Justia U.S. 5th Circuit Court of Appeals Opinion Summaries

Delek petitions for review of OSHA citations for violations of its process safety management rules, which govern an employer’s responsibility to inspect, and to develop inspection and recording regimes for, machinery that handles large volumes of hazardous chemicals. Item 4 alleges a failure to resolve open findings and recommendations identified during process hazard analyses that occurred in 1994, 1998, 1999, 2004, and 2005—prior to Delek purchasing and taking possession of the refinery. Item 8 alleges an inadequate monitoring and inspection regime for certain equipment involved in process safety management. Item 12 alleges that Delek failed to determine and document a response to the findings of a 2005 compliance audit in a timely manner. Item 12 was also conducted before Delek took possession of the refinery. The court concluded that citations for Items 4 and 12 are barred by the six-month statute of limitations in 29 U.S.C. 658(c). Accordingly, the court vacated those items. The court also concluded that the regulations relevant to the citation for Item 8 are ambiguous and the Secretary's interpretation is reasonable. The court affirmed the citation for Item 8. View "Delek Refining, Ltd. v. OSHC" on Justia Law

West Texas LTC Partners, Inc., doing business as Cedar Manor Nursing & Rehabilitation Center ("Cedar Manor"), appealed a Departmental Appeals Board ("DAB") of the U.S. Department of Health and Human Services ("HHS") decision. In 2013, Cedar Manor was surveyed by the Texas Department of Aging and Disability Services ("DADS"). The surveyor found Cedar Manor out of compliance with three regulations after observing the care provided to two wheelchair-bound residents, Resident #1 and Resident #4. Early the next year, DADS found additional violations of several regulations. The surveys were conducted by a designated state agency on behalf of the Centers for Medicare & Medicaid Services ("CMS") of HHS. The findings were reviewed by CMS, and civil money penalties ("CMPs") or other remedies may be imposed by the Secretary of HHS if the facility was found noncompliant. For the two sets of violations, CMS recommended two CMPs: $6,050 per day for three days, and $350 per day for forty-two days, to run consecutively from the end of an "immediate hazard" penalty. Cedar Manor appealed the findings and CMPs and requested a hearing before an administrative law judge ("ALJ"). CMS moved for summary judgment on all of the violations after the briefing and evidence were submitted. The ALJ granted summary judgment and upheld the CMPs. On de novo review, the DAB affirmed. The Fifth Circuit found that the DAB decision was neither arbitrary and capricious nor unsupported by substantial evidence, it denied Cedar Manor's petition for review. View "West Texas LTC Partners, Inc. v. Dept. of Health & Hum. Svcs." on Justia Law

In response to secretly recorded videos released by the Center for Medical Progress depicting conversations with Planned Parenthood employees elsewhere, LDHH terminated PPGC Louisiana Medicaid provider agreements. PPGC and the Individual Plaintiffs filed suit against LDHH under 42 U.S.C. 1983, alleging violations of 42 U.S.C. 1396a(a)(23) and the First and Fourteenth Amendments of the U.S. Constitution. The Individual Plaintiffs, three women who are Medicaid beneficiaries and who receive medical care from one of PPGC’s Louisiana facilities, seek to continue receiving care from PPGC’s facilities. The Individual Plaintiffs contend that LDHH’s termination action will deprive them of access to the qualified and willing provider of their choice, PPGC, in violation of Medicaid’s free-choice-of-provider provision. The district court entered a preliminary injunction against LDHH’s termination of PPGC’s Medicaid provider agreements. The court held that the Individual Plaintiffs met their burden to show their entitlement to a preliminary injunction; the district court did not abuse its discretion in preliminarily enjoining LDHH’s termination of PPGC’s provider agreements; and thus the court affirmed the district court's preliminary injunction, remanding for further proceedings. View "Planned Parenthood v. Gee" on Justia Law

JTB Tools challenges the dismissal of its suit against defendants, alleging that the district court erred in granting OSHA’s Rule 12(b)(1) motion to dismiss for lack of subject-matter jurisdiction and in transferring the case to this court. The court affirmed the district court's transfer, holding that this court has exclusive jurisdiction to review OSHA’s actions pursuant to 29 U.S.C. 655(f). Because JTB Tools failed to adequately brief its merits arguments before this court, the court held that JTB Tools waived any potential right to relief and the court dismissed the case. View "JTB Tools & Oilfield v. United States" on Justia Law

Wal-Mart petitions for review of the decision of the Commission finding that the company failed to comply with 29 C.F.R. 1910.132(d)(1), which requires the company to perform a hazard assessment of its distribution center. The court concluded that the regulation, the preamble, and the non-mandatory appendix fail to resolve the ambiguity as to whether Wal-Mart may use its Searcy hazard assessment as the hazard assessment for the allegedly identical New Braunfels location. In such circumstances, the court gives substantial deference to an agency’s interpretation of its own regulation. While section 1910.132(d)(1) may not require an employer to conduct a full-fledged hazard assessment of all identical workplaces, it is reasonable to interpret section 1910.132(d)(1) to require an employer to confirm that workplaces are indeed identical before a hazard assessment for one workplace can qualify as the hazard assessment for another location. Therefore, the court agreed with the Commission’s conclusion that the Secretary’s interpretation of section 1910.132(d)(1) is reasonable. However, because Wal-Mart lacked adequate notice of that interpretation, the court vacated the citation and the related penalty. View "Wal-Mart Distrib. Center v. OSHC" on Justia Law

Chapter 1301 of the Texas Insurance Code requires healthcare insurers to make coverage determinations and pay claims made by preferred healthcare providers within a specified time or face penalties. HCSC filed suit seeking a declaratory judgment against Methodist, seeking a declaration that Chapter 1301 does not apply to HCSC as the administrator of particular health plans, and the Federal Employee Health Benefits Act of 1959 (FEHBA), 5 U.S.C. 8901, et seq., preempts application of the statute to its administration of claims under the Federal Employees Health Benefits Program (FEHBP). The district court granted summary judgment to HCSC. The court held that Chapter 1301 is not applicable to BCBSTX’s activities as administrator of the self-funded plans or state government plans, nor to those activities that it performs as administrator of claims under the BlueCard program. The court also held that FEHBA preempts Chapter 1301’s application to the claims processed by BCBSTX under FEHBP plans. Accordingly, the court affirmed the judgment. View "Health Care Serv. Corp. v. Methodist Hospitals" on Justia Law

Plaintiffs, religious organizations, filed suit under the Religious Freedom Restoration Act (RFRA), 42 U.S.C. 2000bb to 2000bb-4, challenging a requirement that they either offer their employees health insurance that covers certain contraceptive services or submit a form or notification declaring their religious opposition to that coverage. The district court enjoined the government from enforcing the requirement. The court concluded that the acts plaintiffs are required to perform do not involve providing or facilitating access to contraceptives, and plaintiffs have no right under RFRA to challenge the independent conduct of third parties. Because plaintiffs have not shown that the regulations substantially burden their religious exercise or, in University of Dallas, have not demonstrated a substantial likelihood of doing so, the court need not reach the strict-scrutiny prong or the other requirements for an injunction. Accordingly, the court reversed the judgment of the district court. View "East Texas Baptist Univ. v. Burwell" on Justia Law

The issue before the Fifth Circuit in this case centered on the Origination Clause, and two provisions of the Patient Protection and Affordable Care Act (ACA): the “individual mandate,” which imposed a penalty on non-exempt individuals who lacked qualifying health insurance; and the “employer mandate,” which imposed a tax on certain employers who failed to offer “affordable” health insurance to their employees and their employees’ dependents. The plaintiffs were Steven Hotze, M.D., and his employer, Braidwood Management, Inc. The district court held that the ACA was enacted in conformance with the Origination Clause, and thus dismissed plaintiffs’ complaint on its merits. The Fifth Circuit never reached the merits, and found it unnecessary to address the arguments relating to the Origination Clause. Instead, the Court concluded that the district court lacked subject-matter jurisdiction to entertain the complaint, because Hotze failed adequately to allege an injury that would give him standing to challenge the individual mandate and because Braidwood’s challenge to the employer mandate was barred by the Anti-Injunction Act as a suit seeking to enjoin the collection of a federal tax. Accordingly, the Fifth Circuit vacated the district court’s judgment and remanded this case with instructions to dismiss for lack of subject-matter jurisdiction. View "Hotze v. Burwell" on Justia Law

Medical provider North Cypress Medical Center Operating Co., Ltd. and North Cypress Medical Center Operating Co. GP, LLC (collectively, “North Cypress” or “the hospital”) sued Cigna Healthcare, Connecticut General Life Insurance Company, and Cigna Healthcare of Texas, Inc. (collectively, “Cigna”) for breach of healthcare plans administered or insured by Cigna. North Cypress argued that Cigna failed to comply with plan terms and underpaid for covered services. Cigna counter-claimed, arguing that it paid more than was owed; that North Cypress as an out-of-network provider did not charge the patients for coinsurance, but billed Cigna as if it had. The district court dismissed North Cypress’s ERISA claims for want of standing and Cigna’s ERISA claims as time barred. Finally, the district court granted summary judgment against North Cypress’s breach of contract claims, concluding there was no breach. North Cypress appealed and Cigna cross-appealed. The Eleventh Circuit, after review, affirmed in part, reversed in part, and remanded for further proceedings. In holding that North Cypress had standing to bring ERISA claims, the Court removed the grounds for the district court’s preemption ruling. The parties did not brief the issue of whether the "Discount Agreement" claims would survive un-preempted. Accordingly, the Court vacated the grant of summary judgment and remanded so that the district court could consider the question of preemption in light of our ruling on standing. The Court affirmed the remainder of the district court’s judgment. View "North Cypress Medical Center, et al v. Cigna Health" on Justia Law

Wal-Mart rented space to optometrists using a standard lease agreement requiring optometrists to make representations in their leases of the projected number of hours their offices would remain open. A jury found Wal-Mart liable for setting or attempting to influence office hours of an optometrist in violation of the Texas Optometry Act. Tex. Occ. Code 351.408. The district court subsequently remitted the jury's award of almost $4 million in civil penalties and plaintiffs accepted remittitur. Wal-Mart appealed. The court affirmed the district court's judgment regarding Wal-Mart's liability; reversed and vacated the district court's judgment regarding damages where the district court erred in applying Chapter 41's, Tex. Civ. Prac. & Rem. Code 41.001(5), lower damage cap exception; and remanded.View "Forte, et al. v. Wal-Mart Stores, Inc." on Justia Law