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Appellate Representative Cases

Aetna Health Inc. v. Davila, 124 S. Ct. 2488 (2004)
Lawyer(s): Kendall M. Gray

The appellate group and managed care group represented the firm’s client in the Supreme Court of the United States, reversing an adverse outcome received in the Fifth Circuit. Notwithstanding a media blitz by plaintiffs who claimed to have suffered personal injuries at the hand of HMOs that allegedly “forced” them into treatment regimes against their physicians’ wishes, the Supreme Court refused to accept the plaintiffs’ characterization of their claims. The court held that the claims, at bottom, sought to challenge ERISA benefits determinations for which federal law was the exclusive remedy. In so doing, the Court upheld the right of managed care entities to remove such claims to federal court and, according to the Houston Chronicle, “crushed” the Texas Health Care Liability Act.

Corporate Health Insurance, Inc. v. Texas Department of Insurance, 215 F.3d 526 (5th Cir. 2000), on reh’g, 220 F.3d 641 (5th Cir. 2000), granted, vacated and remanded, 536 U.S. 935 (2002), aff’d as modified, 314 F.3d 78
Lawyer(s): Kendall M. Gray, John B. Shely

When the Texas Legislature attempted to impose liability on managed care entities that administer employee benefit plans, the firm brought suit on behalf of its clients on the grounds that the act was preempted by ERISA. The appellate and managed care groups collaborated on briefing and oral argument that resulted in construction of the Texas Health Care Liability Act greatly exempting the clients from liability in future suits.

Deloitte & Touche LLP v. Fourteenth Court of Appeals, 951 S.W.2d 394 (Tex. 1997) (orig. proceeding)
Lawyer(s):

Ehlmann v. Kaiser Foundation Health Plan of Texas, 198 F.3d 552 (5th Cir. 2000)
Lawyer(s): Kendall M. Gray, John B. Shely

Several health care enrollees brought a putative class action against the firm’s client and several of the largest managed care entities doing business in Texas, claiming among other things that the defendants were breaching their fiduciary duties under ERISA by failing to disclose alleged financial incentives for participating physicians to limit care. The firm’s briefing resulted in dismissal of the plaintiffs’ claims in advance of class certification proceedings. After briefing and argument, the United States Court of Appeals affirmed the dismissal.

Ford v. NYLCare Health Plans of the Gulf Coast, Inc., 301 F.3d 329 (5th Cir. 2002)
Lawyer(s): Kendall M. Gray, John B. Shely

An orthopedic surgeon sued the firm’s client and each of the largest health care plans in which he participated as the representative of a putative class of specialist physicians. He complained of managed care “hassles” and the alleged damage done to specialist practitioners by managed care. The firm led the defense, drafted dismissal briefing that disposed of many of the plaintiff’s claims, and defended class certification proceedings that resulted in the denial of class certification. Finally, the firm moved for summary judgment on the plaintiff’s remaining Lanham Act claim, and summary judgment was granted. After briefing and argument, the United States Court of Appeals for the Fifth Circuit affirmed the summary judgment granted in favor of the firm’s client.

Haynes v. Prudential Health Care, 313 F.3d 330 (5th Cir. 2002)
Lawyer(s): Kendall M. Gray, John B. Shely

A healthcare enrollee sued the firm’s client in Mississippi alleging that he had not received access to needed care as a result of the client’s refusal to recognize the validity of the treating physician’s referral to a wound care center. Based on the firm’s briefing, the district court dismissed the claim on the grounds that it was preempted by ERISA. Notwithstanding the plaintiff’s medical allegations, the United States Court of Appeals for the Fifth Circuit affirmed the judgment in favor of the firm’s client after hearing oral argument.

In re Amoco Oil Company, No. 14-06-00600-CV (dism’d pursuant to settlement Aug. 17, 2006)
Lawyer(s):

In re Houston Northwest Partners, Ltd., 98 S.W.3d 777 (Tex. App.—Austin 2003, orig. proceeding), pet. granted, submitted on oral argument in the Supreme Court of Texas on November 19, 2003 pursuant to consolidation for argument only with Gonza
Lawyer(s):

In re Sweatman, No. 13-04-0028-CV, 2004 WL 1798022 (Tex. App.—Corpus Christi Aug. 12, 2004, orig. proceeding) (per curiam)
Lawyer(s):

Ingersoll-Rand Co. v. Valero Energy Corp., 997 S.W.2d 203 (Tex. 1999)
Lawyer(s): Kendall M. Gray, John B. Shely

Mirant Corp. v. Potomac Electric Power Corp. (In re Mirant Corp.), 378 F.3d 511 (5th Cir. 2004)
Lawyer(s): Kendall M. Gray

Mobil Oil Corp. v. Ellender, 968 S.W.2d 917 (Tex. 1998)
Lawyer(s):

Roark v. Humana, Inc., 307 F.3d 298 (5th Cir. 2002), rev’d sub nom. Aetna Health Inc. v. Davila, 124 S. Ct. 2488 (2004)
Lawyer(s): Kendall M. Gray, John B. Shely

The appellate and managed care groups represented the firm’s client in consolidated cases involving personal injury claims brought against three managed care entities under the Texas Health Care Liability Act. The cases were successfully removed from state court to federal court but the United States Court of Appeals for the Fifth Circuit reversed the decision, holding that two of the three consolidated cases were not completely preempted by ERISA. The story did not end there, however. The Supreme Court granted certiorari, heard oral argument in March 2004, and unanimously reversed the decisions.

Russell v. Amoco Prod. Co., No. 14-05-00068-CV (dism’d pursuant to settlement Aug. 24, 2006)
Lawyer(s):

Sulzer Carbomedics, Inc. v. Oregon Cardio-Devices, Inc., 257 F.3d 449 (5th Cir. 2001)
Lawyer(s): Kendall M. Gray

Union Pacific Resources Group, Inc. v. Rhone-Poulenc, Inc., 247 F.3d 574 (5th Cir. 2001)
Lawyer(s): Kendall M. Gray, Dennis N. Ryan

The firm’s clients brought an action against its former joint venture counterpart claiming that it had been improperly denied the opportunity to exercise a right of first refusal when that counterpart sold all the stock in two subsidiaries involved in the venture. The primary advocacy challenge was to demonstrate a case of fraud by partial disclosure where the misrepresentations arose from the actuarial methods utilized on the pension plans. Despite this difficulty, the United States Court of Appeals for the Fifth Circuit reversed the summary judgment granted by the district court and reinstated the client’s claim.