American Civil Liberties Union v. Trinity Health Corp.

Citations: 178 F. Supp. 3d 614; 2016 U.S. Dist. LEXIS 48073; 2016 WL 1407844Docket: Case No. 15-cv-12611

Court: District Court, E.D. Michigan; April 11, 2016; Federal District Court

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The American Civil Liberties Union of Michigan filed a lawsuit against Trinity Health Corporation and Trinity Health-Michigan on July 23, 2015, later amending the complaint to include the ACLU as a plaintiff. The case revolves around the defendants' adherence to the Ethical and Religious Directives for Catholic Health Care Services, particularly Directive 45, which prohibits abortion. The plaintiffs argue that this policy has caused harm to women, including one member who required a pregnancy termination for health reasons, and that such adherence violates the Emergency Medical Treatment and Active Labor Act (EMTALA) and the Rehabilitation Act. The defendants contend that the plaintiffs lack standing and have failed to state a valid claim. The court, led by Judge Gershwin A. Drain, is first addressing the standing issue under Federal Rule of Civil Procedure 12(b)(1), asserting that the burden of proof lies with the plaintiffs to establish jurisdiction. The court will analyze whether the plaintiffs' claims involve facial or factual attacks on jurisdiction before considering the defendants' additional arguments.

A facial attack challenges the sufficiency of the pleadings, requiring the court to interpret the allegations favorably for the non-moving party and accept them as true. In contrast, a factual attack disputes the factual basis for subject matter jurisdiction, allowing the court to evaluate evidence without a presumption of truthfulness. The Defendants have made a facial attack on the pleadings, which means the court will presume the allegations in the complaint are true and will resolve factual disputes favorably for the Plaintiffs.

Article III of the Constitution restricts federal court jurisdiction to "cases" and "controversies," guided by justiciability doctrines, including standing and ripeness. Plaintiffs must establish standing, demonstrating that their lawsuit does not infringe on the powers of political branches. An association can sue on behalf of its members if those members could sue individually, the interests are relevant to the organization's purpose, and individual member participation is not required.

To establish Article III standing, Plaintiffs must show: (1) an "injury in fact," (2) a causal relationship between the injury and the alleged conduct, and (3) that a favorable court decision is likely to redress the injury. An injury must be concrete, particularized, and imminent, rather than speculative. Plaintiffs argue standing based on two theories: (1) a member was denied treatment at Defendants’ hospitals, suffering severe injury, and (2) a pregnant member with a history of complications fears she will not receive necessary care in the future. Defendants counter that Plaintiffs have not adequately specified any past harm or demonstrated that future harm is sufficiently imminent or concrete, thus questioning Plaintiffs' standing.

Plaintiffs assert two theories of standing in their case against Defendants regarding violations of EMTALA and the Rehab Act. 

First, they argue that numerous past incidents demonstrate that at least one member was denied stabilizing treatment (termination of pregnancy) at a Defendants’ hospital due to conflicting Directives, establishing past harm. However, under legal precedent, past exposure to illegal conduct alone does not create a current case for injunctive relief without ongoing adverse effects. Therefore, Plaintiffs' allegations of past harm do not suffice to confer standing for their request for declaratory and injunctive relief.

Second, Plaintiffs contend that one member, who was pregnant at the time the case was filed and has a history of severe pregnancy complications, fears future inadequate care at the only available hospital. While these claims suggest potential future harm, Defendants argue they are speculative and insufficient for establishing injury in fact. Plaintiffs reference Sandusky County Democratic Party v. Blackwell to support their claim that non-specific future harm can still confer standing. However, this reliance is deemed misplaced since the Sandusky case involved imminent harms related to voting rights, which the court found to be real, not speculative. Thus, the Plaintiffs' claim of future harm does not meet the necessary legal threshold for standing.

The concept of 'imminence' is a key differentiator in this case compared to Sandusky. Plaintiffs argue that the clear threat to their pregnant member, combined with adherence to hospital Directives and the biological reality of pregnancy complications, demonstrates sufficient Article III injury. However, the claim of 'inevitability' is challenged, as it relies on an indefinite timeline and uncertain circumstances surrounding when harm may occur. Unlike the fixed voting dates in Sandusky, the timing of potential complications for the pregnant member is unpredictable. Plaintiffs have not substantiated their claims with facts or evidence to show a substantial risk of complications for this member.

Additionally, regarding Article III ripeness, while declaratory judgments can be sought before an injury occurs, they must address an actual controversy. Plaintiffs must demonstrate either present harm or a significant probability of future harm to justify pre-enforcement review. Ripeness requires that the injury be 'certainly impending,' distinguishing speculative injuries from those suitable for court review. In challenges to health policies, the Supreme Court mandates showing discrete instances where a specific condition necessitates a procedure prohibited by statute. The DeWine case exemplifies this, where plaintiffs identified particular medical conditions that justified the need for a banned procedure, supported by medical records and testimonies, thereby establishing ripeness under the Gonzales standard.

Plaintiffs failed to identify specific medical conditions that would place their members at risk, nor did they provide evidence that any members have such conditions. They only mentioned that one member was pregnant when the claim was filed and that others might become pregnant in the future. The court noted that pregnancy alone does not constitute a "particular condition" warranting the termination of pregnancy. Allowing the claim to proceed based on the current allegations would effectively enable any pregnant woman in Michigan to bring a similar claim. As a result, the claimed harm is deemed speculative and not ripe for judicial review. The court found a lack of subject matter jurisdiction and, therefore, did not consider the Defendants’ Motion to Dismiss under Fed. R. Civ. P. 12(b)(6). Consequently, the court granted the Defendants' Motion to Dismiss, noting that the fact that the only hospital in the plaintiff's county is owned by the defendants does not negate the possibility that the plaintiff could seek care elsewhere.