Department of Health Care Services v. Office of Administrative Hearings
6 Cal. App. 5th 120
| Cal. Ct. App. | 2016Background
- L.M., a young child with cerebral palsy, was eligible for special education (IEP) services and medically necessary OT/PT through Tuolumne County CCS; her IEP (June 2011) listed CCS-provided OT/PT.
- CCS twice reduced its CCS-prescribed OT/PT (Nov 2011 and Sept 2012) without convening IEP team meetings or obtaining parental consent; parents obtained independent assessments that recommended more therapy.
- Parents filed an IDEA due process complaint at OAH alleging CCS unilaterally reduced services and failed to participate in the IEP process; OAH denied CCS’s motion to dismiss and joined the LEA/County, though LEA later settled and was dismissed.
- The ALJ found CCS committed procedural IDEA violations (unilateral reductions; failing to consider independent assessments), ordered restoration to prior IEP levels and awarded compensatory OT/PT hours, and named Parents prevailing.
- The State Department of Health Care Services (Department/CCS) petitioned superior court for administrative and traditional mandamus and declaratory relief seeking to set aside the OAH decision (arguing OAH lacked jurisdiction over CCS and that only CCS physicians determine medical necessity); the trial court denied relief and awarded Parents attorney fees; Department appealed.
Issues
| Issue | Plaintiff's Argument (Department) | Defendant's Argument (Parents/LEA) | Held |
|---|---|---|---|
| Whether OAH has jurisdiction to hear disputes over CCS medical-necessity determinations when OT/PT are in an IEP | CCS/Department: parents must use CCS’s Title 22 appeals; only CCS may decide medical necessity, so OAH lacks jurisdiction | Parents: Chapter 26.5 and its regs preserve IDEA due-process rights; when CCS services are in an IEP, disputes are resolvable at OAH | OAH has jurisdiction: Chapter 26.5 and regs make related-service disputes (including medically necessary OT/PT in an IEP) subject to IDEA due process hearings |
| Whether CCS unlawfully unilaterally reduced services and thus procedurally denied FAPE | Dept argued ALJ exceeded authority and medical necessity findings are CCS’s alone | Parents argued CCS must use IEP process and OAH may redress unilateral changes | ALJ’s procedural findings upheld: CCS improperly reduced services outside IEP process, violating IDEA procedures |
| Whether OAH could order CCS to restore services and provide compensatory OT/PT (and whether ALJ ordered medical treatment unlawfully) | Dept argued only CCS physicians can order/provide medically necessary services and ALJ usurped medical authority by ordering compensatory/restorative services from CCS | Parents/ALJ: compensatory education is an IDEA equitable remedy; where services in an IEP were unilaterally reduced, ALJ can order restoration/compensatory services; regulations require continuation pending hearing | Court affirmedALJ: OAH may award equitable compensatory and require CCS to continue/provide services pending resolution; CCS may seek reimbursement if it prevails |
| Whether Department could obtain declaratory relief and whether Parents entitled to attorney fees | Dept sought declaration that ALJ decision conflicts with Gov. Code §7575 and that LEAs (not CCS) must provide ordered non‑medically‑necessary services; also argued fee award improper in state court | Parents argued declaratory relief was effectively a collateral attack on OAH decision and fee award is authorized under IDEA/state law with concurrent state/federal jurisdiction | Declaratory relief denied as improper vehicle to relitigate/admin-review OAH decision; court affirmed award of attorney fees (state courts have concurrent jurisdiction to award IDEA fees) |
Key Cases Cited
- Winkelman ex rel. Winkelman v. Parma City School Dist., 550 U.S. 516 (2007) (parents have procedural rights in IDEA IEP process)
- Board of Educ. v. Rowley, 458 U.S. 176 (1982) (baseline standards for FAPE and deference issues)
- School Comm. of Burlington v. Dep’t of Educ., 471 U.S. 359 (1985) (compensatory/alternative relief under IDEA; equitable remedies)
- Reid ex rel. Reid v. District of Columbia, 401 F.3d 516 (D.C. Cir. 2005) (compensatory education as individualized equitable relief)
- Campbell v. Regents of Univ. of Cal., 35 Cal.4th 311 (2005) (exhaustion of administrative remedies doctrine)
- Cupertino Union Sch. Dist. v. K.A., 75 F. Supp. 3d 1088 (N.D. Cal. 2014) (discussing compensatory relief calculation and IDEA remedies)
- Natalie D. v. State Dept. of Health Care Services, 217 Cal.App.4th 1449 (2013) (distinguishing cases where Chapter 26.5/IDEA procedures do not apply)