U.S. v. Composite State Bd. of Medical Examiners, State of Ga., No. 80-7410

CourtUnited States Courts of Appeals. United States Court of Appeals (5th Circuit)
Writing for the CourtFRANK M. JOHNSON, Jr.; MILLER
Citation656 F.2d 131
PartiesUNITED STATES of America, Plaintiff-Appellant, v. The COMPOSITE STATE BOARD OF MEDICAL EXAMINERS, STATE OF GEORGIA, et al., Defendants-Appellees. . Unit B
Decision Date14 September 1981
Docket NumberNo. 80-7410

Page 131

656 F.2d 131
UNITED STATES of America, Plaintiff-Appellant,
v.
The COMPOSITE STATE BOARD OF MEDICAL EXAMINERS, STATE OF
GEORGIA, et al., Defendants-Appellees.
No. 80-7410.
United States Court of Appeals,
Fifth Circuit.
Unit B
Sept. 14, 1981.

Page 132

Leland Ware, Dept. of Justice, Washington, D. C., for plaintiff-appellant.

John C. Jones, Asst. Atty. Gen., Atlanta, Ga., for defendants-appellees.

Appeal from the United States District Court for the Northern District of Georgia.

Before MILLER *, Judge, and FRANK M. JOHNSON, Jr. and THOMAS A. CLARK, Circuit Judges.

FRANK M. JOHNSON, Jr., Circuit Judge:

Seeking injunctive and declaratory relief, the United States Government brought this civil action against the Georgia Composite State Board of Medical Examiners, 1 its members, and the State of Georgia. Because some of the issues raised were pending in a state court action brought by the Composite Board against one of the Government's employees, the district court abstained. We reverse and remand for a determination on the merits.

In 1972 Congress established the National Health Service Corps (NHSC) for the primary purpose of alleviating severe inadequacies in the availability of professional health services in specific areas of the country. See 42 U.S.C.A. § 254d et seq. Under the supervision of the United States Public Health Services, the NHSC employs physicians and physician's assistants to provide health services in underserved areas of the country. Any public or non-profit entity located in a NHSC-designated medically underserved area may apply for the assignment of NHSC personnel. It has been the practice of the Public Health Service not to require NHSC physicians or physician's assistants to be licensed in the state in which they are assigned if they are licensed in some other state. The NHSC has engaged in the practice of allowing its physician's assistants to order routine medications.

In October 1976, at the request of the Brooks County Hospital Authority in Quitman, Georgia, the NHSC assigned one of its physicians, Dr. Norris Lewis, to Quitman. At the time of his assignment Dr. Lewis was licensed to practice medicine by the State of Georgia. Dr. Lewis' responsibilities as a NHSC physician included the supervision of the assigned paraprofessionals at the NHSC site.

Based upon the increasing patient load during the first year of Dr. Lewis' assignment, in October 1977, the Brooks County Hospital Authority requested that NHSC assign another physician to Quitman to assist Dr. Lewis. Unable to assign another physician to the Brooks County Hospital

Page 133

Authority at that time, NHSC agreed to and did assign a physician's assistant, Alan Armstrong. At the time of his assignment Mr. Armstrong was certified to provide health services as a physician's assistant in the State of New York, but he was not certified by the State of Georgia. 2 Prior to the time Mr. Armstrong began to perform his duties as a physician's assistant, Dr. Lewis and Mr. Armstrong inquired of NHSC whether Mr. Armstrong was required to be certified in Georgia; NHSC informed them that it was NHSC policy that physician's assistants need not be licensed in the state in which they serve if they are licensed by any state or certified by a National Board. Relying on this policy, Dr. Lewis and Mr. Armstrong entered into an agreement setting forth Mr. Armstrong's duties and responsibilities. The specified duties and responsibilities, which were consistent with Mr. Armstrong's position description, included the ordering of routine medications. Under the supervision of Dr. Lewis, Mr. Armstrong performed the duties and fulfilled the responsibilities, including the ordering of routine medications, that had been specified in the agreement.

On September 28, 1978, Dr. Lewis was notified by the Composite Board that a hearing would be held on November 14, 1978, to determine whether disciplinary action should be taken against him for permitting an unlicensed individual to practice medicine in violation of Georgia law. A hearing was held, and at this time Dr. Lewis apparently asserted that Mr. Armstrong had signed prescriptions without Lewis' knowledge or approval. On February 7, 1979, the Hearing Officer appointed by the Composite Board ruled that Dr. Lewis violated Georgia Code § 84-916(a)(10) by permitting Mr. Armstrong to practice as a physician's assistant without state certification and by allowing Mr. Armstrong to write prescriptions without his co-signature. The Hearing Officer recommended that Dr. Lewis be privately reprimanded.

The Composite Board declined to accept the Hearing Officer's recommendation and, on March 21, 1979, ruled that in addition to violating Georgia Code § 84-916(a)(10) Dr. Lewis violated Georgia Code § 84-916(a)(9) by knowingly aiding, assisting and advising Mr. Armstrong to practice medicine contrary to Georgia law and the Rules of the Composite Board. The Board suspended Dr. Lewis' license for six months and probated the entire suspension under the condition that Dr. Lewis comply with all provisions of Georgia law pertaining to the practice of medicine. If Dr. Lewis again implemented the working arrangement with Mr. Armstrong or another physician's assistant his license would be subject to suspension or revocation, and he would possibly be subject to indictment.

An appeal from the order of the Composite Board was filed in the Superior Court of Fulton County, Georgia, Norris S. Lewis v. The Composite Board of Medical Examiners, Civil Action No. C-51995, Superior Court of Fulton County. The United States of America and the Secretary of Health, Education and Welfare filed a motion to intervene as parties; the Composite Board resisted the motion and the motion was subsequently denied. The Georgia court, however, granted the United States and the Secretary amicus curiae status. The case has since been remanded to the Composite Board for further proceedings.

Alleging that it was threatened with irreparable harm and that it had no adequate remedy at law, the United States filed this action in federal district court against the State, the Composite Board, and Board members. The United States sought to enjoin defendants from suspending, continuing in effect any suspension, or enforcing any suspension of Dr. Lewis' license based upon his supervision of Alan Armstrong or any of his other actions taken in performance of his duties as a NHSC officer. The Government also sought an order declaring that the actions of Lewis in supervising

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Alan Armstrong are in accordance with federal law, that the actions of the Composite Board against Dr. Lewis based upon his supervision of Alan Armstrong are in conflict with federal law and are null and void, and that defendants may not regulate or purport to regulate the activities of NHSC assignees in any manner inconsistent with the programs and policies of the United States Public Health Service or the NHSC.

Defendants filed a motion to dismiss, urging that the Anti-Injunction Act, 28 U.S.C.A. § 2283, precludes the granting of either declaratory or injunctive relief and that, in any event, the district court should abstain from rendering a decision since the action against Dr. Lewis was pending in state court. The district court correctly determined that the Anti-Injunction Act is inapplicable when the United States is the federal plaintiff, e. g., Leiter Minerals, Inc. v. United States, 352 U.S. 220, 77 S.Ct. 287, 1 L.Ed.2d 267 (1957), and defendants do not challenge this determination on appeal. Even though the action was not barred by the Anti-Injunction Act, the court deemed abstention appropriate under the facts of the case.

The district court rested its decision to abstain 3 on the principles enunciated in Younger v. Harris, 401 U.S. 37, 91 S.Ct. 746, 27 L.Ed.2d 669 (1971) and its progeny, see, e. g., Trainor v. Hernandez, 431 U.S. 434, 97 S.Ct. 1911, 52 L.Ed.2d 486 (1977); Huffman v. Pursue, Ltd., 420 U.S. 592, 95 S.Ct. 1200, 43 L.Ed.2d 482 (1975). These cases teach that abstention is appropriate when "absent bad faith, harassment, or a patently invalid state statute, federal jurisdiction has been invoked for the purpose of restraining state criminal proceedings, state nuisance proceedings antecedent to a criminal prosecution, ... or collection of state taxes ...." Colorado River Water Cons. Dist. v. United States, 424 U.S. 800, 816, 96 S.Ct. 1236, 1245, 47 L.Ed.2d 483 (1976) (citations omitted). On appeal the State adopts and urges the reasoning of the district court. On the other hand, the United States urges that abstention is always inappropriate when the United States is seeking to assert a superior federal interest. Alternatively, the United States argues that the facts of this case fall within an exception to Younger and thus abstention is inappropriate. We agree with the United States that abstention is inappropriate when, as here, the United States is seeking to assert a federal interest against a state interest. We also agree with the alternative contention of the United States.

It is abundantly clear that this action is not barred by the Anti-Injunction Act. See, e. g., Leiter Minerals, Inc. v.

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United States, supra, 352 U.S. at 225-26, 77 S.Ct. at 290-91. The United States urges that, for the same policy reasons that support the exception of the United States from the Anti-Injunction Act, abstention is inappropriate when the United States seeks to assert in federal court a superior federal interest. 4 Hence, a brief examination of the Act and the policy it advances is necessary for an evaluation of the position of the United States. 5

The Anti-Injunction Act provides: "A court of the United States may not grant an injunction to stay proceedings in a State court except as authorized by Act of Congress, or where necessary in aid of its jurisdiction, or to protect or effectuate its judgments." Whether the Act applies to actions...

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27 practice notes
  • United States v. Texas, 1:21-CV-796-RP
    • United States
    • United States District Courts. 5th Circuit. Western District of Texas
    • 6 Octubre 2021
    ...seeks to assert in federal court a superior federal interest.” United States v. Composite State Bd. Of Medical Examiners, State of Ga., 656 F.2d 131, 135 (1981). As discussed supra in Section IV(B)(1)(a)(ii), the United States has a significant federal interest in ensuring its agencies are ......
  • Massachusetts Delivery Ass'n v. Coakley, No. 11–1441.
    • United States
    • United States Courts of Appeals. United States Court of Appeals (1st Circuit)
    • 20 Enero 2012
    ...(8th Cir.1999) ( Younger may apply to non-parties in “extraordinary circumstances”); United States v. Composite State Bd. of Med. Exam'rs, 656 F.2d 131, 137 (5th Cir. Unit B 1981) (“[A]bstention bars prospective relief to a person not a party to the state action only in the extraordinary si......
  • Seneca-Cayuga Tribe of Oklahoma v. State of Okl. ex rel. Thompson, SENECA-CAYUGA
    • United States
    • United States Courts of Appeals. United States Court of Appeals (10th Circuit)
    • 3 Mayo 1989
    ...not mitigate this conflict, the proper forum to resolve it is federal court. Cf. United States v. Composite Bd. of Medical Examiners, 656 F.2d 131, 136 (5th Cir.1981) (holding alternatively that purpose of Younger abstention is to avoid conflict between state and federal governments; where ......
  • Mille Lacs Band of Indians v. State of Minn., Civ. No. 4-90-605.
    • United States
    • United States District Courts. 8th Circuit. United States District Court of Minnesota
    • 13 Mayo 1994
    ...States is suing a state in federal court to assert its federal interests. United States v. Composite State Bd. of Medical Examiners, 656 F.2d 131, 136 (5th Cir.1981). The United States is a plaintiff-intervenor in this case seeking to advance important federal interests. Abstention would be......
  • Request a trial to view additional results
27 cases
  • United States v. Texas, 1:21-CV-796-RP
    • United States
    • United States District Courts. 5th Circuit. Western District of Texas
    • 6 Octubre 2021
    ...seeks to assert in federal court a superior federal interest.” United States v. Composite State Bd. Of Medical Examiners, State of Ga., 656 F.2d 131, 135 (1981). As discussed supra in Section IV(B)(1)(a)(ii), the United States has a significant federal interest in ensuring its agencies are ......
  • Massachusetts Delivery Ass'n v. Coakley, No. 11–1441.
    • United States
    • United States Courts of Appeals. United States Court of Appeals (1st Circuit)
    • 20 Enero 2012
    ...(8th Cir.1999) ( Younger may apply to non-parties in “extraordinary circumstances”); United States v. Composite State Bd. of Med. Exam'rs, 656 F.2d 131, 137 (5th Cir. Unit B 1981) (“[A]bstention bars prospective relief to a person not a party to the state action only in the extraordinary si......
  • Seneca-Cayuga Tribe of Oklahoma v. State of Okl. ex rel. Thompson, SENECA-CAYUGA
    • United States
    • United States Courts of Appeals. United States Court of Appeals (10th Circuit)
    • 3 Mayo 1989
    ...not mitigate this conflict, the proper forum to resolve it is federal court. Cf. United States v. Composite Bd. of Medical Examiners, 656 F.2d 131, 136 (5th Cir.1981) (holding alternatively that purpose of Younger abstention is to avoid conflict between state and federal governments; where ......
  • Mille Lacs Band of Indians v. State of Minn., Civ. No. 4-90-605.
    • United States
    • United States District Courts. 8th Circuit. United States District Court of Minnesota
    • 13 Mayo 1994
    ...States is suing a state in federal court to assert its federal interests. United States v. Composite State Bd. of Medical Examiners, 656 F.2d 131, 136 (5th Cir.1981). The United States is a plaintiff-intervenor in this case seeking to advance important federal interests. Abstention would be......
  • Request a trial to view additional results

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