2009 WI 16
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Supreme Court of |
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Case No.: |
2006AP1506 |
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Complete Title: |
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Joseph Blunt, Sr. and Margaret Blunt, Plaintiffs-Appellants-Petitioners, State of Subrogated-Plaintiff, v. Medtronic, Inc., Defendant-Respondent. |
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REVIEW OF A COURT OF APPEALS DECISION 2007 WI App 191 Reported at: 305 (Ct. App. 2007-Published) |
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Opinion Filed: |
February 17, 2009 |
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Submitted on Briefs: |
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Oral Argument: |
October 7, 2008
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Source of Appeal: |
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Court: |
Circuit |
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County: |
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Judge: |
Richard J. Sankovitz
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Justices: |
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Concurred: |
BRADLEY, J., concurs (opinion filed). ABRAHAMSON, C.J., joins concurrence. |
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Dissented: |
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Not Participating: |
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Attorneys: |
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For the plaintiffs-appellants-petitioners briefs were
filed by John C. Cabaniss, Thomas
Armstrong, and von Briesen &
Roper, S.C.,
For the
defendant-respondent there was a brief by Michael
K. Brown, Lisa M. Baird, and Reed
Smith LLP,
An amicus curiae brief
was filed by Stephanie A. Scharf, David
W. Austin, and Schoeman, Updike,
Kaufman & Scharf,
An amicus curiae brief
was filed by Anne Berleman Kearney,
Joseph D. Kearney, and Appellate
Consulting Group,
An amicus curiae brief
was filed by William C. Gleisner, III
and the Law Offices of William C.
Gleisner,
2009 WI 16
notice
This opinion is subject to further editing and modification. The final version will appear in the bound volume of the official reports.
REVIEW of a decision of the Court of Appeals. Affirmed.
¶1 PATIENCE DRAKE ROGGENSACK, J. We review a decision of the court of appeals[1] affirming the circuit court's decision[2] granting summary judgment in favor of Medtronic, Inc. Both the circuit court and the court of appeals agreed that the express preemption provision of the 1976 Medical Device Amendments to the Federal Food, Drug and Cosmetic Act, specifically 21 U.S.C. § 360k(a) (2000),[3] preempted the negligence, strict liability and loss of consortium claims asserted by the plaintiffs, Joseph and Margaret Blunt (the Blunts).
¶2 Our decision in this case turns on whether the Blunts' state law
tort claims are preempted by federal law.
In order to decide this issue, we must answer three questions. The first is whether Medtronic's Marquis 7230
implantable cardioverter defibrillator (the Marquis 7230 defibrillator), which
was approved under the Food and Drug Administration's (FDA) premarket approval
process, 21 U.S.C. § 360e, met the federal "requirement"
specific to that device, pursuant to 21 U.S.C. § 360k(a), when it received premarket approval. The second question is whether the Blunts'
common law claims, which allege negligence, strict liability and loss of
consortium, constitute state requirements that are "different from, or in
addition to," the federal requirement.
The third question is whether the preemption analysis of Riegel v. Medtronic, Inc., ___
I. BACKGROUND[6]
¶3 In 2002, Medtronic applied for FDA premarket approval to market
and distribute its Marquis 7230 defibrillator.
Under the Medical Device Amendments, a defibrillator such as the Marquis
7230 is a Class III device, subject to the FDA's strictest regulation and
oversight, because it is "for a use in supporting or sustaining human life
or for a use which is of substantial importance in preventing impairment of
human health." 21 U.S.C. § 360c(a)(1)(C). With some exceptions,[7]
a Class III device may not be marketed or distributed without premarket
approval from the FDA.
Premarket approval is a "rigorous" process. A manufacturer must submit what is typically a multivolume application. It includes, among other things, full reports of all studies and investigations of the device's safety and effectiveness that have been published or should reasonably be known to the applicant; a "full statement" of the device's "components, ingredients, and properties and of the principle or principles of operation"; "a full description of the methods used in, and the facilities and controls used for, the manufacture, processing, and, when relevant, packing and installation of, such device"; samples or device components required by the FDA; and a specimen of the proposed labeling. [21 U.S.C.] § 360e(c)(1). Before deciding whether to approve the application, the agency may refer it to a panel of outside experts, 21 CFR § 814.44(a) (2007), and may request additional data from the manufacturer, § 360e(c)(1)(G).
. . . .
Once a device has received premarket approval, the [Medical Device Amendments] forbids the manufacturer to make, without FDA permission, changes in design specifications, manufacturing processes, labeling, or any other attribute, that would affect safety or effectiveness. § 360e(d)(6)(A)(i). If the applicant wishes to make such a change, it must submit, and the FDA must approve, an application for supplemental premarket approval, to be evaluated under largely the same criteria as an initial application. § 360e(d)(6); 21 CFR § 814.39(c).
After premarket approval, the devices are subject to reporting requirements. § 360i. These include the obligation to inform the FDA of new clinical investigations or scientific studies concerning the device which the applicant knows of or reasonably should know of, 21 CFR § 814.84(b)(2), and to report incidents in which the device may have caused or contributed to death or serious injury, or malfunctioned in a manner that would likely cause or contribute to death or serious injury if it recurred, § 803.50(a). The FDA has the power to withdraw premarket approval based on newly reported data or existing information and must withdraw approval if it determines that a device is unsafe or ineffective under the conditions in its labeling. § 360e(e)(1); see also § 360h(e) (recall authority).
Riegel, 128
¶4 On December 17, 2002, the FDA provided device-specific premarket approval to Medtronic for its Marquis 7230 defibrillator. Subsequent to this approval, as a result of laboratory testing, Medtronic became aware of a potential shorting problem with the defibrillator's battery. This shorting problem could cause the defibrillator's battery to rapidly discharge, leading to a potentially fatal loss of power in the device.[8]
¶5 Medtronic submitted to the FDA a premarket approval supplemental application containing three design changes that addressed the shorting issue. On October 23, 2003, the FDA approved these changes.[9] However, at no relevant time did the FDA withdraw its approval of the original defibrillator,[10] and following the supplemental premarket approval, Medtronic continued to market and distribute the original defibrillator.
¶6 In May of 2004, an original Marquis 7230 defibrillator was implanted in Joseph Blunt. In February of 2005, Medtronic advised physicians of the shorting problem. Less than ten days after his physician received notice of this problem, Joseph Blunt underwent surgery to remove the device at his doctor's suggestion. However, at no time did his defibrillator malfunction.
¶7 Following the second surgery, the Blunts sued Medtronic, alleging negligence, strict liability and loss of consortium based on the second surgery. Medtronic moved for summary judgment, arguing that the Blunts' claims were expressly preempted by 21 U.S.C. § 360k(a). Section 360k(a) is a provision of the Medical Device Amendments that provides in pertinent part:
[N]o State or political subdivision of a State may establish or continue in effect with respect to a device intended for human use any requirement--
(1) which is different from, or in addition to, any requirement applicable under this chapter to the device, and
(2) which relates to the safety or effectiveness of the device or to any other matter included in a requirement applicable to the device under this chapter.
¶8 Before the circuit court and court of appeals, Medtronic argued that federal premarket approval constituted a "requirement applicable under this chapter" to the device, also known as a federal "requirement." 21 U.S.C. § 360k(a)(1). In addition, Medtronic argued that the Blunts' state tort claims alleging negligence and strict liability were expressly preempted by § 360k(a)(1) because they constituted state requirements that were "different from, or in addition to," the federal requirement that related "to the safety or effectiveness of the device." § 360k(a). The Blunts' contentions were directly opposite Medtronic's in regard to these two issues.
¶9 At the time the circuit court ruled on Medtronic's motion, prior to the Supreme Court's decision in Riegel, there was a split among federal appellate courts with respect to both issues. Regarding the first issue, most federal circuit court decisions had concluded that device-specific premarket approval constituted a federal requirement within the meaning of 21 U.S.C. § 360k(a)(1). See Riegel v. Medtronic, Inc., 451 F.3d 104 (2d Cir. 2006), aff'd, ___ U.S. ___, 128 S. Ct. 999 (2008); Gomez v. St. Jude Med. Daig Div. Inc., 442 F.3d 919 (5th Cir. 2006); McMullen v. Medtronic, Inc., 421 F.3d 482 (7th Cir. 2005), cert. denied, 547 U.S. 1003 (2006); Cupek v. Medtronic, Inc., 405 F.3d 421 (6th Cir. 2005), cert. denied sub nom Knisley v. Medtronic, Inc., 546 U.S. 935 (2005); Horn v. Thoratec Corp., 376 F.3d 163 (3d Cir. 2004); Brooks v. Howmedica, Inc., 273 F.3d 785 (8th Cir. 2001); Martin v. Medtronic, Inc., 254 F.3d 573 (5th Cir. 2001); Kemp v. Medtronic, Inc., 231 F.3d 216 (6th Cir. 2000); Mitchell v. Collagen Corp., 126 F.3d 902 (7th Cir. 1997). An opinion of the Eleventh Circuit was the lone exception. See Goodlin v. Medtronic, Inc., 167 F.3d 1367 (11th Cir. 1999).
¶10 With respect to the second issue, a majority of federal circuit courts that had addressed the issue also concluded that state tort claims that relate to safety or effectiveness of the device constituted state requirements "different from, or in addition to," the federal requirement, and thereby were preempted under 21 U.S.C. § 360k(a). See Riegel, 451 F.3d at 122; Gomez, 442 F.3d at 929-30; McMullen, 421 F.3d at 488-89; Cupek, 405 F.3d at 424; Horn, 376 F.3d at 176; Brooks, 273 F.3d at 796; Papike v. Tambrands Inc., 107 F.3d 737, 741 (9th Cir. 1997). Again, the Eleventh Circuit's decision in Goodlin was the lone exception. Goodlin, 167 F.3d at 1378-79.
¶11 In its order granting Medtronic's motion for summary judgment, the
circuit court analyzed these lines of cases, and concluded that the reasoning
of the majority of the federal circuits was more persuasive on both
issues: (1) that device-specific
premarket approval constituted a federal requirement; and (2) that state tort
claims based on an alleged lack of safety in a device that had received
premarket approval constituted state requirements "different from, or in
addition to," the federal requirement.
As a result, because Medtronic's original Marquis 7230 had received
device-specific premarket approval, and because the Blunts' claims sounded in
negligence and strict liability based on the safety of that device, the circuit
court held that their claims were preempted by 21 U.S.C. § 360k(a). Accordingly, the circuit court granted
summary judgment to Medtronic. The court
of appeals, in affirming the circuit court, essentially adopted the circuit
court's reasoning.[11] Blunt, 305
¶12 We granted review and now affirm.
II. DISCUSSION
A. Standard of Review
¶13 We review a summary judgment decision independently, employing the
same methodology as the circuit court. Acuity v. Bagadia, 2008 WI 62, ¶12, 310
B. Riegel v. Medtronic
¶14 The United States Supreme Court has given significant direction
with respect to the preemptive effect of 21 U.S.C. § 360k(a) when a defendant in a state law tort claim has
received device-specific premarket approval for a Class III medical
device that is alleged to have caused harm. In its 2008 decision in
Riegel, which was released subsequent to the court of appeals' decision
in this case, the Supreme Court confirmed that device-specific premarket
approval of a Class III medical device constitutes a federal
"requirement" within the meaning of § 360k(a):
Premarket approval . . . imposes "requirements" under the [Medical Device Amendments] . . . . Unlike general labeling duties, premarket approval is specific to individual devices. [Premarket approval] is federal safety review. . . . [T]he FDA may grant premarket approval only after it determines that a device offers a reasonable assurance of safety and effectiveness . . . . [T]he FDA requires a device that has received premarket approval to be made with almost no deviations from the specifications in its approval application, for the reason that the FDA has determined that the approved form provides a reasonable assurance of safety and effectiveness.
Riegel, 128
¶15 With respect to whether 21 U.S.C. § 360k(a) precludes state tort claims that relate "to the
safety or effectiveness of" premarket-approved devices because they are
"state requirements," Riegel also held that it did. The Supreme Court explained:
Absent other indication, reference to a State's "requirements" includes its common-law duties. . . . [C]ommon-law liability is "premised on the existence of a legal duty," and a tort judgment therefore establishes that the defendant has violated a state-law obligation. . . . And while the common-law remedy is limited to damages, a liability award "'can be, indeed is designed to be, a potent method of governing conduct and controlling policy.'"
[With respect to premarket approval], there is nothing to contradict this normal meaning. To the contrary, in the context of this legislation excluding common-law duties from the scope of pre-emption would make little sense. State tort law that requires a manufacturer's [devices] to be safer, but hence less effective, than the model the FDA has approved disrupts the federal scheme no less than state regulatory law to the same effect. Indeed, one would think that tort law, applied by juries under a negligence or strict-liability standard, is less deserving of preservation. A state statute, or a regulation adopted by a state agency, could at least be expected to apply cost-benefit analysis similar to that applied by the experts at the FDA: How many more lives will be saved by a device which, along with its greater effectiveness, brings a greater risk of harm? A jury, on the other hand, sees only the cost of a more dangerous design, and is not concerned with its benefits; the patients who reaped those benefits are not represented in court. . . . [I]t is implausible that the [Medical Device Amendments] was meant to "grant greater power (to set state standards 'different from, or in addition to' federal standards) to a single state jury than to state officials acting through state administrative or legislative lawmaking processes." That perverse distinction is not required or even suggested by the broad language Congress chose in the [Medical Device Amendments], and we will not turn somersaults to create it.
Riegel, 128
¶16 Again, the Court resolved the federal circuit split, adopting the
position of the majority of circuits that have considered the issue. In doing so, the Supreme Court noted that
under the Medical Device Amendments, "the solicitude for those injured by
FDA-approved devices . . . was overcome in Congress's estimation by
solicitude for those who would suffer without new medical devices if juries
were allowed to apply the tort law of 50 States to all innovations."
¶17 The device at issue in Riegel was one for which supplemental approval had been issued. We shall assume for the sake of our discussion that it was the latest supplemental approval given for that medical device because the Supreme Court did not discuss whether a supplemental approval given at a subsequent date would have had any effect on an earlier approved device sold after a subsequent supplemental approval had issued. In the case before us, the original Marquis 7230 defibrillator is the subject of the Blunts' claims, and the Marquis 7230 that was given supplemental approval is not at issue. With these principles in mind, we now proceed to discuss the Blunts' claims in light of Riegel.
C. Riegel and the Blunts' Claims
¶18 Riegel holds that state tort claims based on injuries caused
by a Class III medical device that was granted device-specific premarket
approval may be preempted by 21 U.S.C. § 360k(a).
¶19 The
Blunts contend that Medtronic is liable under theories of negligence and strict
products liability due to the condition of the original Marquis 7230
defibrillator when it was implanted into Joseph Blunt. Premarket approval is specific to each
individual Class III medical device, and it is the federal safety review
of each such device.
¶20 With respect to negligence, the Blunts' complaint alleged that "Medtronic was negligent in the design, testing, manufacture, marketing, warnings and sale of the [defibrillator] which was implanted in plaintiff," and the "negligence of . . . Medtronic was a proximate cause of the injuries and damages sustained by plaintiffs." These allegations assert that the original Marquis 7230 defibrillator could have been safer to use, despite Medtronic's obtaining device-specific premarket approval from the FDA, had Medtronic not been negligent. As a result, the Blunts' negligence claim does relate to the safety of the original Marquis 7230 defibrillator, as "safety" is used in 21 U.S.C. § 360k(a) according to Riegel.
¶21 With respect to strict liability, the Blunts' complaint alleged that: (1) Medtronic's original Marquis 7230 defibrillator, "as manufactured, designed, tested, marketed and sold by . . . Medtronic[,] was in a defective and unreasonably dangerous condition to users when it left the possession and control of . . . Medtronic"; (2) Medtronic's original Marquis 7230 defibrillator "was defective in that it had a potential battery shorting mechanism which could cause rapid battery depletion thereby rendering the [defibrillator] useless and unavailable to shock or pace the heart into a normal rhythm if plaintiff suffered a rapid, life threatening heart rhythm disturbance"; and (3) "[t]he unreasonably dangerous and defective condition of the [defibrillator] was a proximate cause of the damages sustained by plaintiffs."
¶22 Here again, the Blunts assert that, despite receiving device-specific premarket approval for the original Marquis 7230 from the FDA, Medtronic designed and sold a Class III medical device that was "defective and unreasonably dangerous." That theory of liability is based on allegations that draw into question the safety of a Class III device for which the FDA granted device-specific premarket approval. Therefore, it is a claim that relates "to the safety or effectiveness of" such a device within the meaning of 21 U.S.C. § 360k(a), as construed in Riegel.
¶23 We next consider the second step in our Riegel
analysis: whether the state law tort
claims of negligence and strict products liability are requirements
"different from, or in addition to" the federal requirement. We begin by noting that these tort claims are the same tort
claims that the Supreme Court held were requirements that were "different
from, or in addition to," the federal requirement of premarket approval in
Riegel.
¶24 As
the Supreme Court explained, "[i]n [Medtronic, Inc. v.] Lohr, [518
U.S. 470, 512 (1996)] five Justices concluded that common-law causes of action
for negligence and strict liability do impose 'requirement[s]' and would be
preempted by federal requirements specific to a medical device."
¶25 Here,
the FDA granted Medtronic device-specific premarket approval for the original
Marquis 7230 defibrillator. Accordingly,
the state law claims of negligence and strict liability do impose requirements
that are different from or in addition to the federal requirement of premarket
approval.
D. The Supplemental
Approval of the Marquis 7230
¶26 The Blunts argue that their claims are not preempted because when Medtronic obtained supplemental premarket approval of its Marquis 7230 defibrillator with the design changes addressing the shorting problem, the effect of the FDA's premarket approval of the original defibrillator was "superseded."[14] Stated otherwise, the Blunts contend that after Medtronic received supplemental premarket approval for the Marquis 7230 and sold its original Marquis 7230, Medtronic sold a device that was no longer subject to a federal "requirement." Under that scenario, the Blunts contend, no federal "requirement" existed to preempt their state tort claims.
¶27 At oral argument, both parties acknowledged, with some variation, that: (1) the "original" Marquis 7230 was either the 23rd or 29th supplemental premarket-approved device; (2) there were either five or eight supplemental premarket-approved defibrillator devices between that original Marquis 7230 and the supplemental Marquis 7230 that addressed the potential shorting problem; and (3) since the first approval, there have been approximately 75 supplemental premarket approvals of the Marquis 7230 defibrillator.
¶28 We begin by noting that Congress expressly preempted requirements
that were different from or in addition to the federal requirement of
device-specific premarket approval for Class III medical devices. 21 U.S.C. § 360k(a); Riegel, 128
The [Medical Device Amendments] provide[] that no State "may establish or continue in effect with respect to a device . . . any requirement" relating to safety or effectiveness that is different from, or in addition to, federal requirements.
Riegel, 128
¶29 It is beyond dispute that the FDA has the power to withdraw premarket approval or to recall a device to which it has given premarket approval. 21 U.S.C. § 360e(e)(1); 21 U.S.C. § 360h(e). As the Supreme Court noted:
[t]he FDA has the power to withdraw premarket approval based on newly reported data or existing information and must withdraw approval if it determines that a device is unsafe or ineffective under the conditions in its labeling.
Riegel, 128
¶30 Under the comprehensive scheme that Congress has enacted, withdrawal of the manufacturer's right to market its premarket-approved devices is accomplished through affirmative acts of the FDA. There is nothing to suggest that premarket approval ceases without FDA action. For example, federal law directs that for the withdrawal or temporary suspension of premarket approval "due notice and opportunity for informal hearing" must be given. 21 U.S.C. § 360e(e)1. We also note that the FDA has express authority to recall premarket approved Class III medical devices when the FDA finds "there is a reasonable probability that a device intended for human use would cause serious, adverse health consequences or death." 21 U.S.C. § 360h(e)(1).
¶31 In addition, Medtronic continued to be obligated to comply with the
premarket approval reporting requirements with respect to the original Marquis
7230 defibrillator, subsequent to supplemental premarket approval of the
changes to the defibrillator. Riegel,
128
Postapproval reports. Continued approval of this [premarket approval] is contingent upon the submission of postapproval reports required under 21 CFR [§] 814.84 at intervals of 1 year from the date of approval of the original [premarket approval].
The content of these premarket approvals is consistent with the discussion in Riegel, cited immediately above. Accordingly, if the premarket approval of the original Marquis 7230 defibrillator were not ongoing, there would be no need to direct Medtronic to report at least annually on the results of further use and testing of the device.[15]
¶32 We have found nothing in the comprehensive federal regulatory scheme that suggests a change in device-specific premarket approval of a Class III medical device occurs simply because a subsequent device has received supplemental premarket approval, and the Blunts have identified no such provision in the federal law. Accordingly, we conclude that the supplemental premarket approval that Medtronic received did not affect the federal requirement of premarket approval granted to the original Marquis 7230 defibrillator.
¶33 Furthermore, the United States Supreme Court has interpreted other
federal statutory schemes to which preemption arguments have been made in a
manner that supports this conclusion.
For example, in Geier v. American
Honda Motor, 529 U.S. 861 (2000), the United States Department of
Transportation had required that new automobiles employ at least one of a
variety of approved passive restraint systems, including automatic seatbelts
and airbags. Geier, 529
In effect, petitioners' tort action depends upon its claim that manufacturers had a duty to install an airbag . . . . Such a state law——i.e., a rule of state tort law imposing such a duty——by its terms would have required manufacturers of all similar cars to install airbags rather than other passive restraint systems, such as automatic belts or passive interiors . . ., even though [the regulation] required only that 10% of a manufacturer's nationwide fleet be equipped with any passive restraint device at all.
¶34 Applying the reasoning of Geier to this case, we note that Medtronic had received FDA device-specific premarket approval to sell both the original and the supplemental defibrillators. The Blunts acknowledge this, yet the Blunts' tort claims seek to impose liability for selling the original Marquis 7230 defibrillator.
¶35 While the ultimate holding in Geier was based on implied
preemption and our decision is based on express preemption, the facts before us
are analogous to the facts in Geier because in Geier the federal
government approved airbags and also other restraints, such as lap and shoulder
belts.
¶36 In Geier, Honda had installed airbags in some of its autos,
in conformance with federal regulation; however, Geier was injured in an auto
that contained lap and shoulder belts, also in conformance with federal
regulations.
¶37 In Geier, the Court upheld a preemption defense for the lap
and shoulder belts, concluding that because both types of restraint had been federally
approved, a state tort claim would conflict with the federal scheme under which
the approvals had been granted.
¶38 In addition, other
courts seem to take for granted that a manufacturer often may have a
number of different supplemental premarket-approved devices on the market at
any given time. See, e.g.,
¶39 Finally, supplemental approvals do not necessarily occur because newer versions are more safe than predecessor versions, but rather, because the law requires premarket approval for most changes in design. For example, under 21 C.F.R. § 814.39(a), supplemental approval must be obtained when the proposed changes allow for a new use of the device, affect the labeling or packaging of the device or require a different facility to process the device. Therefore, we conclude that when a manufacturer obtains supplemental approval for a medical device, absent further FDA action, prior approvals of the device remain valid and accordingly the federal requirement established by premarket approval is ongoing.
¶40 The relevant federal statutes, the FDA's regulations and the relevant case law support preemption by the device-specific premarket approval of the original Marquis 7230 defibrillator. Therefore, that premarket approval remained the federal requirement that preempts the Blunts' claims under 21 U.S.C. § 360k(a). Accordingly, pursuant to 21 U.S.C. § 360k(a), as interpreted in Riegel, we conclude that the Blunts' state law tort claims are preempted.
¶41 In an effort to get around the holdings in Riegel, the Blunts
also contend that the federal statute's use of the word "requirement"
means that the medical device manufacturer is "required" to sell only
one version of the device. The Blunts
explain that since Medtronic had the option of selling either the original
Marquis 7230 defibrillator or the supplemental Marquis 7230, it was no longer
"required" to sell only the original defibrillator. Therefore, they contend that their claims
that arise from the use of the original Marquis 7230 are not preempted. Stated otherwise, they argue that since there
is no longer a federal "requirement" that relates solely to the
original Marquis 7230, state tort law requirements have no federal requirement
from which they are "different from, or in addition to." Judge Fine also employed this reasoning in
his dissent. Blunt, 305
¶42 Riegel provides a precise meaning for the term,
"requirement," as used in 21 U.S.C. § 360k(a). It
is not the meaning suggested by the Blunts.
Through the federal requirement of device-specific premarket approval,
"the FDA requires a device to be made with almost no deviations from the
specifications in its approval application." Riegel, 128
¶43 As a result, the term, "requirement," as it is construed in Riegel, encompasses both federally mandated criteria[18] for medical devices before they can be marketed and sold (a federal requirement) and state tort claims that require manufacturers to design their devices with a certain level of safety (a state requirement) before they are marketed and sold in order to avoid tort liability. However, under Riegel, the term, "requirement," does not mean that a manufacturer is "required" to sell one particular approved device among several devices that have been given device-specific premarket approval. To the contrary, premarket approval does not require the manufacturer to sell any premarket approved medical devices at all. Accordingly, the Blunts' arguments do not change our conclusion stated above that pursuant to 21 U.S.C. § 360k(a), as interpreted in Riegel, the Blunts' state law tort claims are preempted.
III. CONCLUSION
¶44 Our decision in this case turns on whether the Blunts' state law tort claims are preempted by federal law. In order to decide this issue, we must answer three questions. The first is whether Medtronic's Marquis 7230 implantable cardioverter defibrillator (the Marquis 7230 defibrillator), which was approved under the Food and Drug Administration's (FDA) premarket approval process, 21 U.S.C. § 360e, met the federal "requirement" specific to that device, pursuant to 21 U.S.C. § 360k(a), when it received premarket approval. The second question is whether the Blunts' common law claims, which allege negligence, strict liability and loss of consortium, constitute state requirements that are "different from, or in addition to," the federal requirement. The third question is whether the preemption analysis of Riegel applies to claims against the Marquis 7230 defibrillator, even though supplemental premarket approval was given to a later defibrillator. Because we conclude that the United States Supreme Court's decision in Riegel provides definitive direction on these questions, we answer all of them in the affirmative. We therefore conclude that § 360k(a) preempts the Blunts' claims. Accordingly, we affirm the decision of the court of appeals.
By the Court.—The decision of the court of
appeals is affirmed.
¶45 ANN WALSH BRADLEY, J. (concurring
in the judgment). I write separately
in order to express my concern that the United States Supreme Court's
interpretation of the 1976 Medical Device Amendments does not adequately
protect the safety of the citizens of
¶46 I also write separately because I disagree with the majority's reliance on Geier v. American Honda Motor Co., Inc., 529 U.S. 861 (2000). The Geier case turns on implied preemption. Nevertheless, the majority uses Geier to conclude that the Blunt's tort claims must be dismissed based on express preemption.[19] Because express preemption and implied preemption are distinct legal theories based on different facts and analysis, Geier does not support the majority's determination in this case.
I
¶47 The purpose of the federal Medical Devices Amendments of 1976, 21
U.S.C. § 360 et
seq., was "to provide for the safety and effectiveness of medical devices
intended for human use[.]" 90 Stat.
539 (1976) (preamble); see also Medtronic, Inc. v. Lohr, 518
¶48 It is the responsibility of the state legislature and courts to
develop a tort system that protects the health and safety of the citizens they
serve. The United States Supreme Court
has "long presumed that Congress does not cavalierly pre-empt state-law
causes of action." Lohr, 518
¶49 The
Medical Device Amendments provide that no State may "establish or
continue in effect . . . any requirement"
that is "different from, or in addition to" the federal requirements
and "which relates to the safety or effectiveness of the device[.]" 21 U.S.C. § 360k(a). In 1996, the Court stated that
"it would take language much plainer than the text of § 360k(a) to
convince us that Congress intended that result [that state tort claims are
preempted]." Lohr,
518
¶50 However, 12 years later, with precisely the same language in force,
the Court concluded that the language was apparently plain enough. The Court determined that state tort law
claims are state "requirements" and that the express language of § 360k(a) preempts
them. Riegel, __
¶51 Despite basing its conclusion on a determination that the language is plain, the Court turned to the policy reasons supporting its determination. The policy reason cited by the Supreme Court in favor of preemption is that it is better for one centralized agency——the Food and Drug Administration (FDA)——to do the necessary cost-benefit analysis in determining whether a device is safe enough for the market:
It is not our job to speculate upon congressional motives. If we were to do so, however, the only indication available——the text of the statute——suggests that the solicitude for those injured by FDA-approved devices . . . was overcome in Congress's estimation by solicitude for those who would suffer without new medical devices if juries were allowed to apply the tort law of 50 States to all innovations.[20]
Riegel, __
¶52 This is a policy rationale that may be meritorious if the premarket approval process provided at least minimum assurances of safety. It presumes that the FDA premarket approval process is indeed rigorous and that the devices approved are safe for use. Recent reporting on the FDA calls these presumptions into question.
¶53 Recently, there has been a flood of criticism directed at the FDA approval process, much of the criticism coming from whistleblowers within the FDA itself. It is not at all apparent that the FDA approval process actually guarantees a minimum level of safety for medical devices. A January 2009 letter from nine FDA scientists could not be more clear: "The purpose of this letter is to inform you that the scientific review process for medical devices at FDA has been corrupted and distorted by current FDA managers, thereby placing the American people at risk." Letter from nine FDA scientists (names redacted), to John D. Podesta, Presidential Transition Team 1 (Jan. 7, 2009).
¶54 The letter charges managers of the Center for Devices and
Radiological Health (CDRH) with "corrupting and distorting the scientific
evaluation of medical devices, and . . . interfering with our responsibility to ensure
the safety and effectiveness of medical devices before they are used on the
American public."
Managers at CDRH have ignored the law and ordered physicians and scientists to assess medical devices employing unsound evaluation methods, and to accept non-scientific, nor clinically validated, safety and effectiveness evidence and conclusions, as the basis of device clearance and approval. Managers . . . have ignored serious safety and effectiveness concerns of FDA experts. Managers have ordered, intimidated, and coerced FDA experts to modify scientific evaluations, conclusions and recommendations in violation of the laws, rules and regulations and to accept clinical and technical data that is not scientifically valid nor obtained in accordance with legal requirements . . . . These same managers have knowingly tried to avoid transparency and accountability by failing to properly document the basis of their non-scientific decisions in administrative records.
¶55 As one example of the FDA's ineffectiveness in ensuring basic
device safety, the FDA scientists point to the 1998 approval of a mammography
computer-aided detection device.
¶56 Congress is aware of some of the problems within the FDA, and the House Committee on Energy and Commerce conducted an investigation on the matter in October of 2008. As a result of its findings, the Committee sent a letter to the Commissioner of the FDA, stating that the Committee "recently received compelling evidence of serious wrongdoing in connection with FDA's review, clearance, and approval process of medical devices."[22] The letter states that FDA scientists "supplied substantial evidence demonstrating that medical devices submitted for FDA review . . . have been received and/or cleared or approved in violation of agency regulation and guidance mandated to assure safety and effectiveness."[23]
¶57 The preemption doctrine should not be employed to allow for the
normal standard of care to be substandard care.
I conclude, as I must, that Riegel controls and that the Blunts'
tort claims are preempted.[24] However, the result may be no meaningful
protection for
II
¶58 I also write separately to express my disagreement with the majority's discussion of Geier v. American Honda Motor Co., Inc., 529 U.S. 861 (2000). See majority op., ¶¶33-37. The basis for the majority's conclusion in this case (and for the Supreme Court's conclusion in Riegel) is express preemption. Yet, Geier is a case that turns on conflict preemption, a form of implied preemption.[25] Because the cases turn on distinct legal theories, I do not find Geier relevant to the court's determination in this case.
¶59 Express preemption and implied preemption are separate legal
theories, based on distinct factual inquiries.
Express preemption is exactly what it sounds like——the text of a congressional enactment explicitly
provides that state law claims are preempted.
See English v. Gen. Elec. Co., 496
¶60 One form of implied preemption is "conflict preemption." Under this doctrine, a particular
state law is preempted because of an "actual conflict" with a federal
regulation——even in the
absence of a broad congressional mandate to preempt all state law in the
area. See id. State law is preempted due to a conflict with
federal law when it is impossible for a party to simultaneously comply with
state and federal requirements, or when the state law "stands as an
obstacle to the accomplishment and execution of the full purposes and
objectives of Congress."
¶61 The majority appears to suggest that a case about implied preemption lends support to the majority's express preemption analysis. That is, the Blunts' claims are expressly preempted because the facts of the case are "analogous" to the facts in a case regarding a different Congressional act and in which a different preemption doctrine applies. Majority op., ¶35. This cannot be. Because the majority here takes a superficial approach to the facts and the law in Geier, it misses the essence of that case and misapplies its holding.
¶62 In Geier, the Supreme Court determined that the plaintiff's
state tort law claim was impliedly preempted via the doctrine of conflict
preemption. 529
¶63 In determining that Geier's claim was impliedly preempted, the
Court looked to the comments and drafting history of the safety standards to
determine the Department's intent.
¶64 In Geier, the Court concluded the Department made an affirmative determination that it did not want manufacturers to install airbags in all of their automobiles. Because Geier's tort claim would require manufacturers to install airbags in all of their automobiles or risk liability, the state tort claim actually conflicted with the accomplishment of a federal objective. Therefore, it was impliedly preempted. See id.
¶65 In this case, the facts in the record do not support a finding of implied preemption. At the time that Blunt received the allegedly defective defibrillator, the FDA permitted Medtronic to market both the original and the improved defibrillator. Majority op., ¶32. There is no indication in the record, however, that the FDA made an affirmative decision that its policy objectives would be best served if Medtronic sold both types of defibrillators at once. Without such affirmative determination, state tort law claims do not frustrate the accomplishment of the FDA's objective and are not preempted under the doctrine of conflict preemption.
¶66 For the above reason, I determine that the reasoning of Geier is inapt in this case. Because I do not agree with the majority's blending of preemption doctrines, I respectfully concur.
¶67 I am authorized to state that SHIRLEY S. ABRAHAMSON, C.J. joins this concurrence.
[1] Blunt v. Medtronic, Inc., 2007 WI App 191, 305
[2] The Honorable Richard J.
Sankovitz of
[3] All further references to the United States Code are to the 2000 version unless otherwise noted.
[4] "Supplemental
premarket approval," or "supplemental approval," is FDA approval
for a device that is similar to a device that previously has received premarket
approval, where the manufacturer changes the "design specifications,
manufacturing processes, labeling, or any other attribute, that would affect
safety or effectiveness." Riegel v. Medtronic, Inc., ___
[5] We note that when this
case was presented for oral argument there were two federal preemption cases
pending before the United States Supreme Court.
See Good v. Altria
Group, Inc., 501 F.3d 29 (1st Cir. 2007), cert. granted, ___
[6] The facts related are undisputed unless otherwise noted.
[7] The Medical Device Amendments grandfathered approval for certain Class III devices. For example, those devices sold before the Medical Device Amendments' effective date are not required to undergo the premarket approval process. 21 U.S.C. §§ 360c(f)(1), 360e(b)(1). In addition, a manufacturer need not obtain premarket approval for a new device if it is "substantially equivalent" to a device that is exempt from premarket approval. 21 U.S.C. § 360c(f)(1)(A).
[8] The parties do not
dispute that this failure rate was on the order of 1 in 10,000 and that no
device failed outside of controlled testing conditions. For some perspective, consider that the FDA,
on a prior occasion, had approved "a ventricular assist device for
children with failing hearts, even though the survival rate of children using
the device was less than 50 percent."
Riegel, 128
[9] Both parties agree that
the 2002 approval of the "original" Marquis 7230 defibrillator was
itself a "supplemental" premarket approval of an earlier approved
design. It appears that there were a
number of earlier revisions (according to oral argument, either 23 or 29
revisions) to the device that also received premarket approvals prior to the
December 17, 2002 approval of the "original" Marquis 7230. Therefore, for the sake of our discussion, we
will refer to the December 17, 2002 approval as the approval of the
"original" Marquis 7230, and the October 23, 2003 approval as
the approval of the supplemental Marquis 7230.
As the United States Supreme Court noted, "an application for
supplemental premarket approval [is] evaluated under largely the same criteria
as an initial application." Riegel,
128
[10] In the Blunts' briefs to this Court, they supplemented much of their factual background information with citations to In re Medtronic, Inc., Implantable Defibrillators Litigation, 465 F. Supp. 2d 886 (D. Minn. 2006), which also dealt with the original Marquis 7230 defibrillator. However, the claims in that case were based on different factual allegations and legal theories than those alleged here. Furthermore, the March 16, 2006 FDA recall referenced in that case to which the Blunts refer did not occur until after Joseph Blunt's surgery.
[11] Judge Fine dissented from the decision of the court of appeals.
[12] The Blunts also alleged loss
of consortium. That claim is
derivative of the negligence and strict liability claims made by Joseph
Blunt. Peters v. Menard, Inc., 224 Wis. 2d 174, 193 n.8, 589
N.W.2d 395 (1999) ("[L]oss of consortium claims are derivative."); Kottka v. PPG Indus., Inc., 130 Wis. 2d
499, 521, 388 N.W.2d 160 (1986) ("The
claim for a loss of consortium
is derivative, in the sense that
it does not arise unless the other spouse has sustained a personal injury.")
(citing Fitzgerald v. Meissner
& Hicks, Inc.,
38
[13] Many medical devices were
already on the market when Congress enacted the Medical Device Amendments to
the Food, Drug and Cosmetic Act. Medtronic,
Inc. v. Lohr, 518
[14] At oral argument, counsel for the Blunts was difficult to pin down on what he meant by saying that the original premarket approval was "superseded" by the supplemental approval. However, he appeared to contend both that the federal requirement evidenced by premarket approval for the original Marquis 7230 defibrillator was changed when the supplemental approval issued and also that there was no longer a federal requirement relating to the sale of the original Marquis 7230. We address both concepts.
[15] See also 21 U.S.C. § 360e(d)(6) (providing the standards for supplemental approvals, without mentioning any effect that supplemental approvals may have on prior approvals); 21 CFR § 814.39(c) (same).
[16] In Geier
v. American Honda Motor, 529 U.S. 861 (2000), the Supreme Court
considered both the express preemption provisions in the federal law and
implied preemption. Due to a savings
clause in the express preemption provision, the Court concluded that express
preemption did not bar Geier's tort claim.
[17] Our conclusion that
federal approval of the device under review is critical to our decision is
supported by the reasoning in Sprietsma v. Mercury Marine, 537 U.S. 51
(2002). Even though Sprietsma's
holding turns on implied preemption, its conclusion that preemption did not
occur there confirms how important federal governmental action is in a
preemption analysis.
[18] Not all approvals
received under the Medical Device Amendments constitute federal
"requirements" under 21 U.S.C. § 360k(a), as interpreted in Riegel. For example, devices that receive FDA
approval because they are "substantially equivalent" to premarket
approval-exempted devices under 21 U.S.C. § 360c(f)(1)(A) are not subject to the federal
requirement, and tort claims based on such devices are not preempted. See Riegel, 128
S. Ct. at 1007; Lohr, 518
[19] The majority misconstrues the Blunts' arguments. The Blunts argue that their tort claims are not state requirements "different from, or in addition to" federal requirements because Medtronic had the option of selling one of two approved devices. Thus, the Blunts assert that Medtronic was allowed to——but was not required to——sell the allegedly defective device that was implanted in Joseph Blunt.
The majority addresses the Blunts' argument only as an afterthought. See majority op., ¶¶41-43. Instead, the majority focuses on an argument never advanced by the Blunts, that is, whether supplemental approval of a subsequent device extinguished the prior device's Food and Drug Administration (FDA) approval. See majority op., ¶¶26-40. This is an argument that does not appear in the Blunts' brief, and that counsel for the Blunts specifically disclaimed during oral argument. See Wisconsin Court System, Supreme Court Oral Arguments, http://wicourts.gov/opinions/soralarguments.htm (search "Party name" for "Blunt"; then follow "Playback" link) at 19:15.
[20] Concurring in the judgment, Justice Stevens stated:
There is nothing in the preenactment history of the [Medical Device Amendments] suggesting that Congress thought state tort remedies had impeded the development of medical devices. Nor is there any evidence at all to suggest that Congress decided that the cost of injuries from Food and Drug Administration-approved medical devices was outweighed "by solicitude for those who would suffer without new medical devices if juries were allowed to apply the tort law of 50 States to all innovations." That is a policy argument advanced by the Court, not by Congress.
Riegel v. Medtronic, Inc.,
__
[21] A recent law review article closely tracks this rationale, declaring that "preemption is necessary to ensure that federal regulatory agencies, like the Food and Drug Administration (FDA), are the only governmental actors able to impose requirements on manufacturers——thereby ensuring a nationally standardized system of safety regulations without myriad local variations." Note, Preemption of State Common Law Claims, 122 Harv. L. Rev. 405, 405 (2008).
[22] Letter from Representative John D. Dingell and Representative Bart Stupak, Chairmen, U.S. House of Representatives Committee on Energy and Commerce, to the Honorable Andrew C. von Eschenbach, Commissioner, U.S. Food and Drug Administration 1 (Nov. 17, 2008).
[23]
[24] Tort law claims are not preempted, however, to the extent that they seek damages for a manufacturer's violation of federal requirements:
Where a state cause of action seeks to enforce [a federal] requirement, that claim does not impose a requirement that is "different from, or in addition to," requirements under federal law. To be sure, the threat of a damages remedy will give manufacturers an additional cause to comply, but the requirements imposed on them under state and federal law do not differ. Section 360k does not preclude States from imposing different or additional remedies, but only different or additional requirements.
Medtronic, Inc. v. Lohr, 518 U.S. 470, 513 (1996) (O'Connor, J., concurring in part and dissenting in part) (emphasis in original); see also Riegel, 128 S. Ct. at 1011 ("§ 360k does not prevent a State from providing a damages remedy for claims premised on a violation of FDA regulations; the state duties in such a case 'parallel,' rather than add to, federal requirements.").
[25] In fact, in Geier
the Court determined that a Department of Transportation safety standard did
not expressly preempt state tort law claims.
Geier v. Am. Honda Motor Co., Inc., 529