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Lee Memorial Health Systems v. Lietty Guillermo

November 18, 2011



This cause comes before the Court on Defendant Susan and Jeffrey Garvin's (the "Garvins") Motion for Abstention ("Motion for Abstention"), filed August 5, 2011 (Doc. 38). On September 2, 2011, Plaintiff Lee Memorial Health Systems ("LMHS") filed a Response in Opposition (Doc. 50) to the Garvin's Motion. For the reasons that follow, the Motion for Abstention will be granted.


LMHS is a political subdivision of the State of Florida, created by the Florida Legislature to operate, control, and maintain public hospitals and other healthcare facilities in Southwest Florida. See Doc. 13, ¶ 6. Prior to November 2, 2004, the law in Florida was clear that health care facilities, such as LMHS, were not required to disclose "confidential information and records" in certain circumstances, such as pursuant to investigations of medical malpractice. Id. at ¶ 11. However, on November 2, 2004, the Florida electorate approved an amendment to the State Constitution titled "Patients' Right to Know About Adverse Medical Incidents" ("Amendment 7"). Id. at ¶ 12; Fla. Const. Art. X, § 25. Amendment 7 allows patients "access to any records made or received in the course of business by a health care facility or provider relating to any adverse medical incident."

Id. at § 25(a). On June 20, 2005, the Florida Legislature passed an enabling act, codified as Florida Statutes § 381.028, to implement Amendment 7. See Doc. 13, ¶ 14.

On or about November 8, 2010, LMHS received a notice of intent to Initiate Litigation for Medical Malpractice by the Garvins. Id. at ¶ 72. The notice also requested LMHS produce Amendment 7 documents. Id. at ¶ 74. On or about November 22, 2010, the Garvins served LMHS with a Request for Production, again requesting various Amendment 7 documents. Id. at ¶¶ 77-78. On or about November 24, 2010, the Garvins filed a medical malpractice suit against LMHS relating to care provided at a LMHS facility. See Garvin v. Lee Memorial Health System, Case No. 10-CA-004822, in the Circuit Court of the Twentieth Judicial Circuit, in and for Lee County, Florida. Id. at Ex. Q. LMHS has objected to both the request in the Garvins' Notice and the Request for Production. Id. at ¶¶ 79-80.

On January 7, 2011, LMHS filed an Amended Complaint (Doc. 13) against the Garvins and others with this Court. Counts One through Four of the Amended Complaint seek declaratory relief to the effect that Amendment 7 is preempted by the Patient Safety and Quality Improvement Act of 2005 ("PSQIA"), the Health Insurance Portability and Accountability Act ("HIPPA"), the Health Care Quality Improvement Act of 1986 ("HCQIA"), and that it violates the Contract Clause. Id. Count Five seeks injunctive relief, requesting the Court find LMHS need not comply with Amendment 7. Id. On August 5, 2011, LMHS filed a Motion for Summary Judgment (Doc. 37). On that same day, the Garvins filed a Motion for Abstention (Doc. 38), requesting the Court abstain from considering LMHS' Complaint pursuant to Younger v. Harris, 401 U.S. 37 (1971), and its progeny.


I. The Principles of Abstention and Comity Are Not Obviated by the Submission of LMHS to Federal Jurisdiction

LMHS asserts that as the principles of federalism and comity were established for the benefit of the state and its entities, as a political subdivision of the state, it has the right to waive these principles. See Doc. 50, pp. 2-3. Moreover, LMHS submits it has voluntarily submitted itself to this federal forum, obviating the principles upon which Younger abstention is based. As such, LMHS contends the Garvin's Motion for Abstention should be denied. The Court finds these arguments unavailing.

The policies underlying Younger abstention arise out of maintaining a proper respect for state functions. See Middlesex County Ethics Comm. v. Garden State Bar Ass'n, 457 U.S. 423, 432, 102 S.Ct. 2515, 2521, 73 L.Ed.2d 116. To that end, the Supreme Court has stated: The policies underlying Younger abstention have been frequently reiterated by this Court. The notion of 'comity' includes 'a proper respect for state functions, a recognition of the fact that the entire country is made up of a Union of separate state governments, and a continuance of the belief that the National Government will fare best if the States and their institutions are left free to perform their separate functions in their separate ways.' Minimal respect for the state processes, of course, precludes any presumption that the state courts will not safeguard federal constitutional rights.

Middlesex, 457 U.S. at 431 (quoting Younger, 401 U.S. 37, 44, 91 S.Ct. 746, 750, 27 L.Ed.2d 669 (1971)). Moreover, in Ohio Bureau of Employment Services v. Hodory, the court states "Younger v. Harris reflects a system in which there is sensitivity to the legitimate interests of both State and National Governments, and in which the National Government, anxious though it may be to vindicate and protect federal rights and federal interests, always endeavors to do so in ways that will not unduly interfere with the legitimate activities of the states. Ohio Bureau of Empl. Services v. Hodory, 431 U.S. 471, 479-80, 97 S.Ct. 1898, 1904, 52 L.Ed.2d 513 (1977) (citing Younger, 401 U.S. at 44).

LMHS bases its argument primarily on the decision in Hodory. In Hodory, the appellee Paul Hodory applied to the appellant, Ohio Bureau of Employment Services, for unemployment benefits, but his claim was disallowed under an Ohio statute. Id. at 471. While appellee's request for reconsideration was pending before the Board of Review, he filed a class action in federal district court against the appellants, the Bureau, and its director for declaratory and injunctive relief, asserting the Ohio statute conflicted with federal law and denied due process and equal protection. Id. The Bureau argued before the district court that principles of comity required it to abstain from the case. The district court held that abstention was unwarranted and ruled in favor of Hodory on the merits. Subsequently, the Bureau and its director took direct appeal to the Supreme Court. Id. at 476. On appeal, neither party claimed the district court should have abstained from deciding the case. Instead, the issue of abstention was raised in an amicus curiae brief. Id. In finding that abstention was not required on appeal, the Court stated, "Younger and these cited cases express equitable principles of comity and federalism. They are designed to allow the State an opportunity to 'set it's own house in order' when the federal issue is already before a state tribunal." Id. at 479-80. Moreover, the Court found that under the circumstances, Younger principles of equity and comity did not require the Supreme Court to refuse Ohio the immediate adjudication it sought. Id. at 480. The Supreme Court also noted that the appellants, the Ohio Bureau of Employment Services "in effect are the State of Ohio". Id. at 477

In Hodory, the State of Ohio, not a political subdivision of the State, was a party to the case. Moreover, on appeal neither party challenged the district court's ruling on abstention and the Supreme Court did not express any view on whether the district court erred in refusing to abstain on Younger grounds. In fact, Younger abstention would not have been discussed at all, had it not been raised by the amicus. Id. at 476. Accordingly, Hodory does not stand for the proposition that a federal court may not abstain from hearing a claim when a political subdivision of the state, as a party, voluntarily submits itself to a federal forum.

LMHS also cites Brown v. Hotel and Restaurant Employees and Bartenders Int'l Union Local 54, to support its position that the State, or any of its entities', voluntary submission to a federal forum obviates the principles upon which Younger abstention is based. Brown v. Hotel and Restaurant Employees and Bartenders Int'l Union Local 54, 468 U.S. 491, 104 S.Ct. 3179, 82 L.Ed.2d 373 (1984). However, just as in Hodory, the parties consisted of, among others, the State and its officials: G. Michael Brown, the Director of New Jersey's Department of Law and Public Safety, Division of Gaming Enforcement; the Division of Gaming Enforcement; and the Governor of New Jersey. They were represented by the New Jersey Attorney General. The Unions nor Brown, the Division, or the Governor objected to having their appellate claims heard in federal court. See id. at 500, n. 9 ("The New Jersey Attorney General . . . does not, however, press the Younger abstention claim before this Court, and instead submits to the jurisdiction of this Court in order to obtain a more expeditious and final resolution of the merits of the constitutional issue."). Unlike in Hodory and Brown, here there is no consent on behalf of both parties to have their claims heard in ...

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