Justia Massachusetts Supreme Court Opinion SummariesArticles Posted in Health Law
Atlanticare Medical Center v. Division of Medical Assistance
On appeal from a federal appellate court's decision that the Federal Medicare scheme prohibits State Medicaid agencies, including MassHealth, from receiving funds from Medicare, the Supreme Judicial Court ordered that this case be remanded for modification of the declaratory judgment, holding that MassHealth demonstrated a sufficient change in circumstances to warrant modification to allow MassHealth to seek reimbursement where the liable third party is Medicare.In Atlanticare Medical Center v. Commissioner of the Division of Medical Assistance, 439 Mass. 1, 3, 5 (2003) (Altanticare I), the Supreme Judicial Court concluded that the Federal Medicaid scheme tasked the State Medicaid agency, not individual providers, with seeking reimbursement from liable third-party insurers, including Medicare. When the Center for Medicare & Medicaid Services (CMS) refused to issue reimbursements from Medicare to MassHealth, MassHealth brought suit. In 2011, the United States Court of Appeals for the First Circuit held that the Federal Medicare scheme prohibited MassHealth from receiving funds from Medicare. Therefore, a Federal Medicare regulation was amended to acknowledge the practice of State Medicaid agencies obtaining Medicare reimbursements through providers, rather than seeking such reimbursements directly from Medicare. MassHealth sought to modify the declaratory judgment and restore its ability to obtain reimbursements from providers, rather than liable third parties. The Supreme Judicial Court remanded the case for modification of the judgment, holding that changed circumstances required modification. View "Atlanticare Medical Center v. Division of Medical Assistance" on Justia Law
Massachusetts General Hospital v. C.R.
The Supreme Judicial Court reversed the decision of the Appellate Division dismissing as untimely Massachusetts General Hospital's (MGH) petition seeking to have C.R. committed, holding that the activity governed by Mass. Gen. Laws ch. 123, 12(a) is separate from the three-day involuntary hospitalization period established under Mass. Gen. Laws ch. 123, 12(b).The day after C.R. was admitted to a psychiatric facility but six days after she was initially brought to the emergency department of MGH by police pursuant to section 12(a), MGH filed its petition for commitment pursuant to Mass. Gen. Laws ch. 123, 7 and 8. The Appellate Division of the Boston Municipal Court concluded that MGH's petition was untimely because the three-day window under section 12(b) begins running when the patient is initially restrained under section 12(a). The Supreme Judicial Court reversed, holding (1) the three-day period under section 12(b) is necessary to fully evaluate the patient and was not intended by the Legislature to be shortened by the section 12(a) time period; and (2) as applied to C.R., the statute did not violate due process, as the section 12(a) period of confinement was no longer than necessary under the circumstances of this case. View "Massachusetts General Hospital v. C.R." on Justia Law
Posted in: Health Law
Committee for Public Counsel Services v. Chief Justice of Trial Court
The Supreme Judicial Court held that, due to the crisis caused by the COVID-19 pandemic, pretrial detainees who have not been charged with an excluded offense are entitled to a rebuttable presumption of release on personal recognizance and a hearing within two business days of filing a motion for reconsideration of bail and release.To decrease exposure to COVID-19 within correctional institutions, Petitioners sought the release to the community of as many pretrial detainees and individuals who have been convicted and are serving a sentence of incarceration as possible. The Supreme Judicial Court held (1) the risks inherent in the COVID-19 pandemic constitute a changed circumstance within the meaning of Mass. Gen. Laws ch. 276, 58, tenth paragraph, and the provisions of Mass. Gen. Laws ch. 276, 57; (2) any individual who is not being held without bail under Mass. Gen. Laws ch. 276, 58A and who has not been charged with an excluded offense as set forth in Appendix A to this opinion is entitled to a rebuttable presumption of release; and (3) to afford relief to as many incarcerated individuals as possible, the parole board and Department of Corrections are urged to work with the special master to expedite parole hearings and the issuance of parole permits. View "Committee for Public Counsel Services v. Chief Justice of Trial Court" on Justia Law
Buckman v. Commissioner of Correction
The Supreme Judicial Court answered questions reported by a single justice upon Petitioners' petition pursuant to Mass. Gen. Laws ch. 249, 4 asserting claims for mandamus, injunctive, and declaratory relief after the superintendent for each petitioner refused to review Petitioners' petitions for medical parole as submitted regardless of the superintendent's view as to the completeness or adequacy of the petition.Specifically, the Court answered that, when a prisoner submits a written petition for medical parole, the superintendent or sheriff of the facility where the prisoner is incarcerated must consider the petition even if the superintendent or sheriff does not consider the petition complete or adequate. Further, the superintendent or sheriff bears the burden of preparing or procuring a medical parole plan and recommendation as to the release of the prisoner. Lastly, the commissioner, on receipt of the petition and recommendation, is required to provide the prisoner with all supporting documents submitted by the superintendent or sheriff with the recommendation. View "Buckman v. Commissioner of Correction" on Justia Law
Commonwealth v. Stirlacci
In this case involving the indictments of Dr. Frank Stirlacci and his office manager, Jessica Miller, for violations of the Controlled Substances Act and for submitting false health care claims to insurance providers, the Supreme Judicial Court affirmed in part and reversed in part the superior court's judgment dismissing several of the indictments, holding that there was sufficient evidence to indict Shirlacci on twenty-six counts of improper prescribing and to indict both defendants on twenty of the twenty-two counts of submitting false health care claims.The charges against Defendants included twenty-six counts each of improper prescribing, twenty counts each of uttering a false prescription, and twenty-two charges each of submitting a false health care claim. The trial judge dismissed the indictments for improper prescribing and uttering false prescriptions and dismissed six of the indictments against each defendant for submitting false health care claims. The Supreme Judicial Court reversed in part, holding (1) the evidence was sufficient to indict Stirlacci on all counts of improper prescribing, but Miller's status as a nonpractitioner precluded her indictment on improper prescribing; (2) there was insufficient evidence to indict either defendant for uttering false prescriptions; and (3) there was sufficient evidence to indict both defendants on twenty counts of submitting false health care claims. View "Commonwealth v. Stirlacci" on Justia Law
Ryan v. Mary Ann Morse Healthcare Corp.
The Supreme Judicial Court reversed the decision of the trial court dismissing this case alleging that a Massachusetts assisted living residence's (ALR) charge to new residents of an upfront "community fee" violated the security deposit statute, Mass. Gen. Laws ch. 186, 15B, holding that if an ALR charges upfront fees that are not used to fund distinct assisted living services, it does so in violation of section 15B.Plaintiff alleged that the community fee, which was intended to cover upfront administrative costs, move-in assistance, an initial service coordination plan, and a replacement reserve for building improvements, violated section 15B because it exceeded the upfront costs allowed by the statute. Defendant filed a motion to dismiss, arguing that ALRs are not subject to section 15B. The trial court granted the motion to dismiss. The Supreme Judicial Court remanded this case, holding (1) ALRs may institute upfront charges beyond those permitted by Mass. Gen. Laws ch. 186, 15B(1)(b) to the extent those charges correspondent to the distinct services enumerated in Mass. Gen. Laws ch. 19D, 13 or to other services specifically designed for ALRs; and (2) further factual development was required to determine whether the fee at issue here was permissibly charged and used for services distinct to ALRs. View "Ryan v. Mary Ann Morse Healthcare Corp." on Justia Law
Pembroke Hospital v. D.L.
In this case involving involuntary civil commitment due to mental illness, the Supreme Court held that an individual may not be said to have been "discharged" from a facility within the meaning of Mass. Gen. Laws ch. 123 if his iberty has not been restored.D.L. was held involuntarily at Pembroke Hospital on a temporary basis due to mental illness. When Pembroke's petition to extend D.L.'s confinement was denied, Pembroke purportedly "discharged" D.L. but also detained and transported him without his permission to a second hospital for another mental health evaluation. This evaluation led to an order for involuntary confinement. The Appellate Division found that there was no abuse of the involuntary commitment procedure under Mass. Gen. Laws ch. 123, 12. The Supreme Court disagreed, holding that Pembroke violated chapter 123 by failing to discharge D.L. after the denial of its petition to continue D.L.'s confinement. View "Pembroke Hospital v. D.L." on Justia Law
Posted in: Health Law
In re M.C.
The Supreme Judicial Court affirmed the judgment of a municipal court judge civilly committing M.C. for a period of two months, holding that the record contained sufficient evidence to support M.C.’s involuntary commitment and that M.C. was not denied due process of law despite the hearing being conducted at a hospital rather than at a court house and in the absence of a complete, verbatim transcript.Although M.C. sought to have the civil commitment hearing conducted at a court house, the hearing was held at the psychiatric facility where M.C. had been temporarily committed. At the beginning of the proceeding the court-owned recording equipment malfunctioned, and then two different alternate recording devices were used to record the remainder of the hearing. The Supreme Judicial Court affirmed the judge’s decision to civilly commit M.C., holding that the available transcript provided an adequate basis for appellate review and contained sufficient evidence to support M.C.’s involuntary commitment. View "In re M.C." on Justia Law
Correa v. Schoeck
A pharmacy has a limited legal duty to take reasonable steps to notify a patient and his or her prescribing physician of the need for prior authorization each time the patient tries to fill a prescription.Only the pharmacy, and not the physician or the patient, is notified by a health insurer when a prescribing physician must complete a prior authorization form and submit it to the insurer. In this case, prior authorization was necessary for Yarushka Rivera to obtain insurance coverage for Topamax, a medication she needed to control life-threatening seizures. When Rivera reached age nineteen, her insurer refused to pay for the prescription because it had not received the necessary prior authorization form. Rivera, who was unable to afford the medication without insurance, suffered a fatal seizure at the age of nineteen. Plaintiff brought this action for wrongful death and punitive damages against Walgreen Eastern Co., Inc. The superior court concluded that Walgreens had no legal duty to Rivera to notify Rivera’s prescribing physician of the need for prior authorization. The Supreme Court reversed, holding that Walgreens owed a legal duty of care to take reasonable steps to notify Rivera and her prescribing physician of the need for prior authorization each time Rivera tried to fill her prescription. View "Correa v. Schoeck" on Justia Law
In re F.C.
The Appellate Division erred in summarily dismissing F.C.’s appeal from a terminated commitment and treatment order as moot in reliance on Matter of N.L., 476 Mass. 632, 633 (2017).Following F.C.’s involuntary hospitalization, McLean Hospital filed a petition for F.C.'s commitment. F.C. was involuntarily committed and treated after a hearing. F.C. appealed, and his appeal was staying pending the decision in Matter of N.L. As the appeal was pending, F.C. was discharged from the facility. Citing Matter of N.L., the Appellate Division summarily dismissed the appeal as moot. The Supreme Judicial Court vacated the Appellate Division’s order and remanded for determination of the appeal on its merits, holding that appeals from expired or terminated commitment and treatment orders under Mass. Gen. Laws ch. 123, 7, 8, and 8B should not be dismissed as moot where the parties have a continuing interest in the case. View "In re F.C." on Justia Law