Health Law Cases Outline
Health law encompasses a wide variety of topics, including provider duties, professional regulation, the business of health, and individual health rights, protections, and freedoms. Many federal, state, and local laws and regulations govern the healthcare industry, but courts also play a role in establishing and interpreting rights and responsibilities. Constitutional questions sometimes arise, such as privacy and autonomy rights. Health law also mixes with tort law in instances such as medical malpractice and products liability. Below is an outline of key cases in health law with links to the full text of virtually every case, provided free by Justia.
The Duty to Treat
A provider’s duty to treat patients has evolved over time with the implementation of certain statutes and regulations. For example, the Emergency Medical Treatment and Active Labor Act (EMTALA) requires that hospitals with Medicare agreements treat anyone seeking treatment in an emergency room by providing an appropriate screening and stabilizing or transferring emergency patients.
Hurley v. Eddingfield 一 Doctors have no duty to treat patients unless they undertake that duty.
Childs v. Weis 一 A doctor does not have a duty to treat an individual, even in an urgent situation, if there is no doctor-patient relationship.
Ricks v. Budge 一 Once a doctor-patient relationship has been established, the doctor’s duty to treat the patient lasts for the duration of the case giving rise to the relationship, unless the duty has been terminated earlier by the patient’s discharge of the doctor or the doctor’s withdrawal after reasonable notice.
White v. Harris 一 The cessation of doctor-patient contact does not terminate the doctor’s responsibility for a breach of the duty to provide services consistent with the applicable standard of care.
Campbell v. Mincey 一 Generally, hospitals with emergency rooms have no common law duty to accept, treat, and admit every individual seeking care. Furthermore, a hospital policy requiring that local physicians authorize admission unless there is a true emergency is reasonably related to a legitimate state objective.
Wilmington General Hospital v. Manlove 一 A hospital that holds itself out as providing emergency care must treat patients in unmistakable emergencies.
Burditt v. U.S. Dep’t of Health & Human Services 一 Under the Emergency Medical Treatment and Active Labor Act (EMTALA), hospitals with Medicare provider agreements with the federal government must treat everyone who enters their emergency rooms by appropriately screening them for emergency conditions and, if they have an emergency condition, appropriately transferring or treating them.
Baber v. Hospital Corporation of America 一 Patients may only bring suit for an EMTALA violation against a hospital, rather than a physician. Patients may bring suit for harm directly resulting from a hospital’s failure to appropriately screen, stabilize, or transfer the patient. Medical facilities may bring suit for improper transfers of emergency patients or women in active labor. Furthermore, EMTALA only requires that hospitals apply their standard screening procedure for emergency conditions to all patients uniformly and does not require that the screening satisfy a national standard of care.
Moses v. Providence Hospital and Medical Centers, Inc. 一 Any individual who suffers harm as a direct result of an EMTALA violation may sue, including a non-patient. However, the individual may only sue a hospital; EMTALA does not confer a private right of action against individual physicians. Furthermore, discharging a patient from a facility may count as a transfer for the purpose of EMTALA’s stabilization requirement.
Bryan v. Rectors and Visitors of the University of Virginia 一 EMTALA does not preempt state medical malpractice law. EMTALA’s stabilization requirement only applies to the hospital’s actions in the immediate aftermath of admitting the patient for treatment while it decides what to do next.
Bryant v. Adventist Health System/West 一 A hospital may not be liable under EMTALA merely because it failed to detect an emergency medical condition. Furthermore, EMTALA’s stabilization requirement generally ends once a hospital admits an individual for inpatient care.
Provider Malpractice and Liability
Healthcare providers are commonly sued for their negligent acts or omissions under a theory of medical malpractice. In addition to the breach of a general duty of care, liability may arise through contract or through vicarious liability. Hospitals have duties separate from physicians’ duties to ensure patient safety.
Hall v. Hilbun 一 The appropriate standard of care against which to judge a doctor’s duty is a national standard, rather than a local standard.
Conn v. U.S. 一 Clinical practice guidelines alone do not establish the standard of care in a medical malpractice suit.
Helling v. Carey 一 A physician may still be liable even if their actions conform to the standard of the profession. (Helling is not a popular opinion.)
Brook v. St. John’s Hickey Memorial Hospital 一 A physician is presumed to have the knowledge and skill necessary to employ some innovation to fit the circumstances of a particular case, and not all innovation will be considered a medical experiment.
Richardson v. Miller 一 Evidence of off-label use of a drug, introduced with other expert evidence on the standard of care, may be relevant to determining whether the drug presented an unacceptable risk to the patient.
Arroyo v. U.S. 一 A claim accrues under the Federal Tort Claims Act when the plaintiff discovers or reasonably should have discovered that their injury could be attributed to the government; mere knowledge of a potential government cause is enough to begin the clock.
Tunkl v. Regents of University of California 一 A hospital liability release in its admission form is void as against public policy.
Shorter v. Drury 一 A hospital liability release for undesirable results due to a patient’s refusal of a certain treatment may be valid.
Marsh v. Arnot Ogden Medical Center 一 Punitive damages in a medical malpractice case may be appropriate when a defendant’s conduct showed a reckless indifference equivalent to willful or intentional misdoing or a wanton and reckless disregard of a plaintiff’s rights.
Herskovits v. Group Health Cooperative of Puget Sound 一 Causation in a wrongful death action based on medical malpractice does not require that the plaintiff prove that the victim would have been more likely than not to survive if not for the malpractice. A negligent defendant may be held liable for a substantial reduction in the victim’s chance of survival directly caused by the negligence.
Ostrowski v. Azzara 一 A patient’s pre-treatment health habits will not bar recovery for medical malpractice.
Wickline v. State of California 一 A healthcare payor cannot be held liable for the negligent discharge of a patient when it is the treating physician’s responsibility to decide when to discharge the patient.
Kaplan v. Mayo Clinic 一 Expert testimony is not necessary to support a breach-of-contract claim against a physician for failing to perform a promised procedure.
Grimes v. Kennedy Krieger Institute, Inc. 一 Informed consent agreements may create a contract, and the relationship between researcher and subject in non-therapeutic research projects may give rise to legal duties.
Scott v. SSM Healthcare St. Louis 一 Hospitals may be liable for a doctor’s actions if there is a principal-agent relationship, even though doctors exercise independent medical judgment.
Burless v. West Virginia University Hospitals, Inc. 一 Hospitals may be vicariously liable for a doctor’s negligence because of an apparent agency relationship, even if the doctor is an independent contractor.
Washington v. Washington Hospital Center 一 A hospital may be liable for its own deviation from the applicable standard of care if this caused a plaintiff’s injury.
Darling v. Charleston Community Memorial Hospital 一 A hospital has an independent obligation to supervise and review the care provided by its staff.
Thompson v. Nason Hospital 一 A hospital may be liable for negligence if it had actual or constructive knowledge of the defect or procedures that caused the harm, and its negligence was a substantial factor in bringing about the harm.
Muse v. Charter Hosp. of Winston-Salem, Inc. 一 A hospital policy of discharging patients when their insurance expires is a clear breach of the duty not to institute policies or practices that interfere with a doctor’s exercise of medical judgment.
Informed Consent
Informed consent is a patient’s right to receive all material information necessary to make an informed decision before accepting or rejecting a physician’s recommended treatment. Physicians may be liable for failing to disclose such material information.
Canterbury v. Spence 一 A physician has a duty to reasonably disclose any material information necessary for the patient to make an informed decision. Information is material if a reasonable person, considering what the physician knows or should know about their patient’s position, would likely find the information significant in deciding whether to submit to the treatment.
Culbertson v. Mernitz 一 A physician has a duty to disclose any information that a reasonably prudent physician in their situation would disclose.
Arato v. Avedon 一 Material information necessary for a patient to make an informed decision does not necessarily include statistical life expectancy or other possibilities that may affect a patient’s non-medical interests and rights.
Moore v. Regents of the University of California 一 A physician’s failure to disclose their personal research or economic interests that may affect their professional judgment may be the basis for a cause of action for failing to obtain informed consent or breach of fiduciary duty.
Confidentiality and HIPAA
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that protects patients’ sensitive health information from disclosure without consent or notice. It applies to covered entities such as healthcare providers and health plans. Covered entities may disclose protected health information without authorization in limited situations.
Humphers v. First Interstate Bank of Oregon 一 A doctor has a duty to keep medical and related information about a patient confidential.
Doe v. Marselle 一 A willful violation of Connecticut’s AIDS confidentiality law requires only a knowing disclosure, rather than a disclosure intended to injure.
Yath v. Fairview Clinics, N.P. 一 Posting private medical information on social media satisfies the publicity element of an invasion-of-privacy claim. Furthermore, a state statute giving patients a private right of action for improper disclosure of their medical information is not preempted by HIPAA.
End of Life Care
Patients generally have the right to make their own health decisions, including the decision to refuse medical treatment. However, the issue becomes more complicated when the individual cannot express their own wishes.
Bouvia v. Superior Court 一 A patient has the right to refuse any treatment, even treatment that may prolong their life.
Public Health Trust of Dade County v. Wons 一 A competent adult may refuse a blood transfusion because of their religious beliefs, even if without it they may die.
Cruzan v. Director, Missouri Dep’t of Health 一 A state may require clear and convincing evidence of an incompetent individual’s desire to withdraw life-sustaining treatment before the family may terminate life support for that individual.
Guardianship of Schiavo 一 An individual’s life support may be terminated so long as there is clear and convincing evidence of such a desire, even if there is conflicting or inconsistent evidence.
Betancourt v. Trinitas Hospital 一 Determining the medical treatment that should be provided to incompetent or dying patients is a matter of substantial public importance and is a matter capable of evading judicial review, but unique circumstances may render such a case moot when the patient dies.
Gonzales v. Oregon 一 Even if a drug falls within the Controlled Substances Act, a doctor can prescribe it for a patient if it is allowed in the context of assisted suicide for terminally ill individuals under state law.
Baxter v. Montana 一 There is no Montana precedent or statute indicating that physician-assisted suicide is against public policy.
Washington v. Glucksberg 一 A state law banning physician-assisted suicide does not violate the Due Process Clause.
Drug Regulation
Both federal and state laws regulate the prescription, sale, and use of drugs. The U.S. Food and Drug Administration (FDA) reviews, approves, and regulates prescription drugs, among other things, to protect and promote public safety.
Abigail Alliance v. von Eschenbach 一 Terminally ill patients do not have a constitutional right to access experimental drugs not approved by the FDA.
Gonzales v. Raich 一 State laws permitting the medical use of marijuana do not prevent Congress from prohibiting its use for any purpose in those states under the Commerce Clause.
Conant v. Walters 一 The First Amendment protects a doctor’s right to recommend medical marijuana.
Products Liability and Preemption
Traditional tort law provides remedies for individuals injured by products in cases of manufacturing defects, design defects, or failures to warn. However, the Medical Device Amendments to the Food, Drug, and Cosmetic Act expressly preempt some state law claims for FDA-approved drugs.
Riegel v. Medtronic, Inc. 一 The Medical Device Amendments to the Food, Drug, and Cosmetic Act preempt state common-law claims challenging the safety or effectiveness of medical devices marketed in a form that received pre-market approval from the FDA.
Wyeth v. Levine 一 State tort law claims, such as failure-to-warn claims, are not preempted by the FDCA with regard to prescription drugs, but they are an additional level of safeguards for consumers that complements the goals of the FDA.
PLIVA, Inc. v. Mensing 一 Failure-to-warn claims based on generic drugs are preempted by the FDA’s interpretation of federal drug regulations.
Mutual Pharmaceutical Co. v. Bartlett 一 Design defect claims based on generic drugs are preempted by federal law.
Dolin v. GlaxoSmithKline LLC 一 A failure-to-warn claim may be preempted when there is such a conflict between state and federal law that it is impossible to obey both.
Public Health
Public health concerns organized efforts to prevent disease and promote the health of society at large. Legal analyses of public health issues attempt to balance individuals’ right to privacy and autonomy with the interests of the community as a whole.
Jacobson v. Massachusetts 一 A state may enact a compulsory vaccination law, since the legislature has the discretion to decide whether vaccination is the best way to prevent smallpox and protect public health. The legislature may exempt children from the law without violating the equal protection rights of adults if the law applies equally among adults.
Zucht v. King 一 City ordinances that require that students be vaccinated to attend school and that vest broad discretion in health authorities to determine when and under which circumstances such a requirement will be enforced do not violate the Fourteenth Amendment.
Employment Division v. Smith 一 A law prohibiting certain drug use is constitutional under the Free Exercise Clause if it is facially neutral and generally applied.
Prince v. Massachusetts 一 The government may restrict parental authority in the interests of child health and welfare.
City of Newark v. J.S. 一 A state may have the authority to involuntarily commit a person with tuberculosis, a communicable disease, to a hospital so long as it adheres to the standards and procedures applicable to involuntary civil commitments and applies the least restrictive means possible.
Whalen v. Roe 一 Requiring healthcare providers to store the private information of patients who receive prescriptions for drugs that can be illegally abused is permissible, despite the privacy rights of the patients.
Coverage, Regulation, and ERISA
Most people with health insurance in the U.S. receive it through an employer. The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law designed to protect individuals covered by voluntarily established health plans in private industry. State laws may provide other protections, so long as they are not preempted by ERISA.
Katskee v. Blue Cross/Blue Shield of Nebraska 一 Ambiguities in a health insurance policy are interpreted in favor of the insured.
Jordan v. Group Health Ass’n 一 Group health plans are not insurance providers if their principal purpose is to provide a service, rather than to indemnify by assuming a risk of loss.
Rush Prudential HMO, Inc. v. Moran 一 Health maintenance organizations (HMOs) may be insurers and thus subject to state regulation of insurers. State laws directed toward the insurance industry are saved from preemption under ERISA’s saving clause.
Hughes v. Blue Cross of Northern California 一 An insurer may be liable for failing to make a good faith effort to obtain all relevant records before denying that care was medically necessary. Furthermore, an insurer’s determination of which care is medically necessary must not significantly stray from community medical standards.
Aetna Health Inc. v. Davila 一 ERISA prevents individuals from suing HMOs in state court for pure eligibility decisions.
Pegram v. Herdrich 一 Mixed treatment and coverage eligibility determinations made by HMOs through physicians are not fiduciary acts subject to ERISA liability.
Retail Industry Leaders v. Fielder 一 A state law that effectively requires employers to structure their employee healthcare plans in a certain way is preempted by ERISA.
Golden Gate Restaurant Ass’n v. City and County of SF 一 An ordinance that requires that employers spend a certain amount on health care, but that does not effectively mandate that employers structure their healthcare plans to provide a certain level of benefits, is not preempted by ERISA.
Potvin v. Metropolitan Life Ins. Co. 一 If an insurer has so much power over the industry that they could impair a physician’s ability to practice, they must only remove physicians from their preferred provider list on a substantively rational and procedurally fair basis.
National Federation of Independent Business v. Sebelius 一 The individual health insurance mandate under the Affordable Care Act was a permissible use of Congress’ taxing power, but the way in which the ACA conditioned all Medicaid funding on states’ compliance with a significant expansion was not a valid use of Congress’ spending power.
King v. Burwell 一 Congress intended the tax credits authorized under the Affordable Care Act to be available through both state and federal exchanges.
Burwell v. Hobby Lobby Stores, Inc. 一 The Religious Freedom Restoration Act (RFRA) permits a closely held for-profit corporation to deny its employees the health coverage of contraceptives to which the employees are otherwise entitled by the federal Patient Protection and Affordable Care Act, based on the religious objections of the corporation’s owners.
Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania 一 The Department of Health and Human Services may promulgate exemptions to the ACA to allow for-profit organizations to exempt themselves from the contraceptive coverage requirement based on religious or moral grounds.
Medicaid and Medicare
Medicaid is a federal and state program that provides healthcare coverage for individuals with limited income. Medicare is a similar federal program that provides healthcare coverage for individuals 65 and older and individuals with certain disabilities. Medicaid and Medicare laws protect both individual patients and providers.
Orthopaedic Hospital v. Belshe 一 State Medicaid reimbursement rates must be reasonably related to what the services actually cost hospitals to efficiently and economically provide quality care unless the deviation can be justified.
Methodist Hospitals, Inc. v. Sullivan 一 State Medicaid reimbursement rates must not be so low that they lead to lower access to care in comparison to that of the general population in that area. Providers may have a private right of action to enforce this standard. However, there is no requirement that a state conduct studies before modifying reimbursement rates.
In re The Estate of Michael Patrick Smith v. Heckler 一 The Secretary of Health and Human Services has a duty under the Medicaid Act to establish a system to continue to be adequately informed of whether facilities receiving federal funding are complying with the requirements of the Act, including providing high-quality patient care.
Fairfax Nursing Home, Inc. v. U.S. Dep’t of Health & Human Services 一 The upper range of civil monetary penalties for failing to comply with Medicare regulations may be imposed when deficiencies have caused or are likely to cause serious injury, harm, impairment, or death to a nursing home resident.
Westside Mothers v. Haveman 一 Individuals may have a private right of action under Section 1983 for alleged non-compliance with Medicaid screening and treatment provisions.
Fraud and Abuse
Providers may be liable for fraud and abuse when they act deceptively or improperly to increase their profits, such as when they bill for services not rendered, order unnecessary treatment, or accept kickbacks for referrals.
U.S. v. Krizek 一 Liability under the False Claims Act may arise when claims are submitted with reckless disregard for the truth.
U.S. ex rel. Mikes v. Straus 一 Implied false certification under the False Claims Act is only appropriate when the underlying statute or regulation expressly conditions payment on compliance.
U.S. v. Greber 一 It is illegal to pay a referring physician to encourage future referrals, even if the payment was to compensate for services.
U.S. ex rel. Drakeford v. Tuomey 一 Under the Stark Law, a physician may not make referrals to entities that pay the physician aggregate compensation that takes into account the volume or value of referrals or business that the physician generates for the entity. Subsequently, a hospital may not submit Medicare reimbursement claims for services rendered pursuant to this type of referral.
Licensing
States regulate the medical profession by imposing licensing requirements on physicians and empowering medical boards to review and discipline physicians and other actors according to the rules and regulations of the profession.
Modi v. W. Va. Board of Medicine 一 A medical board may not reject proposed findings without providing a precise and explicit statement of facts and reasoning.
In re Williams 一 A medical board need not present expert testimony in every case against a physician, but it must use reliable, probative, and substantial evidence to support the charge, rather than its own opinions.
In re Guess 一 A showing of actual harm to a patient or the public is not required to revoke a physician’s license to practice medicine.
State v. Miller 一 Whether an individual engaged in the practice of medicine may be subject to broad interpretation.
Sermchief v. Gonzales 一 Nurses may engage in certain medical practices without engaging in the unauthorized practice of medicine.
Lange-Kessler v. Dep’t of Educ. of State of NY 一 A state law prescribing that midwives must be licensed and must have a practice agreement with a physician or hospital providing obstetric services is rationally related to a legitimate state interest. Furthermore, the right to privacy does not include the right to choose a direct-entry midwife.
Berlin v. Sarah Bush Lincoln Health Center 一 The corporate practice of medicine doctrine does not apply to licensed hospitals practicing medicine through a staff of licensed physicians.
Antitrust and the Business of Health
Antitrust law seeks to preserve competition and choice by prohibiting anti-competitive behavior. Some actions are per se illegal, but when an activity is not per se illegal, it may violate antitrust principles if it is a suspect action with no valid pro-competitive justification. Hospitals are also regulated in how they pay taxes and how they may be sold.
Arizona v. Maricopa County Medical Society 一 Maximum fee agreements between medical societies and member doctors are per se illegal as price-fixing agreements under Section 1 of the Sherman Act.
North Carolina State Bd. of Dental Examiners v. FTC 一 State-action antitrust immunity does not apply to a state board that places restraints on an occupation when a majority of its decision-makers, elected by others in the occupation, are active market participants in the occupation, and the state does not actively supervise the board, nor has the board acted pursuant to a clearly articulated and affirmatively expressed state policy.
Teladoc, Inc. v. Texas Medical Board 一 State-action immunity is an affirmative defense that the defendant bears the burden of proving.
FTC v. Actavis, Inc. 一 Reverse payment settlement agreements are not per se illegal but should be analyzed according to the rule of reason.
King Drug Co. of Florence v. Smithkline Beecham Corp. 一 No-authorized generic agreements are subject to antitrust scrutiny as in FTC v. Actavis.
AHS Hosp. Corp. v. Town of Morristown, Corp. 一 For a hospital’s property to qualify for a property tax exemption, it must be owned by an entity organized exclusively for a tax-exempt purpose, all the property must be actually used for the tax-exempt purpose, and the hospital’s operation and use of the property must not be conducted for profit.
Provena Covenant Medical Center v. Dep’t of Revenue 一 A medical institution will only qualify for a property tax exemption if it receives sufficient revenue from its charitable care.
Manhattan Eye, Ear & Throat Hosp. v. Spitzer 一 In order to sell a non-profit hospital, the terms of the transaction must be fair and reasonable, and the purposes of the corporation must be promoted by the sale.
This outline has been compiled by the Justia team for solely educational purposes and should not be treated as an independent source of legal authority or a summary of the current state of the law. Students should use this outline as a supplement rather than a substitute for course-specific outlines.
