Shawanda V. Collins v. Centers for Medicare and Medicaid Services

United States Court of Appeals
For the Seventh Circuit
Chicago, Illinois 60604
Submitted February 24, 2025*
Decided February 25, 2025
Before
MICHAEL B. BRENNAN, Circuit Judge
AMY J. ST. EVE, Circuit Judge
DORIS L. PRYOR, Circuit Judge
No. 24-2557
SHAWANDA V. COLLINS,
Plaintiff-Appellant,
v.
CENTERS FOR MEDICARE AND
MEDICAID SERVICES, et al.,
Defendants-Appellees.
Appeal from the United States District
Court for the Eastern District of
Wisconsin.
No. 24-cv-0490-bhl
Brett H. Ludwig,
Judge.
O R D E R
Shawanda Collins’s mother died after receiving treatment in the Advocate
Aurora Health system. While her mother was in one of its hospitals, staff members
allegedly barred Collins from visiting her because they viewed Collins as an “angry
black female.” Collins sued Aurora for race discrimination and violations of her
* The appellees were not served with process and are not participating in this
appeal. After examining the appellant’s brief and the record, we have concluded that
the case is appropriate for summary disposition. F ED. R. A PP . P. 34(a)(2)(C).
NONPRECEDENTIAL DISPOSITION
To be cited only in accordance with F ED. R. APP . P. 32.1

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mother’s rights. The district court dismissed all claims. We agree with the court that
most of Collins’s claims fail, but we conclude that she sufficiently pleaded that Aurora
unlawfully blocked her from the hospital because of her race and remand that claim.
We accept the facts in Collins’s complaint as true and review them in the light
most favorable to her. Luevano v. Wal-Mart Stores, Inc., 722 F.3d 1014, 1027 (7th Cir.
2013). On July 14, 2021, Collins’s mother, Veronica Lee Collins Dixon, was admitted to
Aurora St. Luke’s Medical Center in Wisconsin for malnutrition. After Collins
complained about her mother’s care, St. Luke’s staff members “falsely portrayed [her]
as an ‘angry black female’ provoking discriminatory actions based on their racial
profiling and their hate speech.” Hospital staff barred her from visiting or calling her
mother, and they also falsely reported that she had threatened an armed attack on the
hospital (although security officers did not believe that report). She also alleges that the
hospital’s medical errors so aggravated her mother’s condition that, after she was
transferred to an affiliated hospital, she died from resulting complications.
Collins sued Aurora, the corporate owner of St. Luke’s, and others. In her
amended complaint, she accuses Aurora of violating her rights under Title VI of the
Civil Rights Act, 42 U.S.C. § 2000d; the First or Fourteenth Amendments; and state law.
She also brought claims against Aurora, as well as federal and state regulators, based on
the allegedly inadequate care provided to her mother and to African American patients
generally. These included asserted violations of 42 C.F.R. § 482.13, Title XIX of the Social
Security Act, the Patient Safety and Quality Improvement Act, the Administrative
Procedure Act, and Wisconsin’s Deceptive Trade Practices Act.
The court screened this suit and dismissed it. See 28 U.S.C. § 1915(e)(2)(B)(ii). It
ruled that the claims (other than the one against Aurora under Title VI) had many fatal
defects, including the absence of state actors required for § 1983 liability, the lack of a
private right of action, and the lack of standing. The court then turned to Collins’s
Title VI claim against Aurora. It considered her allegation that St. Luke’s staff portrayed
Collins as an “angry black female” and that this portrayal provoked discriminatory
treatment. But it ruled that the allegation was conclusory and did not outweigh the
implication from the complaint that the staff barred her from the hospital because she
had complained about her mother’s treatment, a reason that did not offend Title VI.
Collins then appealed. To determine whether Collins could proceed pro se in this
appeal on behalf of her mother’s estate, we ordered that she state whether she is the
estate’s sole beneficiary. See Malone v. Nielson, 474 F.3d 934, 937 (7th Cir. 2007). She has
since informed us that she is not. (See Docket No. 14, Notice of Appellant Regarding

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Beneficiary Status, filed Jan. 16, 2025.) Her status as a non-exclusive beneficiary disposes
of most of her claims on appeal.
Collins first argues that 42 C.F.R. § 482.13 and other federal laws allow for a right
of action by a patient harmed through inadequate medical care. We need not reach that
issue because such claims belong to the estate of Collins’s mother, not to Collins. Under
Wisconsin’s law, federal claims belong to an estate if they arise from the decedent’s
personal injury, as is the case here. See Hutchinson ex rel. Baker v. Spink, 126 F.3d 895, 898
(7th Cir. 1997); W IS . S TAT. A NN . § 895.01(1)(am)(7). And because Collins is not the sole
beneficiary of the estate, she cannot sue on the estate’s behalf when proceeding pro se.
Malone, 474 F.3d at 937. Although Collins challenges this rule, we consistently apply it
to protect the interests of an estate’s other beneficiaries. To the extent that Collins argues
that federal and state regulators harmed her by inadequately protecting the interests of
all African Americans, the claim fails because it is “a generally available grievance
about government” for which she lacks standing. Lujan v. Defs. of Wildlife, 504 U.S. 555,
573–74 (1992). Finally, even if Collins could bring constitutional claims against Aurora
on behalf of the estate (or to the extent she seeks to bring those claims on her own
behalf), she fails to allege that Aurora is a state actor, as § 1983 requires. A defendant
does not become a state actor simply by complying with regulations. Scott v. Univ. of
Chi. Med. Ctr., 107 F.4th 752, 760 (7th Cir. 2024).
That brings us to Collins’s Title VI claim against Aurora and her argument that
the district court applied an improperly high pleading standard. Title VI provides: “No
person in the United States shall, on the ground of race, color, or national origin, be
excluded from participation in, be denied the benefits of, or be subjected to
discrimination under any program or activity receiving Federal financial assistance.”
42 U.S.C. § 2000d. This law supplies a private right of action against the recipient of the
assistance who has intentionally discriminated against a covered plaintiff based on a
protected category like race. Alexander v. Sandoval, 532 U.S. 275, 280–81, 285 (2001).
We have not articulated the pleading standard under Title VI, but cases under
Title VII are analogous. In Swierkiewicz v. Sorema N. A., 534 U.S. 506, 511, 513, 515 (2002),
the Supreme Court held that Title VII plaintiffs need not plead race discrimination with
“specificity,” “particularity” or in the form of a “prima facie case.” After Swierkiewicz,
we ruled that statements that race or sex intentionally motivated a decision suffice
under Title VII. See, e.g., Tamayo v. Blagojevich, 526 F.3d 1074, 1084 (7th Cir. 2008);
E.E.O.C. v. Concentra Health Servs., Inc., 496 F.3d 773, 781 (7th Cir. 2007). We reaffirmed
this rule after Bell Atlantic Corp. v. Twombly, 550 U.S. 544 (2007) and Ashcroft v. Iqbal,

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556 U.S. 662 (2009). See Freeman v. Metro. Water Reclamation Dist. of Greater Chi., 927 F.3d
961, 965 (7th Cir. 2019). We see no reason to distinguish between pleading standards
under Title VI and Title VII in a case like this one where the plaintiff, who is pro se,
receives the benefit of a more relaxed standard when pleading discrimination. Luevano,
722 F.3d at 1027.
With this standard in mind, we conclude that Collins has adequately pleaded
intentional race discrimination by Aurora, an alleged recipient of federal assistance. She
asserts that Aurora’s staff, having “falsely portrayed [Collins] as an ‘angry black
female,’” prevented her from visiting her dying mother because she is African
American. True, the complaint may also be narrowly read to suggest that hospital staff
had other motivations to block her access—because Collins complained about her
mother’s treatment, or because she had threatened harm—reasons that Title VI does not
bar. But at this stage, Collins is entitled to have us draw the reasonable inferences in her
favor. McCray v. Wilkie, 966 F.3d 616, 620 (7th Cir. 2020). So construed, the complaint
adequately pleads that Aurora intentional discriminated against her by shutting her out
of a federally funded hospital because she is African American.
Before we conclude, we observe an issue that the district court will need to
address on remand: Does Title VI cover a visitor, like Collins, to St. Luke’s? Title VI is
one of many civil rights statutes that link a prohibition on discrimination to federal
funding. E.g., 20 U.S.C. § 1681; 29 U.S.C. § 794; 42 U.S.C. § 6102; 42 U.S.C. § 18116. These
statutes require plaintiffs to show that they fall within the “zone of interests” covered
by the statute. See T.S. ex rel. T.M.S. v. Heart of CarDon, LLC, 43 F.4th 737, 740–41
(7th Cir. 2022). Long ago, we applied this rule to a Title VI case by requiring that the
plaintiff “be the intended beneficiary of, an applicant for, or a participant in a federally
funded program.” Doe ex rel. Doe v. St. Joseph’s Hosp. of Fort Wayne, 788 F.2d 411, 418–20
(7th Cir. 1986) (internal quotation marks and footnote omitted), overruled on other
grounds by Alexander v. Rush N. Shore Med. Ctr., 101 F.3d 487 (7th Cir. 1996); see also
Simpson v. Reynolds Metals Co., 629 F.2d 1226, 1235 (7th Cir. 1980) (applying the principle
to a claim raised under 29 U.S.C. § 794). That would appear to exclude from coverage
Collins, a prospective visitor and not a patient. But in 1988, Congress enacted the Civil
Rights Restoration Act, 42 U.S.C. § 2000d-4a (provision relevant to Title VI), which
clarified that a recipient of federal funds may not discriminate in any of its operations.
In Heart of CarDon, we held that this Act undermined the “intended beneficiary” rule,
and we rejected a defendant’s invocation of it there. 43 F.4th at 744–46.

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Heart of CarDon was not a Title VI case, and we have not yet addressed whether
the Civil Rights Restoration Act eviscerates the “intended beneficiary” rule we laid out
in St. Joseph’s Hospital for Title VI, and whether Collins, as a visitor, falls within
Title VI’s “zone of interest.” In this appeal’s current posture, where the complaint was
dismissed at screening without adversarial briefing addressing this issue, we are not
equipped to answer it. We therefore vacate the judgment on Collins’s claim under
Title VI—that she experienced racial discrimination—so that Aurora can be served. If
Aurora moves to dismiss on the ground that Collins does not fall within Title VI’s “zone
of interest,” the district court should in the first instance invite briefing on the matter
and resolve it in a manner consistent with Heart of CarDon, 43 F.4th at 740–41, 744–46.
We close by quickly dispatching a final issue. Collins argues that the district
court erred by not addressing her state law claims. Because we reinstate her claim
under Title VI based on discrimination that she experienced, the district court will need
to decide whether to exercise supplemental jurisdiction over those state-law
claims. See Brunson v. Murray, 843 F.3d 698, 715 (7th Cir. 2016).
We AFFIRM in all respects except for Collins’s one claim against Aurora that,
through its staff, Aurora violated Title VI by blocking her access to one of its hospitals
based on her race. We VACATE the judgment on that single claim and REMAND for
further proceedings consistent with this order.

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