After the waiver was granted, a group of "economically vulnerable" Arizonans filed a class action against the Secretary and the director of Arizona’s Medicaid agency, alleging that (1) the increased and expanded mandatory co-payments violated the Medicaid Act’s cost-sharing restrictions, (2) the waiver was illegal, and (3) they had received inadequate notice of the changes. The trial court ruled that the plaintiffs, while vulnerable, were not defined as a "medically needy" population under the Medicaid Act. Because Arizona’s state health care plan does not cover them, the trial court found that the state was exempted from the law’s cost-sharing provisions as an "expansion population."

On appeal, the Ninth Circuit Court of Appeals agreed on this point, but remanded the case for a new look at the waiver and notice issues because of the following:

There is little, if any, evidence that the secretary considered the factors [federal statute] requires her to consider before granting Arizona’s waiver. . . . The record is not sufficient for this court to review the agency’s consideration of the impact Arizona’s demonstration project would have on the economically vulnerable.

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Around that time, the Colorado Department of Health began investigating an outbreak of Hepatitis C. After Parker was indicted in August 2009, her former employers contacted about 6,000 patients who could have been exposed to Parker’s strain of hepatitis C. Genetic testing of 17 patients who tested positive for the disease showed a 97% chance that their strain was genetically linked to Parker’s.

At Parker’s sentencing hearing, the judge rejected her plea bargain and sentenced her to 30 years imprisonment, instead of the 20 recommended in sentencing guidelines. The judge noted the following:

The repeated theft and abuse of fentanyl, one of the most puissant drugs on the planet for selfish, personal gratification to get high while exposing so many innocent, unsuspecting, undeserving people to this insidious and incurable disease is as incomprehensible as it is unconscionable. She finally and thankfully got caught.

Parker appealed the sentence, calling it unreasonable and an abuse of discretion. The Tenth Circuit Court of Appeals, however, upheld the order, stating that the sentence was reasonable in light of all the circumstances. The court further noted that “. . . Parker’s crime stands out as particularly repugnant. [She] displayed a callous disregard for human suffering. By stealing fentanyl from operating carts, Parker deprived surgical patients of needed anesthesia. At least one of her victims awoke mid-surgery in severe pain."

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The Gaetas sued Perrigo and other manufacturers of generic ibuprofen, alleging defective design, defective marketing, breach of express and implied warranties, negligence and gross negligence, and deceit by concealment. The Gaetas claimed that Perrigo failed to warn doctors and consumers that ibuprofen could cause liver injury if mixed with other drugs. In response, Perrigo argued that the Gaetas’ state-law failure-to-warn claims were preempted by the labeling and marketing regulations of the Food and Drug Administration (“FDA”) governing generic drugs. The trial court agreed, concluding that since federal law required generic drugmakers to conform to the approved labeling of brand-name drugs, Perrigo could not have changed its labeling without violating federal law.

The Gaetas appealed the decision to the Ninth Circuit Court of Appeals. While the appeal was pending, the United States Supreme Court issued its opinion in Wyeth v. Levine, holding that approval of medication by the FDA does not shield a manufacturer of brand-name medications from liability under state law. After Levine, the Gaetas won a limited remand from the Ninth Circuit so that the trial court could reconsider its decision with the Supreme Court ruling in mind. The trial court denied the motion for reconsideration, however, and ruled that the high court’s decision only applied to brand-name drug manufacturers.

The Gaetas again appealed the trial court’s decision. With its holding, the Ninth Circuit joins the Fifth and Eighth Circuits in applying Levine to generic drugs as well. The court noted that (1) manufacturers are primarily responsible for warning consumers about possible drug dangers because they have better access to information about their products than the FDA, and (2) there is nothing in Levine that limits this responsibility to brand-name drug manufacturers. The court stated that both sets of manufacturers must take specific steps when they learn of new risks associated with their products. Finally, the court concluded that compliance with both state and federal law was not “impossible.” Accordingly, the court remanded the case to the trial court for further proceedings.

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The trial court dismissed the lawsuit entirely. On appeal, the Second Circuit Court of Appeals agreed that most of the case was meritless, including Spiegel’s bid for a different judge on remand. He argued that U.S. District Judge Sandra Townes was biased and “had undertaken to scour the record to find a basis for knocking out plaintiffs’ claims.”

However, the Second Circuit revived Spiegel’s claim that the karate school violated the New York City Human Rights Law barring employers from firing workers “because of an actual or perceived . . . disability” because no New York appellate court had yet addressed whether obesity alone could constitutes a disability the law.

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After a five-week trial last year, U.S. District Judge Nicholas G. Garaufis found that the state “denied thousands of individuals with mental illness in New York City the opportunity to receive services in the most integrated setting appropriate for their needs,” adding that “these actions constitute discrimination” under the Americans with Disabilities Act and the Rehabilitation Act. The court noted that “virtually all” of the 4,300 mentally ill residents of adult homes were not in the most “integrated settings appropriate to meet their needs.” The judge then ordered the state to place all qualified mentally ill individuals in supported housing, if they choose, within four years.

In his most recent opinion, the judge criticized the state’s remedial proposal, saying it “scarcely begins to address the violations identified by the court.” The state proposed to create 200 supportive housing units per year over the next five years, for a total of only 1,000 new units. The judge wrote as follows:

The court is disappointed and, frankly, incredulous that defendants sincerely believe this proposal would suffice. As if failing to provide a meaningful remedy for current adult home residents were not bad enough, defendants also make absolutely no provision of supported housing for potential future adult home residents, ensuring that the violations found by this court will inevitably recur.

The judge also stated he will appoint a monitor to make sure the state complies with the order. For the full story, click here.

The separation of powers clause prohibits one branch of government from exercising ‘powers properly belonging to another. Thus, the inquiry under the separation of powers clause is not whether the damages cap is rationally related to a legitimate government interest but, rather, whether the legislature, through its adoption of the damages cap, is exercising powers properly belonging to the judiciary.

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The trial court granted Main Line Hospitals summary judgment, ruling that Torretti had not presented sufficient evidence that her doctor knew a medical emergency was imminent when he sent her to another hospital for monitoring. On appeal, Torretti argued that, because she is a diabetic and had a high-risk pregnancy, each visit to her doctor would qualify as “presentment of an emergency medical condition to trigger EMTALA coverage.” However, the Third Circuit Court of Appeals noted that such a trigger would broaden the scope of EMTALA beyond Congress’s intent, stating the following:

We believe it is clear that Congress did not intend EMTALA to cover these individuals every time they come to the hospital for their [routinely scheduled] appointments, even though they suffer from serious medical conditions that risk becoming emergent.

The court also noted that EMTALA was “not a federal malpractice statute,” although Torretti may be able seek recovery in some other form.

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Plaintiff suffered severe injuries to her foot during a motorcycle accident.  She was taken to St. Edward Mercy Medical Center (“St. Edward”), which did not have plastic surgeon on call to assist in the repair of her foot.  Plaintiff’s emergency room physician contacted the on-call plastic surgeon, Dr. James Kelly, at Sparks Regional Medical Center (“Sparks”) and learned that Dr. Kelly’s privileges at Sparks had been revoked.  Dr. Kelly refused to treat plaintiff.

Plaintiff’s father then contacted Sparks about the possibility of plaintiff receiving treatment there.  Employees of Sparks refused to accept plaintiff as a transfer patient from St. Edward, but noted that she could receive treatment if plaintiff’s father were to bring her to Sparks.  Plaintiff’s father then contacted another hospital, and another plastic surgeon came to St. Edward.

Plaintiff subsequently sued Sparks for refusing to accept her as a transfer patient, arguing that the delay in treatment resulted in the lost of her big toe.  Plaintiff alleged that Sparks violated, among other things, the anti-dumping provision of the Emergency Medical Treatment and Labor Act (“EMTALA”).  Sparks moved for summary judgment and asserted that plaintiff had failed to state a claim under EMTALA.  The trial court agreed and granted summary judgment.

On appeal, the Arkansas Court of Appeals explained that the “comes to” language in the anti-dumping provision of EMTALA is dispositive.  Because plaintiff never presented to Sparks and, therefore, was never turned away, she had no cause of action.

Creative Compounds imported 8,800 pounds of powdered egg whites from Peru.  Initially, Creative Compounds intended the powdered egg whites, a protein ingredient, to be for human consumption in nutritional products.  The price for powdered egg whites in the United States had risen, and Creative Compounds sought a cheaper version from Peru.

Egg product imports are regulated by two statutes.  The first, the Animal Health Protection Act (“AHPA”), regulates egg products intended for animal consumption.  The second, the Egg Products Inspect Act (“EPIA”) regulates egg products intended for human consumption.  The EPIA restricts importation of egg products for use as human food unless they were processed under “an approved continuous inspection system of the government of the foreign country of origin.”  21 U.S.C. 1046(a)(2).  Currently, only Canada and the Netherlands maintain a continuous inspection system equal to that of the United States.

Creative Compounds sought and received an import permit from the government to allow importation of the 8,800 pounds of powdered egg whites from Peru. However, the import permit noted that the product must be accompanied by an original certificate from the government of Peru stating that the product complied with AHPA regulations.  Creative Compounds did not obtain such a certificate.  The product was shipped from Peru to New York, then transported to Chicago, where it was mistakenly allowed through Customs, and then was moved to Creative Compounds’ warehouse in Missouri.

The government learned of that the powdered egg whites had been imported in violation of the EPIA and detained them until Creative Compounds could obtain the required certification from Peru.  When Creative Compounds could not obtain a certificate, the government filed a lawsuit to seize the product and destroy it.  The trial court granted the United States’ motion for summary judgment, noting that after the powdered egg whites cleared Customs and was transported to Missouri, they became a domestic article under the EPIA and, therefore, could not be transported to sold.

On appeal, Creative Compounds argued that it should be allowed to return the powdered egg whites to Peru.  The Eighth Circuit disagreed, following the trial court’s strict interpretation of the EPIA.