Supreme Court Affirms Right of Nursing Home Patient to Sue the State

The U.S. Supreme Court in Washington on May 12, 2023. Madalina Vasiliu/The Epoch Times

Americans who depend on government programs like Medicaid and food stamps can sue to secure rights under laws that created those programs, the U.S. Supreme Court ruled on June 8.

In a 7–2 decision, the high court upheld an appeals court ruling that green-lighted an Indiana man’s family to sue over his care at a state-run nursing home using a 150-year-old Reconstruction-era federal law known as Section 1983, which provides a cause of action for victims of civil rights violations by state or local government officials.

The Talevski Case

The dispute was brought in 2019 by the family of Gorgi Talevski, a dementia patient who was admitted in 2016 to a nursing home operated by the Health and Hospital Corporation of Marion County (HHC) in Indiana.

In court fillings, the Talevski family claimed that the facility poorly managed their father’s dementia, over-medicated him with powerful psychotropic drugs as chemical restraints, and forcefully transferred him to different facilities, which allegedly caused his condition to deteriorate.

Suing through his daughter, Talevski accused the nursing home and HHC officials overseeing the facility of violating the Federal Nursing Home Reform Act (FNHRA), which sets the minimum standards of care that nursing homes receiving Medicaid funding must follow.

Talevski died in 2021, while the litigation was pending.

The HHC tried to get the case dismissed, claiming that Talevski didn’t have the right to sue using Section 1983.

Specifically, the HHC argued that only civil rights or equal protection laws are enforceable under Section 1983, because the statute was originally enacted in the aftermath of the Civil War and to specifically protect people freed from slavery.

It also argued that Medicaid is essentially a “contract” where state governments agree to comply with federally imposed rules in return for federal money, meaning that third-party beneficiaries like Talevski have no business in enforcing those rules.

Indiana’s Attorney General Todd Rokita, a Republican, is among allies supporting the HHC. In a court brief filed along with 21 other Republican attorneys general, Rokita warned that “unauthorized lawsuits” seeking to enforce federal grant conditions would invite unelected federal judges to interfere with how state and federal officials do their jobs.

“We all want nothing but the best care for our seniors. But this case principally concerns the need to hold grant relationships accountable to voters—and the need to respect the authority of Congress,” he wrote in a statement. “That means that individual beneficiaries who are not parties to the contracts should not be able to sue to enforce grant conditions unless Congress expressly authorizes them to do so.”

The Core Questions

A federal district court sided with the state, but the 7th Circuit Court of Appeals allowed the case to move forward.

In their overruling decision, the circuit judges concluded that the two rights Talevski specifically pressed—the right to be free from unnecessary chemical restraints and rights to remain in a facility without being transferred except in certain circumstances—are unambiguously implied in the text of FNHRA, and therefore Talevski could sue to enforce them under Section 1983.

At the U.S. Supreme Court, the case boiled down to two questions.

The first, broader question concerns whether the Supreme Court should follow a half-century of precedent, which has consistently interpreted Section 1983 as capable of securing “rights” under laws enacted by Congress under the Constitution’s Spending Clause, such as ones that created Medicaid and Supplemental Nutrition Assistance Program (SNAP), better known as food stamps.

The second and much more narrow question is whether the FNHRA’s protection of rights against chemical restraint and improper discharge and transfer are federal rights covered by Section 1983.

The Decision

A majority of Supreme Court justices, consisting of the court’s entire progressive wing and some members of the conservative wing, answered “yes” to both questions.

“By its terms, Section 1983 is available to enforce every right that Congress validly and unambiguously creates,” Justice Ketanji Brown Jackson wrote in the majority opinion. “The test that our precedents establish leads inexorably to the conclusion that the FNHRA secures the particular rights that Talevski invokes, without otherwise signaling that enforcement of those rights via Section 1983 is precluded as incompatible with the FNHRA’s remedial scheme.”

Justices Samuel Alito and Clarence Thomas dissented.

In his dissenting opinion, Thomas argued that Congress doesn’t simply raise new federal rights when it creates and sets rules for new spending programs. Otherwise, that would violate the 10th Amendment’s anti-commandeering doctrine, which prohibits the federal government from forcing states to adopt or enforce federal law.

“Spending conditions like FNHRA’s are nothing more than commands to states ... to administer federal benefits programs on terms dictated by Congress,” he wrote. “Such conditions cannot be treated as having the force of federal law imposing direct obligations on the States and securing correlative rights of private parties without violating the anti-commandeering doctrine.”

Meanwhile, Alito argued that the nursing home law already has a process for remedy in place and should not be disrupted by Section 1983 lawsuits.

“Allowing Section 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,” Alito wrote.