Man, 41, given just two years to live after mistaking ‘bizarre' symptom for a trapped nerve
WHEN Andres Albaladejo noticed a "bizarre" symptom in his left arm he didn't think it was anything sinister.
Little did the 41-year-old know it was the first sign of Amyotrophic Lateral Sclerosis (ALS) and he would have just two to three years to live.
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Andres and his wife, Carmen Albaladejo, 39, noticed a twitch in his left arm in April 2023 but didn't think it was anything sinister.
A visit to the chiropractor confirmed Andres had a trapped nerve, but the weakness in his left arm continued, so Andres went to a neurologist.
The neurologist performed three EMGs - a medical test that measures the electrical activity in muscles - and referred Andres to an ALS - amyotrophic lateral sclerosis - clinic in October 2023.
The clinic said Andres had ALS - a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord - and told him and his family he had two to three years to live.
In September 2024, Andres underwent stem cell therapy - to slow down or reverse the progression of the disease - which worked, but the effects have now worn off.
Carmen is now concentrating on making as many memories as possible with Andres and their 11-year-old daughter, Sophia.
Andres, a former school resource officer, from Tampa, Florida, US, said: "I was heartbroken when I heard the news, like my life was being taken from me piece by piece - I still have so much of me to give.
"I'm angry that I won't be here to see my little girl grow into the smart, kind, and beautiful woman I know she will be. I think that hurts the most.
"Instead, she has to watch me fall apart in front of her eyes.
"I just hope that throughout all of this, my daughter still sees me as her hero, as I face this disease with determination and strength."
Eric Dane's Brave Battle: ALS Diagnosis and a Triumphant Return to Work
Carmen noticed Andres' left arm was twitching in April 2023, but they both thought it was a pinched nerve.
Soon after, Andres started experiencing weakness in his left arm, which he thought was strange.
His wife, Carmen, a senior accountant, said: "I noticed the twitching in his left arm and asked what was going on. IT WAS BIZARRE.
"I asked if he could feel it, if he was doing anything to make it twitch, but he said no.
"We thought it was a pinched nerve, but over time, he started experiencing arm weakness, and he wasn't able to grip with his left arm."
Two to five years to live
In June 2023, Andres went to the chiropractor, and an X-ray showed he did have some nerve compression, which came as a relief to the couple.
After treatments with the chiropractor, the arm weakness did not go away, and Andres was sent to a neurologist.
Carmen said: "At the time, the doctors said they were going to schedule him for a disc replacement surgery for the disc that was compressing his nerve.
"But before they went ahead and did that, they did three EMGs with the neurologist becoming more concerned each time as the twitching was travelling to his chest."
Andres was then transferred to an ALS clinic, where, after a strength test, he was diagnosed with ALS - the same condition Stephen Hawking had - and given a prognosis of two to five years.
Carmen and Andres were shocked and confused by the diagnosis, so they asked for a second opinion, which confirmed the ALS diagnosis.
From having a pinched nerve to being diagnosed with a terminal disease eight months later - we were in shock and denial
Andres Albaladejo
Carmen said: "From having a pinched nerve to being diagnosed with a terminal disease eight months later - we were in shock and denial.
"It was devastating, you can never imagine it happening to you or a loved one.
"In eight months, our lives completely changed. We thought it was nerve compression, and now Andres has a terminal illness with a prognosis of two to five years.
"It is a lot to hear in one appointment."
Andres is currently taking an ALS medication to slow the progression of the disease.
In September 2024, friends, family and strangers clubbed together to raise $26,235 (around £19,323) for stem cell therapy in the Cayman Islands in a bid to attempt to slow down or reverse the progression of the disease.
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Currently, there are no FDA-approved stem cell therapies for ALS available in the US, but there are several trials to investigate the safety and efficacy of using stem cells to potentially slow or halt the progression.
Carmen said the treatment worked, but the effects have now worn off, and they can't afford another round of treatment.
She said: "We are facing the disease head-on and dealing with it every day.
"At this point, we are getting our affairs in order, as we can not see any promising treatments we can afford.
"We are trying to stay strong and make the best out of our situation."
Carmen recently bought a book for their daughter, Sofia, to sit with Andres and fill out so she can have memories of her dad.
Carmen said: "It is called 'about my father' a book that she will put together.
"She will get to ask him questions about his childhood, and get to know him from a different perspective.
"It allows her to have something that she could treasure forever."
What is ALS?
Amyotrophic lateral sclerosis (ALS) is a fatal type of motor neuron disease.
It causes progressive degeneration of nerve cells in the spinal cord and brain.
Early symptoms may include:
Muscles weakness and twitching - this can be in the arms, legs, or even the tongue, causing difficulty with fine motor skills, such as gripping objects, or difficulty with speech.
Muscle cramps - These can be painful and may affect various muscles, including those in the hands and feet.
Fasciculations - These are muscle twitches that can be persistent and may interfere with sleep.
Tripping and falling - Loss of motor control in the legs and feet can lead to difficulties with balance and coordination.
Dropping things - Hand weakness can make it difficult to hold and manipulate objects.
Slurred speech - Difficulty speaking and swallowing can occur due to weakness in the muscles controlling speech and swallowing.
Difficulty swallowing - This can make eating and drinking challenging.
The exact cause of ALS is unknown, but it's believed to be a combination of genetic and environmental factors.
While about 10 per cent of ALS cases are familial (meaning they have a family history), the majority are sporadic, occurring without a known family history.
If you suspect you have ALS, the first step is to see your GP.
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Encourage patient choice and therapeutic continuity by allowing the patient-authorized transfer of medical records. Invalidate non-competes for health care workers who earn less than a minimum annual compensation threshold. Maryland Maryland recently enacted a statute restricting non-competes for certain health care professionals. Effective July 1, 2025, non-competes in Maryland are void with: Under this new law, non-competes are only enforceable against health care employees earning more than $350,000 annually if the restrictions do not either: Tennessee Tennessee law imposes restrictions on non-competes with covered health care providers, including podiatrists, chiropractors, dentists, optometrists, physicians, osteopathic physicians, and psychologists, but not physicians specializing in emergency medicine. Non-competes with covered providers are enforceable only if: The agreement is in writing and signed by the provider and employing or contracting entity. The temporal restriction is for two years or less. The geographic restriction, if any, does not exceed the greater of: a ten-mile radius from the provider's primary practice site; or the county where the primary practice site is located. If there is no geographic restriction, the provider can only be restricted from practicing their profession at any facility where the employing or contracting entity provided services while the provider was employed with that entity. (T.C.A. §§ 63-1-148 and 63-6-204.) Additional conditions apply in Tennessee to non-competes with certain employing or contracting entities, including: Hospitals (T.C.A. § 63-6-204(f)(2), (3); see also T.C.A. § 68-11-205(b)(2), (3)). Renal dialysis clinics (T.C.A. § 63-6-204(g)(2), (3); see also T.C.A. § 68-11-205(c)(2), (3)). Faculty practice plans (T.C.A. § 63-6-204(h)). Nursing homes (T.C.A. § 68-11-205(f)(2)). Texas In Texas, a non-compete with a licensed physician is enforceable only if it: Other States In addition to other restrictions, several state laws render physician non-competes unenforceable under certain circumstances when the employing entity terminates the employment relationship without cause. This type of restriction exists in states such as: Connecticut, when the employer terminates the employment without cause (Conn. Gen. Stat. Ann. § 20-14p(b)(2)). Indiana, when the employer terminates the employment without cause or the physician terminates the relationship for cause (Ind. Code § 25-22.5-5.5-2.5(b)). However, for agreements originally entered into on or after July 1, 2025, Indiana renders void and unenforceable all non-competes between physicians and a hospital, hospital parent company, hospital affiliated manager, or hospital system, regardless of the circumstances of the employment termination (with limited exceptions for the sale of a business) (Senate Enrolled Act No. 475, adding a new Ind. Code §§ 25-22.5-5-2.3 and 25-22.5-5.5-1.4(b)(3)). Pennsylvania, which generally bans non-competes with health care practitioners, but includes an exception for covenants of no more than one year in duration, provided the employer has not terminated the employment relationship (35 P.S. § 10324(a), (b)). Sale of Business Exceptions Several state statutes that restrict the enforceability of non-competes with certain health care professionals include exceptions for covenants related to the purchase or sale of a business or partnership interest. For example, Tennessee's statute, which sets temporal and geographic limits on enforceable health care non-competes, also provides that non-competes made in conjunction with the purchase or sale of a health care provider's practice may restrict the provider's right to practice if the temporal and geographic scope of the non-compete are reasonable. The statute creates a rebuttable presumption that the temporal and geographic limitations agreed to by the parties are reasonable. (T.C.A. §§ 63-1-148 and 63-6-204.) Rhode Island's statute provides that non-competes for physicians and advanced practice registered nurses are generally prohibited but are enforceable in connection with the purchase or sale of a practice if the non-compete restriction is no longer than five years (R.I. Gen. Laws §§ 5-37-33 and 5-34-50). Pennsylvania's statute also has exceptions for the sale of a business. The Pennsylvania Fair Contracting for Health Care Practitioners Act provides that non-competes with covered health care practitioners generally are enforceable only if both: The non-compete restriction is no longer than one year. The health care practitioner was not dismissed by the employer. Under the statute, covered health care practitioners include: Medical doctors. Doctors of osteopathy. Certified registered nurse anesthetists. Certified registered nurse practitioners. Physician assistants to an osteopathic or medical practice. These restrictions, however, do not apply to covenants connected to: The sale of a health care practitioner's ownership interest in an entity or all or substantially all of the entity's assets. Transactions resulting in the sale, transfer, or change in control of the entity. An ownership interest in the business entity. (35 P.S. §§ 10321 to 10325.) Other states with sale of business exceptions to health care non-compete bans or restrictions include: Indiana, regarding physician non-competes with hospitals, hospital parent companies, hospital affiliated managers, and hospital systems, provided the physician owns more than 50% of the business entity at the time of sale (Senate Enrolled Act No. 475, adding a new Ind. Code §§ 25-22.5-5-2.3 and 25-22.5-5.5-1.4(b)(3) (effective July 1, 2025)). Montana (Mont. Code Ann. § 28-2-724(3)). South Dakota (SDCL 53-9-11.2). West Virginia (W. Va. Code § 47-11E-4). Buyout Provisions Some statutes addressing health care non-competes allow physicians the right to buy their way out of the non-compete. For example, Texas's statute provides that a non-compete with a licensed physician is not enforceable unless, among other requirements, the agreement provides an opportunity for the physician to buy out of the covenant at a reasonable price or, at the option of either party, as determined by a mutually agreeable arbitrator. If the parties are unable to agree on a reasonable price or the selection of an arbitrator, a court-appointed arbitrator will determine a reasonable price. (Tex. Bus. & Com. Code Ann. § 15.50(b)(2).) The failure to include the required buyout provision renders the agreement unenforceable (LasikPlus of Tex., P.C. v. Mattioli, 418 S.W.3d 210, 219-20 (Tex. App.—Houston [14th Dist.] 2013, no pet.) (holding that the court had no authority to enforce or reform an agreement lacking a buyout provision)). Under Tennessee law, when a physician sells their practice, any employment agreement or medical practice sale agreement restricting the physician's right to practice after the sale must both: Allow the physician to void the restriction on the physician's practice by buying back the physician's practice either: for the original purchase price of the practice; or if the parties agree in writing, at a price not to exceed the fair market value of the practice at the time of the buyback. Not require the physician to give more than 30 days' notice to exercise the repurchase option, provided that this does not otherwise affect any contract termination notice requirements. If the buyback provision is dependent on determining the fair market value of the practice, the contract must specify the method of determining fair market value by independent appraisal, if the parties cannot agree. (T.C.A. § 63-1-148(b).) Liquidated Damages Provisions Although many states allow for liquidated damages provisions in health care non-competes, the damages generally must be reasonably related to an actual injury. For example, under Delaware law, non-competes between or among physicians restricting a physician's right to practice medicine in a particular location or for a defined period of time after termination of the employment agreement are void. However, Delaware law contains an exception to this blanket ban, which allows for the enforcement of a reasonable liquidated damages provision. Specifically, the law states that provisions that 'require the payment of damages in an amount that is reasonably related to the injury suffered by reason of termination of the principal agreement' are enforceable and that these '[p]rovisions may include, but not be limited to, damages related to competition' (6 Del. Code Ann. § 2707). Arizona also applies a reasonableness requirement for liquidated damages provisions under common law. For example, in Tortolita Veterinary Services, PC v. Rodden, the court held that liquidated damage provisions in veterinarians' non-competes may be enforceable if the provisions: Are intended to compensate the non-breaching party, rather than penalize the breaching party. Approximate the loss: anticipated at the time of contract creation; or that actually occurred. (498 P.3d 125, 129-132 (Ariz. Ct. App. 2021).) Generally Applicable Non-Compete Statutes In recent years, states have increasingly passed laws that limit or restrict the use of non-competes and, sometimes, other restrictive covenants, such as non-solicits and non-treatment agreements. In states without a specific health care statute, the general non-compete laws typically govern non-competes with health care workers. Several states have enacted laws invalidating non-competes for certain workers or imposing other requirements on the enforceability of non-competes by, for example: Setting a maximum duration for non-competes. Invalidating non-competes for employees or contractors who earn less than a specified minimum annual compensation threshold. Imposing notice requirements, such as requiring that the non-compete be disclosed to the employee before employment begins or at least 14 days before the employee signs the non-compete. Requiring that compensation be paid during the non-compete period. Mandating that the employer advise the employee of their right to consult with an attorney before signing the non-compete. Common Law Reasonableness Analysis In states without any non-compete statute, courts typically apply a common law analysis to determine the enforceability of non-competes. While the analysis starts with the premise that non-competes are generally disfavored, courts typically enforce non-competes when they are narrowly tailored and reasonably necessary to protect an employer's legitimate business interest without unduly restricting an employee's ability to earn a living or harming the public interest. Courts have applied these principles when determining the enforceability of physician non-competes in common law jurisdictions (see, for example, Glascock v. Covenant Med. Ctr. Inc., 2022 WL 2824734, at *2-3 (Iowa Ct. App. July 20, 2022) (enforcing a 25-mile, 18-month non-compete against a bariatric surgeon); MetroHealth Sys. v. Khandelwal, 183 N.E.3d 590, 596 (Ohio App. 8th Dist. 2022) (modifying and enforcing as modified a two-year, 35-mile non-compete against a burn surgeon and the director of a burn center); Weber v. Tillman, 913 P.2d 84, 89-90 (Kan. 1996) (upholding a physician's non-compete because it was reasonable and not adverse to the public welfare)). Courts often find that a medical practice's relationships with its existing patients constitute legitimate business interests that are worthy of protection (see, for example, Surgery Ctr. Holdings, Inc. v. Guirguis, 318 So. 3d 1274, 1280-81 (Fla. 2d DCA 2021) (holding that patient goodwill within a 25-mile radius was a legitimate business interest warranting enforcement of two-year non-solicit provisions against departing physicians); Ansaarie v. First Coast Cardiovascular Inst., P.A., 252 So. 3d 287, 291-92 (Fla. 1st DCA 2018) (enforcing a five-mile, two-year non-compete prohibiting a doctor from providing or soliciting competing cardiovascular services); Healthcare Servs. of the Ozarks, Inc. v. Copeland, 198 S.W.3d 604, 613 (Mo. 2006) (finding that patients were a protectable interest and enforcing a non-compete against a home health care provider)). Courts also have held that hospitals have a legitimate interest in protecting confidential business information, such as patient lists, patient referral lists, and the hospital's investment in training its physicians (Cmty. Hosp. Grp., Inc. v. More, 869 A.2d 884, 897 (N.J. 2005) (enforcing a physician non-compete as modified to reduce the geographic scope)). Some courts have held that physician non-competes, while not per se unenforceable, require stricter scrutiny than employee non-competes in other industries because of strong public policy and ethical considerations (see, for example, Valley Med. Specialists v. Farber, 982 P.2d 1277, 1283 (Ariz. 1999) (finding that 'the doctor-patient relationship is special and entitled to unique protection' and holding that a pulmonologist's three-year non-compete for practicing medicine was unenforceable)). Non-Treatment Agreements Non-treatment agreements are another form of restriction imposed on health care practitioners' professional activities. Non-treatment agreements can be either stand-alone agreements or, more commonly, provisions within non-competes. They differ from non-solicits in that they prevent health care professionals from treating a former patient even if the patient requests continued treatment from that professional. Some states: Disfavor non-treatment provisions as a matter of public policy. For example, the Arizona Supreme Court held that a non-treatment clause prohibiting a physician from providing medical care or assistance to former patients for three years within five miles of any of the employer's offices was not reasonable. Among other reasons, the court stated that a patient's right to see the doctor of their choice is entitled to substantial protection and that the covenant violates public policy because of the sensitive and personal nature of the doctor-patient relationship. (Valley Med. Specialists v. Farber, 982 P.2d 1277, 1285 (Ariz. 1999).) Prohibit non-treatment provisions for certain types of patients. For example, Texas law requires restrictive covenants to provide that a physician will not be prohibited from providing continuing care and treatment to a specific patient or patients during the course of an acute illness even after the contract or employment has been terminated (Tex. Bus. & Com. Code Ann. § 15.50(b)(3)). Ethical Concerns With Physician Non-Competes In addition to the challenges of enforcing non-competes generally, imposing non-compete restrictions on physicians may raise ethical issues for practitioners. According to an American Medical Association (AMA) ethics opinion, non-competes 'restrict competition, can disrupt continuity of care, and may limit access to care.' The opinion states that: While the AMA ethics opinion may raise legitimate concerns about health care non-competes, it merely discourages, but does not prohibit, these agreements. Although a court tasked with deciding a contract dispute may consider the opinion as a factor when balancing the equities, the opinion is not legally binding. In addition to the challenges of enforcing non-competes generally, imposing non-compete restrictions on physicians may raise ethical issues for practitioners. According to an AMA ethics opinion, non-competes 'restrict competition, can disrupt continuity of care, and may limit access to care.' Most courts addressing the issue have not found that the AMA ethics opinion (or its predecessor versions) renders physician non-competes per se void (see, for example, Mohanty v. St. John Heart Clinic, S.C., 866 N.E.2d 85, 94 (Ill. 2006) (explaining that the opinion discourages but does not prohibit restrictive covenants in physician employment contracts, is not the equivalent of a statute or rule of professional conduct, and does not render physician non-competes per se void); see also Skaf v. Wy. Cardiopulmonary Servs., P.C., 495 P.3d 887, 897 (Wyo. 2021) (finding, before the state enacted a statutory ban, that nothing in the opinion renders physician non-competes per se void)). At least one court has relied on the AMA ethics opinion in concluding that most physician non-competes violate public policy (Murfreesboro Med. Clinic, P.A. v. Udom, 166 S.W.3d 674 (Tenn. 2005)). However, that case has been superseded by Tennessee's health care non-compete statute, which allows physician non-competes under certain circumstances (see Tennessee above). Other Considerations Regarding Health Care Non-Competes Several unique issues impact the use and enforceability of non-competes in the health care sector, including health care deserts, telemedicine, staffing agencies, and applications for injunctive relief. Health Care Deserts The use and enforcement of non-competes with health care professionals is further complicated when they restrict a physician's ability to provide services in a health care desert. Health care deserts (or medical deserts) are areas where access to health care services is limited. Patients may be unable to access the care they need or may experience long wait times between the request for an appointment and a consultation with a physician. This may be explained by any number of factors, such as: Scarcity of health professionals, particularly specialists, in a region. Limited health care facilities. Disproportionately high costs of access. A court tasked with determining the enforceability of a health care non-compete within a health care desert may consider public policy arguments regarding the effect, if any, of a non-compete on patients' access to medical care. For example, in Aesthetic Facial & Ocular Plastic Surgery Center, P.A. v. Zaldivar, the court held that a non-compete restricting a physician's practice of a sub-specialty of oculo-facial surgery was unenforceable as against public policy (826 S.E.2d 723, 728-30 (N.C. Ct. App. 2019)). In reaching this conclusion, the court evaluated the risk that the physician non-compete presented to the public by considering: The shortage of specialists in the field in the restricted area. The impact of establishing a monopoly in the restricted area, including fees and availability of doctors for emergencies. The public interest in having a choice in the selection of a physician. (Aesthetic Facial, 826 S.E.2d at 727.) Telemedicine E-commerce has made geographic boundaries less relevant for many businesses, including health care practices engaged in telemedicine. Telemedicine enables health care practitioners to provide diagnostic, treatment, and monitoring services to their patients remotely, often allowing patients to connect with physicians and other health care providers beyond the area or state where the patients reside. It is especially useful in providing greater access to treatment and services for individuals in health care deserts, such as rural or other traditionally underserved areas. (For more information, see Telehealth: Overview on Practical Law.) The use of telemedicine expanded dramatically during the COVID-19 pandemic and continues in the post-pandemic environment. The fact that physicians engaged in telemedicine may treat patients over a broader geographic area (potentially in multiple states) than in traditional medical practice raises practical and policy considerations when assessing the enforceability of non-competes. This is especially true regarding the reasonableness of a covenant's geographic scope and the application of appropriate state law. Employers and others drafting non-competes, non-solicits, and non-treatment agreements for health care professionals should consider the possibility that the workers subject to those restrictions may provide competitive services via telecommunication, rather than in person. For example, imagine a doctor who resigned from a position treating patients in person at a Virginia medical practice and who is subject to a post-employment non-compete that prevents the doctor from working for a competing practice or soliciting former patients within a designated region of Virginia. If the doctor lives in Maryland, it is unclear whether providing telemedicine services from Maryland to patients in Virginia would violate the non-compete. While there is little case law addressing the impact of the location of a telemedicine practice on the enforceability of non-competes, guidance from medical regulatory boards in the context of licensing requirements suggests that the location of the patient, rather than the physician, is likely to be controlling. For example, the Virginia Board of Medicine states: 'The practice of medicine occurs where the patient is located at the time telemedicine services are used, and insurers may issue reimbursements based on where the practitioner is located. Therefore, a practitioner must be licensed by, or under the jurisdiction of, the regulatory board of the state where the patient is located and the state where the practitioner is located.' (Virginia Board of Medicine Telemedicine, Guidance document 85-12 (revised June 24, 2021, effective Aug. 19, 2021); for a chart on telemedicine requirements for providers in all 50 states and the District of Columbia, see State Telehealth Requirements for Private Payors Chart on Practical Law.) Another issue to consider is the degree to which a telemedicine health care employer can enter into a reasonable non-compete or non-solicit with a physician who treats patients remotely over a broad geographic area. While the health care employer may have a legitimate business interest in restricting the physician from practicing anywhere the physician had treated patients, depending on the size and locations of the employer's roster of patients, a multi-state or nationwide restriction may be overly broad and unenforceable if it realistically prevents the physician from practicing medicine. Staffing Agencies Many hospital health care workers, such as nurses, anesthesiologists, and radiologists, are employed by employment or staffing agencies. These workers commonly enter into contracts with the staffing agencies that restrict them, for a specified time period after the contract's termination, from working for the agencies' clients (that is, the hospitals or other institutions where the workers perform medical services) or for competing agencies. Staffing agencies also often enter into agreements with hospitals and other client institutions prohibiting the institutions from directly hiring those workers for a specified time period following the termination of their employment with the agencies or their assignment with the client institutions. Some state statutes prohibit or limit the staffing agencies from entering into these agreements. For example, Iowa has a worker-friendly statute prohibiting a health care employment agency from entering into a contract with an agency worker or health care entity where the contract: Restricts the employment opportunities of an agency worker by including a non-compete provision. Requires the payment of liquidated damages, employment fees, or other compensation if the health care entity later hires an agency worker as a permanent employee. (Iowa Code Ann. § 135Q.2(3).) Kentucky has a similar statute regarding temporary direct care staff contracted with or employed by a health care services agency. It prohibits health care services agencies from: Restricting the employment opportunities of an agency employee, including by using contractual non-competes or buyout clauses. Requiring the payment of liquidated damages, employment fees, or other compensation if the institution where the agency employee worked later hires them as a permanent employee. (KRS 216.724.) Courts also have grappled with the issues raised by medical staffing agency non-competes. For example, in St. Joseph's Hospital Health Center v. American Anesthesiology of Syracuse, P.C., the plaintiff hospital sued staffing companies that had assigned their employees (anesthesiologists and nurse anesthetists) to the hospital. The hospital and staffing companies had entered into an agreement that prohibited the hospital, for two years after the termination of the agreement, from soliciting employees or taking action to cause employees to end their employment with the staffing companies. The staffing companies also had entered into non-competes with their employees. (2024 WL 4930688, at *1-2 (N.D.N.Y. Dec. 2, 2024).) After the hospital terminated the agreement, it extended employment offers to many staffing company employees, claiming that this action was necessary to hire enough anesthesiologists. The hospital sued the staffing companies, claiming that they engaged in antitrust violations (an unreasonable restraint of trade and unlawful monopolization). The staffing companies counterclaimed for breach of contract. The court denied the staffing companies' motion to dismiss the antitrust claims, advising the parties that non-competes and non-solicits would be carefully scrutinized and that public policy favors access to medical professionals. (St. Joseph's, 2024 WL 4930688, at *3-6; see also Magtoles v. United Staffing Registry, Inc., 665 F. Supp. 3d 326, 347-49 (E.D.N.Y. 2023) (refusing to enforce a staffing company's nationwide non-compete with nurses, noting that it would be 'plainly harmful to the general public if dozens of licensed nurses and practitioners were prohibited from contributing their services to an industry as valuable and important as nursing').) Applications for Injunctive Relief Non-compete litigation often involves applications to courts for injunctive relief, such as a temporary restraining order (TRO) or preliminary injunction (PI). Among the factors considered by the courts in granting or denying the requested relief is a balancing of the equities, namely, the harm to the employer if the court denies the relief weighed against the harm to the employees or the general public if the court grants it. In the case of health care non-competes, the public harm may be significant, especially in health care deserts and other less populated areas, because the court's order may impact patient choice and health care access. For example, parties seeking enforcement of restrictive covenants may seek a TRO or PI prohibiting medical professionals from engaging in the practice of medicine or a given specialty within a defined geographic region. This in turn may prevent these medical professionals from: Working for competitors or opening a new practice in the area. Soliciting their former patients. Treating their former patients and therefore disrupting continuity of care. Conversely, health care employers have legitimate business interests in protecting: In the case of health care non-competes, the public harm may be significant, especially in health care deserts and other less populated areas, because the court's order may impact patient choice and health care access. Many factors impact courts' decisions on applications for equitable relief involving health care non-competes. As with other non-competes, these determinations involve a fact-specific analysis. Courts may be more hesitant to grant injunctive relief regarding health care non-competes given the possible effects on patients' access to adequate health care (including specialty care) and patients' ability to see the medical professionals they choose. (For a collection of resources on injunctive relief generally, see Injunctive Relief Toolkit (Federal) on Practical Law.) Best Practices for Using and Enforcing Health Care Non-Competes For health care professionals and the entities that employ them, regulatory and policy issues may affect the enforceability of health care non-competes. These issues apply to non-competes entered into in connection with the purchase or sale of a medical practice, although these situations are often addressed by statute. The applicable laws vary widely across jurisdictions and are changing rapidly. Health care employers and their counsel should follow certain best practices when drafting, implementing, and enforcing non-competes. For example, they should: Continue to monitor changes in federal and state law that may affect health care non-competes, including changes to general non-compete laws in jurisdictions where health care non-competes are not specifically regulated, and consult with counsel for the latest developments. Implement annual reviews of health care non-competes to assess their continuing enforceability, and revise, replace, or revoke the non-competes as appropriate. Consider alternative protections for confidential information. Patient lists and other information can be protected as trade secrets or confidential information if the employer takes sufficient measures to preserve confidentiality, such as by: If considering litigation to enforce a health care non-compete, counsel should gather evidence, strategize, and realistically assess their chance of success before proceeding (for more on litigating restrictive covenant and trade secret cases, see Preparing for Non-Compete Litigation, Trade Secrets Litigation, and Employment Litigation: DTSA Claims on Practical Law).
Daily Mail
an hour ago
- Daily Mail
Girl, 9, has hand bitten off by 8ft shark while snorkeling off Florida coast
A nine-year-old had her hand bitten off by an 8ft shark on Wednesday when she was attacked while snorkeling off the coast of Florida with her family. Leah Lendel, nine, was swimming in the waters Boca Grande with her mother Nadia and her siblings at around noon. Bystanders said a bull shark bit off her right hand and part of her wrist as she emerged from the water covered in blood. With the help of nearby construction workers, the family called 911 and created a tourniquet out of a beach towel to stop the bleeding. Leah was airlifted along with her father was airlifted to Tampa, 100 miles away and admitted for emergency surgery in which the limb was reattached. One of the construction workers, Alfonso Tello, told local outlets: 'When we see that little girl come out from the water with no hand, it was like something out – it gets me. Everybody was in shock.' Tello and his coworkers were on lunch break when he heard the girl's screams. The men rushed to the water to help, unaware they had just witnessed a shark attack. Tello's coworker Raynel Lugo told WINK: 'The hand, it was just hanging by this piece. The whole thing was completely hanging out. You can see bones all completely red.' Her mother, Nadia Lendel, an Instagram blogger with almost 100,000 followers, posted an update to her supporters just after the attack. 'Please keep our family in your prayers. Leah got bit by a shark today while snorkeling. She has to get airlifted to the hospital and is undergoing surgery.' In her update to a CBS affiliate, Nadia said: 'They had to get arteries from her leg to the hand. Got the blood flow back to her hand. Install pins in bones. Still has open tissues. 'They will be monitoring her here for a week. But thank God she can move her fingers.' Leah Lendel's uncle Max Derinsky also offered NBC News further details on the girl's condition: 'The doctors were able to do some miracles and put her hand back together. 'She will be in the hospital for a while and then a lot of physical therapy to hopefully get her hand functioning again.' In Boca Grande, May through July is known as tarpon season, when the large fish are most populous around the island. Their most active period also coincides with shark mating season. The Boca Grande Fire Department Chief CW Blosser told local news outlets that in his time as chief, he'd only seen two shark attacks. Both of them were during tarpon season. Bull sharks are attracted to the schools of tarpon and pose a risk to swimmers and those fishing in the area.
