Moody Emergency Med. Services v. City of Millbrook

• Decision Date: 12 June 1997
• Docket Number: Civil Action No. 96-C-1827-N.
• Citation: 967 F.Supp. 488
• Parties: MOODY EMERGENCY MEDICAL SERVICE, INC., Plaintiff, v. The CITY OF MILLBROOK, et al., Defendants.
• Court: U.S. District Court — Middle District of Alabama

967 F.Supp. 488

MOODY EMERGENCY MEDICAL SERVICE, INC., Plaintiff, v. The CITY OF MILLBROOK, et al., Defendants.

Civil Action No. 96-C-1827-N.

United States District Court, M.D. Alabama, Northern Division.

June 12, 1997.

COPYRIGHT MATERIAL OMITTED

Neva C. Conway, Millbrook, AL, for Plaintiff.

Alex L. Holtsford, Jr., Nix, Holtsford & Vercelli, P.C., Montgomery, AL, Bob Allen, Millbrook, AL, for Defendants.

MEMORANDUM OPINION AND ORDER

CARROLL, United States Magistrate Judge.

This matter is before the court for consideration of defendants' motions to dismiss filed January 9, 1997, and April 4, 1997. For the reasons discussed below, the court finds that the motions are due to be granted.

I. INTRODUCTION

Plaintiff, Moody Emergency Medical Service, Inc., filed this action against the City of Millbrook, Alabama, its mayor Al Kelly, individually and in his official capacity, its Chief of the Fire Department Larry Brown, individually and in his official capacity, and Millbrook's former mayor and fire department chief, Moe Minor and Sidney Turner, respectively,¹ alleging that the city of Millbrook has a custom, policy and practice of referring emergency 911 calls only to the Millbrook Fire Department/Rescue Services. Plaintiff argues that Millbrook's method of assigning emergency 911 calls allows the establishment of a monopoly by one emergency service provider, namely, the city of Millbrook's Fire Department. Plaintiff contends that Millbrook's practice violates the equal access provision of the Medicaid Subchapter of the Social Security Act, 42 U.S.C. § 1396a(a)(30)(A), the Fifth and Fourteenth Amendments of the United States Constitution and various state laws. Plaintiff seeks compensatory, declaratory and injunctive relief. Plaintiff alleges that this court has jurisdiction pursuant to 28 U.S.C. §§ 1331 and 1343.

After the Millbrook defendants moved to dismiss the complaint against them, plaintiff amended the complaint to add the Commissioner of the Alabama Medicaid Agency, Gwen Williams, in her official capacity, as a defendant. Plaintiff contends that the Alabama Medicaid Agency has failed to provide and enforce a proper and efficient plan to provide medical services to Medicaid and/or Medicare recipients. Plaintiff does not allege any additional causes of action against defendant Williams. Defendant Williams also moved to dismiss the complaint.

Defendants argue that the complaint should be dismissed for failure to state a claim. Defendants contend that plaintiff's claim alleging violation of the equal access provision of the Social Security Act must fail because Moody Emergency Services does not have standing to seek relief under that statute and plaintiff does not state a claim that is actionable under Section 1396a(a)(30)(A); and plaintiff's complaint does not allege a violation of the Fifth or Fourteenth Amendments. Additionally, defendant Williams argues that the complaint against her should be dismissed because she has no authority over Millbrook's operation of its 911 emergency service system.

II. STANDARD OF REVIEW

The law is well settled that a complaint cannot be dismissed for failure to state a claim unless it appears beyond doubt that the plaintiff can prove no set of facts which would entitle him to relief. Hishon v. King & Spalding, 467 U.S. 69, 73, 104 S.Ct. 2229, 2232, 81 L.Ed.2d 59 (1984); Scheuer v. Rhodes, 416 U.S. 232, 236, 94 S.Ct. 1683, 1686, 40 L.Ed.2d 90 (1974); Conley v. Gibson, 355 U.S. 41, 45-46, 78 S.Ct. 99, 101-102, 2 L.Ed.2d 80 (1957). In considering a motion to dismiss the court must construe the facts alleged in the complaint in the light most favorable to the plaintiff.² Scheuer, 416 U.S. at 236, 94 S.Ct. at 1686; Conley, 355 U.S. at 45-46, 78 S.Ct. at 101-102; Burch v. Apalachee Community Mental Health Services, Inc., 840 F.2d 797, 798 (11th Cir.1988), aff'd sub nom. Zinermon v. Burch, 494 U.S. 113, 110 S.Ct. 975, 108 L.Ed.2d 100 (1990). If the allegations in the complaint do not state a cause of action as a matter of law, the motion to dismiss should be granted. Neitzke v. Williams, 490 U.S. 319, 326-327, 109 S.Ct. 1827, 1832-1833, 104 L.Ed.2d 338 (1989).

III. DISCUSSION

The question before the court is whether a private emergency medical service may maintain an action against a municipality and state medicaid agency challenging the city's method for referring emergency 911.

1. Statutory Claim

Section 1983 creates a private right of action for damages and injunctive relief against individuals and governmental entities whose conduct under the color of state or local law deprives a plaintiff of rights, privileges or immunities secured by the U.S. Constitution or federal laws. 42 U.S.C. § 1983 (1982).³ On its face, Section 1983 redresses violations of federal statutes as well as constitutional rights. Maine v. Thiboutot, 448 U.S. 1, 4, 100 S.Ct. 2502, 2504, 65 L.Ed.2d 555 (1980). In application, however, the Supreme Court has carved two exceptions wherein claims alleging statutory violations are not actionable under Section 1983. A plaintiff may not maintain a suit based on violation of a federal statute if (1) "the statute [does] not create enforceable rights, privileges, or immunities within the meaning of Section 1983," or (2) "Congress has foreclosed such enforcement of the statute in the enactment itself." Wilder v. Virginia Hosp. Ass'n, 496 U.S. 498, 508, 110 S.Ct. 2510, 2516, 110 L.Ed.2d 455 (1990) (quoting Wright v. Roanoke Redevelopment & Housing Auth., 479 U.S. 418, 423, 107 S.Ct. 766, 770, 93 L.Ed.2d 781 (1987)). See also Golden State Transit Corp. v. City of Los Angeles, 493 U.S. 103, 106, 110 S.Ct. 444, 448, 107 L.Ed.2d 420 (1989). Therefore, a plaintiff cannot pursue remedies under Section 1983 based on a violation of federal statutory rights or privileges unless the statute creates an enforceable right and Congress has not specifically foreclosed a remedy under Section 1983. Silver v. Baggiano, 804 F.2d 1211, 1216 (11th Cir.1986).

The Supreme Court has ruled definitively that based on the legislative history and language of the Medicaid Subchapter of the Social Security Act, particularly that the Subchapter does not include provisions for private judicial or administrative enforcement, Congress did not foreclose a private right of remedy under Section 1983 for violations of the Medicaid Act. Wilder, 496 U.S. at 517-523, 110 S.Ct. at 2521-2525. Additionally, it is not a point of contention among the parties that Congress has not foreclosed a private right of action for violations of the Medicaid Act. Therefore, the issue this court must address is whether the equal access provision of the Medicaid Act, 42 U.S.C. § 1396a(a)(30)(A), "creates an enforceable right."

A. Private Enforceability of Section 1396a(a)(30)(A)

In assessing whether a federal statute creates a private enforceable right the court must determine whether (1) the plaintiff is the intended beneficiary of the violated provision; (2) the violated provision creates a binding obligation on the defendant governmental unit rather than reflecting a "congressional preference" for a certain kind of conduct; and (3) the interest asserted by plaintiff is "too vague and amorphous" such that it is "beyond the competence of the judiciary to enforce."⁴ Wilder, 496 U.S. at 509, 110 S.Ct. at 2517.

The starting point for determining whether a statute creates an-enforceable private right of action is the statute itself. The Medicaid program is a cooperative between the federal and state governments for providing medical services to qualifying recipients. Silver, 804 F.2d at 1215. State participation in the Medicaid program is voluntary. If a state chooses to participate, however, it must comply with the requirements outlined in the Medicaid Subchapter of the Social Security Act. Wilder, 496 U.S. at 502, 110 S.Ct. at 2513; 42 U.S.C. § 1396a. A participating state must submit a plan for providing medical services to qualified recipients which is approved and partially subsidized by the federal government. See 42 U.S.C. § 1396. The requirements that the state plan for medical assistance must satisfy are provided in Section 1396a(a). Among the requirements is that a participating state must

provide such methods and procedures relating to the utilization of, and the payment for, care and services available under the plan (including but not limited to utilization review plans as provided for in section 1396b(i)(4) of this title) as may be necessary to safeguard against unnecessary utilization of such care and services and to assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area

42 U.S.C. § 1396a(a)(30)(A).⁵ This provision is commonly referred to as the "equal access" clause.

The equal access clause creates two distinct substantive rights: (1) the state's methods and procedures for reimbursement must ensure "equal access" to medical care and services; and (2) the reimbursement rates derived under the state's method must be sufficient to retain an adequate number of health care providers. Visiting Nurse Ass'n, 93 F.3d at 1011; Arkansas Medical Society, Inc. v. Reynolds, 6 F.3d at 522 & 529-530. The purpose of the "equal access" provision is to require the state to focus its attention on the adequacy of its reimbursement levels to encourage participation of health care providers. Clark v. Kizer, 758 F.Supp. 572, 578 (E.D.Cal.1990). A state plan breaches its obligation under the equal access provision if the state reimbursement rate is so inadequate that the number of participating Medicare health care providers is substantially lower than the number of health care providers available to the general population, id. at 576-577, if the procedures and method for Medicare...