Justia Civil Procedure Opinion Summaries

An indigent patient was admitted to St. Alphonsus Regional Medical Center (St. Alphonsus) on October 7, 2017, and continued to receive treatment in the hospital until she was discharged on January 12, 2018. During her stay, St. Alphonsus filed a third-party medical indigency application on her behalf, and later filed two additional requests for payment of services. The Board of Ada County Commissioners (the Board) approved payment for dates of service from October 7 until October 10, 2017, but denied payments for services provided from October 11 until December 31, 2017, relying on the opinion of the Ada County Medical Advisor that the services provided on those dates were not “medically necessary” under the definition in Idaho Code section 31-3502(18)A(e). St. Alphonsus appealed the Board’s initial determination, but the final determination upheld the denial for payment beyond October 11. Upon St. Alphonsus’ petition, a district court reversed the Board’s decision, finding that the services “currently available” to a patient were to be considered as a “necessary medical service.” The Board argued “there did exist options for the Patient to proceed to rehabilitation at a facility other than St. Alphonsus, but for the Patient’s lack of funding.” Furthermore, the Board asserted that Idaho Code section 31-3502(18)A(e) is unambiguous in that “[t]here is no wording in [sub]section (e) of the statute that limits the ‘most cost-effective services’ to services that the Patient can afford to pay for.” After review, the Idaho Supreme Court determined the Board exceeded its statutory authority in denying St. Alphonsus reimbursement for providing medically necessary services. “The Board’s denial of payment was not based on substantial evidence and prejudiced St. Alphonsus’ substantial right to compensation for services rendered to an indigent patient.” View "St. Alphonsus Regional Medical v. Ada County" on Justia Law

Plaintiff, a Nevada physician who treats patients covered by Medicare, filed suit seeking an injunction compelling the contractor that administers Medicare in his region to change the method of evaluating his claims. The district court granted the injunction.The Ninth Circuit vacated the preliminary injunction, concluding that the Medicare statute permits a court to review only claims that have been presented to the agency. The panel explained that, because this case does not involve a claim that was presented to the agency, the district court lacked subject matter jurisdiction. Accordingly, the panel remanded to the district court with instructions to dismiss the complaint for lack of jurisdiction. View "Odell v. U.S. Department of Health & Human Services" on Justia Law

A patient sued a hospital, arguing the hospital violated the Alaska Health Care Decisions Act (HCDA) when it temporarily assumed decision-making authority over his medical care while he was incapacitated and treated him without his consent or that of his parents, whom he had previously authorized to make medical decisions on his behalf if he were rendered incompetent or incapacitated. The hospital argued it was entitled to immunity under the HCDA because it held a good faith belief that the patient’s parents lacked authority to make medical decisions for him, based on conduct that convinced health care providers at the hospital that the parents were not acting in the patient’s best interest. The superior court agreed with the hospital and granted its summary judgment motion, concluding that the immunity provisions applied. The superior court concluded the hospital was entitled to immunity because its doctors had acted in good faith and in accordance with generally accepted medical standards. In a matter of first impression for the Alaska Supreme Court, it determined the superior court overlooked the requirement for specific good faith as to the authority or lack thereof of the patient’s surrogate or agent. The grant of summary judgment was reversed and the matter remanded for further proceedings. View "Bohn v. Providence Health & Srvs - Washington" on Justia Law

Plaintiffs, consisting of the estate of decedent Edward William Kuntz (decedent), his wife, and his three children, sued, among others, the Kaiser Foundation Hospital and the Permanente Medical Group, Inc. (collectively Kaiser), asserting causes of action sounding in elder abuse, negligent infliction of emotional distress, and wrongful death. Kaiser filed a petition to stay the action and compel arbitration. The trial court granted the petition as to the elder abuse cause of action, staying the other causes of action. Ultimately, the trial court entered judgment in favor of Kaiser. Plaintiffs appealed, arguing: (1) Kaiser failed to satisfy its burden of producing a valid agreement to arbitrate; and (2) Kaiser failed to comply with the mandatory requirements of Health and Safety Code section 1363.1 concerning the disclosure of arbitration requirements. Finding no reversible error, the Court of Appeal affirmed. View "Kuntz v. Kaiser Foundation Hospital" on Justia Law

Shawna Tanner, the plaintiff below, appealed an adverse ruling on summary judgment. Tanner was approximately 35 weeks pregnant and in custody at the Metropolitan Detention Center in Bernalillo County, New Mexico when she went into the final stages of her pregnancy. Over the ensuing thirty hours, commencing with the point at which her water broke, Appellees—employees of a nationwide private medical contractor—ignored and minimized her symptoms, refused to transport her to a hospital, and failed to conduct even a cursory pelvic examination. Only minimal attention was given to her: water, Tylenol, and sanitary pads. After thirty hours of pain and trauma, Tanner gave birth to her son. The child was born with his umbilical cord wrapped around his neck. He was not breathing. He had no pulse. This appeal considered whether full-time employees of a for-profit, multi-state corporation organized to provide contract medical care in detention facilities may assert a qualified immunity defense to shield themselves from 42 U.S.C. 1983 liability. The Tenth Circuit found neither historical justifications of special government immunity nor modern policy considerations supported the extension of a qualified immunity defense to Appellees. Judgment was reversed and the matter remanded for further proceedings. View "Tanner v. McMurray" on Justia Law

This case arose from the tragic death of 21-year-old Madison Jensen while in custody of the Duchesne County Jail. Jensen was arrested after her father alerted law enforcement to her drug use and possession of drug paraphernalia. Her estate brought this action for deprivation of civil rights under color of state law. The district court granted summary judgment in favor of the county and qualified immunity to jail supervisors and staff, but denied qualified immunity to jail medical personnel, Defendants-Appellants (Nurse) Jana Clyde and Dr. Kennon Tubbs. The district court held that genuine issues of material fact precluded qualified immunity on the Estate’s claims of: (1) deliberate indifference to serious medical needs against Nurse Clyde; and (2) supervisory liability against Dr. Tubbs. The Tenth Circuit ultimately concluded that when an individual’s sole purpose was “to serve as a gatekeeper for other medical personnel,” and that person delays or refuses to fulfill the gatekeeper role, he may be liable for deliberate indifference. Clyde was the gatekeeper in this case, and she failed to fulfill that role when she chose to give Jensen Gatorade instead of calling Dr. Tubbs or PA Clark. Accordingly, Clyde was given sufficient notice that what she was doing violated Jensen’s rights to medical care. The Court affirmed as to Clyde and reversed as to Dr. Tubbs. View "Estate of Madison Jody Jensen v. Clyde" on Justia Law

Smith suffered an injury from a car accident, retained an attorney for a personal injury lawsuit, and authorized her attorney to obtain her healthcare information. The attorney requested Smith’s medical records from MHS, on three occasions. RecordQuest, not MHS, answered those requests and charged Smith’s attorney (who paid on her behalf) a $20.96 handling fee and an $8.26 certification fee each time.Smith brought a class action, alleging these charged fees contravened the permissible fee schedule set out in Wis. Stat. 146.83(3f)(b) for healthcare records requests and resulted in the unjust enrichment of RecordQuest. The district court dismissed both claims, reasoning that the statute imposes a duty upon only healthcare providers.” RecordQuest is not a healthcare provider but is the agent of MHS; “no principle of agency law holds that a principal’s liability is imputed to the agent when the agent performs the act that results in the principal’s liability.” Smith’s unjust enrichment claim failed because any unjust benefit that Smith allegedly conferred to RecordQuest belonged to MHS.The Wisconsin Court of Appeals subsequently expressly disagreed with the district court’s analysis of Smith’s statutory claim. The Seventh Circuit reversed the dismissal of the statutory claim but affirmed as to Smith’s unjust enrichment claim. Under section 146.83(3f)(b), Smith has a remedy at law for any “injustice” that allegedly resulted from excessive payments; the equitable remedy of unjust enrichment is derivative of and predicated upon the statutory claim. View "Smith v. RecordQuest LLC" on Justia Law

Plaintiff-appellee Christina Smith was the mother of Joshua England. Her claims arose from the death of England from a ruptured appendix in May 2018, while England was housed at the Joseph Harp Correctional Center (JHCC), an Oklahoma Department of Corrections (ODOC) facility in Lexington, Oklahoma. England was a 21-year-old prisoner at JHCC who was a few months away from release when he submitted multiple sick call requests. At the fifth such request, England complained his stomach hurt and he was short of breath. Unable to bear the pain while waiting at the clinic, England died in his cell from a ruptured appendix with acute peritonitis. Defendants-Appellants Joe Allbaugh, the Director of the Department of Corrections at the time this claim arose, and Carl Bear, the Warden of Joseph Harp Correctional Center (collectively, Defendants) appealed the district court’s order denying their motion to dismiss Smith's subsequent lawsuit relating to England's death on grounds of qualified immunity. The Tenth Circuit reversed, finding Smith alleged only that JHCC medical staff failed to follow procedure, not that Defendants failed to enforce those policies. Furthermore, the Court determined Smith failed to plead sufficient factual allegations to support deliberate indifference on the part of these defendants. Likewise, Smith failed to sufficiently plead Defendants improperly hired, supervised, and retained certain medical staff employees. View "Smith v. Allbaugh" on Justia Law

When Medicare overpays hospitals, it offsets that mistake by reducing future payments. By 2013, Medicare was out $11 billion because of new diagnostic codes and bookkeeping that did not keep up. Congress required that the Secretary of Health and Human Services recoup that amount by the end of fiscal year 2017 by reducing the base rate (standardized amount) paid for inpatient care and directed the Secretary to adjust the base rate by 0.5% each year through 2023, 129 Stat. 87, 163 (2015). Subsequently, while reviewing the 2017 budget, the Secretary realized that a -3.2% adjustment would leave the agency short of its $11 billion goal and announced a -3.9% adjustment. Congress then told the Secretary to increase the base rate by 0.4588% (not 0.5%) in 2018, 130 Stat. 1033, 1320 (2016). In 2017, the Secretary adjusted the base rate -3.9%. The agency met its goal. In 2018, the Secretary adjusted the base rate -3.4412%.Medicare providers sued, arguing that the Secretary should have reversed that expedient at the end of 2017 rather than carry it over into 2018, costing the hospitals $840 million in lost payments. The D.C. Circuit affirmed the dismissal of the suit. While the hospitals felt a “significant financial impact” from the -0.7% adjustment, Section 7(b)(5) bars judicial review of adjustments made under the Act. View "Fresno Community Hospital and Medical Center v. Cochran" on Justia Law

Plaintiffs Amber Brooks and Jamie Gale brought tort claims based on injuries they sustained when their breast implants began to deteriorate. The district court found they failed to state a claim upon which relief could be granted, and dismissed their complaint with prejudice. Plaintiffs appealed, arguing that though Congress heavily regulated the production and use of medical devices, there was a narrow preemption by which plaintiffs could plead their claim arising from the failure of that medical device. They also alleged the district court abused its discretion by denying their motion for leave to amend their complaint. The Tenth Circuit agreed with the district court that federal law preempted all of plaintiffs' claims, and any any state-law claims were insufficiently pled. With respect to the trial court's dismissal of plaintiffs' complaint with prejudice, the Tenth Circuit determined plaintiffs elected to "stand by their 'primary position,' and took no available avenue to amend their complaint. Therefore, the Tenth Circuit declined to grant their request now, and found the trial court did not abuse its discretion in denying Plaintiffs' request for leave to amend. View "Brooks v. Mentor Worldwide" on Justia Law