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  Health Care - Legal News


The Supreme Court on Monday ruled for doctors who face criminal charges for overprescribing powerful pain medication in a case arising from the opioid addiction crisis.

Justice Stephen Breyer wrote for the court that prosecutors must prove that doctors knew they were illegally prescribing powerful pain drugs in violation of the federal Controlled Substances Act.

The ruling came as the U.S. has been seeing record numbers of drug overdose deaths, many from the highly lethal opioid fentanyl.

Evaluating the convictions of two doctors who are each facing more than two decades in prison, the justices ruled on a subject on which advocates for patients and doctors had urged the court to distinguish between criminal behavior and medical errors made in good faith.

It did so in the ruling. Prosecutors, Breyer wrote, “must prove beyond a reasonable doubt that the defendant knowingly or intentionally acted in an unauthorized manner.” The justices ruled unanimously for the doctors, though only six endorsed Breyer’s standard for conviction.

Fear of aggressive prosecution already has led doctors to avoid prescribing opioids “against their best medical judgment,” the National Pain Advocacy Center told the court in a written filing.

But the justices did not throw out the convictions of two doctors whose appeal was heard in February. Instead, it ordered federal appeals courts to take a new look at their cases.

The court ruled on appeals from Xiulu Ruan of Mobile, Alabama, and Shakeel Kahn, who practiced medicine in Ft. Mohave, Arizona, and Casper, Wyoming.

Ruan is serving a 21-year federal prison term. Kahn is in prison for up to 25 years. They will get another chance to argue that their convictions should be overturned.

Ruan and a partner, James Couch, were convicted of overprescribing medications at their Physicians Pain Specialists of Alabama clinic and a pharmacy.

Kahn was convicted of conspiracy to unlawfully distribute and dispense controlled substances resulting in death, including oxycodone, an opioid pain reliever, and fentanyl, a synthetic opioid.

Jessica Burch, of Lake Havasu City, Arizona, was a patient of Kahn’s who died from an overdose in 2015.


Tennessee and South Carolina are joining five other states in extending health care coverage to women with low-to-modest incomes for a full year after childbirth, U.S. Health and Human Services Secretary Xavier Becerra announced on Friday.

The expansion of Medicaid and the Children’s Health Insurance Program comes as the U.S. Supreme Court could be poised to overturn women’s constitutional right to abortion. That could make the coverage more urgently needed than ever if more women, especially older women or those in poorer health, end up carrying pregnancies to term. In Tennessee, a trigger law would outlaw abortion in the state if Roe v. Wade were overturned. South Carolina has a law banning abortions after six weeks.

States are currently required to provide 60 days of coverage after childbirth, but medical experts say women can die from pregnancy-related conditions up to a year after giving birth and that most pregnancy-related deaths are preventable. Maternal mortality is particularly serious for Black women, whose pregnancy-related death rate is three times that of white women.

Asked about the effect of an abortion ban on Tennessee women at a Thursday news conference, Republican Gov. Bill Lee, who opposes abortion, pointed to the extension.

“It’s important that we recognize that women in crisis need support and assistance through this process. For example, that’s why we’ve expanded our postpartum coverage for women in TennCare,” Lee said.

TennCare is Tennessee’s version of Medicaid, the federal-state program covering about one in five Americans, from many newborns, to low-income adults and frail nursing home residents. The program pays for about four out of every 10 births in the United States.

About 700 U.S. women die annually because of pregnancy-related problems, a little over half after the woman has given birth, according to data from the Centers for Disease Control and Prevention. Nearly 12% of maternal deaths occur 43 to 365 days after delivery.

The expanded coverage is made possible by a provision in the COVID-19 relief bill that will expire after five years unless Congress reapproves it or makes it permanent.


A federal appeals court has ruled that Tyson Foods can’t claim it was operating under the direction of the federal government when it tried to keep its processing plants open as the coronavirus spread rapidly within them during the early days of the pandemic.

So the Des Moines Register reports that a lawsuit filed by several families of four workers who died after contracting COVID-19 while working at Tyson’s pork processing plant in Waterloo will be heard in state court. The families allege that Tyson’s actions contributed to the deaths.

Tyson had sought to move the case to federal court because it said federal officials wanted it to keep its plants running. The company cited an executive order former President Donald Trump signed that designated meat processors as essential infrastructure.

“The fact that an entity — such as a meat processor — is subject to pervasive federal regulation alone is not sufficient to confer federal jurisdiction,” Judge Jane Kelly wrote in the decision.

The court also noted that Trump’s order was signed in late April 2020 after many of its workers were infected. More than 1,000 Tyson workers at the Waterloo plant tested positive for the virus that spring and at least six died.

Tyson spokesman Gary Mickelson said the Springdale, Arkansas-based company is disappointed in the court ruling, but he defended the steps Tyson took to keep workers safe during the pandemic.

“We’re saddened by the loss of any of our team members to COVID-19 and are committed to protecting the health and safety of our people,” Mickelson said. “We’ve implemented a host of protective measures in our facilities and in 2021 required all of our U.S. team members to be vaccinated.”


Medical providers and Montana residents with compromised immune systems are challenging a state law that prevents employers from mandating vaccines for employees.

They argue the law passed by the 2021 Legislature violates federal requirements for safe workplaces and reasonable accommodations for people with disabilities, and want a federal judge to rule it doesn’t apply to hospitals and other medical providers.

The Montana Medical Association, private physician groups, a Missoula hospital and seven individuals filed the complaint in U.S. District Court in Missoula on Wednesday.

Montana’s Republican-controlled Legislature passed a law that said requiring vaccines as a condition of employment is discriminatory and violates the state’s human rights laws. Montana is the only state with such a law.

The complaint argues the new law prevents medical providers from taking steps to protect employees and patients who have compromised immune systems and also violates Occupational Safety and Health Act provisions that require employers to provide workplaces free from hazards.

It also argues the law violates the right to a clean and healthful environment under the Montana constitution.

The complaint names Attorney General Austin Knudsen and Commissioner of Labor and Industry Laurie Esau as defendants. Their offices did not immediately respond to requests for comment Thursday.


A federal judge has ordered two men to pay back a total of more than $2.4 million for their role in defrauding a health care insurance provider for low-income people in Maine.

One man also was sentenced to two years in prison on Friday and the other was sentenced to three years of probation. Both had pleaded guilty in 2019.

According to court records, the two were Somali interpreters who conspired with several mental health counseling services in the Lewiston and Auburn areas to submit claims to MaineCare for services that weren’t rendered as billed from 2015 to 2018.

In some cases, one of the men conspired with a counseling center director to change the diagnosis of many clients so they could remain eligible to receive MaineCare reimbursement.

A lawyer for the man sentenced to three years probation said she thought the judge took a thoughtful approach to his sentencing. Unlike other defendants in the case, her client is not an American citizen and may face the possibility of being deported. She said the sentence will allow her client, who didn’t have a criminal record, to spend time with his family and work to support them.


The pending Supreme Court case on the fate of the Affordable Care Act could give the Biden administration its first opportunity to chart a new course in front of the justices.

The health care case, argued a week after the election in November, is one of several matters, along with immigration and a separate case on Medicaid work requirements, where the new administration could take a different position from the Trump administration at the high court.

While a shift would be in line with President Joe Biden’s political preferences, it could prompt consternation at the court. Justices and former officials in Democratic and Republican administrations routinely caution that new administrations should generally be reluctant to change positions before the court.

Justice Elena Kagan, who as solicitor general was the top Supreme Court lawyer for President Barack Obama before he appointed her to the court, said in a 2018 forum that the bar should be high.

“I think changing positions is a really big deal that people should hesitate a long time over, which is not to say that it never happens,” Kagan said at the time. Indeed, Trump’s Justice Department made a switch four times in the first full high court term of the administration.

Still, the health care case is a good candidate for when a rare change of position may be warranted, said Paul Clement, who was solicitor general under President George W. Bush.

The Justice Department defends federal laws at the Supreme Court “whenever reasonable arguments can be made,” Clement said at an online Georgetown University forum.

The Trump administration called on the justices to strike down the entire Obama-era law under which some 23 million people get health insurance and millions more with preexisting health conditions are protected from discrimination.

Biden was vice president when the law was enacted, famously calling it a “big (expletive) deal” the day Obama signed it into law in 2010.


A more conservative Supreme Court appears unwilling to do what Republicans have long desired: kill off the Affordable Care Act, including its key protections for pre-existing health conditions and subsidized insurance premiums that affect tens of millions of Americans.

Meeting remotely a week after the election  and in the midst of a pandemic that has closed their majestic courtroom, the justices on Tuesday took on the latest Republican challenge to the Obama-era health care law, with three appointees of President Donald Trump, an avowed foe of the law, among them.

But at least one of those Trump appointees, Justice Brett Kavanaugh, seemed likely to vote to leave the bulk of the law intact, even if he were to find the law’s now-toothless mandate that everyone obtain health insurance to be unconstitutional.

“It does seem fairly clear that the proper remedy would be to sever the mandate provision and leave the rest of the act in place,” Kavanaugh said.

Chief Justice John Roberts, who wrote two earlier opinions preserving the law, stated similar views, and the court’s three liberal justices are almost certain to vote to uphold the law in its entirety. That presumably would form a majority by joining a decision to cut away only the mandate, which now has no financial penalty attached to it. Congress zeroed out the penalty in 2017, but left the rest of the law untouched.

“I think it’s hard for you to argue that Congress intended the entire act to fall if the mandate were struck down when the same Congress that lowered the penalty to zero did not even try to repeal the rest of the act. I think, frankly, that they wanted the court to do that, but that’s not our job,” Roberts said.

In the court’s third major case over the 10-year-old law, popularly known as “Obamacare,” Republican attorneys general in 18 states and the administration want the entire law to be struck down. That would threaten coverage for more than 23 million people, as well as millions of others with preexisting conditions that now would include COVID-19.

California, leading a group of Democratic-controlled states, and the Democratic-controlled U.S. House of Representatives are urging the court to leave the law in place.

The Supreme Court could have heard the case before the election, but set arguments for a week after. The timing could add a wrinkle to the case since President-elect Joe Biden strongly supports the health care law.

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