Opinion ID: 3010687
Heading Depth: 2
Heading Rank: 6

Heading: Public Health Services Act

Text: Appellants contend that they are entitled to qualified immunity as to Larsen's claim that the termination of his benefits violated his rights under the Public Health Services Act, 42 U.S.C. SS 300bb-1 et seq. (PHSA). The PHSA provides that state-operated group health plans must offer 18 months of continuing coverage to qualified beneficiaries who otherwise would lose coverage as a result of a qualifying event. 42 U.S.C. SS 300bb-1(a), 300bb-2(2). The PHSA defines the term qualifying event to include termination (other than by reason of [the] employee's gross misconduct). Section 300bb-3(2). Appellants contend that Larsen did not have a clearly established right to continuing coverage under the PHSA, because reasonable officials could believe that Larsen's termination was not a qualifying event within the meaning of the PHSA entitling him to elect continuing coverage. According to appellants, reasonable officials could conclude that Larsen's termination was by reason of . . . gross misconduct, thus excluding his termination from the definition of a qualifying event under section 300bb-3(2), and rendering him ineligible for coverage under section _________________________________________________________________ substantial or motivating factor for the retaliatory action, a defendant must establish not merely that he could properly have taken the same adverse action based on an independent legally sufficient reason, but also that he would have done so in the absence of protected conduct. Bradley v. Pittsburgh Bd. of Educ., 913 F.2d 1064, 1075 (3d Cir. 1990). The mere fact that the 1993 version of section 16 provided for termination of benefits upon removal would not defeat Larsen's retaliation claim if he could demonstrate that appellants decided to apply that provision, rather than the more lenient version of section 16 that existed at the time of vesting, due to retaliatory animus. 25 300bb-1(a). In support of their argument that Larsen's termination reasonably could be viewed as a termination by reason of . . . gross misconduct, appellants emphasize that Larsen had been convicted of two felony counts, removed from office by the Court of Common Pleas as part of his criminal sentence, suspended from office by the Court of Judicial Discipline for his criminal conduct which that court found had undermined public confidence in the judiciary, and called before the Senate on a writ of impeachment summons. Br. at 20-21. Neither the PHSA, nor the comparable statute applicable to private employers, defines the term gross misconduct. See 42 U.S.C. SS 300bb-1 et seq.; 29 U.S.C. SS 1161 et seq.20 Moreover, as of the time appellants decided to terminate Larsen's benefits, the cases construing these provisions had not set forth a clear definition of gross misconduct under the PHSA.21 These cases, however, had applied the standard to conduct which reasonable officials could believe was no more egregious than Larsen's conduct in unlawfully procuring controlled substances through the use of his subordinates. See, e.g., Burke v. American Stores Employee Benefit Plan, 818 F. Supp. 1131 (N.D. Ill. 1993) (holding that use of improperly procured promotional discount vouchers to obtain free products from employer's retail outlets constituted gross misconduct); Adkins v. United Int'l Investigative Servs., Inc., 1993 WL 345186 (N.D. Cal. 1993) (holding that leaving post unattended and falsifying records to receive additional paychecks constituted gross misconduct); Conery v. Bath Assocs., 803 F. Supp. 1388, 1396 (N.D. Ind. 1992) (holding that misappropriation of _________________________________________________________________ 20. The analogous provision governing private employers is set forth in the Consolidated Omnibus Budget Reconciliation Act (COBRA), 29 U.S.C. S 1161(a), which requires the employer to offer continuing coverage to employees who otherwise would lose coverage under the plan as a result of a qualifying event. 21. In Burke v. American Stores Employee Benefit Plan, 818 F. Supp. 1131, 1135 (N.D. Ill. 1993), the court, applying 29 U.S.C. S 1161(a), noted that, [t]here is little direct statutory or judicial guidance on the meaning of `gross misconduct.'  While the Burke court looked to Illinois state law for guidance, we have not made any comparable state-law analysis. 26 funds constituted gross misconduct). We are satisfied from these cases and from the language of the PHSA that Larsen has not adequately alleged a violation of the PHSA and thus his complaint with respect to that statute does not pass muster under the first prong of a Siegert analysis. Moreover, even if it did, because a reasonable official could believe that the acts which resulted in Larsen's termination amounted to gross misconduct, it was not clearly established that Larsen's termination was a qualifying event triggering his right to coverage under the PHSA. Larsen contends that, regardless of the egregiousness of his conduct, it cannot be characterized as gross misconduct under the PHSA because it did not occur within the scope of his employment as an associate justice. Br. at 26-27. However, nothing in the statutory language or relevant case law clearly establishes, or even suggests, that gross misconduct under the PHSA must occur within the scope of employment. Accordingly, it appears that a reasonable official applying the plain language of the PHSA could conclude that any termination which occurred by reason of [the] employee's gross misconduct would fall within the exception to section 300bb-3(2) and thus would not constitute a qualifying event entitling the employee to continuing coverage, regardless of whether the conduct occurred within the scope of employment.22 Because Larsen did not adequately allege a violation of the PHSA and because, therefore, there was no clearly established law indicating that Larsen's termination was a qualifying event under section 300bb- 3(2), appellants are entitled to qualified immunity as to Larsen's claim under the PHSA. _________________________________________________________________ 22. Even if it were clearly established thatgross misconduct encompassed only misconduct within the scope of employment, a reasonable official could believe that Larsen's conduct was sufficiently related to his employment to satisfy such a requirement. As the district court noted, 955 F. Supp. at 1581 & n.33, the criminal misconduct which led to Larsen's removal from office involved Larsen's use of his subordinates and his state employees' prescription plan to procure prescription medications unlawfully. Absent some authority to the contrary, reasonable officials could conclude that this nexus between Larsen's misconduct and his employment would satisfy any requirement in that regard. 27