Osullivan, M.D. v. U.S. Department of Health and Human Services

District Court, District of Columbia·Decided March 12, 2024·No. Civil Action No. 2022-1189·Published

Opinion

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

CIARA O’SULLIVAN, et al., Plaintiffs

v. Case No. 22-cv-1189 (CRC)

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, et al.,

Defendants.

MEMORANDUM OPINION

Dr. Ciara O’Sullivan is an Irish physician currently serving as a consultant and professor at the Mayo Clinic. She arrived at the Clinic in 2016, following four years of post-graduate medical training in the United States on a “J-1” nonimmigrant visa. Absent a waiver from the U.S. Citizenship and Immigration Services, Dr. O’Sullivan’s J-1 visa requires her to return to Ireland for a period of two years before she can seek U.S. permanent resident status. Touting her many accolades and significant contributions to the Mayo Clinic, in 2017, the Clinic applied to the Department of Health and Human Services (“HHS”) for a recommendation that the return requirement of her visa be waived. But following a negative assessment by an agency review panel, HHS denied the Mayo Clinic’s request in 2019 as well as a subsequent request for reconsideration involving a different set of reviewers in 2021. Dr. O’Sullivan and the Clinic then brought suit, challenging HHS’s 2021 denial as arbitrary and capricious under the Administrative Procedure Act (“APA”). The complaint seeks a declaratory judgment that the denial was unlawful, vacatur of the agency’s decision, and a writ of mandamus compelling the agency to give Dr. O’Sullivan a favorable recommendation or else adjudicate the application consistent with the applicable law.

HHS first moved to dismiss the complaint on jurisdictional grounds. The agency contended that the decision to deny the waiver recommendation was committed to agency discretion by law and that the Immigration and Nationality Act (“INA”) otherwise barred judicial review. The Court denied HHS’s motion to dismiss as to Plaintiffs’ APA claim, finding that the agency’s regulations provided sufficient standards for judicial review, and that the INA posed no further bar. It correspondingly dismissed Plaintiffs’ mandamus claim, finding that its APA jurisdiction precluded jurisdiction under the Mandamus Act by providing a possible alternative remedy.

Both parties have since moved for summary judgment on the administrative record. But while this litigation was underway, the Mayo Clinic resubmitted another application on behalf of Dr. O’Sullivan to HHS, providing additional evidence and seeking still further reconsideration of the agency’s denial of a waiver recommendation. This most recent request is fatal to the Court’s merits review of the agency’s 2021 denial, as it renders that decision nonfinal. Without final agency action, the APA does not provide Plaintiffs with a cause of action. The Court will therefore deny Plaintiffs’ motion for summary judgment, grant HHS’s cross motion for summary judgment, and dismiss the case without prejudice to refiling after any unfavorable decision on the most recent application.

I. Background The J-1 Exchange Visitor Program is a visa program designed to facilitate international cultural exchange. See 22 U.S.C. § 2451. Foreign-national physicians, like Dr. O’Sullivan, often use the J-1 visa program to complete graduate medical education in the United States. See 8 U.S.C. § 1101(a)(15)(J); 22 C.F.R. § 62.27(a). As part of the program, J-1 physicians generally must return to their home country (or country of last residence) for a period of at least

two years before they can pursue U.S. permanent resident status or certain other employment visas. See 8 U.S.C. § 1182(e). However, the Director of the U.S. Citizenship and Immigration Services (“USCIS”) may waive this requirement upon recommendation of an “interested United States Government agency,” or “IGA.” See id.

An IGA may request a waiver of the return requirement for a J-1 visitor who “is actively and substantially involved in a program or activity . . . of interest to such agency.” 22 C.F.R. § 41.63(c)(1). Upon favorable recommendation from the IGA, waiver requests are considered by the Department of State’s Waiver Review Division, which ultimately forwards its recommendation to the U.S. Department of Homeland Security for USCIS’s final adjudication. See 22 C.F.R. §§ 41.63(a)(2), (c); 8 C.F.R. § 212.7(c)(9). HHS is among the government agencies that may make an IGA waiver recommendation, in its case “for the delivery of health care service to carry out the Department’s mission to increase access to care for the nation’s most medically underserved individuals.” 45 C.F.R. § 50.3(a). As alleged in the complaint, “a favorable recommendation from an IGA nearly always results in [an] ultimate positive recommendation from the Department of State and then approval of the waiver request by USCIS.” Compl. ¶ 9.

Breast cancer researcher and Irish citizen Dr. Ciara O’Sullivan entered the United States on a J-1 nonimmigrant visa to complete her post-graduate medical training between July 2012 and June 2016. Id. ¶¶ 42–44. After finishing her studies, Dr. O’Sullivan went on to serve as an Assistant Professor of Medicine in the Mayo Clinic College of Medicine and as a consultant within the Clinic’s Division of Medical Oncology. Id. ¶ 42. She is currently living and working in the United States in valid “O-1” nonimmigrant status, which is “reserved for those with ‘[extraordinary] ability in the sciences, arts, education, business or athletics which has been

demonstrated by sustained national or international acclaim.’” Id. ¶ 45 (quoting 8 U.S.C. § 1101(a)(15)(O)). However, because of Dr. O’Sullivan’s time in J-1 status, absent a waiver she will need to spend at least two years in Ireland before pursuing various other U.S. immigration options, including permanent residence. See 22 C.F.R. § 41.63(a)(1)(iii). Without permanent resident status, Dr. O’Sullivan is unable to apply for certain research grants. Id. ¶ 46.

In September 2017, the Mayo Clinic applied to HHS for an IGA waiver recommendation for Dr. O’Sullivan. See Certified Administrative Record (“CAR”), at 1–5. Its application packet included detailed descriptions of Dr. O’Sullivan’s accomplishments and current research and sought to address each of HHS’s criteria for waiver recommendations. See, e.g., CAR at 12–49 (Letter in Support of J-1 Waiver Application). As set forth in its regulations, HHS assigned three reviewers to evaluate the application and provide a recommendation on whether to grant it. See 8 C.F.R. § 50.2. All three declined to recommend waiver of the return requirement due to various perceived deficiencies in the application, leading the agency to deny the Clinic’s request in May 2019. CAR at 52–56, 64–66. In September 2019, the Mayo Clinic requested that HHS reconsider its initial denial, and submitted additional information addressing the reviewers’ concerns. See CAR at 127–30. After considerable back and forth between the Clinic and the agency, including another submission of supporting documentation, id. at 70–75, and two new technical reviews declining to recommend Dr. O’Sullivan, id. at 57–60, HHS issued a “final determination” denying the Clinic’s waiver recommendation request in January 2021. Id. at 69.

Plaintiffs, Dr. O’Sullivan and the Mayo Clinic, filed this suit in April 2022, challenging HHS’s decision under the APA and INA and seeking relief pursuant to the Mandamus Act and

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