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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. MISSING
Regular Panel Decision

Texas Health Care Information Council v. Seton Health Plan, Inc.

Seton Health Plan, Inc., a licensed health maintenance organization (HMO), failed to file its annual Health Plan Employer Data Information Set (HEDIS) reports for 1999 and 2000 with the Texas Health Care Information Council, leading to a dispute over civil penalties. The State, through the Attorney General, initially demanded $153,000, interpreting 'each act of violation' as each day of non-compliance, while Seton contended the maximum penalty was $10,000 per unfiled report. Seton filed a declaratory judgment action to construe the statute, and the district court sided with Seton, assessing a minimum penalty of $1,000 for each report. The State appealed, raising issues of mootness, sovereign immunity, the penalty amount, denial of injunctive relief, and attorney's fees. The appellate court affirmed the district court's interpretation of the penalty, the assessed penalties, and the denial of injunctive relief, but remanded the issue of the State's attorney's fees.

Declaratory JudgmentStatutory ConstructionCivil PenaltiesSovereign ImmunityInjunctive ReliefAttorney's FeesHEDIS ReportHealth Maintenance OrganizationTexas Health and Safety CodeAdministrative Procedure Act
References
43
Case No. 03-02-00114-CV
Regular Panel Decision
Dec 19, 2002

Texas Health Care Information Council and the State of Texas, Office of the Attorney General v. Seton Health Plan, Inc.

This case involves an appeal by the Texas Health Care Information Council and the State of Texas, Office of the Attorney General, against Seton Health Plan, Inc. The core dispute centered on the interpretation of civil penalties for Seton's failure to file annual Health Plan Employer Data Information Set (HEDIS) reports as required by the Texas Health and Safety Code. Seton sought a declaratory judgment asserting that the maximum penalty for such a violation was $10,000 per report, while the State initially pursued a penalty based on each day of violation. The district court sided with Seton on the maximum penalty, assessed minimum penalties of $1,000 for each of the two unfiled reports, denied the State's request for injunctive relief, and ordered the State to pay Seton's attorney's fees. On appeal, the Court of Appeals affirmed the district court's declaratory judgment, the denial of injunctive relief, and the penalty assessment. However, the appellate court reversed and remanded the issue of the State's attorney's fees, ruling that the State was statutorily entitled to reasonable attorney's fees under Government Code section 402.006(c) due to its recovery of a civil penalty.

Texas LawHealth Care RegulationHEDIS Report ViolationCivil PenaltiesDeclaratory Judgment ActionSovereign Immunity WaiverInjunctive Relief DeniedAttorney's Fees AwardStatutory ConstructionAdministrative Law
References
44
Case No. 15-25-00092-CV
Regular Panel Decision
May 06, 2025

Bright Health Management, Inc. v. Texas Department of Insurance and Cantilo & Bennett, L.L.P., Special Deputy Receiver of Bright Healthcare Insurance Company of Texas

This case involves an appeal by Bright Health Management, Inc. (BHM) against Bright Health Insurance Company of Texas (BHICOT), which is currently in receivership. The appeal challenges an order from the 455th Judicial District Court in Travis County, Texas. The Special Deputy Receiver (SDR) for BHICOT moved to compel BHM, a non-party to the liquidation, to produce all BHICOT-related records, specifically electronically stored information (ESI) from BHM's integrated email system. BHM requested the implementation of ESI protocols to protect its privacy, privileged, and confidential information related to its other clients, and sought reimbursement for the costs of production, citing its Management Services Agreement (MSA) with BHICOT and Texas law governing non-party discovery. The District Court, adopting the Special Master's recommendation, denied BHM's request for ESI protocols and ordered BHM to bear all production costs, asserting that BHM created the commingled system for its own economic benefit. BHM argues that this ruling disregards established Texas ESI jurisprudence and its contractual and statutory rights to cost reimbursement, and seeks reversal of the District Court's order.

Insurance ReceivershipElectronic DiscoveryESI ProtocolsNon-Party DiscoveryCost ReimbursementAffiliate TransactionsManagement Services AgreementTexas Insurance LawConfidentialityPrivilege Protection
References
20
Case No. 15-24-00114-CV
Regular Panel Decision
Oct 04, 2024

Cecile Erwin Young, in Her Official Capacity as the Executive Commissioner of the Texas Health and Human Services Commission; Molina Healthcare of Texas, Inc.; And Aetna Better Health of Texas, Inc. v. Cook Children's Health Plan, Texas Children's Health Plan, Superior Health Plan, Inc., and Wellpoint Insurance Company

This case involves an appeal concerning a temporary injunction and the denial of a plea to the jurisdiction issued by the 353rd Judicial District of Travis County. The appellants, including Cecile Erwin Young (Executive Commissioner of HHSC), Molina Healthcare of Texas, Inc., and Aetna Better Health of Texas, Inc., are challenging the lower court's decision. The appellees (Cook Children's Health Plan, Texas Children's Health Plan, Superior Health Plan, Inc., and Wellpoint Insurance Company) had sought to enjoin the Texas Health and Human Services Commission (HHSC) from proceeding with STAR & CHIP and STAR Kids managed care procurements. The core legal arguments revolve around whether HHSC's procurement processes violated Texas law, thereby rendering the intended contract awards unlawful ultra vires acts, and whether the appellees' claims are barred by sovereign immunity or failure to exhaust administrative remedies. The appellants contend that the district court abused its discretion by granting the injunction and denying the plea.

Appellate CourtTemporary InjunctionPlea to the JurisdictionSovereign ImmunityUltra Vires ClaimsProcurement DisputeManaged Care ContractsMedicaidCHIPTexas Health and Human Services Commission
References
95
Case No. 03-16-00358-CV
Regular Panel Decision
May 23, 2016

Patricia Mosley// Texas Health and Human Services Commission and Texas Department of Family and Protective Services v. Texas Health and Human Services Commission and Texas Department of Family and Protective Services// Cross-Appellee, Patricia Mosley

Patricia Mosley is appealing a trial court's decision that affirmed the Texas Health and Human Services Commission's (HHSC) order to place her on the Employee Misconduct Registry (EMR). This placement stems from an incident where AW, a disabled individual under Mosley's one-to-one supervision, swallowed batteries. Mosley argues that her actions did not constitute neglect, asserting that maintaining constant arm's-length supervision for nearly seven hours alone was impossible, AW's secretive self-harming behavior was unforeseeable given the absence of warning signs, and she lacked adequate training for AW's specific needs. The core legal arguments revolve around the definition of 'neglect' as a negligent act requiring foreseeability and the proper application of a negligence standard versus a strict liability standard.

Employee Misconduct RegistryNegligenceForeseeabilityDirect Care ServicesDisabled IndividualsHealth and Human ServicesAppellate ReviewAdministrative LawSubstantial Evidence RuleSupervision Requirements
References
36
Case No. 17-0345
Regular Panel Decision
May 03, 2019

Patricia Mosley v. Texas Health and Human Services Commission and Texas Department of Family and Protective Services

Patricia Mosley challenged her placement on the Employee Misconduct Registry by the Texas Department of Family and Protective Services. She sought judicial review without filing a motion for rehearing, relying on a misleading agency letter and regulation. The Supreme Court of Texas affirmed that a motion for rehearing is a jurisdictional prerequisite for judicial review under the Administrative Procedures Act. However, the court also ruled that the agency's affirmative misrepresentation regarding the appeal process violated Mosley's due process rights, preventing her from exhausting administrative remedies. The case was remanded to the Health and Human Services Commission to allow Mosley to file a motion for rehearing, thereby restoring her opportunity for judicial review.

Administrative LawJudicial ReviewDue ProcessMotion for RehearingEmployee Misconduct RegistryTexas Health and Human Services CommissionTexas Department of Family and Protective ServicesJurisdictional PrerequisiteStatutory InterpretationAgency Misrepresentation
References
43
Case No. MISSING
Regular Panel Decision

Seife v. National Institutes of Health

Plaintiff Charles Seife, acting pro se, filed a Freedom of Information Act (FOIA) lawsuit against the National Institutes of Health (NIH) to obtain records concerning "special governmental employees" (SGEs) who serve on NIH advisory panels. Seife specifically requested documents from the ethics files of 44 NIH SGEs related to managing conflicts of interest, including "recusal lists" and "waiver determinations." NIH produced partially redacted documents, withholding information based on FOIA Exemptions 3 and 6, which protect confidential financial disclosure reports and personal privacy. The court granted Seife's motion in part, ordering NIH to release unredacted waiver determinations concerning SGEs' financial interests and relationships, but allowed redaction of identifying information about spouses or dependent children, and upheld the withholding of recusal lists. The decision balanced the SGEs' privacy interests against the public's interest in government transparency and accountability regarding potential conflicts of interest.

FOIANational Institutes of HealthSpecial Governmental EmployeesConflict of InterestRecusal ListsWaiver DeterminationsEthics in Government ActFinancial DisclosurePrivacy InterestsGovernment Transparency
References
35
Case No. 22-0558
Regular Panel Decision
Dec 22, 2023

Scott & White Memorial Hospital D/B/A Baylor Scott & White McLane Children's Medical Center A/K/A Baylor Scott & White Health v. Dawn M. Thompson, R.N.

Dawn Thompson, a registered nurse, was terminated by Scott & White Memorial Hospital after reporting child abuse concerns to Child Protective Services (CPS). The hospital stated the termination was due to Thompson's third violation of their personal-conduct policy, specifically disclosing protected health information to a school nurse without authorization. Thompson sued, alleging retaliation in violation of Section 261.110(b) of the Texas Family Code, which protects professionals who report child abuse. The Supreme Court of Texas affirmed that this statute requires a "but-for" causation standard, meaning the adverse action would not have occurred without the protected conduct. The Court found that Scott & White conclusively proved that Thompson would have been terminated for the HIPAA violation regardless of her CPS report, thereby negating the causation element of her claim. Consequently, the Supreme Court reversed the court of appeals' judgment and reinstated the trial court's summary judgment in favor of Scott & White.

Texas Family CodeWhistleblower ActEmployment TerminationRetaliation ClaimSummary JudgmentBut-For CausationHIPAA ViolationChild Abuse ReportProtected ConductNurse Employment
References
14
Case No. 99 Civ. 11886 WCC
Regular Panel Decision
Jul 11, 2000

Leonard v. DUTCHESS CTY. DEPT. OF HEALTH

Plaintiffs, including restaurant and bowling center owners and the National Smokers Alliance, challenged smoking regulations promulgated by the Dutchess County Department of Health and Board of Health. They alleged violations of equal protection, free speech, 42 U.S.C. § 1983, the New York State Constitution, and Article 78. The defendants moved to dismiss, arguing lack of subject matter jurisdiction, while plaintiffs moved for summary judgment and injunctive relief. The court, treating both as motions for summary judgment, found that the Board of Health exceeded its authority under the New York State separation of powers doctrine by enacting regulations that balanced economic, social, and privacy interests, rather than solely health concerns. Specifically, the court noted the Board's consideration of non-health factors, the non-interstitial nature of the regulations compared to state law, and the County Legislature's prior failure to pass similar legislation. Consequently, the court granted plaintiffs' motion for summary judgment and permanently enjoined the defendants from enforcing the challenged smoking regulations.

Smoking RegulationsPublic Health LawSeparation of PowersAdministrative Agency OverreachSummary JudgmentInjunctive ReliefDutchess CountyClean Indoor Air ActConstitutional LawArticle 78
References
12
Case No. MISSING
Regular Panel Decision
May 27, 2014

Rumsey v. Northeast Health, Inc.

Plaintiff Ellen Rumsey, a former teacher, sued Northeast Health, Inc. and St. Peter's Health Partners alleging retaliatory termination in violation of Title VII and NYSHRL, and breach of contract. Rumsey claimed her employment was terminated after she supported a coworker's pregnancy discrimination claim and participated in a related internal investigation. Defendants moved for summary judgment, arguing a legitimate, non-retaliatory reason for termination based on Rumsey's repeated inappropriate behavior and a classroom incident. The court found that Rumsey failed to establish a causal connection between her protected activities and termination, citing intervening disciplinary events and her history of problematic working relationships. The motion for summary judgment was granted, and all claims were dismissed with prejudice.

RetaliationTitle VIINYSHRLPregnancy DiscriminationSummary JudgmentEmployment TerminationWorkplace DisputeAt-Will EmploymentBreach of ContractHuman Resources
References
50
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