Today there is no joy in Mudville, folks. Mighty Preemption has struck out and is on the injured players list for the foreseeable future. See Wyeth v. Levine, No. 06-1249 (U.S. March 4, 2009).
This happened in a game where the facts seemed to weigh heavily in Preemption's favor. The FDA had known about the risk of gangrene resulting from IV push of Phenergan for more than 40 years. It had, over time, approved separate revisions to the medicine's label so that -- by the time the physician's assistant decided to give Ms. Levine an IV push of Phenergan at one of the riskiest of all vein sites and ignore the shooting and burning pain described in the label -- there were six separate places in the labeling that addressed the risk of harm that Ms. Levine experienced. The FDA continued to allow doctors to choose IV push as a last-resort form of Phenergan administration even after the labeling had been studied by an advisory panel. The label even provided in bold, all-caps type: "INADVERTENT INTRA-ARTERIAL INJECTION CAN RESULT IN GANGRENE OF THE AFFECTED EXTREMITY." Levine, slip op., dissent at 15-16 (Alito, J., dissenting).
And at the trial, plaintiffs' counsel had clearly set up the state law conflict, declaring that the label should say "Do not use this drug intravenously." Wyeth, slip op., dissent at 2 (Alito, J., dissenting). Panels of preemption Poo Bahs predicted that this was a case where implied conflict preemption would be found, but its parameters very, very narrowly defined.
So much for the academics. As we all now know, the court -- in an opinion written by Justice Stevens -- held that there was no implied conflict preemption. Mark Herrmann and Jim Beck have a good discussion of the court's basic holding here.
I want to focus in this post on three aspects of the opinion.
The first aspect is the "presumption against preemption." This "presumption" is a canard that generally has been trotted out only when the Court is going to find against preemption. Moreover, Levine and this term's decision in Altria Group, Inc. v. Good, 129 S. Ct. 538 (2008) represent a complete turnaround on this presumption and a stunning reversal of position for Justice Stevens. Justice Thomas's dissent in Good lays out well how the court's reliance on the "presumption against preemption" had waned in the express preemption context. Good, 129 S. Ct. at 555-58 (Thomas, J., dissenting).
But the presumption also had been expressly rejected by the Court in the implied conflicts preemption context. To begin with, in Freightliner Corp. v. Myrick, 514 U.S. 280, 287-88 (1995), the Court expressly rejected the argument that implied preemption cannot exist where there is an express preemption provision. Then, in Geier v. American Honda Motor Co., 529 U.S. 861, (2000), Justice Breyer wrote a majority opinion that expressly rejected Justice Stevens's call in the dissent for the use of a presumption against preemption in analyzing implied preemption.
In Geier, the Court was faced with a statute that not only had an express preemption provision, but also a savings clause that preserved state law causes of action that were not preempted. Nevertheless, the Court held that implied conflict preemption still could apply where a state law directly conflicted with a federal regulation:
Neither do we believe that the pre-emption provision, the saving provision, or both together, create some kind of "special burden" beyond that inherent in ordinary pre-emption principles--which "special burden" would specially disfavor pre-emption here. The two provisions, read together, reflect a neutral policy, not a specially favorable or unfavorable policy, toward the application of ordinary conflict pre-emption principles.
Id. at 870-71 (citations omitted).
Taking Justice Stevens to task, the Court refused to impose the presumption against preemption that he advocated in the dissent:
Nothing in the statute suggests Congress wanted to complicate the ordinary experience-proved principles of conflict pre-emption with an added "special burden." Indeed, the dissent's willingness to impose a "special burden" here stems ultimately from its view that "frustration-of-purpos[e]" conflict pre-emption is a free-wheeling, "inadequately considered" doctrine that might well be "eliminate[d]." In a word, ordinary pre-emption principles, grounded in longstanding precedent, apply. We would not further complicate the law with complex new doctrine.
Id. at 874 (citations omitted).
Even as recently as 2001 the Court reiterated its commitment to ordinary conflict preemption principles. See Buckman Co. v. Plaintiffs' Legal Committee, 531 U.S. 341, 353 (2001) ("our ordinary pre-emption principles apply" even in the face of the Medical Device Amendments' express preemption provision).
And yet in Levine, Justice Stevens -- who for years had been dissenting from preemption decisions for their failure to employ a special "presumption against preemption" -- suddenly was able to assemble a majority willing to sign on to a presumption against preemption (Levine, slip op. at 8) and bolster it with reliance on the statute's express preemption provision (id. at 10-11, 18).
As I have commented in previous posts, the "presumption against preemption" can be a troubling substitute for actual analysis of the conflicts preemption arguments, and since its articulation in Good last December, it already is being applied in a variety of contexts outside of drugs and medical devices to deny motions based on federal preemption. Justice Stevens's use of the presumption in Levine undoubtedly will further impede the effectiveness of conflict preemption arguments far beyond the drug and medical device arena. Defendants arguing preemption must use the language of Geier to focus the courts on the "ordinary" principles of conflicts preemption if they are to have any hope of receiving a thoughtful analysis of the issue.
The second aspect I'd like to focus on is the striking lack of deference to the relevant agency here. NYU Professor Catherine Sharkey has pointed out on numerous occasions that for the most part, the result in the Supreme Court's preemption cases follows what the relevant federal agency has advocated. In fact, Professor Sharkey has articulated her own approach to preemption called the "agency reference model" that would facilitate input from federal agencies on preemption questions.
Given the Supreme Court's general deference to agency viewpoints in preemption cases, Levine is all the more remarkable for its utter rejection of the FDA's explanation as to how the state law cause of action conflicts with the FDA's labeling determination. Levine, slip op., dissent at 22 (Alito, J., dissenting). It is, of course, understandable that the Court may have had some skepticism of the FDA's "preemption preamble" and the manner in which it was enacted. Id., slip op. at 20-23. And the Court noted that the agency's position appeared to have changed over time. Yet, to refuse even to consider the arguments made in the FDA's amicus brief or accord them any deference (id. at 24, n.13) seems unprecedented.
The third aspect I'd like to focus on are the three stratagems that underlie the opinion and may be the basis for distinguishing it in future cases.
Stratagem #1: The jury verdict established only that the warning was insufficient and did not require contraindicating IV administration. Horse feathers. The labeling addressed the problems with IV administration in six places. The only way that the labeling could have been stronger was to completely contraindicate IV administration of the medicine -- a method of administration the FDA clearly chose to allow. The dissent makes it clear that contraindication is exactly what the plaintiff's lawyer argued for at trial. And yet the only way Justice Stevens could cobble together a majority was to engage in the artifice that the jury verdict was about the strength of the warning. In future lawsuits where the defendant is able to show a direct conflict between the state law claim and the federal regulation, Levine will be distinguishable on this ground.
Stratagem #2: The "Change Being Effected" Rule gave defendant the authority to change its label without FDA approval. The majority clings to the notion that the CBE Rule gave Wyeth actual discretion to do something with its label other than what the FDA had approved. That conclusion seems obviously false, and the subsequent curative regulations make that plain. Indeed, the Court stretches so far as to say that Wyeth could have unilaterally changed its label from what the FDA previously approved not just upon new evidence, but upon merely a new interpretation the company might have of old evidence the FDA was aware of. This argument, of course, effectively makes FDA approval of labeling meaningless.
Levine is patently distinguishable because of this stratagem; if the statutory scheme at issue in future cases does not give the defendant discretion to make changes, then a true conflict between the state law and the federal rule is more likely to exist.
Stratagem #3: The FDA made no determination regarding the IV-push method of administering Phenergan. This argument came in various forms. The Court repeated a trial court finding that there was no evidence the FDA gave more than passing attention to IV-push administration. Id., slip op. at 16. Elsewhere, the Court distinguished Geier by observing that the FDA had not issued a formal regulation with notice and comment. The dissent does a fine job of demonstrating the careful consideration FDA gave to IV administration over the years. And the dissent makes it plain that an agency's decision does not have to be manifested in a regulation adopted after notice and comment to have the force and effect of federal law. But this much is plain: in future cases asserting preemption, if there is an actual agency regulation at issue (as opposed to an individual determination), Levine is easily distinguishable.
One final note regarding the concurring opinions in Levine. It seems clear that Justice Breyer remains open to the possibility that a federal agency may set a standard that is both a "ceiling as well as a floor." He merely would require that the agency be very explicit about doing so.
Justice Thomas, however, seems to have thrown in the towel on implied conflict preemption as articulated in Geier, at least as it relates to those instances in which compliance with the federal and state standards may be technically possible, but the state standard stands as an obstacle to the achievement of the federal purposes:
This Court's entire body of "purposes and objectives" pre-emption jurisprudence is inherently flawed. The cases improperly rely on legislative history, broad atextual notions of congressional purpose, and even congressional inaction in order to pre-empt state law. I, therefore, cannot join the majority's analysis of this claim, or its reaffirmation of the Court's "purposes and objectives" jurisprudence.
Levine, slip op., Thomas concurrence at 13 (Thomas, J., concurring in the judgment); see also id. at 16-21.
Justice Thomas also remains a formalist; it matters greatly to him exactly how the federal law with purported preemptive effect was made:
The Supremacy Clause thus requires that pre-emptive effect be given only to those federal standards and policies that are set forth in, or necessarily follow from, the statutory text that was produced through the constitutionally required bicameral and presentment procedures.
Id. at 5; see also id. at 22-23.
In sum, the result in Levine is profoundly disappointing from a defense perspective. A pharmaceutical company was held liable for a side-effect that the medical community and the FDA had been aware of for decades and was warned about six times in an FDA-approved label. Nevertheless, despite Levine, defendants in a variety of regulatory schemes still have a number of compelling arguments in favor of implied conflict preemption; they must simply pay attention to how Levine was decided and do their best to articulate their conflict preemption arguments in ways that make Levine easily distinguishable.