Rubenstein v. Benedictine Hosp 790 F. Supp. 396

8/9/2019 Rubenstein v. Benedictine Hosp 790 F. Supp. 396

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Date/Time of Request: Tuesday, June 22, 2010 15:07 EasternClient Identifier: PATRON ACCESSDatabase: FSFINDCitation Text: 790 F.Supp. 396Lines: 1370Documents: 1Images: 0

MENTALLY ILL CASES

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United States District Court,N.D. New York.

Jane RUBENSTEIN, and Mary Ann Bagatta, Indi-vidually, and on Behalf of all Others Similarly Situ-ated, and Disability Advocates, Inc., as the Protec-tion and Advocacy Agency for Mentally Ill Indi-

viduals in the Hudson Valley Region of New York State, Plaintiffs,

v.BENEDICTINE HOSPITAL, Dr. George Joseph,

Dr. K. Gulati, and Unidentified Staff Physician, De-fendants.

No. 92-CV-1046.

April 7, 1992.

Patients who had been involuntarily committedfiled civil rights action against private hospital andphysician. On motions for summary judgment, theDistrict Court, Cholakis , J., held that: (1) the hos-pital and physician were acting under color of statelaw when they initiated involuntary commitmentproceedings; (2) the patients adequately alleged thestate action needed to maintain a claim for injunctive relief directly under the FourteenthAmendment; (3) the state tort claims were withoutmerit; and (4) the action involved fact-specific in-quiries and, thus, was not appropriate for class cer-tification.

Motions for summary judgment granted in part anddenied in part.

West Headnotes

[1] Constitutional Law 92 4337

92 Constitutional Law92XXVI I Due Process

92XX VII(G) Partic ular Issues and Applica-tions

92XXVII(G)15 Mental Health

92k4337 k. Commitm ent and Proceed-ings Therefor. Most Cited Case s

(Formerly 92k255(5))When State deprives person of his or her libertythrough civil commitment, person is entitled to dueprocess safeguards. U.S.C.A. Const.Amends. 5 , 14 .

[2] Civil Rights 78 1326(5)

78 Civil Rights78II I Federal Remedies in General

78k13 23 Color of Law78k132 6 Particular Cases and Contexts

78k1326(3) Private Pers ons or Corpor-ations, in General

78k1326(5 ) k. Cooperation withState Actor. Most Cited Cases

(Formerly 78k198(4))Private hospital acted under color of state lawand was state actor in initiating involuntary com-mitment of patients; hospital engaged in publicfunction that infringed upon patients' liberty in-terest under pervasive statutory scheme, there wasclose nexus between state and hospital's activities,and power to deprive a person of liberty was ordin-

arily one reserved to state. 42 U.S.C.A. 19 83 ;N.Y.McKinney's Mental Hygiene Law 7.01 ,7.05 (a), par. 3, 7.17 (d), 29.11 , 31.01 -31.29 , 31.23(c).




78k1326(3) Private Pers ons or Corpor-

ations, in General78k1326(5 ) k. Cooperation with

State Actor. Most Cited Cases(Formerly 78k198(4))

Emergency room physician who initiated involun-tary commitment proceedings against patient wasacting under color of state law and, thus, his ac-

Page 1790 F.Supp. 396, 2 NDLR P 329(Cite as: 790 F.Supp. 396)

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tions involved state action; in addition to enga-ging in public function by initiating involuntarycommitment, physician had become designee of county community service director. 42 U.S.C.A. 1983 ; N.Y.McKinney's Mental Hygiene Law 9.37, 9.37 (e).




78k1326(3) Private Pers ons or Corpor-ations, in General

78k1326(5 ) k. Cooperation withState Actor. Most Cited Cases

(Formerly 78k198(4))

Constitutional Law 92 3941

92 Constitutional Law92XXVI I Due Process

92XX VII(D) Appli cability to Governmentalor Private Conduct; State Action

92k3941 k. Non-Government Entities andIndividuals, Actions Of. Most Cited Case s

(Formerly 92k254(4))Actions taken by private hospital and emergencyroom physician in initiating involuntary commit-ment proceedings against patients under New York law were sufficiently public actions that amountedto state action to support claim for injunctive re-lief directly under Fourteenth Amendment; state ac-tion requirement for seeking injunctive relief underFourteenth Amendment was coextensive withunder color of law requirement for claims under 19 83 . 42 U.S.C.A. 1983 ; U.S.C.A.Const.Amend. 14 .



78k13 28 Perso ns Protected and Entitled toSue

78k133 2 Third Party Rights; Decedents78k1332(6) k. Other Par ticular Cases

and Contexts. Most Cited Case s(Formerly 78k202)

Nonprofit corporation that entered into contractwith New York State to provide protection and ad-vocacy services to mentally disabled persons hadstanding to pursue civil rights action against privatehospital and physician who initiated involuntarycommitment proceedings against patients, even if nonprofit corporation did not personally suffer in- jury in fact; Protection Advocacy System for Men-tally Ill Individuals Act gave corporation the rightto pursue legal remedies on behalf of clients. Pro-tection and Advocacy for Mentally Ill Individuals

Act of 1986, 105(a), (a)(1)(B), 42 U.S.C.A. 10805(a) , (a)(1)(B ); Mental Retardation Facilitiesand Community Mental Health Centers Construc-tion Act of 1963, 102-145, as amended, 42U.S.C.A. 6001 -6081 ; 42 U.S.C.A. 1983 .

[6] False Imprisonment 168 2

168 False Imprisonment168 I Civil Liability

168I( A) Acts Constituting False Imprison-ment and Liability Therefor

168k1 Nature and Elements of False Im-prisonment

168k2 k. In Genera l. Most Cited Case sElements of false imprisonment under New York law are that defendant intended to confine plaintiff,that plaintiff was conscious of confinement, thatplaintiff did not consent to confinement, and thatconfinement was not otherwise privileged.

[7] False Imprisonment 168 11

168 False Imprisonment

168 I Civil Liability168I( A) Acts Constituting False Imprison-

ment and Liability Therefor168k9 Defenses

168k11 k. Exercise of Authority orDuty. Most Cited Cases

(Formerly 257Ak51.20, 168k15(1))


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Emergency room physician who acted in compli-ance with New York's Mental Hygiene Law in initi-ating involuntary commitment proceedings againstpatients was acting under privilege and could not beheld liable for false imprisonment under New York law. N.Y.McKinney's Mental Hygiene Law 9.3 7, 9.39 .

[8] Assault and Battery 37 2

37 Assault and Battery37 I Civil Liability

37I(A ) Acts Constituting Assault or Batteryand Liability Therefor

37k1 Nature and Elements of Assault andBattery

37k2 k. In G enera l. Most Cited Case sTo recover damages under New York law for bat-tery founded on bodily contact, plaintiff must provethat there was bodily contact, that contact was of-fensive, and that defendant intended to make con-tact.





37k2 k. In G enera l. Most Cited Case sEmergency room physician could not be held liablefor battery by offensive touching under New York law in connection with actions he took in attempt-ing to examine patients and in commencing invol-untary commitment proceedings pursuant to NewYork's Mental Hygiene Law. N.Y.McKinney'sMental Hygiene Law 9.37 , 9.39 .





37k2 k. In G enera l. Most Cited Case sAssault claim under New York law requires allega-tions that plaintiff has been put in imminent appre-hension of harmful or offensive contact.





37k2 k. In G enera l. Most Cited Case sEmergency room physician could not be held liableunder New York law for alleged assault in connec-tion with examination or attempted examination of patients, absent any indication that he threatenedpatients with physical harm or that patients were infear of such harm.

[12] Health 198H 786

198H Health198HV Malpractice, Negligence, or Breach of

Duty198H V(F) Perso ns Liable

198Hk786 k. Multiple Professionals orHealth Care Workers in General. Most Cited Cases

(Formerly 299k15(5.1), 299k15(5) Physiciansand Surgeons)Emergency room physician who initiated involun-tary commitment proceedings against patients un-der New York's Mental Hygiene Law could not beheld liable for alleged medical malpractice; allegedmisconduct occurred during course of initial exam-ination and commencement of involuntary commit-

ment proceedings, and any actions that occurredafter patient had been admitted were not done byemergency room physician. N.Y.McKinney's Men-tal Hygiene Law 33.01 et seq .

[13] Damages 115 57.49


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115 Damages115II I Grounds and Subjects of Compensatory

Damages115III (A) Direc t or Remote, Contingent, or

Prospective Consequences or Losses115III(A)2 Mental Suffering and Emo-

tional Distress115k57.49 k . Privilege or Immunity;

Exercise of Legal Rights. Most Cited Case s(Formerly 115k49.10)

Emergency room physician's conduct in commen-cing involuntary commitment proceedings pursuantto New York's Mental Hygiene Law was privileged,and, thus, could not form basis of recovery underNew York law for alleged intentional infliction of

emotional distress. N.Y.McKinney's Mental Hy -giene Law 9.37 , 9.39 .

[14] Federal Civil Procedure 170A 186.10

170A Federal Civil Procedure170AI I Parties

170AI I(D) Class Actions170AII(D)3 Particular Classes Represen-

ted170Ak186.1 0 k. Prisoners and In-

mates. Most Cited Case s

Civil rights action filed by patients who had beeninvoluntarily committed involved fact-specific in-quiry into whether patients were dangerous tothemselves or others and, therefore, action was notappropriate for certification as class action.Fed.Rules Civ.Proc.Rule 23(a), (b)(2), 28 U.S.C.A .;N.Y.McKinney's Mental Hygiene Law 9.37 ,9.39 ; 42 U.S.C.A. 1983 .*397 Disabilities Advocates, Inc., Albany, N.Y.(Cailie Currin and Timothy A. Clun e, of counsel),for plaintiffs.

Thuillez, Ford Law Firm, Albany, N.Y. (Michael J.Hutter, Jr ., of counsel), for defendant, BenedictineHosp.

*398 Martin, Clearwater Law Firm, New York City(Anthony M. Sol a, of counsel), for defendant, Dr.George Joseph.

Nixon, Hargrave, Devans & Doyle, Albany, N.Y. (Andrew C. Ro se , of counsel), for defendant, Dr.Kulbhushan Gulati.

MEMORANDUM DECISION AND ORDER

CHOLAKIS , District Judge.

This action involves the involuntary commitment of the two individual plaintiffs and, ostensibly, of themembers of the would-be class of plaintiffs.Plaintiffs Rubenstein and Bagatta are individualswho, by different means, arrived, on different dates,at the emergency room of defendant Benedictine

Hospital, a private hospital as that term is definedin Article 28 of the New York Public Health Law,and a facility as that term is defined in the NewYork Mental Hygiene Law.

Defendant Gulati is a physician who was workingin the emergency room of the Hospital on the daysthat the individual patients arrived. DefendantJoseph is a physician who works in the psychiatricward of the Hospital. Finally, plaintiff DisabilityAdvocates, Inc. (DAI) is a not-for-profit corpora-tion, dedicated to providing advocacy and legal

representation to people with a diagnosis of mentalillness. Complaint par. 5.

As presently filed, the complaint alleges ninecauses of action: (1) 198 3; (2) deprivation of liberty without due process, in violation of the Fifthand Fourteenth Amendments to the United StatesConstitution and Article I, Section 6 of the NewYork State Constitution; (3) that defendants' reli-ance on the plaintiffs' past diagnoses of mental ill-ness in making the determination to involuntarilycommit them violated plaintiffs' rights to equal pro-

tection under the Fourteenth Amendment to theUnited States Constitution and Article I, Section 11of the New York State Constitution; (4) false im-prisonment; (5) battery; (6) assault; (7) negligencewith respect to plaintiff Bagatta; (8) intentional in-fliction of emotional distress; and (9) negligence.


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By this complaint, plaintiffs seek (a) certification of a class; (b) a declaratory judgment declaring thatdefendants' involuntary commitment based solelyon previous diagnoses is unlawful; (c) an injunctionenjoining defendants from involuntarily committingindividuals unless there is a present finding of amental illness which poses a substantial risk of seri-ous danger to the individual or others; (d) compens-atory and punitive damages; (e) attorneys' fees un-der 1988; and (f) costs and disbursements.Plaintiffs also demand a jury trial.

FACTS

Plaintiff Rubenstein

According to the complaint, on January 24, 1991,plaintiff Rubenstein went to the New Paltz PoliceDepartment complaining of chest pains and short-ness of breath. Id. par. 14. She requested that thepolice call an ambulance to take her to an emer-gency room. Id.

Upon arrival, Rubenstein told defendant Dr. Gulatiof her chest pains but, rather than treat her physicaldistress, Gulati allegedly ignored the somatic com-

plaints and instead made a statutory application foran involuntary commitment of plaintiff, pursuant toNYMHL 9.37 .FN1 Id. par. 17.

FN1. The relevant portions of 9.3 7 canbe found in Appendix A to this opinion.

Plaintiff alleges that Gulati's application gave no in-dication that it was based on his own evaluation orthat plaintiff posed a substantial risk of physicalharm to herself or others. Gulati, allegedly a de-signee of the director of community services stated

This request is made due to the behavior and/orspecific acts described below: Pt. talking continu-ously; shouting at people; crying intermittently onstreet as per New Paltz police. Id. Plaintiff furtheralleges that, based upon Gulati's application,plaintiff was physically restrained and transportedto and subsequently admitted to Hudson River Psy-

chiatric Center (HRPC). Id. par. 19.

Rubenstein denies posing a substantial risk of harmto herself or others. Id. pars. *399 20-23. Sheclaims she did not consent to being involuntarilycommitted to HRPC and, finally, asserts that, uponher arrival at HRPC, HRPC did not determine thatshe posed a substantial risk of physical danger toherself or others. Id. par. 25.

Plaintiff Bagatta

In September 1990, Bagatta was an outpatient re-ceiving treatment for previously diagnosed mentalillness, and taking certain medication in connection

with her treatment. Although Bagatta had been hos-pitalized in the past for the illness, she had not beenhospitalized for approximately ten years prior to theevents underlying the complaint in this action. Id.par. 26.

Around that time, Bagatta's medication was reducedfrom 50 mg to 10 mg doses, a change [p]laintiff was having difficulty adjusting to. Id. par. 27. Ac-cording to the complaint, upon information andbelief, on September 17, 1990 Bagatta's parentscalled the Ulster County Mental Health clinic

(UCMH) to report changes in Bagatta's behavior.UCMH issued a pick up order to be executed bylocal police officers. Id. par. 28. Police allegedlyforcibly removed Bagatta from her apartment, infour-point leather restraints, and a Hudson ValleyAmbulance ambulance transported her to defendantHospital's emergency room. Id. par. 29.

Again, upon information and belief, defendant Gu-lati was the admitting physician, allegedly examin-ing plaintiff pursuant to N.Y. MENTAL HY G.LAW 9.3 9.FN2 Acc ording to plaintiff, Gulati'sbasis for plaintiff's admission, as stated on the ad-mission form, consisted of the following state-ments: Pt. is known to have paranoid schizo -phrenia . Has not taken medications for one week;scared people are hurting her. Complaint Par. 31.

FN2. The relevant portions of 9.3 9 may


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be found in Appendix B to this opinion.

Bagatta further alleges that Gulati relied on state-ments of Bagatta's mother to the effect that Bagattahad been confused, unable to sleep and had beenreading and underlining the Bible and books aboutHitler. Id. par. 33. Gulati allegedly notified defend-ant Joseph of Bagatta's admission. Id. par. 34. OnSeptember 18, 1990, Bagatta was examined by anas-yet unidentified physician on the psychiatricstaff of the Hospital, who stated in writing thatBagatta had the [p]otential for self endangerment. Id. par. 36.

Bagatta alleges that, after the individual defendantslabelled her as uncooperative and treatment res-istant, they failed to create a properly therapeuticrelationship with plaintiff. This allegation is madeparticularly with respect to defendant Joseph. Id.par. 37. Bagatta alleges that, as a result of the actsand omissions of the defendants, her conditionworsened while she was at the Hospital, which con-dition continued to exist during a subsequent ap-pearance before a New York State Supreme CourtJustice. Id. pars. 38-40. FN3

FN3. Bagatta also claims she was denied

food and drink in her room, access to dent-al floss and a dentist, and was subjected toinvoluntary medication. Id. pars. 41-44.

In November 1990, the defendants petitionedJudge Bradley of the Ulster County Supreme Courtto further retain Bagatta and to medicate her overher objection. The judge dismissed the petition tomedicate but ordered Bagatta's transfer to HRPC. Id. par. 45. Finally, Bagatta claims to have dramat-ically improved upon admission to HRPC, volun-tarily accepted medication and was soon spending

weekends at home. Id. pars. 47-49.

A separate set of allegations in the complaint, underthe t it le Organizational and Class-WidePlaintiffs, states that the defendants routinely andsystematically involuntarily admit people who arenot at the time of admission posing a substantial

risk of danger to themselves or others, id. par. 52,that such practices result in wide-spread denial of liberty without meeting the statutory requirementsand without the required due process of law, id.par. 53, and that the hospital is liable for the actsand omissions of its employees under respondeat superior. Id. par. 54.

*400 DISCUSSION

Applicable Legal Standards

Defendants move for summary judgment and to dis-miss. On a motion to dismiss, the district court

must construe the complaint's allegations in thelight most favorable to the plaintiff and accept thewell-pleaded allegations as true. Scheuer v. Rhodes ,416 U.S. 232, 236, 94 S.Ct. 1683, 1686, 40 L.Ed.2d90 (1974 ); Wanamaker v. Columbian Rope Co., 740F.Supp. 127, 133 (N.D.N.Y.1990 ). Summary judg-ment, on the other hand,

shall be rendered forthwith if the pleadings, de-positions, answers to interrogatories, and admis-sions on file, together with the affidavits, if any,show that there is no genuine issue as to any ma-

terial fact and that the moving party is entitled toa judgment as a matter of law.

Fed.R.Civ.P. 56(c ). Summary judgment procedureis properly regarded not as a disfavored proceduralshortcut, but rather as an integral part of the FederalRules as a whole, which are designed to secure the just, speedy and inexpensive determination of everyaction. Celotex Corp. v. Catrett, 477 U.S. 317 ,327, 106 S.Ct. 2548, 2555, 91 L.Ed.2d 265 (198 6)(citation omitted).

If the movant meets its initial burden of demon-strating that there is no genuine issue as to any ma-terial fact, the nonmovant, by affidavits or as oth-erwise provided in this rule, must set forth specificfacts showing that there is a genuine issue for trial.Fed.R.Civ.P. 56( e) . The evidence of the non-movant is to be believed, and all justifiable infer-


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8/24

ences are to be drawn in his favor. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255, 106 S. Ct.2505, 2513, 91 L.Ed.2d 202 ( 1986) ; see alsoThompson v. Gjivoje, 896 F.2d 716, 720 (2dCir.1990) (all reasonable inferences and any ambi-guities are drawn in favor of the nonmoving party).

The mere existence of some alleged factual disputebetween the parties, however, will not defeat anotherwise properly supported summary judgmentmotion. Instead, [o]nly disputes over facts thatmight affect the outcome of the suit under the gov-erning law will properly preclude the entry of sum-mary judgment. Factual disputes that are irrelevantor unnecessary will not be counted. Anderson, 477

U.S. at 248, 106 S.Ct. at 2510 .

The function of the judge is not himself to weighthe evidence and determine the truth of the matterbut to determine whether there is a genuine issuefor trial. Id. at 249, 106 S.Ct. at 2511 . Although todo so would be helpful to a reviewing court, thereis no requirement that the trial judge make findingsof fact. See id. at 250, 106 S.Ct. at 2511 .

1. Section 1983 and State Action

All defendants move for summary judgment withrespect to the plaintiffs' claim under 42 U.S.C. 1983 .FN4 Section 198 3 liability is premised upon afinding that a defendant has, under color of statelaw, deprived a plaintiff of rights secured by theConstitution and laws of the United States. Section1983 plaintiffs must therefore prove two elements:First, plaintiff must demonstrate that he or she hasbeen deprived of a right secured by the Constitutionand the laws of the United States. Second, plaintiff must prove that the defendant depriving plaintiff of such right was acting under color of any statute of the state. See Flagg Bros., Inc. v. Brooks, 436 U.S.149, 155, 98 S.Ct. 1729, 1732-33, 56 L.Ed.2d 1 85(1978) . FN5

FN4. The relevant portions of the text of 1983 is as follows:

Every person who, under color of anystatute, ordinance, regulation, custom, orusage, of any State or Territory or theDistrict of Columbia, subjects, or causesto be subjected, any citizen of the UnitedStates or other person within the juris-diction thereof to the deprivation of anyrights, privileges, or immunities securedby the Constitution and laws, shall be li-able to the party injured in an action atlaw, suit in equity, or other proper pro-ceeding for redress.

FN5. The under color of state law re-quirement has been held to be the equival-

ent of state action for the purposes of theFourteenth Amendment. See Rendell-Baker v. Kohn, 457 U.S. 830, 838, 102 S.Ct.2764, 2769-70, 73 L.Ed.2d 418 (1982 ).

*401 All three defendants claim that they did notact under color of state law. The underlying ques-tion is whether the alleged infringement of rights bythe private actor is fairly attributable to the State.See Lugar v. Edmondson Oil Co., 457 U.S. 92 2,102 S.Ct. 2744, 73 L.Ed.2d 482 (1982 ). The fairlyattributable issue is approached in two parts. As

the Lugar Court stated:

First, the deprivation must be caused by the exer-cise of some right or privilege created by theState or by a rule of conduct imposed by the Stateor by a person for whom the State is respons-ible.... Second, the party charged with thedeprivation must be a person who may fairly besaid to be a state actor. This may be because he isa state official, because he has acted togetherwith or has obtained significant aid from state of-ficials, or because his conduct is otherwise

chargeable to the State.

Id. at 937, 102 S.Ct. at 2753- 54 (emphasis added).In addressing the necessarily fact-bound inquirythat confronts the Court in these cases, the Courthas developed several factors or tests to de-termine what makes a private entity or individual a


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state actor for purposes of 198 3. These testshave been characterized as (1) the public functiontest; (2) the state compulsion test; (3) the nexustest; and, (4), in the case of prejudgment attach-ments, the joint action test.

In Jackson v. Metropolitan Edison Co., 419 U.S .345, 95 S.Ct. 449, 42 L.Ed.2d 477 (197 4) , plaintiff sued the defendant utility under 1983 after the de-fendant terminated its electric service to plaintiff for nonpayment of amounts due. The SupremeCourt, rejecting plaintiff's claim that the defendantwas a state actor, first stated that [t]he mere factthat a business is subject to state regulation doesnot by itself convert its action into that of the state

for purposes of the Fourteenth Amendment. Id. at350, 95 S.Ct. at 453 . One's status as a regulated en-tity or practitioner (e.g., a doctor) is insufficient,absent more, to convert a private action into stateaction. Id. at 354, 95 S.Ct. at 455 .

Instead, said the Court, the inquiry must be wheth-er there is a sufficiently close nexus between theState and the challenged action of the regulated en-tity so that the action of the latter may be fairlytreated as that of the State itself. Id. at 351, 9 5S.Ct. at 454 . The Court first rejected plaintiff's con-

tention that the utility's monopoly status required afinding of state action. Id.

The Court then addressed plaintiff's claim that de-fendant provided an essential public service,therefore performing a public function. The Courtstated that, although it has found state actionpresent in the exercise by a private entity of powerstraditionally exclusively reserved to the State, id .at 352, 95 S.Ct. at 4 54, Pennsylvania courts haverejected the argument that the furnishing of utilityservices is a state function. The Court further stated

that the case would be different [i]f we were deal-ing with the exercise by [the defendant] of some power delegated to it by the State which is tradi-tionally associated with sovereignty, such as emin-ent domain. Id. at 352-353, 95 S.Ct. at 454(emphasis added).

In Flagg Bros., supra, the Court held that a ware-houseman's sale of goods entrusted to him for stor-age, as permitted under a New York statute, wasnot state action. Plaintiffs there claimed that de-fendant warehouseman deprived them of propertywithout due process of law.

The Court rejected plaintiffs' claim that the statehad delegated to defendant powers traditionallyexclusively reserved to the State, reasoning thatthe settlement of disputes between debtors andcreditors is not traditionally an exclusive publicfunction. 436 U.S. at 161, 98 S.Ct. at 173 6. Suchpublic functions have included elections, see,e.g., Terry v. Adams, 345 U.S. 461, 73 S.Ct. 809, 97

L.Ed. 1152 (1953 ) and Smith v. Allwright, 321 U.S.649, 64 S.Ct. 757, 88 L.Ed. 987 (1 944) , and thecompany town phenomenon. See Marsh v. Alabama, 326 U.S. 501, 66 S.Ct. 276, 90 L.Ed. 265(1946) . The Court also stated that

there are a number of state and municipal func-tions not covered by our election *402 cases orgoverned by the reasoning of Marsh which havebeen administered with a greater degree of ex-clusivity by States and municipalities than has thefunction of so-called dispute resolution.

Among these are such functions as education, fireand police protection, and tax collection. We ex-press no view as to the extent, if any, to which acity or State might be free to delegate to privateparties the performance of such functions andthereby avoid the strictures of the FourteenthAmendment.

436 U.S. at 163-164, 98 S.Ct. at 1737 .

In Rendell-Baker v. Kohn, 457 U.S. 830, 102 S.Ct .2764, 73 L.Ed.2d 418 (1982 ), one of a trio of cases

on the issue that were written during the Court'sterm that year, plaintiffs were six teachers fired bythe board of a private school serving maladjustedadolescents, which school received a large amountof state and federal support. The Court rejectedplaintiffs' claim that the acts of the board consti-tuted state action.


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The Court first held that the school's receipt of public funds does not make the discharge decisionsacts of the State. Id. at 840, 102 S.Ct. at 2770-7 1.Second, the discharge decisions were not compelledor even influenced by any state regulation. Id. at841, 102 S.Ct. at 277 1. Third, the Court held that,although the education of maladjusted high schoolstudents is a public function, the State's mere legis-lative choice to provide services for such studentsat public expense does not mean the services werethe exclusive province of the State. Id. at 842 ,102 S.Ct. at 27 72. Fourth, the Court rejectedplaintiffs' argument that there existed a symbioticrelationship between the school and the State so asto imbue the school's actions with the state's iden-

tity.FN6

FN6. In Burton v. Wilmington Parking Au-thority, 365 U.S. 715, 81 S.Ct. 8 56, 6L.Ed.2d 45 (1961 ), the Court held that therefusal of a restaurant located in a publicparking garage to serve blacks constitutedstate action. The Court reasoned that theState profited from the discriminatory con-duct, since the restaurant was its tenant.This kind of symbiotic relationship wasnot found in Kohn.

In Blum v. Yaretsky, 457 U.S. 991, 102 S.Ct. 2777 ,73 L.Ed.2d 534 (1982 ), the Court found that the de-cisions of private nursing homes and physicians totransfer or discharge Medicaid patients did not con-stitute state action for purposes of the FourteenthAmendment. As in its earlier cases, the Court heldthat the mere fact that a private entity is subject toextensive regulation by the State is insufficient toconvert the entity into a state actor. A plaintiff must also show that there is a sufficiently closenexus between the State and the challenged actionof the regulated entity so that the action of lattermay be fairly treated as that of the State itself. Id. at 1004, 102 S.Ct. at 2785- 86 (quoting Metro- politan Edison, 419 U.S. at 350, 95 S.Ct. at 453) .

Second, the Court stated that

although the factual setting of each case will besignificant, our precedents indicate that a Statenormally can be held responsible for a private de-cision only when it has exercised coercive poweror has provided such significant encouragement,either overt or covert, that the choice must in lawbe deemed to be that of the State. [citations omit-ted]. Mere approval of or acquiescence in the ini-tiatives of a private party is not sufficient to justi-fy holding the State responsible for those initiat-ives under the terms of the Fourteenth Amend-ment.

Id. 457 U.S. at 1004, 102 S.Ct. at 2785-8 6. Finally,the Court reiterated that the required nexus may be

present if the private entity has exercised powersthat are traditionally the exclusive prerogative of the State. Id. at 1005, 102 S.Ct. at 278 6 (quoting Metropolitan Edison, 419 U.S. at 353, 95 S.Ct. at455).

The Court thereafter found tht there was no stateaction present in that case. Most relevant to thepresent case, the Court rejected plaintiffs' argumentthat the federal Medicaid statute and the New York State Constitution made the State responsible forproviding every Medicaid patient with nursing

home services. Id. 457 U.S. at 1011, 102 S.Ct. at2789. The Court held *403 that the state Constitu-tion only mandated money for the needy, not partic-ular types of care, and that the federal statute onlyrequired the State, to be entitled to federal monies,to provide money for services, not provide servicesthemselves. See id. Finally, the Court stated that

Even if respondents' characterization of theState's duties were correct, however, it would notfollow that decisions made in the day-to-day ad-ministration of a nursing home are the kind of de-

cision traditionally and exclusively made by thesovereign for and on behalf of the public.

Id. at 1011-1012, 102 S.Ct. at 2789-90 .

The first question on these motions is whether thedefendants, in causing plaintiffs to be involuntarily


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