Opinion ID: 4707703
Heading Depth: 2
Heading Rank: 3

Heading: Sixth Circuit

Text: The Sixth Circuit has also emphasized that the VA’s medical team and clinics have a legal duty to abide by ordinary standards of medical care, irrespective of a veteran’s status. See Anestis v. United States, 749 F.3d 520, 526 (6th Cir. 2014). In Anestis, the Sixth Circuit reversed the district court’s dismissal for lack of jurisdiction of an FTCA suit brought by a veteran’s widow. Id. at 522, 524. Veteran Anestis committed suicide after he was turned away from two VA clinics. Id. at 522. At the first VA clinic, the intake clerk recognized that Anestis was in urgent need of treatment, but no mental health professional was available that day. Id. at 523. So she sent him to another clinic. Id. That second VA clinic turned Anestis away because: (1) he did not have his DD-214 (a document reflecting a veteran’s deployment dates and other information) showing his eligibility; and (2) his enrollment status in the VA’s electronic record was “Rejected: Below Enrollment Group Threshold.” Id. at 521–23. Both parties agreed Anestis was ineligible for VA benefits that day. Id. at 527. In her FTCA lawsuit, Anestis’s widow alleged claims of medical malpractice for failure to provide mental health treatment when her husband needed emergency care. Id. at 524. The district court dismissed her claims, concluding they necessarily challenged a VA benefits determination. Id. 44 USCA11 Case: 20-11365 Date Filed: 07/29/2021 Page: 45 of 58 The Sixth Circuit acknowledged that the VJRA creates “a broad preclusion of judicial review” of the Secretary’s decisions “regarding benefits.” Id. at 525 (quotation marks omitted). But the court rejected the government’s argument that the VA clinics’ decisions not to provide Anestis medical care were benefits determinations under the VJRA. Id. The Sixth Circuit focused particularly on the fact that the plaintiff widow was “not challenging the VA’s decisions and actions regarding [Anestis’s] application for benefits or his eligibility or enrollment status.” Id. at 526. The plaintiff did not argue that Anestis “should have been eligible for benefits.” Id. at 527. Instead, the widow argued that “the VA violated standards of medical care and its own policies by refusing treatment when [Anestis] presented himself at two VA facilities in a state of emergency.” Id. In this way, “the VA violated its duty as a hospital, irrespective of [Anestis’s] status as a veteran.” Id. at 526. Thus, the plaintiff’s claim “exist[ed] wholly independently of a need for any benefits determination.” Id. at 527. The Sixth Circuit hastened to add, however, that “simply characterizing a claim as a ‘failure to treat’ claim does not preclude a benefits determination from also being at issue.” Id. at 527. The “distinction,” the Sixth Circuit explained, “lies in whether the failure or denial of treatment resulted from a decision by the VA or was the result of the VA’s negligence in failing to abide by a legal duty.” 45 USCA11 Case: 20-11365 Date Filed: 07/29/2021 Page: 46 of 58 Id. The plaintiff’s claim involved the latter, and the district court thus maintained jurisdiction to adjudicate the FTCA claim. Id. at 528. Importantly, too, the Sixth Circuit rejected the government’s argument that the plaintiff’s claim necessarily involved a benefits determination because her claim challenged “numerous aspects of VA medical-benefits decision-making,” since she claimed the VA “failed to adhere to their internal policies when [Anestis] sought treatment.” Id. at 527–28 (quotation marks omitted). The Sixth Circuit reasoned that the government’s interpretation of “benefits determination” was so broad as to effectively bar suit against the VA “under any circumstances for failure to provide medical treatment,” which would have been at odds with the VJRA, which, after all, “only specifies that the Secretary must decide all questions affecting ‘provision[] of benefits.’” Id. at 528 (quoting 38 U.S.C. § 511).13 With the distinctions drawn in these circuit decisions in mind, we now apply the VJRA to Mr. Smith’s case. 13 The Sixth Circuit also addressed how the case before it fit into the then-extant precedent from the D.C. and Ninth Circuits. Anestis, 749 F.3d at 525–27. The Sixth Circuit favorably compared the claims before it to the claims that the D.C. Circuit allowed to go ahead in Thomas, noting that, “[l]ike the claims in Thomas, [the plaintiff’s] claim is based on standards of care that govern medical professionals.” Id. at 527. As for the Ninth Circuit’s precedent, the Sixth Circuit acknowledged Shinseki, but noted that the Ninth Circuit’s holding in that case was that the veterans’ claim—challenging delays in the VA’s adjudication of veterans’ mental health care—“clearly” would have required the district court “to review [a] benefits determination in order to reach a decision.” Id. at 526–27. No such review was needed in Anestis. Id. at 527. 46 USCA11 Case: 20-11365 Date Filed: 07/29/2021 Page: 47 of 58