Articles Posted in Health Law

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The Pennsylvania Office of the Attorney General (OAG), on behalf of the Commonwealth, filed suit against more than two dozen nursing homes and their parent companies (collectively, “Appellees”), alleging violations of the Unfair Trade Practices and Consumer Protection Law, (“UTPCPL”), and unjust enrichment. After consideration of Appellees’ preliminary objections, the Commonwealth Court dismissed the claims and this appealed followed. After its review, the Pennsylvania Supreme Court found the dismissal of the UTPCPL claims was improper, but the dismissal of the unjust enrichment claim was proper because the claim was filed prematurely. Accordingly, the Court reversed the Commonwealth Court’s order and remanded for further proceedings. View "Commonwealth, AG Shapiro v. GGNSC LLC, et al" on Justia Law

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At issue in this appeal before the Pennsylvania Supreme Court was the "breadth of gubernatorial power" concerning home health care services, and whether Pennsylvania Governor Thomas Wolf's executive order (2015-05) was an impermissible exercise of his authority. The Order focused on the in-home personal (non-medical) services provided by direct care workers (“DCW”) to elderly and disabled residents who receive benefits in the form of DCW services in their home rather than institutional settings (“participants”), pursuant to the Attendant Care Services Act (“Act 150”). After careful consideration of the Order, the Supreme Court concluded Governor Wolf did not exceed his constitutional powers. Thus, the Court vacated the Commonwealth Court’s order, and remanded for additional proceedings. View "Markham, et al v. Wolf" on Justia Law

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This case was one in a longstanding dispute between major health services providers operating in Western Pennsylvania: UPE, a/k/a Highmark Health and Highmark, Inc. (collectively, Highmark) and UPMC (University of Pittsburgh Medical Center). Highmark and UPMC separately entered into Consent Decrees with the Commonwealth's Office of Attorney General (OAG). In this case, an issue arose concerning the obligations imposed by the Consent Decrees relative to UMPC's attempt to terminate ten hospital Medicare Acute Care Provider Agreements it had with Highmark. Pertinent here, UPMC's Consent Decree required it to treat Highmark's Medicare Advantage Plan consumers as in-network through the end date of the Consent Decree. UPMC allowed Provider Agreements with Highmark to renew annually in satisfaction of its in-network obligation. UPMC informed Highmark in accordance with the notice provisions, it would terminate the Provider Agreements on December 31, 2018, but would nonetheless continue to comply with all terms and obligations of those agreements through June 30, 2019, pursuant to the Decree runout provision. Highmark filed for an injunction and to hold UPMC in contempt. The Commonwealth granted OAG's petition to enforce, rejecting UPMC's contention that the six-month runout provision of the Provider Agreements satisfied its obligation to remain in "contract" with Highmark. The Pennsylvania Supreme Court reversed, finding the runout provision of the Provider Agreement satisfied UPMC's obligation to contract for in-network access to its facilities for Highmark's MA Plan subscribers through June 30, 2019. View "Pennsylvania v. UPMC, et al" on Justia Law

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In consolidated cases, the Pennsylvania Supreme Court granted allowance of appeal to determine whether and to what extent a hospital and a health care staffing agency have a legal duty to prevent a terminated employee from causing harm to patients at another health care facility. Plaintiffs claimed David Kwiatkowski, a radiology technician formerly employed at UPMC Presbyterian Hospital (“UPMC”), who was placed there by staffing agency Maxim Healthcare Services, Inc. (“Maxim”), engaged in the diversion and substitution of intravenous fentanyl. Specifically, Kwiatkowski injected himself with fentanyl from a preloaded syringe, refilled the syringe with saline or another substance, and then replaced the now-contaminated syringe where it could be used by others to inject patients. In doing so years later at a Kansas hospital, Kwiatkowski allegedly communicated hepatitis C to Plaintiffs, who were patients at that hospital. Pursuant to federal regulation, UPMC (but not Maxim) indisputably had a legal obligation to report the diversion of controlled substances to the United States Department of Justice’s Drug Enforcement Administration (“DEA”). UPMC failed to do so. The Superior Court determined that Plaintiffs established that both UPMC and Maxim (collectively, “Defendants”) had a duty to report Kwiatkowski’s misconduct to the DEA and to “law enforcement,” and that Defendants’ failure to do so could have provided a basis for negligence claims. The Supreme Court affirmed the Superior Court’s ruling with respect to UPMC, and reversed the Superior Court’s ruling to the extent it imposed the same duty upon Maxim. View "Walters v. Univ. of Pittsburgh Med. Ctr." on Justia Law

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In a medical malpractice action, Monongahela Valley Hospital (“MVH”) contracted with UPMC Emergency Medicine, Inc. (“ERMI”) to provide staffing and administrative services for its emergency room. Both MVH and ERMI claimed the statutory evidentiary privilege in the Pennsylvania Peer Review Protection Act, 63 P.S. secs. 425.1-425.4 (PRPA) protected from disclosure the performance file of Marcellus Boggs, M.D. (“Dr. Boggs”) that had been prepared and maintained by Brenda Walther, M.D. (“Dr. Walther”), who served as the director of MVH’s emergency department and was Dr. Boggs’ supervisor. Dr. Boggs and Dr. Walther were employees of ERMI. In January 2011, Eleanor Reginelli was transported by ambulance to MVH’s emergency department with what she reported at the time to be gastric discomfort. She was treated by Dr. Boggs. Mrs. Reginelli and her husband, Orlando Reginelli, alleged Dr. Boggs failed to diagnose an emergent, underlying heart problem and discharged her without proper treatment. Several days later, Mrs. Reginelli suffered a heart attack. In 2012, the Reginellis filed an amended complaint containing four counts sounding in negligence. The Reginellis deposed, inter alia, Dr. Boggs and Dr. Walther. At her deposition, Dr. Walther testified that she prepared and maintained a “performance file” on Dr. Boggs as part of her regular practice of reviewing randomly selected charts associated with patients treated by Dr. Boggs (and other ERMI-employed emergency department physicians). In response, the Reginellis filed discovery requests directed to MVH requesting, among other things, “the complete ‘performance file’ for [Dr. Boggs] maintained by [Dr. Walther.]” MVH objected to production of the performance file, asserting that it was privileged by, inter alia, the PRPA. Under the facts presented in this case and the applicable statutory language of the PRPA, the Pennsylvania Supreme Court determined neither ERMI nor MVH could claim the evidentiary privilege: ERMI was not a “professional health care provider” under the PRPA, and the performance file at issue here was not generated or maintained by MVH’s peer review committee. Therefore, the Court affirmed the Superior Court to uphold the trial court’s ruling that PRPA’s evidentiary privilege had no application in this case. View "Reginelli v. Boggs" on Justia Law

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In an appeal by allowance, the issue presented to the Pennsylvania Supreme Court was whether the Superior Court applied the correct statute of limitations for a survival action in a medical professional liability case. In 2005, Elise Dubose was admitted to Albert Einstein Medical Center (Einstein) after she fell in her home and sustained severe head injuries, including anoxia and a brain injury. She was transferred to Willowcrest Nursing Home where Mrs. Dubose suffered malnourishment, dehydration, conscious pain from bedsores, a bone infection, and a sepsis systemic infection. An ulcers located at the sacral region of the spine which Mrs. Dubose developed during her initial hospitalization, gradually increased in size. The sacral ulcer became infected with bacteria from contact with feces. This infection caused sepsis in Mrs. Dubose in September 2007, and she was admitted to Einstein with sepsis. On October 18, 2007, Mrs. Dubose died from sepsis and multiple pressure sores. On August 13, 2009, Robert Dubose, as administrator for Mrs. Dubose's estate, filed a complaint against Willowcrest and Albert Einstein Healthcare Network (collectively Appellants) sounding in negligence and alleged wrongful death. The Supreme Court concluded the statute of limitations for medical professional liability cases in the form of wrongful death or survival actions was two years from the time of the decedent’s death. View "Dubose v. Willowcrest Nur. Home" on Justia Law

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A representative of Extendicare Health Facilities, Inc., d/b/a Havencrest Nursing Center (Extendicare), executed an arbitration agreement with Anna Marie Taylor (“Decedent”) requiring the arbitration of claims arising from Decedent’s stay at the Extendicare facility. Following Decedent’s death, Daniel and William Taylor (“the Taylors”) brought wrongful death claims on behalf of themselves as wrongful death beneficiaries and survival claims on behalf of Decedent’s estate against Extendicare and two other defendants. Extendicare moved to bifurcate the wrongful death and survival actions, and to compel arbitration of Decedent’s survival claim pursuant to the arbitration agreement and the Federal Arbitration Act (FAA). The trial court relied upon Pennsylvania Rule of Civil Procedure 213(e) to deny Extendicare’s motion to bifurcate, and the Superior Court affirmed. The Pennsylvania Supreme Court granted review to determine whether the FAA preempted the lower courts’ application of Rule 213(e) under the facts presented. Upon review, the Court concluded that the FAA preempted the application of Rule 213(e), and required arbitration of the survival claim against Extendicare. The Court therefore reversed the Superior Court, and remanded to the trial court for further proceedings. View "Taylor v. Extendicare Health Facilities, Inc." on Justia Law

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This appeal centered on the availability of attorneys’ fee awards against insurance companies that have invoked the peer-review provisions of the Motor Vehicle Financial Responsibility Law (MVFRL). In 2004, Angela LaSelva sustained injuries in a motor vehicle accident. She was treated by a licensed chiropractor, David Novatnak, D.C., who practiced with appellee Doctor’s Choice Physical Medicine and Rehabilitation Center, P.C. (“Provider”). Provider submitted invoices for the services directly to LaSelva’s first-party benefits insurance carrier, Appellant Travelers Personal Insurance Company (“Insurer”), as required per the Motor Vehicle Financial Responsibility Law. Insurer later requested peer review through IMX Medical Management Services (“IMX”), a peer review organization (“PRO”). IMX, in turn, enlisted Mark Cavallo, D.C., to conduct the peer review. Dr. Cavallo issued a report deeming certain of the treatments provided by Dr. Novatnak to have been unnecessary. Based on this report, Insurer denied reimbursement for the treatment aspects deemed as excessive. Provider opposed this withholding and commenced a civil action against Insurer. Among other things, the complaint alleged that all treatments undertaken through Provider were reasonable and necessary and that the review conducted by IMX did not comport with the mandates of Section 1797 of the MVFRL. Furthermore, Provider asserted that IMX failed to comply with requirements of the Pennsylvania Code directing PROs to apply national or regional norms in their determinations or, where such norms do not exist, to establish written criteria to be used in conducting reviews. As relevant here, the complaint included a specific demand for attorneys’ fees. After a bench trial, the common pleas court entered a verdict in the Provider’s favor, encompassing an award of attorneys’ fees of approximately $39,000. On appeal, the Superior Court reversed the decision to strike the fee award. The Supreme Court reversed the Superior Court: "the Superior Court’s cryptic pronouncement of 'absurdity' [regarding fee-shifting] that lacks foundation. . . . This Court remains cognizant of the shortcomings of the peer-review regime. We have no reasonable means, however, of assessing the degree to which these may be offset by the benefits of cost containment and potentially lower insurance premiums available to the public at large. Rather, the Legislature is invested with the implements to conduct investigations, hearings, and open deliberations to address such salient policy matters. In such landscape, we decline to deviate from conventional statutory interpretation to advance directed policy aims." View "Doctor's Choice v. Traveler's Personal Ins." on Justia Law

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The issue this case presented for the Pennsylvania Supreme Court’s review centered on review of a Commonwealth Court order Court interpreting a provision of a consent decree, negotiated by the Office of Attorney General of Pennsylvania ("OAG") and approved by the Commonwealth Court, between Appellant UPMC, a nonprofit health care corporation, and Appellee Highmark, a nonprofit medical insurance corporation, which established the obligations of both parties with respect to certain health care plans serving vulnerable populations. Specifically, the Court considered whether the Commonwealth Court erroneously interpreted this "vulnerable populations" provision as creating a contractual obligation for UPMC to treat all participants in Highmark’s "Medicare Advantage Plans" (for which Highmark and UPMC currently have provider contracts which UPMC has indicated it will terminate) as "in-network" for purposes of determining the rates it is permitted to charge these individuals for physician, hospital, and other medical services during the duration of the consent decree. After careful review, the Supreme Court affirmed the Commonwealth Court’s finding that the "vulnerable populations" clause of the consent decree required UPMC to "be in a contract" with Highmark for the duration of the consent decree, and, thus, that UPMC physicians, hospitals, and other services shall be treated as "in-network" for participants in Highmark Medicare Advantage plans which were subject to provider contracts between Highmark and UPMC set to be terminated by UPMC on December 31, 2015. The Court also affirmed the portion of the Commonwealth Court’s order requiring judicial approval for any further changes in business relationships between these parties which were governed by the consent decree, but quashed as not yet ripe for review the portion of the order which directed the OAG to file a request for supplemental relief to effectuate compliance with the consent decree. View "Pennsylvania v. UPMC" on Justia Law

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Consolidated direct appeals to the Pennsylvania Supreme Court centered on appellees' efforts to resurrect a defunct state-run health insurance program. Appellees were recipients of state-subsidized, low-cost health insurance via the "adultBasic" program, which was previously administered by the Department of Insurance and made available to certain qualifying adults in Pennsylvania. The program received the bulk of its funding from the proceeds of a 1998 multi-state master settlement agreement between forty-seven states and several major U.S. tobacco product manufacturers. The allocation and distribution of funds received annually by the Commonwealth under this settlement was initially administered outside of the Fiscal Code, via the Tobacco Settlement Act (TSA). As relevant here, for purposes of fiscal years 2010-2011 and 2011-2012, the General Assembly used modifications to the Fiscal Code to override the TSA’s requirements for tobacco settlement monies. One effect of the amendments was to divert tobacco settlement funds more generally to other fiscal priorities of the Commonwealth. In March 2011, Appellees Cheryl Sears and seventy-four other former recipients of adultBasic filed an original-jurisdiction petition for review at the Commonwealth Court, styled as a class action. As amended, the petition contended, inter alia, that the redirection of tobacco settlement monies under Acts 46 and 26 violated the TSA’s requirements for appropriation and allocation of tobacco settlement funds. The petition also asserted that these enactments offended various provisions of the Pennsylvania Constitution governing legislative processes, including the general requirement that no bill shall be passed containing more than a single subject. Appellees sought declaratory, mandamus, and injunctive relief retroactively reestablishing the adultBasic program and reimbursing the program over two hundred million dollars. Appellee Eric Weisblatt commenced a separate action, also styled as a class action, proffering materially similar allegations and claims for relief, in the relevant respects, only naming executive-branch officials and agencies as defendants. Appellees in both proceedings moved for a preliminary injunction to preclude the Treasury from disbursing the tobacco settlement monies which were due to be received that month as appropriated per Act 46. Relief was denied by the court, however, upon its finding that the harm asserted by Appellees was neither immediate nor irreparable. Several weeks after the Commonwealth Court’s issuance of its opinion in Sears, the court issued a divided decision in "Weisblatt." During the pendency of the appeals, additional omnibus amendments to the Fiscal Code were enacted into law, which, inter alia, effectuated a repeal of the allocation formula provided in the TSA; the result formally displaced adultBasic funding within the terms of the TSA itself. In light of these amendments, Appellees renewed their request for relief from the supersedeas, which was again denied. Upon review of both sides' arguments appealing the Commonwealth Court's decision, the Supreme Court held that Appellees lacked standing to pursue the relief requested in their petitions for review. View "Sears v. Wolf" on Justia Law