Justia Civil Procedure Opinion Summaries

The Patient Protection and Affordable Care Act (ACA) creates “navigators,” to assist consumers in purchasing health insurance from exchanges, 42 U.S.C. 18031(i), and authorizes the Department of Health and Human Services to establish standards for navigators and exchanges. HHS regulations recognize: federal navigators, certified application counselors (CACs), and non-navigator assistance personnel. They conduct many of the same activities, but federal navigators have more extensive duties. Plaintiffs, federally-certified counselor designated organizations, employ CACs. The federal government established a Missouri Federally Facilitated Exchange. The Health Insurance Marketplace Innovation Act (HIMIA), Mo. Rev. Stat. 376.2000, regulates “person[s] that, for compensation, provide[] information or services in connection with eligibility, enrollment, or program specifications of any health benefit exchange.” Regulatory provisions dictate what state navigators and cannot do. Plaintiffs challenged: the definition of state navigators; three substantive provisions; and penalty provisions. The district court granted a preliminary injunction, finding that the ACA preempted HIMIA. The Eighth Circuit affirmed in part, finding likelihood of success in challenges to HIMIA requirements that: state navigators refrain from providing information about health insurance plans not offered by the exchange; that in some circumstances, the navigator must advise consultation with a licensed insurance producer regarding private coverage; and that CACs provide information about different health insurance plans and clarify the distinctions. The court vacated the preliminary injunction, holding that ACA does not entirely preempt HIMIA. View "St. Louis Effort For AIDS v. Huff" on Justia Law

Providers of “habilitation services” under Idaho’s Medicaid plan are reimbursed by the state Department of Health and Welfare. Section 30(A) of the Medicaid Act requires Idaho’s plan to “assure that payments are consistent with efficiency, economy, and quality of care” while “safeguard[ing] against unnecessary utilization of . . . care and services,” 42 U.S.C. 1396a(a)(30)(A). Providers of habilitation services claimed that Idaho reimbursed them at rates lower than section 30(A) permits. The district court entered summary judgment for the providers. The Ninth Circuit affirmed, concluding that the Supremacy Clause gave the providers an implied right of action, under which they could seek an injunction requiring compliance. The Supreme Court reversed, concluding that there is no private right of action. The Supremacy Clause instructs courts to give federal law priority when state and federal law clash, but it is not the source of any federal rights and does not create a cause of action. The suit cannot proceed in equity. The power of federal courts of equity to enjoin unlawful executive action is subject to express and implied statutory limitations. The express provision of a single remedy for a state’s failure to comply with Medicaid’s requirements, the withholding of Medicaid funds by the Secretary of Health and Human Services, 42 U.S.C. 1396c, and the complexity associated with enforcing section 30(A) combine to establish Congress’s “intent to foreclose” equitable relief. View "Armstrong v. Exceptional Child Ctr., Inc." on Justia Law

Sarun, uninsured when he received emergency services from a hospital owned by Dignity Health, signed an agreement to pay the "full charges, unless other discounts apply.” The agreement explained uninsured patients might qualify for government aid or financial assistance from Dignity. After receiving an invoice for $23,487.90, which reflected a $7,871 “uninsured discount,” and without applying for any other discount or financial assistance, Sarun filed a putative class action, asserting unfair or deceptive business practices (Business and Professions Code 17200) and violation of the Consumers Legal Remedies Act (Civ. Code, 1750). The complaint alleged that: Dignity failed to disclose uninsured patients would be required to pay several times more than others receiving the same services, the charges on the invoice were not readily discernable from the agreement, and the charges exceeded the reasonable value of the services. The trial court dismissed, finding that Sarun had not adequately alleged “actual injury.” The court of appeal reversed. Dignity’s argument Sarun was required to apply for financial assistance to allege injury in fact would be akin to requiring Sarun to mitigate damages as a precondition to suit. Mitigation might diminish recovery, butt does not diminish the party’s interest in proving entitlement to recovery. View "Sarun v. Dignity Health" on Justia Law

Lance, 53 years old, has spent much of his adult life incarcerated or institutionalized. After being paroled in 1997, he was admitted to mental health facilities 15 times before the involuntary admission at issue. In 2008 after serving a sentence for parole violations, he was involuntarily admitted to Chester Mental Health Center (CMHC). A 2011 petition included a certificate by a CMHC staff psychiatrist that described threats, violent acts, resisting treatment, and inappropriate behaviors. At the commitment hearing a CMHC social worker, testified that he had interviewed Lance and those treating him, had reviewed the clinical file, that Lance has “an Axis I diagnosis of schizoaffective disorder, bipolar type, paraphilia NOS, history of noncompliance with the medications, and an Axis II diagnosis of antisocial personality disorder,” that Lance displayed “delusional thought content which is grandiose, paranoid, and persecutory in nature,” that he had periodic inappropriate sexual conduct, that he engaged in acts of verbal and physical aggression, and that he was noncompliant with medication. Lance appealed his involuntary admission, arguing the court violated the Mental Health and Developmental Disabilities Code, 405 ILCS 5/1-100, by disregarding his request, in testimony, to be voluntarily admitted. The appellate court ruled more than nine months after the term of commitment ended and reversed. The Illinois Supreme Court reinstated the trial court ruling, The Mental Health Code does not require a ruling for or against voluntary admission, based on an in-court request for voluntary admission during a hearing for involuntary admission, nor does it require a court to sua sponte continue a proceeding for involuntary admission upon such a request.View "In re Lance H." on Justia Law

Real party in interest Michael Wiley brought a putative class action against Renown Regional Medical Center regarding its lien practices. Both parties filed motions for summary judgment. After a hearing, the district court denied Renown’s motion and granted Wiley’s motion. Notably, the court found in favor of Wiley on two of his claims for relief even though the full merits of those claims were not specifically argued in the cross-motions for summary judgment or at the hearing. Renown then filed this original petition for a writ of mandamus challenging the district court’s order. The Supreme Court (1) granted the petition in part, holding that the district court erred by granting summary judgment on the two causes of action that were not argued in summary judgment briefing or in oral argument; and (2) denied the remainder of the petition.View "Renown Reg'l Med. Ctr. v. Second Judicial Dist. Court" on Justia Law

Petitioner filed suit against her former employers, alleging violation of Health and Safety Code section 1278.5 and a violation of public policy. Petitioner subsequently filed a petition for writ of mandate challenging the denial of a jury trial. The court concluded that denial of a jury trial in this case is a proper matter for writ relief. The court also concluded that the statutory language and legislative history of section 1278.5 reflect an intent to permit a jury trial. Even apart from this evidence of legislative intent, the court concluded that a jury trial is appropriate as the gist of plaintiff's cause of action sounds in law rather than equity. Accordingly, the court granted the petition for writ of mandate.View "Shaw v. Super. Ct." on Justia Law

A patient at a health clinic learned that a clinic employee, who was not authorized to access the patient’s medical record, had discussed the patient’s pregnancy with a clerical worker at the clinic. The patient complained to a supervisor, accusing the clinic employee of breaching medical confidentiality. Shortly afterward, the clinic operator fired the employee, citing a breach of confidentiality. The employee then sued the patient for defamation. The patient counterclaimed for invasion of privacy and abuse of process, the latter claim being based on the employee’s filing and withdrawing an earlier petition for a protective order. At some point the clinic investigated the patient’s complaint and determined that it was unsubstantiated. It was later revealed that the patient herself was the source of the employee’s knowledge about the patient’s pregnancy. At trial the patient claimed that she had an absolute privilege to accuse the employee of breaching medical confidentiality. The superior court rejected that argument and determined that the patient had only a conditional privilege. The superior court also denied the patient’s motion for summary judgment and made several challenged evidentiary rulings. After a three-day jury trial, the superior court granted a directed verdict on the patient’s abuse-of-process counterclaim. The jury returned a verdict for the employee on her defamation claim, awarding one dollar in nominal damages; the jury rejected the patient’s counterclaim of invasion of privacy. Finding the employee to be the prevailing party, the superior court awarded her partial attorney’s fees. The patient appealed the superior court’s ruling on conditional privilege, its denial of her motion for summary judgment, and its evidentiary rulings. She also argued the trial court erred in giving jury instructions, in its decision to grant a directed verdict on her abuse-of-process counterclaim, and in its award of attorney’s fees to the employee. She claimed various violations of her state and federal constitutional rights. The Supreme Court concluded that the superior court did not err in any of its legal or evidentiary rulings or in its instructions to the jury, and it therefore affirmed the superior court in all respects.View "Greene v. Tinker" on Justia Law

The patient in this case alleged that his physician negligently performed a surgical procedure and breached his duty to obtain informed consent. The patient also sued the supervising health services corporation based on vicarious liability and independent negligence. The jury found both the physician and the corporation negligent and apportioned liability between them. On appeal, the physician and corporation argued the trial court erred in several evidentiary rulings, incorrectly instructed the jury on proximate cause, and wrongly awarded pre- and post-judgment interest. In cross appeals, the physician and corporation sought review of the trial court’s decision to submit a supplemental question to the jury, as well as its failure to alter the damages award based on the jury’s response to that supplemental question. The Supreme Court affirmed the judgment in favor of the patient. The trial court should not have requested supplemental information from the jury after the verdict. Although the trial court decided not to modify the verdict, the jury’s response to the supplemental question arguably could have affected other proceedings between the physician and corporation. The case was remanded with instructions to the Superior Court to vacate the supplemental verdict. View "Shapria, M.D. et al. v. Christiana Care Health Services, Inc., et al." on Justia Law

E.Y., a child, was diagnosed with diplegic cerebral palsy. His mother alleges that E.Y.’s illness resulted from medical malpractice by the federally-funded Friend Family Health Center, where she received her prenatal care, and the private University of Chicago Hospital, where she gave birth. Federal law makes a suit against the Center a suit against the United States under the Federal Tort Claims Act (FTCA) that had to be filed within the FTCA’s two-year statute of limitations, 28 U.S.C. 2401(b). The district court granted summary judgment for the government, finding that the suit was filed about two weeks too late. The mother argued that although she was aware she might have a claim against the University Hospital more than two years before filing this suit, she remained unaware that the Friend Center might be involved until she received a partial set of medical records on December 14, 2006, making her suit timely. The Seventh Circuit reversed. A reasonable trier of fact could find that Ms. Wallace the mother was unaware and had no reason to be aware of the Friend Center’s potential involvement in her son’s injuries until less than two years before she filed suit. View "E. Y., v. United States" on Justia Law

Foglia, an RN, was hired by Renal, a dialysis care services company, in 2007, and was terminated in 2008. Foglia filed a qui tam complaint against Renal under the False Claims Act, 31 U.S.C. 3729, in 2009. The United States chose not to intervene. In a second amended complaint, Foglia claimed that Renal falsely certified that it was in compliance with state regulations regarding quality of care, falsely submitted claims for reimbursement for the drug Zemplar, and re-used single-use Zemplar vials. The court dismissed, finding that Foglia had failed to state his claim with the heightened level of particularity required by Federal Rule of Civil Procedure 9(b) for fraud claims. The court noted Foglia’s failure to provide a “representative sample” or to “identify representative examples of specific false claims” and that even if Foglia’s claim had met the requirement of Rule 9(b), Foglia “provided no authority under an express or implied false certification theory that the claims submitted … violated a rule or statute establishing compliance as a condition of payment.” Foglia appealed dismissal of his claim of over-billing on Zemplar. The Third Circuit reversed, noting that it was a close case, the need to assume that Foglia was correct in alleging that Renal did not follow proper procedures if it was to harvest “extra” Zemplar from used vials, and that only Renal has access to the documents that could prove the claim. View "Foglia v. Renal Ventures Mgmt., LLC" on Justia Law