Bowen v American Hospital Association: Syllabus

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Section 504 of the Rehabilitation Act of 1973 provides that "[n]o otherwise qualified handicapped individual ... shall, solely by reason of his handicap, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance." In 1984, the Secretary of Health and Human Services (Secretary) promulgated regulations requiring: (1) health care providers receiving federal funds to post notices that because of § 504's prohibition against discrimination on the basis of handicap, health care should not be withheld from infants on the basis of their mental or physical impairments; (2) state child protective services agencies to establish procedures to prevent unlawful medical neglect of handicapped infants, and when considered necessary, in the judgment of the responsible official of the Department of Health and Human Services, to protect a handicapped infant's life or health; (3) immediate access to patient records; and (4) expedited compliance actions. In consolidated actions in Federal District Court, respondents sought to declare the regulations invalid and to enjoin their enforcement. The court granted the requested relief on the authority of United States v. University Hospital, 729 F.2d 144 (CA2), and the Court of Appeals affirmed on the basis of that earlier decision.

Held: The judgment is affirmed.

794 F.2d 676, affirmed.

Justice STEVENS, joined by Justice MARSHALL, Justice BLACKMUN, and Justice POWELL, concluded that the regulations in question are not authorized by § 504. Pp. 2110-2123.

(a) A hospital's withholding of treatment from a handicapped infant when no parental consent has been given cannot violate § 504, for without the parents' consent the infant is neither "otherwise qualified" for treatment nor has he been denied care "solely by reason of his handicap." There is nothing in the administrative record documenting the Secretary's belief that there exists "discriminatory withholding of medical care" in violation of § 504 which would justify federal regulation. None of the examples cited by the Secretary as justification for the regulation suggest that the hospitals receiving federal funds, as opposed to parents, withheld medical care on the basis of handicap. Pp. 2114-2117.

(b) The complaint-handling process the Secretary would impose on unwilling state agencies is totally foreign to the authority to prevent discrimination conferred on him by § 504. While the Secretary can require state agencies to document their own compliance with § 504, nothing in § 504 authorizes him to commandeer state agencies to enforce compliance by other recipients of federal funds (in this instance, hospitals). Pp. 2118-2120.

(c) The Secretary's basis for federal intervention is perceived discrimination against handicapped infants in violation of § 504, and yet the Secretary has pointed to no evidence that such discrimination occurs. The administrative record does not contain the reasoning and evidence necessary to sustain federal intervention into a historically state-administered decisional process that appears -- for lack of any contrary evidence -- to be functioning in full compliance with § 504. Nothing in § 504 authorizes the Secretary to dispense with the law's focus on discrimination and instead to employ federal resources to save the lives of handicapped newborns, without regard to whether they are victims of discrimination by recipients of federal funds or not. Section 504 does not authorize the Secretary to give unsolicited advice either to parents, to hospitals, or to state officials who are faced with difficult treatment decisions concerning handicapped children. The administrative record demonstrates that the Secretary has asserted the authority to conduct on-site investigatiorts, to inspect hospital records, and to participate in the decisional process in emergency cases in which there was no colorable basis for believing that a violation of § 604 had occurred or was about to occur. These investigative actions are not authorized by § 504, and the regulations that purport to authorize a continuation of them are invalid. Pp. 2120-2123.

STEVENS, J., announced the judgment of the Court, and delivered an opinion in which MARSHALL, BLACKMUN, and POWELL, JJ., joined. BURGER, C.J., concurred in the judgment. WHITE, J., filed a dissenting opinion, in which BRENNAN, J., joined and in Parts I, II, IV, and V of which O'CONNOR, J., joined, post, p. 2123. O'CONNOR, J., filed a dissenting opinion, post, p. 2132. REHNQUIST, J., took no part in the consideration or decision of the case.

Charles J. Cooper, Alexandria, Va., for petitioner.

Richard L. Epstein, Chicago, Ill., for respondents American Hosp. Ass'n, et al.

Ben W. Heineman, Jr., Washington, D.C., for respondents American Medical Ass'n, et al.

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Posted 9 Sep 2000.