Odi v. Alexander, CIVIL ACTION NO. 15-4903

Decision Date02 May 2019
Docket NumberCIVIL ACTION NO. 15-4903
Parties John ODI v. Gary ALEXANDER, et al.
CourtU.S. District Court — Eastern District of Pennsylvania

Robin A. Feeney, Andrew P. Rosen, Fine & Staud LLP, Philadelphia, PA, for John Odi.

Matthew R. Skolnik, PA Office of Attorney General, Philadelphia, PA, for Gary Alexander, et al.

MEMORANDUM

SURRICK, District Judge Presently before the Court is Defendants' Motion for Summary Judgment with respect to the claims asserted in Plaintiff's Second Amended Complaint. (ECF No. 41.) For the following reasons, Defendants' Motion will be granted.

In this civil rights action pursuant to 42 U.S.C. § 1983, Plaintiff John Odi, individually and as representative of the estate of his deceased mother, Lily Odi, alleges that Defendants unlawfully denied Ms. Odi Medicaid benefits, also known as "Medical Assistance" or "MA," based upon her race and national origin. Plaintiff alleges that this led to Ms. Odi's death from metastatic breast cancer

. Plaintiff asserts claims against Defendants for violation of Ms. Odi's equal protection and procedural due process rights and for violation of the Medicaid Act and associated regulations.1

Defendants contend that they are entitled to judgment on Plaintiff's claims because, based on the undisputed facts and applicable law: (1) there is no evidence that any of the Defendants were personally involved in any alleged violations of Ms. Odi's rights; and (2) the denial of Ms. Odi's 2012 application for Medicaid did not violate her statutory or constitutional rights.

In response, Plaintiff argues that Ms. Odi was entitled to Medicaid under the statutory and regulatory provisions applicable to non-citizens, and that Defendants were involved in alleged discriminatory eligibility determinations with respect to Ms. Odi. Based on a detailed review of the record, and although Plaintiff has identified immaterial factual ambiguities and potential negligence by non-parties, there is simply no evidentiary basis to support a finding that any of the Defendants were personally involved in any deprivation of Ms. Odi's rights, or a finding that the Medicaid determinations applied to her in fact violated her constitutional or statutory rights.2 The fact that Ms. Odi and the Odi family had to deal with metastatic breast cancer

is indeed unfortunate. However, the sympathetic nature of this situation does not provide a legal basis to hold Defendants liable for Plaintiff's claims.

I. BACKGROUND
A. Factual Background
1. The Parties and DHS Personnel

Lily Odi immigrated to the United States from Nigeria in May 2008 at the age of 70. (Odi Dep. 22-24, Defs.' SJ Ex. D, ECF No. 41-4.)3 Ms. Odi initially came to the United States on a visa to live with her son, Plaintiff John Odi, and his wife and children in Delaware County, Pennsylvania. (Id. at 23-24, 27-28.) Ms. Odi subsequently applied for, and was granted, Lawful Permanent Resident ("LPR") status in the United States and was issued a Permanent Resident Card, also known as a "Green Card," effective April 9, 2010.4 (Id. at 28-30; see also L. Odi Green Card, Pl.'s Opp. Ex. B, ECF No. 43-2.)

Defendants Gary Alexander and Beverly Mackereth are both former Secretaries of Pennsylvania's Department of Human Services ("DHS"), the state agency responsible for administering Medical Assistance, also known as Medicaid, in Pennsylvania.5 (Second Amended Complaint ("SAC") ¶ 9, ECF No. 24; Defs.' SJ Br. 2, ECF No. 41.) Alexander was DHS Secretary from February 2011 to February 2013. (SAC ¶ 9.) Mackereth succeeded Alexander and served as DHS Secretary from February 2013 to January 2015. (Id. ¶ 12.) Defendant Linda Robson is the Executive Director of the DHS County Assistance Office for Delaware County ("DCAO"), and Defendant Jane Richards, now retired, was the District Administrator of the DCAO office in Darby, Pennsylvania, during the time period relevant to this action.6 (Robson Dep. 26, 29-30, Pl.'s Opp. Ex. K, ECF No. 43-11.) During the relevant period, Robson was Richards' direct supervisor. (Id. at 29-30; see also Richards Dep. 12, Defs.' SJ Ex. C, ECF No. 41-3.) Richards, in turn, supervised the Darby DCAO Managers ("Managers"), Caroline Hardy and Andrea Clark. (Richards Dep. 12-13.) The Managers supervised several income maintenance casework supervisors ("Supervisors"), including, among others, Thomas Sanders and a Mr. Gibson. (Robson Dep. 164; Richards Dep. 31-32; Sanders Dep. 7-8, Defs. SJ Ex. B, ECF No. 41-2.)

Sanders and others in his position supervised the DCAO's income maintenance caseworkers ("Caseworkers"). The Caseworkers were responsible for the day-to-day handling of applications for Medicaid and other DHS benefit programs.7 (Sanders Dep. 11-12, 17.) The Supervisors did not review all of a Caseworker's files or records but did random monthly reviews. (Robson Dep. 35.) Caseworkers issued determinations as to an applicant's eligibility for Medicaid with the aid of the DHS Medical Assistance Eligibility Handbook, other DHS policy and procedure publications, and a computer system that applied the statutory and regulatory eligibility criteria to the applicant information in the DHS system. (Robson Dep. 34-35, 44, 111; Sanders Dep. 17-20; Concepcion Dep. 34-35, 69-70, Pl.'s Opp. Ex. G, ECF No. 43-7.) During the relevant time period, Caseworkers and other DHS personnel involved with benefit applications entered and maintained narratives and information about applicants' cases in a computer software system known as eCIS. (Concepcion Dep. 40-42.) The Darby DCAO Caseworkers involved with Ms. Odi's Medicaid applications included Latifah K. Sabreen, Maria Concepcion, and Brenda Johnson. (Robson Dep. 138, 145, 147, 164, 176, 194.)

2. Lily Odi's Medicaid Applications
(a) 2009 Application

In mid-September 2009, Ms. Odi experienced stomach pain, and Plaintiff took her to the emergency room at Delaware County Memorial Hospital ("DCMH"), where she was diagnosed with pancreatitis

. (Odi Dep. 39-40; 2009 Appl., DHS DEFS 000132, Defs.' SJ Ex. F, ECF No. 41-6.) DCMH successfully treated Ms. Odi's pancreatitis with laser surgery. (Odi Dep. 44, 47-48.) At the request of DCMH, Plaintiff submitted an application for Medicaid to the DCAO on his mother's behalf. (Id. at 47.) Since Ms. Odi did not yet have LPR status, the Application correctly identified her citizenship status as "5. Other – Not Eligible for Benefits Except for Emergency Medical Benefits."8 (Odi Dep. 62-64; see also 2009 Appl., DHS DEFS 000135.)

It is undisputed that DHS granted Ms. Odi's 2009 Application for Medical Assistance for the treatment of her pancreatitis

as an emergency medical condition. (eCIS Narratives, DHS DEFS 0293, Defs' SJ Ex. G, ECF No. 41-7 (stating "PH auth for 9/13/09-9/28/09 only due to client's citizenship status. client verf. emergency letter from hosp. client also verf. residence, and management. Notices sent"); see also Odi Dep. 70-71 (stating he had no reason to believe the 2009 Application was not granted).) DHS records indicate that DCAO Caseworker Sabreen was assigned to Ms. Odi's file at the time her 2009 Application was approved. (eCIS Narratives, DHS DEFS 0293; see also Robson Dep. 175-76.) The charges for Ms. Odi's pancreatitis treatment at DCMH totaled $ 238,695 and were covered by Medicaid. No one sought payment from Plaintiff or his mother for any charges related to Ms. Odi's treatment for pancreatitis. (2009 Appl., DHS DEFS 000142; Odi Dep. 59-60, 65, 69.) After Ms. Odi's pancreatitis was treated, through approximately May 2011, Plaintiff obtained primary medical care for his mother at a clinic on a fee-for-service basis and did not seek Medical Assistance for that care. (Odi Dep. 75.)

(b) 2011 Application

In approximately May 2011, Ms. Odi complained about "something going on around her breast," and her primary care physician referred her to Springfield Hospital, which offered free breast screening for uninsured women over 40. (Id. at 76-77.) After having a mammogram

, Ms. Odi was diagnosed with breast cancer. (Id. at 77-79.) She was then referred to DCMH, where the physician who performed Ms. Odi's biopsy told Plaintiff that his mother's cancer was at the "middle stage" and would require a mastectomy followed by chemotherapy and radiation. (Id. at 80-83.) The surgeon advised Plaintiff that they needed to apply for Medical Assistance for his mother before the hospital could perform a mastectomy. (Id. at 81-82, 84.)

Plaintiff applied for Medicaid on his mother's behalf and included with the application information about Ms. Odi's nationality, ethnicity, and citizenship status. (Id. at 83-85, 99-100.) On or about June 23, 2011, DHS approved Ms. Odi for emergency Medical Assistance for her initial breast cancer

treatment. (eCIS Narrative 6/23/2011, DHS DEFS 0292; see also Odi Dep. 84-88.) DHS records regarding the approval state:

Approval given for [Medical Assistance] for [L]ily Odi for emergency medical assistance for undocumented alien. Ms. Odi has been diagnosed with breast cancer

and needs further treatment. Without treatment her condition could be fatal. Approval given to 12/31/11. Renewal to be done then with an update of her medical condition and further management review.9

(eCIS Narrative 6/23/2011, DHS DEFS 0292.) It is undisputed that Ms. Odi received Medical Assistance for her cancer

treatment—including for the mastectomy, chemotherapy, and radiation—for 12 months, from approximately June 2011 through approximately May or June 2012. (eCIS Narrative 6/27/2011, DHS DEFS 0292; Odi Dep. 94-98, 106-110.) DHS informed Plaintiff that in order for his mother to receive Medical Assistance beyond the 12-month period, they were required to reapply for or seek renewal of her benefits before the expiration of that period. (Odi Dep. 97-98, 106, 112-115.)

DHS records reflect that Ms. Odi did not submit the renewal packet for her Medical Assistance by the date that it was due, May 14, 2012. The eCIS Narrative dated May 16, 2012, entered by Caseworker Sabreen,...

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