H.E. v. Horton
| Decision Date | 07 November 2016 |
| Docket Number | 1:15-cv-3792-WSD |
| Parties | H.E., by and through William and Jennifer Emerich, her adoptive parents and legal guardians as next friends, Plaintiff, v. KEITH HORTON, et al., Defendants. |
| Court | U.S. District Court — Northern District of Georgia |
This matter is before the Court on Defendants'1 Motion to Dismiss Amended Complaint [28] ("Motion to Dismiss"). Also before the Court is Plaintiff H.E.'s, by and through William and Jennifer Emerich, her adoptive parents and legal guardians as next friends, ("Plaintiff") Motion for Preliminary Injunction [34].
Plaintiff is a six-year old girl who suffers from certain psychiatric and emotional illnesses. (Am. Compl. [25] ¶¶ 2, 21). In April 2012, the juvenile court in Clayton County, Georgia placed Plaintiff and her two sisters into the care of Jennifer and William Emerich, after finding the placement was in the best interests of the children. (Am. Compl. ¶ 22). Plaintiff alleges that, at the time of their placement with the Emerich family, Plaintiff and her sisters were eligible for adoption assistance benefits under Title IV-E of Social Security Act. (Am. Compl. ¶ 23). A state medical card was issued to the Emerichs for the benefit of Plaintiff and her sisters. The card entitled Plaintiff and her sisters to comprehensive physical and mental health care coverage. (Am. Compl. ¶ 23).
Plaintiff alleges that Title IV-E adoption assistance and entitlement to Medicaid "go hand in hand." (Am. Compl. ¶ 24). According to Plaintiff, individuals who are eligible for Title IV-E adoption assistance are automatically in a group of Medicaid beneficiaries referred to as "mandatory categorically needy." (Am. Compl. ¶ 24). In other words, according to Plaintiff, her receipt of Medicaid was automatic by virtue of her eligibility for Title IV-E adoption assistance. (Am. Compl. ¶ 24).
Plaintiff alleges that Georgia was, and continues to be, legally obligated to provide Plaintiff medically necessary psychiatric treatment, pursuant to the State's participation in the federal Medicaid program. (Am. Compl. ¶ 25). From April 2012 to December 2012, Plaintiff and her sisters received full medical care coverage. In December 2012, "services were abruptly cancelled without notice." (Am. Compl. ¶ 26).
Plaintiff alleges that the Individual Capacity Defendants2 ignored Ms. Emerich's requests for assistance "in correcting the improper categorization of [Plaintiff]'s Medicaid eligibility and in making available to [Plaintiff] all medically necessary health care treatment." (Am. Compl. ¶ 28). Plaintiff alleges she made each of the Individual Capacity Defendants aware of Plaintiff's severe illnesses, behavioral health challenges, and developmental disabilities. (Am. Compl. ¶ 28).
Plaintiff alleges that, without appropriate medical care, Plaintiff's medical conditions grew worse. She was hospitalized multiple times and required multiple surgeries to correct her worsening self-injurious behaviors. (Am. Compl. ¶ 29). The Emerichs paid "out of pocket for some of the medically necessary servicesDefendants were legally obligated to approve and make available to [Plaintiff]." (Am. Compl. ¶ 30).
Plaintiff alleges that, in July 2013, the Individual Capacity Defendants acknowledged the legal obligation to provide medically necessary care and treatment to Plaintiff, and that the prior failures to make these services available to Plaintiff were the result of mis-categorizing her Medicaid eligibility in December 2012. (Am. Compl. ¶ 31). In July 2013, the Individual Capacity Defendants or their agents issued a corrected, retroactive statement indicating Plaintiff had been Title IV-E eligible since April 2012, when she was placed with the Emerich family. (Am. Compl. ¶ 32).
Plaintiff alleges that she continued to be denied access to medically necessary care and treatment after the July 2013 correction. (Am. Compl. ¶ 33). In May 2014, the Individual Capacity Defendants corrected Plaintiff's erroneous Medicaid eligibility categorization. (Am. Compl. ¶ 34). Even after this correction, Plaintiff did not have access to medically necessary care and treatment. (Am. Compl. ¶¶ 34, 35).
Plaintiff alleges that the Medicaid Act, 42 U.S.C. § 1396 et seq., requires a participating State's medical plan to include mandatory Early and Periodic Screening, Diagnosis and Treatment ("EPSDT") services for all Medicaid-eligiblechildren. (Am. Compl. ¶ 38 (citing 42 U.S.C. § 1396a(a)). The "catch-all" provision, 42 U.S.C. § 1396d(r)(5), Plaintiff claims requires states to make available placement in a Psychiatric Residential Treatment Facility ("PRTF") or Residential Treatment Center ("RTC"), when such placement is medically necessary for Medicaid-eligible children like Plaintiff. (Am. Compl. ¶¶ 40-41). Plaintiff alleges that Defendants failed to make PRTF or RTC services available to Plaintiff, and, as a result, Defendants failed to provide Plaintiff with appropriate EPSDT services, in violation of the Medicaid Act. (See Am. Compl. ¶ 1).
Plaintiff brings her claims under 42 U.S.C. § 1983. (Am. Compl. ¶ 1). Plaintiff seeks a preliminary injunction ordering Defendants Reese and Berry (the "Official Capacity Defendants") to approve Plaintiff's placement at an appropriate PRTF or RTC. (Am. Compl. ¶¶ 1, 43-46). She seeks monetary damages against the Individual Capacity Defendants, alleging they were not performing discretionary functions when they violated federal law by denying medically necessary services to Plaintiff, and that their conduct was malicious, intentional, or recklessly or callously indifferent to Plaintiff's health, wellbeing and protected rights. (Am. Compl. ¶¶ 47-52). Plaintiff also seeks attorneys fees under 42 U.S.C. § 1988. (Am. Compl. ¶ 53).
On October 29, 2015, Plaintiff filed her Complaint [1]. On December 9, 2015, Defendants filed their Motion to Dismiss Plaintiff's original complaint [10]. On December 15, 2015, Plaintiff filed her first Motion for Preliminary Injunction [13]. On January 15, 2016, Plaintiff filed her Motion for Leave to File an Amended Complaint, seeking to add Clyde Reese and Frank Berry, in their official capacities, as Defendants. On May 10, 2016, the Court issued an order [24] granting Plaintiff's Motion for Leave to File an Amended Complaint and denying as moot Plaintiff's first Motion for Preliminary Injunction and Defendant's Motion to Dismiss Plaintiff's original complaint.
On May 24, 2016, Defendants filed their Motion to Dismiss Amended Complaint. Defendants argue dismissal is required because: (1) Plaintiff does not have an enforceable federal right under Section 1983, (2) the Official Capacity Defendants are immune from suit under the 11th Amendment, (3) the Individual Capacity Defendants are entitled to qualified immunity, and (4) the Amended Complaint fails to state a claim.
On August 1, 2016, Plaintiff filed her Motion for Preliminary Injunction. In it, Plaintiff explains that her doctors have recommended that she be treated in a PRTF with specialists trained to work with children who suffer from ReactiveAttachment Disorder ("RAD"). Plaintiff asserts there are no PRTFs in Georgia that are qualified to treat Plaintiff. According to Plaintiff, the crux of the parties' dispute is that Defendants refuse to approve Plaintiff's placement at an out-of-state PRTF. Plaintiff has located two appropriate facilities out of state: one located in Montana, and another in New Mexico. Plaintiff seeks a preliminary injunction hearing "where Plaintiff[] may submit evidence of an appropriate PRTF for [Plaintiff]'s immediate placement." ([34.1] at 5-6).
On August 24, 2016, Defendants filed their response [36]. Defendants contend that the dispute is not ripe for adjudication, including because Defendants "never had the opportunity to formally evaluate and rule upon any request to place [Plaintiff] in an out-of-state PRTF, nor did [Plaintiff] submit another PRTF application or contest the August 2015 PRTF determination that offered her . . . a level-of-care equivalent." ([36] at 12).
In Defendants' Surreply Brief [41],3 Defendants contend that they are currently determining whether all in-state and community resources have been exhausted, as required by O.C.G.A. § 49-5-226, and, if so, what further actions—including but not limited to a referral for out-of-state PRTF services—may betaken with regard to Plaintiff. Defendants thus maintain there is no concrete dispute capable of court resolution, because there still has not been a final State determination whether out-of-state treatment is warranted.
On a motion to dismiss pursuant to Rule 12(b)(6) of the Federal Rules of Civil Procedure, the Court must "assume that the factual allegations in the complaint are true and give the plaintiff[] the benefit of reasonable factual inferences." Wooten v. Quicken Loans, Inc., 626 F.3d 1187, 1196 (11th Cir. 2010). Although reasonable inferences are made in the plaintiff's favor, "'unwarranted deductions of fact' are not admitted as true." Aldana v. Del Monte Fresh Produce, N.A., 416 F.3d 1242, 1248 (11th Cir. 2005) (quoting S. Fla. Water Mgmt. Dist. v. Montalvo, 84 F.3d 402, 408 n.10 (11th Cir. 1996)). Similarly, the Court is not required to accept conclusory allegations and legal conclusions as true. See Am. Dental Ass'n v. Cigna Corp., 605 F.3d 1283, 1290 (11th Cir. 2010) ( Ashcroft v. Iqbal, 556 U.S. 662 (2009); Bell Atl. Corp. v. Twombly, 550 U.S. 544 (2007)).
"To survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to 'state a claim to relief that is plausible on its face.'"Iqbal, 556 U.S. at 678 (quoting Twombly, 550 U.S. at 570). Mere "labels and conclusions" are insufficient. Twombly, 550 U.S. at 555. "A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the...
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