Doe v. Chiles

(10th Cir.1995). remand, the On district court affirmed its earlier orders of sanctions. DOE, through 1-13 John/Jane Mr./ Leavitt, v. See Utah Women’s Clinic No. 93- Mrs. DOE Sr. No.’s 1-13 as natural (D.Utah C-407B, 15, slip op. at 6-7 Jan. guardians on behalf of 1- Doe John/Jane 1997). plaintiffs appear us now before similarly 13 and on behalf those situ appeal for the second time the sanctions ated, Florida Association of Rehabilita . imposed by the district court exercise We Incorporated, tion Facilities A Not-For- jurisdiction under 28 U.S.C. 1291. Association, Profit United Cerebral Pal

sy Florida, Incorporated, A Florida Corporation, Not-for-Profit A Plaintiffs- prevailing defendant in a civil Appellees, rights attorney’s action recover fees 1988 if U.S.C. the suit “was vex v. atious, frivolous, brought to harass or CHILES, capacity Lawton in his official Hensley embarrass the defendant.” v. Eck Florida, as Governor of the State of erhart, 2, 429 n. Williams, individually Robert and in his 1937 n. A capacity Secretary official of the De attorney’s district court’s award of fees will partment of Health & Rehabilitative upset appeal only represents if it Florida, Gary Services of the State of L., abuse of discretion. See Jane 61 F.3d Clarke, individually and in his official Any legal analysis im underlying the capacity Secretary as Assistant for Med sanctions, however, position of is reviewed icaid, Department of Health & Rehabili Ricketts, Supre de novo. v. See Florida, tative Services of the State of Cir.1986). Kimber, capacity Charles in his official Secretary Developmen as Assistant for. light Supreme Court’s decision Department tal Services of the of Health Planned Parenthood Penn Southeastern Services, & Rehabilitative State of Flori sylvania Casey our decision Jane da, Secretary Department L., we reverse the district court’s order of Services, Health and Rehabilitative Ed 1, 1994, February judgment February its Feaver, capacity, ward A. in his official 3, 1994, 20, 1994, its judg order June its Defendants-Appellants. ment of June and its order of January vacate all awards of No. 96-5144. L., attorney’s fees and costs. See Jane Appeals, United States Court of (discussing 1513-17 standards for Eleventh Circuit. determining legal whether theories are frivo fees); purpose attorney’s lous for of awarding Feb. Casey, 505 S.Ct. at 2822- (upholding Pennsylvania’s in statute, leaving .open formed-consent while possibility challenge that a constitutional

to an informed-consent in another

jurisdiction could be successful on a different record). parties

factual Each of the is or attorneys’

dered to bear its own fees and

costs. Butterworth, Gen., Atty.

Robert A. Smith, Jr., of the General Chesterfield Office Tallahassee, FL, Counsel, McCoy, Charlie Gen., Gen., Atty. Atty. Asst. Office FL, Tallahassee, Defendants-Appellants. Tetzeli, Weinger M. and Helena Steven Kurzban, Kurzban, Kurzban, Weinger & FL, Tetzeli, P.A., Miami, Plaintiffs-Ap- pellees.

in violation of section and the Fifth and Fourteenth Amendments appellees’ United States Constitution. The complaint alleged they class-action were HATCHETT, Judge, Before Chief “receiving therapies, training *, BARKETT, Judge, Circuit and PROPST other active treatment Judge. District Senior eligibility entitled virtue of [their] for a HATCHETT, Judge: Chief placement in residential The com- [ICF].” plaint further appel- averred that most of the § In this action based on U.S.C. waiting lees years” had been for “over five court found that officials of the the district for Medicaid services and were “lan- Department of Health and Rehabili- Florida guishfing] training therapies without the failing were to furnish Medic- tative Services desperately appellants so need.”2 The promptness” aid assistance with “reasonable delays do not contest that serious have oc- developmentally disabled individu- fact, curred. in their initial brief to this als, violating provision and thus were court, they acknowledge practices that their 1396(a)(8).1 Act, U.S.C. waiting periods “resulted in of several Thereafter, enjoined the court the officials years.”3 injunctive, sought The provide failing from the assistance within declaratory monetary and incidental relief. period, a “reasonable” time exceed and, ninety days. appeal, for The officials pre-trial proceedings, Amidst extended herein, the reasons stated we affirm the certification, appellees moved for class judgment of the district court. summary judgment.4 both sides moved for 22, 1996, July granted On the district court I. BACKGROUND appellees summary judgment, holding: plaintiffs-appellees- In March Section of the Medicaid [A]ct, developmentally Medicaid-eligible, specifically prompt- disabled the reasonable retarded) (ie., clause, mentally individuals who had ness is enforceable under 42 U.S.C. entry placed waiting been lists for into 1983. “Medical assistance under develop plan” for intermediate care facilities has been defined as medical services. (“ICF/DD” mentally obliged disabled or The to furnish [S]tate “ICF/MR”) services, pursuant however, only this lawsuit to the extent that —instituted 1983, claiming placements to section that the defendants- such are offered in the Federal (“HCFA”) appellants causing delays Agency Financing were unreasonable Health Care approved plan. regarding services State Once a state elects ICF/DD * (ii) Propst, prevention regres- Honorable Robert B. Senior U.S. District The deceleration Alabama, Judge optimal for the Northern District of sit- sion or loss of current functional sta- ting designation. tus. 483.440(a)( 1)(i) (ii)(1996). 42 C.F.R. - Legislature redesignated the Florida program is restricted to individuals with Department and Rehabilitative Ser- Health sufficiently severe retardation and related mental Department Family vices as the of Children and designed "generally conditiоns. It is not separate Department Services and established a independent who are able to function clients 20.19, §§ Stat. of Health. See Fla. Ann. 20.43 supervision with little or in the absence of (West 1998). Supp. program.” continuous active treatment 483.440(a)(2)(1996). program: 2. Under the ICF/DD Appellants’ Reply (appellants 3. See also Br. at

Each client must receive a continuous active length dispute "did not the occurrence and program, aggressive, treatment which includes delays”). implementation program spe- consistent of a treatment, generic training, cialized and health ..., services and related services that is direct- In December the district court dismissed Chiles, toward— Lawton the Governor of Flori- ed defendant da, (i) plaintiffs, acquisition necessary organizational of the behaviors and the Florida Facilities, much Association of Rehabilitation Inc. and client function as self Florida, Inc., independence Palsy possible; from this determination and United Cerebral lawsuit. 3, 1996, service, September appellants filed On that service becоmes 6, 1997, appeal.6 January part the state Medicaid their notice of On subject requirements appellants’ of Federal court denied the the district stay judgment law. final emergency motion to issue, appeal. January this argument pending on this Defen- On At oral schedule; expedited briefing that Florida’s [HCFA] conceded court ordered an dants provide for approved plan does appellants’ emergency motion for denied Further, facilities. appel- stay pending appeal as to the named ICF/MR disputed the facts Defendants have not lees; appellants’ emergency granted [Sjtate’s failure to conform alleging the stay pending appeal as to relief motion for provisions forth in that stat- with the set putative class members. ute, construes as an ad- which the Court placing delays in mission of unreasonable II. CONTENTIONS persons into developmentally disabled facilities. ICF/MR appellants challenge the district omitted.)5 (Citations footnote and liability as to on four court’s determination 26, 1996, magistrate judge a August On (1) grounds. Acсording appellants: report recommending that the dis- signed a standing bring this law- appellees the lack grant appellees’ the motion to trict court (2) suit; recipients services can- of Medicaid developmentally certify a class “all those not assert a cause of action under section persons who have not received disabled (3) 1396a(a)(8); section does not placement.” con- prompt After [ICF/DD] give rise to a federal enforceable under hearing August the ducting a on 1983; the Eleventh Amend- section and judgment final court entered district appellants bars this action. The also ment “shall, ordering appellants with- day, that the contend that the district court abused its Order, days the of this establish date rendering injunctive relief it discretion the Plan a reasonable within the State’s Medicaid imposed. ninety waiting period, not to exceed list time argument appellants’ standing find the eligible We days, for individuals who unworthy meritless and of further discourse.7 placement in ICF/DD.” appellees’ problems. severely retarded and not the cоnstitu- health Jane is 5. The court did reach but, Syndrome. for the has Downs She can walk tional claims. talk, totally part, depen- and she is most cánnot daily upon her life dent others for all of activities. appeal, Subsequent filing of the notice of waiting years for Jane has been for about ten monetary claims the the district court denied The uncontroverted evidence services. ICF/DD pressed against appellants Robert had reveals that failure to receive these ser- Jane’s Gary Williams and Clarke. approaching timely anything a vices in fashion has her to lose several skills and fail to caused standing appellants’ claim 7. The crux future, Kathy develop others. As to the Whit- any appellees have not demonstrated aker, professional qualified a mental retardation injury resulting appellants’ failure from the Jane, who evaluated concluded as follows: timely Medicaid services a manner. training Future vision of Jane without indi- argument as The district court described this skills, lessening a lack of cates a continued "frivolous,” appellants' counsel and the motivation, oppor- escalated isolation with no argument passing during oral before raised it in contact, peer development and tunities for agree this court. We with district court daily meaningful lack of activities to reduce the showing plethora reveals "a of facts record spent simply listening to the ineffectual time radio, developmentally disabled the harm caused to doing puzzles. child-like music proce- persons by the State of Florida’s current person many, many strengths Jane is recipients dure which allows dissolving day that will dissolve and are each been determined to be in need of who have as she is denied [services]. placed to be wait- services indefinite Whitaker’s conclusion went uncontradicted in ing lists.” party standing "[A] district court. appellee injunctive party alleges, plight Jane Doe 6 is illustra- relief ... if seek thirty-nine years ultimately proves, approximately a real and immediate ... tive. Jane is City injury.” age parents, v. Hunts- her who are threat of ville, Church and lives home with future Cir.1994). (11th significant 30 F.3d in their sеventies and have mid-to-late part rights.”). A section as constitutional Accordingly, of the discussion As the Court re cently Freestone, appellants’ statutory Blessing made clear in ar- below addresses — U.S.-,-, 1353, 1359, 137 liability; part B as to assesses guments (1997): claim; L.Ed.2d 569 appellants’ Eleventh Amendment appellants’ part addresses the contentions C through § In order to seek redress injunctive regarding relief the district plaintiff must assert the viola- court rendered. tion right, merely federal a viola-

tion traditionally law. We have looked at three factors when determining III. STANDARDS OF REVIEW particular statutory provision whether a We review a district court’s conclu First, gives right. rise to Con- County sions of law de novo. DeKalb Sch. gress must have provi- intended that the Schrenko, Dist. v. in question plaintiff. sion benefit Sec- — Cir.) curiam), denied, (per cert. ond, plaintiff must demonstrate that -, right assertedly ‍​​​​​‌‌‌‌​‌‌​‌​‌​‌‌​‌​‌‌‌​‌​​‌‌‌​​‌​‌​‌‌​​​​‌​​​‍protected by the stat- grant review the district court’s of in- “We “vague amorphous” ute is not so discretion, junctive relief for abuse of mean judicial its enforcement would strain com- ing we must affirm unless we at least deter Third, petеnce. unambig- statute must mine that the district court has made a clear uously impose binding obligation on the judgment applied error of or has an incorrect words, States. In other giv- legal Corp. v. standard.” SunAmerica Sun ing right rise to the asserted must be Canada, 1325, Assurance 77 F.3d Co. of Life mandatory precato- couched in rather than (11th Cir.) (internal quotation 1333 marks ry terms. — omitted), denied, cert. and citations U.S. (Citations omitted.) See also v. Wilder Vir (1996). -, 79, 117 S.Ct. 136 L.Ed.2d 37 Ass’n, 498, 509, ginia Hosp. 496 U.S. 110 2510, 2517, 110 L.Ed.2d 455 IV. DISCUSSION (“Such inquiry pro an turns on whether the question vision in was intended to benefit the A. so, putative plaintiff. If creates imposes liability any right Section 1983 an it merely enforceable unless reflects who, law, acting congressional preference one under color of state for a certain kind deprives person “any rights, privileges, binding obligation conduct rather than a unit, governmental or immunities secured on the or Constitution unless the inter (West § 42 Supp. plaintiff vague and laws.” U.S.C.A. 1983 est is asserts too 1997). Thiboutot, 1, amorphous beyond 4- compe Maine v. 448 U.S. such that it is enforce.”) (internal 8, 2502, 2504-06, judiciary 100 S.Ct. 65 555 to L.Ed.2d tence of the (1980), marks, Supreme quotation Court held that section citations and brackets omit ted); James, 993, 1983 can be used to vindicate violations of Harris v. 127 999 & (11th Williams, Cir.1997); statutory rights. Maynard n. 7 See also Golden v. (11th Cir.1996). Corp. City Angeles, v. State Transit Los 72 F.3d If a statu 444, 448, factors, tory provision 493 U.S. 110 S.Ct. meets these three (1989) (“As language presumption L.Ed.2d 420 rebuttable “that the is en indicates, plainly § remedy Blessing, statute encom 1983” forceable under arises. --, passes statutory violations of federal as well at 1360.8 Supreme statutory particular provision, For detailed discussion of the federal law. A area, Harris, example, may manifestly precatory Court’s case law in this see be so majority, F.3d at fairly impose 997-1004. The Harris howev- that it could be read not to er, Bradshaw, unit, failed obligation” governmental to mention Liradas r. “binding on a (1994). may amorphous” "vague or its terms be so case, following In that Justice Souter wrote the determining “deprivation” whether a for a Court: unanimous might judicial have occurred would strain have, true, recognized competence. Congress might We And that even the itself make give statutory [of 1983] broad text section does it сlear that violation of a statute will not not every liability by express § alleged authorize a either suit for violation of rise to 435.930(a)-(b) § cooperative regulation “Medicaid is a federal- Another program through agency which the Federal “[t]he state states that must time establish provides to financial assistance Government in determining eligibility standards may they so that furnish medical care States applicant form of what are.” needy individuals.” 435.911(a) (1996). to § periods C.F.R. These 2513.9 law does not S.Ct. at Federal “[n]inety days appli exceed are not to require provide services Florida apply cants who for Medicaid on the basis participate order to in Medicaid pro disability” “[f]orty-five days other for all 1396a(a)(10)(C)(iv), § gram. See U.S.C.A. 435.911(a)(1)-(2) § applicants.” C.F.R. (West Supp.1997); King (1996). Moreover, agency “must not use Sullivan, F.Supp. King v. waiting period.” as “a the time standards” (“A (D.R.I.1991) state has the participating 435.911(e)(1) (1996). It is this all.”.). not option to offer ICF-MR services panel’s “rea task determine whether the Florida, however, has elected do so. See promptness” clause of section sonable (West 409.904(3) Supp. Fla. Stat. Ann. 1396a(a)(8) “gives right.”10 rise to a federal 1998). a state elects “[W]hen service, part Preliminarily, optional that service becomes we note that re this court’s subject state Medicaid cent Harris v. not decision James did Harris, requirements Tallahassee of federal law.” issue at address the bar. Cook, Regional Memorial Medical Center the “narrow decided issue” “whether Cir.1997) (per cu recipients have a McCrimon, riam); see also McMillan v. 807 transportation in an be enforced (“The (C.D.Ill.1992) F.Supp. 481-82 fact § 1983.” 127 action under F.3d at 996. The op is an Program] [Home Services transportation plain right to that the Harris it from the exempt tional service does not sought appeared “explicitly tiffs enforce 1396a(a)(8).”). requirements of It is section Act, the Medicaid but in a federal undisputed government the federal 42 C.F.R. regulation,” 431.53. 127 F.3d fifty-five percent shoulders about of the costs majority rejected 1005. Harris first providing that Florida incurs in ser “finding any rights notion of enforceable vices. interpretation valid administrative of a stаt right.” ute that creates some enforceable 1396a(a)(8) plan “A Section reads: 127 F.3d at 1008. The court then concluded provide for medical assistance must ... transportation regulation did “not application wishing all individuals to make any specific define the content of con right plan shall medical assistance under for plaintiffs upon by Congress,” ferred so, opportunity have that such to do “Congressional thus its nexus to intent to assistance shall be with reasonable furnished rights” create federal was “too tenuous to promptness eligible to all individuals.” 1396a(a)(8) (West right.” an enforceable 127 F.3d at Supp.1997) U.S.C.A. .create added). plaintiffs 1010. The held that the had (emphasis corresponding regula- A rights pursuant no provides enforceable to agen- Medicaid responsible tion state 1396a(a)(1), 1396a(a)(4)(A), “must,” Act sections or cy among things, “[f]urnish other 1396a(a)(19). 127 any F.3d at In addi promptly recipients Medicaid to without 1010-11. tion, delay right transporta found caused administrative the court “no agency’s [to procedures,” regulation conjunction furnish Med- under read in tion] to “[c]ontinue 1396a(a)(10)(B), 1396a(a)(8), regularly icaid with” eligible to all individuals until sections 1396a(a)(23). ineligible.” found to be doing, F.3d at 1011. In so Act, by providing commonly comprehensive Security words or alter- 9. of the Title XIX Social Act, apart known at 42 native But from Medicaid is codified enforcement scheme. . cases, §§ exceptional gen- U.S.C. these 1396-1396v 1983 remains erally presumptively remedy available claimed appellees violations of federal law.' Clearly, the "identif[ied] have 10. Livadas, particularity right[] they Blessing, U.S. at 114 S.Ct. at 2083 claim[].” (citations omitted). at-, S.Ct. at brackets 1360. upon it majority recipients made clear that was right federal deciding transportation the issue of whether section enforceable under section 1396a(a)(8) gives right rise to a provision

reasonably prompt of assistance: short, 127 F.3d at 1011-12.11 In the majority may statutes cre It be each these opinion in Harris does particu not dictate a right;27 similarly, may some federal it ates lar outcome on panel.12 the issue before this transportation regulation is a be that the above, As stated the first factor for tous interpretation provi of eаch of these valid address is Congress whether Chevron[, U.S.A., “intended sions Inc. v. Natu provision in question Council, Inc., benefit ral Resources Defense -, plaintiff.” Blessing, at S.Ct. at 1369a(a)(8) Again, However, provides section we do not think these ]. plan factors, “[a] State for medical if assistance two even we found both to be must ... true, that all up wishing to a individuals would add application to make transportation. transpor each ease the medical assistance under the regulation opportunity tation would be valid not shall have be do so, reasonably it and that such cause defines the content of assistance shall be fur rights statutory provisions, nished with promptness created reasonable to all regulation Wright City as did the [v. individuals.” U.S.C.A. 1396a(a)(8) (West Redevelopment Housing Roanoke & Au Supp.1997) (emphasis added). thority, plain language provi (1987)], promptness L.Ed.2d 781 but because the sion’s reasonable clause is clear objectives regulation ly furthers the broad Medicaid-“eligible intended to benefit indi underlying statutory provision. each viduals” —such as the in this ease.13 words, Thеrefore, other we do not think that trans we do not in concluding hesitate portation providers to and from is reason that the clause meets the first factor. See (“Because ably part Sobky, F.Supp. understood the content at 1146 of a of assis prompt requirements establishes tance, assistance, comparable providing phrased or choice services and is in terms of Instead, among providers. regula benefitting if the seeking individuals Medicaid ser vices, interpretation provi recipients tion is a valid of these Medi-Cal are the intended sions, beneficiaries.”) (internal transportation quotation would be because marks omitted); Forrest, ensuring be a reasonable means of Blanchard v. Civ. A. No. assistance, (E.D.La. prompt provision compa (Unpublished Opinion) 93-3780 (reasonable assistance, 1994) 6, among provid Sept. rable or choice promptness clause 1396a(a)(8) Congressional provide[s] ers. Such links to intent of section “certainly a may support Wilder, be validity plaintiffs”); sufficient to the benefit cf. (“There regulation; 510, a we think at 110 S.Ct. at can be 2517-18 support too tenuous to that providers conclusion little doubt that health care are the Congress unambiguously conferred intended beneficiaries of the Boren Amend- services.”); McMillan, majority In footnote the stated that mean 807 argument only ("[C]ourts “assume[d] for sake of F.Supp. interpreted that at 480 have provisions right.” these create some federal 127 1396a(a)(8) second clause in section as- —'such F.3d at 1011 n. 27. sistance shall be furnished with reasonable promptness apply- to all individuals’—as Judge reasoning Kravitch dissented from the ing beyond application to benefits the initial majority opinion and result of the in Harris. See Medicaid.”); King by King, F.Supp. 776 at 651 (Kravitch, J., dissenting). 127 F.3d at 1012-21 ("Placement public [a in the Ladd Center undoubtedly ICF/MR] is 'medical assistance un- reject appellants’ 13. We contention that ”); plan.’ Baggiano, der the see also Silver v. 804 "providers of services” are the intended benefi- (11th Cir.1986) ("As 1216 with the promptness ciaries of the reasonable clause. whole, See, 1123, Medicaid e.g., Sobky Smoley, [the statute as "freedom оf F.Supp. 1396a(a)(23) (E.D.Cal.1994) (" provision requires of] choice” was intend- (footnote plan’ recipients.”) ‘medical assistance under the ed to benefit Medicaid omitted). to be fur- promptness, nished with reasonable and this can qualify as enforceable specific and definite Medicaid Act]. ment [to 1396a(a)(13)(A) not, ..., respondent sys rights that are rights establishes ] [section providers judi beyond competence tem for reimbursement of the suggests, benefiting health care phrased in terms of ciary Wright, to enforce.” 479 U.S. at Transit, providersGolden S.Ct. at 774. 451-52; Wright, at at U.S. S.Ct. Wilder, presented question In was (“The Brooke at at 773-74 U.S. S.Ct. “whether the Boren Amendment Housing Act of 1937] [to Amendment Act, requires reimburse [Medicaid] amended in as further could not be clearer: according finds ment to rates that ‘State charged as rent no tenants could be adequate ... are reasonable and to meet the percent than 30 of their more and no less efficiently costs which must be incurred tenants The intent to benefit income.... facilities,’ economically operated is en undeniable.”); Maynard, at 852-53. pursuant in 1983.” forceable an action Next, inquire we whether 501-02, 110 (quoting 496 U.S. at S.Ct. at 2513 asserted- have that “demonstrate[d] 1396a(a)(13)(A)) (citation 42 U.S.C. omit ly protected by ‘vague the statute' is not so ted). in inquiry The Court answered amorphous’ that its enforcement would and, rejected doing, the affirmative so competence.” at judicial Blessing, strain was “too argument the amendment words, -, at 1359. other S.Ct. - amorphous’ judicially ‘vague and to be en case, whether of this we ask the context Wilder, forceable.” U.S. recipients’ enforcing putative position, support at 2522. In of its prompt ex- reasonably medical assistance regula Court observed the statute competence. our institutional We ceeds tion at issue set out factors which the states think not. adopting had to consider in rates. support for our conclusion in the We find 110 S.Ct. at 2522-23.14 The Wright ánd Supreme decisions Court’s Court also stated: Wright, residents of lów-income Wilder. projects alleged pub- that their local housing gives That the States sub- amendment (“PHA”) housing authority lic had overbilled choosing among stantial discretiоn rea- utilities, thus them for their had violated may calculating sonable methods of rates Brooke Amendment —which mandated affect the standard under which a court “ family pay ‘shall as rent’ that a low-income comply whether the rates with the reviews percentage specified of its income”—and amendment, but not render it does implementing regulations required by a amendment unenforceable court. amount for the “rent” include a “reasonable” range While there be a of reasonable use of utilities. 479 U.S. rates, certainly there are some rates out- rejected 768. The Court the PHA’s asser- range side that that no State could ever provision for a tion that “the ‘reasonable’ adequate find to reasonable and be vague allowance for utilities is too and amor- Although knowledge the Act. some phous confer on tenants an enforceable hospital industry might required meaning ‘right’ within the 1983.” findings ‍​​​​​‌‌‌‌​‌‌​‌​‌​‌‌​‌​‌‌‌​‌​​‌‌‌​​‌​‌​‌‌​​​​‌​​​‍respect a with to evaluate State’s Wright, 479 U.S. at 107 S.Ct. at 774. rates, the reasonableness of its such an Relying primarily legality speci- on the inquiry compеtence is well within the ficity regulations “defining of the the statuto- Judiciary. utilities,” ry concept including of ‘rent’ as Wilder, 519-20, at at Congress Court concluded that “the benefits U.S. S.Ct. (footnote omitted).15 sufficiently 2522-23 intended to confer tenants are Wright continuing viability that the Boren 15. and Wilder The Court noted Amendment Harris, provided guidance provision at "more than the See 127 F.3d at 1004 is not in doubt. housing Wright, law”). issue which vested in the in (Wright good and Wilder "remain authority setting utility discretion for substantial Wilder, allowances.” 496 U.S. at 519 n. S.Ct. at 2523 n. 17. view, in statutory provisions at issue section further Like the fleshed —as 1396a(a)(8)’s Wilder, by re- Wright regulations section out these a federal —creates be furnished assistance, that “assistance shall quirement right reasonably prompt to eligible promptness is, to all with reasonable provided assistance without unreasonable sufficiently specific presents a individuals” delay. readily susceptible to and definite standard M., Suter v. Artist U.S. S.Ct. view, evaluating In our

judicial assessment. 1360, 118 (1992), compel L.Ed.2d does not provision promptness of the the reasonable case, contrary plain conclusion. assistancе is less onerous than of Medicaid statutory pursuant tiffs claimed a to a evaluating whether a state’s Medicaid reim- Adoption section of the Assistance and Child are “reasonable and ade- bursement rates (“AACWA”), Welfare Act requiring of 1980 Moreover, quate.” Wright and Wilder “ for a eligible ‘[i]n order State to be indicate, that a state retains the fact substan- payments part, under this it shall have a determining the relevant tial discretion in approved by Secretary Health [of periods time “does not render the [clause] that, provides Human which ... Services] Wilder, by a unenforceable court.” U.S. case, each reasonable efforts will be made at 2523. there at 110 S.Ct. “While prior ... of child foster periods of reasonable range [time care, prevent to or eliminate the need for assistance], certainly provision of there home, removal of the child from his and ... range periods] outside that [time some possible make for the child to return to ... no State could ever find to be reasonable home____’” Suter, his at Act.” [Medicaid] (quoting 42 U.S.C. Indeed, given 110 S.Ct. at 2523. 671(a)(15)).. plaintiffs alleged in Suter egregious facts of this case it is difficult responsible agencies state failed to appellants argue for the make such “reasonable efforts.” 503 U.S. at agree not factor. do meet second We 352, 112 S.Ct. at 1364. The Court held that appellees’ with the assertion that this con- plaintiffs possess statutory did not text, delays is axiomatic that of ‘several “[i]t 671(a)(15). right under section 503 U.S. at years’ ... are far outside the realm of rea- Although the Court sonableness.” explicitly capable-of-judi- did discuss the regulations We also find that the further factor, holding eial-enforcement its relied in statutory right define the contours of the part on the fact that the “reasonable efforts” reasonably prompt provision of assistance. meaning directive one “whose will obvi was (“Wright Harris 127 See 1008-09 ously vary with the circumstances of each long would seem to indicate that so as the individual case.” 503 U.S. at specific right upon statute itself confers a at 1368. plaintiff, regulation merely and a valid fur- Indeed, procedural history of Suter ther defines оr fleshes out the content of that enforcing reveals that the “reasonable ef conjunction right, then the statute —‘in forts” strain AACWA would regulation’ may create a federal — ease, judicial competence. In that in March regulation.”). as further defined As the district entered order en above, regulation stated section 435.930 re- joining Department the Illinois “[fjurnish Children quires that a state “must” Medic- (“DCFS”) Family fading Services from promptly recipients any delay aid without assign placed in a caseworker to each chdd agency’s proce- caused administrative custody working days DCFS within three dures,” and to furnish Medicaid “[c]ontinue was first the timé'the chdd’s case heard regularly to all individuals until court, juvende fading reassign from ineligible.” are found to be 435.930(a)-(b) (1996). noted, working days within three § caseworker As also 42 435.911(a) responsib any relinquished date caseworker acceptable sets forth the Suter, ility particular 503 eligibility for a case. time limits for determinations— 1990, April ninety days disability-based applications at 112 at 1365. In for S.Ct. forty-five days weekly reporting a and for all others. our district court established 718 (same); Columbia, compliance Wellington the March v. District

mechanism for with of (D.D.C.1994) injunction. April required (same); F.Supp. 1990 The order 5-6 every Friday provide Blum, (same); that would DCFS Blanchard see also Kessler v. (S.D.N.Y.1984) all plaintiffs’ counsel list of children F.Supp. (quot- just “whose cases entered have Juvenile ing approval proposition with that “[i]n recently or who lost their case Court have express compli- of an absence time for worker, along of names involved with ance, uniquely courts are suited to determin- caseworkers and relevant dates of com (internal reasonable”) ing quotation what is completion assignments.” mencement or omitted). marks Johnson, M. v. 984 n. Artist factor we third address whether the rev’d, (7th Cir.1990), nom., sub Suter Artist promptness “unambiguous reasonable clause M., 347, 112 1360, 118 S.Ct. L.Ed.2d ly impose[s] binding obligation on the appeal, On the Seventh Circuit at-, Blessing, States.” 117 S.Ct. at 1359. remanded for the district court to make fac language undoubtedly of the statute is findings regarding delays tual the nature of mandatory precatory cast rather than assignments progress in caseworker 1396a(a)(8) (West terms. See U.S.C.A. they reforms as at the DCFS existed time (“A Supp.1997) plan assis medical injunction in the trial court rendered the provide ... tance must that all individuals M., March 1990. Artist 917 F.2d at 984. In wishing to application make as medical issues, findings order to render on these plan oppor sistance under the shall have the February district court had to review “the so, tunity to do and that such assistance shall logs regarding of the DCFS caseworker promptness be furnished with reasonable assignment” “closely scrutinize “the [ ]” individuals.”) added). eligible (emphasis all January February activities addition, receipt a state’s of federal Med M., (emphasis DCFS.” Artist 917 F.2d at 984 expressly icaid funds is conditioned on its added). compliance provisions with the of section simply Federal courts are not well- (West 1992). 1396a. See U.S.C.A. 1396c equipped undertakings. quite for such It is Wilder, Accordingly, dictates, under the evident, “[wjhat that constitutes 496 U.S. at we hold promptness in providing ‘reasonable’ that promptness the reasonable clause meets inherently assistance is more circumscribed the third factor.17 judicially than concеpt ascertainable they passed Because have the three- ‘reasonable efforts’ children____” test, appellees factor to a Sobky, foster entitled F.Supp. presumption statutory rebuttable their 1147.16 We conclude that the have right right reasonably prompt shown that their enforceable under section 1983. --, Blessing, assistance under section 1360. Howev er, vague amorphous proper Congress specifi is not so “dismissal is if judicial cally remedy its enforcement would strain foreclosed a 1983.” (internal competence. at-, Sobky, F.Supp. at 1147 Blessing, See 117 S.Ct. at 1360 require 16. We also note that the Court found it did the AACWA not states to make Suter "significant” ‍​​​​​‌‌‌‌​‌‌​‌​‌​‌‌​‌​‌‌‌​‌​​‌‌‌​​‌​‌​‌‌​​​​‌​​​‍regulations were AACWA's keep together, reasonable efforts to families but specific." "not 503 U.S. at 112 S.Ct. at Secretary-approved plans have discussed, 1369. As this is not the case with the pronouncing that such reasonable efforts will be which, regulations, relevant ing requir- Medicaid Suter, made. See 503 U.S. at 112 S.Ct. at states to medical assistance without 1396a(a), however, 1367. Section does not con- any delay prоcesses attributable to administrative limiting language. tain such “The [under establishing pro- and in concrete time limits on 1396a(a)(8)] merely procedural section is not cessing applications, flesh out plan provide [the one that that medical assis- 1396a(a)(8)'s meaning of section reasonable promptness]; tance be furnished reasonable promptness mandate. rather, provides Act substantive [reasonably prompt provision of assistance] as 671(a)’s Relying preliminary on section lan- well.” 496 U.S. at 110 S.Ct. at guage order "[i]n for State to be payments part, under this have a shall approved by Secretary,” the Suter court held

719 omitted). Constitution, “Congress regarded which we have marks quotation by forbidding expressly, evidencing recourse Eleventh Amendment and ex so do itself, impliedly, by or emplifying, pro § in the statute we have extended a State’s 1983 comprehensive enforcement creating brought by tection from suit to suits incompatible that is with individual State’s own citizens.” v. scheme Idaho Coeur d’Al — Idaho, Blessing, U.S.-,-, § at 1983.” ene Tribe enforcement 117 of 2028, 2033, (1997) (cit ——, Supreme 117 S.Ct. at 1360. Court S.Ct. 138 L.Ed.2d 438 Lоuisiana, 1, repeatedly ing has stressed that burden of Hans v. 10 S.Ct. 504, (1890)). making showing this rests with the defen- 33 842 Consequently, L.Ed. See, at-, e.g., Blessing, 117 S.Ct. “the dant. Eleventh Amendment constitutes an ab Wilder, 1362; 496 at 110 being by at U.S. solute bar to a state’s sued its own- 2523-24; Transit, citizens, 493 among S.Ct. at Golden State others.” County DeKalb 449; 107, Schrenko, Wright, 680, at 110 S.Ct. at 479 Sch. Dist. v. U.S. F.3d (11th Cir.) curiam) (internal 423, Wisely, (per at 107 S.Ct. at 770. quotation U.S. — argument omitted), denied, U.S.-, in appellants have made no such marks cert. 110, 601, 139 496 U.S. at this court. See L.Ed.2d 489 S.Ct. (finding “little merit” to the S.Ct. support grant To the district court’s “Congress has en- argument foreclosed - case, injunctive appellees of relief in this of the Medicaid Act under

forcement rely parte Young, on the Ex U.S. 1983”). (1908), doctrine, S.Ct. 52 L.Ed. 714 sum, we hold that the have a “permits enjoin federal courts to state reasonably prompt provision right to officials conform their conduct to the re 1396a(a)(8) of assistance under section law, quirements of federal if even there is an Act, is enforce- this ancillary impact treasury.” on the state able under section 1983.18 Schrenko, (citing at 690 Milliken Bradley, 433 U.S. B. (1977)). ' As the Court pro The Eleventh Amendment reinforced, recently plaintiffs has claim power of the vides: “The Judicial United injunctive against seeking prospective relief States shall not be construed extend ongoing state officer’s violation of federal law equity, in any suit law or commenced or ordinarily proceed in court. can Co prosecuted against one of the United States Idaho, at-, Tribe eur d’Alene State, of another or Citizens Citizens 2040; see also Tribe Fla. v. Seminole Subjects any Foreign- State.” U.S.' —- Florida, nn. 14 & Const, Supreme XI. The amend. Court 16, 134 nn. 14 & L.Ed.2d 252 application sovereign not limited its immu (1996).19 in nity to the suits the text of the described respect This Eleventh Amendment. “To court’s recent decision Tallahassee Cook, concept immunity, implicit Regional in the Medical Center v. broader Memorial 1146-47; individuals, Sobky, F.Supp. eligible statutory 18. Accord Well- assistance 5-6; ington, F.Supp. We also provision plainly prong Blanchard.. the third satisfies Harris, opinion dissenting Thus, alone, note that in her standing test. the Wilder Judge expressed Kravitch the view that section 1396a(a)(8) upon plaintiffs an confers 1396a(a)(8), right to medical assistance. enforceable alone, standing creates enforceable J., (Kravitch, (foot- dissenting) at 1018 plainly medical assistance. It satisfies the first omitted). (11th Cir.1997) curiam), (per through its denial of reimbursement to Cook, psychiatric patient hospitals Plaintiffs for adolescent controls this issue. two “grace days,” thereby provide in-patient shifts defieien- psychiatric that care under pro- cies of the State’s medical brought assistance program Florida’s Medicaid suit gram, resulting impact and the fiscal of the against Agency Director of Florida same, hospitals. to the Plaintiff (“AHCA”), for Care Health Administration injunctive declaratory seeking and relief un (footnote omitted). 109 F.3d at 700-01 Amendment, der section and the Boren prac- district ‍​​​​​‌‌‌‌​‌‌​‌​‌​‌‌​‌​‌‌‌​‌​​‌‌‌​​‌​‌​‌‌​​​​‌​​​‍court held the defendant’s 1396(a)(13)(A). 109 F.3d at 695- U.S.C. Amendment, tices violated the Boren factual background 96.20 Cook was as declaratory injunctive rendered decrees. follows: 109 F.3d at 703-05. This court affirmed in full holdings liability the trial court’s toas organizational funding to or

[D]ue deficien- declaratory relief. 109 F.3d 694-95. pro- cies in the state’s medical assistance gram, shortage there is an extreme prоspective This also affirmed the spaces at care available alternative facili- injunctive against the relief entered defen- psychiatric patients. ties for ... adolescent dant, AHCA: enjoined

Defendant AHCA is from fu- Amendment, ture violations the Boren repeatedly Plaintiffs have therefore adopt as set forth herein. AHCA for shall posture themselves forced into the found hospital outpa- each interim Plaintiff caring psychi- retaining for adolescent tient reimbursement rate that reason- patients atric after necessity the medical adequate able and to costs of an meet .the ceases, in-patient, for acute care services economically efficiently facility. run treatment at facility because an alternative AHCA shall reimburse Plaintiffs in accor- medically necessary patient, was for the rate, existing dance in-patient placement but such an alternative set- rate, outpatient by the interim as dictated ting impossible greatly delayed. dr was necessity each individual circumstances, Under these the Plaintiffs injunction case. This is to remain in full patients discharge force and effect until further order home, medically since are not able to Court. return such an unsupervised setting.... to (brackets omitted). Thus, forced, hospitals F.3d at through no own, holding This confirms our patients fault of their belief that retain these neatly parte until instant lawsuit fits within the setting an alternative Ex Like, Cook, Young possible. exception. hospitals the prospective in this case seek retrospective review, [Keystone On Peer injunctive enjoin relief state officials from Organization, Review which is under con- is, law, continuing to violate federal tract to review the Medicaid claims at is- Medicaid Act. sue,] guidelines abides Medicaid de- nying' payment in-patient Plaintiffs panel, correctly The Cook vacat- psychiatric services for grounds pro- adolescents at the ed on Eleventh Amendment point longer those services are no medical- visions of the district court’s order com- ly necessary. However, pelled Legislature Florida’s failure thе Florida to “amend its adopt payment inap- Medicaid include reimbursement propriate medically necessary level of inappropriate care services causes level of deny any AHCA to care reimbursement services.” F.3d at 704. In the hospitals “grace days,” present case, two Judg- for those the district Final re- court’s gardless of “Accordingly, the duration the ment adolescent reads: it is ORDERED patient shall, has to wait before an alternative AND ADJUDGED Defendants AHCA, out-patient setting Order, days is available. within 60 this date of discussed, exceptions Appendix opinion. With certain will be order as A to its 109 F.3d at panel the Cook affirmed "on the basis of the well- order,” reasoned district court and attached that Reagen, 886 F.2d Plan a Weaver v. within State’s establish Cir.1989) (“Once a state chooses to offer such waiting period, time not' list reasonable optional compli- are it is to act in ninety days, for individuals who services bound exceed applica- Act in institution- ance with the and the placement [Medicaid] eligible for ICF/DD language regulations implementation means in the of- facilities.” This ble al care ”). into incorporate appellants Accordingly, appel- the must those services.... providing services present scheme lants’ assertion here does little to undermine their waiting period list regarding propriety ensure a our the procedures that confidence ninety days. Consequently, injunction. of not more than district court’s to poses Amendment no bar the Eleventh Second, appellants the assert that the dis- injunctive relief the lawsuit or to the this enjoinment prevents trict them from court’s against appellants. the imposed court district emphasizing community- the Cook, 704-05. 109 F.3d at See developmentally based services to disabled place in care. The individuals institutional C. appellants years state that in “Florida recent the appellants’ final claim is that The emphasized the use of the home and enjoin in court abused its discretion district community principal based waiver as its vehi- provide Medicaid services at ing them to the expanding improving long-tеrm cle and put ninety days. appellants The issue within developmen- care services to individuals with arguments support of this forth several appellants’ tal disabilities.”21 The belief position. necessarily im- the district court’s order will First, misplaced. plain lan- emphasize" option- pede the this trend is The appellants the injunction program. guage As we of the district court’s does al nature of the ICF/DD stated, however, prevent appellants continuing from to when a state “even have service, pursue community-based and ser- optional the home provide to an elects program waiver in accordance with fed- part of the state Medicaid vices service becomes dictates, statutory regulatory requirements eral and includ- subject is to the 1396a(a)(8).22 698; Cook, ing section law.” 109 F.3d at see also Security “permits provide At the June States to how to services. 21. The Social Act offer, hearing, example, statutory requirements, counsel stated that under a waiver of require array community-based "[w]hat I have asked this Court db serviсes of home comply with section of the defendants that an individual needs to avoid institutionaliza- (1996). [1396]a(a)(8) statute and leave it of the Medicaid 441.300 See tion." 1396n(c) (West they comply.” At Supp.1997); gener- to the defendants as to how U.S.C.A. see hearing told Program; Community- in October counsel ally another Home 48,532 Services, magistrate judge: Fed.Reg. Based program, participate order to in this people these services that are needed [T]he provide: must states plaintiffs], according.- to -the defendants [the cases, and, many according plaintiffs, recipient determined that when a Assurance provided a[n] [institu than in likely require provided could be other the level of care to be ICF/MR, They provided could be in the recipient tional] bed. ... or his or her in an people’s representative homes. legal will be— pro- (1) something called the waiver any avail- There is Informed of feasible alternatives waiver; position al- gram to the state has [0]ur .... able under been, provide everybody ways they if want to Given the choice of either institutional they don’t need to be community-based with services so services. home arrange- 441.302(d)(1) (2)(1996). housing out of their current taken 42 C.F.R. - physical they get thera- hearing will ment —because We note that at a before district therapy, py, occupational on-call appellants’ the other counsel on June court needed, great. are that’s There waiting services that that a list also exists under admitted - They always welcome program won’t be a lawsuit. is not the mon- "[t]here waiver because people in the manner program.” did services ey Counsel available to fund delays.. which see fit. extent of the not mention the the one filed a lawsuit based on We have exists, which is surprising given appellees’ that the 22. This is not you’re prompt] if Medic- appellants repeatedly [a stressed that the counsel ICF/MR if—like the criteria. And determining aid and meet complete should retain discretion Third, appellants give option devote three sen- Florida of “termi- officials tences in their initial brief to the contention nat[ing][the] receipt money of federal rather ninety-day overly time limit is strin- assuming] unanticipated than burdens.” gent. appellants argue that the district appellants’ overstated, concern here is imposed regard this time limit without recipient Spending federal funds under empha- the state’s resources or its recent legislation always option. Clause retains this providing community-based sis on services as fashioning [I]n remedies for violations of a substitute for institutionalization. We have Spending by recipients Clause already statutes addressed latter contention. As former, funds, appellants’ the bald statement the recognize must courts does not convince us that the district court recipient that the has alternative choices of event, any abused its discretion. In “[inade- assuming the additional complying costs of quate appropriations state not do excuse non- with what a court has announced is neces- compliance” with the Medicaid Act. Alabama sary to conform to federal law or of not Harris, Nursing Home Ass’n 617 F.2d using federal funds and withdrawing from (5th Cir.1980); Cook, see also program entirely. the federal Although a F.3d at 704. may identify enjoin the violation and Fourth, appellants argue the in that the its recipients continuance or order of fed- junction contend, overly They broad. for prospectively perform eral funds then- example, that judgment “[t]he final was not duties receipt incident to the of federal inadequacy lengthy waiting limited to the — money, recipient option the has the of placement produced time for in ICFs —that withdrawing terminating and hence the alleged injury.” the disagree We could not prospective injunction. force of the injunction more. is crafted toward generating waiting a “reasonable list time Guardians Ass’n v. Civil Service Com’n of period” Thus, for individuals. when York, City 582, 596, New 463 U.S. appellants the further that “[t]he assert dis (1983) S.Ct. (opin- 77 L.Ed.2d 866 trict court ... should have an[ ] ordered end White, J., J.) (internal Rehnquist, ion of lengthy waiting periods [to] generally, with omitted). quotation marks and citation out dictating problem how the was to be Finally, appellants contend that “the corrected,” we complete find ourselves in sought granted relief And, essentially was accord. that is what the district court political remedy did. Casey, , —, See Lewis v. which the 518 U.S. district court 343 — should have avoided.” This assertion is mer (“The remedy must of course be limited to “Injunctive may, course, itless. relief inadequacy produced injury-in- applied to state officials whose actions dero established.”).23 plaintiff fact that the laws____” gate federal Medicaid Smith v. Fifth, Miller, Cir.1981) (cit appellants argue that the district court abused its discretion ing parte because it did not Young). Ex anything ¶ people away ....”) 11(e) ("Defen- imately years want to entice five else — hy services, offering package deny some other dants that [John] Doe 2b has been on a great. waiting years, that's list for ten but admit that he has waiting eight been on a residential list addition, 23. and unlike the circumstances years."). appellants Nor did the contest Casey, certainly in this case have See, ¶ delays pervasive. e.g., were Answer at appellants' ongoing established that the violation large (appellants “admit there are num- "systemwide.'' Casey, law is See at waiting bers] individuals sеr- ICF/DD Indeed, -& n. 116 S.Ct. at 2184 & n. 7. vices”). Instead, they argued delays appellants.did the trial court the not contest the permissible were under the law. The record See, length delays existence or at issue. hundreds, thousands, perhaps reveals that even e.g., Capacity Defendants' Official Answer & Af- eligible developmentally persons disabled ¶ ("Answer") 9(c) (admit- firmative Defenses being provided not any- services with ICF/DD ting "seeking that Jane Doe 1 was a residential thing resembling promptness. reasonable Con- placement facility years”), in an for 8 sequently, reject appellants' ICF/DD we contention ¶ 10(d) (“Admit [John] Doe 2 has been on a showing 'sys- that "there was no of statewide or waiting approx- list for an injuiy." tem' wide was left undefined term “reasonable efforts”

V. CONCLUSION statutory guid by Congress. “No further reasons, we affirm foregoing For the as to ‘reasonable efforts’ ance is found how court. of the district judgment 360, 112 Id. S.Ct. at are to be measured.” AFFIRMED. fur agency regulations 1368. Nor did specify meaning of the term. The ther BARKETT, concurring:, Judge, Circuit regu ... “significant that the Court found excel Judge Hatchett’s in Chief I concur specific lations are not do separately I opinion in this case. write lent any that failure to do notice to the States view, my additionally why, in explain with the thing other than submit v. Artist Suter Supreme Court’s decision features, approved by the requisite to be 1360, 118 M., 347, 112 L.Ed.2d further condition on the re Secretary, is a (1992), the conclusion does not mandate government.” ceipt of funds from Federal prompt reasonable Medicaid Act’s Id. 1396a(a)(8),’ mandate, 42 U.S.C. ness contrast, closely more re U.S.C. not be enforced at issue sembles the Boren Amendment Suter, Supreme Court held Suter. provision in Wilder than the AACWA not enforce the reasonable plaintiffs could States, only requires Section Adoption Assistance provision of efforts funding, to have a of federal condition (“AACWA”), Act of 1980 Welfare and Child providing that plan for medical assistance 671(a)(15). pro- That section 42 U.S.C. provided with reason assistance will be such vides, for a part, that order “[i]n in relevant imposes a substan promptness, it also .able this payments to be assis duty on States to tive approved by the plan part, it shall have promptness. E.g., tance with reasonable that, in each Secretary provides ... Anderson, Blanco v. Cir. (A) case, made efforts' will be reasonable Wilder, 1994). right [guaranteed As in “the in foster placement of a child prior to the 1396a(a)(8)] merely procedural by is not care, the need for prevent or eliminate plan provide that medical assis one [that (B) home, from removal of the child his reasonably promptly]; provided tance be to return to possible for the child to make provides a rather the Act substantive his home.” reasonably prompt medical provision of [the not en- concluding plaintiffs could Wilder, 496 U.S. assistance].” provision,- reasonable efforts - force the Chief Judge Hatchett’s at 2517. As Chief opinion for the Court Judge Rehnquist’s demonstrates, plain language of opinion First, emphasized points. Suter two, make regulations Act and its the Medicaid that, emphasized unlike the substan- Court mandatory language crystal This clear. this rates at issue to reasonable tive puts regulations its in both the Act and Ass’n, Hospital Virginia 496 U.S. Wilder assis provision that their on notice States (1990), 110 L.Ed.2d reasonably prompt. tance must be that a State did not mandate the AACWA keep to- families make reasonable efforts plan approved only that it have a

gether, but Secretary Human Ser- of Health ‍​​​​​‌‌‌‌​‌‌​‌​‌​‌‌​‌​‌‌‌​‌​​‌‌‌​​‌​‌​‌‌​​​​‌​​​‍and requires that reasonable efforts

vices Suter,

made. (“the place requirement Act does States, requirement goes so but have a that the State far as to ensure Secretary containing the 16

approved features”).

listed that,

Second, unlike the Suter Court noted Act

the Medicaid notes prongs two of the Wilder test because it is plaintiffs and is intended to benefit the manda- not, Young parte [Ex ] 19. “The doctrine is howev Furthermore, though tory on the States. even er, limitations. A federal court cannot without promptness” arguably the term "reasonable relief, remedy retrospective designed to award 1396a(a)(8) vague, specific and definite in past of federal Coeur d'Alene violations law.” that "all individuals" be its command at-, Idaho, (O’Con 117 S.Ct. at 2043 Tribe of Because furnished “medical assistance.” J., Thomas, JJ., nor, concurring Scalia judicially would enforceable part concurring judgment). against a State that refused to

Case Details

Case Name: Doe v. Chiles

Court Name: Court of Appeals for the Eleventh Circuit

Date Published: Feb 26, 1998

Citation: 136 F.3d 709

Docket Number: 96-5144

Court Abbreviation: 11th Cir.