Justia Civil Procedure Opinion Summaries

In 2016, Kansas sent notices of decisions to terminate its Medicaid contracts with two Planned Parenthood affiliates, Planned Parenthood of Kansas and Mid-Missouri (“PPGP”), and Planned Parenthood of the St. Louis Region (“PPSLR”). The notices cited concerns about the level of PPGP’s cooperation in solid-waste inspections, both Providers’ billing practices, and an anti-abortion group’s allegations that Planned Parenthood of America (“PPFA”) executives had been video-recorded negotiating the sale of fetal tissue and body parts. Together, the Providers and three individual Jane Does (“the Patients”) immediately sued Susan Mosier, Secretary of the Kansas Department of Health and Environment (“KDHE”), under 42 U.S.C. 1983, alleging violations of 42 U.S.C. 1396a(a)(23) and the Equal Protection Clause of the Fourteenth Amendment. The Plaintiffs sought a preliminary injunction enjoining Kansas from terminating the Providers from the state’s Medicaid program. "States may not terminate providers from their Medicaid program for any reason they see fit, especially when that reason is unrelated to the provider’s competence and the quality of the healthcare it provides." The Tenth Circuit joined four of five circuits that addressed this same provision and affirmed the district court’s injunction prohibiting Kansas from terminating its Medicaid contract with PPGP. But the Court vacated the district court’s injunction as it pertained to PPSLR, remanding for further proceedings on that issue, because Plaintiffs failed to establish standing to challenge that termination. But on this record, the Court could not determine whether PPSLR itself could establish standing, an issue the district court declined to decide but now must decide on remand. View "Planned Parenthood v. Andersen" on Justia Law

Plaintiff-appellant Elizabeth Cates was a former patient of defendant-appellee Integris Health, Inc.’s medical facility and claimed defendant wrongfully billed her, and others like her, for services. She filed this action in state court, alleging state-law claims for breach of contract, violation of the Oklahoma Consumer Protection Act, and deceit. Defendant successfully moved to dismiss these claims on the ground that they were expressly preempted by the federal Employee Retirement Income Security Act. On appeal, the Oklahoma Supreme Court reversed and held that plaintiff’s claims were not preempted. The case was returned to the trial court for further proceedings. View "Cates v. Integris Health, Inc." on Justia Law

The Idaho Supreme Court answered a certified question of Idaho law from the United States District Court for the District of Idaho. The question certified centered on whether, for purposes of the dispute in this lawsuit, the terms ‘state board of correction’ as used in Idaho Code 20-237B(1) and ‘department of correction’ as used in Idaho Code § 20-237B(2), included privatized correctional medical providers under contract with the Idaho Department of Correction. The Court answered the question certified in the negative. View "In Re: Pocatello Hospital, LLC v. Corazon, LLC" on Justia Law

Appellant BCBSM, Inc. (“Blue Cross”) denied respondent James Linn’s insurance claim because the requested treatment was not considered medically necessary under the parties’ health-plan contract. After Blue Cross denied the claim, an external-review entity determined that the treatment was, in fact, medically necessary for Linn’s condition. Blue Cross paid the claim, but Linn and his wife sued Blue Cross for breach of contract. The district court granted summary judgment for Blue Cross, concluding that the treatment was not medically necessary under the contract’s plain terms and that Blue Cross fulfilled its contractual obligations when it paid for the treatment following the external review. The court of appeals reversed. Because the Minnesota Supreme Court concluded: (1) external-review decisions were independent determinations of medical necessity that did not supersede contractual definitions of medical necessity; and (2) the health-plan contract plainly excluded coverage for Linn’s claim for treatment, the Court reversed. View "Linn v. BCBSM, Inc." on Justia Law

Plaintiff Lisa Wilson appealed dismissal of her complaint seeking damages against defendants, University of Alabama Health Services Foundation, P.C. ("UAHSF"); Carla Falkson, M.D.; Tina Wood, M.D.; Ravi Kumar Paluri, M.D.; and Mollie DeShazo, M.D., based on the tort of outrage. Wilson's complaint alleged that, in late 2011, her elderly mother, Elizabeth Monk Wilson ("Elizabeth"), was diagnosed with and underwent treatment for colon cancer. According to Wilson, before the onset of Elizabeth's illness, Elizabeth had executed an advanced health-care directive that "instruct[ed] ... caregivers to use all available means to preserve [Elizabeth's] life" and further named Wilson as Elizabeth's health-care proxy "in the event [Elizabeth] became 'too sick to speak for' herself." Elizabeth subsequently suffered a recurrence of her cancer. In August 2015, she was admitted to the University of Alabama at Birmingham Hospital, a facility operated by UAHSF. In her complaint, Wilson alleged that, while Elizabeth was in the hospital, she was treated by the doctors. She further alleged that the doctors made numerous and repeated tactless comments to Elizabeth and Wilson about Elizabeth's condition and her impending death, and to the effect that she was wasting resources by being in the hospital instead of dying at home. Wilson's complaint alleged a single claim for damages "for the tort of outrage, and for the tort of intentional infliction of emotional distress" and sought compensatory and punitive damages. Wilson sought to hold UAHSF vicariously liable for the alleged conduct of the doctors, which conduct, she alleged, occurred within the line and scope of the doctors' employment with UAHSF. The Alabama Supreme Court determined the trial court's holding that the tort of outrage "is limited to three situations" was an incorrect statement of law: the tort can be viable outside the context of the above-identified circumstances and has previously been held to be so viable. The Court therefore reversed the trial court's judgment and remanded the case for further proceedings where the trial court should, under the standard appropriate for a motion to dismiss under Rule 12(b)(6), determine whether the alleged conduct was "so extreme in degree as to go beyond all possible bounds of decency and be regarded as atrocious and utterly intolerable in a civilized society." View "Wilson v. University of Alabama Health Services Foundation, P.C." on Justia Law

This case turned on whether an attorney-in-fact made a “health care decision” by admitting her principal to a residential care facility for the elderly and, in the process, agreeing to an arbitration clause. The trial court found she acted outside the scope of her authority under the power of attorney, and the arbitration clause this appeal seeks to enforce was void. The issue this case presented for the Court of Appeal’s review centered on the scope of two statutes, the Power of Attorney Law (Prob. Code, sec. 4000 et seq. (PAL)), and the Health Care Decisions Law (Prob. Code, sec. 4600 et seq. (HCDL)), in light of the care a residential care facility for the elderly agreed to provide, and actually provided, in this instance (Health & Saf. Code, sec. 1569 et seq.). For resolution, the Court had to parse the authority of two of the principal’s relatives, one holding a power of attorney under the PAL and one holding a power of attorney under the HCDL. The Court concluded admission of decedent to the residential care facility for the elderly in this instance was a health care decision, and the attorney-in-fact who admitted her, acting under the PAL, was not authorized to make health care decisions on behalf of the principal. As a result of this conclusion, the Court affirmed the trial court’s denial of a motion by the residential care facility to compel arbitration. Because the attorney-in-fact acting under the PAL did not have authority to make health care decisions for her principal, her execution of the admission agreement and its arbitration clause are void. View "Hutcheson v. Eskaton Fountainwood Lodge" on Justia Law

Artur Hefczyc appealed an order denying his motion for class certification in his lawsuit against Rady Children's Hospital-San Diego (Rady). On behalf of a proposed class, Hefczyc sought declaratory relief to establish that Rady's form contract, signed by patients or guarantors of patients who receive emergency room care, authorized Rady to charge only for the reasonable value of its services, and that Rady therefore was not authorized to bill self-pay patients based on its master list of itemized charge rates, commonly referred to as the "Chargemaster" schedule of rates, which Hefczyc alleged was "artificial" and "grossly inflated." The trial court denied Hefczyc's motion for class certification, concluding that the class was not ascertainable, that common issues did not predominate, and that class action litigation was not a superior means of proceeding. Hefczyc contends that the trial court erred in denying class certification because, as the complaint sought only declaratory relief, the motion for class certification was brought under the equivalent of Federal Rules of Civil Procedure, rule 23(b)(1)(A) or (b)(2) (28 U.S.C.), for which he was not required to establish the ascertainability of the class, that common issues predominated and that class action litigation was a superior means of proceeding. Hefczyc also contended that even if the trial court properly imposed those three requirements in this action, the trial court abused its discretion in concluding that those requirements were not met. After review, the Court of Appeal concluded that Hefczyc's arguments lacked merit, and accordingly affirmed the order denying class certification. View "Hefczyz v. Rady Children's Hosp." on Justia Law

E. Kendrick Smith, an Atlanta lawyer, brought this action to compel a corporation, Northside Hospital, Inc. and its parent company, Northside Health Services, Inc., (collectively, “Northside”), to provide him with access to certain documents in response to his request under the Georgia Open Records Act (“the Act”). A government agency owns and operates a large and complex hospital as part of its mission to provide healthcare throughout Fulton County. The agency leased its assets (including the hospital) to the Northside for a 40-year term at a relatively minimal rent. All governmental powers were delegated to Northside with respect to running the hospital and other assets. Northside’s organizing documents reflected that its purpose aligned with the agency’s: to provide healthcare for the benefit of the public. Thirty years into the arrangement, the corporation became “massive,” and owned other assets in surrounding counties. In resisting Smith’s request for records, Northside argued it no didn’t really do anything on behalf of the agency (in part because the now nearly-nonexistent agency has no idea what the corporation is doing), and thus the corporation’s records of a series of healthcare-related acquisitions weren’t subject to public inspection. The Georgia Supreme Court surmised that if the corporation’s aggressive position were wholly correct, it would cast serious doubt on the legality of the whole arrangement between Northside and the agency. Smith argued everything Northside did was for the agency’s benefit and thus all of its records were public. The Supreme Court concluded both were wrong: Northside’s operation of the hospital and other leased facilities was a service it performed on behalf of the agency, so records related to that operation were public records. But whether the acquisition-related records sought here were also public records depended on how closely related the acquisition was to the operation of the leased facilities, a factual question for the trial court to determine on remand. View "Smith v. Northside Hospital, Inc." on Justia Law

Plaintiff YDM Management Company, Inc. (YDM) appeals from a judgment of the trial court in favor of defendant Sharp Community Medical Group, Inc. (Sharp), after Sharp successfully moved for summary judgment of YDM's operative complaint. YDM purchased accounts receivable from Doctors Express, a company that operated urgent care facilities in San Diego, for services rendered to Sharp managed care members. In its role as an Independent Practice Association (IPA), Sharp provided health insurance to its managed care members, and paid claims for services provided to its members. At the time that it provided the services at issue to Sharp members, Doctors Express did not have a preferred provider contract with Sharp. Providers without a contract with an IPA were reimbursed for nonemergency medical services provided to the IPA's members at amounts significantly less than the "reasonable and customary value for the health care services rendered." However, an IPA such as Sharp was required by regulation to reimburse out of network providers for the full "reasonable and customary value" for any emergency medical services provided to its members. As the assignee of Doctors Express, YDM filed this lawsuit seeking additional reimbursement from Sharp for services provided by Doctors Express to members of Sharp's health plan, beyond the amount that Sharp had already reimbursed Doctors Express for those services. The trial court granted summary judgment in favor of Sharp. On appeal, YDM contended the trial court erred in granting summary judgment in Sharp's favor based on the declaration of a Sharp employee, and that the court erred in failing to give adequate consideration to the declaration of YDM's expert in concluding that there was no triable issue of material fact. The Court of Appeal concluded the trial court did not err in granting summary judgment in favor of Sharp. View "YDM Management Co., Inc. v. Sharp Community Med. etc." on Justia Law

In 2012, petitioners Saint Francis Hospital, Inc., Neurological Surgery, Inc., and Douglas Koontz, M.D. performed decompressive laminectomies of respondent Johnson John’s spine at the C2-3, C3-4, C4-5, C5-6 and C6-7 regions. After the operation, respondent allegedly became partially paralyzed, suffered constant pain, was hospitalized for four months and submitted to additional medical treatment. Respondent filed suit against petitioners in 2016, alleging negligence, gross negligence, medical malpractice and sought punitive damages for petitioners’ failure to render reasonable medical care, breach of the duty of care owed and respondent’s resulting injuries. In commencing the action, respondent failed to attach an affidavit of merit to the Petition or otherwise comply with Okla. Stat. tit. 12, section 19.1. In lieu of answer, petitioners filed their respective motions to dismiss and asserted, among other things, respondent’s failure to include the statutorily required affidavit of merit or, in the alternative, obtain a statutorily recognized exception. Respondent averred that the statutory directive unconstitutionally restrained a litigant's right to access the courts and was an unconstitutional special law. The district court provided notice to the Attorney General's office concerning the challenged statute. As intervenor, the Attorney General essentially urged the district court to enforce the affidavit requirements. The district court ultimately overruled petitioners’ motions to dismiss, and rejected respondent’s special law challenge. The court determined that section 19.1 unconstitutionally imposed a substantial and impermissible impediment to access to the courts, and this barrier was unconstitutional regardless of the financial worth of a litigant and was not cured by exercising the indigent from this burden. The Oklahoma Supreme Court agreed with the district court’s ruling, and found section 19.1 was an impermissible barrier to court access and an unconstitutional special law. Section 19.1 was therefore stricken. View "John v. St. Francis Hospital" on Justia Law