PEDIATRIC AND FAMILY MEDICAL FOUNDATION, DBA Eisner Pediatric and Family Medical Center v. XAVIER BECERRA, Secretary of the United States Department of Health and Human Services

NOT FOR PUBLICATION
UNITED STATES COURT OF APPEALS
FOR THE NINTH CIRCUIT
PEDIATRIC AND FAMILY MEDICAL
FOUNDATION, DBA Eisner Pediatric and
Family Medical Center,
Plaintiff-Appellant,
v.
XAVIER BECERRA, Secretary of the
United States Department of Health and
Human Services,
Defendant-Appellee.
No. 20-55517
D.C. No.
2:17-cv-00732-SJO-AS
MEMORANDUM*
Appeal from the United States District Court
for the Central District of California
S. James Otero, District Judge, Presiding
Argued and Submitted May 6, 2021
Pasadena, California
Before: WARDLAW and GOULD, Circuit Judges, and DONATO,** District
Judge.
Eisner Pediatric and Family Medical Center (Eisner) appeals from the
* This disposition is not appropriate for publication and is not precedent
except as provided by Ninth Circuit Rule 36-3.
** The Honorable James Donato, United States District Judge for the
Northern District of California, sitting by designation.
FILED
AUG 31 2021
MOLLY C. DWYER, CLERK
U.S. COURT OF APPEALS

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district court’s grant of summary judgment for defendant Secretary of the United
States Department of Health and Human Services (HHS). We have jurisdiction
pursuant to 28 U.S.C. § 1291. We previously referred the case to mediation and
administratively closed it, but the mediation was not successful. We now reopen
the case, and reverse in part and remand.
A district court’s summary judgment ruling is reviewed de novo. Baccei v.
United States, 632 F.3d 1140, 1144 (9th Cir. 2011) (citation omitted). Because the
parties are familiar with the facts, they will not be recounted here.
The district court properly concluded that Eisner lacked standing to
challenge HHS’s particularized determination process under 42 C.F.R. § 6.6.
Eisner never applied for a particularized determination, and it did not allege any
harm from that process.
With respect to HHS’s July 2015 letter removing California Hospital
Medical Center (CHMC) from the scope of Eisner’s grant under Section 330 of the
Public Health Service Act (PHSA), 42 U.S.C. § 254b, the district court correctly
concluded that the removal of the site was not barred by HHS’s deeming
determination for Eisner for the 2015 calendar year. HHS’s notice of deeming
action, which “deem[ed] Eisner Pediatric & Family Medical Center to be an
employee of the PHS [i.e., Public Health Service], for the purposes of section 224
[i.e., 42 U.S.C. § 233], effective 1/1/2015 through 12/31/2015,” expressly advised

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Eisner that “[d]eemed health centers must continue to receive funding under
Section 330 of the PHS Act, 42 U.S.C. § 254b, in order to maintain coverage as a
deemed PHS employee. If the deemed entity loses its Section 330 funding, such
coverage will end immediately upon termination of the grant.” As this language
indicates, deeming Eisner to be an employee of the Public Health Service under the
Federally Supported Health Centers Assistance Act (FSHCAA), 42 U.S.C.
§ 233(g), through December 31, 2015, was not a guarantee that Eisner’s scope of
project for which it received funding under the PHSA would remain the same for
that time period.
However, the district court did not properly conclude that the July 2015
letter was sufficient under the Administrative Procedure Act (APA), 5 U.S.C.
§ 706(2)(A). The agency did not adequately explain why it was reversing its
position on the federal grant status of CHMC, eight years after having approved
CHMC as a health service site within the scope of Eisner’s PHSA grant.
The letter provided two ostensible reasons for the change of course, neither
of which was sufficient. First, the agency stated that Eisner’s 2007 change in
scope request, which had requested to add CHMC to Eisner’s scope of grant, “did
not fully address issues of control and oversight over the delivery of services under
the Coverage Agreement.” This statement does not shed any light on how the
2007 request fell short in these areas, and leaves us to “speculate on reasons that

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might have supported [the] agency’s decision,” which we may not do. Encino
Motorcars, LLC v. Navarro, 136 S.Ct. 2117, 2127 (2016).
Although agencies are free to reverse course, they must “provide a reasoned
explanation for the change.” Id. at 2125 (citations omitted). HHS did not do that,
and when an agency has “failed to provide even [a] minimal level of analysis” such
that its “path may reasonably be discerned,” its “action is arbitrary and capricious
and so cannot carry the force of law.” Id. (quotations and citations omitted).
The second reason given by the agency was a non sequitur. It stated that
“EPFMC’s continuous staffing of California Hospital Medical Center’s OB/GYN
Department pursuant to a Coverage Agreement with the Hospital did not fit within
the FTCA coverage standards set forth in 42 C.F.R. § 6.6.” But FTCA coverage
under the Federally Supported Health Centers Assistance Act, and the scope of a
grant funded under the Public Health Service Act, are two separate issues. The
letter’s reference to the lack of FTCA coverage for the CHMC site consequently
did not explain why HHS was removing CHMC from the scope of Eisner’s PHSA
grant, especially when eight years had passed since HHS had approved the addition
of the CHMC site to Eisner’s scope of grant. The agency relied on an irrelevant
factor, which again rendered its decision to remove CHMC arbitrary and
capricious. See Yetiv v. U.S. Dep’t of Housing & Urb. Dev., 503 F.3d 1087, 1091
(9th Cir. 2007).

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The district court’s grant of summary judgment for HHS on Eisner’s APA
claim is consequently reversed, and on remand, the district court is directed to
enter summary judgment for Eisner on that claim.
On the issue of standing, the parties agree that we can order the complaint
corrected to name the proper plaintiff entity that suffered injury: Pediatric and
Family Medical Center dba Eisner Pediatric and Family Medical Center. The
complaint is deemed so amended. See 28 U.S.C. § 1653; Oliver v. Ralphs Grocery
Co., 654 F.3d 903, 907-08 (9th Cir. 2011).
AFFIRMED IN PART, REVERSED IN PART, AND REMANDED.

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