80 F.4th 762
6th Cir.2023Background
- Legacy Medical Transport, an Ohio-based nonemergency ambulance company near the Kentucky border, applied for a Kentucky certificate of need (CON) to serve Kentucky patients; Kentucky requires a CON showing a “need” to open or expand health facilities, including ambulance services.
- Multiple incumbent Kentucky ambulance providers protested Legacy’s application; the Cabinet hearing officer denied the CON in part because incumbents provided an adequate supply and Legacy had not shown unmet need.
- Legacy sued Kentucky Cabinet officials asserting dormant Commerce Clause and other constitutional claims; the district court dismissed all claims except the dormant Commerce Clause claim and thereafter granted summary judgment for the Cabinet.
- The Sixth Circuit affirmed as to Legacy’s challenge to providing intrastate Kentucky ambulance service, holding the CON law is facially neutral, lacks discriminatory effect or purpose, and does not impose a substantial burden on interstate commerce under Pike.
- The Sixth Circuit reversed as to Legacy’s request to provide interstate trips (Kentucky → Ohio), holding Buck v. Kuykendall controls and bars a State from denying a license to an interstate common carrier on the ground that existing interstate service is adequate.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Privileges or Immunities Clause challenge | Truesdell: CON regime violates privileges or immunities. | Cabinet: Slaughter‑House controls; no relief. | Denied — Slaughter‑House forecloses the claim. |
| Dormant Commerce Clause — discrimination (intrastate challenge) | Legacy: CON discriminates against out‑of‑state providers (competitor veto; incumbency protection). | Cabinet: Law is facially neutral, applies to all applicants equally, and statistics show no pro‑local effect. | Rejected — law is neutral on face, lacks discriminatory effect or purpose. |
| Dormant Commerce Clause — Pike balancing (intrastate burden vs. local benefits) | Legacy: CON imposes substantial burdens (blocked entry, costs, reduced competition and quality). | Cabinet: Burdens are borne largely by Kentucky consumers and new entrants; no substantial burden on interstate commerce per Nat’l Pork Producers. | Rejected — plaintiff failed to show a substantial burden on interstate commerce, so no Pike invalidation. |
| Dormant Commerce Clause — interstate application (Kentucky→Ohio trips) | Legacy: Buck forbids a State from blocking interstate common‑carrier competition by denying certificates based on adequacy of existing service. | Cabinet: Buck is distinguishable or repudiated by modern two‑step dormant Commerce Clause test. | Accepted for Legacy — Buck controls; State may not deny interstate carrier a license because existing interstate service is deemed adequate. |
Key Cases Cited
- Buck v. Kuykendall, 267 U.S. 307 (1925) (States may not deny licenses to interstate common carriers on the ground that existing interstate service is adequate)
- Nat’l Pork Producers Council v. Ross, 143 S. Ct. 1142 (2023) (modern dormant Commerce Clause framework; require showing of substantial burden on interstate commerce before Pike balancing)
- Pike v. Bruce Church, Inc., 397 U.S. 137 (1970) (balancing test: invalid if burdens on interstate commerce clearly exceed local benefits)
- C & A Carbone, Inc. v. Town of Clarkstown, 511 U.S. 383 (1994) (facially discriminatory local ordinance favoring a local processor invalid under dormant Commerce Clause)
- H. P. Hood & Sons, Inc. v. Du Mond, 336 U.S. 525 (1949) (State licensing denial that restricts interstate commerce to protect local interests violates Commerce Clause)