Justia Government & Administrative Law Opinion Summaries

Articles Posted in Health Law
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In 2021, the U.S. Department of Health and Human Services (HHS) issued a rule requiring Title X grant recipients to provide neutral, nondirective counseling and referrals for abortions upon patient request. Tennessee, a long-time Title X recipient, recently enacted laws criminalizing most abortions. Consequently, Tennessee limited its counseling and referrals to options legal within the state, leading HHS to discontinue its Title X grant, citing non-compliance with federal regulations. Tennessee sued to challenge this decision and sought a preliminary injunction to prevent the grant's termination.The United States District Court for the Eastern District of Tennessee denied Tennessee's request for a preliminary injunction. The court concluded that Tennessee was unlikely to succeed on the merits of its claim and that the balance of the preliminary injunction factors favored HHS. The court found that Tennessee did not demonstrate a strong likelihood of success on its claims under the Spending Clause or the Administrative Procedure Act (APA).The United States Court of Appeals for the Sixth Circuit reviewed the district court's decision and affirmed the denial of the preliminary injunction. The appellate court held that HHS's 2021 Rule was a permissible construction of Title X and that Tennessee had voluntarily and knowingly accepted the grant's terms, including the counseling and referral requirements. The court also found that HHS's actions did not violate the Spending Clause or the APA. The court concluded that Tennessee failed to show irreparable harm and that the public interest favored the correct application of Title X regulations. Therefore, the district court's decision to deny the preliminary injunction was upheld. View "Tennessee v. Becerra" on Justia Law

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Bruce Kelley and his spouse, Nancy Kelley, filed a medical malpractice lawsuit in Vermont state court after Bruce Kelley was paralyzed from the waist down while residing at Franklin County Rehabilitation Center (FCRC). They alleged that Dr. Teig Marco, employed by Richford Health Center, Inc. (RHC), negligently treated Kelley, leading to his paralysis. RHC is a federally funded community health center deemed a member of the Public Health Service under the Federally Supported Health Centers Assistance Act (FSHCAA).The United States intervened and removed the case to federal district court, asserting that RHC and Dr. Marco were covered under the Federal Tort Claims Act (FTCA) due to their deemed status. The United States District Court for the District of Vermont held an evidentiary hearing and determined that the FSHCAA did not apply to Dr. Marco’s treatment of Kelley because Kelley was not a patient of RHC, and the treatment did not fall under the specified statutory criteria for nonpatients. Consequently, the District Court remanded the case to state court for lack of subject matter jurisdiction.The United States Court of Appeals for the Second Circuit reviewed the case and affirmed the District Court's decision. The appellate court agreed that Kelley was not a patient of RHC and that Dr. Marco’s treatment did not meet the criteria for FTCA coverage for nonpatients under the FSHCAA. The court concluded that the treatment did not qualify as after-hours coverage or emergency treatment and that RHC had not sought a particularized determination of coverage from the Department of Health and Human Services. Therefore, the remand to state court was appropriate, and the District Court's order was affirmed. View "Kelley v. Richford Health Center, Inc." on Justia Law

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In August 2020, Joe Willie Cannon, an inmate at Anamosa State Penitentiary (ASP), injured his right wrist while playing basketball. He sought medical attention from ASP staff, including nurses and a doctor, but experienced delays and inadequate treatment. Cannon alleged that the medical staff's failure to promptly diagnose and treat his wrist injury, which was later found to be a displaced fracture, constituted deliberate indifference to his serious medical needs, violating his Eighth Amendment rights.The United States District Court for the Northern District of Iowa denied summary judgment to four defendants—Dr. Michael Dehner and Nurses Amy Shipley, Courtney Friedman, and Barbara Devaney—who claimed qualified immunity. The court found that a reasonable jury could conclude that the defendants acted with deliberate indifference to Cannon's medical needs. The defendants appealed this interlocutory order.The United States Court of Appeals for the Eighth Circuit reviewed the case de novo. The court concluded that the district court failed to properly apply the principle that each defendant's knowledge and conduct must be individually assessed. The appellate court found that the nurses' actions, including their assessments and treatment plans, did not amount to deliberate indifference. Similarly, Dr. Dehner's decisions, including ordering an X-ray and referring Cannon to an orthopedic specialist, were based on his medical judgment and did not constitute deliberate indifference.The Eighth Circuit held that each appellant was entitled to qualified immunity because Cannon failed to prove that any of them acted with deliberate indifference to his serious medical needs. The court reversed the district court's order and remanded the case for further proceedings consistent with its opinion. View "Cannon v. Dehner" on Justia Law

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The plaintiffs, Medicare beneficiaries with chronic illnesses, rely on home health aides for essential care. They allege that Medicare-enrolled providers have either refused to provide in-home care or offered fewer services than entitled, attributing this to the policies of the Secretary of Health and Human Services. They sought systemwide reforms through a lawsuit.The United States District Court for the District of Columbia dismissed the plaintiffs' complaint for lack of Article III standing. The court found that the plaintiffs failed to plausibly allege that their requested relief would redress any harm. The court noted that the injuries were caused by private home health agencies (HHAs) not before the court and that it was speculative whether enjoining the Secretary would change the HHAs' behavior. The court also found the plaintiffs' requested relief too general, making it difficult to evaluate its potential impact.The United States Court of Appeals for the District of Columbia Circuit reviewed the case and affirmed the district court's dismissal. The appellate court held that the plaintiffs failed to demonstrate redressability, a key component of standing. The court noted that the plaintiffs' injuries stemmed from the independent choices of private HHAs, and it was speculative that the requested injunctions would prompt these agencies to change their behavior. The court emphasized that the plaintiffs did not provide sufficient evidence to show that the Secretary's enforcement policies were a substantial factor in the HHAs' decisions. Consequently, the plaintiffs lacked standing to bring the suit, and the dismissal for lack of jurisdiction was affirmed. View "Johnson v. Becerra" on Justia Law

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Nevada Health CO-OP, a health insurance provider, received two loans from the Centers for Medicare & Medicaid Services (CMS) under the Affordable Care Act’s CO-OP program. These loans included a start-up loan and a solvency loan. In 2015, Nevada Health faced financial difficulties and was placed into receivership by the Nevada Commissioner of Insurance. CMS subsequently terminated the loan agreement and began offsetting payments owed to Nevada Health against the start-up loan debt.The United States Court of Federal Claims reviewed the case and granted summary judgment in favor of the Nevada Commissioner of Insurance, acting as the receiver for Nevada Health. The court found that the government improperly withheld statutory payments owed to Nevada Health under the ACA. The court also held that the government could not invoke 31 U.S.C. § 3728 to withhold these payments in the future.The United States Court of Appeals for the Federal Circuit reviewed the case. The court affirmed the lower court’s judgment that the government improperly withheld payments owed to Nevada Health. The court held that the loan agreement subordinated the government’s claim to those of policyholders and basic operating expenses, thus precluding the government from asserting offset rights to jump ahead of these senior creditors. However, the appellate court vacated the portion of the lower court’s order that addressed the government’s ability to invoke 31 U.S.C. § 3728, ruling that the lower court exceeded its jurisdiction by addressing this issue, which was not raised by the parties. View "Richardson v. United States" on Justia Law

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The case involves healthcare providers and air ambulance services challenging regulations established by the Departments of Health and Human Services, Labor, and the Treasury. These regulations were designed to guide independent arbitrators in resolving insurance reimbursement disputes under the No Surprises Act, which aims to protect patients from unexpected medical bills by limiting their out-of-pocket costs for emergency and certain non-emergency services provided by out-of-network providers.The United States District Court for the Eastern District of Texas reviewed the case and vacated the regulations, finding that they improperly favored the qualifying payment amount (QPA) over other statutory factors that arbitrators are required to consider. The court held that the regulations conflicted with the No Surprises Act and violated the Administrative Procedure Act (APA) by imposing additional requirements not found in the statute. The court also found that the plaintiffs had standing to sue based on procedural and financial injuries.The United States Court of Appeals for the Fifth Circuit reviewed the case and affirmed the district court's decision. The Fifth Circuit held that the regulations exceeded the Departments' authority by imposing a sequence in which arbitrators must consider the QPA first, disregarding information deemed not credible or unrelated, and requiring arbitrators to explain why they deviated from the QPA. The court found that these provisions placed undue emphasis on the QPA, contrary to the statute's requirement that all factors be considered equally. The court also upheld the district court's universal vacatur of the challenged provisions, rejecting the Departments' arguments for more limited relief. View "Texas Medical Association v. Health and Human Services" on Justia Law

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The case involves a dispute over the issuance of medical marijuana dispensary licenses in the city of Warren. In 2019, the Warren City Council adopted an ordinance to regulate these licenses, which involved a Review Committee scoring and ranking applications. The Review Committee held 16 closed meetings to review 65 applications and made recommendations to the city council, which then approved the top 15 applicants without further discussion. Plaintiffs, who were denied licenses, sued, alleging violations of the Open Meetings Act (OMA) and due process.The Macomb Circuit Court found that the Review Committee violated the OMA and invalidated the licenses issued by the city council. The court held that the Review Committee was a public body subject to the OMA and that the city council's approval process was flawed. Defendants and intervening defendants appealed, and the Michigan Court of Appeals reversed the trial court's decision. The appellate court held that the Review Committee was not a public body under the OMA because it only had an advisory role, and the city council retained final decision-making authority. The appellate court also upheld the trial court's dismissal of the plaintiffs' due process claims.The Michigan Supreme Court reviewed the case and reversed the Court of Appeals' decision. The Supreme Court held that the Review Committee was a public body subject to the OMA because it effectively decided which applicants would receive licenses by scoring and ranking them, and the city council merely adopted these recommendations without independent consideration. The court emphasized that the actual operation of the Review Committee, rather than just the language of the ordinance, determined its status as a public body. The case was remanded to the Court of Appeals to consider whether the open meetings held by the Review Committee cured the OMA violations and to address other preserved issues. View "Pinebrook Warren LLC v. City Of Warren" on Justia Law

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The case involves a coalition of states led by Washington suing the FDA over its 2023 REMS, which eliminated in-person dispensing requirements for the abortion drug mifepristone. Washington argues that the FDA should have further reduced restrictions on the drug, claiming that the remaining requirements impose unnecessary hurdles. Idaho, leading another coalition of states, sought to intervene, arguing that the elimination of the in-person dispensing requirement would harm its interests by making the drug easier to obtain and harder to police, potentially increasing Medicaid costs and endangering maternal health and fetal life.The United States District Court for the Eastern District of Washington denied Idaho's motion to intervene. The court found that Idaho did not have a significantly protectable interest that would be impaired by the litigation, as its complaint concerned different aspects of the 2023 REMS. The court also denied permissive intervention, concluding that Idaho's claims did not share common questions of law or fact with Washington's claims.The United States Court of Appeals for the Ninth Circuit reviewed the case and affirmed the district court's denial of Idaho's motion to intervene as of right. The Ninth Circuit held that Idaho must independently satisfy the requirements of Article III standing because it sought different relief from Washington. The court concluded that Idaho's complaint did not establish a cognizable injury-in-fact that was fairly traceable to the FDA's revised safe-use restrictions. Idaho's alleged economic injuries, law enforcement burdens, and quasi-sovereign interests were deemed too speculative or indirect to confer standing. The court dismissed for lack of jurisdiction the portion of the appeal concerning the denial of permissive intervention. View "STATE OF WASHINGTON V. FDA" on Justia Law

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A group of hospitals challenged a rule by the Department of Health and Human Services (HHS) that adjusted Medicare reimbursement rates. HHS had increased reimbursements for hospitals in the lowest wage quartile and decreased them for others to maintain budget neutrality. The hospitals argued that this adjustment exceeded HHS's statutory authority under the Medicare Act.The United States District Court for the District of Columbia ruled in favor of the hospitals, finding that HHS lacked the authority to make such adjustments. However, the court did not vacate the rule but remanded it to HHS with instructions to recalculate the reimbursements.The United States Court of Appeals for the District of Columbia Circuit reviewed the case and agreed with the lower court that HHS exceeded its authority. The court held that the Medicare Act's wage-index provision did not allow HHS to deviate from the congressionally prescribed formula. The adjustments provision also did not grant HHS the power to override the specific statutory formula. The court concluded that HHS's action must be vacated, not just remanded. Additionally, the court directed that the hospitals should receive an award of interest on the recalculated reimbursements as required by the Medicare statute.The court affirmed in part, reversed in part, and remanded the case to the district court for further proceedings consistent with its opinion. View "Bridgeport Hospital v. Becerra" on Justia Law

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The case involves a congressional program that awards grants for family-planning projects, with the Department of Health and Human Services (HHS) setting eligibility requirements. Oklahoma, a grant recipient, expressed concerns about these requirements, citing state laws prohibiting counseling and referrals for abortions. HHS proposed that Oklahoma provide neutral information about family-planning options, including abortion, through a national call-in number. Oklahoma rejected this proposal, leading HHS to terminate the grant. Oklahoma challenged the termination and sought a preliminary injunction.The United States District Court for the Western District of Oklahoma denied Oklahoma's motion for a preliminary injunction, determining that Oklahoma was unlikely to succeed on the merits of its claims. Oklahoma then appealed the decision.The United States Court of Appeals for the Tenth Circuit reviewed the case. Oklahoma argued that it would likely succeed on the merits for three reasons: (1) Congress's spending power did not allow it to delegate eligibility requirements to HHS, (2) HHS's requirements violated the Weldon Amendment, and (3) HHS acted arbitrarily and capriciously. The Tenth Circuit rejected these arguments, holding that:1. The spending power allowed Congress to delegate eligibility requirements to HHS, and Title X was unambiguous in conditioning eligibility on satisfaction of HHS's requirements. 2. The Weldon Amendment, which prohibits discrimination against health-care entities for declining to provide referrals for abortions, was not violated because HHS's proposal to use a national call-in number did not constitute a referral for the purpose of an abortion. 3. HHS did not act arbitrarily and capriciously in terminating Oklahoma's grant, as the eligibility requirements fell within HHS's statutory authority, and Oklahoma did not demonstrate a likely violation of HHS's regulations.The Tenth Circuit affirmed the district court's denial of the preliminary injunction, concluding that Oklahoma had not shown a likelihood of success on the merits of its claims. View "State of Oklahoma v. HHS" on Justia Law