Dedrick v. Youngblood, 98-6499

• Citation: 200 F.3d 744
• Decision Date: 12 January 2000
• Docket Number: No. 98-6499,98-6499
• Parties: (11th Cir. 2000) Maggie DEDRICK, individually, & as mother & next friend of Lakendra Dedrick, deceased minor, Plaintiff-Appellee, v. Dr. Clifton YOUNGBLOOD, et al., Defendant-Appellant.
• Court: United States Courts of Appeals. United States Court of Appeals (11th Circuit)

Page 744

200 F.3d 744 (11th Cir. 2000)

Maggie DEDRICK, individually, & as mother & next friend of Lakendra Dedrick, deceased minor, Plaintiff-Appellee, v. Dr. Clifton YOUNGBLOOD, et al., Defendant-Appellant.

No. 98-6499.

United States Court of Appeals, Eleventh Circuit.

Jan. 12, 2000.

Appeal from the United States District Court for the Northern District of Alabama. (No. 98-00961-CV-C-W), U.W. Clemon, Judge.

Before BLACK, Circuit Judge, and GODBOLD and FAY, Senior Circuit Judges.

GODBOLD, Senior Circuit Judge:

This case involves the interpretation of a public health service employee under the Federally Supported Health Centers Assistance Act. The Act was enacted in 1992 to reduce the growing costs of malpractice insurance to private nonprofit health centers that provide health services to medically underserved populations, commonly referred to as " 245(b) health centers" or "eligible entities." The Act essentially makes the U.S. government the medical malpractice insurer for qualifying 245(b) health centers, their officers, employees, and contractors, allowing these "deemed" health centers to forgo obtaining private malpractice insurance. Youngblood based his appeal on an expanded interpretation of the definition of a contractor under 233.

We must decide whether a doctor is considered a U.S. Public Health Service Employee within the meaning of 233 of the Act if at the time he allegedly committed malpractice he was performing medical services as an employee of a legal entity that has contracted with a FSHCAA eligible health care entity. It appears that we are the first circuit to address this issue.¹ The district court remanded the case after it determined that Dr. Youngblood was not a contractor with provider coverage under the definition provided in 233 of the Act. We agree that Youngblood is not a covered provider under 233 and affirm the decision of the district court.

Determining the contractual relationship of the parties is essential to properly interpreting this statute.² Youngblood entered into an employment contract with Capstone Health Services Foundation for a term of one year. Under the terms of the contract Youngblood became a member of the OB-GYN Department of the University of Alabama School of Medicine, Tuscaloosa. Capstone contracted to obtain professional liability insurance for Youngblood. Shortly after Youngblood entered into his employment contract with Capstone, Capstone entered into a provider agreement with West Alabama Health Services, Inc. Capstone agreed to provide OB-GYN related services to Medicaid eligible pregnant women at West Alabama facilities. The contract provided that Capstone would maintain malpractice insurance for its employees.

Youngblood treated Maggie Dedrick while he was providing OB-GYN services to a West Alabama clinic. Youngblood concedes that at the time he provided the services he was "on-call" for West Alabama pursuant to the provider contract between Capstone and West Alabama. Capstone billed West Alabama for the services rendered by Youngblood to Dedrick.

Dedrick filed a malpractice action against Youngblood in Alabama state court for alleged negligent acts that occurred during the treatment of her pregnancy. Youngblood removed the case to federal court on the ground that he was a covered employee under 233 of the Act. He contends that federal jurisdiction was proper because of the special relationship between the Act and the Federal Tort Claims Act, 28 U.S.C. 1346(b). The Act provides the exclusive remedy for medical malpractice of employees or contractors of the Public Health Service. However, the district court held that Youngblood was not a Public Health Service "employee" under 233 at the time of the alleged medical malpractice and remanded the case to state court.

The Act defined a Public Health Service employee to include "an entity described in [ 233(g)(4)], and any officer, governing board member, or employee of such an entity, and any contractor of such an entity who is a physician or other licensed or certified health care practitioner (subject to paragraph 5)." 42 U.S.C. 233(g)(1)(A). Paragraph (5) states:

an individual may be considered a contractor of an entity ... only if ..

A)the individual normally performs on average of at least 321/2 hours of service per week for the entity for the period of the contract. 233(g)(5); or

B)in the case of an individual who normally performs less than 321/2 hours of service per week for the entity for the period of the contract, the individual is a licensed or certified provider of services in the fields of family practice, general internal medicine, general pediatrics, or obstetrics and gynecology.

42 U.S.C. 233(g)(5).

Although Youngblood is an employee of Capstone and has no separate contract with West Alabama, he contends that the statute does not exclude him because it does not explicitly require direct contractual relations with West Alabama for him to be "deemed" an employee. Youngblood contends that the Act permits an individual physician to be "deemed" a Public Health Service employee if that physician performs services for a public health entity pursuant to a contract. However, strict interpretation requires that a contractor be an "individual" who contracts with an eligible entity. 42 U.S.C. 233(g)(1)(A); 233(g)(5).

Suits brought under the FTCA are generally limited to those claims arising from the negligent conduct of government employees. 28 U.S.C. 1346(b). The FTCA retains sovereign immunity over claims against contractors. See Tisdale v. U.S., 62 F.3d 1367, 1371 (11th Cir.1995). However, when a statute like the Act expands the liability of the government we must strictly construe the language used by Congress because the inclusion of contractor liability serves as an expanded waiver of sovereign immunity. See, e.g., Department of the Army v. Blue Fox, Inc., 525 U.S. 255, 119 S.Ct. 687, 691, 142 L.Ed.2d 718 (1999).

The expanded definition of a "contract employee" under 233(g) of the Act to certain contractors of qualified health centers is clearly not an unlimited extension to all contractors. The text of 233(g) states "or any contractor of such an entity who is a physician or other licensed or certified health care practitioner." 42 U.S.C. 233. We interpret the personal pronoun "who" as identifying only individual physicians who contract with eligible entities, not organizations or foundations who contract with eligible entities.³

The statutory language of the Act requires us to distinguish contracts by which an individual physician contracts with the eligible entity and those where the physician uses a separate entity,...