Articles Posted in Health Law

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A Hospital brought this lawsuit against a TennCare managed care organization (MCO), alleging that the MCO had not paid the Hospital all it was due for emergency services provided to the MCO’s TennCare enrollees. The MCO counterclaimed, seeking recovery of alleged overpayments made pursuant to the TennCare regulations. Thereafter, the MCO filed a motion for partial summary judgment, arguing that the Uniform Administrative Procedures Act (UAPA) required the Hospital to exhaust its administrative remedies by bringing its claims before TennCare prior to filing suit. The trial court agreed and dismissed the Hospital’s complaint and the MCO’s counterclaim for lack of subject matter jurisdiction. The Supreme Court reversed, holding (1) the UAPA requires exhaustion of administrative remedies in this matter to the extent that resolution of the parties’ claims would require the trial court to render a declaratory judgment concerning the validity or applicability of TennCare regulations; but (2) while the UAPA prohibits the trial court from rendering such declaratory relief absent exhaustion of administrative remedies, it does not address claims for damages. Remanded to the trial court with directions to hold the parties’ damage claims in abeyance pending resolution of administrative proceedings regarding the validity or applicability of the TennCare regulations at issue. View "Chattanooga-Hamilton County Hosp. Auth. v. UnitedHealthcare Plan of the River Valley, Inc." on Justia Law

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Plaintiffs filed this action against Defendant, a licensed clinical social worker, alleging negligence, negligence per se, and intentional infliction of emotional distress for providing counseling services for their minor daughter without their consent. Defendant filed a motion to dismiss based on Plaintiffs’ failure to comply with the pre-suit notice and certificate of good faith requirements of the Tennessee Health Care Liability Act (“THCLA”). Plaintiffs responded that their claims were not subject to the THCLA’s procedural requirements because their claims sounded in ordinary negligence. The trial court dismissed all of Plaintiffs’ claims, concluding that the THCLA encompassed Plaintiffs’ claims because they related to the provision of “health care services” by a “health care provider.” The Court of Appeals vacated the trial court’s order and remanded, concluding that the trial court erred by failing to apply the Supreme Court’s analysis in determining if Plaintiffs’ claims sounded in ordinary negligence or health care liability. The Supreme Court reversed the Court of Appeals, holding (1) the Tennessee Civil Justice Act of 2011, which amended the THCLA, statutorily abrogated the Court’s decision in Estate of French; and (2) Plaintiff’s complaint was subject to the THCLA, which required them to provide pre-suit notice and a certificate of good faith. View "Ellithorpe v. Weismark" on Justia Law

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Prentice Delon Hyler sought health care services from Action Chiropractic Clinic, LLC (Plaintiff) after she was injured in an automobile accident. Hyler executed an “Assignment of Rights” to Plaintiff for medical benefits payable to Hyler by Erie Insurance Exchange. Erie was the automobile liability insurance provider for the opposing driver involved in the accident. Erie and Hyler entered into a settlement agreement providing that Erie would pay Hyler $8,510 for claims relating to the accident. Plaintiff sued both Erie and Hyler seeking to recover the $5,010 it was owed from Hyler. The trial court granted Erie’s motion for summary judgment, concluding that the Assignment of Rights was not a valid assignment. The Supreme Court affirmed, holding that the assignment in this case was ineffective. View "Action Chiropractic Clinic, LLC v. Hyler" on Justia Law

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In this health care liability case, Plaintiffs, before filing their health care liability complaint, gave Defendants written notice pursuant to Tenn. Code Ann. 29-26-121(a)(1). Plaintiffs subsequently voluntarily dismissed their case. The next year, Plaintiffs filed a new complaint, raising the same claims against the same defendants. Plaintiffs did not give Defendants pre-suit notice before filing the second action. The trial court dismissed the complaint with prejudice for Plaintiffs’ failure to comply with the notice requirement of section 29-26-121(a)(1). The Court of Appeals reversed, determining that, since the complaints were essentially identical, the statute required only that Defendants be notified once. The Supreme Court reversed and dismissed the action without prejudice, holding (1) section 29-26-121(a)(1) requires that plaintiffs notify prospective defendants of a forthcoming health care liability lawsuit before the filing of each complaint, and the sanction for failure to comply with the statute is dismissal without prejudice; and (2) Plaintiffs in this case failed to provide the required pre-suit notice. View "Foster v. Chiles" on Justia Law

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Three patients, who were injured in unrelated motor vehicle accidents, were all treated at the Regional Medical Center at Memphis (Hospital). In each case, either the patient’s insurance company or TennCare paid the Hospital the full amount of the adjusted charges for their case. However, the Hospital refused to release the lien it had perfected under the Tennessee Hospital Lien Act as it awaited recovery from the third-party tortfeasors the full, unadjusted amount of the hospital lien. The patients filed suit. The trial court dismissed the suit, but the Court of Appeals reversed, determining that the hospital could not maintain its lien because each of the patients’ debts had been extinguished. The Supreme Court affirmed in part and reversed in part, holding (1) except for the unpaid co-pays and deductibles, which are a patient’s responsibility, neither the Act nor the Hospital’s contracts with the patients’ insurance companies authorized the Hospital to maintain its lien after the patients’ insurance company paid the adjusted bill; and (2) one of the patients in this case had not extinguished her debt to the Hospital and was therefore not entitled to have the lien against her extinguished. View "West v. Shelby County Healthcare Corp." on Justia Law

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Plaintiff filed a health care liability action against Defendant-health care providers. Six days before filing his complaint, Defendant sent a pre-suit notice of his potential claim to each Defendant by certified mail, return receipt requested, as permitted by Tenn. Code Ann. 29-26-121(a)(1). Defendants filed a motion to dismiss on the basis that Plaintiff failed to file with his complaint an affidavit of the person who had sent the pre-suit notice by certified mail. The trial court dismissed the complaint. The court of appeals affirmed but noted the harsh results strict compliance produces in cases such as this one where no prejudice is alleged. The Supreme Court reversed and reinstated the complaint, holding (1) the statutory requirement that an affidavit of the person who sent the pre-suit notice by certified mail be filed with the complaint may be satisfied by substantial compliance; and (2) Plaintiff substantially complied with the statute in this case. View "Thurmond v. Mid-Cumberland Infectious Disease Consultants, PLC " on Justia Law

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After Plaintiff filed a health care liability action against Defendant, the General Assembly enacted Tenn. Code Ann. 29-26-121 and -122, which implemented pre-suit notice and certificate of good faith requirements. Plaintiff subsequently dismissed her original action and filed two successive actions. The second action did not comply with sections 29-26-121 and -122, but the third action complied with the statutes. Plaintiff filed a motion to consolidate her second and third actions. Defendant moved to dismiss, arguing that Plaintiff’s second action should be dismissed for failure to comply with the notice and certificate of good faith requirements and that her third action should be dismissed based on the doctrine of prior suit pending. The trial court denied the motions to dismiss. The Supreme Court granted Defendant’s application for extraordinary appeal. During the pendency of the appeal, Plaintiff voluntarily dismissed her second action. The Supreme Court affirmed the judgment of the trial court, holding that Plaintiff’s third complaint was timely filed because Plaintiff properly provided pre-suit notice of her claim prior to filing her third action and was entitled to a 120-day extension in which to refile her complaint. Remanded. View "Cannon ex rel. Good v. Reddy" on Justia Law

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Plaintiff filed a health care liability action against Defendant, a physician. Plaintiff's original complaint was filed prior to the effective date of the pre-suit notice requirements of Tenn. Code Ann. 29-26-121. Plaintiff voluntarily dismissed his original action. Plaintiff subsequently filed his action after the effective date of section 29-26-121. Defendant filed a motion for summary judgment, contending that Plaintiff's second action was barred by the statute of limitations. Plaintiff responded that (1) his pre-suit notice commenced his new action prior to the expiration of the one-year saving statute; and (2) alternatively, section 29-26-121 extended the saving statute by 120 days. The trial court denied the motion, and the court of appeals affirmed. The Supreme Court affirmed, holding (1) Plaintiff's action was commenced by the filing of his second health care liability complaint rather than by providing pre-suit notice; and (2) a plaintiff who files his initial action prior to the effective date of section 29-26-121 dismisses his original action, properly provides pre-suit notice, and refiles his action after the effective date of section 29-26-121 is entitled to the 120-day extension. View "Rajvongs v. Wright" on Justia Law

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Plaintiff filed a healthcare liability suit against several healthcare providers (collectively, Defendants). Defendants moved to dismiss the complaint based on Plaintiff's noncompliance with Tenn. Code Ann. 29-26-121(a)(2)(E), which requires that a plaintiff's pre-suit notice to a healthcare provider include a HIPAA complaint medical authorization in order to permit the healthcare provider to obtain complete medical records from all other providers that are being sent a notice. The trial court denied Defendants' motion, concluding that Plaintiff's noncompliance with section 29-26-121(a)(2)(E) was excused by extraordinary cause. The Supreme Court reversed and dismissed the complaint, holding that Plaintiff was required to substantially comply with section 29-26-121(a)(2)(E), and Plaintiff's failure to comply was not excused by extraordinary cause. View "Stevens ex rel. Stevens v. Hickman Cmty. Health Care Servs., Inc." on Justia Law

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Decedent died following complications that arose when she received anesthesia. Decedent's husband (Plaintiff) filed suit against various health care providers, including Defendant, which contracted with the hospital to provide anesthesia services to its obstetric patients. Plaintiff alleged that Defendant was vicariously liable for the negligent acts of its corporate owner and president, a medical doctor, who was on call the night Decedent received the anesthesia but refused to come to the hospital to administer the anesthesia. Defendant failed to raise the statute of repose as a defense to the vicarious liability claim. After a jury trial, the trial court set aside the verdict for Defendants and granted a new trial. Defendant then moved to amend its answer to assert a repose defense and to dismiss the case based on the statute of repose. The trial court denied Defendant's motions, ruling that Defendant had waived the statute of repose defense. The Supreme Court affirmed, holding that Defendant failed to timely raise the statute of repose as an affirmative defense. View "Pratcher v. Methodist Healthcare Memphis Hosps." on Justia Law