Medtronic Petitions Supreme Court Concerning Preemption and Adverse Event Reports

Medtronic, Inc., has petitioned the U.S. Supreme Court to review a decision from the Ninth Circuit Court of Appeals concerning whether the Medical Device Amendments (MDA) to the Food, Drug and Cosmetic Act (FDCA) preempt a state-law claim alleging that Medtronic violated a duty under federal law to report adverse-event information.

Background

In 2000, Richard Stengel had a SynchroMed EL Pump and Catheter, manufactured by Medtronic, surgically implanted into his abdomen to deliver pain relief medication directly into his spine. In 2005, after a hospitalization, he was diagnosed with ascending paralysis of his lower body, caused by the catheter, and a neurosurgeon removed the catheter. Stengel remained paralyzed after the surgery. In 2006, the FDA inspected a Medtronic facility and discovered that Medtronic was aware of the risks associated with the pump and catheter, and had known about them prior to Stengel’s paralysis. The FDA issued a warning letter to Medtronic, stating that Medtronic had misbranded the device by concealing known risks. Medtronic recalled the device in the spring of 2008, three years after Stengel’s paralysis.

The Stengels claimed that Medtronic was negligent under Arizona law because it allegedly failed to provide the FDA with information about adverse events involving the pump and catheter. The Ninth Circuit held that the state-law claim was not impliedly or expressly preempted by the MDA. Further, the court held that the general duty of care under Arizona common law incorporated a requirement to furnish adverse-event information to the FDA. (Stengel v Medtronic Incorporated, 704 F.3d 1224, January 10, 2013).

Petition for Certiorari

The Medtronic petition to the Supreme Court notes that courts of appeal have been divided regarding the applicability of both implied and express preemption under the MDA to state-law claims based on alleged violations of duties imposed by federal law. Regarding whether the MDA impliedly preempts state-law claims, the Ninth Circuit in this case and the Fifth Circuit in Hughes v Boston Scientific Corp., 632 F.3d 762 (2011) have said “no”; while the Sixth and Eighth Circuits have said “yes.” (See In re Medtronic, Inc., Sprint Fidelis Leads Prods. Liab. Litig (623 F.3d 1200, 1205-06 (8th Cir 2010); and Cupek v Medtronic, 405 F.3d 421, 423-24 (6th Cir. 2005)).

The circuit courts are also split on whether the MDA expressly preempts state-law claims alleging a violation of a generalized, rather than a device-specific, federal requirement. In Riegel v Medtronic, Inc. (552 U.S. 312 (2008)), the U.S. Supreme Court held that 21 U.S.C. sec. 360k expressly preempts state common-law claims regarding medical devices that have received premarket approval, unless those claims are based on state-law duties that are parallel to—and thus do not impose requirements different from, or in addition to—federal requirements. In the wake of Riegel, two circuits have held that this parallel duty exception is not applicable where a state-law duty is alleged to be parallel to a generalized federal duty that applies to all medical devices; four circuits have held the contrary position.

The petition further notes that the Ninth Circuit’s decision “would effectively eviscerate” the U.S. Supreme Court’s earlier decisions in Riegel and Buckman Co. v Plaintiffs’ Legal Comm. (531 U.S. 341 (2001)). “A claim concerning a device that has received pre-market approval can avoid preemption only if it is based on a state-law duty that is both (1) independent of (Buckman), and (2) parallel to (Riegel), a duty imposed by federal law,” according to the petition.

The petition concluded that this case is an “ideal vehicle for addressing a recurring question of exceptional importance to device manufacturers and the public health.”

All-Metal Hip Replacement to be Phased Out

DePuy Orthopaedics, a unit of Johnson & Johnson, announced that it was phasing out production of all-metal replacement hips that were beset with high early failure rates. DePuy is just one of a number of manufacturers moving away from using all-metal replacement hips. All-metal replacement hips — in which both the cup and ball of a device are made from metal — are estimated to account for 1 in 3 hip implants in the U.S.

In 2010, DePuy Orthopaedics recalled an all-metal model known as the ASR XL Acetabular System (ASR) because it was failing just a few years after implant. Beginning in 2008, the FDA received approximately 400 complaints from patients who had ASR hip replacements. The 2010 recall came after data from a study indicated that the five-year failure rate of ASR approached 13 percent, or 1 in 8 patients. Artificial hips made from a combination of plastic and metal generally last 15 years or more before replacement of the device is warranted.

Johnson & Johnson is facing approximately 10,000 lawsuits from patients who allege injuries from failures in the all-metal ASR implants sold by the company.

Beyond these failures, replacement of implanted all-metal hip device can be problematic as well, as the procedure can leave behind dangerous, possibly deadly fragments that may not be discovered for years. Additional complications from the hip replacement system may include increased metal ion levels in the blood, bone staining, and tissue damage or muscle damage. After the ASR recall, DePuy continued to sell a different all-metal hip replacement called the Pinnacle.

In its statement announcing the phase out, DePuy noted the sharply declining demand for the all-metal devices coupled with a recent proposed rule by the FDA regarding all-metal devices. The FDA proposed rule would require all metal-on-metal hip replacements with existing 510(k) clearances to be
approved through the premarket approval (PMA) process. Sales of all-metal components used in the hip replacement systems are expected to end in August.

Testing of “Organ in a Box” Yields Promising Results

Although it might seem like science fiction, scientists have created a box  to keep transplant organs “alive” during their transport. The Organ Care System™ (OCS) maintains the organ in a functioning state during shipment.  The company making them hopes to submit the device to the Food and Drug Administration for approval in the future.

According to CNN, the OCS LUNG is approved in Europe and is undergoing clinical trials in the United States. Preliminary results showed that patients whose donated lung was transported in the box had fewer complications and greater overall outcome. TransMedics, the company behind the OCS, hopes to start a new era in organ transplants. According to their website:

Lung transplantation programs around the world face significant challenges in organ availability, patient outcomes, and overall cost of patient care caused by the limitations of the current cold static lung preservation method.

The OCS™ LUNG is a portable perfusion, ventilation, and monitoring system that maintains the organ in a near physiologic state. The system enables surgeons to perfuse and ventilate the organ between the donor and recipient sites.

Image Courtesy of TransMedic.com

Image Courtesy of TransMedic.com

TransMedics is currently testing out a similar device for donor heart transportation. CNN reports that the device costs approximately $58,000, and the internal chamber must be replaced for each patient.