KP, by and through his father SP, JF, by and through his mother AF, DR, by and through his mother MR, AP, by and through her mother PP, SC, by and through her mother AT, TR, by and through his mother CR, Plaintiffs, v. JULIE HAMOS, in her official capacity as Director of the Illinois Department of HEALTHCARE AND FAMILY SERVICES, Defendants.
Case No. 12-2044
UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF ILLINOIS Urbana Division
Thursday, 25 October, 2012
E-FILED 11:15:06 AM Clerk, U.S. District Court, ILCD 2:12-cv-02044-SEM-TSH # 37 Page 1 of 12
Six children, K.P., J.F., D.R., A.P., S.C., and T.R., in the Central District of Illinois bring suit, through their parents, against Defendant Julie Hamos, in her official capacity as Director of the Illinois Department of Healthcare and Family Services. In a four-count Complaint, Plaintiffs assert that Defendant, by refusing to provide Plaintiffs with treatment for their mental health disorders in integrated settings, has failed to provide them with medically necessary services, in violation of the Medicaid Act,
In August 2012, Defendant filed her Motion to Dismiss Counts II, III, and IV of Amended Complaint (#32) and Memorandum of Law in Support (#33). Shortly thereafter, Plaintiffs filed their Response to Defendant‘s Motion to Dismiss Counts II, III, and IV of Complaint (#35). After reviewing the parties’ pleadings and memoranda, the Court recommends that Defendant‘s Motion to Dismiss Counts II, III, and IV of Amended Complaint (#32) be GRANTED IN PART and DENIED IN PART.
The Court takes the following background from Plaintiffs’ Amended Complaint (#14), accepting all well-pleaded factual allegations as true. See AnchorBank, FSB v. Hofer, 649 F.3d 610, 614 (7th Cir. 2011). Plaintiffs are children who are Medicaid-eligible and have been diagnosed with mental health disorders, as well as emotional, developmental, or behavioral disorders. Defendant is the Director of the Illinois Department of Healthcare and Family Services (“HFS“), which is the state agency charged with administering Medicaid, the joint federal and state program that funds medically necessary treatment for certain low-income individuals. Prior to any Medicaid-funded admission to an inpatient hospital for psychiatric services, Medicaid-eligible children are screened through the Screening, Assessment, and Support Services Program (“SASS“), a partnership between HFS and the Illinois Department of Human Services (“DHS“). See
Plaintiffs maintain that Defendant has refused to arrange for and provide them with treatment in integrated settings, either in a residential treatment facility or through intensive home and community-based services.1 Defendant “has refused to contract with qualified mental health professionals and providers that are willing and able to provide intensive behavior supports and other mental health treatment in lesser restrictive settings to Medicaid-eligible children.” (#14, ¶ 27.) Plaintiffs, as a result, have been psychiatrically hospitalized and/or are at risk for future psychiatric hospitalizations, despite the fact that psychiatric hospitalizations are more costly than placement in residential treatment centers or home and community-based services. Specifically, K.P., J.F., D.R., A.P., and S.C. have been psychiatrically
Plaintiffs need either intensive home and community-based services or residential treatment and are at risk for future hospitalizations if they do not receive the treatment they request.
Plaintiffs filed this case in February 2012. In Count I, Plaintiffs bring claims under the Early and Periodic Screening, Diagnostic and Treatment provision of the Medicaid Act,
Plaintiffs seek a declaratory judgment that Defendant has failed to comply with the Medicaid Act, the ADA, and the Rehabilitation Act; an injunction enjoining Defendant from violating Plaintiffs’ rights under the Medicaid Act, the ADA, and the Rehabilitation Act; and money damages under the Rehabilitation Act.
II. Legal Standard
Defendant moves to dismiss Counts II, III, and IV of Plaintiffs’ Amended Complaint under
In considering a motion to dismiss for failure to state a claim, the Court is limited to the allegations in the pleadings. See Citadel Grp. Ltd. v. Wash. Reg‘l Med. Ctr., 692 F.3d 580, 591 (7th Cir. 2012). The Court must evaluate the complaint in the light most favorable to the plaintiff, accepting as true all well-pleaded factual allegations and drawing all reasonable inferences in the plaintiff‘s favor. AnchorBank, 649 F.3d at 614. Importantly, however, the
III. Discussion
A. Count II under the ADA and Count III under the Rehabilitation Act
Defendant moves to dismiss Plaintiffs’ claims of discrimination under the ADA and the Rehabilitation Act, and under
An individual with a disability2 states an integration mandate claim against a public entity, under the ADA, and against a recipient of federal funds, under the Rehabilitation Act,3 by alleging that 1) an integrated treatment setting is appropriate; 2) the individual does not oppose treatment in an integrated treatment setting; and 3) integrated treatment can be reasonably accommodated, taking into account the state‘s resources and the needs of other individuals with disabilities. See Radaszewski, 383 F.3d at 608, 614-15 (“The allegations of Radaszewski‘s complaint permit the inference that a home placement remains appropriate for [the plaintiff], that he and his family do not oppose such a placement, and that such a placement can be reasonably accommodated, taking into account the resources available to the state and the needs of others with comparable disabilities.“); see also Olmstead, 527 U.S. at 587 (holding that placement of individuals with disabilities in community settings is required where “the State‘s treatment professionals have determined that community placement is appropriate,4 the transfer from institutional care to a less restrictive setting is not opposed by the affected individual, and the placement can be reasonably accommodated, taking into account the resources available to the
State and the needs of others with mental disabilities“); J.T. ex rel. A.F. v. Hamos, No. 12-CV-03203, 2012 WL 4760645, at *6-7 (C.D. Ill. Oct. 5, 2012); S.B. ex rel. W.B. v. Hamos, No. 12-CV-03077, 2012 WL 4740291, at *6 (C.D. Ill. Oct. 3, 2012).
Here, Plaintiffs have stated plausible claims of discrimination under the ADA and Rehabilitation Act: first, they allege that they need either placement in a residential treatment center or intensive home and community-based services in order to address their mental health disorders; second, they do not oppose such treatment; third, they allege that integrated treatment would actually cost Defendant less than psychiatric hospitalization, from which this Court draws the inference that the state could reasonably accommodate Plaintiffs’ requested treatment.
Defendant‘s arguments to the contrary are unavailing. Defendant first asserts that Plaintiffs fail to state a claim under either the ADA or the Rehabilitation Act because the Complaint indicates that Plaintiffs want to be institutionalized, as several Plaintiffs seek placement in a residential treatment facility. However, as Plaintiffs clarify in their response to Defendant‘s motion to dismiss, there is a difference between psychiatric hospitalization and placement in a residential treatment facility, as the latter would permit Plaintiffs to attend school and engage in community activities. Thus, Plaintiffs seek a more integrated treatment setting than psychiatric hospitalization.
Second, Defendant argues that K.P. and J.F.‘s claims under the ADA and Rehabilitation Act fail because it was DHS, not Defendant, that allegedly denied K.P. and J.F.‘s requests for grants under the Individual Care Program. Defendant contends that “it is . . . completely unclear how something DHS has declined to do, which allegedly would permit such placement, should be laid at the feet of HFS.” (#33, p. 9.) Unfortunately, the Complaint is unclear about the roles that Defendant and DHS play in the Individual Care Program; as to K.P., the complaint states that “K.P. was denied an Individual Care Grant by the Illinois Department of Human Services[,]” (#14, ¶ 113); as to J.F., the Complaint indicates that “J.F. was not considered for referral to the
Additionally, Defendant urges that Plaintiffs’ claim under the Rehabilitation Act fails because they are not “otherwise qualified” for the integrated treatment settings they seek. Citing Grzan v. Charter Hospital of Northwest Indiana, 104 F.3d 116 (7th Cir. 1997), Defendants maintain that Plaintiffs are not “otherwise qualified” because, “absent the handicap of their mental health disorders, they would not have been eligible for placement in a residential mental health facility in the first place.” (#33, p. 11.) Grzan, which was not an integration mandate case, recites a traditional pattern of proof for disability discrimination cases that is inapplicable in cases brought under the integration mandate. The Grzan court, in evaluating the plaintiff‘s claim under the Rehabilitation Act that she was subjected to discrimination when her psychiatric counselor enticed her into a sexual relationship, reasoned,
“Otherwise qualified” means that were she not handicapped, [the plaintiff] would have qualified for the program or treatment she was denied because of her handicap. . . . [The plaintiff] is not “otherwise qualified” because, absent her handicap, she would not have been eligible for treatment in the first place. . . .Without a showing that the non-handicapped received the treatment denied to the “otherwise qualified” handicapped, the appellants cannot assert that a violation of section 504 has occurred.
Grzan, 104 F.3d at 120-21 (citations and internal quotation marks omitted). Olmstead established, however, that “unjustified institutional isolation” of an individual with a disability violates the ADA (and the Rehabilitation Act), “even in the absence of traditional proof that the disabled person is being treated differently from a nondisabled person who is otherwise similarly
Finally, Defendant contends that Plaintiffs’ claim under
The parties offer the Court little assistance in resolving the issue: Defendant provides no analysis of the Rehabilitation Act‘s enforcement scheme; likewise, Plaintiffs respond to Defendant‘s argument in only a footnote. The Court notes that Judge Myerscough, when deciding motions to dismiss earlier this month in cases nearly identical to this one, faced precisely this argument from Defendant (as well as a lack of briefing from both sides).
See J.T. ex rel. A.F. v. Hamos, 2012 WL 4760645, at *7; S.B. ex rel. W.B. v. Hamos, 2012 WL 4740291, at *7. Because the briefing from the parties was minimal, Judge Myerscough declined to decide the issue at the motion to dismiss stage and, instead, denied the motion to dismiss and invited Defendant to raise the issue again in a motion for summary judgment. The Court agrees with Judge Myerscough‘s sound approach and, thus, recommends denying Defendant‘s motion to dismiss Plaintiffs’
B. Count IV: Damages under the Rehabilitation Act and 42 U.S.C. § 1983
In Count IV, Plaintiffs seek damages under the Rehabilitation Act and under
As an initial matter, although Defendant does not raise this argument, the Court finds that Plaintiffs’ claim under
As to Plaintiffs’ claim for damages under the Rehabilitation Act, compensatory damages are an available remedy for discrimination claims brought under the Rehabilitation Act, see Barnes v. Gorman, 536 U.S. 181, 187-89 (2002),6 but only upon a showing that the defendant
acted with discriminatory intent. See Zachary M., 829 F. Supp. 2d at 662; Phipps v. Sheriff of Cook County, 681 F. Supp. 2d 899, 917-18 (N.D. Ill. 2009) (ADA case) (noting that Seventh Circuit has yet to address issue definitively but collecting cases from other circuits holding that a discriminatory intent is required for compensatory damages). A plaintiff may establish discriminatory intent by showing that the defendant acted with “deliberate indifference,” that is, “both knowledge that a harm to a federally protected right is substantially likely, and a failure to act upon that likelihood.” Phipps, 681 F. Supp. 2d at 918 (citation and internal quotation marks omitted). “Deliberate indifference can be inferred from a defendant‘s deliberate indifference to the strong likelihood that pursuit of its questioned policies will likely result in a violation of federally protected rights.” Id. (citation and internal quotation marks omitted).
The Court finds that Plaintiffs have alleged sufficient facts to give rise to an inference of deliberate indifference. Plaintiffs allege that defendant is “well aware” that many children in Illinois with mental health disorders are not receiving medically necessary treatment. (#14, ¶ 6.) As of 2009, of the more than 18,000 children in Illinois with “severe mental illness and severe emotional disturbances,” only 220 received intensive community-based services. (#14, ¶¶ 7-8.) Nonetheless, Defendant has refused to contract with providers that are prepared to offer treatment in integrated settings to Medicaid-eligible children and, instead, “opts to fund children living with behavioral and emotional problems in hospitals and institutions.” (#21, ¶ 21.) Accepting these allegations as true, the Court makes the reasonable inference that Defendant—though faced with the strong likelihood that her policies will result in unjustified institutionalization of Medicaid-eligible children like Plaintiffs, in violation of the Rehabilitation Act—has failed to act to remedy this situation. Plaintiffs have alleged sufficient facts to support an inference of deliberate indifference and, therefore, state a plausible claim for damages under the Rehabilitation Act.
For the reasons discussed above, this Court recommends that Defendant‘s Motion to Dismiss Counts II, III, and IV of Amended Complaint (#32) be GRANTED as to Plaintiffs’ claim, in Count IV, for damages under
The parties are advised that any objection to this recommendation must be filed in writing with the clerk within 14 days after being served with a copy of this Report and Recommendation. See
ENTERED this 25th day of October, 2012.
s/DAVID G. BERNTHAL
UNITED STATES MAGISTRATE JUDGE