Latimer v. Robinson
| Decision Date | 20 May 2004 |
| Docket Number | No. 3:03-0670.,3:03-0670. |
| Parties | Harvey L. LATIMER, D.D.S., Huey Newberry, D.D.S., Patricia Newberry, D.D.S., and Darryl Bivens, D.D.S., Plaintiffs, v. Kenneth S. ROBINSON, M.D., in his official capacity as Commissioner of the Department of Health, and Manny Martins in his official capacity as Deputy Commissioner, Tennessee Tenncare Bureau, Defendants. |
| Court | U.S. District Court — Middle District of Tennessee |
Michael V. Thompson, Nashville, TN, for plaintiffs.
Sue A. Sheldon, Office of the Attorney General and Reporter, Nashville, TN, for defendants.
Presently pending before the Court is Defendants' Motion to Dismiss and/or for Summary Judgment (Docket Entry No. 10), to which Plaintiffs have responded in opposition. For the reasons explained herein, Defendants' Motion to Dismiss shall be GRANTED.
On July 28, 2003, Plaintiffs Harvey L. Latimer, D.D.S., Huey Newberry, D.D.S., Patricia W. Newbury, D.D.S., and Darryl Bivens, D.D.S., all general practice dentists licensed by the State of Tennessee, filed their Complaint with this Court alleging claims under the Fourteenth Amendment to the United States Constitution and 42 U.S.C. § 1983. Plaintiffs contend that their due process rights were violated when the Bureau of TennCare determined that TennCare, Tennessee's federally funded medical assistance program, would no longer cover orthodontic services provided by general practice dentists except under limited circumstances.1 Plaintiffs request that this Court grant them declaratory and injunctive relief, reasonable attorney fees and costs, and other relief as this Court deems appropriate. This Court has federal question jurisdiction over the section 1983 claims, see 28 U.S.C. § 1331 (1994). Defendants now move for dismissal of the entire case, or in the alternative, summary judgment.
Defendants have attached documents outside the pleadings to their Motion to Dismiss and/or for Summary Judgment. Normally, their attachments would lead the Court to convert Defendants' Motion to Dismiss to a Motion for Summary Judgment. Weiner v. Klais & Co., Inc., 108 F.3d 86, 88 (6th Cir.1997) (). In certain circumstances, however, conversion is improper, despite the presence of extrinsic materials. See Plassman v. City of Wauseon, 85 F.3d 629 (6th Cir.1996) ().
Federal Rule of Civil Procedure 12(b) does not require a court to convert a motion to dismiss, despite a party's submission of extrinsic evidence, where one or more of the following exists: (1) the evidence consists of proceedings of which the court is permitted to take judicial notice, see Rodic v. Thistledown Racing Club, Inc., 615 F.2d 736, 738 (6th Cir.1980); (2) the documents' contents are alleged in the plaintiff's complaint, and their authenticity is unchallenged, see Branch v. Tunnell, 14 F.3d 449, 454 (9th Cir.1994); and (3) the defendant's attachment of extrinsic material to its motion to dismiss does not rebut, challenge, or contradict anything in the plaintiff's complaint, see Song v. City of Elyria, 985 F.2d 840, 842 (6th Cir.1993); 5A Charles Alan Wright & Arthur R. Miller, Federal Practice and Procedure § 1366 n. 23 (3d ed.1990).
Further, submission of extrinsic materials does not require conversion when the documents attached to the defendant's motion to dismiss are referred to in the plaintiff's complaint and are central to plaintiff's claim. See Jackson v. City of Columbus, 194 F.3d 737, 745 (6th Cir.1999); Katt v. Titan Acquisitions, Ltd., 133 F.Supp.2d 632, 637 (M.D.Tenn.2000) (citing Nieman v. NLO, Inc., 108 F.3d 1546, 1555 (6th Cir.1997)).
In this case, it is proper for the Court to consider Defendants' Motion without converting it to one for summary judgment, despite the presence of extrinsic evidence, given that the evidence does not rebut, challenge, or contradict anything in Plaintiffs' Complaint, see City of Elyria, 985 F.2d at 842, and that Defendants' attachments are referred to in Plaintiffs' Complaint and central to their claims, see City of Columbus, 194 F.3d at 745. The documents attached by Defendants are: (1) a copy of a December 31, 2002, Memorandum by Manny Martins, Deputy Commissioner of the Bureau of Tenncare, describing the Dental Carve-Out ; and (2) a copy of Executive Order No. 23, which transfers the TennCare program from the Department of Health to the Department of Finance and Administration (Id., Exh. B). The first document is specifically referenced in Paragraphs 10 and 12 of Plaintiffs' Complaint, and the second document relates to Defendants' proposed Order of Substitution, and does not address or contradict any of Plaintiffs' substantive claims. Thus, the Court shall consider the attached documents without converting Defendants' Motion.
It is well settled that a court's task in analyzing the sufficiency of a complaint for the purpose of a motion to dismiss is necessarily narrow and limited. See Miller v. Currie, 50 F.3d 373, 377 (6th Cir.1995). The issue is not whether a claim ultimately will prevail, but Id. (citing Scheuer v. Rhodes, 416 U.S. 232, 236, 94 S.Ct. 1683, 40 L.Ed.2d 90 (1974)).
Moreover, in reviewing a motion to dismiss for failure to state a claim upon which relief may be granted, a court must review the complaint in the light most favorable to the non-moving party, construing all of its allegations in her favor. See Skees v. United States, 107 F.3d 421, 423 (6th Cir.1997) (citations omitted). A complaint should not be dismissed under Rule 12(b)(6) of the Federal Rules of Civil Procedure "unless it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief." Scheuer, 416 U.S. at 236, 94 S.Ct. 1683 (quoting Conley v. Gibson, 355 U.S. 41, 45-46, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957)); see also G.M. Eng'rs and Assocs. v. West Bloomfield Township, 922 F.2d 328, 330 (6th Cir.1990) (citation omitted).
The relevant facts are as follows: Tennessee participates in the federally funded medical assistance program created by the Medicaid Act, 42 U.S.C. §§ 1396 to 1396v, and Tennessee Code Annotated §§ 71-5-101 to 71-5-2314. Since 1994, the program has operated as a managed care program under the name TennCare, pursuant to a section 1115 demonstration waiver granted by the Secretary of Health and Human Services. The TennCare program assigns each enrollee to a private managed care organization ("MCO") and pays each MCO a fixed monthly amount, referred to as a capitation payment, for each TennCare beneficiary enrolled in the MCO's health plan. Each MCO is required to provide the beneficiary with medically necessary health care services covered by the scope of benefits established by the TennCare waiver and the contract or "risk agreement" between the state and the MCOs.
State medical assistance programs are authorized to establish criteria for providers and restrict covered individuals' choice of providers. The TennCare program is not prevented from "setting reasonable standards related to the qualifications of providers or ... restricting recipients' free choice of providers." 42 C.F.R. §§ 431.51(c)(2), (c)(3). The Bureau of TennCare determined that, effective January 1, 2003, only specialists such as orthodontists or periodontists would be acceptable providers of orthodontic treatments covered by TennCare. . In areas where no specialists reside, "generalists with documentation of orthodontic training who have demonstrated proficiency in successfully treating TennCare enrollees diagnosed with severe, handicapping malocclusion will be considered in treating these patients." (Id.) Prior to the dental carve-out, general dentists with a particular combination of education and experience were approved by the TennCare program to provide covered orthodontic services. The Bureau of TennCare's justification for the "dental carve-out" was "concerns related to the competence and proficiency of generalists in treating orthodontic cases that represent the most difficult cases." (Id.) Currently, the scope of the benefits established in the TennCare waiver includes only specific orthodontic services. For individuals over the age of 21, the orthodontic services covered by TennCare are for individuals who have (1) "a severe, handicapping malocclusion or another congenital or developmental anomaly or injury ..." or (2) following repair of an enrollee's cleft palate. .
Plaintiffs are four general practice dentists who have been providers under the TennCare program for several years. Three Plaintiffs maintain practices in Nashville, and one maintains his practice in Hickman County. According to Plaintiffs a large number of their patients are TennCare enrollees, and Plaintiffs derive a substantial part of their income from performing both general dental procedures and orthodontic procedures on TennCare enrollees. Prior to the dental carve-out, Drs. Latimer, Huey Newberry and Patricia Newberry derived thirty percent of their income from TennCare orthodontic patients, and Dr. Bivens derived twenty percent of his income from TennCare orthodontic patients. Now, because Plaintiffs cannot be compensated by TennCare for any orthodontic services they provide to TennCare enrollees, Plaintiffs allege that they have lost a large percentages of their incomes.
According to Plaintiffs, the State of Tennessee affords them the right to provide orthodontic services,...
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