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

Under Part A of the Ryan White Comprehensive AIDS Resources Emergency Act the U.S. Department of Health and Human Services (HHS) disburses funding to combat HIV/AIDS infection in metropolitan areas that are home to more than a specified number of individuals who have AIDS. When HHS determined that the Ponce metropolitan area no longer had enough AIDS cases to qualify for continued Part A funding, Ponce and several community health groups brought this lawsuit claiming that HHS had unfairly drawn the boundaries of Ponce’s metropolitan area too narrowly. The district court concluded that HHS acted arbitrarily and capriciously in defining the “metropolitan area” of Ponce and that HHS’s methodology for defining metropolitan areas in Puerto Rico was unfair and discriminatory. The First Circuit reversed, holding that Congress could reasonably be said to have told HHS to use the boundaries that it used in defining the Ponce metropolitan area. Remanded for entry of judgment in favor of Defendants dismissing the complaint with prejudice. View "Municipio Autonomo de Ponce v. U.S. Office of Mgmt." on Justia Law

Plaintiffs filed a second amended complaint against Defendant, a medical doctor, alleging claims based on medical negligence, Defendant’s failure to obtain informed consent, and battery. The district court granted summary judgment in favor of Defendant as to the medical battery claim. After a trial as to Plaintiffs’ informed consent claim, the jury returned a verdict for Defendant. The First Circuit affirmed in part and vacated and remanded in part, holding (1) the district court properly dismissed Plaintiffs’ battery claim; but (2) the district court erred by excluding expert testimony that a fine-needle aspiration biopsy was a viable non-surgical alternative to a surgical biopsy. View "Bradley v. Sugarbaker" on Justia Law

Defendant, Plaintiff’s co-worker at a mental health facility in Norton, Massachusetts, issued an order, pursuant to Mass. Gen. Laws ch. 123, 12, authorizing Plaintiff to be seized from her home and brought to a hospital for a psychiatric evaluation, certifying that there was a “very substantial risk” that Plaintiff would injure herself. Pursuant to that order, the police took Plaintiff from her home and drove her to the hospital. A doctor at the hospital determined that Plaintiff was lucid and released her. Plaintiff subsequently brought a 42 U.S.C. 1983 claim against Defendant. The district court dismissed Plaintiff’s claim for failure to state a claim that Defendant had violated Plaintiff’s federal constitutional rights. The First Circuit affirmed, holding that Plaintiff failed to state a plausible claim for relief. View "Durand v. Harpold" on Justia Law

Home Orthopedics Corp. was a medical equipment supplier based in Puerto Rico. Raul Rodriguez, the president of another home medical supplier in Puerto Rico, attempted to collect a consulting fee Home Orthopedics agreed to pay him. Home Orthopedics refused to continue paying the fee when it discovered that the contract upon which it was based was fraudulent. Soon companies in the health insurance field started terminating their contracts with Home Orthopedics. Home Orthopedics filed an amended complaint seeking relief against numerous defendants - some of whom worked with Rodriguez and others of whom worked for the companies that terminated their contacts with Home Orthopedics - for violating, among other laws, the Racketeer Influenced and Corrupt Organizations Act (RICO). Specifically, Home Orthopedics alleged that Defendants conspired to help Rodriguez strong-arm more money from Home Orthopedics. The district court dismissed Home Orthopedics’ claims. The First Circuit affirmed, holding (1) Home Orthopedics failed to sufficiently allege a “pattern of racketeering activity” necessary to sustain its RICO claim; and (2) the district court did not err in denying Home Orthopedics’ motion to conduct limited discovery and then to amend its complaint for a second time. View "Home Orthopedics Corp. v. Rodriguez" on Justia Law

Relators’ daughter was being treated by counselors at Arbour Counseling Services in Lawrence, Massachusetts when she was prescribed a medication for her purported bipolar disorder. The daughter experienced an adverse reaction to the drug and eventually suffered a fatal seizure. Relators filed this action against Defendant Universal Health Services, Inc., Arbour’s owner and operator, under both the federal and Massachusetts False Claims Acts, alleging that Arbour, in submitting reimbursement claims to the state Medicaid agency for services rendered by the staff members who treated their daughter, fraudulently misrepresented that those staff members were properly licensed and supervised, as required by law. Specifically, Relators alleged that Arbour’s alleged noncompliance with supervision and licensure requirements rendered its reimbursement claims actionably false. The district four dismissed the complaint for failure to state a claim. The First Circuit reversed the dismissal of the complaint with one limited exception, holding (1) a healthcare provider’s noncompliance with conditions of payment is sufficient to establish the falsity of a claim for reimbursement; and (2) Relators appropriately stated a claim with particularity under the False Claims Act. View "United States, ex rel. Escobar v. Universal Health Servs., Inc." on Justia Law

Kenneth Jones filed this qui tam action pursuant to the False Claims Act alleging that, in submitting a grant application to the National Institute on Aging (NIA), Dr. Ronald Killiany and Dr. Marilyn Albert (together, Defendants) knowingly made false statements and knowingly falsified certain scientific data, which influenced the NIA’s decision to award more than $12 million in federal funds to Massachusetts General Hospital and Brigham and Women’s Hospital. The district court initially granted summary judgment for Defendants. The First Circuit vacated that order and remanded the case for trial. A jury found for Defendants. The First Circuit affirmed, holding (1) Jones failed to preserve his argument that he was entitled to judgment as a matter of law, but even if he had, there was sufficient evidence for the jury to find in favor of Defendants; and (2) the district court did not err in denying Defendants' motion for a new trial. View "United States v. Brigham & Women's Hosp." on Justia Law

In 1995, a number of government agencies opened investigations into the dealings of Fresenius Medical Care Holdings, Inc. with various federally funded health-care programs. In 2000, Fresenius entered into a series of criminal plea and civil settlement agreements with the government. The civil settlement agreements released several claims against Fresenius, including claims made under the False Claims Act (FCA). Those agreements eschewed any tax characterization. Thereafter, the parties began disputing the tax treatment of the balance of the civil settlements. Fresenius commenced a tax refund action for the purpose of determining the deductibility of the amount in dispute. The district court concluded that where the parties had eschewed any tax characterization, the critical consideration in determining deductibility was the extent to which the disputed payment was compensatory as opposed to punitive. At trial, the court’s jury instructions embodied this conclusion. The jury found that a large chunk of the settlement was deductible. The court accepted this finding and ordered tax refunds totaling more than $50,000,000. The First Circuit affirmed, holding that, “in determining the tax treatment of an FCA civil settlement, a court may consider factors beyond the mere presence or absence of a tax characterization agreement between the government and the settling party.” View "Fresenius Med. Care Holdings, Inc. v. United States" on Justia Law

Santana-Concepcion underwent exploratory brain surgery around a “symptomatic arachnoid cyst” during which a neurosurgeon placed a shunt to relieve pressure created by the cyst. Santana-Concepcion, along with her husband and four children, later filed suit against the neurosurgeon and the hospital at which the surgery was performed, alleging medical malpractice and lack of informed consent. The district court granted summary judgment to Defendants, holding (1) the claims of Santana-Concepcion and her adult children were time-barred; (2) the medical malpractice claim of Santana-Concepcion’s minor children was foreclosed by the “error of judgment” defense; and (3) the informed consent claim of the minor children failed on the element of causation. The First Circuit affirmed, holding that the district court properly granted summary judgment on (1) the medical malpractice claims of Santana-Concepcion and her adult children and the informed consent claims of the adult children, as they were not filed within the limitations period; (2) the minor plaintiffs’ medical malpractice claims, as they were unable to generate a genuine issue of material fact as to the application of the “error of judgment” defense; and (3) the informed consent claims of the minor plaintiffs for lack of causation. View "Santana-Concepcion v. Centro Medico del Turabo, Inc." on Justia Law

Plaintiff sought insurance coverage for gastric lap band surgery. Defendant, a health-care insurer that covered Plaintiff by virtue of Plaintiff’s husband’s employment with the federal government, refused to cover the full cost of the surgery. Plaintiff brought tort and breach of contract claims against Defendant in the Puerto Rico Court of First Instance. Defendant removed the action to the federal district court, asserting, inter alia, that the Federal Employees Health Benefits Act of 1959 (FEHBA) completely preempted Plaintiff’s local-law claims, thus conferring original jurisdiction on the federal court. Defendant then moved to dismiss the case, arguing that the FEHBA demanded exhaustion of administrative remedies. Plaintiff, in the meantime, requested that the district court remand the case to the Court of First Instance. The district court (1) denied Plaintiff’s motion to remand, holding that the FEHBA completely preempted Plaintiff’s claims and, thus, federal jurisdiction attached; and (2) dismissed the action for Plaintiff’s failure to exhaust administrative remedies. The First Circuit Court of Appeals reversed the district court’s judgment of dismissal and its order denying remand, holding that the court erred in concluding that the FEHBA afforded complete preemption. View "Lopez-Munoz v. Triple-S Salud, Inc. " on Justia Law

Marilyn Davidson, an intellectually disabled individual, was in the care of the Massachusetts Department of Developmental Services (DDS) most of her life. In 1985, Marilyn was transferred to the Fernald Developmental Center, an intermediate care facility (ICF). In 2003, the Commonwealth of Massachusetts decided to close Fernald. DDS planned to transfer Marilyn to the Wrentham Developmental Center, another ICF. Plaintiffs, Marilyn’s guardians, filed a complaint in the federal district court, alleging that Marilyn’s transfer violated the federal Medicaid statute and various implementing regulations. Plaintiffs also sought a motion for a preliminary injunction. The district court denied the injunction and held that the statutory and regulatory provisions cited in the complaint did not create a private right of action. Marilyn was subsequently transferred to Wrentham, and Fernald was closed. The First Circuit Court of Appeals remanded the case to the district court with instructions to dismiss Plaintiffs’ complaint, holding (1) Plaintiffs’ claim for damages was barred by the Commonwealth’s Eleventh Amendment immunity from suit for damages in federal court; and (2) Plaintiffs’ claims for declaratory and injunctive relief were moot. View "Davidson v. Howe" on Justia Law