## Facts

- Renee D. Bell, proceeding pro se as personal representative of the Estate of Sylvia C. Fann, sued HCR Manor Care Facility of Winter Park, a second private nursing home (Metro West Facility), and Dr. Haver, a physician at a private hospital.
- Bell alleged defendants failed to properly care for an open wound on Fann’s back while Fann was in their care, causing the wound to become infected and leading to Fann’s death.
- Bell attempted to frame the alleged malpractice and wrongful death as federal claims under 42 U.S.C. § 1983 and the Federal Tort Claims Act (FTCA), along with related state-law theories.
- For the § 1983 claim, Bell alleged defendants should be treated as acting “under color of state law” because they were licensed (and regulated) by the state.
- For the FTCA claim, Bell sought to impose liability on the private facilities and physician under a federal sovereign-immunity waiver that generally applies to torts committed by federal employees.
- Defendants moved to dismiss. The district court dismissed Bell’s complaint for lack of subject-matter jurisdiction, reasoning that the federal claims had “no plausible foundation.”
- Bell appealed to the Eleventh Circuit.

## Issues

1. When the jurisdictional challenge turns on the same elements that determine the merits of a nonfrivolous federal claim, may the district court dismiss under Rule 12(b)(1) for lack of subject-matter jurisdiction, or should it treat the motion as one under Rule 12(b)(6)?
2. Did Bell state a plausible § 1983 claim by alleging that private nursing homes and a private physician were state actors because they were licensed and regulated by the state?
3. Did Bell state a plausible FTCA claim against private nursing homes and a private physician who were not federal agencies, federal employees, or the United States?

## Decision

- The Eleventh Circuit held the district court erred by dismissing for lack of subject-matter jurisdiction because the jurisdictional question was intertwined with the merits of Bell’s federal claims.
- The court affirmed dismissal of the § 1983 claim on the merits because Bell did not plausibly allege that any defendant acted under color of state law; state licensing and regulation, without more, did not convert private medical providers into state actors.
- The court affirmed dismissal of the FTCA claim because the FTCA permits suits only for certain torts committed by federal employees, and the proper defendant is the United States; Bell sued only private parties.
- The case was remanded for the district court to decide whether to exercise supplemental jurisdiction over any remaining state-law claims.

## Legal Principles

- If a Rule 12(b)(1) motion challenges jurisdiction on grounds that are bound up with the elements of the asserted federal cause of action, the court should assume jurisdiction and evaluate the pleading under Rule 12(b)(6) (or later under summary judgment standards), rather than dismiss for lack of jurisdiction.
- To state a claim under 42 U.S.C. § 1983, a plaintiff must plausibly allege that the defendant acted “under color of state law”; private medical providers do not become state actors merely because they are licensed or regulated by the state.
- On a Rule 12(b)(6) motion, courts accept well-pleaded factual allegations as true but do not accept bare legal conclusions (such as labeling a private party a “state actor”) without supporting factual allegations.
- The FTCA waives sovereign immunity only for certain torts committed by federal employees acting within the scope of employment, and the United States is the proper defendant; private entities and private physicians are not proper FTCA defendants based solely on participation in regulated health-care systems.

## Conclusion

In *Bell v. HCR Manor Care Facility*, the Eleventh Circuit ruled that the district court should not have treated the weakness of Bell’s § 1983 and FTCA theories as a jurisdictional defect, but the court still affirmed dismissal because Bell alleged only private medical negligence by private actors (with no plausible state action) and sued private defendants who could not be liable under the FTCA, remanding only for a decision on supplemental jurisdiction over any state-law claims.


Bell v. HCR Manor Care Facility, 432 Fed. Appx. 908 (2011)