Virginia Hosp. Ass'n v. Baliles
| Decision Date | 22 March 1989 |
| Docket Number | No. 88-1306,88-1306 |
| Citation | 868 F.2d 653 |
| Parties | , 25 Soc.Sec.Rep.Ser. 3, Medicare&Medicaid Gu 37,666 The VIRGINIA HOSPITAL ASSOCIATION, Plaintiff-Appellee, v. Gerald BALILES, Governor of Virginia; Eva S. Teig, Secretary of Human Resources of Commonwealth of Virginia; Bruce U. Kozlowki, Director, Medical Assistance Services; Bette O. Kanter, Member State Board of Medical Assistance Services; Joseph M. Teefy, Member State Board of Medical Assistance Services; R. Michael Berryman, Member State Board of Medical Assistance Services; Ford Tucker Johnson, Sr., D.D.S. Member State Board of Medical Assistance Services; A. Epps, Jr., Medical Doctor; Ruth Hanft, Member State Board of Medical Assistance Services; Bertha L. Davis, Ph.D., Member State Board of Medical Assistance Services; Kathleen Leutze, Member State Board of Medical Assistance Services; Robert N. Lambeth, Jr., Member State Board of Medical Assistance Services; Elsa A. Porter, Member State Board of Medical Assistance Services; John N. Simpson, Member State Board of Medical Assistance Services; Defendants-Appellants, State of Alaska; State of Arizona; State of California; State of Florida; State of Georgia; State of Idaho; State of Indiana; State of Kansas; State of Michigan; State of Minnesota; State of Missouri; State of New Hampshire; State of New Jersey; State of New Mexico; State of North Dakota; Commonwealth of Pennsylvania; State of Rhode Island; State of South Carolina; State of South Dakota; State of Tennessee; State of Vermont; State of Wisconsin; State of Wyoming; American Hospital Association Amicus Curiae. |
| Court | U.S. Court of Appeals — Fourth Circuit |
Roger Lewis Chaffe, Senior Asst. Atty. Gen. , for defendants-appellants.
Martin Andrew Donlan, Jr. (Judith B. Henry, Peter M. Mellette, Lynne Fleming, Crews & Hancock on brief), for plaintiff-appellee.
(Gregory M. Luce, Irwin Cohen, Martha Ellett, Eric Schwartz, Fulbright & Jaworski; Michael F. Anthony, American Hosp. Ass'n on brief), for amicus curiae American Hosp. Ass'n.
, for State amici curiae.
Before RUSSELL and ERVIN, Circuit Judges, and KISER, United States District Judge for the Western District of Virginia, sitting by designation.
Defendants, officials of the government of the Commonwealth of Virginia, 1 (hereinafter collectively referred to as "Virginia") appeal the denial of their motion for summary judgment seeking to dismiss an action commenced against them by the Virginia Hospital Association ("VHA"). VHA is a nonprofit organization, the members of which are all public or private Virginia health care providers, principally hospitals ("providers"). VHA sued to enjoin the procedures Virginia uses to determine what rate of reimbursement VHA members receive for treating Medicaid patients. Virginia argued that for various reasons VHA's suit is not currently justiciable. The district court disagreed and certified its order for appeal under 28 U.S.C.A. Sec. 1292(b). We affirm.
VHA brought this Sec. 1983 action to challenge Virginia's procedures for reimbursing hospitals for the costs of treating Medicaid patients ("Virginia Plan"). 2 VHA seeks the following relief: (1) a declaration that the Virginia Plan violates the Medicaid Act, 42 U.S.C.A. Sec. 1396 et seq. ("Medicaid Act"), and therefore also the Supremacy Clause ("Count I"); (2) a declaration that the Virginia Plan violates its members' due process rights ("Count II"); (3) a permanent injunction of the Virginia Plan ("Count III").
On September 22, 1986, the district court granted summary judgment for Virginia on the ground that collateral estoppel precluded VHA from litigating issues decided in Mary Washington Hospital, Inc. v. Fisher, 635 F.Supp. 891 (E.D.Va.1985), a similar action brought by one VHA member hospital. We reversed that decision and remanded the case. Virginia Hospital Association v. Baliles, 830 F.2d 1308 (4th Cir.1987).
Virginia then moved for summary judgment based on a number of nonjusticiability arguments. Virginia disputed VHA's contention that the Medicaid Act creates a right actionable under Sec. 1983, and argued that the Medicaid Act evidences a congressional intent to foreclose private enforcement. Virginia further contended that stare decisis or the Eleventh Amendment barred VHA's suit, and that VHA lacked standing. Virginia alleged finally that the statute of limitations barred VHA's claim, that the claim is not ripe, and that the district court should abstain.
The district court denied Virginia's motion, holding the action currently justiciable. We agree and affirm.
We believe Virginia's most substantial argument is that VHA has no right actionable under Sec. 1983, and so we address that issue first.
Virginia argues that only health care recipients, and not individual or associated health care providers, have rights enforceable under the Medicaid Act. We agree with the district court that the Medicaid Act supplies VHA with an enforceable right, and that Virginia failed to establish a congressional intent to foreclose private enforcement.
Section 1983 supplies VHA with no substantive rights. The statute serves simply as a vehicle to redress the deprivation under color of state law "of any rights ... secured by the [federal] Constitution and laws...." 42 U.S.C.A. Sec. 1983 (West 1981). The initial query is accordingly whether the Medicaid Act provides VHA with any substantive right.
There is no dispute that the Medicaid Act does not expressly confer a right of action on health care providers. The Supreme Court has held, however, that federal statutes may imply rights actionable under Sec. 1983. Maine v. Thiboutot, 448 U.S. 1, 100 S.Ct. 2502, 65 L.Ed.2d 555 (1980). A number of cases decided since Thiboutot have elaborated criteria for determining whether a particular statute implies a private right of action. In Pennhurst State School v. Halderman, 451 U.S. 1, 15, 101 S.Ct. 1531, 1539, 67 L.Ed.2d 694 (1981), the Court made plain that the touchstone of the determination is congressional intent, as manifest in the language and legislative history of the statute. See also Middlesex City Sewerage Auth. v. National Sea Clammers Ass'n, 453 U.S. 1, 13, 101 S.Ct. 2615, 2623, 69 L.Ed.2d 435 (1981).
In Pennhurst, the Court examined the text and legislative history of the Developmentally Disabled Assistance and Bill of Rights Act of 1975 ("Assistance Act"), 42 U.S.C.A. Sec. 6000 et seq., a statute similar in some respects to the Medicaid Act. Both statutes create programs whereby the Federal Government provides money to States to fund programs for persons specially in need. State participation is voluntary under both statutes, but both require participating states to meet certain conditions to receive federal funds. 3
The Court in Pennhurst noted that while many provisions of the Assistance Act expressly conditioned federal assistance on state compliance, the provision at issue, 42 U.S.C.A. Sec. 6010, did not. 451 U.S. at 13, 101 S.Ct. at 1538. The Court also noted that the right the mentally retarded respondents claimed, that of "appropriate treatment" in the "least restrictive environment", would impose a massive financial obligation on participating states. 451 U.S. at 16-17, 101 S.Ct. at 1539-1540. After examining the language and legislative history of Sec. 6010 and other sections of the Assistance Act, the Court concluded that Sec. 6010 was merely precatory and did not create a right in favor of the respondents. Id. at 18, 101 S.Ct. at 1540. See Wright v. Roanoke Redev't & Hous. Auth., 479 U.S. 418, 423, 107 S.Ct. 766, 770, 93 L.Ed.2d 781 (1987) ().
We note at the outset of our analysis that two other circuits appear to have concluded that Sec. 1396a(a)(13)(A) supplies providers with enforceable rights. Colorado Health Care Ass'n v. Colorado Dep't of Social Serv., 842 F.2d 1158, 1164 n. 5 (10th Cir.1988); Coos Bay Care Ctr. v. Oregon, 803 F.2d 1060 (9th Cir.1986), cert. granted, 481 U.S. 1036, 107 S.Ct. 1970, 95 L.Ed.2d 811 vacated as moot, --- U.S. ----, 108 S.Ct. 52, 98 L.Ed.2d 17 (1987). Because VHA is, for purposes of this decision, simply a medium through which its members...
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