Justia Government & Administrative Law Opinion Summaries

Petitioner Charlotte-Mecklenburg Hospital Authority, d/b/a Carolinas Medical Center-Fort Mill sought a writ of certiorari to review the court of appeals' decision in Amisub of South Carolina, Inc. v. South Carolina Department of Health & Environmental Control, Op. No. 2017-UP-013 (S.C. Ct. App. filed Jan. 11, 2017). In 2005, four hospitals, Petitioner, Respondent Amisub, Presbyterian Healthcare System, and Hospital Partners of America, applied for a certificate of need (CON) to construct and operate an acute-care hospital in Fort Mill. In May 2006, the Department of Health and Environmental Control (DHEC) determined the acute-care hospital was necessary, and granted a CON to Amisub, but denied a CON to Petitioner and the others. DHEC's decision to award the CON to Amisub was based in part on its interpretation of the language of the South Carolina Health Plan that only existing health care providers in York County were eligible for additional hospital beds. Petitioner filed a contested case at the ALC, contending DHEC had erroneously interpreted the language of the Health Plan. Alternatively, Petitioner argued that if DHEC's interpretation was correct, the Health Plan violated the dormant Commerce Clause because it improperly restricted interstate commerce. The ALC found DHEC's interpretation of the Health Plan was not correct, reversed, and remanded to DHEC. The ALC's determination made it unnecessary for the ALC to reach the alternative dormant Commerce Clause claim. On remand, DHEC granted a CON to Petitioner, but denied a CON to the others. Amisub filed a second contested case at the ALC, which again reversed, this time ordering a CON be granted to Amisub and denied to Petitioner. The court of appeals affirmed, finding "the record does not show [Petitioner] presented to the ALC any argument that [Amisub]'s positions on adverse impact and outmigration, if adopted by the ALC, would violate the Dormant Commerce Clause. [Petitioner] waited until filing its Rule 59(e) motion to present this argument, which is too late." If Petitioner had reason to believe this issue was actually being litigated before the ALC in the second contested case, and yet remained silent, the South Carolina Supreme Court would have agreed with the court of appeals. However, the dormant Commerce Clause issues arising out of the language of the Health Plan were resolved in Petitioner's favor in the first contested case. Thus, Petitioner could not reasonably have foreseen the ALC would craft its order in a fashion to revive those issues. Therefore, Petitioner had no reason to raise the dormant Commerce Clause challenge in the second contested case until the ALC issued its order. “No party should be penalized for not addressing an issue as to which it had previously prevailed, and which it did not reasonably contemplate would yet be the basis of the court's ruling.” Accordingly, the Supreme Court reversed the court of appeals' finding that the dormant Commerce Clause issue was not preserved for appellate review, and remanded the case to the court of appeals for a ruling on the merits of the issue. View "Amisub v. SCDHEC" on Justia Law

Little Sisters of the Poor, a Roman Catholic congregation serving the elderly poor of all backgrounds, operates homes for the elderly, all of which adhere to the same religious beliefs. A religious nonprofit corporation that operates a Little Sisters home in Pittsburgh sought to intervene in litigation challenging regulations promulgated under the Patient Protection and Affordable Care Act, 42 U.S.C. 300gg-13(a)(4). That litigation was instituted by the Commonwealth of Pennsylvania, challenging interim final rules, providing for “religious” and “moral “ exemptions to the Act's "contraceptive mandate" for “entities, and individuals, with sincerely held religious beliefs objecting to contraceptive or sterilization coverage,” including “for-profit entities that are not closely-held.” The Third Circuit reversed the denial of their motion. Little Sisters’ interest in the regulations is neither novel nor isolated; it has been involved in Affordable Care Act litigation for years. Little Sisters’ interest in preserving the religious exemption is concrete and capable of definition; the relationships among the organization's various homes indicate a unique interest compared to other religious objectors who might wish to intervene. Those interests are significantly protectable. Little Sisters have demonstrated that they may be “practically disadvantaged by the disposition of the action” and have established that their interests are not adequately represented by the federal government. View "Commonwealth of Pennsylvania v. President United States" on Justia Law

The Board of Directors (the Board) of Bear Valley Community Hospital (Bear Valley) refused to promote Dr. Robert O. Powell from provisional to active staff membership and reappointment to Bear Valley's medical staff. Dr. Powell appealed the superior court judgment denying his petition for writ of mandate to void the Board's decision and for reinstatement of his medical staff privileges. Dr. Powell practiced medicine in both Texas and California as a general surgeon. In 2000, the medical executive committee of Brownwood Regional Medical Center (Brownwood), in Texas, found that Dr. Powell failed to advise a young boy's parents that he severed the boy's vas deferens during a hernia procedure or of the ensuing implications. Further, the committee found that Dr. Powell falsely represented to Brownwood's medical staff, on at least two occasions, that he fully disclosed the circumstances to the parents, behavior which the committee considered to be dishonest, obstructive, and which prevented appropriate follow-up care. Based on the committee's findings, Brownwood terminated Dr. Powell's staff membership and clinical privileges. In subsequent years, Dr. Powell obtained staff privileges at other medical facilities. In October 2011, Dr. Powell applied for appointment to the medical staff at Bear Valley. On his initial application form, Dr. Powell was given an opportunity to disclose whether his clinical privileges had ever been revoked by any medical facility. In administrative hearings generated by the Bear Valley Board’s decision, there was a revelation that Dr. Powell had not been completely forthcoming about the Brownwood termination, and alleged the doctor mislead the judicial review committee (“JRC”) about the circumstances leading to that termination. Under Bear Valley's bylaws, Dr. Powell had the right to an administrative appeal of the JRC's decision; he chose, however, to bypass an administrative appeal and directly petition the superior court for a writ of mandamus. In superior court, Dr. Powell filed a petition for writ of mandate under Code of Civil Procedure sections 1094.5 and 1094.6, seeking to void the JRC's/Board's decision and to have his medical privileges reinstated. The trial court denied the petition, and this appeal followed. On appeal of the superior court’s denial, Dr. Powell argued he was entitled to a hearing before the lapse of his provisional staff privileges: that the Board surreptitiously terminated his staff privileges, presumably for a medical disciplinary cause, by allowing his privileges to lapse and failing to act. The Court of Appeal determined the Bear Valley Board had little to no insight into the true circumstances of Dr. Powell’s termination at Brownwood or the extent of his misrepresentations, thus the Board properly exercised independent judgment based on the information presented. In summary, the Court of Appeal concluded Bear Valley provided Dr. Powell a fair procedure in denying his request for active staff privileges and reappointment to the medical staff. View "Powell v. Bear Valley Community Hospital" on Justia Law

Twelve Medicaid-participating hospitals (“Hospitals”) challenged the Department of Medicaid’s (“DOM’s”) recalculation of their Medicaid outpatient rates for fiscal year 2001. The chancery court affirmed the opinion of the DOM, finding that “DOM interpreted its own regulation – the State Plan, which is its contract with the federal government and which it is required to follow to receive federal funds to require Medicaid to calculate the cost to charge ratio by using Medicare Methodology, which at that time was using a blended rate.” The Mississippi Supreme Court found the plain language of Attachment 4.19-B of the State Plan provided a cost-to-charge-ratio formula for calculating outpatient rates. Laboratory and radiology charges were to be excluded from this formula, because they were reimbursed on a fee-for-service basis. DOM’s inclusion of radiology and laboratory services in the charges and substitution of costs with Medicare blended payment amounts was a clear violation of the State Plan. Therefore, the Court reversed the judgments of DOM and the chancery court. Consistent with its opinion, the Court remanded and ordered the Executive Director of DOM to recalculate the Hospitals’ cost-to-charge ratio using the Hospital’s submitted costs in their cost reports, excluding laboratory and radiology services, and reimbursing the Hospitals the appropriate amounts determined by using the State Plan. View "Crossgates River Oaks Hospital v. Mississippi Division of Medicaid" on Justia Law

After Family Rehabilitation was assessed about $7.6 million for Medicare overpayments, it filed suit for an injunction against recoupment until it received an ALJ hearing. The Fifth Circuit reversed the district court's dismissal for lack of subject matter jurisdiction and remanded in regard to Family Rehabilitation's procedural due process and ultra vires claims. The court held that exhaustion of administrative review was waived because Family Rehabilitation asserted a collateral challenge that could not be remedied after the exhaustion of administrative review. In this case, Family Rehabilitation sought only the suspension of recoupment before a hearing, which was plainly collateral to the result of that hearing, and the combined threats of going out of business and disruption to Medicare patients were sufficient to show that it would suffer irreparable injury. The court affirmed in all other respects. View "Family Rehabilitation, Inc. v. Azar" on Justia Law

Al-Shaikh, an orthopedic surgeon, moved his Fremont practice and sought approval by the Department of Health Care Services (DHCS), under Medi-Cal regulations. He had been an approved Medi-Cal provider in Fremont for six years. DHCS denied his application, claiming that Al-Shaikh’s fee arrangement with his billing service was unlawful. Al-Shaikh appealed. DHCS agreed the provisions it had cited were inapplicable but cited another state law, incorporating a federal Medicaid regulation. Al-Shaikh filed suit, then relocated his Auburn practice, for which he used the same billing service; the relocation was approved by a different DHCS regional office. Al-Shaikh cited an Office of the Inspector General publication that expressly states his fee arrangement does not violate federal law. DHCS approved the Fremont office after three years. The court dismissed the case as moot. Al-Shaikh moved for fees under Code of Civil Procedure 1028.5, which allows a small business or a licensee that prevails in an action against a state regulatory agency to recover a maximum of $7,500 in fees if the agency acted without substantial justification. The court of appeal directed the superior court to award Al-Shaikh the full amount recoverable under section 1028.5. DHCS has an obligation to be knowledgeable about the law it is charged with implementing and was unable to cite a case or regulatory decision supporting its position; it acted without substantial justification. View "Al-Shaikh v. State Department of Health Care Services" on Justia Law

Pursuant to Mississippi Code Section 27-35-119 (Rev. 2017), Natchez Hospital Company, LLC, (“Hospital”) filed a Complaint and Petition For Reduction of Assessment on Software. This ad valorem assessment was made by the Adams County Board of Supervisors (“Board”). Prior to appealing to the circuit court, the Hospital paid the ad valorem taxes as assessed. The Board filed a motion to dismiss for lack of jurisdiction, arguing that the Hospital had failed to post the necessary appeal bond required by Mississippi Code Section 11-51-77 (Rev. 2012), thus depriving the circuit court of jurisdiction. Following a hearing on the motion, the circuit court determined that the Hospital’s failure to post the bond under Section 11-51-77 deprived the court of jurisdiction to hear the appeal and granted the Board’s motion to dismiss. The Hospital appealed the circuit court’s decision to dismiss the case, asking only whether the bond requirement of Mississippi Code Section 11-51-77 was mandatory to confer jurisdiction on a circuit court to hear an appeal from a decision of a board of supervisors regarding an assessment of taxes. The Mississippi Supreme Court determined the Hospital paid the tax, but that was no excuse for not posting the bond to give the trial court jurisdiction to hear its complaint. Therefore, the Supreme Court affirmed dismissal of the Hospital’s case. View "Natchez Hospital Company, LLC v. Adams County Board of Supervisors" on Justia Law

An association representing naturopathic physicians challenged a new Alaska regulation that effectively forbade naturopaths from using and prescribing injectable vitamins and minerals. The association argued the statutory definition of naturopathy included the use of dietetics, that dietetics included injectable vitamins and minerals obtained by pharmaceutical prescription, and that the statutory restrictions on the practice of naturopathy prohibited the use of only prescription drugs, not all prescription medicines. After review, the Alaska Supreme Court concluded the statutory text, the larger statutory context, and the legislative history together suggest that the legislature did not intend to grant prescriptive authority to naturopaths. Therefore, the Court affirmed the superior court’s decision to grant summary judgment against the association on this issue. View "Alaska Association of Naturopathic Physicians v. Alaska Division of Corporations, Business & Professional Licensing" on Justia Law

The Second Circuit denied a petition for review of OSHA's final order affirming a citation issued to a construction company for a repeat violation of an excavation standard and assessing a penalty of $25,000. The court held that the Commission did not abuse its discretion by relying on previous violations more than three years old, because neither the Manual nor the Commissionʹs precedent limits OSHA to a three‐year look back period. Furthermore, the Commissionʹs precedents established that ʺthe time between violations does not bear on whether a violation is repeated.ʺ Finally, this was the company's third violation in six years. View "Triumph Construction Corp. v. Secretary of Labor" on Justia Law

Plaintiff Jimmy Vasquez, an inmate in the Colorado Department of Corrections (“CDOC”), filed suit under 42 U.S.C. 1983, contending CDOC medical providers were deliberately indifferent to his serious medical needs in violation of the Eighth Amendment. Vasquez specifically alleged Defendants delayed treating him for the hepatitis C virus (“HCV”), resulting in his suffering life-threatening permanent liver damage. In appeal No. 17-1026, the Tenth Circuit affirmed the district court’s decision to grant Defendants summary judgment, concluding Vasquez’s claims against Defendants Davis, Webster, Melloh, and Chamjock were time-barred, and Vasquez failed to present sufficient evidence that Defendant Fauvel acted with deliberate indifference. In appeal No. 17-1044, the Court vacated an injunction requiring the CDOC to test Vasquez’s liver function every three months. View "Vasquez v. Davis" on Justia Law