Justia Mississippi Supreme Court Opinion Summaries

Articles Posted in Health Law
by
Methodist Specialty Care Center was the only nursing facility for the severely disabled (NFSD) in Mississippi. NFSDs generally incur higher costs than other nursing facilities, and because of this, Methodist received a percentage adjustment to its new-bed-value (NBV) calculation when the Mississippi Division of Medicaid (DOM) determined how much it should reimburse Methodist for its property costs through the DOM’s fair-rental system. A NBV was intended to reflect what it would cost to put a new bed into service in a nursing facility today. Methodist had received a NBV adjustment of 328.178 percent added to the standard NBV every year since it opened in 2004 until State Plan Amendment (SPA) 15-004 was enacted. During the 2014 Regular Session, the Mississippi Legislature passed House Bill 1275, which authorized the DOM to update and revise several provisions within the State Plan; one such amendment changed Methodist's adjustment rate, and made the facility experience a substantial decrease in its NBV, while all other nursing facilities in the state received increases. Methodist appealed the DOM’s changes to its NBV that were enacted in SPA 15-004. After a hearing, an Administrative Hearing Officer (AHO) upheld the decreased percentage adjustment to Methodist’s NBV, but also determined the DOM had miscalculated Methodist’s NBV adjustment. The DOM had planned to calculate Methodist’s adjustment as 175 percent of the base NBV, but the AHO found that Methodist’s adjusted NBV should be calculated in the same manner as it was calculated preamendment - by taking 175 percent of the standard NBV and adding that value to the standard NBV. Methodist still felt aggrieved because its NBV adjustment rate had not been restored to the preamendment rate. Methodist appealed the DOM’s final decision to the Chancery Court. When the chancellor affirmed the DOM’s final decision, Methodist appealed to the Mississippi Supreme Court. After review, the Supreme Court found the DOM’s final decision was supported by substantial evidence, was not arbitrary or capricious, did not violate Methodist’s constitutional or statutory rights and that the DOM was acting within its power in reaching and adopting its final decision. View "Methodist Specialty Care Center v. Mississippi Division of Medicaid" on Justia Law

by
The Mississippi Division of Medicaid (DOM) appealed a chancery court judgment ordering the DOM to reverse the adjustments for “Legend Drug” costs reported by Windsor Place Nursing Center, Inc., d/b/a Windsor Place Nursing & Rehab Center (Windsor) and Billdora Senior Care, Lexington Manor Senior Care, and Magnolia Senior Care (collectively Senior Care). The chancery court found that legend drug expenses incurred by these providers were properly reported on each of their Long Term Care (LTC) cost reports as an allowable cost and should have been taken into account the by DOM in determining the per diem rates for each provider. The DOM contends that its decision to disallow the legend drug expenses claimed by the providers in their required cost report for reporting years 2005, 2007, and 2008 was supported by substantial evidence, was not arbitrary or capricious, and was within its authority to decide. Therefore, the chancery court’s order must be reversed and the DOM’s decision must be reinstated. The Mississippi Supreme Court agreed with the DOM. "No where in the controlling statutes, the state plan, or Medicaid’s policy do we see language that lends itself to a construction taken by the providers that all prescription drug costs “not covered” by the Medicaid drug program means drug costs 'not paid for' by Medicaid. ... While the DOM may have failed to catch this in the past, legend drugs covered by Medicaid’s Drug Program are subject to direct reimbursement from Medicaid to the dispensing pharmacist, and constitute a non-allowable cost for the provider’s pier diem reimbursement report. And any action taken to the contrary by Medicaid is a violation of its rules and regulations." View "Mississippi Division of Medicaid v. Windsor Place Nursing Center, Inc. et al." on Justia Law

by
The Mississippi State Department of Health entered a final order approving a Certificate of Need for Wound Care Management, LLC, d/b/a MedCentris for the “[p]rovision of [d]igital [s]ubtraction [a]ngiography (DSA) services (Limb Salvage Program).” Vicksburg Healthcare, LLC, d/b/a Merit Health River Region, a hospital in Vicksburg that opposed the certificate of need, appealed the Department’s statutorily affirmed decision pursuant to Mississippi Code Section 41-7-201(2) (Rev. 2018). After considering the record and issues presented, the Mississippi Supreme Court entered an order on its own motion requiring supplemental briefing regarding whether Section 41-7-201(2), as amended, governed the appeal process pertaining to facilities established for the private practice, either independently or by incorporated medical groups of physicians. The Supreme Court held that River Region lacked the right to petition the chancery court for review of the certificate of need under Section 41-7-201(2). Accordingly, the Supreme Court dismissed the case and remanded it to the Hinds County Chancery Court for further proceedings. View "Vicksburg Healthcare, LLC v. Mississippi Dept. of Health & Wound Care Management, LLC" on Justia Law

by
In May, 2015, Spencer Wolfe was being treated for high blood pressure and was prescribed two milligrams of hydralazine two times a day. Some time between May 20, 2015, and May 27, 2015, Wolfe had this prescription filled at Delta Discount Drugs. Delta, however, allegedly mis-filled Wolfe’s prescription with twenty-five milligram tablets of hydroxyzine, rather than the prescribed two milligram tablets of hydralazine. Less than a month later, on June 19, 2015, Wolfe was hospitalized after he had blacked out while driving. The issue this case presented for the Mississippi Supreme Court's review was whether a claim asserted against a pharmacy for allegedly mis-filling a prescription was subject to the two-year professional-malpractice statute of limitations in Mississippi Code Section 15-1-36 or the three-year catch-all statute of limitations in Mississippi Code Section 15-1-49. The Circuit Court ruled that Section 15-1-36 applied to Wolfe’s claims against Delta Discount Drugs and granted Delta’s motion to dismiss with prejudice because Wolfe’s claims were filed beyond the two-year statute of limitations found in Section 15-1- 36. Aggrieved, Wolfe has timely appealed to this Court. After review, and finding no reversible error in that decision, the Supreme Court affirmed. View "Wolfe v. Delta Discount Drugs, Inc." on Justia Law

by
Sixteen-year old Julisa Matute, along with her sister and father, were involved in a motor-vehicle accident in Harrison County, Mississippi. Julisa was transported to Mobile, Alabama, and was admitted to University of South Alabama Medical Center, a hospital operated by University of South Alabama (USA). Julisa died there intestate. Julisa’s mother and sister executed an authorization for the donation of Julisa’s organs with the Alabama Organ Center (AOC). An estate was opened; Julisa’s mother was appointed administratrix of the Estate. Shortly thereafter notice was served to creditors, USA probated a claim against the Estate for medical expenses. The Estate filed a “complaint to contest illegal probated claim and compulsory counterclaim,” alleging that before Julisa’s death, USA representatives approached Julisa’s family and asked that they donate her organs and, in turn, Julisa’s hospital bill incurred at USA would be “totally wiped out and not be collected.” As a result of this alleged agreement, the Estate contested USA’s probated claim and asserted that the “probated claim [wa]s null and void and uncollectable.” In a counterclaim, the Estate alleged emotional distress, fraud, and punitive damages because, according to the Estate, “[t]he hospital told [Julisa’s family] that the bill would be wiped clean for allowing them to have [Julisa’s] organs . . . .” A wrongful-death lawsuit related to the motor-vehicle accident was filed then by the Estate. A settlement was reached among the parties in September 2018. Months later, a hearing was held on USA’s contested probated claim. The chancellor entered a judgment approving the Estate’s Petition to Receive First and Final Accounting, Discharge Administratrix and Close Estate. USA filed a motion to alter or amend the order granting the Estate’s Petition to Approve Settlement of Claims of Wrongful Death Beneficiaries of Julisa, and asserted that the chancellor’s reference to a “hospital lien claim” was erroneous. The chancellor denied the motion. USA timely appealed. The Mississippi Supreme Court determined that while the chancellor properly denied USA's probated claim as uncollectable, the chancellor erred in finding the probated claim was invalid and erroneously ruled on USA's hospital-lien claim. As a result, the chancery court's judgment was affirmed in part, reversed in part, and remanded for further proceedings. View "In the Matter of the Estate of Julisa Matute" on Justia Law

by
Central Mississippi Medical Center (CMMC) appealed a Chancery Court decision denying its appeal of a Division of Medicaid (DOM) hearing. The DOM had determined that CMMC owed it $1.226 million due to overpayment. The Mississippi Supreme Court recently decided a reimbursement dispute involving the DOM, Crossgates River Oaks Hosp. v. Miss. Div. of Medicaid, 240 So. 3d 385 (Miss. 2018). In Crossgates, the hospitals prevailed because the DOM had failed to adhere to the Medicare State Plan Agreement. Applying the same legal principles to this case, the Supreme Court ruled the DOM prevailed because the DOM adhered to the Plan. The chancellor found sufficient evidence to support the DOM’s decision, decreed that it was neither arbitrary nor capricious, and decreed that it did not exceed the DOM’s authority or violate any of CMMC’s statutory or constitutional rights. View "Central Mississippi Medical Center v. Mississippi Division of Medicaid" on Justia Law

by
Mary Thomas awoke, paralyzed, after surgery. She filed a medical malpractice suit against Dr. Adam Lewis, who performed the surgery, claiming her injuries stemmed from two neurosurgeries performed by Dr. Lewis. Thomas also filed suit against Jackson Neurosurgery Clinic and Central Mississippi Medical Center based on vicarious liability. Thomas’s medical malpractice claims were based on an alleged failure of Dr. Lewis to manage Thomas’s mean arterial blood pressure during the first surgery and Dr. Lewis’s decision to perform the second surgery. However, the issue on appeal involved the reliability of expert testimony under Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993). Thomas’s expert, neurosurgeon Dr. Neil Wright, claimed that Dr. Lewis had failed to provide the proper standard of care and, in turn, caused Thomas’s injuries. However, Dr. Lewis argued that Dr. Wright’s opinions were not reliable because they were inconsistent with medical literature. The trial court agreed, struck Dr. Wright’s opinions, and granted partial summary judgment in favor of Dr. Lewis with regard to the first surgery. The trial court also ruled that Dr. Wright could testify to negligence regarding the second surgery. The trial court allowed Thomas to proceed on claims related to the second surgery. Dr. Wright admitted that the decision to perform the second surgery was a judgment call and that he failed to testify that making the decision to proceed with a second surgery was a breach of the standard of care. The trial court considered the evidence and found that Mary Thomas had failed to offer admissible proof from which a reasonable juror could find that Dr. Lewis deviated from a professional standard of care. The trial court directed a verdict in favor of Dr. Lewis, Jackson Neurosurgery Clinic, and Central Mississippi Medical Center, and Thomas appealed. Finding no reversible error, the Mississippi Supreme Court affirmed. View "Thomas v. Lewis" on Justia Law

by
Genesis Hospice LLC provided outpatient hospice care to Medicaid beneficiaries in the Mississippi Delta. Claims Genesis submitted outside the norm, prompting a Mississippi Division of Medicaid audit. A statistical sample of 75 of the 808 billed claims were reviewed, and of that 75, 68 claims were not substantiated by the patients’ records and thus not eligible for payment. The auditing physicians specifically found that the patient records for the 68 rejected claims lacked sufficient documentation to support the given terminal-illness diagnosis and/or lacked documentation of disease progression. Medicaid’s statistician extrapolated that 68 of 75 unsupported claims represented a total overpayment of $1,941,285 for the 808 claims Genesis billed during the relevant time period. And Medicaid demanded Genesis repay this amount. Medicaid’s decision has been affirmed in an administrative appeal before Medicaid and by the Hinds County Chancery Court, sitting as an appellate court. On further appeal to the Mississippi Supreme Court, Genesis essentially argued Medicaid unfairly imposed documentation requirements not found in the federal or state Medicaid regulations. Genesis insisted the only requirement was a physician’s certification that in his or her subjective clinical judgment the patient was terminally ill, which Genesis provided. The Supreme Court found the regulations were clear: a physician’s certification of terminal illness is indeed required, but so is documentation that substantiates the physician’s certification. Because Genesis’ records failed to support 90 percent of its hospice claims, Medicaid had the administrative discretion to demand these unsupported claims be repaid. Therefore, the Supreme Court affirmed. View "Genesis Hospice Care, LLC v. Mississippi Division of Medicaid" on Justia Law

by
Edward and Pattie Hyde brought a medical-negligence case based on loss of chance. Their theory was that the treating physician’s and hospital’s failure to properly test for and timely diagnose Edward’s stroke resulted in his not receiving treatment, namely, an injection of Tissue Plasminogen Activator, (tPA) which they claimed would have led to a better stroke recovery. The trial court dismissed the claim, and the Hydes appealed, asking the Mississippi Supreme Court to abandon long-standing precedent on loss-of-chance. They argued under Mississippi law, they could recover for the "reduced likelihood of a recovery." The Supreme Court was clear “that Mississippi law does not permit recovery of damages because of mere diminishment of the ‘chance of recovery.’” However, the trial court erred in dismissing the Hydes' claim on summary judgment: the Hydes presented expert medical testimony that the majority of stroke patients who timely receive tPA experience substantial improvement. Because their expert supported his opinion with medical literature, the trial judge abused his discretion by excluding this testimony. The Hydes’ expert testimony created a material fact dispute over whether they could recover for loss-of-chance. The Court therefore reversed summary judgment and remanded for further proceedings. View "Hyde v. Martin" on Justia Law

by
Mary Mac Atkinson alleged she was injured after slipping on a liquid substance at Clinton Healthcare. After the parties conducted significant amounts of discovery, Atkinson moved for a spoliation determination, requesting a spoliation jury instruction regarding a missing video, and moved for partial summary judgment as to liability. Clinton Healthcare moved for summary judgment. The trial court granted the motion for spoliation, granted Atkinson’s motion for partial summary judgment, and denied Clinton Healthcare’s motion for summary judgment. The Mississippi Supreme Court determined genuine issues of material fact remained, and the trial court erred by granting Atkinson’s motion for partial summary judgment, but correctly denied Clinton Healthcare’s motion for summary judgment. Additionally, the Supreme Court found the trial court’s order regarding spoliation and the entitlement to a spoliation jury instruction was premature. Therefore, the trial court was affirmed in part, reversed in part, the spoliation order was vacated, and the matter remanded for further proceedings. View "Clinton Healthcare, LLC v. Atkinson" on Justia Law