290 F.3d 178 (4th Cir. 2002), 01-1693, Antrican v. Odom

Docket Nº:01-1693.
Citation:290 F.3d 178
Party Name:Samuel ANTRICAN, minor; Alana Antrican, minor, by their next friend Angela Antrican; Jeshod Hughes, minor; Emani Tatum, minor, by their next friend Thea Gilbert; Arielle McCree, minor, by her next friend Sherry McCree; Austin Brooks, minor, by his next friend Marty Greer, on behalf of themselves and all others similarly situated, Plaintiffs-Appelle
Case Date:May 09, 2002
Court:United States Courts of Appeals, Court of Appeals for the Fourth Circuit
 
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290 F.3d 178 (4th Cir. 2002)

Samuel ANTRICAN, minor; Alana Antrican, minor, by their next friend Angela Antrican; Jeshod Hughes, minor; Emani Tatum, minor, by their next friend Thea Gilbert; Arielle McCree, minor, by her next friend Sherry McCree; Austin Brooks, minor, by his next friend Marty Greer, on behalf of themselves and all others similarly situated, Plaintiffs-Appellees,

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v.

Carmen Hooker ODOM, Secretary of the North Carolina Department of Health and Human Services; Nina M. Yeager, Director of the North Carolina Division of Medical Assistance, Defendants-Appellants.

United States of America, Amicus Curiae.

No. 01-1693.

United States Court of Appeals, Fourth Circuit

May 9, 2002

Argued Feb. 26, 2002.

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[Copyrighted Material Omitted]

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ARGUED:

Ronald Moore Marquette, Special Deputy Attorney General, North Carolina Department of Justice, Raleigh, North Carolina, for Appellants.

Martha Jane Perkins, National Health Law Program,

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Chapel Hill, North Carolina, for Appellees.

Alisa Beth Klein, Appellate Staff, Civil Division, United States Department of Justice, Washington, D.C. for Amicus Curiae.

ON BRIEF:

Roy Cooper, North Carolina Attorney General, Robert J. Blum, Special Deputy Attorney General, Emery E. Milliken, Assistant Attorney General, North Carolina Department of Justice, Raleigh, North Carolina, for Appellants.

Reid C. Adams, Jr., Womble, Carlyle, Sandridge & Rice, Winston-Salem, North Carolina; Garth Gersten, Womble, Carlyle, Sandridge & Rice, Research Triangle Park, North Carolina; Carlene McNulty, North Carolina Justice & Community Development Center, Raleigh, North Carolina, for Appellees.

Robert D. McCallum, Jr., Assistant Attorney General, John Stuart Bruce, United States Attorney, Mark B. Stern, Appellate Staff, Civil Division, United States Department of Justice, Washington, D.C. for Amicus Curiae.

Before NIEMEYER and HAMILTON, Circuit Judges, and JACKSON, United States District Judge for the Eastern District of Virginia, sitting by designation.

Affirmed by published opinion. Judge NIEMEYER wrote the opinion, in which Senior Judge HAMILTON and Judge JACKSON joined.

OPINION

NIEMEYER, Circuit Judge.

Several North Carolina Medicaid beneficiaries commenced this class action under 42 U.S.C. § 1983 against North Carolina State officials to obtain (1) a declaratory judgment that dental screening and treatment services provided to minors in North Carolina under the Medicaid program are inadequate and fail to comply with the requirements of the Medicaid Act and (2) an injunction requiring the State officials to comply with the Medicaid Act by making dental screening and treatment promptly available. The district court, relying on Ex Parte Young, 209 U.S. 123, 28 S.Ct. 441, 52 L.Ed. 714 (1908), denied the North Carolina State officials' motion to dismiss based on Eleventh Amendment immunity. The court also rejected the officials' other jurisdictional challenges. On this interlocutory appeal, we affirm the district court's ruling on Eleventh Amendment immunity, and we decline to exercise pendent appellate jurisdiction over the other grounds on which the State officials relied to support their motion to dismiss the complaint.

I

The plaintiffs, who are minors, allege in their complaint that they have been denied the dental care prescribed by Title XIX of the Social Security Act, known as the "Medicaid Act." Noting that only 16% of North Carolina's dentists participate in the Medicaid program, they allege that they are unable to locate local dentists who are willing to treat them in exchange for Medicaid reimbursement. They assert that Medicaid beneficiaries in North Carolina generally must conduct extensive searches and travel long distances to locate and utilize the services of a dentist who will accept Medicaid reimbursement.

Describing their own experiences, Emani Tatum, 3, alleges that she has had to travel two hours each way to utilize the services of a dentist. While a dental clinic closer to her provided an initial screening, that clinic was unable to provide ongoing care. As a result of the inaccessibility of prompt and adequate care, she has had to have extensive dental care, including three fillings and two crowns. JeShod Hughes, 9, alleges that he has had similar difficulties in obtaining treatment. Arielle

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McCree, 6, alleges that her mother contacted the local Department of Social Services to find a dentist, only to be referred to the public health clinic, which was unable to provide dental services. The Department of Social Services then could not provide the name of any dentist for McCree who would accept Medicaid reimbursement. McCree's mother eventually located a dentist an hour away. Austin Brooks, 6, alleges that his grandmother contacted numerous dentists in his area, but none would accept Medicaid. Because he could not locate a dentist in his area, he could not receive preventive dental treatment. When he began experiencing oral pain, his grandmother located a dentist three hours away. Because of the lack of preventative dental care, Brooks has had to have four of his front teeth pulled and several of his remaining teeth capped.1

Because of their inability to receive adequate dental care, these plaintiffs, through their parents, guardians, or next friends, commenced this action on behalf of themselves and on behalf of others similarly situated against Carmen Hooker Buell, Director of the North Carolina Department of Health and Human Services, and Nina M. Yeager, Director of the North Carolina Division of Medicaid Assistance, in their official capacities.2 Plaintiffs allege that the defendants have: (1) denied North Carolina Medicaid beneficiaries equal access and quality care, in violation of 42 U.S.C. § 1396a(a)(30)(A) and 42 C.F.R. § 447.204; (2) failed to ensure statewide availability of dental services, in violation of 42 U.S.C. § 1396a(a)(1) and 42. C.F.R. § 431.50; (3) denied North Carolina Medicaid beneficiaries timely dental care, in violation of 42 U.S.C. § 1396a(a)(8) and 42 C.F.R. § 435.930; (4) denied Medicaid beneficiaries a free choice of dental care providers, in violation of 42 U.S.C. § 1396a(a)(23) and 42 C.F.R. § 431.51; (5) denied Medicaid beneficiaries dental care that is comparable to the care available to non-Medicaid patients, in violation of 42 U.S.C. § 1396a(a)(10)(B) and 42 C.F.R. §§ 440.230, 440.240; and (6) denied Medicaid beneficiaries proper access to early screening and treatment services, in violation of 42 U.S.C. §§ 1396a(a)(10)(A), 1396a(a)(43), 1396d(a)(4)(B), 1396d(R), and 42 C.F.R. § 441.50 et seq.

For relief, the plaintiffs request (1) a judgment declaring that "the Defendants'

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failure to insure the availability of dental services violates Plaintiffs' rights under the Social Security Act . . . and its implementing rules and regulations" and (2) an injunction requiring the defendants to "make needed dental services immediately available to Medicaid beneficiaries in their respective localities" and requiring the defendants "to comply with the Federal statutes, rules, and regulations" governing Medicaid programs.

The North Carolina officials filed a motion to dismiss the plaintiffs' complaint, asserting Eleventh Amendment immunity, a lack of standing, and the failure of the complaint to state a claim under 42 U.S.C. § 1983 upon which relief can be granted. From the district court's order denying their motion, the North Carolina officials filed this interlocutory appeal, challenging the district court's ruling denying them Eleventh Amendment immunity. They also ask this court to exercise pendent appellate jurisdiction over the other rulings made by the district court.

II

The district court's order denying State officials Eleventh Amendment immunity is an immediately appealable order, see Puerto Rico Aqueduct & Sewer Auth. v. Metcalf & Eddy, Inc., 506 U.S. 139, 144, 113 S.Ct. 684, 121 L.Ed.2d 605 (1993), and our review of this order is de novo, see CSX Transp., Inc. v. Bd. of Pub. Works, 138 F.3d 537, 541 (4th Cir. 1 998).

The North Carolina officials contend that, because they have been sued in their official capacities, they are entitled to sovereign immunity under the Eleventh Amendment to the Constitution. They argue that the exception to such immunity, described in Ex Parte Young, 209 U.S. 123, 28 S.Ct. 441, 52 L.Ed. 714 (1908), is not applicable.

The Ex Parte Young exception to Eleventh Amendment immunity is designed to preserve the constitutional structure established by the Supremacy Clause. Thus, it allows private citizens, in proper cases, to petition a federal court to enjoin State officials in their official capacities from engaging in future conduct that would violate the Constitution or a federal statute. See Ex Parte Young, 209 U.S. at 159, 28 S.Ct. 441 (enjoining enforcement of a State statute found to violate the U.S. Constitution); Green v. Mansour, 474 U.S. 64, 68, 106 S.Ct. 423, 88 L.Ed.2d 371 (1985) (applying Ex Parte Young to an action involving State violation of a federal statute). This exception to sovereign immunity is based on the notion, often referred to as "a fiction," that a State officer who acts in violation of the Constitution is "stripped of his official or representative character and is subjected in his person to the consequences of his individual conduct." Ex Parte Young, 209 U.S. at 160, 28 S.Ct. 441. A State officer acting in violation of federal law thus loses "the 'cloak' of State immunity," Bragg v. West Virginia Coal Ass'n, 248 F.3d 275, 292 (4th Cir. 2 001), cert. denied, — U.S. —, 122 S.Ct. 920, 151 L.Ed.2d 885 (2002), because in such a situation, "[t]he State has no power to impart to [the...

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