Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_10-cv-02261/USCOURTS-azd-2_10-cv-02261-0/pdf.json

Nature of Suit Code: 890
Nature of Suit: Other Statutory Actions
Cause of Action: 28:1362 Indian Tribal Controversy

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WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Quechan Tribe of the Fort Yuma Indian

Reservation, 

Plaintiff, 

vs.

United States of America, et. al., 

Defendants. 

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No. CIV 10-02261-PHX-FJM

ORDER

The court has before it defendants' Motion to Dismiss First Amended Complaint (doc.

23), plaintiff's response (doc. 27), and defendants' reply (doc. 29).

This is an action brought by the Quechan Indian Tribe against the United States

seeking a declaration that the United States has a duty to operate its medical facilities and

practices at a level that meets or exceeds a minimum generally accepted standard of care, and

that the United States has breached that duty. Plaintiff also seeks equitable relief requiring

defendants to ensure its medical services at the Fort Yuma Indian Reservation do not fall

below the minimum standard of care. Defendants move to dismiss plaintiff's First Amended

Complaint ("FAC") for lack of subject matter jurisdiction pursuant to Rule 12(b)(1), Fed. R.

Civ. P. and for failure to state a claim upon which relief may be granted pursuant to Rule

12(b)(6), Fed. R. Civ. P.

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I. Background

The Quechan Indian Tribe is federally recognized. Defendants are the United States

of America, acting through the Department of Health and Human Services, the Indian Health

Service ("IHS"), and the IHS Fort Yuma Service Unit. IHS is an agency of the Department

of Health and Human Services whose mission is to provide health care to American Indians

and Alaska Natives throughout the United States. Its authority derives from two primary

statutes, the Snyder Act, 25 U.S.C. § 13 and the Indian Health Care Improvement Act

("IHCIA"), as amended, 25 U.S.C. § 1601 et. seq. Defendants provide federal health care

services and facilities to the Quechan Indian Tribe via the Fort Yuma Service Unit. Plaintiff

alleges that the physical facilities at Ft. Yuma are in disrepair and unsafe, that Ft. Yuma lacks

basic medical equipment, and that Ft. Yuma affords unsafe and unhealthy medical care as

evidenced, for example, by an "exposure event" in which members of the Tribe received

wound care and were possibly exposed to blood borne pathogens due to improper

sterilization. FAC ¶¶ 58-64. 

Plaintiff alleges seven causes of action. The first three assert various breaches of

statutory and common law trust duties. The fourth alleges a violation of the Administrative

Procedure Act ("APA"), 5 U.S.C. § 702. Plaintiff's fifth claim alleges violations of the Due

Process and Equal Protection Clauses of the Constitution. Finally, plaintiff asserts claims

for a declaratory judgment pursuant to 28 U.S.C. §§ 2201 and 2202 and a writ of mandamus

pursuant to 28 U.S.C. § 1361. 

II. Federal Trust Responsibility Claims

Plaintiff's first three causes of action assert breach of statutory and common law

trust duties. Claim one alleges a breach of the duty to provide health care services and

facilities in compliance with minimum standards of professional medical care. Claim two

asserts a breach of the duty to preserve and maintain trust property. Claim three asserts a

breach of defendants' duty as a health care provider. Plaintiff argues that these duties

arise under the Snyder Act, the IHCIA, and the federal trust responsibility. Defendants

argue that the statutes do not designate specific fiduciary duties, and thus the general trust

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1

 Defendants conflate the two grounds on which they seek dismissal. Because we

conclude that each of plaintiff's claims fails to state a claim upon which relief may be

granted, we dismiss based upon defendants' Rule 12(b)(6) motion and need not reach the

jurisdictional issue.

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responsibility is insufficient to state a valid claim for relief.1

The general trust relationship between the United States and Indian tribes, alone, is

insufficient to create legal obligations in the United States. See Marceau v. Blackfeet

Hous. Auth., 540 F.3d 916, 921 (9th Cir. 2008). When a tribe sues the government for

damages, it "must identify a substantive source of law that establishes specific fiduciary

or other duties, and allege that the Government has failed faithfully to perform those

duties." United States v. Navajo Nation, 537 U.S. 488, 506, 123 S.Ct. 1079, 1091 (2003). 

This standard also applies to equitable relief. See Gros Ventre Tribe v. United States, 469

F.3d 801, 812 (9th Cir. 2006). Accordingly, "unless there is a specific duty that has been

placed on the government with respect to Indians, the government's general trust

obligation is discharged by the government's compliance with general regulations and

statutes not specifically aimed at protecting Indian tribes." Id. at 810 (quoting Morongo

Band of Mission Indians v. F.A.A., 161 F.3d 569, 574 (9th Cir. 1998)).

For example, in Mitchell v. United States, 445 U.S. 535, 100 S.Ct. 1329 (1980)

("Mitchell I"), the Court considered whether the General Allotment Act of 1887

("GAA"), 25 U.S.C. § 331, et. seq., authorized an award of damages for mismanagement

of forests located on tribal land. After examining the GAA's language, history, and

purpose, the Court concluded that it "created only a limited trust relationship" and "did

not impose any duty upon the Government to manage timber resources." Id. at 542, 100

S.Ct. at 1353. In contrast, in United States v. Mitchell, 463 U.S. 206, 103 S.Ct. 2961

(1983) ("Mitchel II") the Court looked at whether other sources of law created legal

duties, and concluded that the comprehensive network of timber management statutes and

regulations imposed specific fiduciary duties on the government to manage timber. Id. at

224, 103 S.Ct. at 2971-72. The cases turn on whether a statute creates only a "bare trust"

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or establishes specific legal duties. Moreover, the trust responsibility arises when the

United States holds tribal property in trust.

The Snyder Act authorizes the United States to provide "for the benefit, care, and

assistance of the Indians throughout the United States for the relief of distress and

conservation of health." 25 U.S.C. § 13. But it imposes no specific legal duty. For

example, in Virgil v. Andrus, 667 F.2d 931, 934 (10th Cir. 1982), the Tenth Circuit

declined to find that the Snyder Act gave rise to a specific fiduciary duty to provide free

lunches to all Indian school children. Moreover, the Ninth Circuit has concluded that the

Snyder Act consists of only broad language and does not impose any specific statutory

duty. See McNabb v. Bowen, 829 F.2d 787, 792 (9th Cir. 1987). 

The Snyder Act consists of extremely broad language and does not refer to a

specific standard of care, much less impose one on defendants. The statute, like the

GAA, does not provide that "virtually every stage of the process of delivering health care

to the plaintiffs be under the IHS' control." Allred v. United States, 33 Fed. Cl. 349, 357

(Fed. Cl. 1995)(internal citations omitted)(holding that plaintiffs failed to state a breach of

trust claim under the Snyder Act or the IHCIA when the government terminated certain

health benefits). The Snyder Act fails to impose an affirmative duty on defendants to

provide a specific level of health care or to maintain facilities at a certain level. Plaintiff's

breach of duty claims cannot rely on the Snyder Act. The provision of services under that

Act is a matter of grace, not a legal obligation.

We next turn to the IHCIA to determine whether it "unambiguously provides that

the United States has undertaken full fiduciary responsibilities" as to the management of

Indian health care. Mitchell I, 445 U.S. at 542, 100 S.Ct. at 1353. The IHCIA requires

defendants to eliminate deficiencies in health status and resources, and to meet the health

needs of Indians in an equitable manner. 25 U.S.C. §1621(a); (c)(1). It also requires

competent personal, §1661(c)(2), and facilities that meet accreditation standards,

§1631(a)(2). While these provisions are more exacting than those in the Snyder Act, they

still do not impose a duty on defendants to provide a certain level of health care, preserve

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and maintain tribal property, or be a health care provider. 

Plaintiff argues that the 2010 amendment to the IHCIA, in which Congress added

the word "trust" to the statute confirms a Congressional intent to impose fiduciary duties

on defendants. See 26 U.S.C. § 1602 (referring to "trust responsibilities and legal

obligations to Indians")(emphasis added). We disagree. In Mitchell I, the United States

held the tribal land "in trust" for Indians, but the Court did not find that dispositive. 445

U.S. at 542, 199 S.Ct. at 1353. Here, the United States does not even hold the Ft. Yuma

facility in trust. It belongs to the United States. It is not held in "trust" for the tribe.

Moreover, one of the goals of the IHCIA is to "ensure maximum Indian 

participation in the direction of health care services." § 1602(3). Because the statute aims

in part to foster tribal self-determination, it would be inconsistent to hold that the United

States is exclusively responsible for Indian health care. See Navajo Nation, 537 U.S. at

494, 123 S.Ct. at 1084 (holding that because the Indian Mining Lease Act encouraged

tribal self-determination, the statute did not impose fiduciary duties); see also McNabb,

829 F.2d at 792 (finding that while the federal government may have some responsibility

for Indian health care, it is not the exclusive provider).

Plaintiff next argues that a number of cases have recognized that the IHCIA

imposes fiduciary duties. See Navajo Nation v. Dep't of Health and Human Serv., 325

F.3d 1133, 1139, n. 6 (9th Cir. 2003)(stating that the IHCIA is notable for "Congress'

recognition of the federal responsibility for Indian health); see also McNabb, 829 F.2d at

792 ("reviewing the text of the IHCIA and the relevant legislative history, one is struck

by Congress' recognition of federal responsibility for Indian health care"); White v.

Califano, 437 F. Supp. 543, 548-49, 555 (D.S.D. 1977), aff'd 581 F.2d 697 (1978)

(finding that the legislative history of the IHCIA indicated that Congress intended that the

government assume a trust responsibility to Indians). We do not disagree that the statutes

discuss the voluntary assumption by the United States of the provision of some health

care to Indians. Such broad policy language, however, does not create a private right of

action or impose any specific duties on defendants. Without specific statutory

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2

 Plaintiff also points to § 1621(a)(1), which authorizes defendants to use appropriated

funds for the purpose of "eliminating the deficiencies in health status and health resources

of all Indian tribes." This does not require defendants to use appropriated funds to repair

deteriorating facilities, such as Ft. Yuma. Rather it speaks in broad permissive terms. 

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entitlement, there is no claim. 

For example, plaintiff points to 25 U.S.C. § 1631 as imposing a duty to provide

adequate facilities. That, however, only requires that defendants "ensure, whenever

practicable, that such facility meets the standards of the Joint Commission on

Accreditation of Health Care Organizations by not later than 1 year after the date on

which the construction or renovation of such facility is completed." § 1631(a)(2). This

does not impose a duty to preserve and maintain the facilities and buildings at Ft. Yuma. 

The statute itself even uses the words, "whenever practicable." Plaintiff does not allege

that defendants failed to ensure that Ft. Yuma met accreditation standards one year from

its construction or renovation.2

Plaintiff contends that defendants' exclusive control and management of Ft. Yuma

implies that defendants assumed fiduciary duties. See United States v. White Mountain,

537 U.S. 465, 475, 123 S.Ct. 1126, 1133 (2003); Mitchell II, 436 U.S. at 209, 222, 225,

103 S.Ct. at 2964, 2970-72. But Ft. Yuma is not a tribal asset that defendants are holding

in trust. See White Mountain, at 537 U.S. at 475, 123 S.Ct. at 1133; Marceau, 540 F.3d at

924 ("[b]ecause the government assumed plenary control over the assets held in trust, the

government likewise assumed an obligation, as trustee, to preserve those assets")

(emphasis added)). Absent a trust asset there is no fiduciary duty to preserve and

maintain as plaintiff alleges. The government, of course, would exercise control over its

facilities.

Plaintiff's claim for "breach of statutory and common law fiduciary duty as health

care provider" also fails to state a cause of action. Plaintiff claims that a fiduciary duty

between members of the tribe and the United States arises out of the physician-patient

relationship. But the operation of a health care facility does not turn defendants into

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fiduciaries. Only individual physicians and patients have such a relationship. 

If a tribal member has been damaged as a result of medical malpractice, that

member may sue the United States under the Federal Tort Claims Act which expressly

waives the government's sovereign immunity for such actions. But plaintiff's parens

patriae lawsuit asking us to find a specific standard of care established in the Snyder Act

and the IHCIA fails to state a valid cause of action for breach of statutory or fiduciary

duties. Plaintiff's first three causes of action are dismissed for failure to state a claim. As

a result, we also dismiss plaintiff's sixth cause of action for a declaratory judgment. 

III. Administrative Procedure Act

Plaintiff's fourth cause of action alleges that defendants' maintenance and operation

of Ft. Yuma violates the Administrative Procedure Act ("APA"), 5 U.S.C. § 702. 

Plaintiff contends that defendants have a "non-discretionary duty to ensure that health

care services [are] affirmatively provided to the Tribe and its members." FAC ¶ 109. In

addition, plaintiff requests a writ of mandamus, pursuant to 28 U.S.C. § 1361, directing

defendants to comply with this duty. Defendants argue that plaintiff's claims fall outside

the scope of judicial review under the APA because the distribution of resources for

Indian health care is committed to agency discretion by law and falls under the exception

to APA review found in 5 U.S.C. § 701(a)(2).

5 U.S.C. § 702 authorizes suit by "a person suffering legal wrong because of

agency action, or adversely affected or aggrieved by agency action within the meaning of

a relevant statute." However, "review is not to be had in those rare circumstances where

the relevant statute is drawn so that a court would have no meaningful standard against

which to judge the agency's exercise of discretion." Lincoln v. Vigil, 508 U.S. 182, 191,

113 S.Ct. 2024, 2030-31 (1993). One example of an administrative decision committed

to agency discretion is the allocation of funds from a lump-sum appropriation. Id. at 192,

113 S.Ct. at 2031. In Lincoln, the Court held that IHS's decision to discontinue services

to handicapped Indian children was committed to agency discretion. Id. at 184, 113 S.Ct.

at 2026. Since Congress never expressly appropriated funds for the program and the

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Snyder Act allocated a lump-sum appropriation for all Indian health care, the IHS's

decision was unreviewable. Id. at 185-189, 113 S.Ct. at 2027-29.

This case is like Lincoln. Congress has not expressly appropriated funds to Ft.

Yuma. Rather, funds were made available via a lump-sum appropriation. Plaintiff

attempts to distinguish Lincoln on the basis that it concerned an agency decision to reallocate resources in a manner that provided a different (but still adequate) level of

service. But "as long as the agency allocates funds from a lump-sum appropriation to

meet permissible statutory objectives, § 701(a)(2) gives courts no leave to intrude."

Lincoln, 508 U.S. at 193, 113 S.Ct. at 2032. Here plaintiff is really challenging

defendants' lack of funding at Ft. Yuma. It does not allege that defendants are using

money appropriated under the Snyder Act for things other than Indian health care. 

Allocating funds to one program over another involves the same discretionary decision as

allocating funds to one health care facility over another. Plaintiff's claim that defendants

have a mandatory, non-discretionary duty that may be reviewed under the APA and

enforced by a writ of mandamus fails. There is no statutory mandate that defendants

provide a certain minimal level of health care to Indians. Congress appropriates what it

wants to and commits to agency discretion how to distribute it. The agencies have the

skill and training to evaluate health care facilities. As the Court has stated, "[t]he

principal purpose of the APA limitations. . . and of the traditional limitations upon

mandamus. . . is to protect agencies from undue judicial interference with their lawful

discretion, and to avoid judicial entanglement in abstract policy disagreements which

courts lack both expertise and information to resolve." Norton v. S. Utah Wilderness

Alliance, 542 U.S. 55, 66, 124 S.Ct. 2373, 2381 (2004). Accordingly, plaintiff's claims

fall outside the scope of judicial review under the APA. Because defendants do not have

a mandatory, nondiscretionary duty to provide a minimal level of health care, plaintiff's

request for a writ of mandamus is denied.

IV. Constitutional Violations

Plaintiff's fifth cause of action alleges that defendants' administration and operation

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of Ft. Yuma endangers tribal members in a way that violates the Due Process and Equal

Protection Clauses of the Constitution. We briefly address each claim.

Plaintiff argues that due process violations exist because exposing members to

communicable diseases violates protections of life and liberty. Additionally, plaintiff

alleges that health care services qualify as an "entitlement" to a constitutionally protected

property interest. FAC ¶ 95. Defendants argue that a right to medical services is not a

protected property interest. Furthermore, no special relationship exists to impose

affirmative duties to provide health care.

Due process generally does not confer an "affirmative right to governmental aid,

even where such aid may be necessary to secure life, liberty, or property interests of

which the government itself may not deprive the individual." DeShaney v. Winnebago

County Dept. of Soc. Serv., 489 U.S. 189, 196, 109 S.Ct. 998, 1003 (1989). In limited

circumstances where a special relationship exists, such as when a person is imprisoned or

involuntarily committed, due process does require that the government provide certain

services. Id. at 198-99, 109 S.Ct. at 1004-05. No such special relationship exists here. 

Plaintiff's attempt to analogize cases dealing with prisoner's rights to health care is

unpersuasive. The special relationship exception applies only when the government has

placed a person in custody. Moreover, even if we consider health care services as an

entitlement (which it is not), recipients of government benefits merely have a limited

property right to due process before essential public entitlements are terminated. See

Allred, 33 Fed. Cl. at 356 (1995)(citing Richardson v. Belcher, 404 U.S. 78, 80-81, 92

S.Ct. 254, 257 (1971)). Health care services at Ft. Yuma have not been terminated. 

Therefore, plaintiff's procedural due process rights have not been implicated and its due

process claim does not "plausibly give rise to an entitlement to relief." Ashcroft v. Iqbal,

__ U.S. __, __ 129 S.Ct. 1937, 1950 (2009).

Plaintiff's equal protection claim rests on allegations that defendants lack a rational

basis to provide "health care services that are a level far below those provided to other

similarly situated Indians in the United States." FAC ¶¶ 99, 102. Plaintiff relies

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primarily on Rincon Bank of Mission Indians v. Califano, 464 F. Supp. 934, 939 (N.D.

Ca. 1970), where the court held that IHS's system of allocating health care funds violated

the plaintiffs' equal protection rights. Defendants, on the other hand, assert that allocation

of scarce funds among different facilities is within their discretion and not unreasonable. 

We agree with defendants and find plaintiff's argument unpersuasive. The government

has broad discretion to allocate funds for discretionary programs without violating equal

protection rights. See Dandridge v. Williams, 397 U.S. 471, 485, 90 S.Ct 1153, 1161

(1970). That is exactly what defendants have done here. Plaintiff's equal protection

claim, thus, also fails.

V. Conclusion

At its core, plaintiff's complaint does not raise legal issues, but policy issues as to

the proper allocation of resources for Indian health care. The Tribe is just one of many

interest groups throughout the country competing for scarce resources. The Tribe's

concerns are best addressed through the political process. Its members' concerns are best

addressed through tort claims.

Accordingly, it is ORDERED GRANTING defendants' motion to dismiss for

failure to state a claim upon which relief may be granted (doc. 23). It is ORDERED

DISMISSING this action with prejudice.

DATED this 31st day of March, 2011.

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