Kanuszewski v. Mich. Dep't of Health & Human Servs.
Kanuszewski v. Mich. Dep't of Health & Human Servs.
Opinion of the Court
On February 8, 2018, Plaintiffs Adam and Ashley Kanuszewski, Shannon Laporte, and Lynette Wiegand filed a complaint pursuant to
I.
When addressing a motion to dismiss for failure to state a claim under Rule 12(b)(6), the Court is to accept all of Plaintiffs' factual allegations as true. See Lambert v. Hartman ,
Since the 1960's, the State of Michigan has operated a newborn screening program, whereby medical professionals take blood samples (dried blood spots, or "DBS
*719cards") from newborn babies to test for various diseases. Am. Compl. ¶ 1, ECF No. 26. The DBS cards are ultimately transferred to the Michigan Neonatal Biobank and stored indefinitely for testing and further research. Id. ¶ 10-11, 33. The parents of the infant children in this case did not consent to the blood test or to the State taking custody of the blood samples. Id. ¶ 3-4. MCL 333.5431(1) directs health care professionals to administer the blood test. Violating the statute is a misdemeanor. MCL 333.5431(5). The statute exempts the blood sampling and testing from informed consent requirements. MCL 333.5431(2).
Plaintiffs were never extended the option to opt-out of the blood test. Id. ¶ 45. Plaintiffs "might have been" presented with an option to opt out of donating the blood to research. Id. ¶ 46. In addition to the blood samples, healthcare professionals also submitted identifying information of the infants. Id. ¶ 50. MDHHS's public documentation promises confidentiality and promises to resist demands for information that could identify the infant. Id. ¶ 66. Despite these promises, "Blood samples on several occasions were provided pursuant to state court orders ... and being sold to third party businesses and researchers." Id. ¶ 70. Michigan Neonatal Biobank "actively sells punches of various sizes to universities and businesses at different rates." Id. ¶ 80. "Since the blood spots contain deeply private medical and genetic information ... the Parents are concerned and fear about the misuse of that information and fear the possibility of discrimination against their Infants and perhaps even relatives through the use of such blood samples and research activity thereon." Id. ¶ 78. "That [f]ear is well-founded and actual as the sharing of blood spots containing deeply private medical and genetic information has recently resulted in the arrest of an alleged killer but has already resulted in the wrongful arrest of persons who were not guilty of any crime." Id. ¶ 79.
II.
The amended complaint alleges that Defendants violated Plaintiffs' fourteenth amendment liberty interest in refusing unwanted medical procedures by conducting the blood test without parental consent (count I) or by improper/incomplete/false consent (count II).Id. ¶¶ 84-90, 91-101. The amended complaint also alleges that Defendants violated Plaintiffs' fourth amendment rights to be free from unreasonable searches and seizures where the initial extraction and seizure for testing was conducted without parental consent (count III), and then indefinite storage was also conducted without parental consent (count IV and V).
Defendants filed three separate motions to dismiss. ECF Nos. 32, 33, 34. The State Defendants (MDHHS, Mary Klen, Sarah Lyon-Callo, Nick Lyons, and Sandeep Shah) argue that Plaintiffs lack standing to assert fourteenth amendment claims because children possess no absolute right to have their parents or guardians make medical decisions on their behalf. State Def. Mot. at 11, ECF No. 32. The State Defendants also argue that neither the parents nor their children have standing to assert fourth amendment claims because any injury they allegedly have suffered as a result of the storage of the blood samples is speculative inasmuch as they only assert an "unsubstantiated, vague 'concern[ ] and fear' about the potential for misuse of their children's stored DBS and 'fear [of] the possibility of discrimination against their infants and perhaps even relatives. ' " Id. at 13 (quoting Am. Compl. ¶ 78) (emphasis in original). They also argue that the blood test was not a search and, if it was, it was a reasonable one. Id. at 32-34. For largely the same reasons, the *720State Defendants contend Plaintiffs have failed to state a claim for violations of the fourth and fourteenth amendments. The State Defendants also argue that the eleventh amendment bars all claims against MDHHS and all claims against the individual Defendants other than the claims for prospective injunctive relief. Id. at 14. Finally, they argue that the claims for money damages against Defendants in their individual capacity are barred by qualified immunity because Defendants have not violated any clearly established rights. Id. at 28-29.
Defendants Michigan Neonatal Biobank and its director Antonio Yancy (in his official capacity) filed their own motion to dismiss, which largely echoes the State Defendants' motion. ECF No. 33. Dr. Yancy filed his own motion to dismiss in his individual capacity, arguing that Plaintiffs have not sufficiently alleged his personal involvement in any constitutional violations. ECF No 34. Because the grounds for dismissal provided in the State Defendants' motion are equally applicable to the remaining Defendants, the latter two motions will not be addressed directly.
III.
A pleading fails to state a claim under Rule 12(b)(6) if it does not contain allegations that support recovery under any recognizable legal theory. Ashcroft v. Iqbal ,
IV.
A.
The newborn screening program does not violate Plaintiffs' substantive due process rights under the fourteenth amendment. Throughout their briefing, the parties refer to three constitutionally protected liberty interests under the fourteenth amendment that might be implicated in this case, often interchangeably. The liberty interests are not interchangeable, however, and it is important to distinguish between the three. First, the parties refer to the right of a child to have its parent make medical decisions on its behalf. Second, the parties refer to the right of a competent person to refuse unwanted medical procedures. Third, the parties refer to a parent's right to make decisions concerning the care, custody, and control of their children.
There does not appear to be any legal authority supporting the notion that children have a constitutionally protected liberty interest in their parent or guardian making medical decisions on their behalf. The case law cited by the parties certainly does not support this notion. Conceptually, this "right" may seem related to the other two. However, when conducting an analysis under the substantive due process clause, it is important to use the precise language describing the constitutionally *721protected liberty interests that have been recognized by the Supreme Court.
As Plaintiffs emphasize, the Supreme Court has recognized that "a competent person has a constitutionally protected liberty interest in refusing unwanted medical treatment." Cruzan by Cruzan v. Dir., Missouri Dep't of Health ,
The Supreme Court has also recognized "the fundamental right of parents to make decisions concerning the care, custody, and control of their children." Troxel v. Granville ,
Supreme Court precedent, however, has not delineated the parameters of a "parent's right to parent" in a way that can be neatly applied to new sets of facts. See Doe v. Heck ,
Applying rational basis review, the court noted that the program promoted the legitimate government interest of safeguarding the health of children via early diagnosis of diseases.
Case law addressing compulsory vaccinations also help support the analysis. In Jacobson , the Supreme Court found that *722compulsory vaccination laws with only medical exemptions do not violate any federal constitutional right. Jacobson v. Massachusetts ,
Although the holding involved a first amendment challenge, not a fourteenth amendment challenge (as is the case here), Nikolao nevertheless provided a guiding principle, namely that the states' interest in promoting the health and safety of young children can, at times, override individual constitutional rights. see also Prince v. Massachusetts ,
Plaintiffs take issue with Defendants' reliance on the compulsory vaccination cases. Plaintiffs appear to concede that the police power may, at times, override individual liberty interests when the police power is used to promote the public health and safety and to prevent a person from harming others. Resp. at 28. Whereas vaccination requirements are intended to benefit the public by promoting herd immunity, Plaintiffs argue that the blood tests at issue in this case only benefit the individual because "[n]one of the maladies, disorders, or diseases sought to be detected [by NSP blood tests] are contagious or can spread by communitive human contact."
Plaintiffs' argument is not persuasive. Indeed, public benefit and herd immunity is one of the main goals of compulsory vaccination requirements. See Nikolao ,
*723The only right potentially implicated here is the right of parents to make decisions concerning their children.
Notably, none of the authority provided by Plaintiffs in their response brief supports the proposition that the right of a parent to make decisions concerning the care, custody, and control of their children includes the right to refuse potentially life-saving testing or treatment on the infant's behalf. Plaintiffs' brief largely consists of quotations from cases supporting broad principles of constitutional law, such as the fact that "minors, as well as adults are protected by the constitution, and possess constitutional rights," and that a minor child is not "the mere creature of the State." Resp. at 23-24, ECF No. 45. These broad statements of law are undoubtedly true and not subject to any debate. However, this does not help resolve the present inquiry, namely whether the facts as pled in this case demonstrate action by the State that violates Plaintiffs' substantive due process rights.
Plaintiffs provide one case, Dubbs , which they contend is "the closest and nearly on-point analogous case applying these principles ..." Id. at 25. In Dubbs , the plaintiffs pled fourth and fourteenth amendment claims challenging a school's practice of requiring blood tests and physical examinations without parental consent. Dubbs v. Head Start, Inc. ,
Notably, however, the 10th Circuit did not express an opinion as to whether the parents' substantive due process rights were violated by the school program. Rather, the 10th Circuit took issue with the district court's reasoning inasmuch as it misapprehended the legal standard by failing to recognize that the parents' had a substantive due process right to control the upbringing (including the medical care) of their children.
The lack of authority supporting Plaintiffs' position is particularly notable given the holding in Spiering , as discussed above, in which the court found no violation of a parent's substantive due process rights under substantially similar facts. Spiering ,
B.
Nor have the parents stated a claim that the retention and use of their children's blood samples violated their substantive due process rights under the fourteenth amendment. Throughout the complaint, the alleged unconstitutional action is frequently described as a continuous *724course of conduct: "a piercing device breaching the outside of the skin of the Infants to extract five or six blood drops and seize those blood spots for medical testing and use by the government." See , e.g. Am. Compl. ¶ 87. Construing the amended complaint as alleging that the retention and use of the blood samples constituted an independent violation of their substantive due process rights (i.e. one not predicated on a finding that the blood test was itself unconstitutional), the amended complaint still fails to state a claim for such a violation. First, it is far from clear that the parents' constitutionally protected liberty interest in the care, custody, and control of their children is in anyway impinged by the government retaining and using the blood samples for research and/or commercial purposes as alleged in the amended complaint. Indeed, the authority provided in Plaintiffs' response is devoted almost exclusively to addressing the propriety of the blood test itself. Although Plaintiffs allege that the retention and use of the blood is generally wrongful and inappropriate, Plaintiffs devote minimal effort toward explaining or supporting the notion that the retention and use violates their substantive due process rights.
To the extent the amended complaint may be read to allege some vague privacy interest that is implicated by the retention and use of the blood, that theory is certainly not developed in the complaint or briefed in Plaintiffs' response. The Court should not and will not develop that claim on Plaintiffs' behalf. Such a theory is unlikely to be viable in any event, considering the statute that authorizes the State program in question expressly provides that any use of the blood samples must be "in a manner that preserves the confidentiality of the test subjects." MCL 333.5431(7)(b). Plaintiffs have not alleged that their blood samples have been used so as to compromise their confidentiality, despite their allegations concerning the use of blood samples belonging to third parties (see Am. Compl. ¶ 70).
Secondly, Plaintiffs have not pled facts demonstrating that their blood samples were used contrary to their express wishes. The amended complaint contains a number of allegations as to the State's practice concerning the use of blood samples generally, or in specific instances involving third parties, for commercial research and other purposes. See, e.g. , Am. Compl. ¶ 10, 12, 33, 70, 79, 80. The amended complaint cannot, however, be reasonably read to contend that Plaintiffs' specific blood samples are being used in a manner that is contrary to the parents' express wishes. In fact, the allegations in the amended complaint cut the opposite way. Paragraph 46 acknowledges that the parents "might have been presented with a card giving the Parents an option of whether they want their Infants' already illegally seized and tested blood to be donated to medical research." Id. ¶ 46 (emphasis in original).
Defendants attached a copy of this consent form to their motion to dismiss, as well as documents which purport to be forms filled out by the parents in this case. ECF Nos. 33-11, 11-12. Plaintiffs take issue with these exhibits for a number of reasons. Plaintiffs argue, without explanation, that these exhibits are improperly attached to a motion to dismiss.
Plaintiffs also allege that they were insufficiently informed about what they were consenting to: "if they did sign such a document they had insufficient understanding of matters they asked/forced to sign and thus were not given proper informed consent." Id. ¶ 48.
In summary, Plaintiffs have made no effort to explain how the retention and use of the blood samples constitutes an independent violation (i.e. one not predicated on a finding that the blood test was itself unconstitutional) of the parents' substantive due process rights to parent their children. Furthermore, it is not reasonably in dispute that the parents were presented with an option to opt out of having their child's blood used for research, and there is no reason to believe that the parents' instructions were not respected. For the foregoing reasons, Plaintiffs have failed to state a claim for a violation of their substantive due process rights based on the retention and use of the blood samples.
C.
Plaintiffs have also failed to state a claim that the blood testing violated their fourth amendment right to be free from unreasonable search and seizure. An initial question is whether the blood test constituted a search under the fourth amendment. The fourth amendment protects "the right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures ..." The fourth amendment is implicated *726when the government's challenged conduct invades an individual's legitimate expectation of privacy in the area searched or the item seized. Rawlings v. Kentucky ,
Defendants cite to Attson to support the proposition that a blood test for strictly medical purposes is not a search under the fourth amendment. Mot. at 33 (citing United States v. Attson ,
Plaintiffs rely on Dubbs for the proposition that the blood test in this case constituted a search. Resp. at 30-31.
The court found that the search in question was analogous to Supreme Court and appellate precedent recognizing a reasonable expectation of privacy when bodily integrity is at issue.
*727Vernonia Sch. Dist. 47J v. Acton,
The parties do not identify any 6th Circuit authority directly on point. In Hearring , the 6th Circuit found that the holding of Dubbs was "not so clearly foreshadowed by applicable direct authority as to leave no doubt that a nurses' medical examination of a student was subject to fourth amendment requirements." Hearring v. Sliwowski ,
Determining that the blood test constitutes a fourth amendment search does not end the inquiry, however. It must be determined whether the search was a reasonable one. Reasonableness is the "touchstone" of the Fourth Amendment. Katz v. United States,
In Dubbs ,
Here, the state-mandated blood screening meets all three criteria. The exercise of governmental authority is entirely distinct from law enforcement. The mandatory blood screening applies to all infants, and involves no individualized considerations of wrongdoing. The Newborn Screening Program is also designed to protect the health and safety of the infants by facilitating early diagnosis, treatment, and prevention.
Notwithstanding its observation that these three criteria were met, the Dubbs court nevertheless concluded that the special needs doctrine did not apply to the facts of that case. Notably, the regulations at issue in Dubbs expressly required the defendants to "obtain advance parent or guardian authorization for all health and developmental procedures administered through the program," which they did not do.
Furthermore, the nature of the intrusion on Plaintiffs' privacy is minimal when compared to the state's interest in protecting infant health. The intrusion involves a prick of the infants' heel after birth to withdraw 5 or 6 drops of blood, which enables the medical professionals to screen for a variety of diseases, facilitating early detection, treatment, and prevention. This search is a far cry from the invasive physical examination at issue in Dubbs , which is apparent from even a cursory reading of the court's description of that search. See Dubbs ,
*729method, which can be frightening to small children."
Applying the special needs doctrine in this case is consistent with Supreme Court precedent. The Supreme Court has applied the special needs doctrine to uphold searches that were as invasive (or more so) than the search in question here, in furtherance of similar public policy goals. See, e.g., Nat'l Treasury Employees Union v. Von Raab,
D.
Plaintiffs have also failed to state a claim that the retention and use of the blood samples violates the fourth amendment rights of the parents or their children. As discussed above at section IV. B., Plaintiffs have not alleged that their blood samples were used contrary to their authorization. Plaintiffs also allege no misuse of their specific blood samples. They aver that "blood samples on several occasions were provided pursuant to state court orders ... and being sold to third party businesses and researchers ... As such, [Defendants] do not resist any such demands for information, including those from courts and law enforcement." Am. Compl. ¶¶ 70-71. These allegations, however, are insufficient to support article III standing, which requires Plaintiffs to demonstrate that they (and not some third party) suffered an injury in fact. See Lujan v. Defs. of Wildlife ,
Based on the alleged misuse of blood samples of other individuals who are not parties to this case, Plaintiffs "are concerned and fear about the misuse of [their private medical and genetic information] and fear the possibility of discrimination against their Infants and perhaps even relatives through the use of such blood samples and research activity thereon." Am. Compl. ¶ . Plaintiffs further allege that their fear is "well-founded and actual as the sharing of blood spots containing deeply private medical information has recently resulted in the arrest of an alleged killer but has already resulted in the wrongful arrest of persons who were not guilty of any crime."
V.
Accordingly, it is ORDERED that the motions to dismiss, ECF Nos. 32, 33, 34, are GRANTED .
It is further ORDERED that the amended complaint, ECF No. 26, is DISMISSED with prejudice.
Mr. Hawkins has since passed away.
A court generally cannot look beyond the face of the Plaintiff's complaint when adjudicating a motion to dismiss for failure to state a claim unless the court converts the motion into a motion for summary judgment after proper notice is given to the parties. However, a district court can consider exhibits attached to Defendants' motion to dismiss without converting the motion into one for summary judgment where two conditions are met: 1) the documents are referred to in the complaint, and 2) are central to the claims contained therein. Gavitt v. Born ,
Plaintiffs' amended complaint contains an exhibit J, which is also referred to in the complaint at paragraph 66. The exhibit is a pamphlet explaining the Newborn Screening program, which states in relevant part: "you can say 'yes' or 'no' to blood spot research. You will be asked to check a box and sign a form found in your baby's newborn screening card. If you say 'yes,' all blood spots taken for newborn screening may be used, except for the blood spot saved for your own use if needed. If you say 'no,' blood spots will be stored but not used for research. You must contact MDHHS if you do not want blood spots stored for any reason after newborn screening."
Considering that the words "asked" and "forced" are hardly synonymous, the Court does not read this paragraph to allege that the parents were compelled to sign the consent forms, and will assume that the word "forced" was added in error. To the extent Plaintiffs wish to stand by the allegation that they were compelled to sign a consent form against their will, Plaintiffs are free to seek leave to amend and clarify this allegation.
Plaintiffs rely on Birchfield and Mcneely for the proposition that "It is explicit from binding Supreme Court precedence [sic ]-a nonconsensual search and seizure of blood requires a warrant and failure to obtain the same is a Fourth Amendment violation." Resp. at 39, ECF No. 45. Neither case supports such a contention. Birchfield held that the fourth amendment does not permit warrantless blood tests incident to arrest for drunk driving. Birchfield v. North Dakota , --- U.S. ----,
See supra section IV. A. for an introduction to the Dubbs case.
Reference
- Full Case Name
- Adam KANUSZEWSKI v. MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES
- Cited By
- 3 cases
- Status
- Published