Walker v. Univ. of Md. Med. Sys. Corp. (Summary)

AGE AND RACE DISCRIMINATION

Walker v. Univ. of Md. Med. Sys. Corp., No. CCB-12-3151 (D. Md. May 30, 2013)

The United States District Court for the District of Maryland granted a motion for summary judgment in favor of a hospital in this age and race discrimination case brought by a former nurse practitioner.

The hospital terminated the nurse practitioner for negligence after a newborn’s death, and the district court found that while the nurse practitioner could have established a claim for discrimination, she would have failed to rebut the hospital’s legitimate, nondiscriminatory reason for her termination, since the nurse practitioner was negligent in discontinuing life-sustaining medications for the newborn, among other things.

Iowa Med. Soc’y v. Iowa Bd. of Nursing (Summary)

BOARD OF NURSING REGULATIONS

Iowa Med. Soc’y v. Iowa Bd. of Nursing, No. 11-1977 (Iowa May 31, 2013)

The Supreme Court of Iowa reversed and remanded a decision of the district court which invalidated the Board of Nursing and Department of Health’s promulgation of certain regulations.

Physician associations brought suit against the nursing board and the health department for their endorsement of regulations that permitted advanced registered nurse practitioners (“ARNPs”) to supervise radiologic technologists using fluoroscopy machines.  The district court found that none of the material facts at issue in the suit were in dispute and concluded that the nursing board and health department regulations were invalid.

The supreme court held that the nursing board’s determination on supervision of fluoroscopy procedures by ARNPs was lawful, stating that the language of the state law allows the nursing board to interpret whether the medical and nursing professions have recognized a particular practice of nurses, and that, unless said practice is “irrational, illogical, or wholly unjustifiable,” the court should uphold the nursing board’s determination.  The supreme court then held that the practice of ARNPs supervising fluoroscopy procedures was not irrational, illogical, or wholly unjustifiable, and concluded that the district court erred by reversing the nursing board’s determination.

Sidibe v. Sutter Health (Summary)

ANTITRUST

Sidibe v. Sutter Health, No. C 12-04854 LB (N.D. Cal. June 3, 2013)

The United States District Court for the Northern District of California granted a health care system’s motion to dismiss an antitrust case filed against it by members of managed care plans.

In this class action lawsuit, a number of members of managed care plans claimed that the “all or nothing” language of the system’s provider contracts with managed care plans caused them to pay more for health care services than otherwise would have been paid, and forced other competitors out of the market, enabling the system to drive up prices by up to 80 percent.

The district court held that the actions of the system did not show predatory conduct, since the provider contracts were simply part of the necessary components of managed care, and that the class failed to present anything other than conclusory statements in their allegations.  The class also failed to demonstrate that the system had significant market power in any of the regions or counties in which the system operated.

Cassidy v. Pocono Med. Ctr. (Summary)

HIPAA

Cassidy v. Pocono Med. Ctr., No. 3:12-CV-1191 (M.D. Pa. May 31, 2013)

The United States District Court for the Middle District of Pennsylvania granted a medical center’s motion for summary judgment in an age discrimination case filed by a nurse.

The nurse brought suit against the hospital after she was terminated for a violation of the Health Insurance Portability and Accountability Act (“HIPAA”).  The nurse claimed that she was terminated solely because of her age and replaced by a younger nurse.

The district court granted summary judgment, stating that while the nurse had demonstrated that she was above the protected age, suffered an adverse employment action, and was replaced by a younger employee, the medical center had provided sufficient evidence that the reason the nurse was terminated was for a HIPAA violation, and the nurse failed to provide evidence that this reason was pretextual.

Fla. Med. Ass’n, Inc. v. Dep’t of Health, Educ., & Welfare (Summary)

MEDICARE REIMBURSEMENT

Fla. Med. Ass’n, Inc. v. Dep’t of Health, Educ., & Welfare, No. 3:78-CV-178-J-34MCR (M.D. Fla. May 31, 2013)

The United States District Court for the Middle District of Florida vacated an injunction issued in 1979 that permanently enjoined the Department of Health and Human Services (“HHS”) from disclosing any list of Medicare reimbursement amounts that identifies providers of services.

The district court stated that the Administrative Procedures Act (“APA”) would have allowed for an injunction that prevented a 1978 disclosure that was announced in 1977.  However, the 1979 injunction that permanently enjoined HHS from ever disclosing any list of reimbursement data that identified individual service providers was far-reaching and was never appropriate under the APA, and the injunction was still inappropriate years later.  Thus, vacating the injunction left the HHS policy in place, which states there is a compelling interest in knowing the individual payment amounts of service providers.

Nayyar v. Mt. Carmel Health Sys. (Summary)

RACE AND NATIONAL ORIGIN DISCRIMINATION

Nayyar v. Mt. Carmel Health Sys., Nos. 2:12-CV-00189, 2:10-CV-00135 (S.D. Ohio June 3, 2013)

The United States District Court for the Southern District of Ohio granted a health care system’s motion for summary judgment on claims brought by a resident for wrongful termination based on, among other reasons, race and national origin discrimination.  The resident’s claims of discrimination were based on the health care system’s alleged disparate treatment between him and a fellow resident for lying.  The district court found that the resident’s conduct, instructing an unqualified nurse to insert an arterial line, directly implicated patient safety and was more egregious than the fellow resident’s tardiness.  Thus, the court concluded that summary judgment was warranted since the resident could not identify a similarly situated employee who was more favorably treated.

U.S. ex rel. Smart v. Christus Health (Summary)

FALSE CLAIMS ACT – QUI TAM RELATOR

U.S. ex rel. Smart v. Christus Health, No. 2:05-CV-287 (S.D. Tex. May 22, 2013)

The United States District Court for the Southern District of Texas denied a relator’s motion to seek a cut of another qui tam action brought by another relator against the same health system.

The original relator successfully recovered over $1.5 million dollars after the system settled claims related to his allegations that it rented office space to physicians at rates that were below fair market value.  The original relator then moved to reopen the case to allow him to seek a share of the recovery in a separate qui tam action against the system that was related to upcoding outpatient claims to inpatient claims.  However, the district court held that the original relator failed to prove that his allegations overlapped with the conduct in the other case.

The district court also denied the original relator’s Freedom of Information Act requests and his request to unseal documents in the other lawsuit because the district court judge has no authority to access the records in the other case or determine what documents should be unsealed.

Calloway v. Ohio State Med. Bd. (Summary)

STATE BOARD OF MEDICINE

Calloway v. Ohio State Med. Bd., No. 12AP-599 (Ohio Ct. App. May 21, 2013)

The Ohio Tenth District Court of Appeals reversed and remanded the judgment of the Franklin County Court of Common Pleas with instructions to order the Ohio State Medical Board to dismiss the proceedings filed against a physician who was subject to disciplinary action after completing a Certificate of Recommendation (“recommendation form”) for an out-of-state physician seeking a medical license in Ohio.

The recommending physician completed the recommendation form for the out-of-state physician based on his knowledge of him 30 years ago in medical school and a 30-minute meeting with the license-seeking physician. The recommending physician then filled out the recommendation form, stating the out-of-state physician’s abilities were “excellent” and affirming his “good moral character,” without answering how long the two doctors have personally known each other.

The board permanently denied the license for the out-of-state physician, as he was a convicted felon who had been professionally disciplined in Illinois and New York. The board alleged that the recommending physician intended to mislead and knowingly made false statements, a judgment which the common pleas court repeated.

However, the recommending physician contended that he was honest in his belief in the out-of-state physician and never intended to mislead, as he was never informed of the physician’s past legal problems and disciplinary actions. The appeals court noted that the board did not make the requisite finding that the physician intended to mislead the board with his recommendation form. As support of this, the appeals court used the physician’s statement that he did not intend to mislead the board by not answering how long he had known the seeking physician, along with the board’s failure to follow its own practice of returning uncompleted forms to the applicant.

The appeals court concluded that the common pleas court abused its discretion in affirming the board’s finding that the physician violated R.C. 4731.22(B)(5). The appeals court also found that the board’s conclusion that the physician’s conduct satisfied the statutory requirements of falsification, thus violating R.C. 4731.22(B)(12), was not supported by reliable, probative and substantial evidence. Falsification requires that the physician knowingly made a false statement. Further, the appeals court found that the physician had no knowledge of the license-seeker’s past problem, thus his statements were not false. As such, the common pleas court was erroneous in concluding that the physician had violated R.C. 4731.22(B)(12).

Cruz-Vazquez v. Mennonite Gen. Hosp., Inc. (Summary)

EMTALA – DISPARATE SCREENING

Cruz-Vazquez v. Mennonite Gen. Hosp., Inc., No. 11-2297 (1st Cir. May 29, 2013)

In this EMTALA case, the United States Court of Appeals for the First Circuit vacated and remanded a lower court’s grant of summary judgment in favor of a hospital. A woman brought suit against the hospital after it failed to follow its third trimester bleeding protocol, allegedly leading to the death of the woman’s child. The lower court dismissed the woman’s EMTALA claim, finding that her claims were as to “faulty” screening (a state malpractice claim) rather than “disparate” screening, which would fall under the scope of EMTALA.

The circuit court found that the lower court erred in granting summary judgment. The hospital’s policy was straightforward and was meant for all patients presenting a very specific set of symptoms. While the circuit court recognized there was a factual question as to whether the treating physicians were justified in treating the patient differently from other patients presenting with like symptoms based on other information they had, a trialworthy issue existed that must be presented in court.

Villare v. Beebe Med. Ctr., Inc. (Summary)

REAPPOINTMENT/CREDENTIALING

Villare v. Beebe Med. Ctr., Inc., No. 08C-10-189 JRJ (Del. Super. Ct. May 21, 2013)

The Superior Court of Delaware granted in part and denied in part a hospital’s motion to dismiss, after a physician brought suit for failure to renew his privileges (the “Credentialing Claim”). The physician had previously sued the hospital for wrongful termination of his trauma services contract, but that suit was unsuccessful (the “Contract Case”).  The hospital argued that the doctrines of res judicata barred his Credentialing Claim, which was based on alleged procedural breaches in the reappointment process three years after the physician’s trauma contract was terminated for cause, because it came from the same causes of action and facts as the Contract Case.

The superior court held that the physician’s Credentialing Claim should not be barred, as each of his suits was based on two separate events that occurred roughly three years apart, and therefore were two separate causes of action. However, because the damages pertaining to the Contract Case were fully adjudicated in the earlier litigations, the superior court found that the physician would be collaterally estopped from alleging that the termination of his trauma services contract led to his failure to be reappointed or from seeking related damages.