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April 22, 2002


The opinion of the court was delivered by: VICTOR Marrero, United States District Judge.

Decision And Amended Order

Plaintiff Monroe S. Harris ("Harris") brought this action challenging the revocation by defendant New York State Department of Health ("DOH" or the "State") of his medical license by reason of various charges of professional misconduct, including instances of incompetent and grossly negligent patient care, fraudulent reporting and failure to maintain proper records. Harris claims that DOH's action failed to make accommodations for his alleged learning and attention deficit disabilities, thereby discriminating against him in violation of Title II of the Americans with Disabilities Act (the "ADA"), 42 U.S.C. § 12101, et seq., and § 504 of the Rehabilitation Act of 1973 (the "Rehabilitation Act" or "§ 504"), 29 U.S.C. § 794, et seq. Harris also asserts violations of his federal constitutional due process and statutory rights protected by 42 U.S.C. § 1983.

The State moved pursuant to Federal Rules of Civil Procedure 12(b)(1) and 12(b)(6) to dismiss Harris's First Amended Complaint on the grounds that the claims there asserted are barred by doctrines precluding federal district court appellate review or relitigation of matters already adjudicated in state courts, as well as by the Eleventh Amendment to the United States Constitution. For the reasons set forth below the motion to dismiss is granted.


Different legal standards govern a court's review of motions to dismiss made pursuant to Federal Rules of Civil Procedure 12(b)(1) and 12(b)(6). On a motion to dismiss pursuant to Fed.R.Civ.P. 12(b)(1), it is a court's duty to resolve disputed jurisdictional facts. See Cargill International S.A. v. M/T Pavel Dybenko, 991 F.2d 1012, 1019 (2d Cir. 1993); see also Ruhrgas A.G. v. Marathon Oil Co., 526 U.S. 574, 583 (1999); Lyndonville Savings Bank & Trust Co. v. Lussier, 211 F.3d 697, 700 (2d Cir. 2000) ("[F]ailure of subject matter jurisdiction is not waivable and may be raised at any time by a party or the court sua sponte."). A court may fulfill its duty by reference to evidence outside the pleadings. See Zappia Middle East Construction Co. v. Emirate of Abu Dhabi, 215 F.3d 247, 253 (2d Cir. 2000). Furthermore, in resolving a challenge to subject matter jurisdiction, a court does not draw inferences in favor of the plaintiff. See Newsom-Lang v. Warren International, 129 F. Supp.2d 662, 663-64 (S.D.N Y 2001).

A district court may grant a motion to dismiss pursuant to Fed.R.Civ.P. 12(b)(6) only if it appears beyond doubt that the non-moving party could prove no set of facts that would entitle it to relief. See Hishon v. King & Spalding, 467 U.S. 69, 73 (1984); Valmonte v. Bane, 18 F.3d 992, 998 (2d Cir. 1994). In reviewing the pleadings, a court must accept the non-moving party's well-pleaded factual allegations as true. See Hishon, 467 U.S. at 73; Dove v. Fordham, 56 F. Supp.2d 330, 335 (S.D.N.Y. 1999). Furthermore, a court may consider documents attached to the complaint as exhibits, or incorporated by reference, as well as any documents that are integral to, or explicitly referenced in, the pleading. See Stuto v. Fleishman, 154 F.3d 820, 826 n. 1 (2d Cir. 1991); Ciambriello v. County of Nassau, 137 F. Supp.2d 216, 222 (E.D.N.Y. 2001).


Harris alleges that from childhood on and continuing throughout his life he has suffered from learning disabilities, of which he was not fully aware until recently, that caused him substantial difficulties at all schools he attended. Despite these impediments, Harris asserts, he graduated from medical school in 1963 and one year later was issued a license to practice medicine and surgery in New York State, where he was board certified in the areas of family practice, geriatric and bariatric medicine. For over thirty years he maintained a practice in Queens County, New York, and held staff privileges at five separate hospitals. Beginning 1989 Harris experienced difficulties with various New York State regulatory agencies and was the subject of several administrative proceedings detailed below.*fn1


In 1992, following an audit commenced in 1989 by the DOH's Bureau of Controlled Substances ("BCS"), Harris entered into a stipulation with the BCS (the "BCS Stipulation") in which he acknowledged that he had made errors in storing and dispensing controlled substances at his medical office in Queens, New York, in violation of Article 33 ("Article 33") of the State's Public Health Law ("PHL"). Two years later, allegedly prompted by the BCS audit of Harris, BPMC commenced a formal investigation of Harris for professional misconduct. In this connection, in September 1994 Harris and the DOH's Office of Professional Medical Conduct ("OPMC") stipulated to a Consent Order (the "Consent Order") in which Harris admitted to violations of Article 33.*fn2 By terms of the Consent Order, Harris was fined, put on probation, his license placed on stayed suspension for two years and he was required to file quarterly audits. Harris's license was reinstated in October 1994.


On three separate occasions between September 1990 and September 1992 Harris filed applications for reappointment to various hospitals where he held privileges to practice medicine. In each case, while the BCS investigation remained pending, he responded "No" to a question on the application inquiring whether he was the subject of any disciplinary action. Again in May 1994, in a similar application for medical practice privileges at another hospital, Harris failed to disclose that he had signed the BCS Stipulation in 1992.

In a reappointment application he filed at the Catholic Medical Center in September, 1994 he omitted to disclose that he had been disciplined by BCS and that just days before he had executed the Consent Order with OPMC agreeing to the stayed suspension and other sanctions. In March 1996, as a consequence of an inquiry by the Catholic Medical Center which revealed the 1994 Consent Order, Harris's appointment renewal to practice at the hospital was denied. Subsequently, in his application in November, 1996, to the State Department of Education for renewal of his medical license he failed to acknowledge that his practice privileges at a hospital had been terminated in March, 1996.


In October, 1998, BPMC filed a Statement of Charges (the "Statement of Charges")*fn3 against Harris. It alleged several counts of misconduct arising from Harris's reappointment applications, including fraudulent practice, moral unfitness, and making or filing false reports, as well as negligence, incompetence and failing to maintain records in connection with his medical practice. (See Statements of Charges at ¶¶ A-F.) The counts regarding negligence and incompetence on more than one occasion allege Harris's failure to perform adequate medical examinations, to provide proper treatment and prescribe appropriate drugs, and to maintain accurate records related to the care he rendered to three specific patients, referred to as Patients A, B and C. (See id. at ¶ G-I.)

A hearing by a BPMC committee was conducted in November and December, 1998. In this connection, Harris introduced the testimony of Dr. Steven Migden ("Migden"), a clinical psychologist Harris retained to examine him in preparation for the BPMC hearing. Migden testified at the December hearing that Harris suffered from certain learning disabilities, including disorders of written expression and dyslexia and possibly attention deficit hyperactivity disorder ("ADHD") and that further testing was necessary to rule out dementia. He asserted that these disabilities "might" have caused Harris to misunderstand or be confused by the hospital reappointment application forms he had filed. (See BPMC Order at 7.)

At the conclusion of the hearing in February 1999 the BPMC issued its ruling and Order. It sustained the six charges of fraudulent practice and six charges of making or filing false statements. The BPMC rejected as "implausible" Harris's contention, as suggested by Migden, that his learning disabilities might have caused him to misunderstand and be confused by the questions on the hospital reappointment applications. (See id.) The BPMC hearing committee, noting that at the 1996 Catholic Medical Center reappointment hearings Harris offered several reasons to explain the manner in which he answered the applications as he did, stressed that "[a]t no time did he claim that he was confused due to a learning disability." (Id. at 8.)

The BPMC also upheld the specifications charging negligence on more than one occasion and incompetence on more than one occasion arising from Harris's medical care of Patients A and C.*fn4 The findings as to Patient A indicate that Harris failed to make an adequate physical examination, to make a proper diagnosis of the patient's condition and to maintain proper records of treatment. Moreover, Harris inappropriately prescribed an appetite suppressant drug to Patient A for nine years even though the patient was not overweight. (id. at 11-12.) As regards Patient C, the BPMC that found Harris's treatment constituted gross negligence, specifically in prescribing to a patient with a history of heart disease a drug contraindicated for persons suffering from such condition. With respect to the counts alleging failure to maintain adequate records, the BPMC noted that Harris had submitted two sets of records. One was hand written and the other was a much more detailed typed version, from which the BPMC inferred that the latter was not prepared contemporaneously but later in anticipation of review. (Id. at 22-23.)

Having concluded that the number and nature of the charges sustained were sufficiently serious, the BPMC revoked Harris's medical license. (Id. at 23.)


Harris appealed the BPMC's ruling to the State Administrative Review Board ("ARB") pursuant to PHL § 230-c(4)(a). In June 1999 the ARB issued a decision and order (the "ARB Order")*fn5 which sustained the BPMC's determination as to both its findings of professional misconduct by Harris and its revocation of his medical license.

Harris alleges in the Complaint that the ARB accepted that Harris was disabled and treated him as such, but refused to accept that his disability could have manifested itself as asserted by Migden and also refused to offer him reasonable accommodations. In fact, the ARB found sufficient evidence on the record to support the BPMC's conclusion that Harris had answered the hospital reappointment and license renewal applications falsely and with the requisite intent to mislead. (See ARB Order, at 9-10.) The ARB considered and rejected Harris's defense attributing his false answers to confusion and lack of understanding of the forms brought about by his claimed learning disabilities. It held that the BPMC had acted properly within its authority as fact finder in rejecting the explanations that the testimony of Harris and Migden offered for Harris's misleading applications. (Id.) The ARB also upheld the BPMC's findings of fact and judgments concerning the sufficiency of the evidence and credibility of the witnesses in concluding that Harris's treatment of Patients A and C fell below the level of accepted medical standards. (Id. at 8.)

Finally, the ARB sustained the revocation of Harris's license as an appropriate penalty under the circumstances, finding no mitigating considerations sufficient to outweigh Harris's misconduct and rejecting his contention that the penalty was excessive and grounded on various errors. (Id. at 12-13.)

In the ARB proceeding, Harris raised six grounds contesting the BPMC Order, none of which argued that his learning disabilities explained or excused the negligent or incompetent medical care he rendered to Patients A and C, as determined by the BPMC. (See ARB Order at 5-6.)


Harris sought judicial review of the ARB's ruling pursuant to PHL § 230-c(5) by commencing an action in the State Supreme Court, Appellate Division, under Article 78 of the New York Civil Practice Law and Rules ("Article 78"). There he renewed his argument that his false answers on the hospital and State licensing applications could be explained and excused by his learning disabilities. The Appellate Division heard oral argument on September 12, 2000 and issued a ruling on October 19, 2000. It unanimously rejected Harris's argument, upheld the ARB's ruling and dismissed the petition. See Harris v. Novello, 714 N.Y.S.2d 365 (App. Div. 3 rd Dep't 2000). The court found "unavailing here" Harris's arguments that the hospital reappointment and medical license renewal application forms were too difficult for him to understand, responding that "[t]he administrative finder of fact is `free to reject [a] plaintiff's explanations' or excuses for false answers on applications, and so long as its determination is not arbitrary or capricious, it will be confirmed." Id. at 368. The court rejected Harris's argument that the revocation penalty was excessive. See id. at 368. The Appellate Division also found in the record a substantial basis to sustain the BPMC's charges of negligence and incompetence as regards Harris's care of Patients A and C. See id. Harris did not seek leave to file an appeal with the New York Court of Appeals.


Harris underwent further evaluation by Migden in January and March 2000. Although not specified in the Complaint, Harris contends that Migden issued a report (the "2000 Report") which allegedly was sent to counsel on July 10, 2000, two days prior to the deadline for the submission of Harris's reply in the Article 78 proceeding. The Complaint asserts that in the results of this subsequent testing, Migden ruled out the possibility of dementia and confirms that Harris has "a static, lifelong learning disability involving written language (i.e., dyslexia and written expression disorder) and a related, chronic problem with attention and concentration that is probably best described as ADHD." (Compl. at ¶ 48). On the basis of the alleged new evidence and findings Harris maintains were contained in Migden's 2000 Report, Harris wrote to DOH on November 2, 2000 (the "November 2000 Letter") requesting administrative reconsideration of the revocation of his license. Harris states that although he requested a response within thirty days, DOH ignored the November 2000 Letter.

This litigation followed. Harris here asserts four causes of action arising out of the State's failure to acknowledge and accommodate his learning disabilities prior to revoking his medical license: violations of the ADA and the Rehabilitation Act; deprivation of property and liberty rights without due process in violation of the Fourteenth Amendment of the federal Constitution; and denial of federal rights protected under 42 U.S.C. § 1983.



This case presents a convergence of several powerful imperatives embodied in our legal system, all of them fundamental to the effective administration of justice and to the proper functioning of the system's separate federal and state components. The parties collide over which of several basic legal principles implicated in their dispute should govern its resolution: whether this Court should exercise its jurisdiction and serve as a forum to vindicate federal rights asserted under 42 U.S.C. § 1983, or whether it is precluded from doing so by reason of a judgment previously rendered in a related proceeding in state court involving the same parties; whether the Court, responding to the invocation of federal law protecting federal rights, should conduct its own inquiry into the merits of the violations asserted, or be bound by the state court's prior decision on the underlying matter; whether the Court should consider federal law questions that allegedly were not actually decided by the state court, or give full effect to the state adjudication as to claims that could have been raised in that proceeding but were not.

At such junctures, in the ensuing confluence and clash of premises, doctrines, policies and objectives, substantial confusion and directional tension often abounds. So here, the parties' conflict over the decisive issues mirrors doctrinal splits that have riven the courts and engendered ambiguity and divided guidance over the same questions. Thus, an overview of the various precepts and policies underlying this action may inform the Court's approach in resolving them. To this end, the Court notes several principles that flow into the mix, and are classified for the purposes of this discussion as concerning matters of structure, comity, access and efficiencies pertaining to the legal system.

1. Structure

The structural principles reflect that, from the beginning, the constitutional blueprint of this country's justice system actually comprised "two essentially separate legal systems", each of which "proceeds" independently of the other with ultimate review in [the Supreme Court] of the federal questions raised in either system." Atlantic Coast Line R.R. Co. v. Brotherhood of Locom. Engrs., 398 U.S. 281, 286 (1970). At the time the federal courts structure was established following the ratification of the national Constitution, each state already had in place its own distinct judicial system. The superimposition of the federal scheme thus required special sensitivity as to how the parallel justice network would function with regards to matters entailing overlapping jurisdiction.

2. Comity

The reality of the dual plan raised a potential for inevitable conflicts and frictions that made it difficult for the overall justice system to "function if state and federal courts were free to fight each other for control of a particular case." Id. Accordingly, to enable the distinct parts to operate harmoniously and effectively within their separate spheres and avoid unnecessary tension, several Congressional statutes and judicial doctrines have endeavored to draw lines providing demarcation and guidance in certain areas where federal-state jurisdictional overlap exists. See id. (citing Oklahoma Packing Co. v. Oklahoma Gas & Elec. Co., 309 U.S. 4, 9 (1940)). Among these prescriptions, some of them central to the resolution of the matter at bar and further discussed below, the following are the most prominent.

a. Full Faith and Credit.

As an integral part of its measures to implement the Constitution's Full Faith and Credit Clause*fn6, Congress in 1790 enacted the Full Faith and Credit Statute,*fn7 codified in 28 U.S.C. § 1738. That legislation, intended to ensure that federal courts extend to state court decisions the same effect accorded to those judgments under the law of the particular state where the judgments are rendered, provides in pertinent part:

[J]udicial proceedings [of any State court] . . . shall have the same full faith and credit in every court within the United States and its Territories and Possessions as they have by law or usage in the courts of such State . . . .

See Allen v. McCurry, 449 U.S. 90, 96 (1980); Migra v. Warren City Sch. Dist. Bd. of Ed., 465 U.S. 75, 80-81 (1984); Kremer v. Chemical Const. Corp., 456 U.S. 461, 466 (1982).

b. Anti-Injunction.

Congress also legislated early in our history to enable state courts to adjudicate disputes without undue interference from federal courts. To this end, it enacted the anti-injunction statute, 28 U.S.C. § 2283, which derives from an Act of 1793*fn8 and provides that:

A court of the United States may not grant an injunction to stay proceedings in a State court except as expressly authorized by Act of Congress, or where necessary in aid of its jurisdiction, or to protect or effectuate its judgments.

See also Younger v. Harris, 401 U.S. 37, 43 (1971); Atlantic Coast Line, 398 U.S. at 286-87; but cf. Mitchum v. Foster, 407 U.S. 225, 242-43 (1972).

c. Preclusion Rules.

To further ensure that federal courts accord state court judgments the same preclusive effect given to such decisions by the rendering state courts, the Supreme Court, in construing 28 U.S.C. § 1738, has held that the doctrines of res judicata and collateral estoppel apply to bar relitigation in federal court of certain issues and claims actually settled or that could have been raised in prior state proceedings. See Allen, 449 U.S. at 105; Migra, 465 U.S. at 85.

d. Review by Certiorari

In defining the appellate jurisdiction of federal courts, Congress prescribed an avenue for direct review by the Supreme Court of final state court judgments grounded on federal law. See 28 U.S.C. § 1257.*fn9 Based on this statute and general principles of federal-state comity, the Supreme Court has held, as enunciated in the doctrine denominated Rooker-Feldman, that the exclusive forum for appellate review of state court decisions construing federal law is the Supreme Court. See Rooker v. Fidelity Trust Co., 263 U.S. 413, 416 (1923); District of Columbia v. Feldman, 460 U.S. 462, 482-83 (1983); Atlantic Coast Line, 398 U.S. at 296; see also ASARCO Inc. v. Kadish, 490 U.S. 605, 622 (1989) ("The Rooker-Feldman doctrine interprets 28 U.S.C. § 1257 as ordinarily barring direct review in the lower federal courts of a decision reached by the highest state court, for such authority is vested solely in this Court.").

Lower federal courts, therefore, lack subject matter jurisdiction to serve as appellate tribunals for the purpose of reversing or modifying such state court judgments, even if grounded on erroneous reading or application of federal law. See Feldman, 460 U.S. at 476; ASARCO, 490 U.S. at 622; Texaco Inc. v. Pennzoil Co., 784 F.2d 1133, 1142 (2d Cir. 1986), rev'd on other grounds, 481 U.S. 1 (1987) ("[A]n inferior federal court established by Congress pursuant to Art. III, § 1, of the Constitution may not act as an appellate tribunal for the purpose of overruling a state court judgment, even though the judgment may rest on an erroneous resolution of constitutional or federal law issues. The exclusive procedure for federal review is that specified in 28 U.S.C. § 1257."); Moccio v. New York State Office of Court Adm'n, 95 F.3d 195, 197 (2d Cir. 1996)

e. Abstention.

Taken together, these principles manifest an unequivocal purpose integral to this country's longstanding governmental arrangement. They convey the value of mutual federal-state court recognition and respect embodied in the concepts of comity and federalism frequently invoked and repeatedly reaffirmed by the Supreme Court as vital to the proper functioning of the justice system. As articulated by the Supreme Court, that notion reflects that:

[A] proper respect for state functions, a recognition of the fact that the entire country is made up of a Union of separate State governments, and a continuance of the belief that the National Government will fare best if the States and their institutions are left free to perform their separate functions in separate ways. . . . What the concept does represent is a system in which there is sensitivity to the legitimate interests of both State and National Governments, and in which the National Government, anxious though it may be to vindicate and protect ...

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