Wake Forest Law Review

By Kelsey Hyde

Today, in the civil case of United States ex rel. Michaels v. Agape Senior Community, Inc., the Fourth Circuit published an opinion affirming the district court’s decision on the Attorney General’s unreviewable veto power under 31 U.S.C. § 3730, and dismissing the appeal of an evidentiary issue. In affirming the lower court’s ruling, the Court found the U.S. District Court for the District of South Carolina properly interpreted the relevant statute and persuasive case law on the issue of the Government’s right to veto a settlement for qui tam action cases in which they elected not to take part. In dismissing the appeal of the district court’s decision to disallow statistical sampling as hard evidence, the Court strictly construed 28 U.S.C. § 1292(b) and declined to review the present issue for it did not concern a pure question of law.

Procedural Matters in Determining the Parties

This action arose from the allegations of Brianna Michaels and Amy Whitesides regarding the dealings of their former employer, defendant Agape Senior Community, Inc. and twenty-three affiliated elder care facilities throughout South Carolina (collectively, “Agape”). The two former employees alleged that Agape had fraudulently billed Medicare and other health care programs run by the Federal Government for thousands of patients who were ineligible or did not actually receive the charged services.

Michaels and Whitesides proceeded with this matter under the False Claims Act (FCA), which authorizes private individuals (referred to as “relators”) to pursue legal actions on behalf of the United States in order to receive civil remedies for fraud committed against the Government, called a “qui tam action”. See 31 U.S.C. §§ 3729-3733. This type of suit permits the Government to intervene within specified time periods, or decline to intervene and instead allow the relators to conduct the action. Id. at § 3730(b)(4)(A)-(B). In this case, the Government declined to intervene, but did alert the relators of a provision in § 3730(b) which provides the Attorney General ultimate, non-reviewable authority to object to proposed settlements and dismissals, a provision at the center of this appeal.

The Two District Court Rulings that Led to Interlocutory Appeal  

Discovery efforts revealed that Agape had filed over 50,000 claims for federal health care programs for a relevant time period in which they had also admitted 10,000 patients. Based on the unreasonable cost of reviewing all such documents and materials pertaining to these claims and individuals, estimated at over $36 million, the relators sought instead to use a statistical sampling of the evidence to prove their case of fraudulent federal health care billing. However, the District Court ruled this to be an improper evidentiary method (referred to as “the statistical sampling ruling”).

The parties then negotiated and reached a proposed settlement agreement, but the Attorney General objected to the settlement amount, pursuant to § 3730(b)(1), based on the Government’s own statistical sampling assessment and estimated damages. Agape sought to enforce the settlement over such objection, but the District court refused and found instead that the Attorney General possessed absolute veto power over such decisions under § 3730(b)(1). In this ruling, the court did note the peculiarity of the Government involving itself in a case in which it chose not to be a party, and by way of a method in which the court had found improper, but still upheld this veto power (referred to as “the unreviewable veto ruling”).

Challenges & Standards of Review on Appeal

On appeal, the Fourth Circuit addressed the district court’s two rulings, the statistical sampling ruling and the unreviewable veto ruling. Namely, these matters raised two issues: (1) the extent of the Attorney General’s power under § 3730(b)(1) to veto an FCA qui tam action settlement in which the Government chose not to intervene; and (2) the authority of the Court of Appeals to review the district court’s decision regarding the evidentiary use of statistical sampling in this case. The Court’s review of these matters was de novo. The appeal of these issues occurred before the actual trial to better serve judicial efficiency, based on the court’s opinion that both involved important and controlling questions whose result could lead to the ultimate termination and judgment of litigation. As such, the Fourth Circuit granted appeal and heard these issues pursuant to 28 U.S.C. § 1292(b).

Fourth Circuit Adopts Finding of Attorney General’s “Absolute Veto Power” Over Such Settlements

            In reviewing the district court’s interpretation of Section 3730(b)(1), the Court began by assessing two different interpretations of this very statute put forth by different circuit courts. First, the Ninth Circuit’s decision in United States ex rel. Killingsworth v. Northrop, 25 F.3d 715 (9th Cir. 1994) held that the Attorney General’s consent-for-dismissal provision for FCA qui tam suits is not absolute, but instead can be limited and subject to a reasonableness review if the government chooses not to intervene. Conversely, the Fifth and Sixth Circuits both determined that the Attorney General has absolute veto power over such settlements, regardless of the Government’s choice to intervene, and therefore relators may not seek voluntary dismissals without the consent of the Attorney General. See Searcy v. Philips Electronics North America Corp., 117 F.3d 154 (5th Cir. 1997); United States v. Health Possibilities, P.S.C., 207 F.3d 335 (6th Cir. 2000).

The Fourth Circuit chose to adopt the interpretation of the Fifth and Sixth Circuits, holding that the Attorney General does indeed have absolute, unreviewable power to consent or object to voluntary settlements in FCA qui tam suits. It reached this conclusion based on the plain language of the statute and the determination that the consent-for-dismissal provision is unambiguous. Additionally, the court found that the statute’s legislative history reveals a clear Congressional intent to grant such unreviewable authority to the Attorney General, and that Congress did in fact act purposefully by choosing not to articulate limitations on this authority. Moreover, the court reasoned that this interpretation is wholly consistent with the FCA, a statutory scheme that still construes the United States Government as the real party of interest, regardless of their choice to intervene.

District Court’s Evidentiary Ruling Did Not Present Question of Law Subject for Review on Interlocutory Appeal

            In examining the district court’s statistical sampling ruling, the Circuit relied on other Fourth Circuit precedent concerning interlocutory review to determine that this issue was not eligible for this specific type of appeal. Namely, the court observed that such review is to be used sparingly under strictly construed requirements, and must involve a controlling question of law. See Myles v. Laffitte, 881 F.2d 125, 127 (4th Cir. 1989). Moreover, the court emphasized that review under Section 1292(b) is not proper when the question turns on genuine issues of fact where the district court applies settled law to the facts and evidence of a particular case. Based on such standards, the Court found that the district court’s ruling to disallow statistical sampling did not concern a question of law regarding its admissibility in general, but instead solely concerned its admissibility with respect to the particular facts and evidence in this case. Thus, the issue did not raise a pure question of law subject to interlocutory review.

Fourth Circuit Affirmed in Part, and Dismissed in Part

Accordingly, the Fourth Circuit affirmed the district court’s unreviewable veto ruling, and dismissed the relators’ appeal of the statistical sampling ruling.

By Kelsey Mellan

On November 4, 2016, the Fourth Circuit issued a published opinion in Scinto v. Stansberry, a civil case involving a prisoner who was allegedly denied medical attention while in a North Carolina prison (“Prison”). Plaintiff Paul Scinto, Sr. suffers from diabetes and claims that while he was incarcerated, he was denied medical care that resulted in permanent injury. Plaintiff alleged this denial of medical care violated his Eighth Amendment right, which prohibits the infliction of “cruel and unusual punishment.” The current issue before the Fourth Circuit is whether the district court erred in dismissing Plaintiff’s constitutional claims against Dr. Derick Phillip, Administrator Susan McClintock, and Warden Patricia Stansberry for denying him medical care while under their supervision at the Prison. In response, Dr. Phillip and Administrator McClintock claimed that because of qualified immunity, they were shielded from civil liability. The Fourth Circuit affirmed the district court’s decision regarding Warden Stansberry and vacated its decision in terms of Dr. Phillip and Administrator McClintock as the court determined their actions violated Plaintiff’s Eighth Amendment rights. Furthermore, the Fourth Circuit rejected the Defendants’ invocations of qualified immunity.

Facts & Procedural History

Plaintiff entered custody at the Prison in June 2005 after serving multiple years at different federal prisons. While incarcerated, Plaintiff suffered from numerous medical conditions, including high blood pressure, hepatitis C, and insulin-dependent diabetes. There were multiple incidents that occurred at the Prison giving rise to these claims. When Plaintiff first arrived at the Prison in June 2005, Dr. Phillip, his primary prison doctor, prescribed him daily insulin injections to control his diabetes. On June 14, 2005, Plaintiff alleged that he requested an insulin injection from Dr. Phillip because his blood sugar was abnormally high. Plaintiff then claimed Dr. Phillip denied him an insulin injection, opting to create a diet plan for Plaintiff instead. According to evidence presented by Plaintiff, Dr. Phillip never followed through on this meal plan Dr. Phillip claimed the only reason he did not give insulin to Plaintiff on June 14 was because of his “angry” attitude and threatening behavior. Dr. Phillip routinely failed to provide insulin to Plaintiff. Plaintiff alleged that inadequate treatment of his diabetes resulted in damage to his nervous system, kidneys, and eyesight.

An additional incident took place on August 24, 2005 when Plaintiff suffered from a medical emergency causing him to experience extreme stomach pain, vomit blood, and become incontinent. Plaintiff claims that despite his multiple attempts to render assistance from Dr. Phillip and Administrator McClintock, he was not provided proper medical attention until two days later, at which time he was diagnosed with gallstones. Both Dr. Phillip and Administrator McClintock interacted with Plaintiff during this medical emergency and took no action to provide medical care for him.

Finally, Plaintiff alleged he was denied a proper diabetic diet during his stay at the Prison. He claimed that every meal served at the Prison was high in sugar and was accompanied by a sugary drink. When he expressed these concerns to both Warden Stansberry and his congressman who forward the concerns to the Warden, Plaintiff stated he was told that inmates were educated about how to select foods appropriate for their medical conditions. Because of the lack of diabetes-friendly food, Plaintiff claimed he suffered from high blood sugar levels, the treatment of which caused him to experience loss of diabetic control and severe destructive episodes of diabetic hypoglycemia and hyperglycemia.

Plaintiff originally brought multiple constitutional claims against numerous Prison officials in the District Court for the District of Columbia. The D.C. District Court dismissed most of these claims against officials and transferred the remaining claims to the District Court for the Eastern District of North Carolina. Cross-motions for summary judgment followed and the district court denied Plaintiff’s motion for summary judgment and granted summary judgment to the defendants on each of Plaintiff’s claims. This appeal only concerns three claims dismissed on summary judgment, each arising under the Eighth Amendment against Dr. Phillip, Administrator McClintock, and Warden Stansberry. Pursuant to Federal Rule of Civil Procedure 56(a), summary judgment is appropriate, “if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.”

Eighth Amendment and Denial of Medical Care

The Eighth Amendment prohibits the infliction of “cruel and unusual punishment.” In Helling v. McKinney, the Supreme Court determined that this amendment pertains to not only physically cruel punishment, but that it also includes “the treatment a prisoner receives in prison and the conditions under which he is confined.” The Supreme Court further defined this right in Farmer v. Brennan, in which the court established that prison officials are required to provide humane conditions of confinement and that inmates receive adequate food, clothing, shelter, and medical care.

To succeed on this constitutional claim pertaining to denial of medical treatment, a plaintiff must demonstrate a prison official’s “deliberate indifference to serious medical needs of prisoners constitutes the unnecessary and wanton infliction of pain proscribed by the Eighth Amendment.” In Farmer, the Supreme Court crafted a 2-pronged test that plaintiffs must fulfill to prove an Eighth Amendment violation. First, plaintiffs must demonstrate that the alleged deprivation was, objectively, “sufficiently serious.” In order to be considered sufficiently serious, the medical need being deprived should be either diagnosed by a physician or so obvious that even a layperson would realize medical attention is necessary. Second, plaintiffs must show that, subjectively, prison officials acted with a “sufficiently culpable state of mind,” in that the official knew of and disregarded an excessive risk to the inmate’s health. This prong requires proof of the official’s actual knowledge of both the inmate’s serious medical condition and excessive risk posed by the official’s action or inaction.

Plaintiff’s Eighth Amendment Claims against Defendants

Plaintiff claims that Dr. Phillip violated his Eighth Amendment right when he refused to give Plaintiff insulin to combat his high blood sugar. The Fourth Circuit determined that Plaintiff demonstrated a genuine dispute of material fact as to both Farmer’s objective and subjective prongs. First, Plaintiff sufficiently proved he suffered from a serious medical condition, insulin-dependent diabetes. The issue of fact concerns whether the serious medical condition of diabetes actually led to the more serious kidney and eyesight problems. Moreover, Dr. Phillip actually treated Plaintiff for his diabetes and it is obvious to even a layperson that insulin-dependent diabetics require insulin injections. In terms of the second subjective prong, Plaintiff adequately demonstrated that not only did Dr. Phillip know about his medical condition, but that the doctor was fully aware of the potential ramifications of mistreatment of the disease. The Fourth Circuit decided that the combination of these facts was enough for Plaintiff’s claim against Dr. Phillip to survive summary judgment.

In terms of Plaintiff’s August 24 medical emergency, he again established genuine issues of material fact as to both Farmer prongs. In terms of the objective prong, Plaintiff’s evidence establishes that there is genuine dispute as to whether as to whether the denial of medical attention during this emergency resulted in serious injury or a substantial risk of serious injury. Subjectively, Plaintiff proved that it was likely both Dr. Phillip and Administrator McClintock were aware of his need for medical assistance. Their failure to take action could give rise to an inference of deliberate indifference, and therefore should survive summary judgment and be presented to a jury.

Despite the aforementioned actions by prison officials, the Fourth Circuit decided the district court correctly determined that Warden Stansberry did not violate Plaintiff’s Eighth Amendment rights. Objectively, Plaintiff failed to raise a genuine dispute of material fact regarding whether, in this case, the lack of a diabetic diet was a sufficiently serious deprivation to be actionable under the Eighth Amendment. Subjectively, the Warden provided adequate evidence to prove that on at least two occasions, inmates were educated on how to choose foods appropriate for their medical conditions. Moreover, several sister circuits have decided that as long as a prison provides some foods that are appropriate for different medical conditions, they have fulfilled their constitutional duties under the Eighth Amendment. Likewise, courts have found that inmates who are denied special diets suffer no constitutional harm so long as they are instead given instruction on how to eat the available meals in a way that satisfies their medical needs. Therefore, the district court was correct in awarding Warden Stansberry summary judgment.

Also, the Fourth Circuit determined that Defendants in this case were not protected by qualified immunity, which shields government officials performing discretionary functions from liability for civil damages insofar as their conduct does not violate clearly established statutory or constitutional rights of which a reasonable person would have known. This is because there is sufficient evidence that Plaintiff’s Eighth Amendment right to adequate medical care and freedom from officials’ deliberate indifference to his medical needs was violated. This right was clearly established, so Dr. Phillip and Administrator McClintock are not entitled to qualified immunity.

Disposition

Therefore, the Fourth Circuit affirmed the district court’s grant of summary judgment in favor of Warden Stansberry and reversed the grant of summary judgment to both Dr. Phillip and Administrator McClintock.