Justia Civil Procedure Opinion Summaries

Petitioner Lisa French went to respondents Centura Health Corporation and Catholic Health Initiatives Colorado d/b/a St. Anthony North Health Campus (collectively, “Centura”) for surgery. Upon reviewing French’s insurance information prior to surgery, Centura advised her that she would personally be responsible for $1,336.90 of the amounts to be billed. After the surgery, however, Centura determined that it had misread French’s insurance card and that she was, in fact, an out-of-network patient. Centura then billed French $229,112.13 and ultimately sued her to collect. The Colorado Supreme Court granted certiorari to review: (1) whether here, Centura’s database used by listing rates for specific medical services and supplies, was incorporated by reference into hospital services agreements (“HSAs”) that French had signed; and (2) if so, whether the price term in the HSAs was sufficiently unambiguous to render the HSAs enforceable. The Court concluded that because French neither had knowledge of nor assented to the chargemaster, which was not referenced in the HSA or disclosed to her, the chargemaster was not incorporated by reference into the HSA. Accordingly, the HSA left its price term open, and therefore, the jury appropriately determined that term. The Court reverse the judgment of the division below, and did not decide whether the price that French was to pay was unambiguous, even if the HSA incorporated the chargemaster. View "French v. Centura Health" on Justia Law

Defendants Kim Reynolds, Governor of Iowa, and Ann Lebo, Director of the Iowa Department of Education, appealed the district court’s entry of a preliminary injunction completely barring enforcement of Iowa’s facial covering statute, Code Section 280.31. The Eighth Circuit vacated the district court’s entry of preliminary injunction completely barring enforcement of Iowa Code Section 280.31 as moot.   The court reasoned that the issue surrounding the preliminary injunction is moot because the current conditions differ vastly from those prevailing when the district court addressed it. The court reasoned that COVID-19 vaccines are now available to children and adolescents over the age of four, greatly decreasing Plaintiffs’ children’s risk of serious bodily injury or death from contracting COVID-19 at school. Further, when Plaintiffs sought a preliminary injunction, delta was the dominant variant, producing high transmission rates and caseloads throughout the country. Now, omicron has become dominant and subsided, leaving markedly lower transmission rates and caseloads throughout Iowa and the country. The court noted that to the extent that the case continues, the Court emphasized that the parties and district court should pay particular attention to Section 280.31’s exception for “any other provision of law.” Iowa Code Section 280.31. This exception unambiguously states that Section 280.31 does not apply where “any other provision of law” requires masks. The word "any” makes the term “provision of law” a broad category that does not distinguish between state or federal law. View "The Arc of Iowa v. Kimberly Reynolds" on Justia Law

This putative class action against California and San Diego County officials challenged California Governor Gavin Newsom’s emergency orders and related public health directives restricting business operations during the COVID-19 pandemic. Plaintiffs, owners of affected restaurants and gyms (Owners), primarily contended the orders were procedurally invalid because they were adopted without complying with the Administrative Procedure Act (APA). Furthermore, Owners contended that the business restrictions were substantively invalid because they effected a taking without compensation, violating the Fifth Amendment to the United States Constitution. Rejecting these claims, the superior court sustained demurrers to the third amended complaint without leave to amend and dismissed the action. While the Court of Appeal sympathized with the position some Owners find themselves in and the significant financial losses they alleged, the unambiguous terms of the Emergency Services Act and controlling United States Supreme Court regulatory takings caselaw required that the judgment be affirmed. View "640 Tenth, LP v. Newsom" on Justia Law

On November 21, 2017, Richard Bush presented to Saint Bernard Parish Hospital for depression and suicidal ideations. At the hospital, Dr. Miguel Aguilera treated and discharged him. Bush attempted re-admittance with the same complaints, but was refused re-admittance. Thereafter, Bush attempted suicide in the hospital bathroom. He was found alive and transported to University Hospital in New Orleans for treatment; however, he succumbed to his injuries from the suicide attempt and died on November 30, 2017. In November 2018, his wife, Patricia Bush, on behalf of herself, her daughters, Madalyn and Ashley Bush, and on behalf of the decedent, Richard Bush, filed a formal pro se complaint with the Patient Compensation Fund (“PCF”) to convene a medical review panel (“MRP”), naming Saint Bernard Parish Hospital and Dr. Aguilera for malpractice relating to Richard Bush's death. The Louisiana Supreme Court granted this writ application in order to determine: (1) whether contra non valentem interrupted prescription; and (2) whether the court of appeal erred in relying on documents that were not entered as evidence and were not part of the record. The Court found that, while contra non valentem may interrupt prescription in a wrongful death claim in certain instances, it did not interrupt prescription in this case due to the fact that the court of appeal incorrectly considered documents that were not in evidence. The Court reversed the court of appeal’s ruling in part, affirmed in part, and remanded for further proceedings. View "Medical Review Panel for the Claim of Richard Bush" on Justia Law

Illinois Insurance Guaranty Fund is a state-created insolvency insurer; when a member insurer becomes insolvent, the Fund pays covered claims. In cases involving insolvent health insurance, many claims are for patients who are eligible for both Medicare benefits and private health insurance. The Fund sought a determination that it is not subject to reporting requirements under section 111 of the 2007 Medicare, Medicaid, and SCHIP Extension Act, 42 U.S.C. 1395y(b)(7) & (b)(8), which is intended to cut Medicare spending by placing financial responsibility for medical costs with available primary plans first. Because time may be of the essence in medical treatment, the government may make conditionally cover medical expenses for Medicare beneficiaries insured by a primary plan, subject to later reimbursement from a primary plan. Section 111 imposes reporting requirements so that the government can identify the primary plan responsible for payment. The Fund believes that it is not an “applicable plan.”The district court dismissed for lack of subject-matter jurisdiction, reasoning the government had not made a final decision through its administrative processes. The Seventh Circuit affirmed. The Fund can obtain judicial review of its claim in a federal court only by channeling its appeal through the administrative process provided under 42 U.S.C. 405(g). The usually-waivable defense of failure to exhaust administrative remedies is a jurisdictional bar here. View "Illinois Insurance Guaranty Fund v. Becerra" on Justia Law

Respondent K.C. appealed a circuit court decision ordering her to involuntary admission to the New Hampshire Hospital (NHH) for a two-year period, to be discharged when clinically appropriate. On appeal, respondent contended NHH presented insufficient evidence at the hearing to support the circuit court’s order. Respondent was diagnosed with bipolar I disorder with manic, psychotic features. She had contacted police in the previous year 300-400 times, believing someone was hacking her phone and “rerouting her to people in black ops.” She had two active protective orders preventing her from contacting her ex-husband and another man, and there was outstanding criminal complaints from her violating those orders. Respondent was admitted to NHH, whereupon she was evaluated by psychiatrists, and the decision was ultimately made to have her committed. Finding no reversible error in the circuit court’s order, the New Hampshire Supreme Court affirmed, finding the evidence presented at respondent’s hearing was sufficient on which to have her involuntarily committed. View "In re K.C." on Justia Law

Dr. Paulus was prosecuted for healthcare fraud. Government consultants reviewed 496 of Paulus’s procedures and concluded that 146 (about 30%) were unnecessary. King’s Daughters Medical Center (KDMC) consultants also reviewed a random selection of Paulus’ procedures. Three experts at trial concluded that Paulus overstated his patients’ arterial blockage and inserted medically unnecessary stents. A jury convicted Paulus. After remand, before sentencing, the government disclosed to Paulus for the first time the “Shields Letter,” stating that when KDMC faced previous legal trouble, it hired independent experts to review 1,049 of Paulus’s cases; they flagged about 7% of his procedures as unnecessary. The defense viewed this evidence as exculpatory and consistent with diagnostic differences of opinion. Before trial, the district court had held that the information was inadmissible and that the parties “[we]re not to disclose” any information about the KDMC Review to Paulus.The Sixth Circuit vacated Paulus’s convictions and remanded, finding that the Shields Letter was material to Paulus’s defense and that failure to disclose it violated Paulus’s “Brady” rights. On remand, the government subpoenaed KDMC for additional information regarding the study referenced in the Shields Letter. KDMC objected, citing the attorney-client, work-product, and settlement privileges. The government filed a motion to compel, which was granted. KDMC sought a writ of mandamus. The Sixth Circuit denied KDMC’s petition. KDMC’s disclosure of some information regarding its experts’ study waived its privilege over the related, undisclosed information now being sought. View "In re: King's Daughters Health System, Inc." on Justia Law

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