## Facts

- Baby Jane Doe was born in October 1983 with severe congenital conditions, including spina bifida, hydrocephalus, and microcephaly, with a high likelihood of profound impairment.
- Physicians proposed neurosurgery that could address aspects of spina bifida and hydrocephalus but carried major risks and would not eliminate severe disability.
- After consultations, the parents declined surgery and chose conservative management; the hospital followed that decision.
- A third-party attorney unsuccessfully sought state-court orders compelling surgery; state courts upheld the parents’ decision as within their authority and consistent with the child’s interests.
- The Department of Health and Human Services (HHS), acting under § 504 of the Rehabilitation Act and related regulations, opened an investigation after a complaint that treatment was being withheld due to disability.
- HHS demanded access to Baby Jane Doe’s medical records to assess possible disability discrimination by a federally funded hospital.
- The hospital refused to disclose the records, citing confidentiality obligations and parental wishes.
- The United States sued for an injunction compelling production of the medical records; the district court dismissed the complaint, and the government appealed.

## Issues

1. Whether § 504 of the Rehabilitation Act authorizes federal oversight of individualized neonatal treatment decisions by treating a choice among medically accepted options as disability “discrimination” in a federally funded hospital.
2. Whether, on these facts, the hospital’s refusal to produce the infant’s medical records violated § 504 or implementing regulations so as to justify injunctive relief compelling disclosure.

## Decision

- The Second Circuit affirmed dismissal of the government’s complaint.
- The court held that § 504 did not reach the challenged conduct: a good-faith medical and parental decision selecting conservative care over surgery amid disputed medical risks and benefits.
- The court rejected the government’s theory that the infant was denied treatment “solely by reason of” handicap; the record reflected medical judgment about prognosis and overall condition rather than discriminatory exclusion.
- Because § 504 did not substantively apply, HHS lacked authority to compel disclosure of the medical records through an enforcement investigation tied to that statute.
- Injunctive relief ordering production of the records was denied.

## Legal Principles

- Section 504 targets exclusion from, denial of benefits of, or discrimination in federally assisted programs “solely by reason” of handicap; it does not automatically convert bedside medical choices into federal civil-rights violations.
- A contested, individualized treatment decision made in good faith—especially where multiple medically accepted approaches exist—does not establish discrimination absent proof that care was withheld solely because of disability.
- An agency’s investigatory and compliance-review powers extend only as far as the statute’s substantive coverage; agencies cannot compel records or cooperation when the alleged conduct falls outside the statute.
- State systems governing medical decision-making for children and child-protection review remain the primary mechanisms for addressing disputed parental treatment decisions unless Congress clearly authorizes federal intervention.

## Conclusion

The Second Circuit held that § 504 did not authorize HHS to investigate or regulate the hospital’s compliance with a parents’ medically supported decision to forego surgery for a severely impaired newborn, and therefore the federal government could not compel production of the child’s medical records under § 504 enforcement authority.


United States v. Univ. Hosp., 729 F.2d 144 (2d Cir. 1984)