Justia U.S. 6th Circuit Court of Appeals Opinion Summaries

Tomei went to Parkwest Hospital after he injured his foot and leg. He is deaf and communicates using American Sign Language. He asked for an interpreter. Parkwest never provided one. Medical staff gave him an antibiotic and ibuprofen and sent him home. Days later he went to the emergency room, where doctors determined he had blood clots in his leg. Parkwest offered only to connect Tomei with an off-site interpreter via webcam. The connection was so glitchy that Tomei could not effectively communicate. After surgery, Tomei could not tell the medical staff that he was still experiencing pain. Tomei was sent home. Tomei’s family doctor sent him to the University of Tennessee Medical Center, where interpreters helped him through a second surgery. Ultimately, doctors amputated nearly one-third of his leg. About 15 months after he was first denied an interpreter, Tomei sued under section 1557 of the Patient Protection and Affordable Care Act (ACA).The Sixth Circuit rejected an argument that the suit was untimely under Tennessee’s one-year statute of limitations for personal injury suits. Unless federal law provides otherwise, a civil action “arising under” a federal statute enacted after December 1, 1990, is subject to a four-year statute of limitations. 28 U.S.C. 1658(a). Tomei brought his discrimination claim under the ACA—not the Rehabilitation Act. No statute or regulation explicitly sets a statute of limitations for violating the ACA’s discrimination bar. View "Tomei v. Parkwest Medical Center" on Justia Law

On April 4, Debra went to Kentucky’s Manchester Memorial Hospital emergency room where she presented with numbness from the waist down, pain in both legs, with the right leg being worse and cold. On April 19, Debra’s right leg was amputated below the knee at the University of Kentucky Medical Center due to serious clots that restricted blood flow. Debra sued healthcare providers for failing to consider that Debra’s symptoms were caused by vascular issues rather than musculoskeletal abnormalities. The only remaining defendant is the government which was substituted under the Federal Tort Claims Act, 28 U.S.C. 1346, 2671–80, for its employee, Dr. Madden, who examined Debra at the federally-supported health center on April 12.The district court entered judgment in favor of the United States. The Sixth Circuit reversed. The proper framing of the causation inquiry was not whether it would have made a difference as to the ultimate outcome if Dr. Madden had properly diagnosed the condition on April 12 but whether it would have made a difference to Debra’s outcome if Madden had considered the possibility of vascular causes as the source of her symptoms on April 12. The district court declined to resolve a dispute as to whether Debra suffered from ischemia from April 4 to April 13, or whether she suffered sudden ischemia on April 13, after she being seen by Madden. View "Chesnut v. United States" on Justia Law

In 2011-2012, Godofsky was a doctor at a “pill mill,” the Central Kentucky Bariatric and Pain Management clinic. The clinic accepted payment by only cash (later by debit card), at $300 for the first visit and $250 per visit thereafter, and did not give change. The clinic had thousands of dollars in cash on hand every day, so the manager was armed with a handgun and patrolled the clinic with a German Shepherd. The clinic scheduled multiple “patients” at the same time, every 15 minutes, and was often open until after 10:00 p.m. The clinic received hundreds of “patients” per day, many of whom had traveled long distances and waited for hours for a few minutes with a doctor who would then provide a prescription for a large amount of opioids, usually oxycodone. The Sixth Circuit affirmed Godofsky’s conviction for prescribing controlled substances, 21 U.S.C. 841(a), and the below-guidelines 60-month prison term and $500,000 fine, upholding the trial court’s refusal to use a jury instruction titled “Good Faith,” which would have instructed the jurors that his “good intentions” were enough for his acquittal or, rather, that the prosecutor had to prove that he had not personally, subjectively, believed that the oxycodone prescriptions would benefit his patients. View "United States v. Godofsky" on Justia Law

While in federal prison in Ohio, Gallivan had surgery. According to Gallivan, the surgery left him permanently disabled and the Bureau of Prisons was to blame. The Bureau found no evidence that its employees had done anything wrong. Gallivan sued the United States for negligence under the Federal Tort Claims Act (FTCA), 28 U.S.C. 1346(b)(1). The district court believed Ohio Civil Rule 10(D)(2) governed and required a person alleging medical negligence to include a medical professional’s affidavit stating that the claim has merit. Gallivan did not include an affidavit with his complaint; the district court dismissed his case. The Sixth Circuit vacated and remanded. The FTCA expressly requires courts to use the Federal Rules. Federal Rule of Civil Procedure 8(a) requires that a complaint include a short and plain jurisdictional statement, a short and plain statement of the claim, and an explanation of the relief sought. Rule 8 implicitly excludes other requirements that must be satisfied for a complaint to state a claim for relief. Rule 8 does not require litigants to file any affidavits. Nor does Rule 12, which does not demand “evidentiary support” for a claim to be plausible. View "Gallivan v. United States" on Justia Law

Ace, a licensed physician, and Lesa Chaney owned and operated Ace Clinique in Hazard, Kentucky. An anonymous caller told the Kentucky Cabinet for Health and Family Services that Ace pre-signed prescriptions. An investigation revealed that Ace was absent on the day that several prescriptions signed by Ace and dated that day were filled. Clinique employees admitted to using and showed agents pre-signed prescription blanks. Agents obtained warrants to search Clinique and the Chaneys’ home and airplane hangar for evidence of violations of 21 U.S.C. 841(a)(1), knowing or intentional distribution of controlled substances, and 18 U.S.C. 1956(h), conspiracies to commit money laundering. Evidence seized from the hangar and evidence seized from Clinique that dated to before March 2006 were suppressed. The court rejected arguments that the warrants’ enumeration of “patient files” was overly broad and insufficiently particular. During trial, an alternate juror reported some “concerns about how serious[ly] the jury was taking their duty.” The court did not tell counsel about those concerns. After the verdict, the same alternate juror—who did not participate in deliberations—contacted defense counsel; the court conducted an in camera interview, then denied a motion for a new trial. To calculate the sentencing guidelines range, the PSR recommended that every drug Ace prescribed during the relevant time period and every Medicaid billing should be used to calculate drug quantity and loss amount. The court found that 60 percent of the drugs and billings were fraudulent, varied downward from the guidelines-recommended life sentences, and sentenced Ace to 180 months and Lesa to 80 months in custody. The Sixth Circuit affirmed, rejecting challenges to the constitutionality of the warrant that allowed the search of the clinic; the sufficiency of the evidence; and the calculation of the guidelines range and a claim of jury misconduct. View "United States v. Chaney" on Justia Law

Rhinehart, then a prisoner, filed suit under 42 U.S.C. 1983, alleging that medical providers associated with the Michigan Department of Corrections (MDOC) denied him necessary treatment for his end-stage liver disease (ESLD). When he died, his brothers filed an amended complaint on behalf of his estate. The district court granted two doctors summary judgment on their Eighth Amendment claims. The Sixth Circuit affirmed. To establish a prison official’s deliberate indifference to a serious medical need, an inmate must show that the alleged wrongdoing was objectively harmful enough to establish a constitutional violation and that the official acted with a culpable enough state of mind, rising above gross negligence. The Rhineharts failed to establish those elements. View "Rhinehart v. Scutt" on Justia Law

Dr. Paulus, a cardiologist at Ashland, Kentucky’s KDMC, was first in the nation in billing Medicare for angiograms. His annual salary was around $2.5 million, under KDMC’s per-procedure compensation package. In 2008, HHS received an anonymous complaint that Paulus was defrauding Medicare and Medicaid by performing medically unnecessary procedures, 42 U.S.C. 1320c-5(a)(1), 1395y(a)(1), placing stents into arteries that were not blocked, with the encouragement of KDMC. An anti-fraud contractor selected 19 angiograms for an audit and concluded that in seven cases, the blockage was insufficient to warrant a stent. Medicare denied reimbursement for those procedures and continued investigating. A private insurer did its own review and concluded that at least half the stents ordered by Paulus were not medically necessary. The Kentucky Board of Medical Licensure subpoenaed records and concluded that Paulus had diagnosed patients with severe stenosis where none was apparent from the angiograms. Paulus had retired; he voluntarily surrendered his medical license. A jury convicted Paulus on 10 false-statement counts and on the healthcare fraud count. It acquitted him on five false-statement counts. The court set aside the guilty verdicts and granted Paulus a new trial. The Sixth Circuit reversed. The degree of stenosis is a fact capable of proof. A doctor who deliberately inflates the blockage he sees on an angiogram has told a lie; if he does so to bill a more expensive procedure, then he has also committed fraud. View "United States v. Paulus" on Justia Law

During 2012-2013, three undercover DEA agents posed as patients during an investigation into Dr. Zaidi’s controlled substances prescription practices. As a result, the DEA Deputy Administrator suspended Zaidi’s controlled substances prescription privileges, finding that his continued registration posed an imminent danger to the public health and safety, 21 U.S.C. 824(d). DEA agents also seized controlled substances from Zaidi’s offices. Following a hearing, an ALJ recommended that the suspension and seizure be affirmed and that Zaidi's registration be revoked. The Administrator affirmed the suspension and seizure, but found the registration issue was moot due to the expiration of Zaidi’s registration and his decision not to seek renewal. The Sixth Circuit affirmed, rejecting arguments that the ALJ arbitrarily and capriciously denied Zaidi the opportunity to present testimony from an expert, employees, and former patients; there was insufficient evidence to support the suspension; the government failed to make a prima facie showing that Zaidi’s continued registration was inconsistent with the public interest; Zaidi’ prescriptions to the three undercover officers were not outside the usual course of professional practice and did not lack a legitimate medical purpose; Zaidi did not falsify medical records; and the sanction imposed was disproportionately harsh. View "Akhtar-Zaidi v. Drug Enforcement Administration" on Justia Law

Means, 18 weeks pregnant, went into labor. She went to Mercy Health, the only hospital within 30 minutes of her residence. Doctors diagnosed preterm premature rupture of the membrane, which usually results in a stillbirth or the baby's death. Means’s unborn baby still had a heartbeat. Mercy sent her home with pain medication without telling Means that the baby would likely not survive or that continuing her pregnancy could endanger her health. The next morning, Means returned with a fever, excruciating pain, and bleeding. Mercy did not give her additional treatment or options, although Means’s physician suspected she had a serious bacterial infection. Mercy sent her home. Means returned that night with contractions. The baby was delivered and died. The pathology report confirmed that Means had acute bacterial infections. Two years later, a public health educator discovered and inquired into Means’s case. Mercy explained that its Directives (ethical guidelines dictated by Catholic doctrine) prohibited inducing labor or similar action. The limitations period had run out on medical malpractice claims. Means sued the Conference of Catholic Bishops, alleging negligence for promulgating and enforcing the Directives. The Sixth Circuit affirmed dismissal. The only link to the Eastern District, where the case was filed, was the decision of Catholic Health Ministries to adopt the Directives. Each individual defendant lives out of state. Means lives in and Mercy is located in the Western District. Means did not allege that the defendants, by adopting the Directives, caused her any cognizable injury.. View "Means v. United States Conference of Catholic Bishops" on Justia Law

Hawver claims that the Jackson, Michigan, Center for Family Health a federally qualified health center, caused her mother’s death by providing negligent medical care. The Federal Tort Claims Act provides the exclusive remedy for claims against federally qualified health centers such as Family Health, 42 U.S.C. 233. By the time Hawver filed suit, the two-year statute of limitations applicable to claims under the Act had run. The district court dismissed, holding that failure to satisfy the Act’s statute of limitations requirements doubles as a failure to satisfy the subject matter jurisdiction requirements of the federal courts and precludes equitable tolling. After the district court’s decision, the Supreme Court’s 2015 decision, United States v. Kwai Fun Wong, held that the Act’s statute of limitations requirements do not implicate the subject matter jurisdiction of the federal courts and that equitable tolling may save a late claim in some circumstances. The Sixth Circuit remanded to the district court to determine whether equitable tolling saves Hawver’s claim. View "Hawver v. United States" on Justia Law