Justia U.S. 1st Circuit Court of Appeals Opinion Summaries

Articles Posted in Health Law

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In this dispute over who was the first-to-file relator in a case brought under the False Claims Act (FCA), 31 U.S.C. 3729 et seq., the First Circuit reversed the judgment of the district court ruling that the first-to-file rule was jurisdictional, holding, for the first time in this circuit, that the first-to-file rule is not jurisdictional and that the Court had jurisdiction over Mark McGuire's crossclaim. The FCA's first-to-file rule prohibits relators other than the first to file from bringing a related action based on the facts underlying the pending action. In this case, the government successfully intervened in several qui tam suits against Millennium Health. Millennium settled with the government, setting aside fifteen percent of the settlement proceeds as a relator's share. McGuire brought a crossclaim for declaratory judgment that he was the first to file and was thus entitled to the fifteen-percent share. The district court dismissed the crossclaim for lack of subject-matter jurisdiction, finding that the first-to-file rule was jurisdictional. The First Circuit reversed, holding (1) the first-to-file rule is not jurisdictional, and therefore, the district court had subject-matter jurisdiction over McGuire's crossclaim; and (2) McGuire was the first-to-file relator and has stated a claim that he is entitled to the relator's share of the settlement. View "McGuire v. Estate of Robert Cunningham" on Justia Law

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The First Circuit affirmed the district court's grant of a preliminary injunction compelling Defendants to provide Plaintiff with medication while she is incarcerated, holding that the district court properly found that a preliminary injunction was warranted under the circumstances of this case. Plaintiff, who was due to be incarcerated for forty days in the county jail, was informed that she was not to receive her twice daily dose of buprenorphine prescribed for an "opioid use disorder" while incarcerated. Plaintiff brought this suit seeking injunctive relief compelling Defendants to provide her medication while she was incarcerated. The district court found a sufficient likelihood of success combined with both a strong balance of harms and a public interest in favor of Plaintiff so as to warrant a preliminary injunction. The First Circuit affirmed, holding that the district court did not abuse its discretion in its preliminary assessment of the issues that must be balanced in deciding a request for preliminary injunctive relief. View "Smith v. Aroostook County" on Justia Law

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In this case concerning arbitration agreements, nursing homes, and wrongful death claims under Massachusetts law, the First Circuit certified questions to the Massachusetts Supreme Judicial Court (SJC) under its Rule 1:03, holding that the dispute in this case turned on the characterization of wrongful death actions by the Commonwealth and presented an unresolved question of Massachusetts law whose answer was unclear. The personal representative of a deceased former nursing home resident brought a state wrongful death action against a set of organizations that oversaw the nursing home (collectively, nursing home). The nursing home sued to compel arbitration. The federal court compelled arbitration and declined to issue a stay of the state wrongful death action. On appeal, the personal representative argued that she was not bound by the decedent’s agreement to arbitrate with the nursing home because her wrongful death right of recovery was independent of the decedent’s wrongful death claim. In asserting that the arbitration agreement was binding, the nursing home argued that Massachusetts beneficiaries’ wrongful death claims are derivative of the decedent’s wrongful death claim. The First Circuit exercised its discretion in favor of certification, holding that Massachusetts law does not clearly decide the independent/derivative or other relevant questions about the status of wrongful death actions in relation to the decedent. View "GGNSC Chestnut Hill LLC v. Schrader" on Justia Law

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The First Circuit affirmed the district court’s judgment in favor of Defendant after this Court remanded the case, holding that any error in the district court’s evidentiary rulings was harmless and that the district court did not commit prejudicial error when it found that Plaintiffs waived their negligence claim. Plaintiffs Barbara and Michael Bradley filed a second amended complaint alleging medical negligence, battery, and the failure to obtain informed consent. The district court granted summary judgment on the battery claim. After a trial, the jury returned a verdict in Defendant’s favor. The First Circuit vacated the judgment and remanded for a new trial on account of an error in excluding the testimony of Plaintiffs’ proffered expert witness. After a second trial, the jury again returned a verdict in favor of Defendant. The First Circuit affirmed, holding (1) assuming, without deciding, that the district court erred in admitting an entry from Barbara’s diary and in admitting an excerpt from Barbara’s medical records from a different hospital, these errors were harmless; and (2) the district court did not commit prejudicial error in finding Plaintiffs to have waived their medical negligence claim. View "Bradley v. Sugarbaker" on Justia Law

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The First Circuit vacated in part the district court’s grant of summary judgment in favor of Defendants in this lawsuit alleging violations of the Emergency Medical Treatment and Active Labor Act (EMTALA) and claiming medical malpractice. Plaintiffs sued Hospital Pavia Hato Rey, APS Healthcare of Puerto Rico (APS), and two doctors. In granting summary judgment, the district court held that the action could not in “equity and good conscience” proceed without two necessary parties but that the parties could not be feasibly joined under Fed. R. Civ. P. 19. The judge found that complete diversity of citizenship of each plaintiff from each defendant was not met on the federal-EMTALA claim, and because no diversity jurisdiction existed, the court declined to exercise supplemental jurisdiction over the local-law claims. The First Circuit vacated the summary judgment for Hospital Pavia on the EMTALA claim and dismissed the local law claims, holding (1) the trial judge Fed. R. Civ. P. 19 analysis could not be sustained; and (2) this Court’s vacating part of the judge’s summary judgment ruling on the federal EMTALA claim undercut the analysis behind his supplemental jurisdiction decision. View "Delgado-Caraballo v. Hospital Pavia Hato Rey, Inc." on Justia Law

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The First Circuit vacated in part the district court’s grant of summary judgment in favor of Defendants in this lawsuit alleging violations of the Emergency Medical Treatment and Active Labor Act (EMTALA) and claiming medical malpractice. Plaintiffs sued Hospital Pavia Hato Rey, APS Healthcare of Puerto Rico (APS), and two doctors. In granting summary judgment, the district court held that the action could not in “equity and good conscience” proceed without two necessary parties but that the parties could not be feasibly joined under Fed. R. Civ. P. 19. The judge found that complete diversity of citizenship of each plaintiff from each defendant was not met on the federal-EMTALA claim, and because no diversity jurisdiction existed, the court declined to exercise supplemental jurisdiction over the local-law claims. The First Circuit vacated the summary judgment for Hospital Pavia on the EMTALA claim and dismissed the local law claims, holding (1) the trial judge Fed. R. Civ. P. 19 analysis could not be sustained; and (2) this Court’s vacating part of the judge’s summary judgment ruling on the federal EMTALA claim undercut the analysis behind his supplemental jurisdiction decision. View "Delgado-Caraballo v. Hospital Pavia Hato Rey, Inc." on Justia Law

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In this action brought by two individuals (Relators) under the False Claims Act (FCA) and various state analogues, the First Circuit affirmed in part and reversed in part the district court’s dismissal of the complaint. The district court concluded that Relators failed to plead false claims under either the FCA or the state-law versions of the FCA with the particularity required by Fed. R. Civ. P. 9(b). The First Circuit held (1) the complaint was correctly dismissed to the extent it relied on the alleged falsity of statements made by the product manufacturer in securing approval from the FDA to market a hip-replacement device; but (2) the district court erred in dismissing the complaint to the extent to rested on allegations that the manufacturer sold latently defective versions of its FDA-approved product on unsuspecting doctors who sought government reimbursement for defective products, as Relators’ complaint was sufficient to survive a Rule 9(b) motion to dismiss. View "Nargol v. DePuy Orthopaedics, Inc." on Justia Law

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Appellant brought a qui tam action against Cyberonics, Inc. alleging that Cyberonics violated the False Claims Act (FCA) and related state statutes by promoting medically unnecessary replacements of batteries in nerve stimular devices, which resulted in patients and medical providers filing false claims for reimbursement from government health care programs. The district court dismissed all but two of Appellant’s claims, including the FCA allegations, for failure to state a claim. Thereafter, the district court denied Appellant’s request for leave to file a second amended complaint on the basis of undue delay. The First Circuit affirmed, holding (1) Appellant’s first amended complaint did not satisfy Fed. R. Civ. P. 9(b)’s particularity requirement, and therefore, the district court did not err in dismissing the first amended complaint; and (2) Appellant did not meet his burden of providing a valid reason for his delay, and the district court did not abuse its discretion in denying Appellant’s motion for leave to amend. View "Hagerty v. Cyberonics, Inc." on Justia Law

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Relators’ daughter died of a seizure after receiving mental health treatment at Arbour Counseling Services, a facility in Massachusetts owned and operated by Universal Health Services (UHS). When Relators learned that Arbour had employed unlicensed and unsupervised personnel, in violation of state regulations, they brought a qui tam action against UHS under the False Claims Act (FCA), alleging that UHS had fraudulently submitted reimbursement claims to the Commonwealth despite knowing that it was in violation of state regulations (a theory of FCA liability known as the “implied false certification theory”). The district court dismissed the complaint, concluding that the regulatory violations were not conditions of payment as required for a claim to be actionable under the FCA. The First Circuit reversed, holding that the regulatory violations at issue were conditions for payment and that Relators appropriately stated a claim with particularity under the FCA. On certiorari, the Supreme Court held that the implied false certification theory can be a basis for FCA liability but remanded the case for further consideration of whether the complaint sufficiently alleged that the regulatory violations were material to the government’s payment decision. The First Circuit again reversed the district court’s grant of UHS’s motion to dismiss after applying the Supreme Court’s guidance on the question of whether UHS’s misrepresentations were material, holding that Relators’ complaint sufficiently stated a claim under the FCA. View "United States, ex rel. Escobar v. Universal Health Services, Inc." on Justia Law

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The consolidated appeals in this case involved a dispute between the Secretary of Health and Human Services and a group of Maine hospitals about certain payments - called disproportionate share payments (DSH payments) - the hospitals had received in reimbursement from the federal government for charity care for fiscal years dating as far back as 1993. Generally speaking, the more low-income patients a hospital services, the higher the hospital’s DSH payment. In this case, the Secretary maintained that the Hospitals were overinclusive in their DSH payment calculations. An intermediary reassessed the DSH payments and recouped from the Hospitals approximately $22 million in alleged overpayments. The Provider Reimbursement Review Board, in turn, ordered the intermediary to restore approximately $17 million to the Hospitals. The Secretary reversed. The Hospitals sought judicial review, but neither side was satisfied with the district court’s ruling. On appeal, the First Circuit reversed in part and affirmed in part, holding (1) the Secretary properly reopened the disputed years and adequately demonstrated that the Hospitals had received substantial overpayments of DSH funds; and (2) the Hospitals’ defenses to repayment were unavailing. View "Maine Medical Center v. Burwell" on Justia Law