Justia Health Law Opinion Summaries

by
The United States Court of Appeals for the Ninth Circuit ruled in a case involving a claimant who was denied Social Security benefits. The claimant, who had undergone surgery to treat a brain condition known as Arnold-Chiari malformation, testified to experiencing severe and frequent headaches. However, the Administrative Law Judge (ALJ) rejected his testimony regarding the severity of his headaches, asserting that his headache symptoms were inconsistent with the medical evidence and his daily activities.The court of appeals found that the ALJ failed to provide clear and convincing reasons for rejecting the claimant's symptom testimony regarding his headaches. It noted that the ALJ did not specify which of the claimant's symptoms were inconsistent with the record evidence. The court also rejected the argument that a claimant must provide independent medical evidence to establish the severity of headaches.Furthermore, the court found that the claimant's daily activities were not inconsistent with his testimony about the severity and frequency of his headaches. The district court's affirmation of the ALJ's decision based on the claimant's conservative treatment was also found erroneous since the ALJ did not consider this factor. Consequently, the court reversed the judgment of the district court, remanding it back to the ALJ to reconsider the credibility of the claimant's headache symptom testimony. View "Ferguson v. O'Malley" on Justia Law

by
The case involved an appeal by two brothers, Jonathan and Daniel Markovich, who were convicted for operating fraudulent drug rehabilitation clinics in Florida. They were found guilty of various charges, including health-care fraud, wire fraud, kickbacks, money laundering, and bank fraud, resulting in fraudulent claims of over $100 million.The brothers appealed their convictions on several grounds. They argued that the district court violated their constitutional rights by denying their motion to compel the prosecution to obtain and disclose confidential medical records possessed by third parties. They also claimed that the court violated Federal Rules of Evidence by admitting unreliable and confusing expert testimony about the clinics' medical and billing practices. Additionally, they argued that the court abused its discretion by admitting lay summary testimony about medical and billing records.The United States Court of Appeals for the Eleventh Circuit affirmed the convictions. The court ruled that the prosecution had no duty to seek out potentially exculpatory evidence not in its possession. It also determined that the expert testimony was clear and reliable, and the summary testimony was proper. The court found that any challenge to bank-fraud counts was forfeited due to a lack of explanation or supporting legal authority. Finally, the court ruled that the district court did not abuse its discretion by denying the brothers' motion for a new trial based on newly discovered evidence. View "United States v. Markovich" on Justia Law

by
This case involves an appeal against a judgment from the Montana Eighteenth Judicial District Court, Gallatin County, which committed the appellant, G.M., into the custody and care of the Montana State Hospital (MSH) for involuntary mental health treatment. The key issue at hand is whether the District Court erroneously found that G.M. was unable to adequately care for her own basic needs and safety based on hearsay statements made by her husband through the testimony of a court-appointed professional.G.M., aged 66 at the time of the petition for involuntary mental health commitment in 2021, was alleged to be suffering from a diagnosed psychotic mental disorder. G.M.'s husband's statements, along with her own behavior and assessments from mental health professionals, were the basis for the court's decision. G.M.'s counsel repeatedly objected to the court-appointed professional's testimony regarding her husband's out-of-court statements, but these objections were overruled.G.M. testified on her own behalf, denying having a mental disorder or requiring treatment. Despite this, the District Court found that due to her diagnosed schizophrenic and delusional mental disorder, G.M. was “substantially unable to provide for her own basic needs of food, clothing, shelter, health, or safety."On appeal, the Supreme Court of the State of Montana affirmed the judgment of the lower court. The court found that the lower court's decision was not clearly erroneous and was supported by substantial admissible evidence. The court stated that the hearsay statements of G.M.'s husband were admissible under the rules of evidence to explain the underlying rationale for the court-appointed professional person's expert opinion. The court also noted that the judgment was independently supported by the professional person's personal observations and opinions on G.M.'s condition and ability to care for her own needs and safety. View "In re Matter of G.M." on Justia Law

by
In 2010, Ángel M. Ayala-Vázquez was indicted and convicted on multiple drug-related charges, including conspiring to possess with intent to distribute and aiding and abetting the possession of with intent to distribute over 280 grams of cocaine base. He was sentenced in 2011 to life imprisonment. In 2021, Ayala filed a motion to reduce his sentence under the First Step Act and for compassionate release due to his hypertension and obesity making him vulnerable to COVID-19.The District Court denied Ayala's motion, concluding that he was ineligible for a sentence reduction under the First Step Act because his sentences were imposed "in accordance with" the amendments made by the Fair Sentencing Act. The court also rejected his request for compassionate release, finding that Ayala failed to demonstrate extraordinary and compelling reasons to warrant such relief. Moreover, the court determined that Ayala posed a danger to other persons and the community.On appeal to the United States Court of Appeals for the First Circuit, the court affirmed the District Court's decision. It concluded that Ayala was indeed convicted of offenses involving 280 grams or more of cocaine base, and his life sentences were in accordance with the Fair Sentencing Act. Therefore, he was not eligible for a sentence reduction under the First Step Act. As for the compassionate release, the court found no abuse of discretion in the District Court's evaluation of Ayala's health conditions and perceived danger to the community. View "United States v. Ayala-Vazquez" on Justia Law

by
The United States Court of Appeals for the Fifth Circuit reviewed a case involving the question of whether the federal Title X program preempts a Texas law that gives parents the right to consent to their teenagers’ obtaining contraceptives. Alexander Deanda, a father raising his children according to Christian beliefs, challenged the Secretary of Health and Human Services' administration of Title X, which funds clinics providing contraceptives to minors without parental notification or consent. Deanda contested this on the grounds that it nullifies his right to consent to his children's medical care, infringing on his state-created right. The court held that Title X does not preempt Texas's law. The statute does not preempt Deanda's parental right to consent to his children's obtaining contraceptives because Title X's goal (encouraging family participation in teens’ receiving family planning services) is not undermined by Texas's goal (empowering parents to consent to their teen’s receiving contraceptives). Instead, the two laws reinforce each other. The court affirmed the district court’s judgment to the extent it declared that Title X does not preempt Texas's parental consent law. However, the court reversed the partial vacatur of a regulation which forbids Title X grantees from notifying parents or obtaining their consent, as the regulation was not challenged by Deanda under the Administrative Procedure Act or otherwise. View "Deanda v. Becerra" on Justia Law

by
In this case, the United States Court of Appeals for the Eighth Circuit was asked to determine whether Arkansas Code § 23-92-604(c), also known as Act 1103, was preempted by federal law. Act 1103 prohibits pharmaceutical manufacturers from limiting the ability of healthcare providers, who are eligible for drug pricing discounts under the Section 340B Program, to contract with outside pharmacies for drug distribution.The Pharmaceutical Research and Manufacturers of America (PhRMA) sued the Commissioner of the Arkansas Insurance Department, arguing that Act 1103 was unconstitutional because it was preempted by the Section 340B Program and the Federal Food, Drug, and Cosmetic Act, under theories of field, obstacle, and impossibility preemption.The court, however, disagreed with PhRMA's arguments. The court found that Act 1103 did not create an obstacle for pharmaceutical manufacturers to comply with 340B, rather it assisted in fulfilling the purpose of 340B. The court also found that Act 1103 did not make it impossible for drug manufacturers and wholesale distributors to comply with the Risk Evaluation and Mitigation Strategies (REMS) Program under the Federal Food, Drug, and Cosmetic Act.Therefore, the court held that Act 1103 was not preempted by either the Section 340B Program or the Federal Food, Drug, and Cosmetic Act. As such, the court affirmed the district court’s decision in favor of the Intervenors and against PhRMA. View "Pharmaceutical Research and Mfrs of America v. McClain" on Justia Law

by
In this case, the United States Court of Appeals for the Tenth Circuit dealt with the appeal of Youlian Zhong, who contested her mandatory minimum sentences for crimes related to her participation in a conspiracy to manufacture and distribute large quantities of marijuana. Zhong argued that the district court erred in finding that she did not qualify for the statutory safety valve for mandatory minimum sentences.Zhong and her husband, Housheng Xian, were found guilty of conspiring to grow more than 1,500 marijuana plants in their residence, intending to process and sell the marijuana. They were convicted on three counts: conspiring to manufacture and possess with the intent to distribute 1,000 and more marijuana plants, manufacturing and possessing with intent to distribute 1,000 or more marijuana plants, and using and maintaining their house for the purpose of manufacturing and distributing marijuana.Before sentencing, Zhong and Xian requested a non-guideline sentence of time served plus five years of supervised release, arguing that they met the requirements of the safety valve provisions. However, the court found that they did not provide all necessary information to the government, particularly regarding their mens rea, or intent, for the crimes for which they were convicted.On appeal, the Tenth Circuit affirmed the lower court's decision. The appeals court held that a defendant must provide the government with information sufficient to prove the mens rea required for the crimes of conviction to meet the requirement of providing “all information and evidence” concerning the offense for the safety valve provision to apply. The court concluded that Zhong did not provide sufficient information about her intent to commit the crimes for which she was convicted, and thus, did not meet her burden to prove that she qualified for safety-valve relief. View "United States v. Zhong" on Justia Law

by
The United States Court of Appeals for the Second Circuit heard a case initiated by Adam Hart, who filed a qui tam action under the False Claims Act (FCA) against pharmaceutical distributor McKesson. Hart alleged that McKesson provided business management tools to its customers for free in exchange for commitments to purchase drugs, which he claimed violated the federal anti-kickback statute (AKS) and several analogous state laws. The district court dismissed Hart's FCA claim, determining he failed to allege McKesson acted "willfully" as required by the AKS.On appeal, the Second Circuit held that to act "willfully" under the AKS, a defendant must knowingly act in a way that is unlawful. The court found that Hart failed to provide sufficient facts to meet this standard. However, the court disagreed with the district court's assertion that Hart's state claims were premised solely on a violation of the federal AKS. Consequently, the Second Circuit affirmed the dismissal of Hart’s federal FCA claim, vacated the dismissal of the remaining state claims, and remanded for further proceedings. View "United States, ex rel. Hart v. McKesson Corp." on Justia Law

by
In a medical malpractice case before the Supreme Court of the State of Nevada, the plaintiff, Kimberly D. Taylor, sued Dr. Keith Brill and Women’s Health Associates of Southern Nevada-Martin PLLC for professional negligence. Taylor alleged that Dr. Brill breached the standard of care by perforating her uterus and bowel during a surgical procedure and failed to inform her of these complications. The jury ruled in favor of Dr. Brill and denied all of Taylor’s claims.The Supreme Court of Nevada held that in a professional negligence action, evidence of informed consent and assumption of the risk are irrelevant and inadmissible when the plaintiff does not challenge consent. The court stated that even if a plaintiff gave informed consent, it would not vitiate the medical provider’s duty to provide treatment according to the ordinary standard of care. Furthermore, evidence of a procedure’s risks must still fall within Nevada's professional negligence statute, and a case-by-case analysis is required to determine whether the evidence should be excluded due to its potential to confuse the jury.The court also held that expert or physician testimony is not required to demonstrate the reasonableness of the billing amount of special damages. The court found that the district court had abused its discretion by prohibiting non-expert evidence demonstrating the reasonableness of the charges for medical treatment received by Taylor.Finally, the court ruled that evidence of insurance write-downs is not admissible under NRS 42.021(1), as it only contemplates evidence of actual benefits paid to the plaintiff by collateral sources.Based on these errors, the Supreme Court of Nevada reversed the judgment and remanded the case for further proceedings, including a new trial. View "Taylor v. Brill" on Justia Law

by
The case involves the Mississippi Division of Medicaid and the Women’s Pavilion of South Mississippi, PLLC. Women's Pavilion, a physician-owned OBGYN clinic, challenged Mississippi Division of Medicaid's calculation of the "encounter rate," a set amount of money per visit by a Medicaid patient. Medicaid set the clinic’s encounter rate at $157.94, which was partially based on the compensation of the five physician owners of the clinic.Women’s Pavilion appealed this decision and requested an administrative hearing. The hearing officer evaluated whether Medicaid’s initial decision was supported by substantial evidence, affirming the reimbursement rate. However, Women’s Pavilion appealed again, arguing that the hearing officer applied the wrong standard of review.The Hinds County Chancery Court agreed with Women’s Pavilion, holding that the hearing officer should have made his own findings of fact and determinations of the issues presented, rather than merely evaluating whether Medicaid’s initial decision was supported by substantial evidence. The court vacated Medicaid’s final decision and remanded the matter back to Medicaid.The Mississippi Division of Medicaid appealed to the Supreme Court of Mississippi. The Supreme Court affirmed the decision of the Hinds County Chancery Court, stating that the hearing officer had erred by applying the standard of review for courts reviewing a final administrative decision, rather than following Medicaid’s own administrative rules governing provider appeals. The case was remanded back to Medicaid for further proceedings under the proper standard of review. View "Mississippi Division of Medicaid v. Women's Pavilion of South Mississippi, PLLC" on Justia Law