Justia Government & Administrative Law Opinion Summaries

Defendants Michael Touchette and Centurion Healthcare brought an interlocutory appeal of a trial court's certification of a class of plaintiffs in a Vermont Rule 75 action. The certified class was comprised of people in the custody of the Vermont Department of Corrections (DOC), each of whom suffered from opioid-use disorder, and alleged defendants’ medication-assisted treatment (MAT) program did not meet prevailing medical standards of care as required by Vermont law. Defendants, the former Commissioner of the DOC and its contract healthcare provider, argued the trial court erred both in finding that plaintiff Patrick Mullinnex exhausted his administrative remedies before filing suit, and in adopting the vicarious-exhaustion doctrine favored by several federal circuits in order to conclude that Mullinnex’s grievances satisfied the exhaustion requirement on behalf of the entire class. Defendants also contended the trial court’s decision to certify the class was made in error because plaintiffs did not meet Rule 23’s numerosity, commonality, typicality, and adequacy-of- representation requirements. After review, the Vermont Supreme Court reversed, concluding that - even if the vicarious-exhaustion doctrine was appropriately applied in Vermont - it could not apply in this case because, on the record before the trial court, no member of the putative class succeeded in exhausting his administrative remedies. Because plaintiffs’ failure to exhaust left the courts without subject-matter jurisdiction, the Supreme Court did not reach defendants’ challenges to the merits of the class-certification decision. View "Mullinnex et al . v. Menard et al." on Justia Law

Empire challenged HHS's 2005 Rule interpreting a Medicare regulation under the Administrative Procedure Act (APA), as part of its appeal of HHS's calculation of its 2008 reimbursement. The 2005 Rule removed the word "covered" from 42 C.F.R. 412.106(b)(2)(i), effectively amending HHS's interpretation of "entitled to [Medicare]" in 42 U.S.C. 1395ww(d)(5)(F)(vi), a subsection of the Medicare Act, 42 U.S.C. 1395 et seq. The district court granted partial summary judgment for Empire, ruling that, while the 2005 Rule was substantively valid, it should be vacated because the rulemaking process leading to its adoption failed to meet the APA’s procedural requirements.The Ninth Circuit affirmed the district court's grant of summary judgment and vacatur of the 2005 Rule on different grounds. The panel held that the 2005 Rule's rulemaking process, while not perfect, satisfied the APA's notice-and-comment requirements. However, the panel held that the 2005 Rule is substantively invalid and must be vacated, because it directly conflicts with the panel's interpretation of 42 U.S.C. 1395ww(d)(5)(F)(vi) in Legacy Emanuel Hospital and Health Center v. Shalala, 97 F.3d 1261, 1265–66 (9th Cir. 1996). Legacy Emanuel interpreted the meaning of "entitled to [Medicare]" as unambiguous and thus the 2005 Rule's conflicting construction cannot stand. The panel remanded for further proceedings. View "Empire Health Foundation v. Azar" on Justia Law

The Eleventh Circuit denied a motion for a stay of a preliminary injunction that enjoins certain applications of a public health order issued in response to the COVID-19 pandemic in Alabama. The public health order, published on March 27, 2020, mandated the postponement of all dental, medical, or surgical procedures. Plaintiffs, abortion providers in Alabama, sought a temporary restraining order (TRO) preventing enforcement of the public health order as applied to pre-viability abortions. After the district court issued a TRO, the state filed a motion to dissolve the TRO and included clarifications. The district court subsequently adopted the state's clarifications and issued an April 3rd order, staying the TRO in part. The state later changed its interpretation again. Based on the evidence presented at the preliminary injunction hearing, the district court determined that the medical restrictions, as read pursuant to the state's earlier interpretation, violate the Fourteenth Amendment.The court held that the state has not made a strong showing that it is likely to succeed on the merits of its appeal or that it will be irreparably injured absent a stay. In this case, because of the state's shifting interpretations of the March 27th and April 3rd orders, the district court had ample authority to issue a preliminary injunction to preserve the status quo and prevent the state from reverting to its initial and more restrictive interpretations.The district court considered Jacobson v. Commonwealth of Massachusetts and Smith v. Avino, but read them together with cases holding that the Fourteenth Amendment generally protects a woman's right to terminate her pregnancy. Applying both the Jacobson framework and the Casey undue-burden test together, the district court concluded that the April 3rd order imposed a plain, palpable invasion of rights, yet had no real or substantial relation to the state's goals. The court held that the district court was permitted to reach this conclusion and to issue a status quo preliminary injunction to ensure that the state did not deviate from the Alabama State Health Officer's interpretation of the April 3rd order at the preliminary injunction hearing. View "Robinson v. Planned Parenthood Southeast Inc." on Justia Law

The Patient Protection and Affordable Care Act established online exchanges where insurers could sell their healthcare plans. The now-expired “Risk Corridors” program aimed to limit the plans’ profits and losses during the first three years (2014-2016). Under 31 U.S.C. 1342, eligible profitable plans “shall pay” the Secretary of the Department of Health and Human Services, while the Secretary “shall pay” eligible unprofitable plans. The Act neither appropriated funds nor limited the amounts that the government might pay. There was no requirement that the program be budget-neutral. The total deficit exceeded $12 billion. At the end of each year, the appropriations bills for the Centers for Medicare and Medicaid Services included a rider preventing the Centers from using the funds for Risk Corridors payments. The Federal Circuit rejected Tucker Act claims for damages by health-insurance companies that claimed losses under the program.The Supreme Court reversed. The Risk Corridors statute created an obligation to pay insurers the full amount set out in section 1342’s formula. The government may incur an obligation directly through statutory language, without details about how the obligation must be satisfied. The Court noted the mandatory term “shall,” and adjacent provisions, which differentiate between when the Secretary “shall” act and when she “may” exercise discretion. Congress did not impliedly repeal the obligation through its appropriations riders. which do not indicate “any other purpose than the disbursement of a sum of money for the particular fiscal years.”The Risk Corridors statute is fairly interpreted as mandating compensation for damages, and neither Tucker Act exception applies. Nor does the APA bar a Tucker Act suit. The insurers seek specific sums already calculated, past due, and designed to compensate for completed labors. Because the Risk Corridors program expired this litigation presents no special concern about managing a complex ongoing relationship. View "Maine Community Health Options v. United States" on Justia Law

The respondent in an involuntary commitment proceeding, "Meredith B.," appealed the ex parte order authorizing her hospitalization for evaluation and the subsequent 30-day commitment order. Respondent argued that the screening investigation was inadequate because she was not interviewed. She asserted that, as a result, both the order hospitalizing her for evaluation and the 30-day commitment order should have been reversed and vacated. Further, she challenged the 30-day commitment order finding she was (1) "gravely disabled" and there (2) was a reasonable expectation she could improve with treatment. After review of the order at issue, the Alaska Supreme Court found the superior court's decision was supported by clear and convincing evidence. "If there was an error during the screening investigation, the error was harmless, because the respondent had the opportunity to testify at the 30-day commitment hearing." View "In the Matter of the Necessity for the Hospitalization of M.B." on Justia Law

Plaintiffs filed suit alleging that TDCJ's adoption and implementation of measures guided by changing CDC recommendations in regards to the COVID-19 pandemic do not go far enough. Plaintiffs filed a class action alleging violations of the Eighth Amendment's prohibition against cruel and unusual punishment, and the Americans with Disabilities Act, seeking a preliminary injunction.The Fifth Circuit granted TDCJ's motion to stay the district court's preliminary injunction, which regulates the cleaning intervals for common areas, the types of bleach-based disinfectants the prison must use, the alcohol content of hand sanitizer that inmates must receive, mask requirements for inmates, and inmates' access to tissues (amongst many other things). The court held that TDCJ is likely to prevail on the merits of its appeal because: (1) after accounting for the protective measures TDCJ has taken, plaintiffs have not shown a "substantial risk of serious harm" that amounts to "cruel and unusual punishment"; and (2) the district court committed legal error in its application of Farmer v. Brennan, by treating inadequate measures as dispositive of defendants' mental state. In this case, even assuming that there is a substantial risk of serious harm, plaintiffs lack evidence of defendants' subjective deliberate indifference to that harm. The court also held that TDCJ has shown that it will be irreparably injured absent a stay, and that the balance of the harms and the public interest favor a stay. Finally, the court held that plaintiffs have not exhausted their administrative remedies as required in the Prison Litigation Reform Act (PLRA), and the district court's injunction goes well beyond the limits of what the PLRA would allow even if plaintiffs had properly exhausted their claims. View "Valentine v. Collier" on Justia Law

In this case, the parties dispute the proper method for calculating the hospital specific limit for annual DSH payments. The Hospitals filed suit challenging the 2017 final rule clarifying that hospitals' "costs incurred" are net of payments from third parties, liked Medicare and private insurers. The Hospitals contend that the Secretary's definition of "costs incurred" conflicted with the Medicaid Act, 5 U.S.C. 706(2)(C).The Fifth Circuit reversed the district court's grant of summary judgment for the Hospitals, and joined three other circuits in holding that the 2017 rule was consistent with the Medicare Act. The court could not agree with the Hospitals that the ordinary meaning and dictionary definitions of "costs" and "payments" rendered the disputed language unambiguous; the court was unpersuaded by the Hospitals' argument that the statute draws a "clear line" between costs and payments; the court rejected the Hospitals' contention that Congress, by expressly excluding payments from Medicaid and the uninsured, meant to exclude only those payments and no others; the court rejected the Hospitals' argument that the express exclusion of third-party payments in a related Medicaid provision indicates that Congress chose not to deduct third-party payments in 42 U.S.C. 1396r-4(g)(1)(A); and the court saw no basis for the Hospitals' argument that the 2017 Rule conflicts with the statutory purpose of the hospital-specific limit. Accordingly, the court remanded for further proceedings. View "Baptist Memorial Hospital - Golden Triangle, Inc. v. Azar" on Justia Law

Plaintiffs, health care providers and their patients, filed suit against Iowa's Department of Public Health and its Health Facilities Council, alleging that Iowa's Certificate of Need laws violate the Fourteenth Amendment's Due Process, Equal Protection, and Privileges and Immunities Clauses.The Eighth Circuit held that plaintiffs' Privileges and Immunities Clause claim was foreclosed by the Slaughter-Houses cases. Applying rational basis review to the Certificate of Need (CON) regime and capital expenditures exemption, the court held that Iowa's CON requirement is rationally related to a legitimate state interest in full-service hospital viability. Furthermore, Iowa's decision to exempt competitors who are non-hospital CON-holders is rationally related to its interest in protecting the viability of full-service hospitals. Therefore, the court affirmed the district court's orders dismissing plaintiffs' Privileges and Immunities claim and granting summary judgment in favor of the state defendants on the remaining claims. View "Birchansky v. Clabaugh" on Justia Law

The Fifth Circuit granted a writ of mandamus directing vacatur of the district court's issuance of a temporary restraining order (TRO) against executive order GA-09 as applied to abortion procedures. In order to preserve critical medical resources during the escalating COVID-19 pandemic, the Governor of Texas issued GA-09, which postpones non-essential surgeries and procedures until 11:59 p.m. on April 21, 2020.The court held that the drastic and extraordinary remedy of mandamus was warranted in this case because the district court ignored the framework governing emergency public health measures, like GA-09, in Jacobson v. Commonwealth of Massachusetts, 197 U.S. 11 (1905); the district court wrongly declared GA-09 an "outright ban" on previability abortions and exempted all abortion procedures from its scope, rather than apply the Jacobson framework to decide whether GA-09 lacks a "real or substantial relation" to the public health crisis or whether it is "beyond all question, a plain, palpable invasion" of the right to abortion; the district court failed to apply the undue-burden analysis in Planned Parenthood v. Casey, 505 U.S. 833, 857 (1992), and thus failed to balance GA-09's temporary burdens on abortion against its benefits in thwarting a public health crisis; and the district court usurped the state's authority to craft emergency health measures, substituting instead its own view of the efficacy of applying GA-09 to abortion. Therefore, the court found that the requirements for a writ of mandamus are satisfied in light of the extraordinary nature of these errors, the escalating spread of COVID-19, and the state's critical interest in protecting the public health. View "In re: Gregg Abbott" on Justia Law

Elaine Kirt died in 2010, due to complications that developed shortly after undergoing eye surgery. On September 23, 2011, her son, Neville Kirt, appearing in person and on behalf of his deceased mother and his two brothers, filed a request with the Division of Administration asking for a medical review panel to review the care provided to his mother by three defendants: Dr. Rebecca Metzinger, the attending surgeon; Dr. Theodore Strickland III, the anesthesiologist for the procedure; and Tulane Medical Center. In a reply letter to Neville, the Patient’s Compensation Fund Oversight Board (PCF) acknowledged receipt of the request; confirmed Dr. Metzinger, Dr. Strickland, and Tulane University Hospital & Clinic were qualified under the Louisiana Medical Malpractice Act (Act); informed Kirt a filing fee of $100 per qualified defendant was due; and requested payment of $300. The notice stated the failure to pay would render the request invalid, without effect, and would not suspend the time to file suit. Days later, then appearing through counsel, the Kirts sent a second letter asking to amend its previous request, adding two additional nurses. The Kirts included a $500 check to cover filing fees. A medical review panel convened, reviewed the care provided by all named healthcare providers, and found no breach of the standard of care. The Kirts thereafter filed against the doctors and nurses. Claims against the doctors were dismissed by summary judgments because there was no proof they breached the standard of care while treating Elaine Kirt. Those judgments expressly barred allocating fault to the dismissed parties and prohibited introducing evidence at trial to establish their fault. The nurses then filed peremptory exceptions of prescription, claiming the request for a medical review panel was invalid because the Kirts failed to pay the final $100 filing fee, and prescription was not suspended for any claims. The trial court concurred with the nurses and granted an exception of prescription. The Supreme Court determined that because the Kirts paid filing fees for five of six named defendants, dismissal of one of the nurses was proper for lack of a filing fee. The Court determined the lower courts did not consider or decide the merits of the Kirts' argument that they could not have reasonable known about the claims against two of the nurse defendants until one was deposed. Because the lower courts did not consider or decide the merits of the Kirts' basis for the exception of prescription, which could have turned on factual findings, the Supreme Court pretermitted consideration of these arguments and remanded the matter to the trial court for further disposition of the exception. View "Kirt v. Metzinger" on Justia Law