appeal was pending, the commitment order expired. The court of appeals dismissed E.F.'s appeal as moot, interpreting T.W. v. St. Vincent Hospital & Healthcare Center, Inc., 121 N.E.3d 1039 (Ind. 2019), as disfavoring the practice of applying the public interest exception except in "rare circumstances." The Supreme Court reversed, holding that E.F. should have the opportunity to make certain arguments before the court of appeals. View "In re Commitment of E.F." on Justia Law

Plaintiff Sean Kelly appealed the grant of summary judgment to the University of Vermont Medical Center (UVMMC) on employment discrimination and breach-of-contract claims arising from UVMMC’s decision not to extend his one-year medical fellowship. UVMMC selected plaintiff for the 2017-18 fellowship. UVMMC was aware that plaintiff suffered from an adrenal deficiency that had delayed the completion of his residency. In the first five months of the fellowship, plaintiff missed nineteen full days and parts of nine more days for various reasons. By February 2018, after missing several more days and expressing that he felt “frustrated with [his] absences” and “overall inadequate as a fellow,” program personnel became concerned that plaintiff was falling behind in his training. In a March 30 meeting, the program director told plaintiff his performance had “deficiencies and these need[ed] to be addressed.” At some point during this period, the director also told plaintiff he “should plan on extending [his] fellowship due to [his] time out and some minor deficits through August.” Plaintiff emailed other program personnel expressing frustration at the prospect of staying through August to complete his training. On April 14, 2018, plaintiff suffered a stroke, and on April 19th he attempted suicide. He was hospitalized from April 14 through May 3 and was not cleared to return to work until June 1, 2018. In all, plaintiff missed approximately six more weeks of the fellowship. On or about May 31, the director called plaintiff and told him that while UVMMC had determined he needed six more months of training to finish the fellowship, it could not accommodate additional training for that length of time. UVMMC paid plaintiff his remaining salary. Plaintiff filed a grievance under the Graduate Medical Education rules; the grievance committee affirmed UVMMC's decision. Because the decision not to extend his fellowship was an academic decision, there was no employment action and consequently no adverse employment action. The Vermont Supreme Court did not find plaintiff's arguments on appeal persuasive, and affirmed the grant of summary judgment in UVMMC's favor. View "Kelly v. University of Vermont Medical Center" on Justia Law

In this appeal, the issue presented for the New Jersey Supreme Court in this case was whether a plaintiff had to submit an affidavit of merit (AOM) in support of a vicarious liability claim against a licensed health care facility based on the alleged negligent conduct of an employee who was not a “licensed person” under the AOM statute. Plaintiff Troy Haviland brought a claim against defendant Lourdes Medical Center of Burlington County, Inc., alleging, as relevant here, that an unnamed radiology technician employed by defendant negligently performed his radiological imaging examination, causing serious injuries. Defendant filed a motion to dismiss plaintiff’s complaint for failure to serve an AOM, which was granted. The Appellate Division reversed, determining that an AOM was not required when a plaintiff’s claim against a licensed person was limited solely to vicarious liability, based upon the alleged negligence of an employee who was not a licensed person under the AOM statute. To this the Supreme Court concurred: the AOM statute did not require submission of an AOM to support a vicarious liability claim against a licensed health care facility based only on the conduct of its non-licensed employee. View "Haviland v. Lourdes Medical Center of Burlington County, Inc." on Justia Law

In March of 2020, West Virginia’s Governor began to adopt public-safety measures in response to the outbreak of the COVID-19 pandemic. Six months later, a group of Plaintiffs sued, challenging those measures as unconstitutional. The district court dismissed their case, holding that the amended complaint failed to state a valid constitutional claim.   On appeal, the Plaintiffs argued for the voluntary cessation exception. The Fourth Circuit vacated the district court’s judgment and remanded with instructions to dismiss the case. The court held that the case is moot because the Governor has long since terminated each of the challenged executive orders, and there is no reasonable chance they will be reimposed.  The court reasoned a defendant claiming mootness based on the voluntary cessation of a challenged practice must show that it is “absolutely clear that the allegedly wrongful behavior could not reasonably be expected to recur. Here, the Governor has not imposed any new COVID-19 restrictions, let alone restrictions similar in scope or subject matter to those Plaintiffs' challenge. Nor have Plaintiffs pointed to any conduct by the Governor suggesting that measures like gathering limits, capacity restrictions, or school closures will be reimposed in the future. View "Eden, LLC v. Jim Justice" on Justia Law

This case addressed the difference between two claims that arose from the same accident and that were based on the same medical care: a medical malpractice claim and a failure to secure informed consent claim. In 2017, Mari Davies was in a single-car rollover accident. When Davies arrived at the E.R. she had hypertension, high blood pressure, left shoulder pain, neck pain, chest pain, abdominal pain, a headache, and some tingling in her left arm. She also had preexisting kidney stones, diverticulosis, pneumonia, and diabetes. Dr. Michael Hirsig evaluated her as soon as she arrived in the E.R.: consulted with a neurosurgeon, ordered tests and prescribed medicines. Dr. Hirsig diagnosed Davies with a stable cervical spine fracture. He determined that she had no “neurological symptoms.” Davies visited her primary care provider the next day. While in his office, Davies exhibited stroke symptoms. She was immediately transported to the E.R. at Providence St. Peter Hospital. She had, indeed, suffered a stroke. It was later determined Davies’ stroke was caused by a vertebral artery dissection (VAD) that occurred at the time of the accident. A VAD is typically detected by a computed tomography angiography (CTA) scan. It was undisputed that the E.R. doctor who treated Davies when she first presented to the hospital, did not order a CTA scan. Davies filed suit against MultiCare Health System, the parent corporation of Good Samaritan Hospital, alleging (1) medical negligence, (2) failure to obtain informed consent, and (3) corporate negligence. On cross motions for partial summary judgment, the trial court dismissed Davies’ informed consent claim. The trial court found no material factual dispute related to the informed consent claim and dismissed it as unsupported by the law. Davies’ medical negligence claims proceeded to trial. The jury found that none of the health care provider defendants were negligent. The Court of Appeals reversed, finding facts in the record sufficient to support an informed consent claim. The Washington Supreme Court adhered to prior decisions holding that in general, a patient cannot bring an informed consent claim where, as here, the physician ruled out the undiagnosed condition entirely. View "Davies v. MultiCare Health Sys." on Justia Law

Defendant-petitioner Lisa Mestas petitioned the Alabama Supreme Court for a writ of mandamus directing the circuit court to vacate its order denying her motion for a summary judgment in this wrongful-death/medical-negligence action brought by David Lee Autrey, as the personal representative of the estate of his wife, Bridgette Ann Moore, and to enter a summary judgment in Mestas's favor on the basis of State-agent immunity. In May 2017, Autrey's wife, Moore, went to the University of South Alabama Medical Center to undergo a surgery required by the prior amputation of her right leg. The surgery was performed without incident, and Moore was transferred to a hospital room for recovery. At approximately 9:30 p.m. that night, nurses found Moore unresponsive. Attempts to revive her were unsuccessful, and Moore was pronounced deceased. It was later determined that Moore died as a result of opioid-induced respiratory depression ("OIRD"). Mestas argued that, at all times relevant to Autrey's lawsuit, she was an employee of the University of South Alabama ("USA") and served as the Chief Nursing Officer ("CNO") for USA Health System, which included USA Medical Center, various clinics, and a children's hospital. According to Mestas, as the CNO, her primary responsibilities were administrative in nature and she had not provided any direct patient care since 2010. Mestas argued that because Autrey's claims against her arose from the line and scope of her employment with a State agency,2 and because she did not treat Moore, she was entitled to, among other things, State-agent immunity. The Supreme Court concluded Mestas demonstrated she was entitled to state-agent immunity, and that she had a clear right to the relief sought. The Court therefore granted her petition and issued the writ, directing the trial court to grant her summary judgment. View "Ex parte Lisa Mestas." on Justia Law

Head Start is a federal program that funds early childhood education for low-income children and provides other resources and education to the children’s families. Michigan Head Start grantees challenged the COVID-19 vaccine mandate for Head Start program staff, contractors, and volunteers imposed by an interim final rule of the Department of Health and Human Services. The district court denied a preliminary injunction.The Sixth Circuit denied an injunction pending appeal. The plaintiffs have not shown that they will likely prevail on the merits. HHS likely did not violate the Administrative Procedure Act when it promulgated the vaccine requirement through an interim final rule instead of notice-and-comment rulemaking, 5 U.S.C. 553(b)(B). That rule contains ample discussion of the evidence in support of a vaccine requirement and the justifications for the requirement, 86 Fed. Reg. 68,055-059. HHS likely has the statutory authority to issue a vaccine requirement for Head Start program staff, contractors, and volunteers under 42 U.S.C. 9836a(a)(1)(A), (E). The risk that unvaccinated staff members could transmit a deadly disease to Head Start children—who are ineligible for the COVID-19 vaccine due to their young age—is “a threat to the health” of the children. The court noted HHS’s history of regulating the health of Head Start children and staff. View "Livingston Educational Service Agency v. Becerra" on Justia Law

In 2019 a woman sued her former husband’s medical provider, alleging that from 2003 to 2010 the provider negligently prescribed the husband opioid medications, leading to his addiction, damage to the couple’s business and marital estate, the couple’s divorce in 2011, and ultimately the husband's death in 2017. The superior court ruled the claims were barred by the statute of limitations and rejected the woman’s argument that the provider should have been estopped from relying on a limitations defense. Because the undisputed evidence shows that by 2010 the woman had knowledge of her alleged injuries, the provider’s alleged role in causing those injuries, and the provider’s alleged negligence, the Alaska Supreme Court concluded that the claims accrued at that time and were no longer timely when filed in 2019. And because the record did not show that the woman’s failure to timely file her claims stemmed from reasonable reliance on fraudulent conduct by the provider, the Supreme Court concluded that equitable estoppel did not apply. View "Park v. Spayd" on Justia Law