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A hospital's withholding of treatment when no parental consent has been given cannot violate § 504 of the Rehabilitation Act of 1973, 29 U.S.C.S. § 794, for without the consent of the parents or a surrogate decisionmaker the infant is neither otherwise qualified for treatment nor has he been denied care solely by reason of his handicap.
Responding to incidents in which severely handicapped infants were denied life-extending medical treatment, the United States Department of Health and Human Services (HHS) promulgated a set of regulations governing health care for such infants pursuant to its authority under 504 of the Rehabilitation Act of 1973 (29 USCS 794). In their final form, these regulations included provisions which: (i) required federally assisted hospitals to post notices stating that 504 prohibited the withholding of nourishment and medically beneficial treatment from infants solely on the basis of their handicap; (ii) required designated state agencies to establish procedures insuring that they use their full authority to prevent such neglect, including requirements that hospitals report such cases to the agencies; (iii) allowed expedited access to patient records, with or without parental consent; and (iv) allowed expedited action to enforce 504 and protect such infants. Various medical organizations filed an action in the United States District Court for the Southern District of New York which, at least in part, challenged the validity of these regulations and sought to enjoin their enforcement. The District Court granted summary judgment in favor of the medical organizations stating that the case was controlled by a previous decision of the United States Court of Appeals for the Second Circuit, in a case involving a seriously deformed newborn infant whose parents had refused to consent to surgical procedures necessary to prolong the infant's life, wherein it was held that 504 did not authorize HHS to obtain pertinent hospital records because that statute was not intended to apply to treatment decisions involving defective newborn infants. The Court of Appeals, in accordance with its previous decision, summarily affirmed the District Court's judgment. Certiorari was granted.
Were the regulations in question authorized by § 504 of the Rehabilitation Act of 1973, 29 U.S.C.S. § 794?
The court held that the regulations were not authorized by § 504 of the Rehabilitation Act of 1973, 29 U.S.C.S. § 794 because they asserted an authority to intervene in decisions which had not been shown to involve discrimination against the handicapped in violation of 504, particularly since HHS, while recognizing that a hospital's withholding of treatment from handicapped infants in the absence of parental consent was not discrimination on the basis of handicap, had justified the regulations on the basis of cases in which the parents had refused consent. Moreover, although HHS had contended that hospitals might discriminate against handicapped infants by not reporting parents' refusal to consent to treatment in such cases, there was no evidence that hospitals had in fact failed to report such cases, much less that they had done so because of the infant's handicap. The court further held that imposing an absolute obligation on state agencies to provide protective services to handicapped infants did not accord with 504's focus on the relative treatment of handicapped and nonhandicapped. There was no indication that Congress, in enacting 504, had intended to impose federal superintendence over a treatment decision process traditionally overseen by the states. Accordingly, the court affirmed the judgment of the district court.