Justia U.S. 2nd Circuit Court of Appeals Opinion Summaries

Plaintiffs filed a putative class action suit against the Secretary on behalf of Medicare beneficiaries who were placed into "observation status" by their hospitals rather than being admitted as "inpatients." Placement into "observation status" allegedly caused these beneficiaries to pay thousands of dollars more for their medical care. The district court granted the Secretary's motion to dismiss and plaintiffs appealed. The court affirmed the dismissal of plaintiffs' Medicare Act, 42 U.S.C. 1395, claims where plaintiffs lack standing to challenge the adequacy of the notices they received and nothing in the statute entitles plaintiffs to the process changes they seek. However, the court vacated the district court's dismissal of plaintiffs' Due Process claims where the district court erred in concluding that plaintiffs lacked a property interest in being treated as "inpatients," because the district court accepted as true the Secretary's assertion that a hospital's decision to formally admit a patient is "a complex medical judgment" left to the doctor's discretion. The district court's conclusion constituted impermissible factfinding, which in any event is inconsistent with the complaint's allegations that the decision to admit is guided by fixed and objective criteria. View "Barrows v. Burwell" on Justia Law

Plaintiffs filed suit challenging the constitutionality of New York State's requirement that all children be vaccinated in order to attend public school. The statute provides two exemptions from the immunization mandate: a medical exemption and a religious exemption. Rejecting plaintiffs' substantive due process, free exercise of religion, equal protection, and Ninth Amendment challenges, the court concluded that the statute and regulation are a constitutionally permissible exercise of the State's police power and do not infringe on the free exercise of religion. The court further concluded that plaintiff's remaining arguments are either meritless or waived. Accordingly, the court affirmed the district court's grant of defendants' motion to dismiss. View "Phillips v. City of New York" on Justia Law

Plaintiffs are health-service providers designated under federal law as Federally Qualified Health Centers (FQHC) and a trade association representing a number of FQHCs. Plaintiffs filed suit challenging New York's methods of reimbursing them for services they provide under Medicaid, seeking injunctive relief under 42 U.S.C. 1983. The district court upheld for the most part the Commissioner's methods for reimbursing FQHCs but granted prospective relief to plaintiffs for reimbursement for certain services they provide to patients enrolled with Medicaid Managed Care Organizations (MCOs). The court concluded that, as to the questions presented on appeal - with only one exception - there are no disputed issues of material fact, and that summary judgment was appropriate; the court agreed with the district court's approach to, and analysis of, the majority of the issues before the court; the court affirmed the grant of summary judgment to the Commissioner on most issues involving his methodologies for reimbursing FQHCs, and affirmed the grant of summary judgment to the FQHCs on issues involving their reimbursement for services provided to MCO enrollees; the court found that the district court erred in concluding that there were no disputed issues of material fact with respect to the Commissioner's methodology for calculating its prospective obligation to make a wraparound payment to FQHCs that provide services under a contract with an MCO; and the court vacated in limited part the district court's grant of summary judgment to the Commissioner and remanded for further proceedings. View "Community Health Care Assoc. of N.Y. v. Shah" on Justia Law

A Vermont statute requires all "health insurers" to file with the State reports containing claims data and other "information relating to health care." Liberty Mutual sought a declaration that the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq., preempted the Vermont statute and regulation. The district court granted summary judgment in favor of Vermont. The court held that the reporting requirements of the Vermont statute and regulation have a "connection with" ERISA plans and were therefore preempted as applied. The court's holding was supported by the principle that "reporting" is a core ERISA function shielded from potentially inconsistent and burdensome state regulation. Accordingly, the court reversed and remanded with instructions to enter judgment for Liberty Mutual. View "Liberty Mutual Ins. Co. v. Donegan" on Justia Law

The City appealed the district court's grant of plaintiffs' motion for a preliminary injunction enjoining Local Law 17. Local Law 17, inter alia, requires pregnancy services centers to make certain disclosures regarding the services that the centers provide. The court concluded that the law was not impermissibly vague; plaintiffs failed to demonstrate a likelihood of success on the merits with respect to one of the challenged disclosures, which requires pregnancy services centers to disclose if they have a licensed medical provider on staff; plaintiffs have demonstrated a likelihood of success on the merits with respect to other provisions challenged by plaintiffs that require other forms of disclosure and impermissibly compel speech; and because the provisions are severable, the court severed the enjoined provisions from the rest of Local Law 17. Accordingly, the court affirmed in part, vacated in part, and remanded for further proceedings. View "The Evergreen Association, Inc v. City of New York" on Justia Law

Plaintiff appealed the district court's dismissal of his complaint against the Guthrie Defendants. Plaintiff's principal issue on appeal required the court to consider whether the unauthorized disclosure of confidential medical information by a medical corporation's employee gives a plaintiff a right of action for breach of fiduciary duty under New York law that runs directly against the corporation, even when the corporation's employee acted outside the scope of her employment and is not plaintiff's treating physician. Plaintiff's appeal presented a question that has not been resolved by the New York Court of Appeals. Accordingly, the court deferred decision and certified the question to the New York Court of Appeals. The court disposed of plaintiff's remaining claims on appeal in a separate summary order filed simultaneously with this opinion. View "Doe v. Guthrie Clinic, Ltd." on Justia Law

The NRDC appealed from the district court's grant of summary judgment to the government. At issue was whether the NRDC had standing under Article III to bring this action to compel the FDA to finalize its regulation of triclosan and triclocarban, two chemicals used in over-the-counter antiseptic antimicrobial soap. The court held that the NRDC presented sufficient evidence of standing to withstand summary judgment as to the regulation of triclosan because standing could be based on exposure to a potentially dangerous product. The NRDC's evidence established that triclosan is potentially dangerous and that at least one of its members was frequently exposed to triclosan-containing soap. The court held, however, that the NRDC presented no evidence of members' direct exposure to triclocarban and failed to establish a particularized injury. View "Natural Resources Defense Council v. United States Food and Drug Admin." on Justia Law

The Board petitioned for enforcement of its decision and order finding that Special Touch violated the National Labor Relations Act, 29 U.S.C. 158(a)(1) and (3), by failing to immediately reinstate striking workers, home health care aides, engaged in protected conduct. The court held that the aides' actions were unprotected because their uncorrected affirmative misrepresentations regarding their plans to strike in response to the pre-strike poll placed 48 of Special Touch's patients in foreseeable imminent danger; the 48 aides engaged in indefensible conduct that was not protected by the NLRA; and Special Touch's failure to immediately reinstate these employees did not violate Section 8(a)(1) or (3). Accordingly, the court denied the petition for enforcement. View "National Labor Relations Board v. Special Touch Home Care Services" on Justia Law

Cage, born in 1960, has an extensive medical history. She offered evidence of: bipolar disorder, depression, suicidal ideation, dizziness, blackouts, memory loss and chest pain. She has not worked since November 2003. Before then, she had worked as a retail cashier, hotel maid and home healthcare aide. Cage also has a long history of drug and alcohol abuse. Her ongoing medical care has included treatment for drug addiction and alcoholism and her other conditions. An Administrative Law Judge of the Social Security Administration denied Cage’s application for Supplemental Security Income benefits, finding that although Cage met certain requirements for being “disabled” under the Social Security Act, 42 U.S.C. 301, she was ineligible for SSI because drug addiction or alcoholism was a contributing factor material to that determination. The district court affirmed. The Second Circuit affirmed. The ALJ properly imposed upon Cage the burden of proving that she would be disabled in the absence of drug addiction and alcoholism and the record supported the ALJ’s finding that she would not be disabled absent drug addiction and alcoholism. View "Cage v. Comm'r of Soc. Sec." on Justia Law

Applicants for and recipients of Medicaid home health Services claimed that the New York State Office of Temporary and Disability Assistance and the New York State Department of Health, violated their statutory right, enforceable under 42 U.S.C.1983, to an opportunity for Medicaid fair hearings. They claimed that this right, as construed by federal regulation, entitles them to “final administrative action” within 90 days of their fair hearing requests. The district court declared that “final administrative action” includes the holding of Medicaid fair hearings, the issuance of fair hearing decisions, and the implementation of any relief ordered in those decisions and permanently enjoined the state agencies to ensure that “final administrative action” implemented within 90 days of fair hearing requests. The Second Circuit affirmed in part, holding that the plaintiffs have a right to a Medicaid hearing and decision ordinarily within 90 days of their fair hearing requests, and that such right is enforceable under section 1983. The permanent injunction was, however, overbroad because “final administrative action” refers not to the implementation of relief ordered in fair hearing decisions, but to the holding of fair hearings and to the issuance of fair hearing decisions. View "Shakhnes v. Eggleston" on Justia Law