King v. The Collagen Corp ( 1993 )


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  • USCA1 Opinion









    January 15, 1993 UNITED STATES COURT OF APPEALS

    FOR THE FIRST CIRCUIT

    ____________________

    No. 92-1278

    JANE KING,

    Plaintiff, Appellant,

    v.

    COLLAGEN CORPORATION,

    Defendant, Appellee.

    ____________________

    APPEAL FROM THE UNITED STATES DISTRICT COURT

    FOR THE DISTRICT OF MASSACHUSETTS

    [Hon. A. David Mazzone, U.S. District Judge]
    ___________________

    ____________________

    Before

    Torruella, Circuit Judge,
    _____________

    Aldrich and Campbell, Senior Circuit Judges.
    _____________________

    _____________________

    Clinard J. Hanby, with whom Susan A. Allinger, John O'Quinn,
    ________________ _________________ ____________
    O'Quinn, Kerensky & McAninch, Michael M. Essmyer, Michael M.
    ______________________________ ___________________ ___________
    Essmyer & Associates, Frank Lynch and LeComte, Emanuelson, Tick &
    ____________________ ___________ ___________________________
    Doyle, were on brief for appellant.
    _____
    Bob Gibbins and Jeffrey R. White, were on brief for the
    ____________ _________________
    Association of Trial Lawyers of America, amicus curiae.
    Joseph J. Leghorn, with whom Peter T. Wechsler, Warner &
    __________________ __________________ _________
    Stackpole, Joe W. Redden, Jr., W. Curtis Webb, and Beck, Redden &
    _________ __________________ ______________ ______________
    Secrest, were on brief for appellee.
    _______
    Bruce N. Kuhlik, Lars Noah, Covington & Burling, Edwin H.
    _______________ _________ ____________________ _________
    Allen, and Retta M. Riordan, were on brief for Health Industry
    _____ ________________
    Manufacturers Association, amicus curiae.


    ____________________


    ____________________














    TORRUELLA, Circuit Judge. Jane King appeals from a
    _____________

    grant of summary judgment entered in favor of Collagen

    Corporation ("Collagen") by the United States District Court for

    the District of Massachusetts. The district court determined

    that plaintiff's claims were preempted by the Medical Device

    Amendments of 1976 ("MDA"), 21 U.S.C. 360c et seq. Because the
    _______

    district court correctly construed the preemption provision of

    the MDA, we affirm.

    FACTS
    FACTS
    _____

    Defendant Collagen manufactures and distributes Zyderm,

    a cosmetic medical device used to correct wrinkles and other skin

    deformities. Zyderm treatment consists of injecting processed

    cow tissue directly under the skin. Zyderm then supports the

    skin from underneath, smoothing out deformities on the surface of

    the skin. The course of treatment may run for several weeks and

    requires up to six applications. Researchers at Stanford

    University developed Zyderm in the early 1970's and Collagen

    placed it on the market in the early 1980's.

    As a medical device, Zyderm falls within the scope of

    the MDA and thus must be approved and regulated by the Food and

    Drug Administration ("FDA"). As a Class III medical device under

    the MDA scheme, it is subject to the most extensive pre-marketing

    approval requirements imposed by the MDA and to similarly

    extensive regulation post-approval. The premarket approval

    process is designed to provide a "reasonable assurance of . . .

    safety and effectiveness" for medical devices which are too

    dangerous or unknown to permit less regulation. 21 U.S.C.















    360c(1)(C). Post-approval regulation is designed to keep the FDA

    apprised of ongoing safety findings or any other information

    about the device as it becomes available. Id. 360e(e) &
    ___

    360i(a).

    Pursuant to the pre-marketing approval process, the FDA

    requires applicants to submit proposed labeling, extensive safety

    testing data and descriptions of manufacturing methods and

    materials. Id. 360e(c)(1). Upon reviewing the materials in a
    ___

    comprehensive manner, the FDA may approve the device for sale or

    return the application to the applicant for further information

    or testing. Id. 360e(d)(1). When the FDA returns an
    ___

    application to the applicant, the FDA must apprise the applicant

    of how to correct all deficiencies. Id. 360e(d)(2). Once the
    ___

    device is approved, the FDA retains the power to withdraw

    approval of the product permanently or suspend its approval

    temporarily if it determines that the device has become unsafe or

    its labeling inadequate. Id. 360e(e)(1)(3). To assist the FDA
    ___

    in making these determinations, manufacturers must maintain

    records and make reports to the FDA on information pertinent to

    the device. Id. 360i(a). Zyderm passed through the Class III
    ___

    approval process prior to marketing, and underwent revisions to

    the original approval afterwards.

    Appellant Jane King sought Zyderm treatment in 1987.

    Following the normal procedure, Ms. King's physician administered

    a test dose of Zyderm before proceeding with the full treatment.

    Shortly after receiving this test dose, Ms. King suffered muscle


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    and joint pains, as well as other symptoms. Her doctor

    subsequently diagnosed her as having dermatomyositis/polymyositis

    ("DM/PM"), an autoimmune disease in which the immune system

    attacks skin and muscle tissue as if it were a foreign substance.

    When Ms. King received Zyderm, Zyderm's FDA-approved

    labeling contraindicated use by those with a personal history of

    autoimmune disease. Since that time, however, the FDA has

    gradually allowed Collagen to change the labeling as it related

    to autoimmune disease. By 1991, Zyderm was no longer

    contraindicated for persons with a history of autoimmune disease.

    The FDA required a warning in 1991, however, that some recipients

    have suffered from unwanted autoimmune reactions, but that no

    causal connection between Zyderm and these reactions has been

    shown.

    Ms. King subsequently filed a first amended complaint

    detailing seven claims against Collagen.1 First, she claimed

    that Collagen was strictly liable for her injuries because Zyderm


    ____________________

    1 Ms. King filed suit against Collagen in 1990 alleging that the
    test dose of Zyderm caused her to develop DM/PM. Count one of
    her suit alleged that Collagen negligently tested, manufactured
    and sold Zyderm. Count two alleged that Collagen breached
    implied warranties of merchantability. Count three alleged fraud
    and deceit in the sale of Zyderm.

    Ms. King subsequently filed the amended complaint. Appellee
    contends that Ms. King informed appellee that she would withdraw
    this amended complaint. As such, appellee never opposed its
    entry. The district court entered the amended complaint, noting
    that no opposition was filed. The district court, however,
    proceeded to grant summary judgment on the basis of Ms. King's
    original complaint. Because the amended complaint contains
    essentially similar claims as the original complaint, with few
    additions, we will address the claims in the amended complaint.

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    was unsafe for its intended purpose and unreasonably dangerous to

    users. Second, she alleged that Zyderm was not safe and fit for

    the purpose intended and therefore was sold in breach of the

    warranty of merchantability. Third, Ms. King alleged that

    negligence in the design, manufacture, marketing and sale of

    Zyderm, including negligence in not revealing dangerous

    propensities of the product, led to her injury. Fourth, she

    maintained that Collagen misbranded and/or mislabeled Zyderm.

    Fifth, she asserted that Collagen made misrepresentations of

    material fact to Ms. King in selling Zyderm to her. Sixth, she

    alleged that Collagen failed to warn her of any defective

    condition. Finally, Ms. King alleged that Collagen fraudulently

    obtained FDA approval.

    Collagen moved for summary judgment shortly after

    Ms. King filed her amended complaint, arguing that FDA regulation

    of Zyderm under the MDA preempted all of the causes of action

    alleged in the complaint. The district court granted this

    motion, relying on a similar case from the Southern District of

    Texas. This case, Stamps v. Collagen Corp., No. H-90-2242, 1991
    ______ ______________

    U.S. Dist. LEXIS 20666 (S.D. Tex. 1991), held that plaintiff's

    various products liability claims arising out of Zyderm treatment

    were preempted by FDA regulation under the MDA.

    LEGAL ANALYSIS
    LEGAL ANALYSIS
    ______________

    I.
    I.

    Article VI of the Constitution dictates that federal

    law "shall be the supreme Law of the Land; and the judges in


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    every State shall be bound thereby, any Thing in the Constitution

    or Laws of any State notwithstanding." U.S. Const. art. VI, cl.

    2. State laws that conflict with federal laws and regulations,

    therefore, are preempted. E.g., Malone v. White Motor Corp., 435
    ____ ______ _________________

    U.S. 497 (1978). In determining whether such a conflict exists,

    it is well settled that the intent of Congress governs. That is,

    preemption does not occur unless Congress so intended. Rice v.
    ____

    Santa Fe Elevator Corp., 435 U.S. 497, 504 (1978).
    _______________________

    Congress may express its intent to preempt state law

    explicitly in the language of the statute. Jones v. Rath Packing
    _____ ____________

    Co., 430 U.S. 519, 525 (1977). Congress may express its intent
    ___

    implicitly by passing an extensive statutory scheme that

    extensively covers the field of regulation. Fidelity Federal
    ________________

    Sav. & Loan Ass'n v. de la Cuesta, 458 U.S. 141, 153 (1982).
    __________________ _____________

    Implied preemption also occurs when a conflict between state and

    federal law makes compliance with both impossible, or when state

    law would frustrate the purpose and objectives of the federal

    law. Id. (citing Florida Lime & Avocado Growers, Inc. v. Paul,
    ___ _____________________________________ ____

    373 U.S. 132, 142-43 (1963); Hines v. Davidowitz, 312 U.S. 52, 67
    _____ __________

    (1941)).

    We are aided in our determination of preemption in this

    case by the Supreme Court's recent treatment of the subject in

    Cipollone v. Liggett Group, Inc., 112 S. Ct. 2608 (1992). In
    _________ ____________________

    Cipollone, a victim of lung cancer sued several cigarette
    _________

    manufacturers for breach of warranties contained in cigarette

    advertisements, for failure to warn of health hazards related to


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    smoking, for fraudulently misrepresenting those hazards to the

    public, and for conspiracy to deprive the public of important

    health information. Id. at 2613. The cigarette manufacturers
    ___

    contended that petitioner's claims were preempted by the federal

    law requiring a health warning to appear on all cigarette

    advertisements and containers.2 Id. at 2614.
    ___

    In analyzing preemption, the Court relied only on the

    specific language of the provision regarding preemption. The

    Court reasoned that "Congress' enactment of a provision defining

    the preemptive reach of a statute implies that matters beyond

    that reach are not preempted." Id. at 2618. The opinion thus
    ___

    analyzed each of petitioner's claims in light of the express

    language of the preemption provision in the cigarette warning

    statute.

    The plurality held that the provision preempted failure

    to warn claims as to advertising practices, but not as to testing

    or research practices. Id. at 2621-22. The plurality reasoned
    ___

    that the Act only preempted state law claims arising out of

    cigarette advertising and promotion, and that appellant's claims

    arising out of testing and research did not relate to advertising

    and promotion. The provision preempted petitioner's fraudulent

    misrepresentation claim that cigarette advertising neutralized

    ____________________

    2 That law stated that "[n]o requirement or prohibition based on
    smoking or health shall be imposed under State law with respect
    to the advertising or promotion of any cigarettes the packages of
    which are labeled in conformity with the provisions of this Act."
    Federal Cigarette Labeling and Advertising Act of 1965, 5, as
    amended by Public Health Cigarette Smoking Act of 1969, 2, 15
    U.S.C. 1334.

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    the effect of the warning in a similar fashion. Id. at 2623-24.
    ___

    The provision, however, did not preempt fraud claims arising out

    of communication other than advertising, such as information

    required to be disclosed to an administrative agency, or out of

    fraudulent statements made in the advertising but unrelated to

    the health warning. Id.
    ___

    The plurality further held that the provision did not

    preempt express warranty claims, because those claims arose due

    to the conduct of the manufacturers who made the warranties

    rather than from state law. Id. at 2622. Finally, the plurality
    ___

    held that the provision did not preempt the conspiracy to deprive

    the public of material facts claims, because they did not arise

    out of state law pertaining to smoking and health, but rather

    arose out of a "duty not to conspire to commit fraud." Id. at
    ___

    2624.

    The analysis of the plurality in Cipollone guides our
    _________

    analysis in this case. We begin by noting that the express

    preemption provision in the MDA, 21 U.S.C. 360k, forecloses

    inquiry into implied preemption, because the fact that Congress

    included it in the MDA implies that matters beyond its reach are

    not preempted. Further, we note that the Cipollone plurality
    _________

    carefully construed the preemption provision to extend no further

    than its language warranted. In doing so, the plurality sought

    to pay proper respect to federal-state relations. This concern

    arises out of "the assumption that the historic police powers of

    the states [are] not to be superseded by . . . Federal Act unless


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    that [is] the clear and manifest purpose of Congress."

    Cipollone, 112 S. Ct. at 2617 (citing Rice, 331 U.S. at 230). We
    _________ ____

    too will carefully construe the preemption provision of the MDA

    to give due regard to questions of federal-state relations.

    II.
    II.

    Bearing these principles in mind, we turn to the

    language of the statute in question. The MDA states that

    (a) Except as provided in subsection (b)
    of this section, no 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.

    21 U.S.C. 360k. Under subsection (b) of 360k, a state may

    petition the FDA in certain circumstances to allow state

    requirements to continue in force. Because no such petition

    affects this case, we are concerned only with the preemptive

    effect of subsection (a). Under subsection (a), we must

    determine whether appellant's products liability claims give rise

    to state law requirements in addition to or different from those

    mandated by the FDA.

    We turn first to the FDA's own understanding of

    subsection (a) for guidance. See Chevron U.S.A., Inc. v. Natural
    ___ ____________________ _______

    Resources Defense Council, Inc., 467 U.S. 837 (1984) (agency's
    ________________________________

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    interpretation of its own statute is controlling so long as not

    contrary to Congress' intent). FDA regulations provide that

    preemption does not apply when the FDA has issued no regulations

    or other requirements specific to the particular device. 21

    C.F.R. 808.1(d). In this case, it is clear that the FDA has

    imposed requirements on Zyderm related to labeling, design,

    manufacturing and other aspects of the device pursuant to the MDA

    scheme.

    If the FDA has issued requirements for a device,

    subsection (a) prohibits states from imposing any requirements

    which differ from or add to the FDA requirements, or which relate

    to the safety or effectiveness of the device. A "State . . .

    requirement" in subsection (a) may emanate from any requirement

    established by a state including statutes, regulations, court

    decisions or ordinances. 21 C.F.R. 808.1(b); see also San
    _________ ___

    Diego Building Trades Council v. Garmon, 359 U.S. 236, 247 (1959)
    _____________________________ ______

    ("[State] regulation can be as effectively exerted through an

    award of damages as through some form of preventive relief. The

    obligation to pay compensation can be, indeed is designed to be,

    a potent method of governing conduct and controlling policy.").

    The language of subsection (a) and the definition of

    state requirement promulgated under it demonstrate a field of

    preemption which is broad, but limited. Any state requirement

    which, in effect, establishes a new substantive requirement for

    the device in a regulated area such as labeling, is preempted.

    21 C.F.R. 808.1(d)(6)(ii). As the Seventh Circuit noted,


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    however, subsection (a) of the MDA does not preempt such claims

    as negligent implantation or removal of devices, or claims

    arising out of contaminated devices. Slater v. Optical Radiation
    ______ _________________

    Corp., 961 F.2d 1330, 1334 (7th Cir. 1992), cert. denied, 1992
    _____ ____________

    U.S. LEXIS 6436 (Oct. 13, 1992).

    Armed with this understanding of subsection (a), we

    will analyze petitioner's claims individually to determine the

    effect of the MDA preemption provision on each.

    A. Strict Liability
    ________________

    Appellant contends that Zyderm is unsafe for its

    intended purpose and unreasonably dangerous to users, and that

    Collagen therefore is liable for any injuries Zyderm may cause.

    Indeed, class III devices such as Zyderm are those that present a

    "potential unreasonable risk of illness or injury" such that

    extensive regulation is required to ensure reasonably safe use.

    21 U.S.C. 360c(a)(1)(C). The FDA must evaluate these devices

    with regard to those for whose use the device is intended. Id.
    ___

    360c(a)(2)(A). The entire MDA scheme for such Class III

    devices as Zyderm, therefore, is aimed at determining and

    regulating the intended purpose of the device, and at ensuring a

    reasonable level of safety for its users.

    It is clear that appellant's strict liability claim

    would impose requirements related to the safety and effectiveness

    of Zyderm. If successful, the claim would require Collagen to

    redesign Zyderm, remove it from the market, or be subject to

    strict liability. The MDA does not permit this. Appellant's


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    claim would force us to determine that Zyderm is unsafe and

    dangerous, in opposition to the contrary determination made by

    the FDA under the MDA. Subsection (a) protects manufacturers of

    medical devices approved by the FDA under the MDA from such state

    law intrusion.

    B. Breach of Warranty
    __________________

    Appellant claims that Collagen breached express and

    implied warranties of merchantability and fitness for a

    particular purpose. Appellant's express warranty claims arise

    out of the labeling and packaging of Zyderm, all of which are

    regulated by the FDA. In labeling and packaging, Collagen could

    not say any less than what the FDA required, and appellee could

    only add extra warnings or safety information, but not

    warranties, without FDA approval. Appellant's express warranty

    claims therefore are preempted because any such warranties only

    could arise out of the FDA-approved labeling and packaging.

    Allowing appellant's express warranty claims effectively would

    impose additional or different requirements on Zyderm's labeling

    and packaging.

    We note that the Court's holding in Cipollone would
    _________

    seem to require the opposite result in this case. However, the

    warnings at issue in Cipollone were different than those here.
    _________

    In Cipollone, the statute required cigarette manufacturers to
    _________

    include a brief health warning in their advertisements; this

    warning did not affect cigarette advertisements in any other way.

    The manufacturers were free to make any claims they wished,


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    including express warranties. Here, however, the MDA has imposed

    much more extensive regulation upon class III device

    manufacturers. The FDA retains rigid control over the entirety

    of the labeling and packaging of class III products, largely

    displacing the ability of manufacturers to make additional

    claims. This high level of control contrasts with the low level

    of control in Cipollone, and ensures that manufacturers will not
    _________

    be held liable for packaging and labeling imposed by the FDA.

    Appellant also alleges that Collagen breached an

    implied warranty of merchantability, and that this breach caused

    her injuries. As an implied warranty is a requirement upon a

    product that arises exclusively from the operation of state

    contract law, this claim is preempted expressly by the MDA.

    Otherwise, it would impose a requirement additional to those

    imposed under the MDA.

    C. Negligence
    __________

    Appellant's third claim alleges negligence in the

    design, manufacture, marketing and sale of Zyderm. This claim

    also is preempted by the MDA. If the MDA does nothing else, it

    regulates the design, manufacture, sale and marketing of class

    III medical devices in an extensive way. The MDA does this

    through the packaging and labeling requirements which directly

    affect the marketing and sale of the product. The same

    requirements also affect the design and manufacture of the

    product in that these processes must be approved by the FDA and

    described in the product's packaging and labeling.


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    As the design, manufacture, marketing and sale of

    Zyderm is the subject of FDA regulation, the negligence claim is

    preempted. Otherwise, a finding of negligence would force

    Collagen to alter these aspects of Zyderm in response to the

    finding of liability, or be subject to liability. Either result

    impermissibly would impose an additional or different state

    requirement upon the design, manufacture, marketing and sale of

    Zyderm.

    D. Product Misbranding, Misrepresentation & Failure to
    ___________________________________________________
    Warn
    ____

    Appellant contends that Zyderm was misbranded or

    mislabeled. Misbranding generally occurs when labeling is "false

    or misleading" in any particular. 31 U.S.C. 352(a). Under the

    MDA, the FDA must reject proposed labeling when the labeling is

    "false or misleading in any particular." Id. 360e(d)(2)(D).
    ___

    As there is no indication in the record that the Zyderm

    administered to Ms. King was anything but what the FDA-approved

    labeling said it would be, notwithstanding appellant's bald

    statements, we find this claim preempted.

    Appellant's fifth and sixth claims of misrepresentation

    and failure to warn are preempted for similar reasons. A finding

    that Collagen misrepresented Zyderm to appellant would impose a

    requirement on Collagen to change its packaging or labeling in

    order to correct the misrepresentation. The failure to warn

    claims similarly challenge the adequacy of Zyderm's FDA-regulated

    packaging and labeling. The MDA forecloses these claims because

    Collagen cannot be forced to change Zyderm's packaging and

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    labeling by virtue of these state law damage claims.

    E. Fraud
    _____

    Appellant's final cause of action alleges that Collagen

    fraudulently obtained FDA approval at the premarketing stage of

    the MDA process, and asks for treble damages due to the fraud.

    This cause of action is more unclear than her other causes of

    action. Collagen insists that the claim originally was based

    upon Mass. Gen. L. ch. 231, 85J, an antifraud statute, while

    appellant urges that it was based on a more general duty not to

    deceive.

    Section 85J provides that "[w]hoever, by deceit or

    fraud, sells personal property shall be liable in tort to a

    purchaser in treble the amount of damages sustained by him." The

    language of this statute corresponds to Ms. King's fraud claim in

    providing for treble damages. Because Ms. King has not specified

    any applicable statute, or other reason why she is entitled to

    treble damages under a general duty not to deceive, we must

    conclude that the fraud claim originally arose under 85J. The

    district court made the same finding in its memorandum and order

    in this case.

    To state a claim for fraud under 85J, the plaintiff

    must be in privity with the seller. Kourouvacilis v. General
    _____________ _______

    Motors Corp., 410 Mass. 706, 575 N.E.2d 734, 735 (1991). In this
    ____________

    case, no privity existed between appellant and Collagen, as

    Collagen only sold its product directly to appellant's physician.

    Thus, as a matter of Massachusetts law, appellant's fraud claim


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    must fail.

    We further note that the fraud claim is, at bottom, a

    failure to warn claim. It seeks to show that Collagen had a duty

    to provide different information in Zyderm's packaging and

    labeling than that which was approved by the FDA. As such, the

    claim is preempted expressly by the MDA.

    CONCLUSION
    CONCLUSION
    __________

    Because we have determined that the MDA expressly

    preempts Ms. King's state law tort claims, the judgment of the

    district court is affirmed.
    ________

    "Concurrence follows"
































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    ALDRICH, Senior Circuit Judge, with whom CAMPBELL,
    ____________________

    Senior Circuit Judge, joins, concurring. While we agree with
    ____________________

    our brother Torruella's result, and a good deal that he says,

    we approach this case somewhat differently. First, a matter

    of housekeeping. On December 13, 1991, a year past the

    scheduled date for completion of the pleadings, plaintiff

    filed a motion to allow an amended complaint, accompanied by

    the complaint. On December 17 she wrote defendant that she

    would withdraw her motion. Defendant, accordingly, did not

    oppose. On December 27 defendant moved for summary judgment.

    In opposing defendant's motion for judgment plaintiff made no

    mention of the proposed new complaint, but, in fact, she did

    not withdraw her motion, and the court later allowed it.

    However, the court's ultimate order granting summary judgment

    did not mention the amendment.

    At first blush we might agree with defendant's

    objection that there were substantive additions in the

    amended complaint, particularly with relation to fraud.

    Apart from fraud, the rest of the amended complaint contains

    six claims as against, originally, two -- negligence and

    breach of implied warranty. There was definitely a purported

    enlargement -- a state tort of strict liability, and a claim

    of express warranty. While the negligence alleged is limited

    to designing and producing a dangerous product, and not that

    the sample sold plaintiff was in some way a departure and



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    individually defective, plaintiff adds mislabeling and

    misrepresentation, and, finally, failure to warn.

    Taking defendant's now alleged seven sins, we group

    them as follows. Strict liability (negligent design),

    implied warranty, negligence, mislabeling, and failure to

    warn are really all of a piece -- failure to warn. On the

    record it is clear that had there been a warning that the

    product might cause the disease that plaintiff allegedly

    suffered she would have no claim under any of these headings.

    On this basis there is thus no real enlargement by the

    amended complaint. Express warranty might be enlargement,

    but there is no basis for claiming it.3 Finally, fraud and

    misrepresentation are not as newly put as they look.

    Defendant would have it that the original allegation related

    only to representations made to the plaintiff. Plaintiff

    states that she intended her language to include

    misrepresentations to the agency. Two of her exhibits

    seeking to raise an issue on the motion for summary judgment

    bear this out. The amendment should stand, as mere

    clarification. However, we read fraud more broadly than does

    our brother, and shall return to it later.

    All agree that there is one basic issue: federal

    preemption. Preemption may apply against state judicial as


    ____________________

    3. Express warranty might have created a problem for the
    defense of preemption, cf. Cipollone v. Liggett Group, Inc.,
    __ _________ ___________________
    112 S. Ct. 2608, 2622-23 (1992).

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    well as legislative action,4 Cipollone v. Liggett Group,
    _________ ______________

    Inc., 112 S. Ct. 2608 (1992), and may take two forms, express
    ____

    and implied, with a heavy burden upon the party asserting it.

    Jones v. Rath Packing Co., 430 U.S. 519, 525 (1977). This is
    _____ ________________

    especially so when the subject is the state interest in

    health and safety. Hillsborough County v. Automated Medical
    ___________________ _________________

    Labs, Inc., 471 U.S. 707, 715, 718-19 (1985). The question
    __________

    is Congressional intent. Wood v. General Motors Corp., 865
    ____ ____________________

    F.2d 395, 401 (1st Cir. 1988), cert. denied, 494 U.S. 1065
    ____________

    (1990). Here, concededly, the statute's purpose is health

    protection, but the parties disagree as to its scope.

    Plaintiff says it is directed to the individual user by

    keeping harmful products off the market and assuring proper

    warnings. Defendant says it is also to benefit the public at

    large by shielding regulated manufacturers against

    inconsistent state regulation, including lawsuits. If their

    legal risks may be too great, worthwhile medical devices may

    be left in the laboratory, to the public's loss.

    Public health is a valid federal purpose, and

    Congress can reasonably weigh possible loss to the

    idiosyncratic few against benefits to the public generally.

    See, e.g., Mary Beth Neraas, The National Childhood Vaccine
    ___ ____

    Injury Act of 1986: A Solution to the Vaccine Liability



    ____________________

    4. A matter that may have troubled the court in Wood v.
    ____
    General Motors, post. See, also, 21 C.F.R. 808.1(b).
    ______________ ____ ___ ____

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    Crisis? 63 Wash. L. Rev. 149 (1988). The legislative

    history shows that this was precisely the Congressional

    intent. Concededly, the U.S. Code Congressional and

    Administrative News, 94th Congress, Second Session, Vol. 3,

    pp. 1070 et seq., Medical Device Amendments of 1976, shows
    __ ___

    the principal emphasis to be on the protection of the

    individual user. But it also shows the intent to "encourage

    . . . research and development" and "permit new and improved

    devices to be marketed without delay." Infra. Perfection is
    _____

    impossible and a few individuals may be denied full

    protection at the cost of benefitting the rest.

    Contained within the Senate Report (94-33)5 are

    the following.

    As medicine progresses, as research
    makes new breakthroughs, an increasing
    number of sophisticated, critically
    important medical devices are being
    developed and used in the United States.
    These devices hold the promise of
    improving the health and longevity of the
    American people. The Committee wants to
    encourage their research and development.
    [1071]

    S. 2368 recognizes the benefits that
    medical research and experimentation to
    develop devices offers to mankind. It
    recognizes, too, the need for regulation
    to assure that the public is protected
    and that health professionals can have
    more confidence in the performance of
    devices. [1075]




    ____________________

    5. The Senate bill was passed in lieu of the House bill.

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    The Committee recognizes the rapidly
    changing nature of the devices field and
    therefore feels that provisions must be
    made to amend standards on the basis of
    improved technology or new scientific
    evidence. Such amendments should be made
    in an expedited fashion so that
    appropriate changes can be rapidly
    implemented. The purpose of this
    authority is to permit new or improved
    devices to be marketed without delay so
    that the public may have such beneficial
    devices available to them as soon as
    possible. [1083]

    Translating this into a simple concept, and taking

    the difference of opinion between the parties to be whether

    the FDA requirements are merely minimum, or are the total

    maximum protection afforded the individual user, we believe

    this a clear demonstration of Congressional choice of the

    latter. We further find that the comprehensive statutory

    language conforms thereto.

    21 U.S.C. 360e(c)(1) provides,

    (1) Any person may file with the
    Secretary an application for premarket
    approval for a class III device. Such an
    application for a device shall contain --

    (A) full reports of all
    information, published or known to
    or which should reasonably be known
    to the applicant, concerning
    investigations which have been made
    to show whether or not such device
    is safe and effective;

    (B) a full statement of the
    components, ingredients, and
    properties and of the principle or
    principles of operation, of such
    device;



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    (C) 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;

    (D) an identifying reference
    to any performance standard under
    section 360d of this title which
    would be applicable to any aspect of
    such device if it were a class II
    device, and either adequate
    information to show that such aspect
    of such device fully meets such
    performance standard or adequate
    information to justify any deviation
    from such standard;

    (E) such samples of such
    device and of components thereof as
    the Secretary may reasonably
    require, except that where the
    submission of such samples is
    impracticable or unduly burdensome,
    the requirement of this subparagraph
    may be met by the submission of
    complete information concerning the
    location of one or more such devices
    readily available for examination
    and testing;

    (F) specimens of the labeling
    proposed to be used for such device;
    and

    (G) such other information
    relevant to the subject matter of
    the application as the Secretary,
    with the concurrence of the
    appropriate panel under section 360c
    of this title, may require.

    Following these detailed requirements, and we note

    especially subsection (F), comes Section 360k(a).

    [N]o State or political subdivision of a
    State may establish or continue in effect



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    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.

    Particularly in the light of the legislative history we read

    this as maximum protection and express preemption, leaving no

    need to seek implications. As all but one of plaintiff's

    sustainable claims are premised on a failure to warn,

    preemption here is unavoidable, given the subsection (F)

    requirement that labels be reviewed by the FDA.

    It follows that most of plaintiff's arguments are

    beside the mark. A few, however, may deserve mention.

    Plaintiff claims that because of the regulation reported in

    21 C.F.R. 814.39(d)(1), to the effect that a manufacturer

    "may," without prior approval, make certain changes that

    enhance safety, defendant had a duty to make such here. It

    is sufficient to say that to interpret "may" as "should"

    would unravel the entire garment. Second, citing Silkwood v.
    ________

    Kerr-McGee Corp., 464 U.S. 238, 251 (1984), plaintiff says
    ________________

    that, if defendant is correct, she has no cause of action.

    Given an ambiguity, this objection is a factor in statutory

    construction, but, of itself, it cannot create an ambiguity,


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    or there could never be preemption. Finally, plaintiff says

    that the FDA's preemption regulation, 21 CFR 808.1(d)

    conflicts with our result. When a statute is clear the

    agency interpretation must give way. Hillsborough County,
    ___________________

    471 U.S. at 714-15.

    A more troublesome issue is the claim labeled

    fraud.

    FRAUD
    _____

    . . . Defendant Collagen Corporation
    fraudulently obtained FDA approval of the
    Zyderm PMA, product and labeling, which
    was a producing or proximate cause of
    damage and injury to Plaintiff.
    Defendant . . . further acted to suppress
    the facts, blame injuries or other causes
    that its product (sic) and prevent
    disclosure of the true risks.[6]

    Plaintiff has a case in point. In Hurley v.
    ______

    Lederle Laboratories Division of American Cyanamid Co., 863
    _______________________________________________________

    F.2d 1173 (5th Cir. 1988), the court, though agreeing with

    the district court that the FDA regulation with respect to

    defendant's vaccine labeling was intended to be preemptive,

    remanded. At issue was the same tension between protecting

    idiosyncratic individuals and the public health. Balancing

    these, the Court concluded,




    ____________________

    6. As in the original complaint, plaintiff sought treble
    damages. Though not mentioned, presumably this demand
    invoked Mass. G.L. c. 231, 85J, that awards treble damages
    in certain cases of "deceit or fraud." We do not read it,
    however, as limiting the scope of plaintiff's claims.

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    [T]his issue should be presented to the
    jury in the form of special
    interrogatories, questioning whether and
    what information the manufacturer
    withheld from the FDA, if any, and
    whether possession of this information
    would have materially altered the content
    of the FDA's warning. This special
    procedure is justified by the federal
    interest in encouraging manufacturers to
    produce vaccines, in that those
    manufacturers need some assurance that if
    they follow certain prescribed
    procedures, such as including an FDA-
    approved warning, they are complying with
    the law.

    Id. at 1180. With respect, one may wonder how "encouraging"
    __

    manufacturers would view the ruling.7 Rather, we side with

    the later case of Papas v. Upjohn Co., 926 F.2d 1019 (11th
    _____ ___________

    Cir. 1991), where the court said, at 1026 n.8,

    To the extent that Hurley purports to
    ______
    recognize an exception to federal
    preemption of common law tort labeling
    claims when the federal statute involved
    explicitly prohibits state regulation of
    labeling and the federal agency has
    received incomplete information from the
    manufacturer, we reject its holding at
    least as applied to FIFRA-regulated
    pesticides. Given the FIFRA regulatory
    scheme, it would be up to the EPA -- and
    not a jury -- to determine first (1)
    ___
    whether the information provided was
    incomplete or inaccurate; (2) whether the
    omitted information is significant enough
    to mandate a change in the label; and (3)
    how, if at all, the label should be
    corrected.




    ____________________

    7. Indeed, we are reminded of the observation that the
    British hanged a negligent admiral "pour encourager les
    autres." Voltaire, Candide, Ch. 23.
    _______

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    To prove fraud, plaintiff must show causality. Surely, where

    the FDA was authorized to render the expert decision on

    Collagen's use and labeling, it, and not some jury or judge,

    is best suited to determine the factual issues and what their

    effect would have been on its original conclusions. Further,

    if the court erred, and incorrectly posited the effect on the

    FDA's use and labeling decision, this would impose a state

    requirement "which is different from, or in addition to, any

    requirement applicable . . . to the device." 21 U.S.C.

    360k(a). In addition to running afoul of the general

    principle against implying personal causes of action, Royal
    _____

    Bus Group, Inc. v. Realist, Inc., 933 F.2d 1056 (1st Cir.
    _______________ ______________

    1991), plaintiff would be breaching the federal dyke in the

    absence of its keeper.

    Papas has been vacated and remanded for further
    _____

    consideration in the light of Cipollone, 112 S. Ct. 2608, but
    _________

    we do not believe this to be a reversal on that point. Our

    position is consistent with Cipollone, that did not preempt
    _________

    fraud found to be outside the communication targeted by the

    regulation.8 112 S. Ct. at 2623-24.






    ____________________

    8. Plaintiff similarly presents a claim for
    misrepresentation, both to the public and to plaintiff's
    physician. As the record shows no statements to the public
    or physicians that go beyond those approved by the FDA, this
    claim collapses into that of fraud on the FDA.

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