Articles Posted in Health Care Law

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There is no hospital in Valencia County. People in Valencia County who are faced with a medical emergency must deal with the emergency itself, and find a way to travel twenty to thirty-five miles to an Albuquerque hospital. Ambulances coming from Valencia County can take two hours or longer to transport a patient to the nearest hospital, process the patient, and return. The long turnaround times mean that ambulance companies sometimes run at full capacity, or “zero status,” and cannot respond to calls from new patients because all available ambulances are in use. Since 1987, appellant Living Cross Ambulance Service has been the only ambulance company in Valencia County operating under a permanent certificate from the Public Regulation Commission (PRC). Living Cross has been at zero status and unavailable to transport patients for less than one percent of ambulance service requests. When Living Cross is at zero status, dispatch requests mutual aid from a nearby ambulance company, and if those mutual aid ambulances are also unavailable, the municipality whose EMTs first responded to the scene must transport the patients at the municipality’s expense. This case was a direct appeal from a final order of the Public Regulation Commission (PRC) granting a permanent certificate to American Medical Response Ambulance Service, Inc. d/b/a American Medical Response, Emergicare (AMR) for both emergency and nonemergency ambulance service in Valencia County. Living Cross petitioned the New Mexico Supreme Court to vacate the final order of the PRC, claiming that the PRC acted arbitrarily and capriciously by granting AMR’s certificate because there was no evidence of need for non-emergency ambulance service in Valencia County, and because there was insufficient evidence of need for additional emergency ambulance service. Living Cross also claimed that the PRC abused its discretion by allowing Living Cross’s former attorney to represent AMR in an initial hearing before ruling on its motion to disqualify the attorney. Upon review, the Supreme Court held that the PRC decision to allow the former Living Cross attorney to appear for AMR during the hearing for the temporary permit was contrary to law, and that the wholesale admission of the record from that hearing as evidence in the hearing for the permanent certificate was plain error, requiring reversal. Because the Court determined that the attorney disqualification issue is dispositive, it did not reach the other issues in this case.View "Living Cross Ambulance Serv. v. N.M. Pub. Regulation Comm'n" on Justia Law

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In consolidated appeals, the issue this case presented to the New Mexico Supreme Court was whether pharmacists who dispense prescription drugs to Medicaid recipients must be paid under the formula set forth in NMSA 1978, Section 27-2-16(B) (1984). Section 27-2-16(B) was enacted when New Mexico only operated under a fee-for-services model. The Legislature created a new, alternative managed care system in 1994 in an effort to rein in costs of medical public assistance. The district court and our Court of Appeals held that Section 27-2-16(B) applied in both the fee-for-services context and in managed care settings. Upon review, however, the Supreme Court reversed, holding that Section 27-2-16(B) applied only in the fee-for-services context, which requires HSD to directly reimburse providers. View "Starko, Inc. v. New Mexico Human Servs. Dep't" on Justia Law

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In this class action lawsuit, the trial court found that the State wrongfully denied health benefits to a number of its part-time employees. The issue this case presented for the Supreme Court's review was how to value the damages suffered by that group of employees when they were denied health benefits. The State argued that the only damages to the employees were immediate medical expenses paid by employees during the time they were denied health benefits. But evidence showed that people denied health care benefits suffer additional damage. They often avoid going to the doctor for preventive care, and they defer care for medical problems. This results in increased long-term medical costs and a lower quality of life. Based on this evidence, the trial court correctly rejected the State's limited definition of damages because it would significantly understate the damages suffered by the employees. The Supreme Court affirmed.View "Moore v. Health Care Auth." on Justia Law