731 F.3d 843
9th Cir.2013Background
- This appeal challenges Washington's Certificate of Need regulations for elective PCIs under the Commerce Clause.
- Memorial Memorial Hospital seeks to perform elective PCIs but lacks on-site cardiac surgery and must obtain a PCI Certificate.
- Regulations require a minimum annual PCI volume of 300 to receive a certificate.
- HMA report recommended 300 as a floor with higher safety at 400+, while some favored 200 as the floor.
- Regional, an in-state competitor with on-site surgery, already performs many PCIs; Memorial is nonprofit and seeks entry.
- District court granted summary judgment; on remand the court held the burden on interstate commerce was not clearly excessive and upheld dismissal.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does the 300-PCI minimum violate the dormant Commerce Clause under Pike? | Memorial argues the burden on interstate commerce is not justified by local benefits. | Department contends the regulation is nondiscriminatory, with incidental impact, and safety benefits justify the burden. | No; burden not clearly excessive; regulation passes Pike balancing. |
| Are the safety benefits of the 300-PCI minimum real and not illusory? | Memorial claims safety benefits are illusory compared to the burden. | Regulation is supported by substantial evidence linking higher volumes to better outcomes. | Yes; substantial evidence links higher volumes to safety, supporting the regulation. |
| Do the regulations discriminate against interstate commerce or amount to economic protectionism? | Memorial asserts an adverse effect on interstate commerce and potential protectionism. | Regulations are even-handed and aimed at public safety, not favoring in-state interests. | No; nondiscriminatory and incidental burden; not a protectionist measure. |
Key Cases Cited
- Pike v. Bruce Church, Inc., 397 U.S. 137 (1970) (balance test for incidental burdens on commerce)
- Exxon Corp. v. Governor of Md., 437 U.S. 117 (1978) (burden on interstate commerce not automatic from valid regulation)
- Hughes v. Oklahoma, 441 U.S. 322 (1979) (incidental burdens analyzed under dormant commerce clause)
- Kassel v. Consol. Freightways Corp. of Del., 450 U.S. 662 (1981) (safety regulation may be upheld despite interstate impact)
- Optometrists v. Nat'l Ass'n of Optometrists & Opticians, 682 F.3d 1144 (9th Cir. 2012) (non-discriminatory regulation may still burden interstate commerce; depends on impact)
- City of Philadelphia v. New Jersey, 437 U.S. 617 (1978) (incidental burdens permissible when safeguarding health and safety)