DHHS Letter of Technical Assistance Regarding Nondiscrimination Obligations in the Provision of Medical Treatment to Infants with Disabilities

August 13, 2026

Amy Yeager
Chief Legal Officer
Children's Medical Center of Dallas
1935 Medical District Dr.
Dallas, TX 75235
Amy.Yeager@childrens.com

Brad LaMorgese
KoonsFuller, P.C.
1717 McKinney Avenue
Dallas, TX 75202
blamorgese@koonsfuller.com

David Lein
Associate Vice Chancellor & Deputy General Counsel
The University of Texas System, Office of General Counsel
210 West 7th Street
Austin, TX 78701
dlein@utsystem.edu

Erin Sine
Vice President and General Counsel
UT Southwestern Medical Center
5323 Harry Hines Blvd.
Dallas, TX 75390-9008
Erin.Sine@UTSouthwestern.edu

RE: Technical Assistance Regarding Nondiscrimination Obligations in the Provision of Medical Treatment to Infants with Disabilities

Dear Counsel:

The Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services enforces federal laws that prohibit discrimination on the basis of disability by recipients of Federal financial assistance, including Section 504 of the Rehabilitation Act of 1973 and Section 1557 of the Affordable Care Act. As recipients of such assistance, your institutions are subject to these laws.

OCR is aware of circumstances involving a newborn infant with a serious congenital condition for whom a recommended, standard-of-care surgical intervention may be at issue. We are writing to offer technical assistance so that all involved are working from a shared understanding of the applicable civil rights requirements. OCR is monitoring the situation and is available as a resource.

Section 504 and Section 1557 prohibit a covered entity from denying or withholding medical treatment, or from providing services in a manner that discriminates, on the basis of disability. Under the Department’s implementing regulation, medical-treatment decisions by recipients may not be based on biases or stereotypes about individuals with disabilities, on judgments that an individual with a disability will be a burden on others, or on the view that the life of a person with a disability has less value than the life of a person without a disability. See 45 C.F.R. Part 84. These principles apply to decisions concerning the provision, denial, or withdrawal of life-sustaining treatment.

These laws do not displace the reasonable medical judgment of treating clinicians. A determination that a particular intervention is not medically indicated, made on a nondiscriminatory basis, is a clinical judgment the civil rights laws leave to the treating professionals. The requirement is that such determinations rest on the individual’s medical circumstances and not on assumptions about the value or burden of life with a disability.

The Department’s regulations also contemplate the use of an infant care review committee to review decisions to withhold or withdraw medically indicated treatment from an infant with a disability who has a life-threatening condition. See 45 C.F.R. § 84.55. Where such a decision is under consideration following the child’s birth, OCR encourages that the committee be convened promptly to review the matter, that life-sustaining treatment be maintained during the pendency of any such review, and that the committee’s findings be documented and preserved. Consistent with the standards referenced above, any such review should assess the infant’s medical circumstances and may not rest on judgments about the value or burden of life with a disability, or on the effect of the infant’s condition on other persons.

OCR would welcome the opportunity to provide technical assistance to your legal, clinical, and ethics leadership on these obligations, including how they intersect with your infant care review processes and your institutions’ emergency-treatment duties.

Please understand this letter as an offer of assistance and a statement of applicable law, not as an allegation or a determination. OCR appreciates your institutions’ commitment to serving all patients consistent with federal civil rights law.

Sincerely,

/s/
Paula M. Stannard
Director, Office for Civil Rights