PermiaCare v. L.R.H.

• Decision Date: 31 January 2020
• Docket Number: No. 08-19-00144-CV,08-19-00144-CV
• Citation: 600 S.W.3d 431
• Parties: PERMIACARE, Ramona Thomas in Her Official Capacity as Executive Director of PermiaCare, and Todd Luzadder in His Official Capacity as Director of Mental Health Services of PermiaCare, Appellants, v. L.R.H., Appellee.
• Court: Texas Court of Appeals

600 S.W.3d 431

PERMIACARE, Ramona Thomas in Her Official Capacity as Executive Director of PermiaCare, and Todd Luzadder in His Official Capacity as Director of Mental Health Services of PermiaCare, Appellants,

v.L.R.H., Appellee.

No. 08-19-00144-CV

Court of Appeals of Texas, El Paso.

January 31, 2020

ATTORNEY FOR APPELLANTS, Carvan E. Adkins, 6000 Western Place, Suite 200, Fort Worth, TX 76107.

ATTORNEY FOR APPELLEE, Julie M. Balovich, Texas RioGrande Legal Aid, Inc., 1331 Texas Ave., El Paso, TX 79901.

Before Alley, C.J., Rodriguez, and Palafox, JJ.

OPINION

JEFF ALLEY, Chief Justice

The State of Texas, through the Texas Health and Human Services Commission, and in turn through its contracted agents, provides community mental health services to eligible patients. In this case, one of those patients sued one of those contracted agents along with two of its officials. The suit claims that: (1) the officials failed to follow several mandated statutory and administrative duties, (2) the officials failed to provide services for which the contracting entity had billed Medicaid, and (3) the contracting entity acted in a discriminatory manner in providing services in violation of the Americans with Disabilities Act and Section 504 of the Rehabilitation Act. Because the contracting entity is deemed to be a state actor, a failure to follow mandated statutory and administrative duties had to be brought as a claim for prospective injunctive relief (also referred to as ultra vires claims) against the officials. Under the federal claims, the patient could sue the entity directly.

In this appeal from the denial of the entity's and the official's plea to the jurisdiction, we conclude that several of the ultra vires claims lack a properly pleaded factual foundation, but that the patient is entitled to an opportunity to re-plead. We conclude that the Medicaid billing claim should have been dismissed, but that the federal claims are properly before the court. The trial court's order on the plea to the jurisdiction is affirmed in part and reversed in part. The case is remanded for further proceedings.

I. BACKGROUND

Appellant PermiaCare is a local mental health authority and community center which contracted with Texas Health and Human Services (HHS) to provide community mental health services to eligible patients living in Pecos County. Appellant Ramona Thomas serves as its Executive Director, and Todd Luzadder as its Director of Mental Health Services (hereinafter the Officials). L.R.H. is a resident of Pecos County who began receiving services from PermiaCare approximately twenty years before the filing of the lawsuit. During that time, L.R.H. was diagnosed with several mental disorders which all parties acknowledge made her eligible for services.

PermiaCare is required to abide by several statutory and administrative regulations set forth in Chapters 533 and 534 of the Texas Health and Safety Code (hereinafter the "Code"), as well as Title 25 of the Texas Administrative Code (hereinafter the "TAC"). L.R.H. contends that PermiaCare violated several of these Texas statutory and administrative provisions, as well as two federal statutes.

A. Factual Background

All of the ensuing factual background comes from L.R.H.'s Second Amended Petition, which chronicles a two-year series of events that began in January of 2016. Given the procedural posture of this case, no proof of any of these allegations appears in our record, and at this point they are just that--allegations.

1. PermiaCare's Caseworkers Report a Probation Violation

Prior to January of 2016, PermiaCare designated L.R.H.'s "level of care" at LOC-4, which entitled her to receive the highest level of services available. For instance, that level of care afforded her the right to receive supported housing services and also gave PermiaCare the discretion to provide her with cognitive behavioral therapy ("CBT"). Sometime in January of 2016, however, L.R.H. was convicted of assaulting her father and placed on community supervision (probation), the terms of which restricted her from being in her parents' home when her father was present. That restriction was problematic, however, because L.R.H. was living in a trailer with no running water or air conditioning behind her parents' home. L.R.H. claims that after her PermiaCare caseworkers conducted a home visit, they informed her probation officer that she violated the terms of her probation. According to L.R.H., the caseworkers spoke with the probation officer on several occasions for the sole purpose of having L.R.H.'s probation revoked so that she could be committed to a state psychiatric hospital.

2. PermiaCare Lowers L.R.H.'s Level of Care in September of 2016

L.R.H.'s probation was indeed revoked on August 18, 2016, causing her to be jailed until August 31, 2016. Because she was in jail and unable to receive services during that time, PermiaCare lowered her level of care to a LOC-1 designation. After her release, it raised her to a LOC-3 designation. L.R.H. contends she did not receive any notice or explanation for why PermiaCare had assigned her to a LOC-3 level, rather than restoring her to a LOC-4 designation. The reduction to a LOC-3 designation meant that she could not qualify for CBT and deprived her of some supported housing services. L.R.H.'s attorney sent a written request on September 12, 2016 to Todd Luzadder, as well as one of her caseworkers, requesting an opportunity to discuss L.R.H.'s treatment plan. PermiaCare responded that the attorney could not have input into L.R.H.'s treatment plan. L.R.H. further claims that PermiaCare failed to respond to a written request seeking the reason for the reduction of level of care and denied her an opportunity to appeal.

3. PermiaCare Raises L.R.H.'s Level of Care in June of 2017

Following her release from jail, L.R.H. moved from her trailer into an apartment, but began experiencing various mental health challenges, which caused her to become disruptive, leading to confrontations with her neighbors and law enforcement. Thereafter, she was admitted to a psychiatric hospital in November and December of 2016, and June of 2017. After her release from the last psychiatric hospital, PermiaCare raised her level of care from a LOC-3 to a LOC-4 designation.

4. L.R.H. Requests Additional Services in November of 2017

By October of 2017, L.R.H. again exhibited disruptive behavior at her apartment complex. After she received notices of lease violations from her landlord in November of 2017, her attorney requested emergency crisis services from PermiaCare to address these issues. During this same time period, L.R.H. and her attorney requested that PermiaCare provide therapy from a "professional therapist," and CBT. According to L.R.H., PermiaCare's Client's Rights Officer, told her that the request for CBT had been denied because such therapy was not effective for her diagnosis of schizoaffective disorder ; the same officer further informed L.R.H. that she should have received a letter advising her of the denial and explaining her appeal rights.

5. L.R.H.'s Appeal is Denied in January of 2018

And again, on January 12, 2018, a caseworker informed L.R.H. that her request for CBT had once again been denied. L.R.H. sent a hand-written letter to PermiaCare stating that she wanted to appeal the decision. Several weeks later, PermiaCare's Client's Rights Officer denied her appeal on the ground that CBT was not appropriate for her diagnosis.

6. L.R.H.'s Caseworkers Communicate with Law Enforcement

In the meantime, L.R.H.'s mental health began to further deteriorate. In January 2018, her apartment manager advised L.R.H.'s caseworkers that she was in the midst of a mental health episode. The caseworkers came to the scene, and allegedly advised a police officer that L.R.H.'s outbursts were a "behavioral problem," and that they did not recommend she be hospitalized. In a subsequent episode later that same month, the caseworkers were again contacted. However, rather than going to the scene, one of the caseworkers allegedly called the police and "asked why they had not arrested her." When the police officer informed the caseworker that they believed L.R.H. was having a mental health crisis, the caseworker allegedly told the officer that her conduct was "purposeful and deliberate," that she was "not experiencing psychosis," and that she "should be treated like anyone else violating the law." L.R.H. was neither hospitalized nor jailed on either of these occasions.

7. L.R.H.'s Request for Additional Services is Granted in February of 2018

On February 15, 2018, L.R.H. was accused of making a "terroristic threat" against her neighbors. The police contacted PermiaCare requesting it perform a crisis assessment, but her caseworkers refused to go to the scene. The police consequently arrested L.R.H. And according to L.R.H., the caseworker also contacted her former probation officer for the purpose of having her probation revoked, even though she was no longer on probation at that time. But shortly after she was released on a personal recognizance bond, PermiaCare authorized 16 sessions of "modified CBT."

8. L.R.H.'s Caseworkers Communicate with her Landlord

Finally, L.R.H. alleges that on an unspecified date after the above-described incidents, she was doing better, in part because she continued to receive CBT, and in part because Medicaid approved her request to receive the services of a home health care worker. However, L.R.H. claims that she has received lease violation notices and that her caseworkers have informed her landlord that she is "faking the symptoms of her mental illness and that her problems are behavioral and not psychological," thereby jeopardizing her housing situation.

B. Procedural Background

Based on these allegations, L.R.H. sued PermiaCare, as well as the Officials in their official capacities. L.R.H.'s second amended petition alleges the Officials committed several ultra vires acts by: (1) failing to provide...