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Supreme Court Victory for Court Access and Nursing Home Residents

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Court Upholds Right of Residents in Publicly-Owned Nursing Facilities to Sue for Violations of the Nursing Home Reform Law

The U.S. Supreme Court upholds the right of nursing home residents in publicly-owned nursing facilities to file lawsuits under 42 U.S.C. §1983 for violations of rights guaranteed under the federal Nursing Home Reform Law (FNHRA) (1987). Health and Hospital Corporation of Marion County v. Talevski, No. 21-806 (Jun. 8, 2023).

After summarizing the legal analysis, Justice Kentaji Brown Jackson, writing for the Court’s 7-2 majority, describes what happened to Gorgi Talevski when his dementia progressed and his family placed him in Valparaiso Care and Rehabilitation, a nursing facility owned by Marion County’s hospital corporation. At admission to the nursing facility, Mr. Talevski “could talk, feed himself, walk, socialize, and recognize his family.” Decision 3. The facility described Mr. Talevski’s sudden deterioration in 2016 as the result of the natural progression of his dementia, but outside physicians confirmed that Mr. Talevski was chemically restrained with six psychotropic medications. Mr. Talevski’s medications were tapered and he began to be able to feed himself again. The family filed a complaint with the state about the inappropriate chemical restraints. Then, the facility began sending Mr. Talevski to a facility 90 minutes away. Following the third transfer, the nursing facility refused to readmit him. Mr. Talevski filed an administrative appeal of his involuntary transfer. Although the Administrative Law Judge ruled for Mr. Talevski and nullified the transfer, the facility ignored the administrative decision. The Talevskis complained to the state again, but, ultimately, realizing that Mr. Talevski had become accustomed to his new facility and fearing retribution from Valparaiso if he returned, the family decided that it would be better for Mr. Talevski to remain in his new facility. Decision 2-4.

In 2019, Mr. Talevski sued the facility. The district court dismissed the complaint, finding no right to sue under §1983, and the Seventh Circuit Court of Appeals reversed. Mr. Talevski died after the Seventh Circuit decision. The Supreme Court agreed to hear the case.

The Supreme Court rules that the plain language of §1983 means that anyone can sue for violations of any federal law “under color of” state law. Id. 5. It rejects Health and Hospital Corporation’s (HHC) argument that, historically, individuals did not have a private right to enforce federal laws. The Court describes the Thirteenth, Fourteenth, and Fifteenth Amendments to the U.S. Constitution as making a “sea change,” id. 6, and the Civil Rights Act of 1871 (enacted in 1874), as creating a new federal cause of action, now codified as §1983, id. 7.

The Court next rejects HHC’s argument that “spending power” laws, based on contract, cannot be used in §1983 litigation by third-party beneficiaries of the laws “because contracts were not ‘generally’ enforceable by third-party beneficiaries at common law.” Id. 8. It finds, first, “at a minimum, contestable,” the argument that people could not file third-party beneficiary lawsuits (citing Brief for Contract Law Professors), id., and second, §1983 claims are usually torts, id. 10.

The Court next finds that the Nursing Home Reform Law can create §1983-enforceable rights, discussing the enactment of Medicare and Medicaid, the Institute of Medicine’s 1987 report Improving the Quality of Care in Nursing Homes, and the Reform Law’s residents’ rights provisions and administrative scheme for inspections and enforcement. Id. 11-13.

Finding that federal laws “have the potential to create §1983-enforceable rights,” the Court next writes that Gonzaga University v. Doe. 536 U.S. 273 (2002) determines whether federal laws unambiguously confer enforceable rights. Id. 13-14. The Court finds that the text of the “unnecessary-restraint and predischarge-notice provisions” at issue in Talevski meets the Gonzaga test “and are presumptively enforceable,” id.14, describing the provisions in detail, id. 15-16.

A final test of whether the rights may be enforced by §1983 is whether Congress, in the statute, made clear its intent that that §1983 not be available. Id. 17. The Court finds “no incompatibility between the FNHRA’s remedial scheme and §1983 enforcement of the rights that the unnecessary-restraint and predischarge-notice provisions unambiguously secure.” Id. 18-19.

The Court rejects the final “rebuttal argument” made by the United States’ amicus brief – that Congress did not intend §1983 to apply because it knew that most facilities are privately owned and would not be subject to §1983 – writing that “it does not invite speculation about ostensible marketplace realities that appear nowhere in the statute’s text or relevant context. The relevant FNHRA provisions speak in neutral terms that do not distinguish between private and public nursing homes.” Id. 21. Finally, the Court finds that the language of the Reform Law “plainly states that “[t]he remedies provided under” its enforcement-process subsection are “in addition to those otherwise available under State or Federal law and shall not be construed as limiting such other remedies.” §1396r(h)(8) (emphasis added). We will not rewrite §1396r(h)(8) in lieu of rewriting §1983.” Id. 22.

Justice Gorsuch’s concurrence describes other issues to be decided another day, including “whether legal rights provided for in spending power legislation like the Act are ‘secured’ as against States in particular and whether they may be so secured consistent with the Constitution’s anti-commandeering principle.” Id.

Justice Barret’s concurrence suggests that §1983 actions “are the exception – not the rule – for violations of spending Clause statutes.”

Justices Thomas and Alito dissent.

Justice Thomas believes that §1983 actions should not be available for Spending Clause statutes, which he views as “no more than a disposition of funds.” Dissent 1. Otherwise, Spending Clause statutes “contradict the bedrock constitutional prohibition against federal commandeering of the States.” Id. 2.

Justice Alito’s dissent, joined by Justice Thomas, contends that relief for violation of rights under §1983 “is foreclosed by the remedial scheme in the Act.” Dissent 1. Quoting Justice Barret’s concurrence, he suggests that the more comprehensive the enforcement scheme in the statute, the less likely that §1983 lawsuits are appropriate. Id. 3.

Justice Alito views the law’s authorizing states to impose remedies in addition to the federal remedies as creating “a clear division of authority that ensures States retain their historical control over nursing-home regulation.” Id. 4. Viewing the Reform Law’s enforcement regime as exclusive, he continues:

Allowing §1983 suits will upset this balance by allowing any plaintiff to demand damages regardless of the remedial regime that States establish pursuant to their explicit authority under the Act. Moreover, whenever a plaintiff files suit, the determination about noncompliance will be taken away from federal and state authorities and given to courts. And because the remedies offered under §1983 will often dwarf the relief available under FNHRA’s reticulated balance of remedies, §1983 will swallow the centralized state and federal review mechanisms the Act imposes.

Id. 4-5. Justice Alito views the Reform Law’s grievance system for residents as “funnel[ing] private complaints to the same state authorities that the Act tasks with enforcement.” Id. 5. He views reliance of the “saving clause” (42 U.S.C. §1396r(h)) as begging the question whether relief under §1983 is otherwise available. Id. 6.

The decision, concurrences, and dissents are available at https://www.supremecourt.gov/opinions/22pdf/21-806_2dp3.pdf

June 26, 2023 – T. Edelman