Latest 8 Cases This Week: Planned Parenthood of Greater Texas Family Planning and Preventative Health Services, Inc. v. Kauffman (5th Cir.), Zoch ...

In (Trial) Courts (Especially) We Trust

VIKRAM DAVID AMAR, JASON MAZZONE

Illinois law dean Vikram David Amar and professor Jason Mazzone describe the increasing importance of courts and lawyers in safeguarding and reinforcing the role of factual truths in our democracy. Dean Amar and Professor Mazzone point out that lawyers and judges are steeped in factual investigation and factual determination, and they call upon legal educators (like themselves) to continue instilling in students the commitment to analytical reasoning based in factual evidence, and to absolutely reject the notion that factual truth is just in the mind of the beholder.

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The Rhetoric About a “Decline” in Religious Liberty Is Good News for Americans

MARCI A. HAMILTON

Marci A. Hamilton, a professor at the University of Pennsylvania and one of the country’s leading church-state scholars, explains why the rhetoric about a “decline” in religious liberty actually signals a decline in religious triumphalism, and is a good thing. Professor Hamilton describes how religious actors wield the Religious Freedom Restoration Act (RFRA) not as a shield, but as a sword to destroy the lives of fellow Americans.

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Planned Parenthood of Greater Texas Family Planning and Preventative Health Services, Inc. v. Kauffman

Court: US Court of Appeals for the Fifth Circuit

Docket: 17-50282

Opinion Date: November 23, 2020

Judge: Priscilla Richman Owen

Areas of Law: Civil Rights, Constitutional Law, Government & Administrative Law, Health 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.

Zoch v. Saul

Court: US Court of Appeals for the Seventh Circuit

Docket: 20-1166

Opinion Date: November 24, 2020

Judge: Per Curiam

Areas of Law: Government & Administrative Law, Health Law, Public Benefits

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.

DaVita, Inc. v. Virginia Mason Memorial Hospital

Court: US Court of Appeals for the Ninth Circuit

Docket: 19-35692

Opinion Date: November 24, 2020

Judge: Susan Graber

Areas of Law: Health Law

DaVita filed suit under the private cause of action under the Medicare Secondary Payer provisions (MSP), alleging that defendants reduced the payment amount for Patient 1's dialysis because of Medicare eligibility as soon as Patient 1 became eligible for Medicare, without waiting the mandatory thirty months. But the reduced payment amount remained greater than the Medicare rate, so Medicare never made any secondary payments. The district court dismissed the complaint, holding that the MSP's private cause of action is available only when Medicare has made a payment. Reviewing de novo, the Ninth Circuit held that the district court erroneously dismissed the complaint on that ground. The panel explained that the statutory text, congressional purpose, and regulatory clues make clear that Congress did not intend payment by Medicare to be a prerequisite to bringing a private cause of action under the MSP. The private cause of action encompasses situations in which a primary plan impermissibly takes Medicare eligibility into account too soon, even if Medicare has not made any payments. Accordingly, the panel vacated in large part and remanded for further proceedings. The panel affirmed the district court's dismissal with respect to the 10-month period after Patient 1 dropped coverage under Virginia Mason's Plan.

DaVita Inc. v. Amy's Kitchen, Inc.

Court: US Court of Appeals for the Ninth Circuit

Docket: 19-15963

Opinion Date: November 24, 2020

Judge: Susan Graber

Areas of Law: ERISA, Health Law

DaVita filed suit alleging that the Amy's Kitchen Employee Benefit Health Plan's dialysis provisions violate the Medicare as Secondary Payer provisions (MSP) of the Social Security Act, the Employee Retirement Income Security Act of 1974 (ERISA), and state law. The district court dismissed the federal claims and declined to exercise supplemental jurisdiction over the state-law claims. Reviewing de novo, the Ninth Circuit affirmed and agreed with the district court's conclusion that the Plan does not violate the MSP because it reimburses at the same rate for all dialysis services, regardless of underlying diagnosis and regardless of Medicare eligibility. The panel also held that DaVita may not bring equitable claims on behalf of Patient 1 under ERISA, because the assignment form the patient signed did not encompass an assignment of equitable claims.

Borden v. Malone

Court: Supreme Court of Alabama

Docket: 1190327

Opinion Date: November 25, 2020

Judge: Mendheim

Areas of Law: Civil Procedure, Health Law, Personal Injury

Dennis Borden, individually and as father and next friend of his son J.B. (minor), appealed the dismissal of his defamation, negligence, wantonness and wilfulness claims against Bobby Malone and Malone's counseling clinic, B.L. Malone and Associates, Inc. Borden and his then-wife, Kathy Smith, received marriage counseling from Malone at the clinic. Borden filed for divorce in 2010. The complaint here alleged that in the divorce proceedings Malone "served in the role of custody evaluator" and recommended to the court that Smith be given sole custody of J.B. Instead of following Malone's recommendation, the court awarded Borden and Smith joint custody. The divorce was finalized in 2012. In 2019, Smith petitioned for modification of custody, seeking sole custody of the child. Borden opposed the petition, alleging that "during the pendency of an adversarial custody dispute involving litigation," Malone began seeing J.B. for counseling at Smith's behest without Borden's consent. J.B. allegedly related to Malone in counseling sessions many deeply personal statements concerning the child's relationship with Borden. Borden's complaint alleged that Malone made numerous defamatory statements in a letter to Smith's custody attorney, that was eventually presented as evidence in the custody hearing (the letter was stricken from evidence because that court ruled the counselor-patient privilege applied). After review, the Alabama Supreme Court reversed the trial court's dismissal of defamation claims to the extent it precluded Borden from maintaining his claim that Malone and the clinic bore some culpability for the dissemination of the letter beyond those who had a direct or close relationship to the custody-modification proceeding. Furthermore, the trial court's dismissal of the count alleging negligence/wantonness/wilfulness was reversed to the extent that it precluded claims based on a breach of confidentiality on behalf of J.B., which were not foreclosed by the litigation privilege. The trial court's dismissal of the claims asserted in that count as to Borden was affirmed.

In Response To The COVID-19 Pandemic

Court: Arkansas Supreme Court

Citation: 2020 Ark. 384

Opinion Date: November 20, 2020

Judge: Per Curiam

Areas of Law: Criminal Law, Health Law

Here, the Supreme Court announced new protocols to maintain the safety of jurors, litigants, attorneys, court personnel and the public in light of the ongoing COVID-19 pandemic. The Court suspended until January 15, 2021 jury trials that have not begun. The Court, however, urged that judges continue to move cases forward, either through the use of technology by virtual or telephonic hearings or through in-person hearings that meet the Arkansas Department of Health's criteria for safe gatherings. The Court held that any delay for speedy-trial purposes due to precautions against the COVID-19 pandemic shall presumptively constitute good cause under Ark. R. Crim. P. 28.3(h) and shall constitute an excluded period for speedy-trial purposes.

St. Luke Institute v. Jones

Court: Maryland Court of Appeals

Docket: 62/19

Opinion Date: November 20, 2020

Judge: Booth

Areas of Law: Health Law

The Court of Appeals affirmed the judgment of the Court of Special Appeals reversing the order of the circuit court directing that Saint Luke Institute, Inc. (SLI) produce a patient's mental health records under seal, holding that the circuit court erred by failing to conduct the necessary statutory relevancy analysis required by the Maryland Confidentiality of Medical Records Act, Md. Code Ann. Health-Gen 4-301 through 309. Plaintiffs filed a civil case in Massachusetts alleging that they were sexually abused by a brother or member of a religious order while they were residing in a children's group home that employed the brother. Plaintiffs filed a proceeding in Maryland seeking discovery of the brother's mental health records they believed were in the custody of SLI, a Maryland facility. The circuit court entered an order directing the SLI to produce the brother's mental health records under seal. The Court of Special Appeals reversed. The Court of Appeals affirmed and outlined the process to be undertaken by the trial court prior to disclosure of mental health records requested by a private litigant in a civil case, holding that remand was required.

Shawreb v. SSM Health Care of Oklahoma

Court: Oklahoma Supreme Court

Citation: 2020 OK 92

Opinion Date: November 24, 2020

Judge: James E. Edmondson

Areas of Law: Civil Procedure, Health Law, Personal Injury

Plaintiffs filed a negligence action based upon the alleged acts of defendants when one of the plaintiffs was staying in a hospital after surgery and received a burn from spilled hot water. The district granted defendants' motion to strike plaintiffs' witness list and defendants' motion for summary judgment. Plaintiffs appealed and the Court of Civil Appeals. After its review, the Oklahoma Supreme Court held the trial court erred in granting summary judgment striking the list of trial witnesses when plaintiffs were not provided time to respond to the motion to strike as granted by District Court Rule 4. Judgment was reversed and the matter remanded for further proceedings.