Barlow v. Marion Cty. Hospital Dist., 80-15-Civ-Oc.

• Decision Date: 29 July 1980
• Docket Number: No. 80-15-Civ-Oc.,80-15-Civ-Oc.
• Citation: 495 F. Supp. 682
• Parties: Frances C. BARLOW et al., Plaintiffs, v. MARION COUNTY HOSPITAL DISTRICT, d/b/a Munroe Memorial Hospital et al., Defendants.
• Court: U.S. District Court — Middle District of Florida

495 F. Supp. 682

Frances C. BARLOW et al., Plaintiffs, v. MARION COUNTY HOSPITAL DISTRICT, d/b/a Munroe Memorial Hospital et al., Defendants.

No. 80-15-Civ-Oc.

United States District Court, M. D. Florida, Ocala Division.

July 29, 1980.

COPYRIGHT MATERIAL OMITTED

Judy R. Collins, Gainesville, Fla., for plaintiffs.

James A. Cornelius, Ocala, Fla., for Munroe Memorial Hospital.

John E. Lawlor, III, Asst. U. S. Atty., Jacksonville, Fla., for HEW.

James G. Mahorner, Asst. Gen. Counsel, Dept. of Health & Rehabilitative Services, Tallahassee, Fla., for State of Florida.

OPINION

CHARLES R. SCOTT, District Judge.

Before the Court are three motions: two motions to dismiss and one motion denominated a motion for summary judgment which the Court will consider as a motion to dismiss. The motions will be denied, but the plaintiffs will be required to amend their complaint.

This action, which purports to be a class action, is brought by several former patients of Munroe Memorial Hospital against a number of defendants which can be conveniently separated into three groups. The first group consists of the hospital special tax district, Marion County Hospital District (the Hospital); the hospital administrator; and the members of the board of trustees of the hospital district. This group will be referred to as the hospital defendants. The second group is composed of the Florida Department of Health and Rehabilitative Services and the Secretary and medical facility specialist of that department. The second group will be referred to as the State defendants. The third and final group consists of the United States Department of Health, Education and Welfare (HEW) and the Secretary of HEW.¹ They will be referred to as the federal defendants.

Reduced to its simplest terms, the complaint alleges that the hospital defendants failed to provide the plaintiffs with free or reduced-cost medical services to which they were allegedly entitled as qualified, indigent persons under Title VI of the Public Health Service Act, as amended, 42 U.S.C. § 291 et seq., commonly known as the Hill-Burton Act.² Each of the named plaintiffs received treatment for which they were unable to pay and subsequently had judgments entered against them in state court as a result of the Hospital's collection efforts to recover the full cost of treatment. With regard to the hospital defendants, plaintiffs request the following relief:

(1) a declaratory judgment that these defendants violated the Hill-Burton Act and the rights of the plaintiffs to equal protection and due process,

(2) an injunction prohibiting continued violation of the Act and further collection activities of the type alleged, and

(3) a mandatory injunction requiring satisfaction of judgments obtained, compensation for money received in payment, correction in the future of any past deficit in the provision of free or reduced-cost services, cessation of all debt collection efforts, and the provision of written notice and eligibility determinations with regard to the plaintiffs and the class of persons which they purport to represent.

The complaint further alleges that the state and federal defendants failed to comply with their statutory duties to monitor or investigate and enforce compliance with the Hill-Burton Act and pertinent regulations. Plaintiffs seek the following relief against the state and federal defendants:

(1) a declaratory judgment that the state and federal defendants violated the Hill-Burton Act and the right of the plaintiffs to equal protection and due process,

(2) an injunction prohibiting future violations, and

(3) a mandatory injunction requiring the state and federal defendants to devise and submit for their respective agencies a plan for court approval, detailing the manner in which future monitoring or investigation and enforcement of compliance will be carried out.

The complaint states that this action arises under the Fifth and Fourteenth Amendments to the Constitution, the Hill-Burton Act, and the Civil Rights Act of 1871, 42 U.S.C. § 1983. The plaintiffs invoke the Court's jurisdiction under 28 U.S.C. §§ 1331 and 1343.

Legislative History³

The Hill-Burton Act was intended to help the states assess their need for additional medical facilities adequate to serve all their citizens and to provide federal money to partly defer construction costs. Public Health Service Act, Title VI, §§ 600 and 601, 42 U.S.C. §§ 291 and 291a (1974). The language of the Act denotes shared state and federal agency responsibility. Initially, the Surgeon General was given supervision over the Hill-Burton Act, with authority to approve state plans for its implementation. This responsibility later passed to HEW. The federal agency was authorized to issue regulations requiring, as a prerequisite to the approval of any hospital application, that the hospital give assurances to the state agency that it would provide service to the entire community without discrimination (the community service assurance), and that a reasonable volume of services would be made available to indigent persons (the uncompensated service assurance). 42 U.S.C. §§ 291c(e)(1) and (2). The instant action concerns the so-called uncompensated service assurance.

The uncompensated service assurance played only a minor role until 1972, when a series of lawsuits apparently moved HEW to issue new regulations which transformed the statutory "reasonable volume of services" into more specific "presumptive compliance levels" and provided for the enforcement of compliance primarily through the state agencies. 42 C.F.R. §§ 53.111(b)(6), (d), and (i). Huddleston, Due Process for Hill-Burton Assisted Facilities, 32 Vand.L.Rev. 1469, 1472-73 (1979); Rosenblatt, Health Care and Administrative Law: A Structural Approach, 88 Yale L.J. 243, 264-70 (1978). The regulations were further amended in 1975 to require that eligibility for uncompensated services be determined before services are rendered in routine cases and that hospitals post notices of the availability of these services. 42 C.F.R. §§ 53.111(f) and (i). These are, for the most part, the regulations which were in effect during the periods alleged in the complaint in the instant case.

The statutory provisions concerning enforcement of the uncompensated service assurance, however, changed significantly in 1975. When funding for the original Hill-Burton Act ran out in 1974, Congress replaced it with the National Health Planning and Resources Development Act of 1974, Title XVI of the Public Health Service Act, as amended, 42 U.S.C. § 300k et seq. 43 Fed.Reg. 49,954-55 (1978). Section 1612(c) of Title XVI, 42 U.S.C. § 300p-2(c) redesignated Section 1627, 42 U.S.C. § 300s-6 shifted to HEW the duty to investigate and enforce compliance and provided for a private civil action against facilities to enforce compliance.⁴ 43 Fed.Reg. 49,955 (1978). It would appear, then, that the regulations in effect at all times pertinent to the events which spawned the instant complaint were based upon statutory authority superseded in part by the enactment of Title XVI. Some four years later, in 1979, HEW promulgated extensive regulations implementing the new statutory authority.⁵

The Instant Case

The complaint goes beyond an action to require the hospital to abide by the assurances which it gave in order to receive federal assistance under the Hill-Burton Act, although that is certainly the central purpose of the lawsuit. The plaintiffs also ask the Court to remedy the alleged failure of the state and federal agencies, to which Congress gave the responsibility for implementing the Hill-Burton Act, to take all reasonable steps to prevent a denial of uncompensated medical services to eligible indigent persons.

The hospital defendants assert that the attempt to enforce compliance and obtain other relief against them in this lawsuit must be dismissed because this Court lacks jurisdiction over the subject matter and because the complaint fails to state a claim for which relief can be granted, pursuant to Rules 12(b)(1) and (6), Fed.R.Civ.P. Addressing the Rule 12(b)(6) basis first, the claim that the hospital defendants have violated their assurances under the Hill-Burton Act and otherwise violated the terms of compliance with the federal statute and regulations is a statutory claim for which this Court may grant relief. Public Health Services Act § 1612, 42 U.S.C. § 300p-2(c) redesignated § 1627, 42 U.S.C. § 300s-6. 28 U.S.C. § 1331. Moreover, the claim that the hospital defendants have deprived eligible persons of the right to the benefits of this Act without due process of law or that a class of those persons have been denied the laws' equal protection is certainly a constitutional claim for which this Court may grant relief. Newsom v. Vanderbilt University, 453 F.Supp. 401 (M.D.Tenn. 1978). Qualified indigent persons are lawful beneficiaries of the Hill-Burton Act as it pertains to uncompensated medical services and may not be deprived of those benefits in violation of the Fourteenth Amendment. Id. A claim under the Fourteenth Amendment, of course, can also be the subject of a civil rights suit pursuant to 42 U.S.C. § 1983, if the claim meets the other requirements of that statute. Likewise, the Supreme Court has recently removed any doubt that a claimed deprivation of civil rights based upon a violation of a federal statute can be brought under § 1983. Maine v. Thiboutot, ___ U.S. ___, 100 S.Ct. 2502, 65 L.Ed.2d 555 (1980) (§ 1983 encompasses claims based on purely statutory violations of federal law, such as Social Security Act).

The hospital defendants argue that the complaint nevertheless fails to state a claim under § 1983 because the allegations do not plead all of the essential elements and because the plaintiffs do no allege that the hospital defendants' actions implemented or executed "a policy statement, ordinance, regulation, or decision officially adopted or promulgated by that...