Right of Individuals to Sue to Enforce the Federal Nursing Home Reform Act

Facts of the Case

In 2016, Gorgi Talevski was placed in the Valparaiso Care and Rehabilitation (VCR) nursing home because of dementia. After entering the nursing home, his functioning declined. For instance, he became unable to eat independently and began losing the ability to speak in English, although he retained the ability to speak Macedonian, his native language. Mr. Talevski’s family then learned that VCR “was chemically restraining Mr. Talevski with six powerful psychotropic medications” (Health & Hosp. Corp., p 1451). With the assistance of an outside neurologist, Mr. Talevski’s medication was tapered and his functioning reportedly improved.

VCR asserted that Mr. Talevski was harassing female residents, and subsequently transferred him three times to a psychiatric hospital situated 90 minutes away. During the third admission to the psychiatric hospital, VCR attempted “to force his permanent transfer to a dementia facility” (Health & Hosp. Corp., p 1451). The Talevskis subsequently filed a complaint with the Indiana State Department of Health protesting the attempted transfer. While the complaint was pending, Mr. Talevski was moved to another facility. An administrative law judge nullified VCR’s attempted discharge of Mr. Talevski. Despite the judge’s decision, VCR continued to refuse Mr. Talevski’s readmission.

In 2019, Mr. Talevski’s wife, Ivanka Talevski, filed a § 1983 lawsuit on his behalf against VCR, American Senior Communities LLC, and Health and Hospital Corporation of Marion County (collectively referred to as HHC) asserting that they violated Mr. Talevski’s rights under FNHRA. FNHRA was enacted in 1987 pursuant to Congress’s spending clause powers and established a set of quality standards that nursing facilities must meet to receive Medicaid funds.

The lawsuit asserted that VCR failed to meet two FNHRA provisions in its care of Mr. Talevski. First, FNHRA mandates that nursing facilities “protect and promote” each resident’s interest in being free from “any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms” (42 U.S.C. § 1396r (c)(1)(A)(ii) (2012)). Second, FNHRA establishes a set of conditions that nursing facilities must meet before discharging or transferring a resident. One such condition is advance notice of a transfer or discharge. Ms. Talevski argued that VCR’s treatment of Mr. Talevski with psychotropic medications and repeated transfer attempts violated these two FNHRA provisions.

Ms. Talevski filed her lawsuit under § 1983, a statute enacted by Congress as part of a package of legislation intended to curb state-sanctioned vigilantism and violence during the Reconstruction Era. Section 1983 allows individuals to sue state actors for violating their civil rights. Since its inception, it has been used to address abuses by state officials and provide remedies for individuals when the enforcement mechanisms offered by the state are inadequate.

HHC argued that § 1983 contains an implicit exception for laws, such as FNHRA, that Congress enacts via its spending power. It claimed that by requiring states to comply with certain requirements in exchange for receiving federal funding, spending clause legislation creates a contract between the federal government and the states. HHC asserted that when § 1983 was enacted in the 1870s, third parties were not allowed to sue to enforce a contract and reasoned that this should preclude lawsuits like Ms. Talevski’s.

The district court granted HHC’s motion to dismiss the lawsuit, reasoning that individuals cannot use §1983 to enforce FNHRA provisions. The Court of Appeals for the Seventh Circuit reversed the lower court’s decision. In response, HHC appealed to the U.S. Supreme Court.

Ruling and Reasoning

The U.S. Supreme Court affirmed the Seventh Circuit’s decision and held that plaintiffs may sue under § 1983 to enforce spending clause legislation such as FNHRA. The majority opinion, authored by Justice Jackson and joined by Chief Justice Roberts and Justices Sotomayor, Kagan, Gorsuch, Kavanaugh, and Barrett, invoked the Court’s longstanding position that spending clause legislation may, but does not always, create § 1983-enforceable rights. The Court disagreed with HHC’s claim that §1983 contains an implicit carve-out for spending clause legislation.

The Court held that Ms. Talevski had standing under § 1983 to file a lawsuit against HHC for violating her husband’s civil rights. To do so, it assessed whether the statute is phrased in terms of “‘rights-creating’, individual-centric language” (Health & Hosp. Corp., p 1457). It found that the FNRHA regulations in question meet that standard, and, as a result, do create rights that plaintiffs may sue to enforce under § 1983. The Court addressed only Ms. Talevski’s standing to sue; it did not comment on the merit of her claims against HHC.

In Justice Barrett’s concurring opinion, which Chief Justice Roberts joined, she highlighted that not all spending clause legislation creates § 1983-enforceable rights. In Justice Gorsuch’s concurring opinion, he questioned whether allowing plaintiffs to sue under § 1983 to enforce spending clause legislation might allow for federal overreach in state affairs but noted that HHC did not fully develop that concern in its argument.

Dissent

Justice Thomas’ dissent expanded on the question raised by Justice Gorsuch in his concurrence, arguing that making spending clause legislation §1983-enforceable would violate the court’s anti-commandeering doctrine, which prohibits the federal government from using state resources to enforce federal laws. Justice Alito’s dissent, joined by Justice Thomas, argued that FNHRA had already established a grievance process for nursing facility residents that should preclude § 1983 lawsuits.