## Facts

- Virgil Walker and Shirley Brown, Black women receiving Medicaid and other public assistance, sued an obstetrician, Dr. Clovis H. Pierce, and several hospital and social-services officials connected to Aiken County Hospital in South Carolina.
- Pierce maintained a personal practice policy: for patients he considered unable to support themselves financially, if they were delivering a third child he would request voluntary sterilization after delivery; if they refused, he would ask them to obtain another physician.
- Walker, a Medicaid recipient with a seventh-grade education, first saw Pierce while pregnant with her fourth child. She refused sterilization at early prenatal visits but later signed a consent form after being unable to secure alternative prenatal care.
- At delivery, another physician again discussed tubal ligation with Walker; she signed two additional consent forms acknowledging the procedure’s permanence. Pierce performed the tubal ligation the following day.
- Walker alleged Pierce threatened termination of state assistance if she did not consent and claimed she signed because resistance was futile.
- Brown alleged similar pressure or conditioning of obstetrical care on sterilization under Pierce’s policy.
- Plaintiffs alleged constitutional violations (including privacy, due process, and equal protection) and sought damages and declaratory and injunctive relief under civil-rights statutes, contending that Pierce and institutional defendants acted in concert to impose sterilization on Medicaid recipients.
- A jury returned verdicts for all defendants except Pierce and awarded Brown $5 in nominal damages; the district court denied declaratory and injunctive relief and entered judgment for the institutional defendants.
- Plaintiffs appealed the judgments favoring the institutional defendants and denial of broader relief; Pierce cross-appealed the nominal damages judgment.

## Issues

1. Whether Pierce’s policy and conduct toward Walker and Brown constituted actionable violations of federal constitutional rights and civil-rights statutes, including coercion or discrimination, sufficient to support damages or equitable relief.
2. Whether the hospital and governmental defendants could be held liable for participating in, adopting, or condoning the alleged sterilization practice.
3. Whether the nominal damages award against Pierce could stand if no constitutional or statutory violation was shown.

## Decision

- The Fourth Circuit affirmed the district court’s judgments for the hospital and governmental defendants and affirmed denial of declaratory and injunctive relief.
- The Fourth Circuit reversed the judgment against Pierce and set aside the $5 nominal damages award to Brown.
- The court concluded the record did not establish unconstitutional compulsion or sufficient proof of unlawful discrimination, and therefore did not support § 1983 liability or damages.

## Legal Principles

- A physician’s stated practice of requesting voluntary sterilization from indigent patients after a third child, coupled with an expressed option to seek another physician, was treated as a matter of private medical practice rather than state-compelled sterilization.
- Repeated execution of sterilization consent forms and contemporaneous discussions describing the procedure’s permanence supported a finding of voluntariness for purposes of rejecting a federal coercion claim on the record presented.
- Absent proof that the challenged conduct constituted a constitutional or statutory violation, nominal damages are not recoverable under § 1983.
- Institutional or governmental defendants are not liable on a theory of concerted action without adequate evidence that they adopted, directed, or implemented an unlawful policy causing the alleged deprivation.

## Conclusion

The Fourth Circuit held that the evidence did not show that the obstetrician’s sterilization policy, as applied to the plaintiffs, amounted to unconstitutional coercion or actionable discrimination under federal civil-rights law; it affirmed judgment for the institutional defendants and reversed the nominal damages award, resulting in judgment for all defendants.


Walker v. Pierce, 560 F.2d 609 (4th Cir. 1977)