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Gorenc v. Klaassen

United States District Court, D. Kansas

August 1, 2019

JOANN KLAASSEN, RN, MN, JD, in her official capacity as the President of THE KANSAS STATE BOARD OF NURSING, et al., Defendants.



         Before the court is defendants Adventist Health Mid-America, Inc. (“Adventist”) and Susan Dahlin, Kathy Gaumer, Laura McMurray, and Lisa Pazdernik's (collectively the “Laborists”) Motion to Dismiss (Doc. 15). The court concludes plaintiffs cannot advance a 42 U.S.C. § 1983 claim because the Laborists and Adventist are not state actors. And, the court exercises its discretion to decline supplemental jurisdiction over plaintiffs' state law claims against the Laborists and Adventist. The court thus grants the Motion to Dismiss (Doc. 15).

         I. Background

         The court derives the following factual allegations from plaintiffs' Complaint (Doc. 1). Plaintiffs are midwives and hold active advanced practice registered nurse (“APRN”) licenses issued by the Kansas State Board of Nursing (“KSBN”). Doc. 1 at 3 (Compl. ¶¶ 7-8). Under Kansas law, the KSBN is tasked with adopting standards, regulations, and professional requirements for APRNs. Kan. Stat. Ann. § 65-1130. Under regulations adopted by the KSBN, APRNs must collaborate with a medical provider to treat patients. Doc. 1 at 7 (Compl. ¶ 36) (citing Kan. Admin. Regs. § 60-11-101(a)).[1]

         Adventist is a Kansas corporation who owns and operates Shawnee Mission Medical Center Health (“SMMCH”). Id. at 4 (Compl. ¶ 12). Sometime in 2016, plaintiffs entered into a Collaborative Practice Agreement (“CPA”) with Dr. Janetta Proverbs, permitting plaintiffs delivery privileges at SMMCH. Id. at 5 (Compl. ¶¶ 21-25). In late 2017 or early 2018, Dr. Proverbs informed plaintiffs that she would terminate the CPA, effective February 2018. Id. (Compl. ¶¶ 23-25).

         Without a CPA with a physician employed or holding privileges at SMMCH, plaintiffs could not attend the deliveries of their clients at SMMCH. Plaintiffs sought a CPA with each of the Laborists, all of whom were Obstetrician/Gynecologists employed by SMMCH. Id. at 4-5 (Compl. ¶¶ 13-16, 26). The chief medical officer at SMMCH informed plaintiffs that each of the Laborists had refused to enter into a CPA with plaintiffs. Id. at 6 (Compl. ¶¶ 29-30). Plaintiffs suggest the Laborists would not enter a CPA because (1) entering into a CPA would conflict with the Laborists “financial self-interest, ” given that plaintiffs and the Laborists serve the same, or at least similar, clientele; and (2) a CPA would have placed “time and energy” burdens on the Laborists. Id. at 9 (Compl. ¶¶ 51-53).

         Plaintiffs allege Adventist adopted policies making it “burdensome on physicians” to enter into CPAs with APRNs such as plaintiffs. Id. at 6 (Compl. ¶ 31). Plaintiffs' Complaint accuses Adventist of “creat[ing] policies harming nurse-midwives” and “refus[ing] to create a policy or directive encouraging or mandating the Laborists-or any other physicians-grant a CPA.” Id. (Compl. ¶ 32). Plaintiffs contend the policies enacted by Adventist, as well as the Laborists' refusal to enter into a CPA, deprived plaintiffs of “Constitutionally protected liberty and property interests” and caused them to miss 25 deliveries at SMMCH. Id. at 15-16 (Compl. ¶¶ 87-88).

         Plaintiffs' Complaint includes two claims against Adventist and three claims against the Laborists. Count III alleges a 42 U.S.C. § 1983 claim against both the Laborists and Adventist. In this claim, plaintiffs contend the Laborists “willfully and maliciously deprived Plaintiffs of their liberty and property interests in practicing their chosen profession and in their freedom of contract.” Id. at 23 (Compl. ¶ 130). And, plaintiffs contend, Adventist “exercise[ed] control and influence” over the Laborists' decisions to not enter into a CPA with plaintiffs. Id. at 24 (Compl. ¶ 131). Count IV advances a state law claim for tortious interference with a contract against the Laborists based on plaintiffs' inability to perform contracts with their clients after they lost delivery privileges at SMMCH. Id. at 25-27 (Compl. ¶¶ 143-53). Count V makes a state law claim for tortious interference with a business expectancy against the Laborists and Adventist because these defendants, when they refused to enter into a CPA with plaintiffs, allegedly restricted the growth of plaintiffs' midwifery practice. Id. at 27-28 (Compl. ¶¶ 154-65).

         The Laborists and Adventist moved under Federal Rule of Civil Procedure 12(b)(6) to dismiss plaintiffs' claims. Doc. 15; Doc. 16 at 4-5. On the § 1983 claim, the Laborists and Adventist argue that (1) the Complaint fails to identify a federally protected right because none of their actions deprived plaintiffs of the opportunity to practice midwifery at hospitals other than SMMCH; (2) they are not state actors; and (3) if they are state actors, they are entitled to qualified immunity. Doc. 16 at 5-18. The Laborists and Adventist also argue that if the court dismisses the § 1983 claim, it could decline supplemental jurisdiction over the state law claims asserted in Counts IV and V. Id. at 18-19. But, if the court were to reach the merits of the state law claims, they argue plaintiffs' Complaint fails to allege facts capable of supporting a reasonable finding that the Laborists and Adventist acted maliciously or unjustifiably by refusing to enter into a CPA with plaintiffs.

         Plaintiffs' Response primarily contends that it is unfair to allow a group of physicians- here, Obstetricians and Gynecologists-to exercise power to preclude midwives from practicing at a hospital of the midwives' choice. See Doc. 24 at 3-4 (“If no CPA is formed under the current rules, Adventist saves money and hassle, but Plaintiffs lose their legal rights and privileges. This is not equitable, fair or voluntary for Plaintiffs.”), 9 (“However, each [Laborist] has their own state-issued license, and Adventist objects to the possibility that Adventist could be compelled to act based on Plaintiffs' financial interests. Clearly, Adventist understands the importance of prohibiting States from compelling one person to act based purely on the financial interests of another. Adventist should have realized that it would be wrong for them to do to others what they do not want done to them.” (footnote omitted)). Plaintiffs contend this is so because physicians, such as the Laborists, can treat pregnant women without entering into a CPA. Plaintiffs also argue the Laborists and Adventist, by restricting plaintiffs' ability to use their APRN licenses-have taken on the role of Kansas legislators.

         II. Standard of Review

         When considering a motion to dismiss under Federal Rule of Civil Procedure 12(b)(6), the court must assume that the factual allegations in the complaint are true. Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). But this requirement does not extend to every assertion made in a complaint. The court is “‘not bound to accept as true a legal conclusion couched as a factual allegation.'” Id. (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007)). “Threadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice” to state a claim for relief. Bixler v. Foster, 596 F.3d 751, 756 (10th Cir. 2010) (quoting Iqbal, 556 U.S. at 678). Also, the complaint's “[f]actual allegations must be enough to raise a right to relief above the speculative level.” Twombly, 550 U.S. at 555 (citations omitted).

         To survive a motion to dismiss under Rule 12(b)(6), a complaint “must contain sufficient factual matter, accepted as true, to ‘state a claim for relief that is plausible on its face.'” Iqbal, 556 U.S. at 679 (quoting Twombly, 550 U.S. at 570). “A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Id. at 678 (citing Twombly, 550 U.S. at 556). “The plausibility standard is not akin to a ‘probability requirement,' but it asks for more than a sheer possibility that a defendant has acted unlawfully.” Id. (quoting Twombly, 550 U.S. at 556).

         The court also will grant a motion to dismiss if an issue of law is dispositive. Neitzke v. Williams, 490 U.S. 319, 326 (1989). And “if as a matter of law ‘it is clear that no relief could be granted under any set of facts that could be proved consistent with the allegations,' a claim must be dismissed, without regard to whether it is based on an outlandish legal theory or on a close but ...

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