C.K. v. Oakland Cmty. Health Network, 20-13301

CourtUnited States District Courts. 6th Circuit. United States District Court (Eastern District of Michigan)
Writing for the CourtDAVID M. LAWSON UNITED STATES DISTRICT JUDGE
PartiesC.K. by his Next Friend, MARISSA SPRINGSTEAD, Plaintiff, v. OAKLAND COMMUNITY HEALTH NETWORK, DANA LASENBY, MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES, ROBERT GORDON, and GOVERNOR GRETCHEN WHITMER, in her official capacity, Defendants.
Docket Number20-13301
Decision Date25 August 2021

C.K. by his Next Friend, MARISSA SPRINGSTEAD, Plaintiff,
v.

OAKLAND COMMUNITY HEALTH NETWORK, DANA LASENBY, MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES, ROBERT GORDON, and GOVERNOR GRETCHEN WHITMER, in her official capacity, Defendants.

No. 20-13301

United States District Court, E.D. Michigan, Southern Division

August 25, 2021


OPINION AND ORDER GRANTING IN PART MOTION FOR PRELIMINARY INJUNCTION AND GRANTING STATE DEFENDANTS' MOTION TO DISMISS

DAVID M. LAWSON UNITED STATES DISTRICT JUDGE

Plaintiff C.K. is a developmentally disabled adolescent who is eligible to receive mental health and community living support services through Medicaid. In 2017, he filed a lawsuit through Marissa Springstead, his mother and Next Friend, against the Oakland Community Health Network (OCHN) and its director, the Michigan Department of Health and Human Services (MDHHS) and its director, and the then-Governor of Michigan (in his official capacity) to compel them to furnish certain support services for his behavioral needs and to which he believed he was entitled under Medicaid. The parties entered into a written settlement agreement, which the Court approved and retained jurisdiction to enforce. In the present case, C.K. has sued the original defendants and the current Michigan governor in her official capacity alleging that the defendants have not lived up to their obligations under that agreement, and he now asks for declaratory and injunctive relief that will ensure that he receives the promised benefits.

The plaintiff also filed a motion for a preliminary injunction to compel the defendants to furnish certain community living and respite services while this case is pending. The Court held an evidentiary hearing conducted via video teleconference facilities on May 12, 2021, and heard the testimony of three witnesses, including C.K.'s mother. Defendant OCHN furnished two affidavits by its executive director. The Court took the motion under advisement, and the parties filed supplemental briefs. The state defendants (MDHHS, its director, and Governor Whitmer) have filed a motion to dismiss alleging that the complaint in this case fails to state a claim against them. The Court recently heard oral argument on that motion, again by teleconference facility. The parties, unfortunately, could not tell the Court that the poor staffing circumstances described at the May 12 hearing since have improved.

The plaintiff has shown that he would suffer irreparable injury absent an injunction mandating the furnishing of community living support, respite, and intensive crisis stabilization services as promised by the OCHN defendants in the settlement agreement. However, he has not made the required showing against the state defendants. The motion for a preliminary injunction, therefore, will be granted in part. The plaintiff has not alleged facts that show that the state defendants breached the settlement agreement or otherwise failed to comply with its terms. Their motion to dismiss will be granted.

I.

A.

According to the complaint, plaintiff C.K. is a 15-year-old Medicaid beneficiary diagnosed with autism spectrum disorder, learning disabilities, and obsessive-compulsive and moodregulation disorders. He has a history of severe outbursts, uncontrolled behavior, and physical aggression, which has resulted in him being hospitalized at least five times for psychiatric treatment. He lives with his mother in his grandmother's house in Oakland County and receives community living support services through the OCHN and the Macomb Oakland Regional Network (MORC). According to his mother, Marissa Springstead, C.K. is capable of living in the community with appropriate services. Springstead says that without appropriate services, C.K. is at high risk of institutionalization.

The OCHN is a specialty prepaid health plan, which is a Medicaid-managed care organization responsible for “providing defined inpatient services, outpatient hospital services, physician services, other specific Medicaid state plan services, and additional services approved by the Centers for Medicare and Medicaid Services under section 1915(b)(3) of Title XIX” of the Social Security Act, 42 U.S.C. § 1396n. Mich. Comp. Laws § 400.109f. Michigan law requires that the OCHN provide mental health services to people with developmental disabilities or serious mental illness living in Oakland County, Michigan. See Mich. Comp. Laws § 330.1208; Mot. PI, ECF No. 13, PageID.81. The OCHN meets its obligations under those statutes by subcontracting with other organizations to provide patient services. Usually, it subcontracts with the MORC to arrange and pay for C.K.'s services. Generally, the MORC would then contract with service providers to furnish the services in C.K.'s individual plan of service.

C.K.'s mother swore in an affidavit that these services “are essential” for C.K.'s health. She explained that C.K. “struggles to communicate, regulate his emotions and express himself appropriately.” Springstead Aff. ¶ 37, ECF No. 13-2, PageID.93. He “often fixates on things and people, ” and if he does not get what he wants, he often exhibits aggressive or violent behavior. Id. at ¶ 39. The community living support services “are designed to help him cope with his emotions, teach him how to communicate appropriately, and express himself without aggression.” Id., ¶ 38 at PageID.94. The service providers “use techniques to redirect him from what he is fixating on . . . with small games or sensory activities. Id. at ¶ 40. And when C.K. fixates on this mother, his service providers “act as an intermediary, redirecting the fixation before CK” acts aggressively. Id. at ¶ 42.

B.

In June 2017, C.K. sued the present defendants and then-Michigan Governor Rick Snyder for declaratory and injunctive relief requiring that the defendants provide certain support services for his behavioral needs. C.K. v. Michigan Dep't of Heath of Human Servs., No. 17-11988. He demanded that he be provided adequate intensive crisis stabilization, applied behavior analysis, community living support services, and respite services under Michigan's Medicaid program. Community living support services are supposed to give C.K. the tools to avoid his potentially dangerous behavior. Intensive crisis stabilization services are meant to intervene when those tools fail. He alleged that discharging him from a hospital without those support services violated his rights under the Americans with Disabilities Act, 42 U.S.C. § 12132 et seq., the Rehabilitation Act of 1973, 29 U.S.C. § 794, and the Social Security Act, 42 U.S.C. §1396a(a)(10), including the “reasonable promptness” provision of section 1396a(a)(8).

The parties settled that case, with the defendants agreeing to pay C.K. $32, 500 (split between the OCHN and MDHHS defendants equally) in exchange for a full release of all claims against them. Additionally, the agreement called for the provision of additional services, and provisions were made for staffing guarantees. The key language of the agreement reads as follows:

3. Intensive Crisis Stabilization Services (ICSS) has been added to CK's Individual Plan of Service as medically necessary. These services will be provided as long as they are determined to be medically necessary through New Oakland or another appropriate ICSS provider. These services will be provided in accordance with the Michigan Medicaid Provider Manual. Response time within Oakland County will be within one hour with the exception of unforeseen circumstances (which will be no more than two hours)
4. Community Living Support (CLS) Services and In-Home Respite will be provided to CK as indicated in the IPOS and scheduled in compliance with the Medicaid Provider Manual Ms. Springstead will no longer be the Employer of Record (EOR) for CLS or In-Home Respite Services. OCHN will require that the contract with any CLS and/or In-Home Respite provider has stipulations preventing the provider from discontinuing service without notice and/or prior to another provider or staffing option being identified. OCHN will enforce contract provisions with MORC to supply its own staff on those occasions where a sub-contracted provider cannot staff CLS and/or In-Home Respite Services. MORC will ensure coordination of care between CLS and ABA by facilitating informal training (shadowing) education, and ongoing communication. At no time will OCHN condone or fund duplicative services

Compl., Ex. A, Settlement Agreement, ECF No. 1-2, PageID.23. C.K. is entitled to about three hours of in-home services per day.

The Court approved the settlement and dismissed the case on April 24, 2018.

C.

The plaintiff lived at home with proper services from June 2018 until March 2020, when the coronavirus pandemic began to upset most aspects of daily living. The parties' differing accounts of what happened during and after March 2020 reflect the plaintiff's unfulfilled needs against the backdrop of the defendants' struggles to address them.

According to the plaintiff, the MORC informed C.K.'s mother that it would no longer have staff to provide his community living supports or respite services. C.K.'s mother states in an affidavit that C.K. did not resume receiving those services until August 10, 2020. She says that from August 10 to October 23, 2020, C.K. had “at least some staff for his” services, but that they “did not fill all of [his]” service hours. C.K.'s services completely stopped from October 23, 2020 through January 3, 2021. On January 4, New Horizons furnished 19 community living support hours split between two staff until January 15, 2021.

The defendants, on the other hand, assert that rather than cutting C.K. off from services, C.K.'s mother advised the MORC that she was very concerned about having staff in her house due to the pandemic and the risk of exposure to her elderly parents, which,...

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