United States District Court, N.D. Alabama, Southern Division
DAVID PROCTOR UNITED STATES DISTRICT JUDGE.
case is before the court on Plaintiffs' Motion for
Remand. (Doc. # 3). The parties have fully briefed the motion
(see Docs. # 3, 11, 12), and the court held oral
argument on the motion on July 9, 2018. After careful review,
and for the reasons explained below, the court concludes that
Plaintiffs' Motion for Remand (Doc. # 3) is due to be
Background and Procedural History
Laura Ownby and Lisa Wright are Alabama residents who
received care from Dr. Paul Castellanos at the University of
Alabama Birmingham, Academic and Medical Center (“UAB
Hospital”). (Doc. # 1-1 at p. 9, ¶ 1). Dr.
Castellanos is an otolaryngologist and airway surgeon who
Plaintiffs describe as a “surgeon of ‘last
resort'” for individuals with “obstructive
airway disease, intractable swallowing disorders, and the
inability to produce a natural voice.” (Id. at
p. 10, ¶ 2). Until May 2018, Dr. Castellanos was
employed by the University of Alabama at Birmingham
(“UAB”) and the University of Alabama Health
Services Foundation, P.C. (“UAHSF”).
(Id. at p. 11-12, ¶¶ 3-4). Plaintiffs
allege that Defendant Dr. William Carroll, the department
chair of Dr. Castellanos' department, counseled him to
focus on “simpler cases” in order to improve the
department's statistical outcomes. (Id. at p.
12, ¶ 4). Moreover, they allege that no other physician
or surgeon at UAB Hospital would treat them or other
“critical airway patients.” (Id. at p.
12, 14, ¶¶ 4-5).
March 2018, Plaintiffs filed a five-count Complaint in
Alabama state court. (Doc. # 1-1 at 8-23). First, Plaintiffs
allege that Defendants have abandoned patients who need
“further, continued treatment by Dr. Castellanos or a
replacement surgeon of the same level of skill, willingness,
and experience.” (Id. at p. 15, ¶ 6).
Plaintiffs claim that the medical care that has been provided
to them by UAB Hospital “may not be abandoned without
reasonable notice or the provision of a competent
replacement.” (Id.). Second, Plaintiffs allege
that three of the Defendants breached an implied contract in
fact to offer them medical services performed by Dr.
Castellanos. (Id. at p. 17-18, ¶ 8). They
specifically contend that these Defendants breached the
implied contract by interrupting the physician-patient
relationships between Dr. Castellanos and themselves.
(Id.). Third, Plaintiffs allege that Dr. Carroll
tortiously interfered with contractual relationships between
Plaintiffs, Dr. Castellanos, and Castellanos' employers.
(Id. at p. 18-19, ¶ 9). They contend that Dr.
Carroll sought to force Dr. Castellanos and his high-risk
patients away from UAB Hospital. (Id.). Fourth,
Plaintiffs allege that Dr. Carroll negligently and wantonly
performed his duties as a supervising physician by attempting
to force Dr. Castellanos' removal from UAB Hospital's
staff. (Id. at 19-20, ¶ 10). Finally,
Plaintiffs request injunctive relief, including (1) the
reversal of UAB's decision to remove Dr. Castellanos from
UAB Hospital's staff until, at a minimum, a replacement
physician with similar skills and willingness to treat
high-risk airway patients can be found, and (2) the reversal
of actions taken to interfere with or curtail necessary
medical treatment that has been provided to Plaintiffs at UAB
Hospital. (Id. at p. 20-22, ¶ 11).
Plaintiffs filed the Complaint, the parties submitted a
stream of motions, most of which do not require discussion.
On May 16, 2018, Plaintiffs filed a motion for declaratory
and/or injunctive relief after the state court had set a
preliminary injunction hearing for May 24, 2018. (Doc. # 1-8
at 203-04). On May 17, 2018, Plaintiffs also filed an Amended
Complaint that named Dr. Robert Brunner, the chair of UAB
Hospital's Credentialing Committee, as a Defendant.
(Id. at 228-29).
23, 2018 (the day before the scheduled preliminary injunction
hearing), Defendant Brunner removed this case from state
court to this court pursuant to 28 U.S.C. §§ 1331,
1367, and 1441. (Doc. # 1). Brunner explained that the
state-law claims in the Complaint implicate substantial
federal interests because physician credentialing is governed
by the Health Care Quality Improvement Act of 1986
(“HCQIA”) and the Conditions of Participation
issued by the Centers for Medicare and Medicaid Services
(“CMS”). (Id. at 6-7). Brunner stated
that the Complaint implicated the Emergency Medical Treatment
and Active Labor Act (“EMTALA”) because
Plaintiffs sought to require the hospital to offer
specialized capabilities after it terminated Dr. Castellanos.
(Id. at 7). Additionally, Brunner contended that
Plaintiffs artfully pled their claims to avoid federal
questions regarding privileging and staff appointments.
(Id. at 7-8). Finally, Brunner asserted that
complete preemption justified this court's jurisdiction
because federal law completely preempts any state laws
regarding physician credentialing, staff governance, medical
staff bylaws, quality assurance, or emergency medical
services. (Id. at 8).
promptly moved to remand the case back to state court. (Doc.
# 3). They emphasize in their remand motion that Defendants
cannot justify a removal based upon a question of federal law
raised as an anticipated defense. (Id. at 2). And,
they insist that their claims do not require UAB Hospital or
UAHSF to re-credential Dr. Castellanos. (Id. at 3).
axiomatic that this court has limited jurisdiction and is
“empowered to hear only those cases within the judicial
power of the United States as defined by Article III of the
Constitution, and which have been entrusted to them by a
jurisdictional grant authorized by Congress.” Univ.
of S. Ala. v. Am. Tobacco Co., 168 F.3d 405, 408 (11th
Cir. 1999) (internal quotation omitted). The removing party
bears the burden of proving the court's jurisdiction, and
any doubts about the propriety of federal jurisdiction should
be resolved in favor of remand. Adventure Outdoors, Inc.
v. Bloomberg, 552 F.3d 1290, 1294 (11th Cir. 2008).
Complete Preemption Does Not Justify This Court's
Subject-Matter Jurisdiction Over Plaintiffs'
their opposition brief to the Motion to Remand, Defendants
UAHSF, UAB Health System Board of Directors, Dr. Carroll, and
Dr. Brunner argue that Plaintiffs' claims are completely
preempted by the Conditions of Participation issued by CMS.
(Doc. # 11 at 17). The court is not convinced.
preemption is a narrow exception to the well-pleaded
complaint rule and exists where the preemptive force of a
federal statute is so extraordinary that it converts an
ordinary state law claim into a statutory federal
claim.” Conn. State Dental Ass'n v. Anthem
Health Plans, Inc., 591 F.3d 1337, 1343 (11th Cir.
2009). To date, complete preemption has been held by the
Supreme Court to exist only with respect to claims seeking
benefits under a plan governed by ERISA, labor contracts
governed by the Labor Management Relations Act of 1947, and
usury claims against federally-chartered banks under the
National Bank Act. Id. at 1343-44 & n. 3.
Complete preemption arises only where “the federal
statutes at issue provide[ ] the exclusive cause of action
for the claim asserted and also set forth procedures and
remedies governing that cause of action.”
Beneficial Nat'l Bank v. Anderson, 539 U.S. 1, 8
(2003) (referencing 29 U.S.C. §§ 185 & 1132).
To decide whether a federal cause of action completely
preempts related state-law causes of action, the court
assesses Congress's intent in creating the cause of
action by examining “such questions as whether the
state claim is displaced by federal law under an ordinary
preemption analysis, whether the federal statute provides a
cause of action, what kind of jurisdictional language exists
in the federal statute, and what kind of language is present
in the legislative history to evince Congress's
intentions.” Blab T.V. of Mobile, Inc. v. Comcast
Cable Commc'ns, Inc., 182 F.3d 851, 857 (11th Cir.
Defendants have failed to show that the CMS regulations cited
in the notice of removal and their opposition to remand brief
create any cause of action, much less an exclusive
federal-law cause of action. (See Docs. # 1 at 8, 11
at 17). Defendants do not specify which federal regulation
creates a cause of action related to the causes of action in
the Complaint. (See Doc. # 11 at 17). Moreover, the
statutes cited by Defendants -- 42 U.S.C. § 1395 and 42
U.S.C. § 1395c -- reflect no Congressional intent to
establish an exclusive federal-law cause of action.
Defendants point to no legislative history that would support
applying complete preemption to the claims in Plaintiffs'
Complaint. Finally, in other contexts, district courts in
this circuit have concluded that provisions in the Medicare
Act and the Medicaid Act do not completely preempt state law
regulating various healthcare fields. See, e.g.,
Main & Assocs., Inc. v. Blue Cross & Blue Shield
of Ala., 776 F.Supp.2d 1270, 1281-82 (M.D. Ala. 2011)
(concluding that 42 U.S.C. §§ 405(g),
1395w-22(g)(5), and 1395w-26(b)(3) did not completely preempt
the plaintiff's claims that the defendant insurer
wrongfully and tortiously failed to reimburse it in
accordance with Medicare regulations); Kennedy v. Health
Options, Inc., 329 F.Supp.2d 1314, 1316-17 (S.D. ...