United States v. University Hospital

Baby Jane Doe was born with spina bifida (i.e., an exposed spinal cord), hydrocephalus (i.e., fluid inside the skull), and microcephaly (i.e., an abnormally small head), as well as other birth defects. These defects impaired many of Doe’s physical functions and created a high probability that she would be severely mentally incapacitated. A surgery that could possibly alleviate some of Doe’s spina bifida and hydrocephalus issues was proposed. This surgery could potentially extend Doe’s life but would still leave her with severe mental incapacity. The surgery also had the potential to cause Doe to lose some of her only existing physical functions and to increase infections and swelling. After much consideration, Doe’s parents chose non-surgical treatment options for the spina bifida and hydrocephalus and declined the surgery. An unrelated attorney then sued to force the hospital to perform the surgery. The trial court found that the parents’ decision was in Doe’s best interests and dismissed the case. The attorney appealed, but the dismissal was affirmed under the theory that an unrelated attorney was not the right party to bring what was essentially a child-abuse claim. The United States Department of Health and Human Services (HHS) (plaintiff) then received a complaint that Doe was being discriminated against by being denied treatment due to a disability. HHS asked University Hospital (defendant) for Doe’s records to evaluate the complaint, but the hospital refused. HHS sued the hospital, claiming that it was violating section 504 of the Rehabilitation Act. HHS identified Doe’s microcephaly as the relevant disability, arguing that Doe’s spina bifida and hydrocephalus were being treated differently from how these conditions would be treated in an infant without microcephaly. The district court dismissed the claim, finding that (1) the hospital’s decision not to operate was based on the parents’ lack of consent, not Doe’s microcephaly disability; and (2) the parents’ decision was reasonable. HHS appealed the dismissal to the Second Circuit.