In Re: Diet Drugs

200 F. App'x 95
CourtCourt of Appeals for the Third Circuit
DecidedAugust 9, 2006
Docket05-4204
StatusUnpublished
Cited by3 cases

This text of 200 F. App'x 95 (In Re: Diet Drugs) is published on Counsel Stack Legal Research, covering Court of Appeals for the Third Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In Re: Diet Drugs, 200 F. App'x 95 (3d Cir. 2006).

Opinion

*97 OPINION OF THE COURT

STAPLETON, Circuit Judge.

Elliot Palay (“Palay”), a claimant in the Multidistrict Diet Drugs Litigation, MDL-1203, appeals an order of the District Court denying Palay’s motion to compel the AHP Settlement Trust to audit Palay’s claim and to declare Palay’s age to have been 49 when he was first diagnosed with a reduced left ventricular ejection fraction. For the reasons that follow, we will affirm the District Court’s order.

I

We have previously set forth the facts of the diet drugs litigation. See, e.g., In re Briscoe, 448 F.3d 201, 206 (3d Cir.2006) (recounting facts of litigation and citing prior cases). The primary risk from diet drug use for present purposes is valvular heart disease (“VHD”). A symptom of VHD is regurgitation of blood through diseased heart valves. This regurgitation can be detected through echocardiograms.

Pursuant to the Settlement Agreement, the AHP Settlement Trust (the “Trust”) was established to administer the benefits to the settlement class. Members of the settlement class may claim varying levels of benefits depending upon the severity of their injuries and other factors. For claimants who have certain documented medical conditions, including that they have demonstrated levels of valvular regurgitation (and are thereby considered “FDA positive”), the Settlement Agreement provides for a system of matrix benefits. Settlement Agreement at § IV.B.2. There are two matrices: the “A” matrix and the “B” matrix. The “A” matrix provides for generally higher benefits. FDA positive claimants are generally eligible for benefits under Matrix A, so long as they do not meet the specified qualifications for Matrix B. Id. at § IV.B.2.d.l.

For claimants who claim benefits based on damage to their mitral valve, one of the conditions that moves such claimants from Matrix A to Matrix B is “acute myocardial infarction associated with acute mitral' regurgitation.” 1 Id. at § IV.B.2.d.(2)(c)(ii)(e). If claimants suffer from that condition and are unable to establish that the regurgitation existed prior to the myocardial infarction, they are given benefits according to Matrix B, and not under the more generous Matrix A.

Within the two matrices, benefits are determined according to two factors: 1) the severity of the disease; and 2) “the age at which the Diet Drug Recipient is first diagnosed as suffering from that level of disease severity.” Id. at § IV.B.2.b. The severity of the disease determines one’s “Level” in the matrix (the matrix row). Benefits increase with the level of severity. One’s age at first diagnosis of the particular level of severity determines the age bracket used to calculate benefits (the matrix column). At a given severity, benefits diminish the later in life one is diagnosed with the particular severity of disease.

A claimant qualifies for Matrix Level III if, inter alia, the claimant’s “left sided valvular heart disease requires] surgery.” Id. at IV.B.2.c.(3). A claimant qualifies for Matrix Level IV if, inter alia, the claimant has “[significant damage to the heart muscle, defined as ... (b) a left ventricular ejection fraction < 40% six months after valvular repair or replacement surgery in patients who have had such surgery.” Id. at IV.B.2.c.(4XcXiv).

Palay was prescribed Redux, one of the diet drugs at issue, in July 1996. In November 1998, when Palay was 49 years old, *98 Palay suffered acute myocardial infarction. He was admitted to the hospital on November 9, 1998. An echocardiogram performed the following day showed moderate mitral regurgitation and a left ventricular ejection fraction of 25-35 percent. A test revealed severe three-vessel coronary artery disease and Palay received coronary bypass surgery. An echocardiogram performed the following day showed roughly similar levels of mitral regurgitation.

Palay filed a claim with the Trust in January 2000. The Trust initially determined Palay to be payable on Matrix B at Level III. Further, because Palay was 49 at the time he was diagnosed as requiring surgery, he was to be paid according to the 45-49 age bracket.

Palay received a new echocardiogram in January 2001, when Palay was 52 years old. This echocardiogram, taken more than two years after his surgery, established that Palay had the required degree of reduced left ventricular ejection fraction six months after his surgery making Palay eligible for Level IV benefits.

As a primary component of his claim, Palay submitted a “Green Form.” One of the questions on the form asked whether Palay had “mitral regurgitation associated with myocardial infarction.” Palay’s doctor answered this question “yes,” but added a handwritten note stating, “Murmur appeared in setting of acute [myocardial infarction]. Relationship to [myocardial infarction] not known [with] certainty.” App. at 67.

On March 2, 2001, the Trust issued a final determination providing for benefits to Palay under Matrix B at Level TV. The Trust determined that the affirmative answer given by Palay’s doctor, despite the handwritten addition, established that the myocardial infarction predated his moderate mitral valve regurgitation, and that that regurgitation was not established until after the myocardial infarction.

Palay submitted additional correspondence and a supplemental Green Form. The supplemental Green Form was attested to by a different doctor than the first form and differed from the original Green Form by stating that Palay did not have myocardial infarction associated with mitral valve regurgitation. The Trust ultimately concluded that the supplemental form and other materials did not change its conclusion that Palay’s benefits should be awarded according to Matrix B and not Matrix A. Palay appealed to the arbitration panel.

On October 21, 2002, the Arbitrator affirmed the Trust’s determination. The Arbitrator found that the Trust’s determination that Palay had not established that his moderate mitral valve regurgitation predated his myocardial infarction was not clearly erroneous in light of the conflicting Green Forms and ambiguous correspondence from Palay’s doctor.

Palay appealed the Arbitrator’s decision to the District Court. On November 26, 2002, while the appeal was pending, the District Court issued Pretrial Order (“PTO”) No. 2662, in which it ordered that “the [Trust] shall audit every claim for matrix level benefits from Fund B that has not as of the date of this order been paid.” App. at 25. As of the date of PTO No. 2662, Palay’s claim had not yet been paid.

On February 6, 2003, in response to a letter from Palay, counsel for the Trust wrote in a letter that:

[T]he Trust intends to submit Mr. Pa-lay’s claim through the medical audit process that is imposed on the Trust pursuant to [PTO No.] 2662....

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Related

MORENCY v. CITY OF ALLENTOWN
E.D. Pennsylvania, 2020
In Re: Diet Drugs V.
451 F. App'x 165 (Third Circuit, 2011)
Gutierrez v. Johnson & Johnson
743 F. Supp. 2d 418 (D. New Jersey, 2010)

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Bluebook (online)
200 F. App'x 95, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-diet-drugs-ca3-2006.