Paul A. Buongiorno, Jr. v. Louis W. Sullivan, Secretary, United States Department of Health and Human Services and United States of America

912 F.2d 504, 286 U.S. App. D.C. 104, 1990 U.S. App. LEXIS 14711, 1990 WL 121515
CourtCourt of Appeals for the D.C. Circuit
DecidedAugust 24, 1990
Docket89-5363
StatusPublished
Cited by17 cases

This text of 912 F.2d 504 (Paul A. Buongiorno, Jr. v. Louis W. Sullivan, Secretary, United States Department of Health and Human Services and United States of America) is published on Counsel Stack Legal Research, covering Court of Appeals for the D.C. Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Paul A. Buongiorno, Jr. v. Louis W. Sullivan, Secretary, United States Department of Health and Human Services and United States of America, 912 F.2d 504, 286 U.S. App. D.C. 104, 1990 U.S. App. LEXIS 14711, 1990 WL 121515 (D.C. Cir. 1990).

Opinion

Opinion for the court filed by Circuit Judge THOMAS.

CLARENCE THOMAS, Circuit Judge:

This case concerns the National Health Service Corps and the rule under which the government decides whether to modify the obligations of someone who has participated in the Corps’ scholarship program. We consider here a challenge to the rule on its face, and a challenge to the rule’ as applied.

I.

A.

The National Health Service Corps (NHSC) exists, in the words of Congress, “to improve the delivery of health services in health manpower shortage areas,” 42 U.S.C. § 254d(a)(2), “to rectify,” in the words of a recent court decision, “the nation’s topological maldistribution of health professionals,” United States v. Beane, Civ. No. 88-8488, mem. op. at 1, 1990 WL 63603 (E.D.Pa. May 7, 1990). 1 To help “assure [the Corps] an adequate supply of trained physicians, dentists, and nurses,” *506 42 U.S.C. § 254l(a), Congress created the National Health Service Corps Scholarship Program. See id. § 254Z. The essentials of the program are simple: the government pays for the schooling of future health care providers, and the students promise in return to work after graduation in medically understaffed areas. See generally United States v. Duffy, 879 F.2d 192, 193-94 (6th Cir.1989); Rendleman v. Bowen, 860 F.2d 1537, 1539-40 (9th Cir.1988).

The particulars of the program are also simple. A student who chooses to participate must sign a contract that conforms to detailed statutory standards. Under an NHSC scholarship contract, the government agrees to pay the student’s tuition and expenses and to provide the student with a monthly stipend. 42 U.S.C. § 254l (f)(1)(A), (g). The student agrees to remain in good academic standing, to graduate, and, subject to exceptions not germane, to serve a year in the Corps for each year he receives government funding (with at least two years’ service required). Id. §§ 254Z (f)(1)(B), 254m; see also United States v. Duffy, 879 F.2d at 193 (describing student’s options). The statute also mandates that the contract include a clause reciting the damages to which the government is entitled if the program participant breaches. 42 U.S.C. §§ 254l (f)(3), 254o. A program participant who refuses to serve in the Corps must pay the government three times the amount awarded under his scholarship, discounted proportionately for months actually served, plus interest. Id. § 2540(b)(1)(A).

When Congress created the scholarship program in 1972, it recognized that exceptions to the damages provision might sometimes be appropriate. It therefore included in the statute a provision that reads, after minor changes, as follows:

The Secretary shall by regulation provide for the partial or total waiver or suspension of any obligation of service or payment by an individual under the Scholarship Program ... whenever compliance by the individual is impossible or would involve extreme hardship to the individual and if enforcement of such obligation with respect to any individual would be unconscionable.

42 U.S.C. § 254o(d)(2). The same year, the Secretary of Health, Education, and Welfare adopted a rule that currently provides:

In determining whether to waive or suspend any or all of the service or payment obligations of a participant as imposing an undue hardship and being against equity and good conscience, the Secretary ... will consider:
(1) The participant’s present financial resources and obligations;
(2) The participant’s estimated future financial resources and obligations; and
(3) The extent to which the participant has problems of a personal nature, such as physical or mental disability, [or] terminal illness in the immediate family, which so intrude on the participant’s present and future ability to perform as to raise a presumption that the individual will be unable to perform the obligation incurred.

42 C.F.R. § 62.12(d). 2

B.

In the spring of 1978, the government awarded a National Health Service Corps scholarship to Paul A. Buongiorno, Jr. The government renewed the scholarship in 1979. Under the terms of the program contract, the government promised to pay Buongiorno’s tuition and expenses for the 1978-1979 and 1979-1980 school years at the Georgetown University School of Medicine and to send Buongiorno a monthly stipend. Buongiorno promised to practice for two years in a part of the country lacking sufficient medical personnel. Buongiorno also promised, pursuant to the statutory mandate, that if he “[f]ail[ed] to begin ... the period of obligated service *507 incurred under this contract,” he would reimburse the government “an amount equal to three times the scholarship funds awarded, plus interest.” Payments to Buongiorno eventually totaled more than $38,000.

Buongiorno graduated from Georgetown in June 1980. The government then deferred his obligations so that Buongiorno could complete a four year residency at Georgetown in psychiatry. In 1982 Buon-giorno’s wife injured her knee, aggravating preexistent health problems and leaving her virtually immobile. Local doctors began treating her.

As Buongiorno’s residency neared its end, he began to explore the possibility of discharging his program obligations in Washington, D.C. Buongiorno learned that service in a program affiliated with the National Research Service (NRS) qualified for NHSC credit. See 42 U.S.C. § 254m(e). In September 1983, Buongior-no applied for an NRS fellowship with the National Institute of Mental Health. The Institute rejected his application the following May.

In December 1984, the NHSC told Buon-giorno that it had assigned him to the Indian Health Service and that he would have to practice in Arizona or Oklahoma. Buongiorno promptly applied for a waiver. In a letter to the Corps dated January 30, 1985, Buongiorno described his wife’s medical condition and how it affected him. He concluded:

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912 F.2d 504, 286 U.S. App. D.C. 104, 1990 U.S. App. LEXIS 14711, 1990 WL 121515, Counsel Stack Legal Research, https://law.counselstack.com/opinion/paul-a-buongiorno-jr-v-louis-w-sullivan-secretary-united-states-cadc-1990.