Hawkins v. Department of Health & Human Services
2012 U.S. App. LEXIS 763
| 1st Cir. | 2012Background
- In 2003 NH DHHS settled with a Medicaid EPSDT dental class and proposed a Decree approved by the district court in January 2004, retaining jurisdiction for five years.
- From 2007–2010 the Class filed four motions alleging noncompliance; the district court denied each motion.
- 2006–2008 negotiations and mediation occurred; the court repeatedly emphasized enforcement via contempt power.
- In 2010 the Class filed motions for contempt and to modify or extend the Decree; the district court denied both.
- The Court reviews contempt standards (clear and convincing) and assesses whether the Department complied with three key obligations: inform about EPSDT, provide timely dental services, and provide statewide orthodontic access.
- The district court focused on current compliance rather than past noncompliance and held that the Decree required contempt procedures and that the 90-day provider update and other timeliness provisions govern compliance assessment.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Enforcement mechanism | Hawkins argues contempt not required for enforcement. | DHHS argues Decree mandates contempt for enforcement. | Contempt required; motion for contempt proper enforcement |
| 2010 contempt standard | Clear and convincing standard applies to noncompliance. | District court could rely on preponderance; evidence insufficient anyway. | District court did not abuse discretion; noncompliance not proven by clear and convincing evidence |
| Evidentiary hearing | An evidentiary hearing was warranted for additional evidence. | No need absent new material evidence. | No abuse; no new material evidence warranted an evidentiary hearing |
| Modification/extension burden | Modifications/extensions necessary due to ongoing noncompliance. | No substantial noncompliance proven; modification/extension inappropriate. | District court did not err; no basis to modify or extend |
Key Cases Cited
- Brewster v. Dukakis, 675 F.2d 1 (1st Cir. 1982) (enforcement of a consent decree via contempt)
- Whitehouse v. LaRoche, 277 F.3d 568 (1st Cir. 2002) (enforcement through contempt proceedings)
- Martel v. Fridovich, 14 F.3d 1 (1st Cir. 1993) (clear standard for contempt where appropriate)
- Islamic Inv. Co. of the Gulf (Bah.) Ltd. v. Harper, 545 F.3d 21 (1st Cir. 2008) (abuse of discretion review in contempt matters; four-part test)
- United States v. Saccoccia, 433 F.3d 19 (1st Cir. 2005) (contempt elements; clear and convincing standard)