Articles Posted in Health Law

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In a workers’ compensation case, the claimant, Darvel Burgess, filed a Disputed Claim for Compensation after his employer, Sewerage & Water Board of New Orleans (“S&WB”), refused to pay a $13,110.02 outstanding bill for prescription medications from Injured Workers Pharmacy (“IWP”). The underlying legal issue was whether the injured employee was entitled to his choice of pharmacy, or whether that right belonged to the employer under the Louisiana Workers Compensation Act (“LWCA”). The Louisiana Supreme Court granted review of this matter to resolve a split in the circuit courts of appeal on this issue. After review, the Supreme Court held the choice of pharmacy in a workers’ compensation case belongs to the employer. View "Burgess v. Sewerage & Water Bd. of New Orleans" on Justia Law

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In 2003, plaintiff Kimberly Thibodeaux became pregnant with her fourth child. Dr. James Donnell was her obstetrician-gynecologist throughout her pregnancy. During the course of the pregnancy, plaintiff was diagnosed with complete placenta previa and, in mid-November, at approximately 29 weeks pregnant, she was hospitalized for four days. Upon Dr. Donnell’s referral, she consulted a maternal/fetal medicine specialist who handled high risk pregnancies; the specialist recommended rest, limited activity, and delivery of plaintiff’s child at 36-37 weeks gestation. Plaintiff returned to the hospital with renewed vaginal bleeding and contractions. Dr. Donnell delivered plaintiff’s child via cesarean section. Shortly after the baby’s delivery, Dr. Donnell performed an emergency cesarean hysterectomy, which entailed removal of plaintiff’s uterus and cervix. After completing the hysterectomy, and while preparing to close plaintiff’s abdomen, Dr. Donnell discovered a large laceration to her bladder, which he repaired himself. After completing the surgery, Dr. Donnell ordered a test to determine if the bladder repair was successful. The test revealed that the bladder sutures were obstructing plaintiff’s ureters, the tubes that drain urine from the kidney into the bladder. This obstruction was then confirmed by a cystoscopy performed by a urologist, Dr. Robert Alexander, consulted by Dr. Donnell. The same day as the birth and cesarean hysterectomy, Dr. Alexander reopened plaintiff’s abdomen, removed the bladder sutures to free the ureters, and re-repaired the bladder laceration. Plaintiff followed up again with Dr. Alexander in late April 2004. Although her bladder healed, plaintiff continued to see Dr. Alexander for three years with irritative bladder symptoms, including urinary frequency every 30-60 minutes, urgency, urine leakage, painful urination, painful sexual intercourse, urination during sexual intercourse, excessive nighttime urination, and abdominal pain. Dr. Alexander diagnosed her with interstitial cystitis, also known as painful bladder syndrome, and prescribed medications, none of which relieved plaintiff’s symptoms. According to Dr. Alexander, plaintiff’s diminished bladder capacity was permanent. The Supreme Court granted review of this case to determine whether the court of appeal properly assessed damages under the principles set forth in “Coco v. Winston Industries Inc.,” (341 So. 2d 332 (La. 1976)). The Court found that, because the court of appeal found manifest error in the jury’s factual findings, the appellate court should have instead performed a de novo review of damages under the principles outlined in “Mart v. Hill,” (505 So. 2d 1120 (La. 1987)). Accordingly, the Court reversed the court of appeal and remanded back to that court for reconsideration under the proper caselaw precedent. View "Thibodeaux v. Donnell" on Justia Law

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The issue this case presented for the Louisiana Supreme Court's review was a res nova issue of whether a claim for negligent credentialing fell within the purview of the Louisiana Medical Malpractice Act (LMMA) and was, therefore, subject to its statutory cap on damages. After completion of the medical review process, plaintiffs Brandi, Veronica, and Joseph Billeaudeau proceeded in their suit against Opelousas General Hospital Authority (OGH), among other defendants, for injuries Brandi sustained allegedly arising from the medical malpractice of Dr. Kondilo Skirlis-Zavala, an independent contractor working in the OGH’s emergency department (ED). Along with their medical malpractice claims, plaintiffs specifically alleged OGH was negligent in credentialing Dr. Zavala and subsequently moved for partial summary judgment, seeking a determination that their negligent credentialing claim was not subject to the LMMA’s cap on damages. The District Court granted the motion and ultimately certified the judgment as final. The Court of Appeal affirmed on appeal. The Supreme Court found plaintiffs’ negligent credentialing claim did not fall within the provisions of the LMMA. Accordingly, the Court affirmed the Court of Appeal. View "Billeaudeau v. Opelousas General Hospital Authority" on Justia Law

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Both of the injured employees in these cases, Charles Morris and Charles Poole, were treated at the Lafayette Bone & Joint Clinic (“LB&J”); Morris was treated by Dr. Louis Blanda and Poole by Dr. John Cobb. Louisiana United Business SIF (“LUBA”), sent letters to LB&J and its doctors stating that LUBA would no longer pay for prescription medications directly dispensed by LB&J and directing LB&J doctors to issue future prescriptions for the instant injured employees that could be filled at local retail pharmacies. Despite these notices and subsequent denials of requests for reimbursement of dispensed prescription medications, LB&J doctors continued to dispense prescription medications to these injured employee patients throughout 2008 and to submit requests for reimbursement to LUBA. LUBA declined payment for these requests, citing its prior notice. LB&J and the treating physicians thereafter filed disputed claim forms with the Office of Workers’ Compensation (OWC), seeking to recover the cost of the medications dispensed, along with penalties and attorney fees. Following a joint trial in these two cases, the OWC judge ruled that the plaintiff/health care providers’ recovery for medications dispensed after the 2008 notice were nonemergency treatment dispensed without consent of the payor. Further, the OWC judge found that no penalties or attorney fees were warranted because LUBA had clearly advised the plaintiff/health care providers that no further reimbursement would be made for prescription medications dispensed by LB&J doctors after the date of the notice. The plaintiff/health care providers appealed, seeking an increase in the amount awarded and an award of penalties and attorney fees. The Louisiana Supreme Court granted writs to review the appellate court decisions, which awarded unreimbursed prescription medication costs beyond the $750 limitation set forth in LSA-R.S. 23:1142(B) and awarded penalties and attorney fees. The Court reversed the appellate court's modification of the amount awarded by the OWC, and affirmed in part, the decision to award penalties and attorney fees. View "LaFayette Bone & Joint Clinic v. Louisiana United Business SIF" on Justia Law

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The Supreme Court granted certiorari in this matter to determine whether a retiree of the City of Slidell, plaintiff Dean Born, could continue participating in the City of Slidell's health insurance plan following the City's adoption of Ordinance No. 3493, which required each city retiree to apply for Medicare coverage upon reaching the age of sixty-five. After review, the Supreme Court affirmed the Court of Appeal's finding that the City could not terminate plaintiff's desired plan coverage and require him to accept Medicare coverage, because plaintiff retired before the effective date of the Ordinance. View "Born v. City of Slidell" on Justia Law

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Across the state, plaintiffs were filing complaints against health care providers from whom they sought treatment following automobile accidents and with whom their health care insurers had contracted reimbursement rates for the services rendered. At issue was the legality of these providers' policy of collecting or attempting to collect the undiscounted rate from the insured if a liability insurer may be liable, implemented through the filing of medical liens against plaintiffs' lawsuits and settlements pursuant to the health care provider lien statute. The Supreme Court granted certiorari to resolve a conflict among the appellate courts of this state on the issue of whether a class action is the superior method for adjudicating actions brought pursuant to the Health Care Consumer Billing and Disclosure Protection Act ("Balance Billing Act"). After review, the Court found plaintiffs in the Third Circuit Court of Appeal proceeded as a class, while plaintiffs in the Second Circuit Court of Appeal were denied class certification. After reviewing the record and the applicable law, the Supreme Court found the class action was superior to any other available method for a fair and efficient adjudication of the common controversy over the disputed billing and lien practices. Accordingly, the Court reversed the judgment of the Second Circuit. Finding all other requirements for class certification properly met, the Court reinstated the judgment of the trial court. View "Baker v. PHC-Minden, L.P." on Justia Law

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The Louisiana Supreme Court granted this writ application to determine whether a plaintiff had a private right of action for damages against a health care provider under the Health Care and Consumer Billing and Disclosure Protection Act. Plaintiff Yana Anderson alleged that she was injured in an automobile accident caused by a third party. She received medical treatment at an Ochsner facility. Anderson was insured by UnitedHealthcare. Pursuant to her insurance contract, Anderson paid premiums to UnitedHealthcare in exchange for discounted health care rates. These reduced rates were available pursuant to a member provider agreement, wherein UnitedHealthcare contracted with Ochsner to secure discounted charges for its insureds. Anderson presented proof of insurance to Ochsner in order for her claims to be submitted to UnitedHealthcare for payment on the agreed upon reduced rate. However, Ochsner refused to file a claim with her insurer. Instead, Ochsner sent a letter to Anderson’s attorney, asserting a medical lien for the full amount of undiscounted charges on any tort recovery Anderson received for the underlying automobile accident. Anderson filed a putative class action against Ochsner, seeking, among other things, damages arising from Ochsner’s billing practices. Upon review of the matter, the Supreme Court found the legislature intended to allow a private right of action under the statute. Additionally, the Court found an express right of action was available under La. R.S. 22:1874(B) based on the assertion of a medical lien. View "Anderson v. Ochsner Health System" on Justia Law

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Defendant Micah Smith was charged with unauthorized participation in a medical assistance program. The State maintained Smith was excluded from participating in medical assistance programs through the administrative process by the Louisiana Department of Health and Hospitals (DHH) for various allegations of fraud and misconduct. After that exclusion, Smith continued to serve as the billing agent for Medicaid providers, despite his exclusion. Smith filed a motion to quash in which he challenged La. R.S. 14:126.3.1(A)(4) as overbroad because it "prohibit[ed] a substantial amount of free speech and actions which would be protected under the First Amendment." He filed a second motion to quash, challenging La. R.S. 14:126.3.1(A)(3) as "so sweeping in its proscription that it denie[d] a wide range of protected benefits to which a majority of Americans are entitled." The district court denied Smith's first motion by granted the second. The State appealed. After review of the district court record and the applicable law, the Supreme Court reversed the district court's declaration that La. R.S. 14:126.3.1(A)(3) was unconstitutional, and remanded the case for further proceedings. View "Louisiana v. Smith" on Justia Law

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Dr. Tommie Granger was a certified cardiac surgeon who had hospital privileges at defendant Christus St. Frances Cabrini Hospital. One of his patients was hospitalized at Cabrini and developed complications. While the doctor was called to the hospital to check on the patient, he and Cabrini staff got into a heated exchange of words within earshot of the patient. The doctor performed an in-room procedure and left. En route, the patient developed further complications, but the doctor was unable to go back to Cabrini to help. He called a colleague to perform the necessary surgery on the patient Cabrini's Board of Directors suspended Granger pending a review of the doctor's conduct regarding that patient. Finding that unprofessional behavior was a contributing factor that adversely affected the patient's care, the Board recommended that the doctor be placed on probation and to self-refer for anger management. When he did not comply, the Board revoked his privileges. The doctor sued, and ultimately won nearly $3 million in damages with respect to Cabrini's peer review proceedings. Upon review, the Supreme Court found that an award of lost income that was included in those damages was given in error, and was vacated. View "Granger v. Christus Health Central Louisiana" on Justia Law

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The Supreme Court granted consolidated writ applications to address the majority opinion of the court of appeal which held the medical malpractice cap enunciated in La.R.S. 40:1299.42(B) was unconstitutional "to the extent it includes nurse practitioners within its ambit.” The Court reiterated its holding in "Butler v. Flint Goodrich Hospital of Dillard University," (508 U.S. 909 (1993)), which found the cap constitutional. Finding the cap to be applicable to all qualified healthcare providers under the Medical Malpractice Act, including nurse practitioners, the Louisiana Supreme Court reversed the judgment of the court of appeal in this respect. Additionally, the Court addressed two other assignments of error asserted by the Louisiana Patients' Compensation Fund and affirmed those portions of the court of appeal judgment. The effect of the Court's holding was to reinstate the trial court judgment in full. View "Oliver v. Magnolia Clinic" on Justia Law