Krasny v. Waser
| Decision Date | 25 June 2001 |
| Docket Number | No. 6:01-CV-405-ORL-31JGG.,6:01-CV-405-ORL-31JGG. |
| Parties | Scott D. KRASNY, Plaintiff, v. Gregory WASER, Waser & Associates, Barbara Abbott, Christopher J. Prusinski, Aetna Life Insurance Company, d/b/a Aetna U.S. Healthcare, Aetna Us. Healthcare, Inc., Defendants. |
| Court | U.S. District Court — Middle District of Florida |
Pamela Mark Burke, Ocoee, FL, for plaintiff.
Thomas Dukes, Orlando, FL, for Gregory Waser, Waser & Assoc.
Lisa J. Augspurger, Orlando, FL, for Barbara Abbott.
Eugene L. Ciotoli, Palm Beach, FL, for Christopher J. Prusinki.
Steven M. Ziegler, Hollywood, FL, for Aetna Ins. Co.
This cause came on for consideration after oral argument on Plaintiff's Motion to Remand (Doc. 15, filed April 6, 2001).
Plaintiff, Scott Krasny, as personal representative of the Estate of Jeannette Rosen Withrow, originally filed this action in state court against Aetna Life Insurance Company and Aetna U.S. Healthcare, Inc. (for convenience, "Aetna") and several healthcare providers. By Notice of Removal served March 27, 2001, Aetna removed the action to this Court on the grounds of ERISA preemption. Plaintiff contends that this is simply a medical malpractice case in which Aetna is vicariously liable for the negligence of its agent physicians.1 Aetna, on the other hand, claims that the complaint calls into question the administration of its plan which thus implicates the ERISA exemption and defeats remand.
The facts alleged in the Amended Complaint may be briefly summarized as follows:
Withrow was an insured under a group health insurance plan issued by Aetna. There is no dispute that this plan is governed by the provisions of ERISA, 29 U.S.C. § 1001, et seq.
On August 17, 1998, Withrow was seen by her neurologist, Dr. Prusinski, with complaints of headaches and nausea. After examining Withrow, Prusinski ordered a STAT CT scan to determine and rule out the presence of a suspected intracranial/subarachoid hemorrhage. (Amended Complaint, ¶ 21). However, instead of immediately sending Withrow for the CT scan, Prusinski contacted Withrow's primary care physician, Dr. Waser, seeking authorization for the STAT CT scan procedure. (Amended Complaint, ¶ 24). Instead of authorizing the procedure, Waser required Withrow to appear at his office for an examination the following day. (Amended Complaint, ¶ 25).
The next day, Withrow visited Waser's office and was seen by his nurse, Barbara Abbott. For reasons which are not disclosed in the complaint, no CT scan was authorized or performed. (Amended Complaint, ¶ 27). Two days later, Withrow suffered a severe intracranial hemorrhage, which caused her death. (Amended Complaint, ¶ 28).
In his Amended Complaint, Plaintiff asserts an action "for wrongful death caused by medical malpractice". (Amended Complaint, ¶ 28). Counts I, II, and IV assert claims of negligence against Prusinski, Waser and Abbott.2 The Plaintiff alleges that Waser and Abbott "deviated from acceptable standards of care" by, inter alia, "failing to conduct a complete examination of MS. WITHROW on August 18, 1998" (Amended Complaint, ¶ 32a, ¶ 36a) and "failing to authorize the STAT CT scan of MS. WITHROW's head as ordered by DR. PRUSINSKI" (Amended Complaint, ¶ 32b, ¶ 36b). The Plaintiff alleges that Prusinski deviated from acceptable standards of care by, inter alia, "failing to recognize the significance of new symptoms MS. WITHROW presented with on August 17, 1998" (Amended Complaint, ¶ 42a) and by "advising or permitting his employee to advise MS. WITHROW that she needed clearance and/or authorization from DR. WASER before the CT scan could be performed if it was to be paid for by Aetna" (Amended Complaint, ¶ 42d).
In Counts V and VI of the Amended Complaint, Plaintiff seeks to hold Aetna Life Insurance Company and Aetna U.S. Healthcare, Inc., liable vicariously for the acts of Waser, Abbott and/or Prusinski. (Amended Complaint, ¶ 45.) In setting up his agency theory, Plaintiff alleges in ¶¶ 47 and 48 that:
47. Alternatively, AETNA impliedly represented to Plaintiff at all times material hereto, that DR. WASER, MS. ABBOTT and/or DR. PRUSINSKI were its agents, servants or employees by requiring her to be seen and examined by these "gatekeeping" health care providers before allowing or authorizing payment of necessary medical treatment such as the CT scan ordered by DR. PRUSINSKI.
48. At all times material hereto, Defendants DR. WASER, MS. ABBOT and/or DR. PRUSINSKI represented or impliedly represented they were the agents, servants or employees of AETNA by advising her who she had to see and/or be examined by before her CT scan would be paid for by AETNA, by advising her she was not authorized by AETNA to have the subject medical treatment until she was seen by one of these Defendants, and by interpreting her AETNA coverage in advising her of the foregoing information.
It is axiomatic that federal courts are courts of limited jurisdiction. Kokkonen v. Guardian Life Ins. Co. of America, 511 U.S. 375, 377, 114 S.Ct. 1673, 1675, 128 L.Ed.2d 391 (1994). They possess only that power authorized by the Constitution and by statute. Id., citing Willy v. Coastal Corp., 503 U.S. 131, 136-137, 112 S.Ct. 1076, 1080, 117 L.Ed.2d 280 (1992) and Bender v. Williamsport Area School Dist., 475 U.S. 534, 541, 106 S.Ct. 1326, 1331, 89 L.Ed.2d 501 (1986). These jurisdictional grants are not to be expanded by judicial decree. Kokkonen, 511 U.S. at 377, 114 S.Ct. 1673, citing American Fire & Casualty Co. v. Finn, 341 U.S. 6, 71 S.Ct. 534, 95 L.Ed. 702 (1951). It is to be presumed that a cause lies outside this limited jurisdiction, Kokkonen, 511 U.S. at 377, 114 S.Ct. 1673, citing Turner v. Bank of North America, 4 U.S. (4 Dall.) 8, 11, 1 L.Ed. 718 (1799), and the burden of establishing the contrary rests upon the party asserting jurisdiction, Kokkonen, 511 U.S. at 377, 114 S.Ct. 1673, citing McNutt v. General Motors Acceptance Corp., 298 U.S. 178, 182-83, 56 S.Ct. 780, 782, 80 L.Ed. 1135 (1936).
"Any civil action brought in a State court of which the district courts of the United States have original jurisdiction, may be removed by the defendant or the defendants, to the district court of the United States for the district and division embracing the place where such action is pending." 28 U.S.C. § 1441(a). District Courts have original jurisdiction over "all civil actions arising under the Constitution, laws, or treaties of the United States." 28 U.S.C. § 1331. In considering whether it possesses "federal question" jurisdiction over a removed case, a district court is guided by the "well-pleaded complaint rule," which provides that the plaintiff's properly pleaded complaint governs the jurisdictional determination. See Louisville & Nashville R.R. v. Mottley, 211 U.S. 149, 152, 29 S.Ct. 42, 43, 53 L.Ed. 126 (1908). Pursuant to that rule, a case may be removed from state court based on federal question jurisdiction only when the plaintiff's statement of his own cause of action shows that it arises under federal law. BLAB T.V. of Mobile, Inc. v. Comcast Cable Communications, Inc., 182 F.3d 851, 854 (11th Cir.1999) (citing Mottley, 211 U.S. 149, 152, 29 S.Ct. 42, 43, 53 L.Ed. 126). Stated differently, only state-court actions that could have been filed initially in federal court may be removed.3 Caterpillar, Inc. v. Williams, 482 U.S. 386, 392, 107 S.Ct. 2425, 2429, 96 L.Ed.2d 318 (1987). The presence of a federal defense does not make the case removable. BLAB T.V. of Mobile, 182 F.3d at 854, citing Caterpillar, 482 U.S. at 393, 107 S.Ct. at 2430. The well-pleaded complaint rule generally makes the plaintiff the master of the claim; in the vast majority of cases, he or she may avoid federal jurisdiction by exclusive reliance on state law. Caterpillar, 482 U.S. at 392, 107 S.Ct. at 2429. The issues raised in the plaintiff's complaint, not those added in the defendant's response, control the litigation. Jass v. Prudential Health Care Plan, Inc., 88 F.3d 1482, 1486 (7th Cir.1996).
There exists, however, an independent corollary to the well-pleaded complaint rule, known as the complete preemption doctrine. Complete preemption occurs when "`the pre-emptive force of a statute is so "extraordinary" that it converts an ordinary state common-law complaint into one stating a federal claim for purposes of the well-pleaded complaint rule.'" Caterpillar, 482 U.S. at 393, 107 S.Ct. at 2430. "Because they are recast as federal claims, state law claims that are held to be completely preempted give rise to `federal question' jurisdiction." BLAB T.V. of Mobile, Inc. v. Comcast Cable Communications, Inc., 182 F.3d 851, 854 (11th Cir.1999), citing McClelland v. Gronwaldt, 155 F.3d 507, 512 (5th Cir.1998).
The Eleventh Circuit Court of Appeals has recognized that "use of the term `preemption' in this context has caused `a substantial amount of confusion between the complete preemption doctrine and the broader and more familiar doctrine of ordinary preemption.'" Smith v. GTE Corp., 236 F.3d 1292, 1313 (11th Cir.2001). Accord, Jass v. Prudential Health Care Plan, Inc., 88 F.3d 1482, 1486-87 (7th Cir. 1996) ().4 Although they share similar titles, the doctrine of complete preemption and the doctrine of ordinary preemption present distinctly different issuesa difference not merely of scope but of quality. The former is used to establish a federal court's subject matter jurisdiction over a case, while the latter merely provides a party with an affirmative defense to a state law claim in either state or federal court. BLAB T.V. of Mobile, 182 F.3d at 854-55.
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