Fields v. United Network for Organ Sharing

District Court, M.D. Florida·Decided June 18, 2025·No. 6:24-cv-01434·Unknown

Opinion

UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA ORLANDO DIVISION

CORTEZ FIELDS,

Plaintiff,

v. Case No: 6:24-cv-1434-JSS-DCI

UNITED NETWORK FOR ORGAN SHARING and ADVENTIST HEALTH SYSTEM/SUNBELT, INC.,

Defendants. ___________________________________/ ORDER Defendants, United Network for Organ Sharing (UNOS) and Adventist Health System/Sunbelt, Inc., move to dismiss the amended complaint (Dkt. 42) filed by Plaintiff, Cortez Fields, for failure to state a claim. (Dkts. 48, 51.) Plaintiff opposes the motions. (Dkts. 56, 57.) Upon consideration, for the reasons outlined below, the court grants the motions in part and denies them in part. BACKGROUND1 The Organ Procurement and Transplant Network (OPTN) “maintain[s] a national registry for organ matching” in the United States. (Dkt. 42 ¶ 26.) UNOS operates the OPTN and accordingly “establishes and implements” policies and procedures as to “how donor kidneys will be awarded to patients with kidney disease.”

1 The court accepts the well-pleaded factual allegations in the amended complaint as true and construes them in the light most favorable to Plaintiff. See Harry v. Marchant, 291 F.3d 767, 769 (11th Cir. 2002) (en banc). As discussed in this order, the court disregards the exhibits to Defendants’ motions and (Id. ¶ 27.) Plaintiff claims that UNOS operates the OPTN pursuant to government contracts that provide UNOS with federal assistance in the form of grants or subsidies, rather than with compensation for goods or services. (Id. ¶¶ 27, 75–76; see id. ¶ 76 (noting that “UNOS’s audited financial statements” classify the payments made to

UNOS as grants); id. ¶ 77 (“[L]egislative history . . . confirms that the legislative intent behind the payments was not to purchase anything from UNOS[] but instead to provide financial assistance . . . .”).) Indeed, Plaintiff pleads, UNOS does not provide any goods or services to the federal government. (Id. ¶ 75.) Adventist operates a transplant hospital in Orlando, Florida, that is affiliated with UNOS. (See id. at 1, 6.)

Adventist regularly obtains Medicare funding and has received relief related to the coronavirus pandemic. (Id. ¶ 78.) Plaintiff suffered from kidney disease for many years, (id. ¶ 5), and had been a patient with Adventist’s hospital for approximately nine years in October 2023, (id. ¶ 16). In July 2022, he began treating his kidney disease through dialysis—a blood-

filtration process that he underwent “during the day,” “four times a week, for approximately five hours each time.” (Id. ¶¶ 6–7, 66.) This treatment purportedly caused him significant damages, including medical expenses, other health problems, emotional distress, “great strain” in his family life, and “grave financial difficulties” due to his inability to work. (Id. ¶¶ 5, 7–10, 82.) During this time, Plaintiff states, he

was on the waiting list for a kidney transplant at Adventist’s hospital and was “biding his time and nursing his health until [Adventist] could find a match” for him. (Id. ¶¶ 11, 21.) However, Plaintiff allegedly endured a “prolonged wait for a kidney and related harms” because of his race, which he describes as Black. (Id. ¶¶ 12, 63.) Plaintiff alleges that for “more than two decades,” UNOS and Adventist used, and encouraged the use of, a “race-based coefficient” to “artificially increase” the

estimated glomerular filtration rate (eGFR) scores “for Black kidney disease patients.” (Id. ¶¶ 1, 80.) According to Plaintiff, these scores indicate patients’ “observed kidney function.” (Id. ¶ 1.) In February 2019, Adventist allegedly administered to Plaintiff an eGFR test with the language “eGFR African American” indicating use of the race- based coefficient. (Id. ¶¶ 58–59.) Plaintiff claims that use of the “coefficient delayed

Black kidney disease patients,” including him, “from being added to the kidney transplant” waiting list and “resulted in Black candidates waiting much longer for kidney transplants than similarly[ ]situated non-Black candidates.” (Id.) Defendants’ conduct regarding the coefficient has purportedly “resulted in non-Black patients receiving numerous kidneys that would otherwise have been given to Black applicants

had their wait time been calculated without consideration of race.” (Id. ¶ 48.) Plaintiff further states that use of the coefficient “relied solely on a defunct, eugenics-style racial stereotype” that “Black Americans . . . have greater muscle mass than non-Black Americans,” as opposed to relying on “valid scientific or peer-reviewed studies.” (Id. ¶ 2; accord id. ¶¶ 45–46.)

According to Plaintiff, in June 2022, UNOS “admitted the racially discriminatory nature of the race-based coefficient for Black Americans” and “approved a measure to require [Adventist and other operators of] transplant hospitals to use a race-neutral calculation when estimating a patient’s level of kidney function.” (Id. ¶ 13 (quotation omitted); accord id. ¶¶ 49–50, 52.) However, Plaintiff claims, for “more than six months,” UNOS “took no affirmative steps to adjust wait times” for Black Americans already on the kidney waiting list. (Id. ¶¶ 14, 53.) Plaintiff further

claims: “In January . . . 2023, UNOS for the first time instructed [Adventist and other operators of] transplant hospitals to notify Black candidates of the . . . change [to race- neutral calculation] and [to] investigate whether Black members of their [waiting lists] were eligible for a wait time modification.” (Id. ¶ 15; accord id. ¶ 54.) Plaintiff alleges that he relied on Adventist to deal with UNOS on his behalf,

(id. ¶ 85), because patients cannot apply directly to UNOS with regard to the kidney transplant waiting list but must instead apply through “an approved transplant hospital,” (id. ¶¶ 28–29 (referring to Adventist and other transplant-hospital operators as UNOS’s “gatekeepers” and “agents in dealing with kidney disease patients”)). According to Plaintiff, Adventist did not ask UNOS to adjust Plaintiff’s wait time until

October 2023, when Adventist finally “admitted it used the race-based coefficient.” (Id. ¶¶ 16, 61.) Plaintiff states that he “was never informed and was thus unaware” that Adventist had applied the race-based coefficient to his eGFR score thereby prolonging his wait for a kidney. (Id. at 5 n.2.) He reports that in December 2023, he received a kidney transplant at a hospital not operated by Adventist. (Id. ¶¶ 17, 65.)

The use of the race-based coefficient purportedly prolonged Plaintiff’s dialysis thereby increasing the damages caused by the dialysis. (See id. ¶¶ 7–10, 12, 18, 66–71, 82–83, 88–89, 92–93.) Accordingly, in August 2024, Plaintiff initiated this action. (See Dkt. 1.) In the operative amended complaint, he asserts three counts against Defendants: violation of Title VI of the Civil Rights Act, 42 U.S.C. § 2000d, against UNOS and Adventist (count one); breach of fiduciary duty against Adventist only (count two); and intentional infliction of emotional distress (IIED) against UNOS and

Adventist (count three). (Dkt. 42 ¶¶ 72–93.) Plaintiff seeks compensatory and punitive damages in addition to legal fees. (Id. at 24.) APPLICABLE STANDARDS In deciding a motion to dismiss for failure to state a claim, a court “accept[s] the allegations in the complaint as true and construe[s] them in the light most favorable

to the plaintiff.” Henley v. Payne, 945 F.3d 1320, 1326 (11th Cir. 2019). “To survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’” Ashcroft v.

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