High Court Case Summaries on Health Law (Keyed to Clark, Fuse Brown, Gatter, McCuskey, and Pendo)
Author:
Editorial Staff, Publisher's
Edition:
9th
Copyright Date:
2022
74 chapters
have results for health
IHC Health Plans, Inc. v. Commissioner of Internal Revenue 8 results (showing 5 best matches)
- Intermountain Health Care Inc. (IHC) formed a subsidiary, IHC Health Services (Health Services), as a non-profit corporation. Health Services operated twenty-two hospitals, and during a two-year period, Health Services provided $1.2 billion in unreimbursed medical care to Medicaid patients and another $91 million in unreimbursed care to indigent patients. The Commissioner of Internal Revenue (Commissioner) (D) recognized Health Services as having tax-exempt status under § 501(c)(3). Later, IHC formed three additional subsidiary health care companies: IHC Health Plans (Health Plans) (P), IHC Care, Inc. (Care), and IHC Group, Inc. (Group) (P) to operate as health maintenance organizations (HMOs). The Commissioner (D) subsequently concluded that none of these three subsidiaries was operating exclusively for exempt purposes pursuant to .... The Commissioner (D) accordingly revoked the subsidiaries’ exempt status. Health Plans (P), Care (P), and Group (P) brought suit in the United...Health
- Intermountain Health Care Health Plans, Inc. (Health Plans) (P) and other subsidiaries (“Care” and “Group”) (P) of Intermountain Health Care Inc. (IHC) contended that they qualified for tax-exempt status under
- 26 U.S.C. § 501(c)(3), an entity must be operated exclusively for charitable purposes, which, as a matter of law, means that it is operated primarily for such purposes. There is a two-part test for this evaluation. First it must be determined if the purpose of the corporation is “charitable,” and second the corporation must operate primarily to serve this purpose. To be “charitable” the corporation must be engaged in activities that convey a benefit to the public. The public benefit is accepted in exchange for lifting the tax burden and is not a benefit the community actually chooses, but rather is one that supplements or advances the work of public institutions already supported by tax revenues. For example, not every activity that promotes health supports charitable tax exemption status, ...promotes health, but pharmacies cannot qualify for charitable exemption on that basis alone. The magnitude of this benefit must give a strong inference that the organization operates primarily...
- operates exclusively for a charitable purpose, however, is a question of fact, which the court reviews for clear error. Under these standards, the way a health care entity structures its health maintenance organizations (HMOs) can be the determining factor for qualifying for exempt status. If an HMO engages in health care research that will ultimately benefit the community, and if it provides subsidized (i.e., below cost) memberships, free health education, indigent emergency services, etc., to a large cross-section of the community, it will likely qualify. As to the inquiry under the “integral-part” doctrine, to have granted all of IHC’s subsidiaries tax-exempt status based upon the action of Health Services would have amounted to the “tail wagging the dog.” The integral-part doctrine requires the primary activity of the entire corporation to be an integral part of the charitable activities being conducted by the affiliate. It is not sufficient for the profit-making arm of the...
- (Health care corporation) v. (Government agency)
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- Dr. Berlin (P) was employed by the Sarah Bush Lincoln Health Center (Health Center) (D), a nonprofit corporation duly licensed to operate a hospital, pursuant to a written agreement. Berlin (P) resigned prior to the expiration of his five-year contract, and he began working at a nearby clinic. The Health Center (D) sought a preliminary injunction to prohibit Berlin (P) from practicing at the clinic, based on the restrictive covenant in the employment agreement. Berlin (P) filed a complaint for declaratory judgment and a motion for summary judgment to have the restrictive covenant contained in the employment agreement with the Health Center (D) declared unenforceable. The circuit court granted summary judgment, holding that the Health Center (D), as a nonprofit corporation employing a physician, was practicing medicine in violation of the prohibition on the corporate practice of medicine, and a divided appellate court affirmed. The Health Center (D) appealed.
- (Nickels, J.) Yes. A duly licensed hospital is authorized by legislative authority to practice medicine by means of its staff of licensed physicians and is excepted from the operation of the corporate practice doctrine. The corporate practice doctrine, which prohibits corporations from employing physicians to provide medical services, is not applicable to licensed hospitals in the modern health care industry for public policy reasons. Consequently, the employment agreement between the Health Center (D) and Dr. Berlin (P) was not unenforceable merely because the Health Center (D) was a corporate entity. Reversed.
- Dr. Berlin (P) sought to have a restrictive covenant prohibiting him from competing with Sarah Bush Lincoln Health Center (D) declared unenforceable.
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- : Intermountain Health Care Health Plans, Inc. (Health Plans) (P) and other subsidiaries (“Care” and “Group”) (P) of Intermountain Health Care Inc. (IHC) contended that they qualified for tax-exempt status under
- IHC Health Plans, Inc. v. Commissioner of Internal Revenue
- St. David’s Health Care System v. United States
- 26 U.S.C. § 501(c)(3), a health care corporation must be operated primarily for charitable purposes, which, as a matter of law, means that it is operated primarily for such purposes. (2) Pursuant to the integral-part doctrine, a corporation may not qualify for tax-exempt status as a charitable organization under
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- joint federal and state program that, together with the Children’s Health Insurance Program (CHIP), provides health coverage to over
- ..., was a patient at Green Valley Health Care Center when she received notice from Medicaid that she no longer qualified for the high-level care provided to her and would have to move to another facility that provided intermediate-level care. Green Valley was certified to provide that level of care, indeed in the same bed Linton (P) occupied, but the facility chose to “decertify” the bed, in keeping with its own internal policy, and compel the plaintiff’s transfer to another facility. Carney, an Alzheimer’s patient, suffered a similar fate, and no placement could be found for her. Her condition declined to the point where she required emergency hospitalization. Tennessee law had previously placed a percentage limitation on the number of available Medicaid beds in nursing homes, but it abolished that program in 1985. Federal law allowed for distinct areas in nursing homes providing different levels of care, but the units had to be separate and within each unit the level of care had...
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Table of Contents 25 results (showing 5 best matches)
- (Gibson, J.) No. A person with an infectious disease who poses a significant risk of communicating an infectious disease to others in the workplace is not otherwise qualified to perform the job. The “direct threat” standard applied in the ADA is based on the same standard as “significant risk” applied by the Rehabilitation Act. Courts defer to the reasonable medical judgments of public health officials in determining whether HIV-positive health care workers pose a significant risk or a direct threat in the performance of the essential functions of their jobs. The Center for Disease Control has released a report advising health care institutions to determine which procedures are exposure-prone and recommends that HIV-infected health care workers not perform such functions. Here, Mauro (P) supervisor explained that a surgical technician may be called upon to assist in the performance of a surgical procedure, though this occurs rarely. The district court did not err in determining that...
- Mauro (P) was employed as an operating room technician at Borgess Medical Center (BMC) (D) when someone called BMC (D) saying that Mauro had full-blown AIDS. Because of the fear of exposure, a new position was offered to Mauro (P), who was HIV positive. Mauro (P) refused the new position, and he was laid off. Mauro (P) then filed suit, alleging discrimination under § 504 of the Rehabilitation Act and the Americans with Disabilities Act (ADA). The district court found that Mauro’s (P) continued employment as a surgical technician posed a direct threat to the health and safety of others and granted BMC’s (D) motion for summary judgment. Mauro (P) appealed.
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- The asserted liberty interest here is the right to refuse a vaccination. Klaassen (P) claims that he is being coerced into refraining from exercising this right because he will be denied the public benefit of a college education if he does not get vaccinated. The right to refuse a vaccination is a substantial liberty intertest, meaning that the governmental action here is subject to rational basis review, not strict scrutiny. Stemming the spread of COVID-19 is unquestionably a compelling interest. Indiana University (D) has a legitimate interest in promoting the health of its campus communities. Klaassen (P) and the other plaintiffs argue that the pandemic is basically over, but this goes against current proclamations from the Secretary of Health and Human Services, the Indiana State Department of Health, Governor Eric Holcomb, and the CDC, all then supported for institutions of higher learning by the U.S. Department of Education and the American College Health Association.
- GOVERNMENT ACTION ON A MATTER OF PUBLIC HEALTH IS SUBJECT TO RATIONAL BASIS REVIEW
- The Trustees (D) provide broad exemptions and the mandate is directed not to the general public, but only to university students and staff. Trustees (D) reasonably concluded that the “benefit dwarfs the potential rare risks.” Klaassen’s (Ps) arguments amount to disputes over the most reliable science. The court will intervene so long as the Trustees (D) process is rational in trying to achieve public health. Trustees (D) have a rational basis to conclude that the COVID-19 vaccine is safe and efficacious for its students. Request denied.
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Aetna Health Inc. v. Davila 5 results
- Ruby R. Calad (P) and Juan Davila (P) were among four health maintenance organization (HMO) subscribers who sued their HMOs (D) for violating Texas law by denying or delaying their receipt of health benefits. Calad (P), who was a beneficiary of a health plan offered by CIGNA HealthCare of Texas Inc. (CIGNA) (D), had a hysterectomy, and CIGNA (D) authorized coverage for only a one-day hospital stay despite the recommendation of Calad’s (P) doctor that she stay in the hospital longer. After Calad (P) suffered complications that caused her to return to the hospital a few days after her release, she sued CIGNA (D) in a Texas state court under the Texas Health Care Liability Act (THCLA). CIGNA (D) removed the case to federal court as preempted by the Employment Retirement Income Security Act of 1974 (ERISA), and the federal court dismissed Calad’s (P) claims as preempted by ERISA. Davila (P) was insured through Aetna Health Inc. (D). His doctor prescribed the drug Vioxx for Davila’s (P)...
- Appeal by health maintenance organizations (HMOs) of Court of Appeals for the Fifth Circuit’s decision to the Supreme Court.
- Immediately after this case was decided, members of Congress concerned with health plans’ treatment of beneficiaries reacted. Rep. John D. Dingell (D-Mich.), ranking member of the House Energy and Commerce Committee, announced he and other Democrats would
- Two participants (P) filed state law claims against their health maintenance organizations (HMOs) for failure to administer proper care. The HMOs (D) argued that their claims were preempted by the Employment Retirement Income Security Act of 1974 (ERISA). The U.S. Court of Appeals found in favor of the participants (P), and the HMOs (D) appealed.
- ...Act of 1974 (ERISA)-regulated employee benefit plan, and where no legal duty (state or federal) independent of ERISA or the plan terms is violated, the suit falls within the scope of ERISA § 502(a)(1)(B). Section 502(a)(1)(B) provides that a civil action may be brought by a plan participant or beneficiary to recover benefits due under the terms of his or her plan, to enforce his or her rights under the plan terms, and to clarify his or her rights to future plan-benefits. The state law claims asserted by Davila (P) and Calad (P) fell within the scope of ERISA § 502(a)(1)(B) because Davila (P) and Calad’s (P) only relationship with or connection to Aetna (D) and CIGNA (D) was through ERISA-governed benefit plans. Several other considerations support the conclusions that ERISA preempts the state law claims. First, the duties imposed on HMOs (D) by the THCLA did not arise independently of ERISA or the plans’ terms. The Texas Health Care Liability Act (THCLA) imposed on HMOs (D)...health
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Beshear v. Acree 3 results
- On January 31, 2020, the United States Department of Health and Human Services declared a national public health emergency based on the rising number of confirmed COVID-19 cases in the United States. On March 6, 2020, Beshear (P) declared a state of emergency in Kentucky. After the statewide declaration, Kentucky’s Cabinet for Health and Family Services (the Cabinet) began issuing orders designed to reduce and slow the spread of COVID-19. On March 17, 2020, the Cabinet issued an order requiring all public-facing businesses that encourage public congregation to close, including gyms, entertainment and recreational facilities, and theaters. Beshear (P) announced on April 21, 2020 a “Healthy at Work” initiative, a phased reopening plan based on criteria set by public health and industry experts. On May 11, 2020 the Commonwealth began reopening its economy and the Cabinet issued minimum requirements that all public and private entities were required to follow, such as maintaining social...
- A GOVERNOR HAS THE POWER TO ISSUE ORDERS DURING A PUBLIC HEALTH EMERGENCY
- Several lawsuits have challenged COVID-19 restrictions issued through executive branch orders on the same grounds as those used by Beshear (P). The Wisconsin Legislature challenged a statewide “Safer at Home” order issued by the state’s chief health officer in response to the population health risks posed by the COVID-19 pandemic. The Wisconsin court held that, because the executive order required individuals statewide to stay home except to conduct certain essential tasks and close all non-essential businesses statewide, it was an agency action of “general applicability” and thus was a rule subject to standard emergency procedures.
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- Virginia taxpayers argued that Virginia’s insurance exchange, which was operated by the federal government, did not entitle them to the advance tax credits available under the Affordable Care Act to purchasers of health insurance through a state-run exchange.
- A taxpayer is eligible for a tax credit if he or she enrolls in an insurance plan through an insurance Exchange, whether established and operated by a state or by the Department of Health and Human Services.
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Whole Woman’s Health v. Hellerstedt 4 results
- (Abortion Providers) v. (Comm’r of the Tex. Dep’t of State Health Servs.)
- Should the substantial burden analysis take into account the extent to which laws that restrict a woman’s access to an abortion serve the government’s interest in promoting health?
- ...test, the extent to which the laws in question serve the government’s stated interest must be weighed against the burden they impose. Here, the provisions at issue do not confer medical benefits that justify the burdens they inflict on women exercising their constitutional right to an abortion. Accordingly, the provisions impose an undue burden and are constitutional. The evidence showed that the admitting privileges requirement did not advance the state’s interest in protecting women’s health, but it did impose a substantial burden by forcing about half of the state’s abortion clinics to close. Likewise, the ambulatory surgical center requirement did not markedly lower the risks of abortions. The requirements were so tangentially related to the procedures performed that they were essentially arbitrary. If the provisions were enforced, only a handful of Texas abortion facilities would remain open, which in itself is a substantial burden on women seeking abortions. The...
- . In 2000, the Court again considered abortion rights and reaffirmed Casey in holding the Nebraska law at issue unconstitutional because (1) it failed to provide an exception to preserve the health of the mother; and (2) it unduly burdened a woman’s right to choose a late-term abortion, thereby unduly burdening her right to choose abortion itself. See
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- : A class of nursing home patients (P) challenged the federal health department (D) practice of enforcing compliance with the Medicaid Act by focusing the homes’ facilities rather than patient care.
- The federal health department must enforce compliance with the Medicaid Act by focusing on patient care.
- Sunshine Haven Nursing Operations v. U.S. Dep’t of Health & Human Services
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- : The Bellevue Hospital Center (P) filed an action challenging the Department of Health and Human Services’ method for calculating Medicare reimbursements. Because the statutory scheme requires hospitals’ costs to be averaged, hospitals with dissimilar costs would inevitably be lumped together.
- : Westside Mothers (Mothers) (P) brought suit against James Haveman (D), the director of the Michigan Department of Community Health, alleging the state of Michigan failed to provide medical services required by the Medicaid program.
- : Exceptional Child Center (P) sued two officials (D) in Idaho’s Department of Health and Welfare, claiming that Idaho violated Medicaid law by reimbursing habilitation service providers at rates lower than the law permits.
- (1) The Medicare statute authorizes the use of “metropolitan statistical areas” (MSAs) as a proxy for “geographical area” as specified in the statute. (2) Expansion of the New York City MSAs to include New Jersey hospitals, where wages are somewhat lower, is not arbitrary or capricious even though it causes the average wage level in the MSA to drop. (3) The Department of Health and Human Services’ implementation of adjustments regarding hiring decisions at hospitals was arbitrary and capricious.
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- In response to a complaint from a Sunshine Nursing Home (D) resident, the Centers for Medicare and Medicaid Services (CMS) contacted the New Mexico Department of Health to conduct surveys of Sunshine (D). The surveys revealed that Sunshine (D) was not in substantial compliance with Medicare requirements. The Health Department sent Sunshine a letter stating providing formal notice of the imposition of statutory denial of payment for new admissions and stating that it would recommend to the CMS office that Sunshine’s provider agreement be terminated if compliance was not achieved. The Department gave Sunshine (D) an extended period of time to come into compliance. The initial complaints were based primarily on the failure to bathe certain residents. Sunshine (D) submitted a plan of correction. Later surveys focused on the improper use of physical restraints and patient body transfer techniques, as well as safety code violations. The plaintiff maintained that Sunshine remained out of...
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- An administrative complaint was filed against Dr. Hoover (P) by the Agency for Health Care Administration (D) claiming she was excessively prescribing controlled substances. Dr. Hoover (P) denied the charge and requested a hearing. The Agency (D) presented two physicians as experts at the hearing. The experts’ had not examined any patient or patient record; the sole basis of their testimony was from pharmacy records. Dr. Hoover (P) testified in great detail about her diagnoses and courses of treatment. The hearing officer recommended that the complaint be dismissed. The Agency (D) filed exceptions to the finding and the Board of Medicine (D) set aside the hearing officer’s findings and penalized Dr. Hoover (P). Dr. Hoover (P) appealed.
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Westside Mothers v. Haveman 2 results
- Westside Mothers (Mothers) (P) brought suit against James Haveman (D), the director of the Michigan Department of Community Health, alleging the state of Michigan failed to provide medical services required by the Medicaid program.
- The Medicaid program provides federal subsidies to participating states to reimburse poor persons for the cost of certain medical care. Participating states must comply with the requirements imposed by the Act, as well as with regulations promulgated by the Secretary of Health and Human Services (HHS). One such requirement is the provision of “early and periodic screening, diagnostic, and treatment services” for eligible persons under 21 years of age. See ...S.C. § 1396d(a)(4)(B). These services include periodic physical exams, immunization, laboratory tests, eye exams, eyeglasses, dental exams and teeth maintenance, hearing exams and treatment of hearing disorders, and health education. The Secretary of HHS has the authority to withhold funding to states in noncompliance with any of Medicaid’s requirements. Westside Mothers (Mothers) (P) alleged that James Haveman (D) refused to provide, or require participating HMOs to provide, the above-names services and sought declaratory and...
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Doe v. Medlantic Health Care Group, Inc. 2 results
- Doe (P) brought suit against Medlantic Health Care Group, Inc. (D) alleging invasion of privacy and breach of a confidential relationship for negligent disclosure of his positive Human Immunodeficiency Virus (HIV) status.
- .... One of Doe’s (P) coworkers at the State Department, Tijuana Goldring (Goldring), also worked at Washington Hospital Center (WHC), the medical institution where Doe (P) was being treated for HIV. Shortly after a visit to the clinic, Doe (P) learned that his co-workers at the State Department knew of his illness and he found himself being subjected to extreme ridicule because of it. Once Doe (P) realized that Goldring was the source of the rumors concerning his medical condition, he filed suit against Goldring for invasion of privacy, and against Medlantic Health Care Group, Inc. (D), the owner of WHC, for breach of confidential relationship. Goldring was later dismissed from the suit, the jury having found that Goldring’s disclosure was not within the scope of her employment at WHC. The jury, however, ruled in favor of Doe (P) against Medlantic (D) awarding damages of $250,000 on the breach of confidential relationship claim. The trial judge, however, granted a motion for...
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In re T.A.C.P. 2 results
- (Parents) v. (Health care providers)
- The parents (P) of the child T.A.C.P. were informed that their child would be born without an upper brain, or anencephalic. The parents (P), hoping to offer some benefit to others in the face of their loss, sought a declaration that the child was “dead”, so that her organs could be donated. The health care providers (D) refused out of fear of liability. The parents (P) then sought a legal ruling on the matter. The question of the definition of death was certified by the appellate court and forwarded to the Supreme Court of Florida.
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- The trustees (D) of the Lucy Webb Hayes National Training School for Deaconesses and Missionaries, a nonprofit institution that provided health care to the poor, did not invest the School’s liquid assets.
- The Lucy Webb Hayes National Training School for Deaconesses and Missionaries (the School) was established in 1891 for the purpose of providing health care services to the poor. It was incorporated as a charitable institution, and the Sibley Memorial Hospital (the Hospital) (D) was built to facilitate its work. The Board was to consist of twenty-five to thirty-five trustees who were to meet twice annually. The Board was to handle all financial matters of the School. In fact, from the early 1950s until 1968, two trustees (D) handled all of these matters. The Finance and Investment Committees never met for years at a time. Some of the trustees (D) were associated with financial institutions. The Hospital (D) maintained most of its liquid assets in these same institutions in non-interest-bearing accounts. A class action suit was brought against the trustees (D) by patients (P) of the Hospital (D) challenging their actions, claiming mismanagement, non-management, and self-dealing.
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St. David’s Health Care System v. United States Your search matches the chapter title
Chapter Fourteen. Fraud and Abuse 1 result
Shannon v. McNulty 3 results
- The Shannons (P) alleged that their physician, Dr. McNulty (D), and their health maintenance organization, HealthAmerica (D), were vicariously liable for the premature delivery and subsequent death of their son.
- When a benefits provider such as a health maintenance organization (HMO) interjects itself into the rendering of medical decisions affecting a subscriber’s care, it must do so in a medically reasonable manner.
- (Melvin, J.) Yes. When a benefits provider such as an HMO interjects itself into the rendering of medical decisions affecting a subscriber’s care, it must do so in a medically reasonable manner. The corporate liability applicable to hospitals may be extended to HMOS as care providers with a substantial role in the total health care of patients. Here, HealthAmerica (D) provided a phone service for emergent care staffed by triage nurses. Hence, it was under a duty to oversee that the dispensing of such advice by those nurses would be performed in a medically reasonable manner. HMOs may therefore be held corporately liable for a breach of duties that causes harm to its subscribers. Reversed and remanded.
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Chapter Fifteen. Antitrust 3 results
Looney v. Moore 2 results
- The plaintiffs, through their parents, sued various defendants for harms they allegedly suffered as a result of taking part in a clinical study while being treated for health issues accompanying their premature births.
- ...an infant to either too much or too little oxygen. The current standard of care allowed for a range of 85 to 95%. For the study, one group of infants was kept at 85 to 89% and the other was kept at an oxygen saturation level between 90 and 95%. The study authors concluded that infants in the high-oxygen range were more likely to be diagnosed with retinopathy, while those in the low range were more likely to die. To enroll in the study, the infants’ guardians had to execute informed consent documents. After the study’s completion, the Department of Health and Human Services questioned whether these informed consent documents had disclosed all of the risks. The plaintiffs in this case alleged that they suffered serious injuries as a result of participating in the study. Two of the participants in the low-oxygen group developed neurological issues. One of the high-oxygen group members developed retinopathy but did not suffer permanent vision loss. The defendants, who ran...
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People First of Alabama v. Merrill 2 results
- The COVID-19 pandemic, at the time of the case, was a public health emergency with 7,129,383 cases of COVID-19 and a reported 204,598 deaths and counting. Evidence suggested the disease was aerosolized and could be transmitted through being in confined spaces with stagnant air.
- At the time the case was brought there was no vaccine and it was unlikely a vaccine would be produced until at least the following year. The Alabama Department of Public Health and various other state and federal authorities had strongly recommended that people remain at home and follow social distancing and masking advice to reduce transmission. COVID-19 posed increased danger to those of old age, people with disabilities, people with pre-existing medical conditions, and people who are Black, Latinx, or Native American. Alabama had reported alarming racial disparities in serious illness and death due to COVID-19.
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Alexander v. Choate 1 result
- ...under the third element. In order to assess whether an MFN clause unreasonably restrains trade, the rule of reason applies. The clause violates the rule of reason if it may suppress or even destroy competition, rather than promote competition. In order to survive a motion to dismiss under this test, the complaint must plausibly allege that the MFNs produced adverse anticompetitive effects within relevant product and geographic markets. Here, the complaint alleges that the MFN clauses have negatively impacted competition in the health insurance markets throughout Michigan by raising competitors’ costs, likely increasing premiums, and directly increasing costs to self-insured employers. The complaint sets forth various examples of specific geographic areas affected. The plaintiffs claim that the requirement that the hospital charge competing insurers at least 23% more than it charges Blue Cross affects potential competitors. In some cases, the hospitals at issue are the only ones...
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Boreali v. Axelrod 4 results
- (Parties Affected by Antismoking Regulations) v. (Comm’r of the N.Y. State Dep’t of Health)
- Did the Public Health Council have the authority to promulgate the smoking regulations?
- (Titone, J.) No. A legislative grant of authority must be construed so that it is no broader than that which the separation of powers doctrine permits. The legislature cannot pass on its lawmaking functions to other bodies. An administrative body oversteps the boundaries of its lawfully delegated authority when it promulgates comprehensive codes to govern tobacco smoking in areas that are open to the public. While the legislature has given the Public Health Council broad authority to promulgate regulations on matters concerning public health, the scope of authority must be deemed limited by the Council’s role as an administrative, rather than a legislative, body. Striking the proper balance among health concerns, cost, and privacy interests is a uniquely legislative function. Following the legislature’s inability to reach an acceptable balance, the Council weighed the concerns of nonsmokers, smokers, affected businesses, and the general public, and, without any legislative guidance,...
- In 1986, the New York Public Health Council published proposed rules, held public hearings, and promulgated a final set of regulations prohibiting smoking in a wide variety of indoor areas that were open to the public, including schools, hospitals, auditoriums, food markets, stores, banks, cabs, and limousines. Restaurants were required to provide nonsmoking areas sufficient to meet customer demand, and employers were required to provide smoke-free work areas and to keep common areas free of smoke. Businesses could prohibit all smoking on the premises if they so chose. Several parties affected by the regulations sued and the trial court set aside the regulations, holding that they exceeded the Council’s statutory authority. An intermediate appellate court affirmed, and the Council appealed again.
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Bragdon v. Abbott 5 results
- EXISTENCE OR NONEXISTENCE OF A SIGNIFICANT HEALTH OR SAFETY RISK MUST BE BASED ON MEDICAL OR OTHER OBJECTIVE EVIDENCE
- The existence or nonexistence of a significant health or safety risk must be determined from the standpoint of the person who refuses treatment or accommodation, and the risk assessment must be based on medical or other objective evidence.
- Must the existence or nonexistence of a significant health or safety risk be determined from the standpoint of the person who refuses the treatment or accommodation, and must the risk assessment be based on medical or other objective evidence?
- Abbott (P), who was infected with human immunodeficiency virus (HIV), disclosed her infection when she visited Bragdon (D), a dentist. When Bragdon (D) informed Abbott (P) of his policy against filling cavities of HIV-infected patients, he offered to perform the work at a hospital with no added fee for his services, though Abbott (P) would be responsible for the cost of using the hospital’s facilities. Abbott (P) sued under § 302 of the Americans with Disabilities Act of 1990 (ADA), alleging discrimination on the basis of her disability. The district court ruled in favor of Abbott (P), holding that her HIV infection was a disability under the ADA, even though her infection had not yet progressed to the symptomatic stage. The court of appeals agreed that treating Abbott (P) in the dental office would not have posed a direct threat to the health and safety of others. Bragdon (D) appealed. The United States Supreme Court granted certiorari.
- ...or nonexistence of a significant health or safety risk must be determined from the standpoint of the person who refuses treatment or accommodation, and the risk assessment must be based on medical or other objective evidence. No individual is required to participate in or benefit from the services in any place of public accommodation when such individual poses a direct threat or safety of others. Bragdon (D) failed to present any objective medical evidence showing that treating Abbott (P) in a hospital would be safer or more efficient in preventing HIV-transmission than treatment in a well-equipped dental office. This Court is concerned, however, that the court of appeals mistakenly relied on the 1993 CDC Dentistry Guidelines, and the 1991 American Dental Association Policy on HIV. This evidence is not definitive. As of September 1994, the CDC had identified seven dental workers with possible occupational transmission of HIV. It is not clear on this record, however, whether this...
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Rush Prudential, Inc. v. Debra C. Moran, et al. 6 results (showing 5 best matches)
- A STATE HEALTH MAINTENANCE ORGANIZATION STATUTE IS PROVIDING THE RIGHT TO AN IME OF DENIALS IS NOT PREEMPTED BY ERISA
- A state health maintenance organization (HMO) statute providing a right to independent medical review of certain denials of benefits is not preempted by the Employment Retirement Income Security Act of 1974 (ERISA).
- Appeal from the reversal of state court judgment enforcing a health maintenance organization (HMO) act.
- Is a state health maintenance organization (HMO) statute providing a right to independent medical review of certain denials of benefits preempted by the Employment Retirement Income Security Act of 1974 (ERISA)?
- (Souter, J.) No. A state health maintenance organization (HMO) statute providing a right to independent medical review of certain denials of benefits is not preempted by the Employment Retirement Income Security Act of 1974 (ERISA). ERISA preempts state laws that relate to employee benefit plans. Moran (P) is a beneficiary of an employee benefit plan. However, ERISA has a savings clause stating that it is not meant to relieve any person from
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- ...a few hospitals in a geographic market. Second, however, patients vary in their hospital preference. They may not be as particular about where they have an appendectomy as they would be about where they have brain surgery; the hospital where their surgeon has admitting privileges may control their choice, despite distance. Third, consumers do not directly pay the full cost of hospital care; their health insurance does. Insured patients are not as concerned about retail prices. We find that the district court made clear factual errors here. Its central error was misunderstanding the hypothetical monopolist test. The court’s analysis fell prey to a version of the silent majority fallacy. In the hypothetical monopolist test, the analyst proposes a candidate market, simulates a monopolization of that market, and then adjusts the candidate market and reruns the simulation as necessary. When the plaintiff’s expert proposed a candidate market in this case, he excluded the effect of “...
- ...Health Care Network (D) and NorthShore University HealthSystem (D) operated hospital networks in Chicago’s northern suburbs. The two entities sought to merge. Section 7 of the Clayton Act forbids asset acquisitions that may lessen competition in any “section of the country”. The Federal Trade Commission (P) and the State of Illinois (P) sued in district court to enjoin the proposed merger while the FTC (P) considered the interpretation of that phrase through its ordinary, but slower, administrative process. The district court found that the plaintiffs had not shown a likelihood of success on the merits and denied the injunction. Its analysis focused on the plaintiffs’ expert’s testimony. The court found no economic basis for distinguishing between academic medical centers and local hospitals, and no reason to think a competitor had to constrain both to be in the geographic market. The court also criticized the expert’s assumption that patients generally insist on access to local...
- This case began with an administrative complaint issued by the FTC (P), in which the FTC (P) alleged that the proposed merger between Advocate Health Care Network (D) and NorthShore University HealthSystem (D) would create the largest hospital system in the North Shore area of Chicago. According to the complaint, the combined entity would have operated a majority of the hospitals in the area and controlled more than 50% of the general acute care inpatient hospital services. The Commission (P) also authorized staff to file for a preliminary injunction to maintain the status quo pending the administrative trial. In the federal court proceeding, the district court denied the motion for a preliminary injunction but granted the plaintiffs’ motion for a stay pending appeal. The Seventh Circuit reversed and remanded the case back to the district court for further proceedings. On March 7, 2017, the district court granted the injunction and the parties abandoned their merger plans.
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Alphabetical Table of Cases 16 results (showing 5 best matches)
United States v. Anthem, Inc. 2 results
- (Government) v. (Health Insurer)
- In 2015, Anthem (D), which is licensed to operate under the Blue Cross Blue Shield health insurance brand in 14 states, reached an agreement to merge with Cigna, with which Anthem (D) competes in those 14 states. The Department of Justice, 11 states, and the District of Columbia (collectively, the government (P)) filed suit to enjoin the merger on the ground that it was likely to substantially lessen competition in violation of the Clayton Act. The district court granted the injunction, rejecting Anthem’s (D) defense that the merger’s anticompetitive effects would be outweighed by its efficiencies, because the merger would yield a superior Cigna product at Anthem’s (D) lower rates. The district court found that Anthem (D) failed to demonstrate that its plan was achievable, and that the merger would benefit consumers. Anthem (D) appealed.
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Gonzales v. Carhart 3 results
- that may become a child.” That interest allows the state, “in order to promote respect for life,” to restrict abortion methods that physicians might otherwise choose. The health exception recognized in cannot be interpreted in a way to “set at naught” the government’s interest in fetal life. Here, there is “documented disagreement whether the Act’s prohibition would ever impose significant health risks on women.” When medical uncertainty exists, the Court defers to legislative choice. In addition, the mother’s health exception requirement cannot be interpreted to preclude regulation of abortion methods that further the government’s interest in protecting and respecting fetal life when there is only uncertainty in the medical community about whether a particular abortion method is ever medically necessary. Here, Congress sought to promote respect for life by drawing a bright line between abortion and infanticide. The statute also recognizes “the bond of love the mother has for her...
- (Ginsburg, J.) The reconstituted Court’s “alarming” decision disrespected precedent gutted the long-standing health exception requirement and showed an unconcealed “hostility” to abortion rights. The ruling “refuses to take Casey and Stenberg seriously.” It ignores district court findings that intact D&E is safer for women with certain conditions and generally offers safety advantages over standard D&E, siding instead with a statute that even the majority recognized contains factual errors. The Court deprives women of the right to make an autonomous choice, even at the expense of their safety.
- , which struck down the Nebraska law that barred abortions in which the physician delivers a “substantial portion” of the fetus into the woman’s vagina for the purpose of performing a procedure that kills the “unborn child” and lacked a health exception. Congress passed a federal statute,
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King v. Burwell 6 results (showing 5 best matches)
- (Virginia Taxpayer) v. (Secretary of Health and Human Services)
- Virginia taxpayers argued that Virginia’s insurance exchange, which was operated by the federal government, did not entitle them to the advance tax credits available under the Affordable Care Act to purchasers of health insurance through a state-run exchange.
- A taxpayer is eligible for a tax credit if he or she enrolls in an insurance plan through an insurance Exchange, whether established and operated by a state or by the Department of Health and Human Services.
- ...percent of the federal poverty line. Persons who met the Act’s income requirements could purchase insurance with the tax credits, which are provided in advance directly to the insurer. ACA also required the creation of an Exchange in each state where people could shop for insurance, usually online. If a state chose not to establish an exchange on its own, the Secretary of Health and Human Services established and operated an Exchange within the state. Although ACA provided that the tax credits were allowed for any applicable taxpayer, the Act also provided that the amount of the credit depended in part on whether the taxpayer had enrolled in an insurance plan through an Exchange established by the state under ACA. Pursuant to an IRS Rule on the subject, the credits were available whether the insurance was provided through a state or the federal Exchange. Virginia taxpayers sued, arguing that the IRS regulation exceeded the agency’s authority and was contrary to law, in violation...
- ...if he or she enrolls in an insurance plan through an insurance Exchange, whether established and operated by a state or by the Department of Health and Human Services. The availability of the credits is among ACA’s key reforms. Whether those credits are available on a federal Exchange is a question of deep economic and political significance that is central to the statutory scheme. We must determine the correct reading of the statute. The petitioners argue that the plain meaning of the statute is strong, but although “an Exchange established by the State” may seem plan when viewed in isolation, the reading turns out to be untenable in light of the statute as a whole. The context and structure of the Act compel us to depart from what may otherwise be a natural reading of the law. Reliance on context and structure leads us to conclude that tax credits are allowed for insurance purchased on any Exchange created under the Act. Those credits are necessary for the federal Exchange...
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- (Idaho Dep’t of Health & Welfare Official) v. (Provider of Habilitation Services)
- Exceptional Child Center (P) sued two officials (D) in Idaho’s Department of Health and Welfare, claiming that Idaho violated Medicaid law by reimbursing habilitation service providers at rates lower than the law permits.
- majority found that the Medicaid Act implicitly precludes private enforcement of § (30)(A). Thus, the healthcare providers could not invoke the court’s equitable powers to circumvent Congress’s exclusion of private enforcement. The sole remedy that Congress provided in the Medicaid Act authorizes the Secretary of Health and Human Services (HHS) to terminate federal funding to all or parts of the state Medicaid program until the state stops violating the federal law. According to the court, this express provision of one method of enforcing a statute suggests that Congress intended to preclude all others.
- ...approved, a Medicaid plan that included coverage for habilitation services—in-home care for individuals who, but for the provision of such services, would require care in a hospital or nursing home. Medicaid requires Idaho’s plan to provide such methods and procedures relating to the utilization of and payment for care and services as may be necessary to safeguard against unnecessary utilization of the care and services, and to assure that payments are consistent with efficiency, economy, and quality of care. Exceptional Child Center (P) sued two officials (D) in Idaho’s Department of Health and Welfare, claiming that Idaho violated Medicaid law by reimbursing habilitation service providers at rates lower than the law permits. The plaintiffs asked the court to enjoin the administrators to increase the rates. The district court entered summary judgment for the providers, holding that Idaho had not set rates in a manner consistent with Medicaid law, and the Ninth Circuit affirmed...
- ...be given in a court of equity to prevent an injurious act by a public officer. The ability to sue to enjoin unconstitutional action by state and federal officers reflects a long history of judicial review of illegal executive action. It is a judge-made remedy, however, and we have never held or even suggested that, in its application to state actors, it rests upon an implied right of action contained in the Supremacy Clause. The power of federal courts of equity to enjoin unlawful executive action is subject to express and implied statutory limitations. Courts of equity can no more disregard statutory and constitutional requirements than can courts of law. The plaintiffs must seek their relief from the Secretary rather than the courts. Here, 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—and the sheer complexity associated with enforcing § 30(A...
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In re The Estate of Michael Patrick Smith v. Heckler 6 results (showing 5 best matches)
- A class of nursing home patients (P) challenged the federal health department (D) practice of enforcing compliance with the Medicaid Act by focusing the homes’ facilities rather than patient care.
- The federal health department must enforce compliance with the Medicaid Act by focusing on patient care.
- Must the federal health department enforce compliance with the Medicaid Act by focusing on patient care?
- (Judge undisclosed.) Yes. The Department of Health and Human Services (D) must enforce compliance with the Medicaid Act by focusing on patient care. Nothing in the Medicaid Act indicates that Congress intended the physical facilities to be the end product of the Act. Rather, the Act repeatedly focuses on the care to be provided. For example, the Act provides that health standards are to be developed and maintained and also provides that states must inform the Secretary of what methods they use to ensure quality care. In light of this, the Secretary must look to patient care actually rendered. The current review system, as implemented by Heckler (D), which looks to facilities only and, therefore only to the potential of care, is insufficient. Reversed and remanded.
- 42 U.S.C. § 1396. The purpose of the Act is to assist states in providing quality care to the disabled. To receive funding, a state must submit to the Department of Health and Human Services a plan that meets the Act’s requirements. These requirements were at issue here.
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Bellevue Hospital Center v. Leavitt 5 results
- The Bellevue Hospital Center (P) filed an action challenging the Department of Health and Human Services’ method for calculating Medicare reimbursements. Because the statutory scheme requires hospitals’ costs to be averaged, hospitals with dissimilar costs would inevitably be lumped together.
- (3) Was the Department of Health and Human Services’ implementation of adjustments regarding hiring decisions at hospitals arbitrary or capricious?
- (1) The Medicare statute authorizes the use of “metropolitan statistical areas” (MSAs) as a proxy for “geographical area” as specified in the statute. (2) Expansion of the New York City MSAs to include New Jersey hospitals, where wages are somewhat lower, is not arbitrary or capricious even though it causes the average wage level in the MSA to drop. (3) The Department of Health and Human Services’ implementation of adjustments regarding hiring decisions at hospitals was arbitrary and capricious.
- (Katzmann, J.) (1) Yes. The Medicare statute authorizes the use of “metropolitan statistical areas” (MSAs) as a proxy for “geographical area” as specified in the statute. The use of MSAs to fill the gap left by the ambiguous term “geographical areas” is reasonable. Health and Human Services’ Center for Medicare & Medicaid Services (CMS) has used MSAs to fill the statutory gap for more than two decades without any action from Congress expressing disapproval, which demands deference at this point. (2) No. Expansion of the New York City MSAs to include New Jersey hospitals, where wages are somewhat lower, is not arbitrary or ...proposed any clearly superior alternatives. Under these circumstances, the agency’s continued use of MSAs was not arbitrary and capricious. (3) Yes. The Department of Health and Human Services’ implementation of adjustments regarding hiring decisions at hospitals was arbitrary and capricious. Application of the adjustment must be implemented in full by Sept. 30...
- The Bellevue Hospital Center (Bellevue)(P) filed an action challenging the Department of Health and Human Services’ method for calculating Medicare reimbursements. Bellevue (P) argued that the new metropolitan statistical areas (MSAs) for New York City, which included New Jersey hospitals, an area where wages are somewhat lower, led Bellevue (P) to conclude that it would receive $812 million less in reimbursements over the next 10 years than they would have under their former wage adjustment. The U.S. District Court for the Southern District of New York found that the term “geographical areas” in the Medicare statute was ambiguous, and that the use of MSAs to fill the gap was reasonable. Because the statutory scheme requires hospitals’ cost to be averaged, hospitals with dissimilar costs would inevitably be lumped together.
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- Doe v. Medlantic Health Care Group, Inc.
- : Doe (P) brought suit against Medlantic Health Care Group, Inc. (D) alleging invasion of privacy and breach of a confidential relationship for negligent disclosure of his positive Human Immunodeficiency Virus (HIV) status.
- : Byrne (P) sued her clinic after it released her health records to a third party pursuant to a subpoena in a paternity suit, despite her instruction not to release them.
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- Byrne (P) sued her clinic after it released her health records to a third party pursuant to a subpoena in a paternity suit, despite her instruction not to release them.
- The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a comprehensive legislative and regulatory scheme to protect the privacy of patients’ health information given advances in information technology. This case considered whether HIPAA, which lacks a private right of action and preempts contrary state law, preempts state law claims for negligence and negligent infliction of emotional distress against a healthcare provider who allegedly breached the confidentiality of a patient’s medical records in the course of complying with a subpoena. The trial court dismissed the claims, but, on appeal, the court concluded that, to the extent the state’s common law provides a remedy for a healthcare provider’s breach of its duty of confidentiality in the course of complying with a subpoena, HIPAA does not preempt the plaintiff’s state common-law causes of action.
- The Health Insurance Portability and Accountability Act of 1996.
- .... The defendant also provided Byrne (P) with the HIPAA-required notice of privacy policy and agreed, pursuant to that policy, that it would not disclose Byrne’s (P) health information without her authorization. Byrne (P) began a personal relationship with Mendoza in 2004. She instructed the defendant not to release her medical records to Mendoza. In 2005, Mendoza filed a paternity case against Byrne (P). Pursuant to a subpoena, the defendant clinic provided a copy of Byrne’s (P) medical records to the court. Byrne (P) alleged that she suffered harassment and extortion threats from Mendoza once he viewed her medical records. She sued, alleging that the clinic breached its privacy policy and asserting other negligence claims. The defendant brought a motion for summary judgment, which was treated as a motion to dismiss. The trial court held that HIPAA preempts any action dealing with the confidentiality or privacy of medical information. However, HIPAA does not create a private...
- ...for the accomplishment and execution of the full purposes and objectives of HIPAA. State laws exempted from preemption include those that relate to the privacy of individually identifiable health information and are more stringent than HIPAA. In its administrative commentary to the final rule, the agency stated that the fact that a state allows an individual to file a civil action to protect privacy does not conflict with HIPAA penalty provisions. When an agency has interpreted its own rule, courts generally defer to that reading. Although HIPAA provides no private right of action, but rather punishes violators with fines and imprisonment, state causes of action are not preempted solely because they impose liability above that authorized by federal law. We conclude that, if Connecticut’s common law recognizes claims arising from a healthcare provider’s alleged breach of its duty of confidentiality in the course of complying with a subpoena, HIPAA and its implementing regulations...
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- : The Shannons (P) alleged that their physician, Dr. McNulty (D), and their health maintenance organization, HealthAmerica (D), were vicariously liable for the premature delivery and subsequent death of their son.
- When a benefits provider such as a health maintenance organization (HMO) interjects itself into the rendering of medical decisions affecting a subscriber’s care, it must do so in a medically reasonable manner.
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- Wons (D) refused to consent to a blood transfusion due to her religious beliefs as a Jehovah’s Witness. At the time she refused, she was competent to make the decision. While unconscious, the Public Health Trust of Dade County (P) obtained a court order allowing the transfusion. When she awoke, Wons (D) appealed the order. The district court held that Wons’s rights of religion and privacy could not be overridden and reversed to order.
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- Linton v. Commissioner of Health and Environment
- Flack v. Wis. Dept. of Health Servs.
- The existence or nonexistence of a significant health or safety risk must be determined from the standpoint of the person who refuses treatment or accommodation, and the risk assessment must be based on medical or other objective evidence.
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- ...a therapist at Arbour Counseling, which was owned by Universal Health Services (UHS) (D). UHS (D) participated in the Medicaid program. The counselors at Arbour were not licensed. Rivera was eventually diagnosed with bipolar disorder and prescribed medication by a “doctor” who was later discovered to be a nurse. Rivera had an adverse reaction to the medication and called Arbour for guidance but was unable to speak with anyone. A few days later, she suffered a seizure and was hospitalized; a few months after that, she suffered a fatal seizure. Her parents filed complaints with several state agencies and eventually sued UHS (D) under both the federal and state False Claims Act. The False Claims Act imposes significant penalties on those who defraud the government. Under a theory of liability referred to as implied false certification, when a defendant (such as UHC (D)) submits a claim (to Medicaid, for instance), it impliedly certifies compliance with all conditions of...
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Jacobson v. Massachusetts 5 results
- STATE’S POLICE POWER INCLUDES THE AUTHORITY TO ENACT REASONABLE REGULATIONS TO PROTECT PUBLIC HEALTH AND SAFETY
- The scope of the state’s police power includes the authority to enact reasonable regulations to protect public health and safety.
- Does the scope of the state’s police power include the authority to enact reasonable regulations to protect public health and safety?
- (Harlan, J.) Yes. The scope of the state’s police power includes the authority to enact reasonable regulations to protect public health and safety. The liberty secured by the Constitution to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly free from restraint. There are manifold restraints to which every person is necessarily subject for the common good. The means employed by Cambridge to stamp out smallpox have a real and substantial relation to the protection of the public health and the public safety. Nothing clearly appears that would justify this Court in holding the statute to be unconstitutional.
- This case has never been repudiated. The Court suggested that at times there simply is no liberty interest in conduct that may put others at risk. In the early part of the twentieth century, courts were extremely deferential to a state’s power to protect the public health.
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Flack v. Wis. Dept. of Health Servs. 2 results
- The party that moves for a preliminary injunction must “make a threshold showing: (1) that they will suffer irreparable harm absent preliminary injunctive relief during the pendency of the action; (2) inadequate remedies at law exist; and (3) they have a reasonable likelihood of success on the merits. Once the moving party has made such a showing, the court determines whether the balance of harm favors the moving party or whether the harm to other parties or the public sufficiently outweighs the movant’s interests. Here, the likelihood of ongoing, irreparable harm facing Flack (P) outweighs any marginal impacts on the DHS’s (D) stated concerns regarding public health or limiting costs. DHS’s (D) concern about protecting the public health by limiting Wisconsin Medicaid to “medically necessary purposes” is misplaced here, given the substantial likelihood that this interest would be served, rather than hindered, by covering Flack’s (P) recommended surgical procedures. The state has an...
- Flack (P) is a transgender Medicaid beneficiary who sought Medicaid coverage for medically necessary treatments for gender dysphoria. Gender dysphoria is a serious medical condition, which if left untreated or inadequately treated can cause adverse symptoms. Wisconsin Medicaid expressly excluded coverage for “Drugs, including hormone therapy, associated with transsexual surgery or medically unnecessary alteration of sexual anatomy or characteristics; [and] Transsexual surgery.” Flack (P) challenged the exclusion as a violation of their rights under Section 1557 of the Affordable Care Act, the Equal Protection Clause of the Fourteenth Amendment to the U.S. Constitution, and the federal Medicaid Act. Flack (P) sought a preliminary injunction barring the Wisconsin Dept. of Health Services (DHS) (D) from enforcing the exclusion.
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- A state health maintenance organization (HMO) statute providing a right to independent medical review of certain denials of benefits is not preempted by the Employment Retirement Income Security Act of 1974 (ERISA).
- Aetna Health Inc. v. Davila
- : Two participants (P) filed state law claims against their health maintenance organizations (HMOs) for failure to administer proper care. The HMOs (D) argued that their claims were preempted by the Employment Retirement Income Security Act of 1974 (ERISA). The U.S. Court of Appeals found in favor of the participants (P), and the HMOs (D) appealed.
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- ...has a specific intent to monopolize; and (2) that the defendant has engaged in anticompetitive conduct that, taken as a whole, creates (3) a dangerous probability of achieving monopoly power. A firm engages in anticompetitive conduct when it attempts to exclude rivals on some basis other than efficiency. Here, UPMC (D) hired employees away from West Penn (P) by paying them bloated salaries, and it made false statements about West Penn’s (P) financial health, which discouraged investors and caused West Penn (P) to pay inflated financing costs on its debt. These allegations plausibly suggest that UPMC (D) engaged in anticompetitive conduct by attempting to drive West Penn (P) out of the market. An antitrust plaintiff must do more, however, than show that it would have been better off absent the violation. The plaintiff must establish that it suffered an antitrust injury, which is an injury of the type the antitrust laws were intended to prevent and that flows from that... ...health...
- ...second-largest hospital system (West Penn) (P) sued Pittsburgh’s dominant hospital system (the University of Pittsburgh Medical Center, or UPMC) (D) and health insurer (Highmark) (D) under the Sherman Act and state law, asserting that the defendants violated the laws by forming a conspiracy to protect one another from competition. Prior to this time, Highmark (D) had been friendly toward West Penn (P) and had even funded a merger between West Penn (P) and several financially distressed providers in order to preserve competition in the market. According to the plaintiff, pursuant to the conspiracy, UPMC (D) used its power in the provider market to insulate the insurer from competition, and in exchange the insurer used its power in the insurance market to strengthen UPMC (D) and weaken the plaintiff. The plaintiff also argued that UPMC (D) attempted to monopolize the Pittsburgh market for specialized hospital services. The district court dismissed the Sherman Act claims and the...
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Howe v. Hull 1 result
- In this case, the examining physician, Dr. Reardon, essentially admitted to Charon that the transfer was related to his HIV status. Dr. Reardon told Charon, “I’m sure you’ve dealt with this before. . .” Howe (P) asked, “What’s that discrimination?” Reardon replied, “You have to understand, this is a small community, and the admitting doctor does not feel comfortable admitting [Charon].” In other cases, it may be much more difficult to prove that discrimination was involved in the medical decision due to the complexity of a patient’s condition. Thus, in cases where a disease process involves multiple body systems the court may find itself in a position of deference to the practitioners providing a defense, even if that provider’s motives are questionable. Also, Titles II and III of the ADA, covering access to professional offices of health care providers and access to government programs, contain an exception when an individual with a disability poses a direct threat to the health or...
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Saint Alphonsus Medical Center-Nampa Inc.; Federal Trade Commission & State of Idaho v. St. Luke’s Health System Your search matches the chapter title
Mahan v. Avera St. Luke’s 1 result
- Avera St. Luke’s (ASL) (D) is part of a regional health care system sponsored by the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota. Since 1901, the Presentation Sisters have provided quality health services to the Aberdeen community. In mid-1996, ASL’s (D) neurosurgeon left Aberdeen. During the process of recruiting his replacement, ASL (D) learned that most neurosurgeon applicants would not be interested in coming to Aberdeen if there was already an orthopedic surgeon practicing in the area. ASL (D) successfully recruited a neurosurgeon in December of 1996. Around this time, ASL (D) learned that OSS (P), a group of Aberdeen orthopedic surgeons, had decided to build a day center that would directly compete with ASL (D). During the first seven months that OSS’s (P) surgery center was open, ASL (D) suffered a 1,000-hour loss of operating room usage. In response, ASL (D) closed ASL’s (D) medical staff with respect to physicians requesting privileges...
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- Provena Hospitals (P) is a subsidiary of Provena Health, a corporation created in association with the Catholic church. Provena Hospitals (P) was exempt from federal income tax and various state taxes, and it sought an additional exemption from property taxes. The Director of Revenue (D) determined that it did not qualify and denied the exemption. Provena Hospitals (P) sought review in the circuit court, which allowed the exemption. The Department (D) appealed.
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Bryan v. Koch 1 result
- In 1979, New York Mayor Koch appointed a task force to examine ways to reduce costly excess hospital capacity while maintaining access to high quality health services. The task force reported, among other findings, that two hospitals located in Harlem should be closed. A class of low income black and Hispanic residents brought suit, alleging that the city’s proposed plan for the municipal hospital system violated Title VI and should therefore be enjoined. The federal district court found in favor of the city and the plaintiffs appealed.
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Erickson v. The Bartell Drug Company 1 result
- Bartell (D) argued that opting not to provide coverage for prescription contraceptive devices did not violate Title VII because contraceptives are voluntary and do not treat or prevent an illness or disease, and thus they were not truly a healthcare issue. The evidence showed, however, that the availability and affordability of effective contraceptives is of great importance to the health of women and children. Bartell (D) also argued that it should be permitted to limit the scope of its employee benefit programs in order to control costs, but cost is not a defense to allegations of discrimination under Title VII. Bartell (D) could not penalize female employees in an effort to keep its benefits costs low.
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Turner v. Memorial Medical Center 1 result
- Caremark International, Inc. (Caremark) (P) provided alternative site health care services as part of its patient care business. Caremark (P) had taken a number of measures to assure compliance with the antikickback provisions of the Medicare fraud and abuse law. When two federal grand juries indicted Caremark (P) and individuals for violations of the antikickback laws, a derivative suit was filed claiming Caremark directors (D) breached their duty of care by failing adequately to supervise Caremark (P) employees. A proposed settlement was reached to recover the corporation’s losses against the individuals who constitute its board of directors, and the court must decide whether the proposed settlement appears to be fair to the corporation and the absent shareholders.
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Flynn v. Holder 1 result
- (Kleinfeld, J.) No. The National Organ Transplant Act does not prohibit compensation for donations of blood and the substances in it, which include the peripheral blood stem cells that are used for modern-day bone marrow transplants. The Secretary of Health and Human Services has not exercised regulatory authority to define blood or peripheral blood stem cells as organs. Under prior practice, the soft, fatty substance in bone cavities had to be extracted during a process painful to the donor in order for a donation to occur, but this is no longer the case. Congress may have had reason to include that process and substance in the definition of “organ” and prohibit payment. But those methods are no longer employed, and the process is similar to a regular blood donation. Because the process no longer involves the donation of an “organ” as defined in the Act, we need not decide whether prohibiting compensation for these donations would be unconstitutional.
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In re Guess 1 result
- ...whether a patient is injured thereby. The court of appeals concluded that in order to be a valid exercise of the board’s police power, the law must be construed to punish the action of a physician only when the action in question poses a danger of harm to the patient or the public. We disagree. When a statute is challenged as being beyond the scope of the police power granted to the board, the statute will be upheld unless it has no rational relationship to a legitimate public purpose. The provision of the statute in question here is reasonably related to the public health. The legislature reasonably believed that a general risk of endangering the public is inherent in any practices that fail to conform to the standards of acceptable and prevailing medical practice in North Carolina. In other words, the legislative intent was to prohibit any practice departing from acceptable and prevailing medical standards, without regard to whether the particular practice itself could be...
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- ...actually worked for the hospital, and WVUH (D) therefore cannot be found liable under the doctrine of respondeat superior, but it can be held liable under a theory of apparent agency. Under West Virginia law, regardless of any contractual arrangements with independent contractors, a hospital is liable to the injured patient for acts of malpractice committed in its emergency room, so long as the requisite proximate cause and damages are present. That same rule should apply outside of the emergency room setting. The public’s confidence in the modern hospital’s portrayal of itself as a full-service provider of health care appears to be at the foundation of the national trend toward adopting a rule of apparent agency to find hospitals liable, under the appropriate circumstances, for the negligence of physicians providing services within its walls. In addition, WVUH (D) did not unequivocally inform Pritt (P) and Burless (P) that the physicians treating them were not employees...
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Washington v. Glucksberg 1 result
United States v. Krizek 1 result
- ...’s procedures controlling reimbursement that could potentially lead to abuse of the system or lead to physicians restricting the clientele of the practice to exclude Medicaid and Medicare recipients. These observations included: (1) no distinction as to the status of the provider so that any person providing a coded services received equal reimbursement—assistant or physician; (2) Medicaid and Medicare reimbursement so dramatically below the normal charges that a practitioner could not support a medical practice on these payments and might decline to treat patients dependent on these reimbursements systems; (3) restrictions limiting billing to “face time” only is impractical where the provision of services necessarily involve study, research, and consultation; and (4) the deceitful practice of requiring separate codes for services when only reimbursing for one of a multitude of services provided. The court added that it hoped the Health Care Financing Administration (HCFA) would...
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- ...actions in restraint of trade are subject to a “rule of reason” requiring extensive inquiry into their purposes and effects. However, some categories of restraint have been deemed so inherently anticompetitive that a per se rule of illegality applies. Horizontal price-fixing is one such category. Here, horizontal price-fixing is what is being affected, so the per se rule would at first glance appear applicable. However, Maricopa (D) and Pima (D) argued that an agreement to fix maximum rather than the minimum prices is not anticompetitive. This is not true. Price ceilings are price floors may have different economic consequences, but price ceilings still have anticompetitive effects, as they may severely intrude upon the ability of competitors to survive in the market. Maricopa (D) and Pima (D) also argued that the health care field should not be included in the per se rule. This Court is unconvinced. The economic analysis for the medical profession is essentially the same as for...
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- ...of children was required in the subject houses in order for the study to be complete. The purpose of the research was to determine how effective varying degrees of lead paint abatement procedures were. The researchers acknowledged that lead paint was particularly hazardous to children, and that lead dust often remained/returned to abated houses over a period of time. The Institutional Review board (IRB) overseeing this research abdicated its responsibility to review the potential safety and health hazard impact of this nontherapeutic study, instead advising the institute to recast the study so as to obscure such dangers. The research study was sponsored jointly by the EPA and the Maryland Department of Housing and Community Development. The parents (P) of children with elevated blood levels of lead brought this action against KKI (D). KKI (D) moved for summary judgment on the basis that no contract existed between KKI (D) and the plaintiffs, and there was inherently no duty...
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- Publication Date: June 6th, 2022
- ISBN: 9781647082345
- Subject: Health Law
- Series: High Court Case Summaries
- Type: Case Briefs
- Description: This title contains briefs for each major case in Clark, Fuse Brown, Gatter, McCuskey, and Pendo's casebook on Health Law. These briefs will help you identify, understand, and absorb the core knowledge points from each case. They are followed by legal analysis, providing contextual background about each case, and connecting the case to the broader concepts developed throughout the casebook. This title also supplies case vocabulary, with definitions of new or unusual legal words found throughout the cases.
