Justia Civil Procedure Opinion Summaries

Among its reforms, the Patient Protection and Affordable Care Act (“ACA”) required private health insurers to provide coverage for individuals regardless of their gender or health status, including preexisting conditions. Congress anticipated these reforms might hamper the ability of insurers to predict health care costs and to price health insurance premiums as more individuals sought health insurance. To spread the risk of enrolling people who might need more health care than others, Congress established a risk adjustment program for the individual and small group health insurance markets. Congress tasked the Department of Health and Human Services (“HHS”) with designing and implementing this risk adjustment program with the states. HHS developed a formula to calculate how much each insurer would be charged or paid in each state. The formula relied on the “statewide average premium” to calculate charges and payments. Plaintiff-Appellee New Mexico Health Connections (“NMHC”), an insurer that was required to pay charges under the program, sued the HHS Defendants-Appellants under the Administrative Procedure Act (“APA”), alleging that HHS’s use of the statewide average premium to calculate charges and payments in New Mexico from 2014 through 2018 was arbitrary and capricious. The district court granted summary judgment to NMHC, holding that HHS violated the APA by failing to explain why the agency chose to use the statewide average premium in its program. It remanded to the agency and vacated the 2014, 2015, 2016, 2017, and 2018 rules that implemented the program. After the district court denied HHS’s motion to alter or amend judgment under Federal Rule of Civil Procedure 59(e), HHS appealed. The Tenth Circuit Court of Appeals: (1) determined NMHC’s claims regarding the 2017 and 2018 rules were moot, so the matter was remanded to the district court to vacate its judgment on those claims and dismiss them as moot; (2) reversed the district court’s grant of summary judgment to NMHC as to the 2014, 2015, and 2016 rules because it determined HHS acted reasonably in explaining why it used the statewide average premium in the formula. Because the Court reversed the district court on its summary judgment ruling in favor of NMHC, it did not address the denial of HHS’s Rule 59(e) motion. View "New Mexico Health Connections v. HHS" on Justia Law

This case involved Cobb Hospital, Inc.'s and Kennestone Hospital, Inc.'s (collectively, “Wellstar”) challenge to the decision by the Georgia Department of Community Health (“DCH”) to grant Emory University Hospital Smyrna (“Emory”) a new certificate of need (“CON”) to renovate a hospital that Emory had recently acquired. After DCH made an initial decision granting the CON, Wellstar appealed to the CON Appeal Panel. The panel’s hearing officer affirmed the decision, ruling that as a matter of law he could not consider Wellstar’s arguments regarding the validity of Emory’s existing CON, and that he would not allow Wellstar to present evidence related to those arguments. Wellstar then appealed the hearing officer’s decision to the DCH Commissioner, allegedly arguing among other things that the decision violated Wellstar’s constitutional right to due process. The Commissioner affirmed the hearing officer’s decision without ruling on the constitutional claim. In Division 2 of its opinion in this case, the Georgia Supreme Court determined the Court of Appeals erred by holding that the constitutional due process claim enumerated by Wellstar was not preserved for appellate review because it was not ruled on during the administrative proceeding that led to the filing of this case in the trial court. The Supreme Court thus granted Wellstar’s petition for a writ of certiorari to address that issue, reversed the Court of Appeals’s opinion, and remanded for that court to reconsider Wellstar’s constitutional claim. View "Cobb Hospital v. Department of Community Health et al." on Justia Law

Plaintiffs alleged in 2016, an anonymous hacker stole the personally identifiable information, including Social Security numbers, addresses, birth dates, and health insurance details, of at least 200,000 current and former patients of Athens Orthopedic Clinic (“the Clinic”) from the Clinic’s computer databases. The hacker demanded a ransom, but the Clinic refused to pay. The hacker offered at least some of the stolen personal data for sale on the so-called “dark web,” and some of the information was made available, at least temporarily, on Pastebin, a data-storage website. The Clinic notified plaintiffs of the breach in August 2016. Each named plaintiff alleges that she has “spent time calling a credit reporting agency and placing a fraud or credit alert on her credit report to try to contain the impact of the data breach and anticipates having to spend more time and money in the future on similar activities.” Plaintiffs sought class certification and asserted claims for negligence, breach of implied contract, and unjust enrichment, seeking damages based on costs related to credit monitoring and identity theft protection, as well as attorneys’ fees. They also sought injunctive relief under the Georgia Uniform Deceptive Trade Practices Act (“UDTPA”), and a declaratory judgment to the effect that the Clinic must take certain actions to ensure the security of class members’ personal data in the future. The Clinic filed a motion to dismiss based on both OCGA 9-11-12 (b) (1) and OCGA 9-11-12 (b)(6), which the trial court granted summarily. The Georgia Supreme Court concluded the injury plaintiffs alleged they suffered was legally cognizable. Because the Court of Appeals held otherwise in affirming dismissal of plaintiffs’ negligence claims, the Supreme Court reversed that holding. Because that error may have affected the Court of Appeals’s other holdings, the Court vacated those other holdings and remanded the case. View "Collins et al. v. Athens Orthopedic Clinic, P.A." on Justia Law

This was a permissive appeal brought by Phillip and Marcia Eldridge1 in a medical malpractice action they filed against Dr. Gregory West (West), Lance Turpin, PA-C (Turpin), and Summit Orthopaedics Specialists, PLLC (Summit). The Eldridges alleged that Phillip became infected with Methicillin-Resistant Staphylococcus Aureus (MRSA) as a result of malpractice committed by West, Turpin, and agents of Summit. The Eldridges claimed West and Turpin breached the standard of care that was due them and as a result, sustained damages. The district court granted various motions, including a motion to dismiss certain causes of action against West, Turpin, and Summit, as well as a motion for summary judgment brought by Turpin and Summit, and a motion for partial summary judgment brought by West. On appeal, the Eldridges contended the district court erred in: (1) dismissing their claims for negligent and intentional infliction of emotional distress, gross negligence, and reckless, willful, and wanton conduct; (2) denying their motion to strike the affidavits of West and Turpin; (3) limiting their claim for damages; and (4) concluding that the Eldridges could only present evidence of damages, specifically medical bills, after the Medicare write-offs had been calculated. The Idaho Supreme Court concurred with the Eldridges, reversed the district court and remanded for further proceedings. View "Eldridge v. West, Turpin & Summit" on Justia Law

Mandamus petitions before the Alabama Supreme Court presented a question of whether the Cherokee Circuit Court and the Etowah Circuit Court (collectively, "the trial courts") could properly exercise personal jurisdiction over the petitioners, out-of-state companies (collectively, the defendants) in actions filed against them by the Water Works and Sewer Board of the Town of Centre ("Centre Water") and the Water Works and Sewer Board of the City of Gadsden ("Gadsden Water"). Centre Water and Gadsden Water alleged the defendants discharged toxic chemicals into industrial wastewater from their plants in Georgia, which subsequently contaminated Centre Water's and Gadsden Water's downstream water sources in Alabama. After moving unsuccessfully in the trial courts to have the actions against them dismissed, the defendants filed petitions for writs of mandamus seeking orders from the Alabama Supreme Court directing the trial courts to dismiss the actions against them based on a lack of personal jurisdiction. The Supreme Court consolidated all the petitions for the purpose of issuing one opinion. Because Indian Summer, Kaleen, and Milliken made a prima facie showing that the trial courts lacked specific personal jurisdiction and Centre Water and Gadsden Water failed to produce any evidence to contradict that showing, the trial courts should have granted their motions to dismiss. Indian Summer, Kaleen, and Milliken have, therefore, demonstrated a clear legal right to the relief sought –- dismissal of Gadsden Water's and Centre Water's complaints against them –- and the petitions for a writ of mandamus in case nos. 1170887, 1171197, and 1171199 were granted. The Supreme Court concluded the trial courts could exercise specific personal jurisdiction over the remaining defendants, and that the remaining defendants did not demonstrated a clear legal right to relief at this stage. View "Ex parte Kaleen Rugs, Inc." on Justia Law

The estate of an individual that died as a result of an injury incurred while being a patient of a nursing home sued the nursing home facility in a wrongful death action. The district court entered default judgment for Plaintiff after Defendant failed to file a response or appear in court multiple times. Over 200 days later, Defendant filed a petition to vacate default judgment and the petition was granted. Plaintiff appealed the ruling, and the Court of Civil Appeals (COCA), affirmed the trial court's decision. The Oklahoma Supreme Court concluded it was "patently clear" Defendant's arguments for the Petition to Vacate Judgment as to liability was without merit. "[The Nursing Home] Meeker was given a multitude of opportunities to respond to the litigation, but failed to respond to a single instance for 280 days after the initial service of process. Meeker failed to respond to any service of process or appear at any hearing, and did not have an argument with merit to support the inability to respond to the litigation." Accordingly the Supreme Court vacated the opinion of the Court of Civil Appeals, reversed the trial court's judgment granting the Petition To Vacate Judgment as to liability, and remanded this matter for a trial on damages. View "Williams v. Meeker North Dawson Nursing, LLC" on Justia Law

Mary Thomas awoke, paralyzed, after surgery. She filed a medical malpractice suit against Dr. Adam Lewis, who performed the surgery, claiming her injuries stemmed from two neurosurgeries performed by Dr. Lewis. Thomas also filed suit against Jackson Neurosurgery Clinic and Central Mississippi Medical Center based on vicarious liability. Thomas’s medical malpractice claims were based on an alleged failure of Dr. Lewis to manage Thomas’s mean arterial blood pressure during the first surgery and Dr. Lewis’s decision to perform the second surgery. However, the issue on appeal involved the reliability of expert testimony under Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993). Thomas’s expert, neurosurgeon Dr. Neil Wright, claimed that Dr. Lewis had failed to provide the proper standard of care and, in turn, caused Thomas’s injuries. However, Dr. Lewis argued that Dr. Wright’s opinions were not reliable because they were inconsistent with medical literature. The trial court agreed, struck Dr. Wright’s opinions, and granted partial summary judgment in favor of Dr. Lewis with regard to the first surgery. The trial court also ruled that Dr. Wright could testify to negligence regarding the second surgery. The trial court allowed Thomas to proceed on claims related to the second surgery. Dr. Wright admitted that the decision to perform the second surgery was a judgment call and that he failed to testify that making the decision to proceed with a second surgery was a breach of the standard of care. The trial court considered the evidence and found that Mary Thomas had failed to offer admissible proof from which a reasonable juror could find that Dr. Lewis deviated from a professional standard of care. The trial court directed a verdict in favor of Dr. Lewis, Jackson Neurosurgery Clinic, and Central Mississippi Medical Center, and Thomas appealed. Finding no reversible error, the Mississippi Supreme Court affirmed. View "Thomas v. Lewis" on Justia Law

Danielle B., a 73-year-old woman who suffers from schizoaffective disorder, was involuntarily committed for 30 days. Her illness led to repeated hospitalizations and temporary improvements with the help of medication. But upon release she has deteriorated after stopping the medication. As a result she has had housing problems and incidents involving police due to her behavior, leading to more hospitalization. Since the 1980s she had been admitted to Alaska Psychiatric Institute (API) 30 times. The last such admission she appealed, arguing the State failed to prove that there were no less restrictive alternatives than commitment. Because the court did not err by finding clear and convincing evidence that there was no less restrictive alternative, the Alaska Supreme Court affirmed the court’s order committing her for involuntary treatment. View "D.B. v. Alaska" on Justia Law

Respondent R.M. appealed a circuit court order that renewed his involuntary admission to New Hampshire Hospital for the purpose of allowing him to remain on a conditional discharge for a period of five years. Respondent was a 30-year-old man who had been hospitalized on multiple occasions as a result of schizophrenia. When respondent doesn't take his prescribed anti-psychotic medication, he becomes paranoid, violent, and suicidal. In addition, he experienced hallucinations, paranoid delusions, and difficulties with impulse control and exhibited “a serious level of aggression.” Respondent was first hospitalized in 2010 after voicing suicidal ideation, stating that he would be “better off dead.” Pertinent here, was admitted on an emergency basis again in February 2015 due to concerns of suicidal threats, incapacity, and his paranoid belief that people were conspiring against him. In early March 2019, a few weeks before the respondent’s three-year conditional discharge was set to expire, the local community mental health center filed a petition to renew his conditional discharge. On appeal, respondent challenged the sufficiency of the evidence and argued the five-year renewal was not the least restrictive treatment option. Finding no reversible error, the New Hampshire Supreme Court affirmed. View "In re R.M." on Justia Law

This matter came from two separate lawsuits commenced in the Pennsylvania courts of common pleas which were subsequently removed to federal district courts on the basis of diversity jurisdiction, and thereafter consolidated for disposition by the United States Court of Appeals for the Third Circuit. Appellee William Scott was covered by an automobile insurance policy issued by Appellant Travelers Commercial Insurance Company. Appellee Samantha Sayles was covered by an automobile policy issued by Appellant Allstate Insurance Company. Allstate’s policy contained a clause, similar to the one in Scott’s policy, providing that, in order to receive first-party medical benefits, the insured had to submit to mental and physical examinations by physicians selected by the insurance company at the company’s behest before medical benefits were paid. Both appellees were injured in separate car accidents, and their respective insurance companies refused to pay their medical bills. The United States Court of Appeals for the Third Circuit certified a question of Pennsylvania law to the Pennsylvania Supreme Court: Does an automobile insurance policy provision, which required an insured seeking first-party medical benefits under the policy to submit to an independent medical exam whenever the insurer requires and with a doctor selected by the insurer, conflict with 75 Pa.C.S. Section 1796(a) of the Pennsylvania Motor Vehicle Financial Responsibility Law (“MVFRL”), such that the requirement was void as against public policy? After review, the Supreme Court concluded that the provision indeed conflicted with Section 1796(a), and was void as against public policy. View "Sayles. v. Allstate Ins Co." on Justia Law