Justia U.S. 7th Circuit Court of Appeals Opinion Summaries

Paramedics rushed Millicent to Franciscan, a designated acute‐stroke‐ready hospital. Franciscan transferred her to its intensive care unit. Three days later, Millicent suffered a stroke. Her condition deteriorated and she was put on life support. The family expressed concern about the adequacy of care and sought to transfer Millicent to another facility. Franciscan assisted in submitting transfer paperwork to two other hospitals. Both declined the requests for insurance reasons. While a third transfer request was pending, Franciscan advised the family that Millicent was brain dead and that it had decided to stop treatment. Nearly two years later, Nartey reviewed Millicent’s medical records, which she claimed lacked the transfer paperwork and test results.Nartey, acting pro se, sued. The court grouped Nartey’s complaint into claims that Franciscan violated the federal Emergency Medical Treatment and Active Labor Act (EMTALA) by failing to provide adequate care or to transfer Millicent, 42 U.S.C. 1395dd; that Franciscan violated Title VI, which prohibits federally funded programs from discriminating on the basis of race, color, or national origin, 42 U.S.C. 2000d, and that Franciscan fraudulently concealed test results, preventing Nartey from timely bringing a medical malpractice claim.The Seventh Circuit affirmed the dismissal of the suit. Although Nartey missed filing deadlines, the court addressed the merits. EMTALA is not a malpractice statute covering treatment after an emergency patient is screened and admitted. While Nartey presented some statistical evidence that hospital transfers are less common among racial minorities, Franciscan was not responsible for Millicent remaining there. A reasonable inquiry would have discovered the alleged concealment. View "Nartey v. Franciscan Health Hospital" on Justia Law

Prosser, a 37-year-old Medicare recipient, suffers from glioblastoma, which causes brain tumors. The five-year survival rate hovers around 5%. Though not curative, Prosser benefits from tumor treating fields therapy (TTF), approved by the FDA in 2011. For most of the day, patients use a device that attaches to the head via adhesive patches that connect to a mobile power supply. The device emits electrical fields to the tumor, which disrupt the division of cancer cells. Early studies show that the device holds promise in prolonging life. TTF therapy is available through a single supplier, Novocure, which rents the device on a monthly basis. The therapy is expensive. Prosser must file a Medicare benefits claim for each period she uses the device. Medicare denied coverage for the treatment period January-April 2018. Though Prosser received the therapy and owed nothing, the denial left Novocure with the bill. Prosser challenged this denial through Medicare’s appeals process before filing suit.The Seventh Circuit affirmed the dismissal of Prosser’s claim for Medicare Part B coverage, holding that she has suffered no injury-in-fact sufficient to satisfy Article III’s standing requirement. Prosser received—and continues to receive—the TTF therapy. She faces no financial liability for the treatment period Medicare denied coverage. Any future financial risk is too attenuated from the denial of the past coverage and far too speculative to establish standing. View "Prosser v. Becerra" on Justia Law

Arnold applied for Social Security disability benefits based on ailments related to her back, heart, and joints, and chronic pain syndrome. Following the initial denial of her claim, Arnold requested a hearing before an ALJ. Arnold testified at the hearing, as did a vocational expert. The ALJ concluded that Arnold was not disabled, finding Arnold had several severe impairments, but that she retained the ability, with certain movement restrictions, to perform her past relevant work as a daycare center director. The district court and Seventh Circuit affirmed the ALJ’s decision, rejecting an argument that the ALJ failed to analyze whether the side effects of her medications impacted Arnold’s ability to work. While there is some evidence of side effects in the record, there is no evidence that the side effects impacted Arnold’s ability to work. On this record, the ALJ was not required to make findings about Arnold’s side effects. View "Arnold v. Saul" on Justia Law

Woodson received prenatal treatment from Dr. Ramsey at NorthShore Health Centers. Ramsey informed Woodson that she would likely need to deliver her baby by C-section. Ramsey delivered P.W. vaginally at Anonymous Hospital. Woodson noticed immediately that something was wrong with P.W.’s left arm. P.W.’s arm did not improve.NorthShore is a Federally-qualified health center (FQHC) that receives federal money (42 U.S.C. 1396d(l)(2)(B)); its employees are deemed Public Health Service employees, covered against malpractice claims under the Federal Tort Claims Act (FTCA), 42 U.S.C. 233(g). NorthShore appears in the federal government's online public database of federal funding recipients whose employees may be deemed Public Health Service employees. Woodson’s attorney, Sandoval, failed to recognize NorthShore’s status as an FQHC. Sandoval reviewed the Indiana Department of Insurance (IDOI) and Indiana Patient’s Compensation Fund online databases and learned that Ramsey and Anonymous Hospital were “qualified” providers under the Indiana Medical Malpractice Act. The IDOI forwarded Woodson’s complaint to Ramsey and his insurance carrier. Those claims remain pending.On December 16, 2015, NorthShore informed Sandoval that NorthShore was a federally funded health center. Woodson filed administrative tort claims, which were denied. Nearly three years after P.W.’s birth, Woodson filed suit against the government and Anonymous Hospital. The Seventh Circuit affirmed that the claims accrued on December 7, 2013, the day P.W. was born, and were untimely under the FTCA’s two-year statute of limitations. Woodson had enough information shortly after P.W.'s birth to prompt her to inquire whether the manner of delivery caused P.W.’s injury. The FTCA savings provision does not apply because the IDOI never dismissed the claims. Neither Ramsey nor NorthShore had a duty to inform Woodson of their federal status. View "P.W. v. United States" on Justia Law

Smith suffered an injury from a car accident, retained an attorney for a personal injury lawsuit, and authorized her attorney to obtain her healthcare information. The attorney requested Smith’s medical records from MHS, on three occasions. RecordQuest, not MHS, answered those requests and charged Smith’s attorney (who paid on her behalf) a $20.96 handling fee and an $8.26 certification fee each time.Smith brought a class action, alleging these charged fees contravened the permissible fee schedule set out in Wis. Stat. 146.83(3f)(b) for healthcare records requests and resulted in the unjust enrichment of RecordQuest. The district court dismissed both claims, reasoning that the statute imposes a duty upon only healthcare providers.” RecordQuest is not a healthcare provider but is the agent of MHS; “no principle of agency law holds that a principal’s liability is imputed to the agent when the agent performs the act that results in the principal’s liability.” Smith’s unjust enrichment claim failed because any unjust benefit that Smith allegedly conferred to RecordQuest belonged to MHS.The Wisconsin Court of Appeals subsequently expressly disagreed with the district court’s analysis of Smith’s statutory claim. The Seventh Circuit reversed the dismissal of the statutory claim but affirmed as to Smith’s unjust enrichment claim. Under section 146.83(3f)(b), Smith has a remedy at law for any “injustice” that allegedly resulted from excessive payments; the equitable remedy of unjust enrichment is derivative of and predicated upon the statutory claim. View "Smith v. RecordQuest LLC" on Justia Law

Cutchin’s wife and daughter were killed in an automobile accident that occurred when another driver, Watson, age 72, struck their vehicle. Cutchin alleges that Watson’s driving ability was impaired by medications she had been prescribed, including an opioid. Cutchin filed a malpractice suit against Watson’s healthcare providers, charging them with negligence for an alleged failure to warn Watson that she should not be driving given the known motor and cognitive effects of those medications. After the providers and their malpractice insurer agreed to a settlement of $250,000, the maximum amount for which they can be held individually liable under the Indiana Medical Malpractice Act (MMA), Cutchin sought further relief from the Patient’s Compensation Fund, which acts as an excess insurer. The Fund argued that the MMA does not apply to Cutchin’s claim and that he is barred from seeking excess damages from the Fund. The district court agreed.The Seventh Circuit certified to the Indiana Supreme Court the questions: Whether Ithe MMA prohibits the Fund from contesting the Act’s applicability to a claim after the claimant concludes a court‐approved settlement with a qualified healthcare provider, and whether the MMA applies to claims brought against individuals (survivors) who did not receive medical care from the provider, but who are injured as a result of the provider’s negligence in providing medical treatment to someone else. View "Cutchin v. Robertson" on Justia Law

Alleging debilitating pain in her back, legs, and hands, Zoch sought disability insurance benefits, 42 U.S.C. 413, 423. An ALJ denied the application, finding that, based on the opinions of three of her four treating physicians, a consulting physician, and the objective medical evidence, she could perform sedentary work.The district court and Seventh Circuit affirmed, rejecting Zoch’s arguments that the ALJ improperly discounted her assertions and an opinion by a physician who relied on those assertions. Substantial evidence supports the ALJ’s decision. Zoch’s testimony of incapacitating pain conflicted with the objective medical evidence, including normal test results: lumbar MRI, wrist x-rays, range of motion, straight-leg raising, strength in extremities, and pressure on her nerves. Zoch’s testimony that she usually walked with a cane conflicted with the doctors’ reports that at all but one appointment she walked normally. Zoch’s testimony that she could not raise her arms or bend over to dress conflicted with a doctor’s observation that Zoch could comfortably bend over to touch her fingertips to her knees. Zoch’s hearing testimony that she could not perform the usual activities of daily living was inconsistent with her assertions in her application. View "Zoch v. Saul" on Justia Law

Most people eligible for Medicaid benefits are “categorically needy” because their income falls below a threshold of eligibility. People with higher income but steep medical expenses are “medically needy” once they spend enough of their own assets to qualify, 42 U.S.C. 1396a(a)(10). Plaintiffs contend that medical expenses they incurred before being classified as “medically needy” should be treated as money spent on medical care, whether or not those bills have been paid, which would increase Illinois's payments for their ongoing care.The Seventh Circuit affirmed the dismissal of their suit. Medicaid is a cooperative program through which the federal government reimburses certain expenses of states that abide by the program’s rules. Medicaid does not establish anyone’s entitlement to receive particular payments. The federal-state agreement is not enforceable by potential beneficiaries. Plaintiffs bypassed their administrative remedies and do not have a judicial remedy under 1396a(r)(1)(A). Section 1396a(a)(8) provides that a state’s plan must provide that all individuals wishing to apply for medical assistance under Medicaid shall have the opportunity to do so and that assistance shall be furnished with reasonable promptness to all eligible individuals; some courts have held that this requirement can be enforced in private suits. If such a claim were available, it would fail. Plaintiffs are receiving benefits. The court also rejected claims under the Americans with Disabilities Act, 42 U.S.C. 12131–34, and the Rehabilitation Act, 29 U.S.C. 794. Plaintiffs receive more governmental aid than nondisabled persons. View "Nasello v. Eagleson" on Justia Law

The False Claims Act, 31 U.S.C. 3729–3733, authorizes relators to file qui tam suits on behalf of the U.S. government. If such an action is successful, the relator receives part of the recovery. The Act prohibits presenting to a federal healthcare program a claim for payment that violates the Anti-Kickback Statute, 42 U.S.C. 1320a-7b(b), Venari formed 11 daughter companies, each for the purpose of prosecuting a separate qui tam action, alleging essentially identical violations of the False Claims Act by pharmaceutical companies. CIMZNHCA, a Venari company, filed suit alleging illegal kickbacks to physicians for prescribing Cimzia to treat Crohn’s disease in patients who received federal healthcare benefits. The government did not exercise its right “to intervene and proceed” as the plaintiff but moved to dismiss the action, representing that it had investigated the Venari claims and found them to lack merit. The court denied that motion, finding the government’s general evaluation of the Venari claims insufficient as to CIMZNHCA and that the decision to dismiss was “arbitrary and capricious.”The Seventh Circuit reversed with instructions to dismiss, construing the government’s motion as a motion to both intervene and dismiss. By treating the government as seeking to intervene, a court can apply Federal Rule of Civil Procedure 41, which provides: “The Government may dismiss the action” without the relator’s consent if the relator receives notice and opportunity to be heard. View "United States v. UCB, Inc." on Justia Law

Vaughn, a quadriplegic, has received home‐based care for over 30 years. She requires help with personal care, household maintenance, mobility exercises, transportation, medications, suctioning secretions from her tracheostomy, and use of the ventilator. When nursing shifts cannot be staffed, Vaughn has relied on friends. Indiana funded her care through two federally-reimbursed Medicaid programs: A&D waiver and core Medicaid. Vaughn could select her own caregivers to receive A&D waiver funds but could not personally direct nursing care funded through core Medicaid. In 2016, Vaughn was hospitalized with pneumonia. She was cleared to be discharged but the state could not find nurses to provide round‐the‐clock care at home at Medicaid rates Vaughn was transferred to a nursing home and filed suit under the Americans with Disabilities Act, 42 U.S.C. 12132; the Rehabilitation Act, 29 U.S.C. 794; and the Medicaid Act, 42 U.S.C. 1396a(a)(8). The court granted Vaughn summary judgment with an injunction requiring the state to “do whatever is necessary to achieve” round‐the‐clock home‐based care, fully paid for by the state.The Seventh Circuit vacated. Vaughn is not entitled to the services she has requested under Indiana’s version of the Medicaid program, as the program was structured before the state adopted a new pilot program. The state is not obligated to reimburse Vaughn’s providers at rates above the approved Medicaid caps, nor must it use funds outside the Medicaid program to comply with a rule about accommodation within the program. View "Vaughn v. Walthall" on Justia Law