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| [1] | U.S. Court of Appeals, Eleventh Circuit |
| [2] | No. 98-6499 |
| [3] | 200 F.3d 744, 2000.C11.0042033 <http://www.versuslaw.com> |
| [4] | January 12, 2000 |
| [5] | MAGGIE DEDRICK, INDIVIDUALLY, & AS MOTHER & NEXT FRIEND OF LAKENDRA
DEDRICK, DECEASED MINOR, PLAINTIFF-APPELLEE, V. DR. CLIFTON YOUNGBLOOD, ET AL., DEFENDANT-APPELLANT |
| [6] | Appeal from the United States District Court for the Northern District
of Alabama. (No. 98-00961-CV-C-W), U.W. Clemon, Judge. |
| [7] | Before Black, Circuit Judge, and Godbold and Fay, Senior Circuit Judges. |
| [8] | The opinion of the court was delivered by: Godbold, Senior Circuit Judge |
| [9] | This case involves the interpretation of a public health service employee
under the Federally Supported Health Centers Assistance Act. The Act was
enacted in 1992 to reduce the growing costs of malpractice insurance to
private nonprofit health centers that provide health services to medically
underserved populations, commonly referred to as " § 245(b) health
centers" or "eligible entities." The Act essentially makes
the U.S. government the medical malpractice insurer for qualifying § 245(b)
health centers, their officers, employees, and contractors, allowing these
"deemed" health centers to forgo obtaining private malpractice
insurance. Youngblood based his appeal on an expanded interpretation of
the definition of a contractor under § 233. |
| [10] | We must decide whether a doctor is considered a U.S. Public Health Service
Employee within the meaning of § 233 of the Act if at the time he allegedly
committed malpractice he was performing medical services as an employee
of a legal entity that has contracted with a FSHCAA eligible health care
entity. It appears that we are the first circuit to address this issue.*fn1
The district court remanded the case after it determined that Dr. Youngblood
was not a contractor with provider coverage under the definition provided
in § 233 of the Act. We agree that Youngblood is not a covered provider
under § 233 and affirm the decision of the district court. |
| [11] | Determining the contractual relationship of the parties is essential to
properly interpreting this statute.*fn2
Youngblood entered into an employment contract with Capstone Health Services
Foundation for a term of one year. Under the terms of the contract Youngblood
became a member of the OB-GYN Department of the University of Alabama School
of Medicine, Tuscaloosa. Capstone contracted to obtain professional liability
insurance for Youngblood. Shortly after Youngblood entered into his employment
contract with Capstone, Capstone entered into a provider agreement with
West Alabama Health Services, Inc. Capstone agreed to provide OB-GYN related
services to Medicaid eligible pregnant women at West Alabama facilities.
The contract provided that Capstone would maintain malpractice insurance
for its employees. |
| [12] | Youngblood treated Maggie Dedrick while he was providing OB-GYN services
to a West Alabama clinic. Youngblood concedes that at the time he provided
the services he was "on-call" for West Alabama pursuant to the
provider contract between Capstone and West Alabama. Capstone billed West
Alabama for the services rendered by Youngblood to Dedrick. |
| [13] | Dedrick filed a malpractice action against Youngblood in Alabama state
court for alleged negligent acts that occurred during the treatment of her
pregnancy. Youngblood removed the case to federal court on the ground that
he was a covered employee under § 233 of the Act. He contends that federal
jurisdiction was proper because of the special relationship between the
Act and the Federal Tort Claims Act, 28 U.S.C. § 1346(b). The Act provides
the exclusive remedy for medical malpractice of employees or contractors
of the Public Health Service. However, the district court held that Youngblood
was not a Public Health Service "employee" under § 233 at the
time of the alleged medical malpractice and remanded the case to state court. |
| [14] | The Act defined a Public Health Service employee to include "an entity
described in [§ 233(g)(4)], and any officer, governing board member, or
employee of such an entity, and any contractor of such an entity who is
a physician or other licensed or certified health care practitioner (subject
to paragraph 5)." 42 U.S.C. § 233(g)(1)(A). Paragraph (5) states: |
| [15] | an individual may be considered a contractor of an entity ... only if
.. A) the individual normally performs on average of at least 321/2 hours
of service per week for the entity for the period of the contract. § 233(g)(5);
or B) in the case of an individual who normally performs less than 321/2
hours of service per week for the entity for the period of the contract,
the individual is a licensed or certified provider of services in the fields
of family practice, general internal medicine, general pediatrics, or obstetrics
and gynecology. 42 U.S.C. § 233(g)(5). |
| [16] | Although Youngblood is an employee of Capstone and has no separate contract
with West Alabama, he contends that the statute does not exclude him because
it does not explicitly require direct contractual relations with West Alabama
for him to be "deemed" an employee. Youngblood contends that the
Act permits an individual physician to be "deemed" a Public Health
Service employee if that physician performs services for a public health
entity pursuant to a contract. However, strict interpretation requires that
a contractor be an "individual" who contracts with an eligible
entity. 42 U.S.C. § 233(g)(1)(A); § 233(g)(5). |
| [17] | Suits brought under the FTCA are generally limited to those claims arising
from the negligent conduct of government employees. 28 U.S.C. § 1346(b).
The FTCA retains sovereign immunity over claims against contractors. See
Tisdale v. U.S., 62 F.3d 1367, 1371 (11th Cir.1995). However, when a statute
like the Act expands the liability of the government we must strictly construe
the language used by Congress because the inclusion of contractor liability
serves as an expanded waiver of sovereign immunity. See, e.g., Department
of the Army v. Blue Fox, Inc., 525 U.S. 255, 119 S.Ct. 687, 691, 142 L.Ed.2d
718 (1999). |
| [18] | The expanded definition of a "contract employee" under § 233(g)
of the Act to certain contractors of qualified health centers is clearly
not an unlimited extension to all contractors. The text of § 233(g) states
"or any contractor of such an entity who is a physician or other licensed
or certified health care practitioner." 42 U.S.C. § 233. We interpret
the personal pronoun "who" as identifying only individual physicians
who contract with eligible entities, not organizations or foundations who
contract with eligible entities.*fn3 |
| [19] | The statutory language of the Act requires us to distinguish contracts
by which an individual physician contracts with the eligible entity and
those where the physician uses a separate entity, such as Capstone, to contract
with the eligible entity. West Alabama contracted with Capstone, his employer.
Although Youngblood is a licensed physician who provided services to the
patients of West Alabama in the area of obstetrics, he did so pursuant to
his contractual relationship with Capstone, not based on any contractual
relationship with West Alabama. Whether Youngblood would have qualified
as a contractor if there was a contract between him and West Alabama is
irrelevant. Youngblood is an employee of the contractor-Capstone. The statutory
expansion of government liability under the FTCA does not apply in this
case because there is no direct contractual relationship between the eligible
entity and the physician.*fn4 |
| [20] | A doctor who wishes to be a covered employee is not precluded simply because
he is a member of a group or a professional corporation. He is only precluded
if he contracts with an eligible entity through another entity or group.*fn5
Therefore, because § 233(g) sets forth an initial requirement that a qualified
individual first must have contracted with a covered entity, Youngblood
was not qualified under the Act because he never contracted with West Alabama. |
| [21] | AFFIRMED. |
| [22] | FAY, Senior Circuit Judge, dissenting: |
| [23] | The majority opinion is sound and well reasoned. My concern is that the
majority is creating a road block to the successful implementation of the
Congressional scheme designed to provide medical services to the indigent. |
| [24] | It is a fact of life that one of the major costs of practicing medicine
is the high cost of malpractice insurance. In an attempt to secure the services
of those doctors necessary to carry out the Federally Supported Health Centers
Assistance Act, the Act provides financial malpractice protection to those
doctors who qualify by placing their conduct under the Federal Tort Claims
Act. |
| [25] | There is no question that Dr. Youngblood would be covered by the Act had
he contracted directly, as an individual physician, with West Alabama. The
majority holds that because there were intermediate or sub-contracts between
West Alabama, Capstone and individual physicians (or their professional
corporations) the doctors are not protected. It seems to me that such a
holding flies in the face of Congressional intent. I would hold otherwise
and, therefore, respectfully dissent. |
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| Opinion Footnotes | |
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| [26] | *fn1 The parties
indicate that the court should be persuaded by a recent Tenth Circuit case.
We agree that the contractual relationship in this case is similar to that
in Duplan v. Harper, 188 F.3d 1195, 1198 (10th Cir.1999). Dr. Harper was
an employee of a corporation, Med-National, Inc., that contracted with the
U.S. Air Force to provide medical services at Tinker AFB. The incident giving
rise to Duplan's claim arose during Dr. Harper's treatment of Duplan pursuant
to the Tinker-Med-National contract. The Tenth Circuit reversed a finding
of the district court and held that Harper was not an employee of the government.
However, the court did not address the key issue in this case: whether Harper
would be considered a contractor with Tinker under § 233. |
| [27] | *fn2 There is
no need to employ a control test to determine whether Youngblood is an employee
of the government because there is no dispute that Youngblood qualifies
only under the contractor exception if he qualifies at all. Although Youngblood
does not dispute that all services rendered to West Alabama were pursuant
to the provider contract between Capstone and West Alabama, he does dispute
the district court's requirement for a direct contractual relationship between
him and West Alabama. |
| [28] | *fn3 Judge Fay's
dissenting opinion relies without citation upon Congressional intent. The
legislative history discusses at some length the need that the Act was addressing.
However, both the 1992 and 1994 legislative histories state that the purpose
of the Act is to relieve the financial burden imposed on eligible health
centers by the costs of malpractice insurance. I cannot find any language
stating that the purpose of the Act is to relieve the cost of malpractice
insurance from any physician who treats any of the eligible entity's patients
See H.R.Rep. No. 398, 104th Cong., 1st Sess.1995, 1996 U.S.C.C.A.N. 767;
H.Rep. No. 823(I), 102d Cong., 2nd Sess.1992, 1992 U.S.C.C.A.N. 2627. In
the case of contractors providing health services to [eligible] health center
patients, coverage is provided only to contractors who are licensed or certified
health care practitioners. H.R.Rep. No. 398, 104th Cong., 1st Sess.1995,
1996 U.S.C.C.A.N. 767, at § 11. |
| [29] | *fn4 We decline
to address the concerns raised by Youngblood at oral argument regarding
whether an individual doctor who contracts with an eligible entity through
his professional corporation would be protected. Those facts are not before
this court. |
| [30] | *fn5 We will
not rewrite the statutory language of § 233(g)(1)(A) to expand the definition
of contractors covered under the statute to include physicians like Youngblood
who perform services for an eligible entity pursuant to an intermediate
contract signed by a practice group or clinic. Youngblood's policy arguments
suggesting that this interpretation of the statute will preclude any physician
employed by a clinic or entity cannot overcome the express language of the
statute. These concerns are more properly disposed of by Congress. |
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