Justia Government & Administrative Law Opinion Summaries

In light of the surging community spread of COVID-19, California's public health and epidemiological experts have crafted a complex set of regulations that restrict various activities based on their risk of transmitting the disease and the projected toll on the State's healthcare system. California permits unlimited attendance at outdoor worship services and deems clergy and faith-based streaming services "essential," but has temporarily halted all congregate indoor activities, including indoor religious services, within the most at-risk regions of the state.South Bay challenges this restriction, along with others, under provisions of the Free Exercise Clause of the First Amendment of the United States and California Constitutions. South Bay argues that the current restrictions on indoor services prohibit congregants' Free Exercise of their theology, which requires gathering indoors. The district court concluded that California's restrictions on indoor worship are narrowly tailored to meet its compelling—and immediate—state interest in stopping the community spread of the deadly coronavirus.The Ninth Circuit affirmed the district court's denial of South Bay's request to enjoin California's temporary prohibition on indoor worship under the Regional Stay at Home Order and Tier 1 of the Blueprint. The panel concluded that, although South Bay has demonstrated irreparable harm, it has not demonstrated that the likelihood of success, the balance of the equities, or the public interest weigh in its favor. The panel stated that California has a compelling interest in reducing community spread of COVID-19, and the Stay at Home Order is narrowly tailored to achieve the State's compelling interest in stemming the recent case surge. The panel also concluded that South Bay has not demonstrated a likelihood of success on the merits with respect to its challenge to California's state-wide ban on indoor singing and chanting. In this case, the State's ban on these activities is rationally related to controlling the spread of COVID-19. The panel could not, however, conclude that the 100- and 200-person attendance caps on indoor worship under Tiers 2 and 3 of the Blueprint survive strict scrutiny. The panel explained that the State has not shown that less restrictive measures, such as basing attendance limits on the size of the church, synagogue or mosque would cause any greater peril to the public. The panel remanded to the district court with instructions to enjoin the State from imposing the 100- and 200-person caps under Tiers 2 and 3 of the Blueprint. View "South Bay United Pentecostal Church v. Newsom" on Justia Law

The People of the State of California, by and through the Santa Clara County Counsel, the Orange County District Attorney, the Los Angeles County Counsel, and the Oakland City Attorney, filed suit against various pharmaceutical companies involved in the manufacture, marketing, distribution, and sale of prescription opioid medications. The People alleged the defendants made false and misleading statements as part of a deceptive marketing scheme designed to minimize the risks of opioid medications and inflate their benefits. The People alleged this scheme caused a public health crisis in California by dramatically increasing opioid prescriptions, opioid use, opioid abuse, and opioid-related deaths. In their suit, the People allege causes of action for violations of the False Advertising Law, and the public nuisance statutes. After several years of litigation, the defendants served business record subpoenas on four nonparty state agencies: the California State Board of Registered Nursing (Nursing Board), the California State Board of Pharmacy (Pharmacy Board), the Medical Board of California (Medical Board), and the California Department of Justice (DOJ). The Pharmacy Board, the Medical Board, and the DOJ served objections to the subpoenas. The Nursing Board filed a motion for a protective order seeking relief from the production obligations of its subpoena. After further litigation, which is recounted below, the trial court ordered the state agencies to produce documents in response to the subpoenas. In consolidated proceedings, the state agencies challenged the trial court's orders compelling production of documents. After review, the Court of Appeal concluded the motions to compel against the Pharmacy Board and Medical Board were untimely, and the defendants were required to serve consumer notices on at least the doctors, nurses, pharmacists, and other health care professionals whose identities would be disclosed in the administrative records, investigatory files, and coroner’s reports. Furthermore, the Court concluded the requests for complete administrative records and investigatory files, were overbroad and not reasonably calculated to lead to the discovery of admissible evidence. "The requests for complete administrative records and investigatory files also ran afoul of the constitutional right to privacy and the statutory official information and deliberative process privileges." The trial court was directed to vacate its orders compelling production of documents, and to enter new orders denying the motions to compel and, for the Nursing Board, granting its motion for a protective order. View "Board of Registered Nursing v. Super. Ct." on Justia Law

Johnson & Johnson and other pharmaceutical defendants sought mandamus relief from an Alabama circuit court order that refused to transfer venue of the underlying lawsuit to the Jefferson County, Alabama circuit court, on grounds that venue in Conecuh County was not proper as to all plaintiffs, or alternatively, on the basis that convenience of the parties and/or the interest of justice required it. In 2019, the plaintiffs filed a complaint at the Conecuh Circuit Court against numerous defendants that, they averred, manufactured, marketed, distributed, and/or dispensed opioid medications throughout Alabama in a manner that was misleading, unsafe, and resulted in drug addiction, injury, and/or death to Alabama citizens. The complaint asserted claims of negligence, nuisance, unjust enrichment, fraud and deceit, wantonness, and civil conspiracy. The manufacturer defendants moved to transfer the case to Jefferson County, reasoning that because 8 of the 17 plaintiffs either had a place of business in Jefferson County or operated hospitals in Jefferson County or adjacent counties, logic dictated that a large percentage of the witnesses for those plaintiffs (i.e., prescribing doctors, hospital administrators, etc.) and their evidence were located in or around Jefferson County. After a review of the circuit court record, the Alabama Supreme Court determined defendants did not demonstrate a clear, legal right to transfer the underlying case from Conecuh to Jefferson County. Therefore, the petition was denied. View "Ex parte Johnson & Johnson et al." on Justia Law

Pursuant to the Affordable Care Act, Congress required hospitals to make public "a list" of "standard charges" in accordance with guidelines developed by the Secretary of Health and Human Services. The Hospital and others challenged the Secretary's rule defining "standard charges" as including prices that hospitals charge insurers.The DC Circuit affirmed the district court's grant of summary judgment in favor of the Secretary, holding that the rule does not violate the Affordable Care Act of 2010, the Administrative Procedure Act, or the First Amendment. The court concluded that, viewed in its entirety, 42 U.S.C. 2718(e) is best interpreted as requiring disclosure of more than list prices. The court explained that section 2718(e) permits the Secretary to require disclosure of negotiated rates, and requiring hospitals to display certain datapoints separately falls squarely within the Secretary's authority to develop guidelines for making the list public. Furthermore, contrary to the Association's argument, the best reading of section 2718(e), in its entirety, permits the Secretary to require hospitals to display the information in multiple ways.In regard to the APA claims, the court concluded that the Secretary adequately addressed the feasibility and administrative burdens, as well as the benefits, of complying with the rule. Furthermore, the court rejected the Association's claim that the agency changed its position. Finally, the court concluded that the Association's argument that the rule violates the First Amendment is squarely barred by the Supreme Court's decision in Zauderer v. Office of Disciplinary Counsel of the Supreme Court of Ohio, 471 U.S. 626 (1985), and the court's case law applying that decision. View "American Hospital Ass'n v. Azar" on Justia Law

Defendants appealed the district court's judgment certifying a plaintiff class and enjoining state defendants from conducting Medicaid fair hearings in a manner that does not result in final determinations of Medicaid eligibility within 90 days of hearing requests. At issue is the phrase "final administrative action" in the context of a federal Medicaid regulation that requires a state agency to take such action within a specified time limit following a Medicaid applicant's request for a fair hearing. 42 C.F.R. 431.244(f).The Second Circuit held that the federal regulatory requirement of "final administrative action" within 90 days requires the state to determine Medicaid eligibility within that time. However, the court explained that such determinations may be made in hearing decisions or on remand to local agencies. Therefore, the regulation mandates that states meet the applicable deadline, but it does not limit states as to the administrative level at which that deadline is met. The court affirmed in part and remanded for further proceedings. View "Lisnitzer v. Zucker" on Justia Law

Calvary Chapel challenges Nevada Governor Steve Sisolak's Directive 021, which prohibits certain gatherings because of the COVID-19 pandemic, as a violation of the Free Exercise Clause of the First Amendment. Specifically, Calvary Chapel challenges section 11 of the Directive, which imposes a fifty-person cap on indoor in-person services at houses of worship.The Ninth Circuit reversed the district court's denial of the church's request for a preliminary injunction barring enforcement of the Directive against houses of worship. The panel held that the Supreme Court's recent decision in Roman Catholic Diocese of Brooklyn v. Cuomo, --- S. Ct. ----, 2020 WL 6948354 (2020) (per curiam), arguably represented a seismic shift in Free Exercise law, and compels the result in this case. Similar to the pandemic-related restrictions in Roman Catholic Diocese, the panel explained that the Directive treats numerous secular activities and entities significantly better than religious worship services. The panel explained that the Directive, although not identical to New York's, requires attendance limitations that create the same "disparate treatment" of religion. Because disparate treatment of religion triggers strict scrutiny review, the panel reviewed the restrictions in the Directive under strict scrutiny. Exercising its discretion, the panel concluded that, although slowing the spread of COVID-19 is a compelling interest, the Directive is not narrowly tailored to serve that interest. In this case, the Directive—although less restrictive in some respects than the New York regulations reviewed in Roman Catholic Diocese—is not narrowly tailored because, for example, "maximum attendance at a religious service could be tied to the size of the [house of worship]."Therefore, Calvary Chapel has demonstrated a likelihood of success on the merits of its Free Exercise claim. Calvary Chapel has also established that the occupancy limitations contained in the Directive—if enforced—will cause irreparable harm, and that the issuance of an injunction is in the public interest. The panel reversed the district court, instructed the district court to employ strict scrutiny review to its analysis of the Directive, and preliminarily enjoined the State from imposing attendance limitations on in-person services in houses of worship that are less favorable than 25% of the fire-code capacity. View "Calvary Chapel Dayton Valley v. Sisolak" on Justia Law

Plaintiffs, individuals living with HIV/AIDS who have employer-sponsored health plans, and who rely on those plans to obtain prescription drugs, filed suit alleging that CVS's program violates the anti-discrimination provisions of the Affordable Care Act (ACA), the Americans with Disabilities Act (ADA), and the California Unruh Civil Rights Act (Unruh Act); denies them benefits to which they are entitled under the Employee Retirement Security Act (ERISA); and violates California's Unfair Competition Law (UCL). The district court granted defendants' motion to dismiss.The Ninth Circuit held that Section 1557 of the ACA does not create a healthcare-specific anti-discrimination standard that allowed plaintiffs to choose standards from a menu provided by other anti-discrimination statutes. Because plaintiffs claim discrimination on the basis of their disability, to state a claim for a Section 1557 violation, they must allege facts adequate to state a claim under Section 504 of the Rehabilitation Act. Applying the section 504 framework, the panel concluded that plaintiffs adequately alleged that they were denied meaningful access to their prescription drug benefit under their employer-sponsored health plans because the program prevents them from receiving effective treatment for HIV/AIDS. Therefore, plaintiffs have stated a claim for disability discrimination under the ACA.However, plaintiffs have failed to establish a claim of disability discrimination under the ADA, because they have not plausibly alleged that their benefit plan is a place of public accommodation. Finally, the panel upheld the district court's denial of plaintiffs' claims under ERISA and their cause of action under California's Unfair Competition Law. The panel affirmed in part, vacated in part, and remanded. View "Doe v. CVS Pharmacy, Inc." on Justia Law

Dr. Korban and his medical practice Delta, practice diagnostic and interventional cardiology. In 2007, Dr. Deming filed a qui tam action under the False Claims Act (FCA), 31 U.S.C. 3729(a)(1)(A)–(C), (G) against Korban, Jackson Regional Hospital, and other Tennessee hospitals, alleging “blatant overutilization of cardiac medical services.” The United States intervened and settled the case for cardiac procedures performed in 2004-2012. Korban entered into an Integrity Agreement with the Office of Inspector General, effective 2013-2016 that was publicly available and required an Independent Review Organization. The U.S. Department of Justice issued a press release that detailed the exposed fraudulent scheme and outlined the terms of Korban’s settlement. In 2015, Jackson Regional agreed to a $510,000 settlement. The Justice Department and Jackson both issued press releases.In 2017, Dr. Maur, a cardiologist who began working for Delta in 2016, alleged that Korban was again performing “unnecessary angioplasty and stenting” and “unnecessary cardiology testing,” paid for in part by Medicare. In addition to Korban and Jackson, Maur sued Jackson’s corporate parent, Tennova, Dyersburg Medical Center, and Tennova’s corporate parent, Community Health Systems. The United States declined to intervene. The district court dismissed, citing the FCA’s public-disclosure bar, 31 U.S.C. 3730(e)(4). The Sixth Circuit affirmed. Maur’s allegations are “substantially the same” as those exposed in a prior qui tam action and Maur is not an “original source” as defined in the FCA. View "Maur v. Hage-Korban" on Justia Law

Alleging debilitating pain in her back, legs, and hands, Zoch sought disability insurance benefits, 42 U.S.C. 413, 423. An ALJ denied the application, finding that, based on the opinions of three of her four treating physicians, a consulting physician, and the objective medical evidence, she could perform sedentary work.The district court and Seventh Circuit affirmed, rejecting Zoch’s arguments that the ALJ improperly discounted her assertions and an opinion by a physician who relied on those assertions. Substantial evidence supports the ALJ’s decision. Zoch’s testimony of incapacitating pain conflicted with the objective medical evidence, including normal test results: lumbar MRI, wrist x-rays, range of motion, straight-leg raising, strength in extremities, and pressure on her nerves. Zoch’s testimony that she usually walked with a cane conflicted with the doctors’ reports that at all but one appointment she walked normally. Zoch’s testimony that she could not raise her arms or bend over to dress conflicted with a doctor’s observation that Zoch could comfortably bend over to touch her fingertips to her knees. Zoch’s hearing testimony that she could not perform the usual activities of daily living was inconsistent with her assertions in her application. View "Zoch v. Saul" on Justia Law

The en banc court held that 42 U.S.C. 1396a(a)(23) does not give Medicaid patients a right to challenge, under 42 U.S.C. 1983, a State's determination that a health care provider is not "qualified" within the meaning of section 1396a(a)(23). The en banc court vacated the preliminary injunction issued by the district court prohibiting the termination of the Providers' Medicaid provider agreements.The Providers provide family planning and other health services to Medicaid patients, and each of the Providers is a member of Planned Parenthood. This case stemmed from a pro-life organization's release of video recordings of conversations at Planned Parenthood (PP) Gulf Coast headquarters. The videos depict two individuals posing as representatives from a fetal tissue procurement company discussing the possibility of a research partnership with PP Gulf Coast. The release of the videos prompted congressional investigations, which ultimately led to the OIG sending each Provider a Notice of Termination of its respective Medicaid provider agreement. The Providers and Individual Plaintiffs filed suit alleging that the terminations violated rights conferred by section 1396a(a)(23) and sought relief under section 1983.The en banc court held that the Individual Plaintiffs may not bring a section 1983 suit to contest the State's determination that the Providers were not "qualified" providers within the meaning of section 1396a(a)(23). The en banc court rested its decision primarily on two independent bases: (1) the Supreme Court's decision in O'Bannon v. Town Court Nursing Center, 447 U.S. 773 (1980), and (2) the text and structure of section 1396a(a)(23), which does not unambiguously provide that a Medicaid patient may contest a State's determination that a particular provider is not "qualified." Rather, the court held that whether a provider is "qualified" within the meaning of section 1396a(a)(23) is a matter to be resolved between the State (or the federal government) and the provider. In so holding, the en banc court overruled Planned Parenthood of Gulf Coast, Inc. v. Gee, 862 F.3d 445 (5th Cir. 2017), which held that a state agency or actor cannot legitimately find that a Medicaid provider is not "qualified" unless under state or federal law the provider would be unqualified to provide treatment or services to the general public, including Medicaid patients who paid for the care or services with private funds. View "Planned Parenthood of Greater Texas Family Planning and Preventative Health Services, Inc. v. Kauffman" on Justia Law