Justia Legal Ethics Opinion Summaries

Al-Shaikh, an orthopedic surgeon, moved his Fremont practice and sought approval by the Department of Health Care Services (DHCS), under Medi-Cal regulations. He had been an approved Medi-Cal provider in Fremont for six years. DHCS denied his application, claiming that Al-Shaikh’s fee arrangement with his billing service was unlawful. Al-Shaikh appealed. DHCS agreed the provisions it had cited were inapplicable but cited another state law, incorporating a federal Medicaid regulation. Al-Shaikh filed suit, then relocated his Auburn practice, for which he used the same billing service; the relocation was approved by a different DHCS regional office. Al-Shaikh cited an Office of the Inspector General publication that expressly states his fee arrangement does not violate federal law. DHCS approved the Fremont office after three years. The court dismissed the case as moot. Al-Shaikh moved for fees under Code of Civil Procedure 1028.5, which allows a small business or a licensee that prevails in an action against a state regulatory agency to recover a maximum of $7,500 in fees if the agency acted without substantial justification. The court of appeal directed the superior court to award Al-Shaikh the full amount recoverable under section 1028.5. DHCS has an obligation to be knowledgeable about the law it is charged with implementing and was unable to cite a case or regulatory decision supporting its position; it acted without substantial justification. View "Al-Shaikh v. State Department of Health Care Services" on Justia Law

Defendants sought ex parte interviews with a number of non-party medical providers in this medical malpractice action. Because of this, an issue arose regarding the scope of the physician–patient privilege in medical-malpractice actions. Section 13-90-107(1)(d), C.R.S. (2017), prohibited certain medical providers from revealing, in testimony or otherwise, information about a patient gathered in the course of treating that patient. That prohibition, however, was not unlimited. The dispute, as presented to the Colorado Supreme Court, did not implicate the physician–patient relationship between Kelley Bailey (“Bailey”) and Defendants, meaning section 107(1)(d)(I) was inapplicable. Instead, the issue here was whether the non-party medical providers were “in consultation with” Defendants such that section 107(1)(d)(II) removed that typically privileged information from the protection of the physician–patient privilege. The Supreme Court held the non-party medical providers were not in consultation with Defendants for the purposes of section 107(1)(d)(II). However, the Court remanded this case to the trial court for consideration of whether the Baileys impliedly waived the physician–patient privilege for the non-party medical providers. On remand, if the trial court concluded that the Baileys did waive that privilege, it should reconsider whether there is any risk that: (1) ex parte interviews with the non-party medical providers would inadvertently reveal residually privileged information; or (2) Defendants would exert undue influence on the non-party medical providers in the course of any ex parte interviews. View "In re Bailey v. Hermacinski" on Justia Law

There is no hospital in Valencia County. People in Valencia County who are faced with a medical emergency must deal with the emergency itself, and find a way to travel twenty to thirty-five miles to an Albuquerque hospital. Ambulances coming from Valencia County can take two hours or longer to transport a patient to the nearest hospital, process the patient, and return. The long turnaround times mean that ambulance companies sometimes run at full capacity, or “zero status,” and cannot respond to calls from new patients because all available ambulances are in use. Since 1987, appellant Living Cross Ambulance Service has been the only ambulance company in Valencia County operating under a permanent certificate from the Public Regulation Commission (PRC). Living Cross has been at zero status and unavailable to transport patients for less than one percent of ambulance service requests. When Living Cross is at zero status, dispatch requests mutual aid from a nearby ambulance company, and if those mutual aid ambulances are also unavailable, the municipality whose EMTs first responded to the scene must transport the patients at the municipality’s expense. This case was a direct appeal from a final order of the Public Regulation Commission (PRC) granting a permanent certificate to American Medical Response Ambulance Service, Inc. d/b/a American Medical Response, Emergicare (AMR) for both emergency and nonemergency ambulance service in Valencia County. Living Cross petitioned the New Mexico Supreme Court to vacate the final order of the PRC, claiming that the PRC acted arbitrarily and capriciously by granting AMR’s certificate because there was no evidence of need for non-emergency ambulance service in Valencia County, and because there was insufficient evidence of need for additional emergency ambulance service. Living Cross also claimed that the PRC abused its discretion by allowing Living Cross’s former attorney to represent AMR in an initial hearing before ruling on its motion to disqualify the attorney. Upon review, the Supreme Court held that the PRC decision to allow the former Living Cross attorney to appear for AMR during the hearing for the temporary permit was contrary to law, and that the wholesale admission of the record from that hearing as evidence in the hearing for the permanent certificate was plain error, requiring reversal. Because the Court determined that the attorney disqualification issue is dispositive, it did not reach the other issues in this case. View "Living Cross Ambulance Serv. v. N.M. Pub. Regulation Comm'n" on Justia Law

In 1979, Plaintiffs sued under 42 U.S.C. 1983, on behalf of present and future recipients, alleging that Tennessee’s Medicaid program violated federal requirements, 42 U.S.C. 1396, and the Due Process Clause. The decades that followed involved intervenors, consent orders, revisions, and creation of a subclass. In 1994, Tennessee converted to a managed care program, TennCare. In 1995, five class members filed motions alleging that TennCare was being administered inconsistent with a 1992 decree and federal law. In 2009, the district court awarded plaintiffs more than$2.57 million for fees and expenses leading up to a 2005 Revised Consent Decree. Plaintiffs had originally requested a lodestar amount of $3,313,458.00, but the court reduced the award by 20 percent on account of plaintiffs’ “limited” success relative to the breadth of defendants’ requests and the scope of the litigation. The court noted that there was “no dispute that Plaintiffs in this case are the prevailing party, and thus entitled to attorneys’ fees under 42 U.S.C. 1988.” The Sixth Circuit vacated parts of the award, noting that section 1988 “is not for the purpose of aiding lawyers and that the original petition for fees included requests for dry cleaning bills, mini blinds, and health insurance. View "Binta B. v. Gordon" on Justia Law

Appellant, the representative of a decedent's estate, hired attorneys David Mushlin and William Nefzger and their law firm to pursue a medical negligence claim against a hospital and several physicians. The trial court later disqualified Mushlin on the ground that Mushlin's prior representation of the hospital was sufficient to create a conflict of interest or at least the appearance of impropriety. The court also noted that Nefzger and the entire firm were conflicted because Mushlin could not effectively be screened from the case and there was a great likelihood of his having constant contact with the other attorneys who would be working on the case in his stead. Appellant subsequently filed a petition for a writ of prohibition, which the court of appeals denied. The Supreme Court affirmed, holding that Appellant failed to show she would suffer great injustice and irreparable injury from the trial court's order disqualifying her lawyer and his law firm from representing her. View "Robertson v. Circuit Court" on Justia Law

The Idaho Supreme Court was asked in a certified question of law from the United States District Court for the District of Idaho whether a legal malpractice claim that is transferred to an assignee in a commercial transaction, along with other business assets and liabilities, is assignable. The question arose from a a wrongful termination and False Claims Act action brought by former hospital employees against their employer. Magic Valley Medical Center was the entity being sued. Twin Falls County owned Magic Valley. Twin Falls County (on behalf of itself and Magic Valley), Twin Falls Health Initiatives Trust, Ltd. (TFHIT), and St. Luke’s Health System, Ltd., St. Luke’s Regional Medical Center, Ltd., and St. Luke’s Magic Valley Regional Medical Center (St. Luke's) entered into a Sale and Lease Agreement for the Creation of a New Health System (Agreement). The sale closed, and St. Luke's carried the burden of the employee litigation, ultimately settling with the plaintiffs. After the transaction closed, Magic Valley no longer existed. Though technically not a merger, the operation and management of the center was taken over by St. Luke's. St. Luke's then sued Magic Valley's former legal counsel for legal malpractice in connection with the employee litigation. The firm moved for summary judgment, arguing that St. Luke's could not pursue a malpractice claim because the purported assignment of such a claim was invalid in Idaho as a matter of law. Upon review, the Idaho Supreme Court answered the district court's certified question in the affirmative: although legal malpractice claims are generally not assignable in Idaho, where the legal malpractice claim is transferred to an assignee in a commercial transaction, along with other business assets and liabilities, such a claim is assignable. View "RE: Order Certifying Question - St. Lukes Magic Valley RMC v. Luciani, et al." on Justia Law

Plaintiff filed several suits against healthcare groups on behalf of the United States, claiming violation of the Medicare Secondary Payer Act, 42 U.S.C. 1395y(b). No court has ever found that the MSP is a qui tam statute, permitting private attorneys general to sue on behalf of the United States. The Sixth Circuit found plaintiff was on notice of the frivolous nature of his filings from their inception in the Tennessee district courts and remanded for a show-cause hearing on why sanctions should not issue. The district court awarded sanctions to two defendants in amounts of $131,158.50 and $145,431.19. The Sixth Circuit affirmed, but denied an award for the appeal.