## Facts

- The Secretary of Health and Human Services issued 1984 regulations under § 504 of the Rehabilitation Act to address alleged discriminatory withholding of medical treatment from disabled newborns.
- The rules applied to hospitals and other health-care providers receiving federal financial assistance.
- The regulations required, among other things:
  - Posting notices stating that health care should not be withheld from infants based on mental or physical impairments.
  - Conditioning state participation on child protective services procedures intended to prevent “unlawful medical neglect of handicapped infants,” including action when HHS deemed it necessary to protect an infant’s life or health.
  - Granting HHS officials immediate access to patient records and enabling expedited compliance actions.
- Hospital associations and individual hospitals sued seeking declaratory and injunctive relief, alleging the regulations exceeded statutory authority under § 504.
- The district court invalidated the regulations and enjoined enforcement; the court of appeals affirmed.

## Issues

1. Whether § 504 authorized HHS to promulgate and enforce the 1984 “Baby Doe” regulations governing alleged discriminatory withholding of medical treatment from handicapped infants in federally funded hospitals.
2. Whether, when parental consent for treatment is absent, a hospital’s withholding of treatment can constitute discrimination against an “otherwise qualified” individual “solely by reason of” handicap under § 504.

## Decision

- The Supreme Court affirmed the judgment invalidating the regulations.
- A plurality concluded the challenged regulations were not authorized by § 504.
- The plurality reasoned that when treatment is withheld because parental consent has not been given, the infant is not “otherwise qualified” for treatment and is not denied care “solely by reason of” handicap.
- The plurality found the administrative record did not show hospitals were discriminating in violation of § 504, as opposed to treatment decisions being driven by parental choices and medical judgment.
- The plurality held the regulations’ state complaint-handling and investigatory machinery was not tied to § 504’s anti-discrimination mandate and was outside the Secretary’s delegated authority.

## Legal Principles

- Regulations promulgated under § 504 must be grounded in § 504’s prohibition of discrimination by recipients of federal funds; the statute does not authorize a general federal regime supervising medical-treatment decisions for disabled newborns.
- “Otherwise qualified” under § 504 incorporates threshold eligibility conditions; where parental consent is required and absent, withholding treatment does not violate § 504 on that basis alone.
- Agency enforcement structures must remain within the authority conferred by Congress; extensive investigatory and compliance schemes cannot be justified under § 504 without a statutory basis and a demonstrated connection to prohibited discrimination.

## Conclusion

The Court held that § 504 did not authorize HHS to impose the 1984 “Baby Doe” regulations on federally funded hospitals and state agencies, particularly where alleged treatment denials occurred without parental consent and where the regulations extended beyond § 504’s limited anti-discrimination function.


Bowen v. Am. Hosp. Ass'n, 476 U.S. 610 (1986)