WOLF PRADO-STEIMAN, by and through his mother and next friend Laura Prado, M.C., by and through his mother and next friend, et al. v. JEB BUSH, in his official capacity as Governor and Chief Executive of the State of Florida, KATHLEEN KEARNEY, in her official capacity as Secretary, Department of Children and Families, et al.
No. 99-11034
United States Court of Appeals, Eleventh Circuit
August 11, 2000
D. C. Docket No. 98-06496-CV-WIDE [PUBLISH]
(August 11, 2000)
Before EDMONDSON and MARCUS, Circuit Judges, and STROM*, District Judge.
MARCUS, Circuit Judge:
Defendants, Governor Jeb Bush and other named state officials, appeal the district court‘s order certifying a broad class of developmentally-disabled persons eligible for Florida‘s Home and Community Based Waiver Program, which provides Medicaid-related services in home- and community-based settings to individuals who meet certain level-of-care requirements. All parties agree that some kind of class or classes should be certified, but Defendants contend that the single class certified by the district court was too broad. Defendants specifically assert that Plaintiffs have not demonstrated that the claims of the named class representatives possess the requisite typicality with the claims of the class at large as required by
I.
A.
The named plaintiffs are individuals with developmental disabilities who meet the level-of-care requirements of an intermediate care facility for individuals with developmental disabilities (“ICF/DD“) under the Medicaid Act, Title XIX of the Social Security Act,
Under the Home and Community Based Services Waiver Act, Title XIX of the Social Security Act,
B.
On May 13, 1998, two of the named plaintiffs, Wolf Prado-Steiman and Marlon Christie, filed a class action lawsuit alleging that various Florida state officials in their official capacity, including the Governor and the Secretary of the Department of Children and Families, have acted unlawfully in their governance of Florida‘s Home and Community Based Medicaid Waiver Program. Plaintiffs allege violations of the American with Disabilities Act,
Plaintiffs assert that as a result of this policy many developmentally-disabled persons who desire HCBW services have been forced to reside in institutional facilities in order to receive Medicaid services. Plaintiffs also allege that Defendants systematically deny Medicaid-eligible, developmentally-disabled persons who apply for HCBW services the procedural due process protections required by the Medicaid Act, including notice of their right to appeal adverse decisions and to continue receiving benefits pending appeal, as well as the opportunity for a fair hearing if their claims are denied or not acted upon with reasonable promptness.5 Plaintiffs seek, among other things, declaratory and
On July 31, 1998, Plaintiffs amended the complaint by right, adding four new individual plaintiffs, Lucy Adawi, Jennifer Batsidas, Daniel Lavin, and Daniel Shell, and one institutional plaintiff, the Advocacy Center for Disabled Persons, Inc. Plaintiffs then moved for class certification. On January 19, 1999, Plaintiffs sought to amend their complaint a second time to add, among other things, twelve further individual plaintiffs as well as a cause of action to enforce certain sections of the Medicaid Act requiring states participating in Medicaid to provide early and periodic screening, diagnosis, and treatment (“EPSDT“) to eligible persons under the age of 21. On February 19, 1999, the court held a hearing on Plaintiffs’ motion for class certification at which it apparently granted Plaintiffs’ request to file the second amended complaint.
In March 1999, the district court granted the class certification motion. It identified as class representatives all seven of the plaintiffs named in the first amended complaint, but declined to identify as class representatives the twelve
[A]ll persons with developmental disabilities who are presently receiving Home and Community-Based Waiver Services or who are eligible to receive Home and Community-Based Waiver Services, or who would receive or be eligible for Home and Community-Based Waiver Services in the future.
The district court also identified ten substantive, classwide claims:
- whether Defendants have violated the ADA by denying individuals, who live in their own homes or with their families in community settings, services such as physical therapy, speech therapy, and dental services that are available to individuals who are ICF/DD‘s;
- whether Defendants have violated the ADA by engaging in diagnosis-based decision-making with their actions to deny or limit access to benefits, services, and opportunities because a person has a particular disability;
- whether Defendants have violated § 504 of the Rehabilitation Act of 1973;
whether Defendants have violated the Medicaid statute‘s requirement of reasonable promptness, 42 U.S.C. § 1396a(a)(8) and42 U.S.C. § 1983 , by failing to provide Medicaid Waiver Services with reasonable promptness;- whether Defendants have violated
42 U.S.C. § 1396n and42 U.S.C. § 1983 , by providing inadequate and inappropriate Home and Community-Based Waiver Services; - whether Defendants have violated
42 U.S.C. § 1396n and42 U.S.C. § 1983 , by funding institutional placements using Home and Community-Based Waiver Services; - whether Defendants have violated
42 U.S.C. § 1396n(c)(2) and42 U.S.C. § 1983 , by denying Plaintiffs their freedom of choice of an appropriate Home and Community-Based Waiver program that meets their health and welfare needs; - whether Defendants have violated Medicaid‘s statewideness requirement,
42 U.S.C. § 1396a(a)(1) , and42 U.S.C. § 1983 , by failing to provide Home and Community-Based Waiver services throughout the State of Florida; - whether Defendants have violated Medicaid‘s EPSDT requirements, violated
42 U.S.C. § 1396a(a)(43)(C) and42 U.S.C. § 1983 , by failing to provide needed EPSDT services directly and to ensure that there are providers who are qualified and willing to provide EPSDT services for children with developmental disabilities; - whether Defendants have violated the Due Process Clause of the U.S. Constitution and
42 U.S.C. § 1983 , by denying Plaintiffs and class members procedural due
process, including notice and the opportunity for a fair hearing to challenge denials, reductions, and termination of Home and Community-Based Waiver benefits.
Applying the prerequisites for class certification required by
Defendants then petitioned our court pursuant to
II.
A court of appeals may in its discretion permit an appeal from an order of a district court granting or denying class action certification under this rule if application is made to it within ten days after entry of the order. An appeal does not stay proceedings in the district court unless the district judge or the court of appeals so orders.
A.
A good starting point is the Committee Note accompanying Rule 23(f), which articulates the drafters’ view of how courts should resolve petitions for appeal under this new rule. The Note emphasizes that “the court of appeals is
[M]any suits with class-action allegations present familiar and almost routine issues that are no more worthy of immediate appeal than many other interlocutory rulings. Yet several concerns justify expansion of present opportunities to appeal. An order denying certification may confront the plaintiff with a situation in which the only sure path to appellate review is by proceeding to final judgment on the merits of an individual claim that, standing alone, is far smaller than the costs of litigation. An order granting certification, on the other hand, may force a defendant to settle rather than incur the costs of defending a class action and run the risk of potentially ruinous liability.
As summarized by the First Circuit, Rule 23(f) serves two key purposes: first, to provide a “mechanism through which appellate courts, in the interests of fairness, can restore equilibrium when a doubtful class certification ruling would
Based on these purposes, the Seventh Circuit in Blair outlined three categories of cases for which Rule 23(f) review may be appropriate. As summarized in Mowbray:
First, an appeal ordinarily should be permitted when a denial of class status effectively ends the case (because, say, the named plaintiff‘s claim is not of a sufficient magnitude to warrant the costs of stand-alone litigation). Second, an appeal ordinarily should be permitted when the grant of class status raises the stakes of the litigation so substantially that the defendant likely will feel irresistible pressure to settle. Third, an appeal ordinarily should be permitted when it will lead to clarification of a fundamental issue of law.
The Seventh Circuit put additional gloss on these three broad categories. It explained that a petitioner who sought to invoke either of the first two categories also would have to “demonstrate that the district court‘s ruling on class certification is questionable -- and must do this taking into account the discretion the district judge possesses in implementing Rule 23, and the correspondingly
Recently, the First Circuit adopted Blair‘s Rule 23(f) taxonomy as “structurally sound” with one notable caveat. Mowbray, 208 F.3d at 294. The Mowbray court worried, we think rightly, that the third Blair category might “encourage too many disappointed litigants to file fruitless Rule 23(f) applications” since “a creative lawyer almost always will be able to argue that deciding her case would clarify some ‘fundamental’ issue.” Id. The First Circuit then emphasized that “interlocutory appeals should be the exception, not the rule” because “many (if not most) class certification decisions turn on ‘familiar and almost routine issues.‘” Id. (citing Comm. Note,
We find both the Blair and Mowbray opinions to be cogent explications of the Rule 23(f) inquiry. We think it important, however, to emphasize some additional considerations that may weigh against frequent interlocutory appellate review of class action certification decisions.
To begin with, there are too many class actions filed each year for federal appeals courts practicably to adjudicate class certification decisions on an interlocutory basis as a matter of course. As a statistical point of reference, we observe that according to the Federal Judicial Center, as of 1998 there were 1,742 active federal cases with class action activity. In 1994, there were only 816 such cases. A similar rise is reported for this Circuit; in 1998, according to the data, there were 221 active cases in this Circuit with class action activity, almost double the number of such cases, 114, during 1994.7 Given these numbers, and the large volume of ordinary final judgments that by law must be considered by the courts of appeals, routinely granting interlocutory appellate review of class certification decisions is simply not practicable.
Moreover, interlocutory appellate review of a class certification decision may short-circuit the district court‘s ability -- or at least willingness -- to exercise
Finally, authorizing interlocutory review simply on the basis of a so-called “fundamental” or “unsettled” question of law sets a difficult precedent. We share the First Circuit‘s concern over encouraging a flood of Rule 23(f) petitions claiming that such a question is in dispute. Given the stakes of class action litigation, and the vast number of persons affected, many routine issues have the potential to take on substantial proportions and assume an importance they
Taking into account all of these considerations, the following guideposts may be utilized in determining whether to grant an interlocutory appeal under Rule 23(f).
First, and most important, the court should examine whether the district court‘s ruling is likely dispositive of the litigation by creating a “death knell” for either plaintiff or defendant. The prospect of irreparable harm from delaying appellate review of the class certification decision until after final judgment undoubtedly creates a compelling need for immediate review. Nevertheless, even ordinary class certification decisions by their very nature may radically reshape a lawsuit and significantly alter the risk-benefit calculation of the parties, leading to claims of irreparable harm. For that reason, the decision to grant interlocutory review based primarily on this factor generally should be limited to those cases
Second, a court should consider whether the petitioner has shown a substantial weakness in the class certification decision, such that the decision likely constitutes an abuse of discretion. Ordinarily, the appropriateness of allowing a
Third, a court should consider whether the appeal will permit the resolution of an unsettled legal issue that is “important to the particular litigation as well as important in itself.” Mowbray, 208 F.3d at 294. Such an issue might be one that is of moment yet is “likely to escape effective review if left hanging until the end of the case.” Id. Alternatively, the issue might be one as to which an appellate ruling
Fourth, a court should consider the nature and status of the litigation before the district court. Some cases plainly will be in a better pre-trial posture for interlocutory appellate review than others. As noted above, the propriety of granting or denying a class, as well as the proper scope of any class that has been granted, may change significantly as new facts are uncovered through discovery.
Finally, a court should consider the likelihood that future events may make immediate appellate review more or less appropriate. Simply by way of example, settlement negotiations involving some or all of the parties affected by the decision, or the prospect of an imminent change in the financial status of a party
We do not create any bright-line rules or rigid categories for accepting or denying
We reiterate, however, that interlocutory appeals are inherently “disruptive, time-consuming, and expensive,” Mowbray, 208 F.3d at 294, and consequently are generally disfavored. Piecemeal appellate review has a deleterious effect on judicial administration. It increases the workload of the appellate courts, to the
We will therefore use restraint in accepting
B.
Turning to the particulars of this case, we acknowledge that this lawsuit may not raise the kind of issues that ordinarily might warrant granting a
Second, while we agree with Defendants that the district court would have been wiser to certify several subclasses rather than one large class, see infra Part III, Defendants do not demonstrate any substantial weakness or profound error of law in the class certification decision. Though in passing Defendants challenge the class certification language as vague, they do not argue that a HCBW class should not have been certified; indeed, they propose that the district court should have certified two HCBW classes. Consequently, because both parties agree that some kind of HCBW class(es) should be certified in this case, the issues raised on appeal are not dispositive of the litigation.11 Moreover, much of the vagueness of the
Defendants’ objection that Plaintiffs have not as yet demonstrated that a named class representative possesses individual or associational standing to bring each of the class‘s subclaims is of greater moment. But although we agree that at least one named representative must have standing to bring each class subclaim, see infra Part III, this argument should have been raised squarely with the district court rather than for the first time in a
Other
III.
We review orders granting class certification for abuse of discretion. See Kendrick v. Jefferson County Bd. of Educ., 932 F.2d 910, 914 (11th Cir. 1991) (citing Walker v. Jim Dandy Co., 747 F.2d 1360, 1363 (11th Cir. 1984)).
(a) Prerequisites to a Class Action. One or more members of a class may sue or be sued as representative parties on behalf of all only if (1) the class is so numerous that joinder of all members is impracticable, (2) there are questions of law or fact common to the class, (3) the claims or defenses of the representative parties are typical of the claims or defenses of the class, and (4) the representative parties will fairly and adequately protect the interests of the class.
In many ways, the commonality and typicality requirements of
It should be obvious that there cannot be adequate typicality between a class and a named representative unless the named representative has individual standing to raise the legal claims of the class. As noted above, typicality measures whether a sufficient nexus exists between the claims of the named representatives and those of the class at large. Without individual standing to raise a legal claim, a named
As the Supreme Court has explained, “[w]e have repeatedly held that a class representative must be part of the class and possess the same interest and suffer the same injury as the class members.” Falcon, 457 U.S. at 156, 102 S. Ct. at 2370 (citing East Texas Motor Freight Sys. v. Rodriguez, 431 U.S. 395, 403, 97 S. Ct. 1891, 1896, 52 L. Ed. 2d 453 (1977)) (internal quotation marks omitted); see also Blum v. Yaretsky, 457 U.S. 991, 999, 102 S. Ct. 2777, 2783, 73 L. Ed. 2d 534 (1982) (explaining that “[i]t is not enough that the conduct of which the plaintiff complains will injure someone. The complaining party must also show that he is within the class of persons who will be concretely affected. Nor does a plaintiff who has been subject to injurious conduct of one kind possess by virtue of that injury the necessary stake in litigating conduct of another kind, although similar, to which he has not been subject.“). This rule makes especially good sense when we consider that one of the core purposes of conducting typicality review is to ensure that “the named plaintiffs have incentives that align with those of absent class members so as to assure that the absentees’ interests will be fairly represented.” Baby Neal, 43 F.3d at 57; see also 1 Newberg & Conte, Newberg on Class Actions, § 3.13 (3d ed. 1992).
In this case, Defendants offer a very narrow argument. As discussed earlier, they do not contend that a HCBW class should not be certified -- in fact they
Having studied the record, it is clear that there are a number of individual standing challenges that cannot be resolved adequately on appeal. For example, Defendants contend that a number of the named plaintiffs have not demonstrated that they are eligible for HCBW services. As best we can tell from the record before us, an HCBW applicant is considered eligible by Defendants if she (1) is a
We observe as well that the class, as presently defined, appears to be composed of too many subgroups with disparate legal claims to warrant certification. As it now stands, the class consists of “all persons with developmental disabilities who are presently receiving Home and Community-Based Waiver Services or who are eligible to receive Home and Community-Based Waiver Services, or who would receive or be eligible for Home and Community-
While the class ostensibly is comprised of developmentally-disabled persons who meet Medicaid eligibility requirements for ICF/DD care, there are sharp differences amongst class subgroups in the type of conduct challenged and the type of injury suffered. Broadly speaking, Plaintiffs allege both substantive and procedural injuries: first, they allege that Defendants provided inadequate and inappropriate HCBW services or denied outright HCBW services to eligible persons who meet the ICF/DD level-of-care requirements due to funding rather than medical necessity concerns; second, they allege that Defendants failed to provide HCBW services with reasonable promptness to eligible individuals; and finally, they allege that Defendants unlawfully failed to provide HCBW applicants with the requisite procedural safeguards including reasonably prompt claims decisions and notice of an applicant‘s right to appeal a claims denial.
We believe these alleged injuries may be better addressed through several subclasses rather than one large class. It appears that there are three general subclasses of HCBW applicants whose interests are affected by this suit. First, there are those individuals who have applied for HCBW services and been approved by Defendants for HCBW services, but who challenge their approved
While the alleged injuries of these subclasses may overlap to some degree, there are obvious and important differences, for example, between the injury claim of an applicant who already has been approved but has not received HCBW services, and an applicant who has been ruled ineligible or who still awaits an eligibility ruling for HCBW services. Notably, each group targets a different “bad act” of Defendants whether it be a failure to provide approved services in a reasonably prompt manner, a claims denial, or a failure to adjudicate a claims application in a reasonably prompt manner. Because these injury claims target different defendant conduct, the type of proof required for each claim necessarily will differ.
In addition, proof of these alleged injuries also requires a threshold showing of eligibility for HCBW services. As noted above, it appears that an HCBW applicant is considered eligible by Defendants if she (1) is a client of
For these reasons, it may be prudent to certify three HCBW subclasses, on the basis of HCBW applicant status. One possible approach would be the following three subclasses:
Class One. All persons with developmental disabilities who have applied for services which are compensable under the Florida Home and Community Based Waiver and who have been determined to be eligible for services but who have not received them with reasonable promptness or have received inadequate or inappropriate services.
Class Two. All persons with developmental disabilities who have applied for services compensable under the Florida Home and Community Based Waiver but who have been adjudged ineligible and/or denied services without notice and opportunity for hearing.
Class Three. All persons with developmental disabilities who have applied for services compensable under the
Florida Home and Community Based Waiver and have not received a reasonably prompt claims determination.
All that said, given the slenderness of the factual record before us, we must leave the ultimate decision as to what kinds of appropriate subclasses to create to the sound discretion of the district court. We also note that Plaintiffs’ suit contains several additional fact-specific claims which, after further factual inquiry, may be better litigated through additional subclasses rather than through subclasses based simply on HCBW applicant status. For example, Plaintiffs’ suit now includes a claim that Medicaid-eligible, developmentally-disabled children under the age of 21 have been denied EPSDT services by Defendants. A separate EPSDT subclass may be appropriate if after further factual development it becomes clear that Defendants’ alleged EPSDT policy is sufficiently different from its HCBW policy. In fashioning appropriate subclasses, the district court also should be careful not to certify subclasses overlapping with certified classes in other related ICF/DD litigation now pending.17
VACATED AND REMANDED.
Notes
Under the ICF/DD program:
Each client must receive a continuous active treatment program, which includes aggressive, consistent implementation of a program of specialized and generic training, treatment, health services and related services . . ., that is directed toward—
(i) The acquisition of the behaviors necessary for the client to function with as much self determination and independence as possible; and
(ii) The prevention or deceleration of regression or loss of current optimal functional status.
The First Amended Complaint named six individual plaintiff class representatives -- Wolf Prado-Steiman, Lucy Adawi, Marlon Christie, Daniel Lavin, Jennifer Batsidas and Daniel Shell -- and one institutional plaintiff class representative -- the Advocacy Center for Persons with Disabilities, Inc. Four of the individual plaintiffs -- Prado-Steiman, Adawi, Christie, and Lavin -- have applied for HCBW services but have been denied coverage. The other two individual plaintiffs -- Batsidas and Shell -- currently receive HCBW services they allege are inadequate.
The following facts pertain to each named plaintiff:
(1) Wolf Prado-Steiman
Wolf is an eight year-old autistic boy who lives at home with his family. There is no dispute that he suffers from severe behavioral problems as a result of his disability. Plaintiffs contend that Wolf, having no assets or income, would be eligible for a HCBW waiver. He has applied for HCBW services and received no written determination on his claim. After this suit was filed, Defendants agreed to pay for 12 behavioral therapy sessions. In an institutional setting, his care would be on-going.
(2) Lucy Adawi
Lucy is a fifty year-old mildly retarded woman with a schizoaffective disorder who lives with her 80 year-old mother. She applied for HCBW services but has received only $44 of necessary medical supplies
(3) Marlon Christie
Marlon Christie is an 18 year-old man with cerebral palsy who must sleep on the floor because he lacks an appropriate bed at home. He applied for HCBW services but was told there is a long waiting list and no available services.
(4) Daniel Lavin
Daniel Lavin is a 22 year-old man with severe mental retardation and cerebral palsy who needs bathroom modifications to make the room handicap-accessible. He applied for HCBW services but has received no services as yet due to his low priority rating on the waiting list. He has not received written notice of a denial of his request.
(5) Jennifer Batsidas
Jennifer Batsidas is a quadriplegic with cerebral palsy. She applied for HCBW services in January 1998 and was not placed on a waiver until October 1998 due to a lack of state funds. She received these funds only after a district coordinator identified her needs as “critical.” She presently receives funds on a “funds available basis.” She alleges that the vocational services she receives from the HCBW Program are inadequate.
(6) Daniel Shell
Daniel Shell is a 32 year-old man with moderate mental retardation and cerebral palsy currently receiving HCBW services in the form of a vocational service workshop. He allegedly has been denied physical therapy equipment recommended by his physician to treat his movement disorder. The equipment was requested in March 1998 and a hearing was not scheduled until January 1999. No hearing decision has yet been made. Shell alleges the services currently provided to him are inadequate.
Class One. All persons with developmental disabilities who have applied for services which are compensable under the Florida Home and Community Based Waiver and who have been determined to be eligible for services but who have not received them with reasonable promptness.
Class Two. All persons with developmental disabilities who have applied for services compensable under the Florida Home and Community Based Waiver but who have been denied them without notice and opportunity for hearing.
- Failure to provide notice and opportunity for a hearing of the denial, reduction, or termination of waiver benefits in violation of the Due Process Clause.
- Failure to provide adequate and appropriate waiver services in violation of
42 U.S.C. § 1396n . - Failure to provide waiver services with reasonable promptness in violation of
42 U.S.C. § 1396a .
All individuals with developmental disabilities who were residing in a Florida DSI as of March 25, 1998, and/or are currently residing in a Florida DSI, who are Medicaid eligible and presently receiving Medicaid benefits, who have properly and formally requested a community-based placement, and who have been recommended by a State-qualified treatment team for a less restrictive placement that would be medically and otherwise appropriate, given each individual‘s particular needs and circumstances.
