Odi v. Alexander
| Decision Date | 07 March 2017 |
| Docket Number | CIVIL ACTION NO. 15-4903 |
| Parties | JOHN ODI, INDIVIDUALLY AND AS THE PERSONAL REPRESENTATIVE OF THE ESTATE OF LILY ODI, DECEASED v. GARY ALEXANDER, ET AL. |
| Court | U.S. District Court — Eastern District of Pennsylvania |
Presently before the Court are: (1) Defendants Gary Alexander and Beverly Mackereth's Motion to Dismiss First Amended Complaint (ECF No. 5); (2) Defendant Linda Robson's Motion to Dismiss First Amended Complaint (ECF No. 12); and (3) Defendant Jane Richards' Motion to Dismiss First Amended Complaint (ECF No. 17). For the following reasons, Defendants' Motions will be granted in part, and denied in part, and Plaintiffs' request to amend the Amended Complaint will be granted.
In this civil rights action, Plaintiff John Odi, individually, and on behalf of his deceased mother, Plaintiff Lily Odi, alleges that Ms. Odi was unlawfully denied Medicaid benefits due to discrimination on account of race and national origin, which ultimately resulted in Ms. Odi's death from an aggressive form of breast cancer. Plaintiffs assert claims for substantive and procedural due process and for equal protection under 42 U.S.C. §§ 1981, 1983, and 1988, 42 U.S.C. § 2000d (Title VI of the Civil Rights Act), and 42 U.S.C. § 1396a(a)(8) (Title XIX of the Social Security Act), and the associated Medicaid Regulation, 42 C.F.R. § 435.930(b). Defendants include Gary Alexander and Beverly Mackereth, both former Secretaries of the Department of Public Welfare of the Commonwealth of Pennsylvania; Linda Robson, Executive Director of the Delaware County Assistance Office; and Jane Richards, the District Administrator for the Darby District of the Delaware County Assistance Office.1 All Defendants are sued in their official and individual capacities.
The facts of this case are set forth in the First Amended Complaint and are as follows. In May 2008, Ms. Odi lawfully emigrated from Nigeria to the United States to live in Pennsylvania with her son, John Odi. (Am. Compl. ¶ 28, ECF No. 4.) On April 9, 2010, Ms. Odi obtained the status of lawful permanent resident and was given a "green card." (Id. ¶ 29.) In May 2011, Ms. Odi was diagnosed with breast cancer and subsequently applied for emergency Medicaid through the Delaware County Assistance Office. (Id. ¶¶ 32-33.)
Medicaid is a public medical insurance program jointly funded by the federal government and the states. (Id. ¶¶ 21-27.) In Pennsylvania, DHS is the state agency that administers Medicaid. (Id. ¶¶ 24-25.) An individual in Pennsylvania who wishes to receive Medicaid applies through the appropriate DHS County Assistance Office, which screens the application and determines whether the applicant is eligible for Medicaid. (Id. ¶¶ 25-27.) DHS and its employees, including all Defendants, were responsible for determining whether an individual like Ms. Odi is eligible for medical assistance. (Id. ¶ 25.)
Ms. Odi's May 2011 application for Medicaid was approved and she received benefits from May 2011 until May 2012. (Id. ¶ 34.) On May 14, 2012, DHS closed Ms. Odi's case andstopped providing her with benefits. (Id. ¶ 35.) When DHS terminated Ms. Odi's benefits, they failed to provide her with renewal forms or with a redetermination notice. (Id.) In June 2012, Ms. Odi filed a new application for Medicaid benefits as she continued to require medical treatment for her breast cancer. (Id. ¶ 36.) In conjunction with this application, a letter was supplied to DHS from Plaintiff's doctor, Dr. Jenia Jeneb-Wolcott, which verified that Ms. Odi suffered from breast cancer. The letter stressed the importance of Ms. Odi continuing to receive ongoing treatment for at least five years. (Id. ¶ 45.)
On July 5, 2012, DHS denied Ms. Odi's June 2012 Medicaid application. (Id. ¶ 37.) DHS stated in the denial that there was "no proof of income or letter forms" supplied with her application. (Id.) In fact, Ms. Odi provided these forms with her application. (Id.) On July 27, 2012, DHS notified Ms. Odi that more information regarding family income would be needed to make a determination about her June 2012 application for Medicaid benefits. (Id. ¶ 38.) On August 1, 2012, John Odi supplied DHS with the requested financial letter. (Id. ¶ 39.)
On August 21, 2012, DHS again denied Ms. Odi's application for emergency Medicaid assistance. (Id. ¶ 40.) In its denial letter, DHS stated that Ms. Odi was not a "United States citizen or an alien lawfully admitted for permanent residence" and therefore did not qualify for benefits. (Id.) DHS's denial letter also cited as a basis for the denial 55 Pa. Code § 149.23, which pertains to the Aid to Families with Dependent Children program ("AFDC"). (Id. ¶ 73.) Code section 149.23 states that "[a] person who is not a citizen of the United States is not eligible for AFDC unless he is an alien lawfully admitted for permanent residence or otherwise permanently residing in the United States under provisions of law." 55 Pa. Code § 149.23. Ms. Odi had been a lawful permanent resident at the time of the denial letter, and since 2010. Shewas therefore not subject to the ineligibility requirements contained in 55 Pa. Code § 149.23. (Id. ¶ 42.)
Defendant Richards and her subordinates failed to review the file or any of the documentation supplied by Ms. Odi. (Id. ¶ 43.) In response to DHS's denial letter, the Delaware County Assistance Office was again supplied with a copy of Ms. Odi's green card, her social security card, and a letter from her doctor stressing the need for continued care. (Id. ¶ 44.) The doctor's letter had previously been provided to DHS in conjunction with the June 2012 application for benefits. (Id. ¶ 45.) All of this information was ignored. (Id. ¶ 44.) Richards allegedly decided that Ms. Odi's breast cancer did not constitute an emergency. (Id. ¶ 41.)
On September 20, 2012, Ms. Odi appealed the denial of her Medicaid benefits. (Id. ¶ 56.) Despite numerous requests to discuss the appeal informally, Plaintiffs were not given the opportunity. (Id. ¶ 46.) Specifically, in October 2012, Mr. Odi repeatedly requested an opportunity to discuss the appeal, both by telephone and in writing. (Id.) Mr. Odi was never afforded a telephone call. (Id. ¶ 47.) Finally, in March 2013, Mr. Odi's demands were granted and DHS agreed to provide Ms. Odi a hearing by telephone. (Id.) The telephonic hearing on the denial of Ms. Odi's benefits took place on April 23, 2013. (Id. ¶ 48.) During the hearing, the Administrative Law Judge and representatives from DHS agreed that Ms. Odi should have had medical assistance. (Id.) Ms. Odi's benefits were reinstated retroactively to August 1, 2012. (Id. ¶ 59.) Notwithstanding the reinstatement, Ms. Odi was never given a functioning "access card" or credential that functioned to pay for the medical services. (Id. ¶ 60.) Ms. Odi several times attempted to use the Access Card that DHS provided to her; however, the card did not work and was rejected by each and every medical provider to which it was presented. (Id.)
On August 3, 2013, Ms. Odi was notified again that her benefits were terminated. (Id. ¶ 62.) She timely appealed the termination. (Id. ¶ 63.) Ms. Odi died from untreated breast cancer on December 13, 2013. (Id. ¶ 64.) Ms. Odi's appeal was nevertheless pursued, ending with a settlement between her representatives and DHS on May 27, 2015. The settlement provided that the benefits were reinstated posthumously for the period covering August 18, 2013 to December 13, 2013. (Id. ¶ 65.)
On August 31, 2015, Mr. Odi, on behalf of himself and the estate of his deceased mother, Ms. Odi, filed a Complaint in this Court against Defendants Alexander, Mackareth, Robson, and Richards. (ECF No. 1.) An Amended Complaint was filed on December 28, 2015. The Amended Complaint contains four counts: Count I asserts a claim under Title VI of the 1964 Civil Rights Act, 42 U.S.C. § 2000d; Count II asserts claims under 42 U.S.C. §§ 1983 and 1988; Count III asserts a claim under 42 U.S.C. § 1981; and Count IV asserts a claim under the Medicaid Statute and Regulations, specifically 42 U.S.C. § 1396a(a)(8) and 42 C.F.R. § 435.930(b). All four counts are asserted against all Defendants, both in their individual and their official capacities.
On January 11, 2016, Defendants Alexander and Mackereth filed a Motion to Dismiss for Failure to State a Claim. (ECF No. 5.) Plaintiffs filed a Response to Defendants' Motion to Dismiss on February 1, 2016. (ECF No. 7.) On May 24, 2016, Defendants Richards and Robson filed a Motion to Dismiss for Failure to State a Claim. (ECF No. 12.) On November 7, 2016, Richards individually filed a Motion to Dismiss for Failure to State a Claim. (ECF No. 17.) On November 18, 2016, Plaintiffs filed a Response to Richards' Motion to Dismiss. (ECF No. 18.)On November 28, 2016, Richards filed a Reply to Plaintiffs' Response to her Motion to Dismiss. (ECF No. 19.)
Under Federal Rule of Civil Procedure 8(a)(2), "[a] pleading that states a claim for relief must contain a short and plain statement of the claim showing that the pleader is entitled to relief." Rule 12(b)(6) provides for the dismissal of a complaint, in whole or in part, for failure to state a claim upon which relief can be granted. A motion under Rule 12(b)(6), therefore, tests the sufficiency of the complaint against the pleading requirements of Rule 8(a). "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.'" Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007)).
A claim is plausible "when the Plaintiffs pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged." Id. A complaint that merely alleges entitlement to relief, without alleging facts that...
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