Doe v. Kidd ( 2011 )

UNPUBLISHED
UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT
No. 10-1191
SUE DOE,
Plaintiff - Appellant,
v.
LINDA KIDD; STAN BUTKUS; KATHI LACY; SOUTH CAROLINA
DEPARTMENT OF DISABILITIES AND SPECIAL NEEDS; ROBERT KERR;
SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES,
Defendants – Appellees,
v.
SANDRA RAY,
Guardian ad Litem Plaintiff.
Appeal from the United States District Court for the District of
South Carolina, at Columbia. Margaret B. Seymour, District
Judge. (3:03-cv-01918-MBS)
Argued: December 8, 2010 Decided: March 24, 2011
Before MOTZ, KING, and GREGORY, Circuit Judges.
Reversed in part, affirmed in part, and remanded with
instructions by unpublished opinion. Judge Gregory wrote the
opinion, in which Judge Motz and Judge King joined.
ARGUED: Patricia L. Harrison, Columbia, South Carolina,
for Appellant. Kenneth Paul Woodington, DAVIDSON & LINDEMANN,
PA, Columbia, South Carolina, for Appellees. ON BRIEF: William
H. Davidson, II, DAVIDSON & LINDEMANN, PA, Columbia, South
Carolina, for Appellees.
Unpublished opinions are not binding precedent in this circuit.
2
GREGORY, Circuit Judge:
Sue Doe, the plaintiff-appellant, is a young woman with
developmental disabilities, including epilepsy, mild mental
retardation, and cerebral palsy. She filed this 42 U.S.C.
§ 1983 action against the South Carolina Department of
Disabilities and Special Needs (“DDSN”), the South Carolina
Department of Health and Human Services (“DHHS”), as well as
Linda Kidd, Stan Butkus, Kathi Lacy and Robert Kerr, in their
official capacities as state administrators (collectively,
“Defendants”). The suit alleges that Defendants violated
various sections of the Medicaid Act related to the provision of
services. In an earlier appeal, Doe v. Kidd, 501 F.3d 348 (4th
Cir. 2007) (“Doe I”), this Court affirmed in part, and reversed
in part the district court’s grant of summary judgment for
Defendants. Only one of Doe’s original claims survived that
appeal, her allegation that Defendants had not complied with the
reasonable promptness provision of the Medicaid Act. Id. at
357.
On remand, the district court again granted summary
judgment in favor of Defendants. Doe subsequently filed this
timely appeal challenging (1) the dismissal of her reasonable
promptness claim; (2) the denial of her motion to amend the
complaint; and (3) the denial of her request for attorney’s
3
fees. 1 Because we find that Defendants have violated Doe’s
rights under the Medicaid Act as a matter of law, we reverse the
district court and grant summary judgment in her favor.
Accordingly, Doe may recover attorney’s fees. However, the
district court properly denied her motion to amend.
I.
We review a grant of summary judgment de novo, and present
all facts and reasonable inferences in the light most favorable
to the nonmoving party. Varghese v. Honeywell Int’l, Inc., 424
F.3d 411, 416 (4th Cir. 2005). The underlying material facts
are not in dispute, and the extensive history of this case is
laid out in further detail in our previous opinion. See
generally Doe I, 501 F.3d at 351-53. DHHS is the South Carolina
state agency responsible for administrating Medicaid programs.
DDSN supervises the treatment and training of South Carolinians
1
Doe makes passing references in her opening brief to the
district court’s orders granting Defendants’ motion for a
protective order and limiting discovery. (See, e.g.,
Appellant’s Br. at 1.) But nowhere in the body of her brief
does she present any legal argument in support of her assertions
that the district court was in error as to these discovery
matters. Federal Rule of Appellate Procedure 28(a)(9)(A)
requires that the argument section of an appellant’s opening
brief contain the “appellant’s contentions and the reasons for
them, with citations to the authorities and parts of the record
on which the appellant relies.” Because Doe has failed to
adhere to this fundamental rule, she has abandoned these
challenges on appeal.
4
with mental retardation and related disabilities. Because South
Carolina accepts Medicaid funding, these agencies are bound to
comply with all related federal laws and regulations. Wilder v.
Va. Hosp. Ass’n, 496 U.S. 498, 502 (1990).
In July 2002, after unsuccessfully applying twice in the
past, Doe filed a third application for DDSN services under the
Medicaid waiver program pursuant to 42 U.S.C. § 1396n(c) (2000),
whereby a state may waive the requirement that persons with
mental retardation or related disabilities live in an
institution in order to receive certain services. The waiver
application process has three steps: first, DHHS needed to
decide whether Doe was eligible for any Medicaid funding; next,
DDSN was required to evaluate Doe to determine what services she
was entitled to; and, finally, DDSN had to decide the most
appropriate “level of care” for Doe as well as the least
restrictive environment or care setting. These settings may
include, listed in order of the least to the most restrictive
placement: (1) a Supervised Living Program II (“SLP II”), an
apartment where recipients of DDSN services reside together;
(2) a Community Training Home I (“CTH I”), a private foster home
where a services recipient resides with a family, one member of
whom is a trained caregiver; or (3) a Community Training Home II
(“CTH II”), a group home with live-in caregivers for four or
fewer recipients. Appeals from DDSN decisions are taken to a
5
DHHS hearing officer and thereafter may be appealed to a South
Carolina administrative law judge.
In December 2002, without having made a final decision as
to Doe’s eligibility for a waiver, DDSN placed Doe on the waiver
program’s non-critical waiting list. Doe appealed this decision
to DHHS, and claimed that DDSN had failed to provide her with
services within a reasonably prompt time frame as required by
federal regulations. Pending that appeal, DDSN moved Doe to its
critical waiting list in February 2003. Doe was advised that
she met certain DDSN eligibility requirements in March 2003.
She was then moved to the top of the critical waiting list.
At a March 2003 hearing on the appeal, a DHHS hearing
officer dismissed the matter. He found that, by moving Doe to
the top of the critical waiting list and determining that she
was eligible for services, DDSN had resolved all of Doe’s claims
in her favor. The hearing officer also found that DDSN had not
provided Doe with services in a “reasonably prompt” period of
time. However, because DDSN was then promising to provide Doe
with services, the hearing officer found that he lacked the
power to provide any other relief and the appeal was dismissed.
Joint Appendix (“J.A.”) 887-89.
In April 2003, DDSN approved a “plan of care” that was
developed for Doe pursuant to 42 C.F.R. § 441.301(b)
(hereinafter the “2003 plan”). J.A. 616-44. The 2003 plan
6
included a regime of personal care, psychological evaluations,
and other services to be provided in-home at the residence of
Doe’s mother. It also recommended that Doe “receive residential
habilitation from a DDSN approved provider” within three months
at a “setting located within the Columbia area to be chosen by
her family.” J.A. 625.
In May 2003, in response to the declining mental health of
Doe’s mother, Doe asked to terminate the in-home services and,
per the 2003 plan, receive “residential habilitation services”
in either a CTH I or CTH II. J.A. 920, 923. In June 2003,
after failing to receive any residential habilitation services,
Doe initiated this action, wherein she accused Defendants of
violating the Medicaid Act. She sought injunctive relief from
DDSN, the payment of medical expenses, and attorney’s fees.
In a letter dated June 26, 2003, DDSN authorized CTH I or
SLP II services for Doe at a residential center (hereinafter the
“authorization letter”). J.A. 942-44. According to the
authorization letter, an assessment of Doe by DDSN revealed that
her needs for “out-of-home placement/residential habilitation
supervision, care and skills training” could be met at either of
these two placements. J.A. 943. However, Doe rejected the DDSN
chosen provider, the Babcock center, because she believed that
the facility could not safely provide her with appropriate
services. Through August 2003, Defendants and Doe discussed
7
some alternative placements, including the possibility of
upgrading the services at another CTH I setting or placement at
a CTH II facility closer to her family. J.A. 1689. However,
Defendants also maintained that a CTH I setting “represents the
best long-term option” for Doe. Id. In an August 16, 2003
letter, DDSN gave Doe permission to reside in a CTH II facility,
where she would receive “respite” or temporary services. J.A.
74. As of December 2010, Doe continues to reside in a CTH II
facility.
In February 2005, DDSN reevaluated Doe’s eligibility for
Medicaid services. Based upon this reevaluation, DDSN now
maintains that Doe is not mentally retarded and, therefore, is
ineligible for the waiver program. J.A. 1208-09. According to
Doe, the reevaluation was initiated in retaliation for her
filing of this lawsuit. J.A. 105-06. She also believes it
contradicts the Social Security Administration’s prior
determination that Doe is mentally retarded, and the similar
longstanding diagnosis of Doe’s physicians. J.A. 93-106. Doe
administratively appealed this reevaluation. J.A. 1207.
However, both a DHHS hearing officer and a state administrative
law court judge agreed with DDSN. See generally Pruitt v. South
Carolina Dep’t of Health and Human Serv., No. 06-ALJ-08-0605-AP,
2008 WL 2828634 (S.C. Admin. L. Ct. June 20, 2008). The matter
is now pending before the South Carolina Court of Appeals.
8
In February 2008, on remand, with only her reasonable
promptness claim properly before the district court, Doe moved
to amend her complaint. J.A. 77. The amended complaint would
have added three causes of action based on the Supremacy Clause
of the Constitution and the Due Process and Equal Protection
Clauses of the Fourteenth Amendment. J.A. 106-15. These new
causes of action would draw into the federal action Doe’s state
court challenges to Defendants’ reevaluation, as well as again
dispute Defendants’ right to decide whether Doe is entitled to
CTH I or CTH II services. The court denied her motion to amend.
On April 21, 2009, Defendants filed a motion for partial
summary judgment on the issue of damages. The court granted
that motion in a short text order on August 19, 2009.
On May 14, 2009, Plaintiffs also filed a motion for summary
judgment, and, that same day, Defendants filed a second motion
for summary judgment on all remaining issues in the case.
Following opposition and reply briefs on these motions, the
district court held a hearing on May 21, 2009.
On January 29, 2010, the district court dismissed Doe’s
reasonable promptness claim. J.A. 17-23. Specifically, the
court held that Defendants are not obligated under the Medicaid
Act to provide or pay for the specific residential habilitation
services from the 2003 plan with reasonable promptness. J.A.
22-23 (citing Bruggeman ex rel. Bruggeman v. Blagojevich, 324
9
F.3d 906, 910 (7th Cir. 2003)). The court dismissed her
reasonable promptness claim because Defendants had promptly and
continuously met their obligation to pay for some residential
habilitation services. It held that, even though the services
funded by Defendants were not the same ones called for in the
2003 plan and the authorization letter, the Medicaid Act did not
actually require Defendants to provide any specific services,
only to pay for some unspecified ones. J.A. 23. The court then
added, speaking to the issues Doe attempted to raise related to
her state administrative appeal, that her “challenge to DDSN’s
level of care and placement decisions must be made through the
administrative procedures available to her in state court.”
II.
We disagree with the district court. Defendants’ failure
to provide Doe with those residential habilitation services
described in her 2003 plan in a reasonably prompt manner
constituted a violation of the Medicaid Act. Thus, we grant
summary judgment in favor of Doe and find that, as the
prevailing party, she is entitled to attorney’s fees. We affirm
the denial of her motion to amend the pleadings.
A.
The sole issue to survive the prior appeal is whether the
requisite medical services were provided to Doe in a reasonably
10
timely manner. Doe I, 501 F.3d at 360. Thus, despite Doe’s
attempts to raise various issues related to the 2005 Medicaid
eligibility determination, here, we must decide only that
single, very narrow issue.
Under the Medicaid Act, “[a] State plan for medical
assistance must -- provide that all individuals wishing to make
application for medical assistance under the plans shall have
opportunity to do so, and such assistance shall be furnished
with reasonable promptness to all eligible individuals.” 42
U.S.C. § 1396a(a)(8). These provisions are “clear” and
therefore establish rights under the Medicaid Act that are
enforceable through § 1983. 2 Doe I, 501 F.3d at 356-57.
It is undisputed that Doe applied for services in 2002, and
qualified for CTH I residential habilitation services in June
2003. However, Defendants claim that she is not entitled to any
relief because (1) they offered her a CTH I placement in June
2
Defendants argue that Doe I misapplied 42 C.F.R.
§ 435.911, which appears to establish a timeline whereby a state
agency must make a determination as to eligibility, but not a
timeline for when an agency must actually furnish services.
(Appellees’ Br. at 39-40.) They would have us instead rely upon
§ 435.930, which states only that Medicaid services are to be
made available “without any delay caused by the agency’s
administrative procedures.” See, e.g., Doe 1-13 By and Through
Doe, Sr. 1-13 v. Chiles, 136 F.3d 709, 721-22 (11th Cir. 1998)
(upholding a district court’s conclusion that “reasonable
promptness” means a period not to exceed ninety days). Because
we find that Defendants have never provided Doe with the
appropriate services, we will not address these more subtle
issues of timeliness.
11
2003, which she then turned down; and (2) because, Defendants
have financed CTH II respite services since July 2003, they are
not required to find a suitable CTH I residential habilitation
placement for Doe. Alternatively, Defendants argue that, here,
Doe has only appealed the district court’s order on Defendants’
motion for summary judgment on the remaining issues, not its
grant of partial summary judgment as to damages. Thus, they
believe, even if we were to find in her favor, she cannot obtain
any meaningful relief.
i.
Contrary to what the district court held and Defendants now
argue, after Doe rejected the CTH I services offered in June
2003, Defendants were still obligated to present her with
alternative CTH I services within a reasonably prompt period of
time. Although this Court dismissed Doe’s freedom of choice
claim, finding that she had no right to choose between CTH I and
CTH II services, we did note that Doe retains a “choice of
providers, so long as the provider operates a CTH I facility,
the kind of setting DDSN has determined would constitute the
least restrictive environment for Doe.” Doe I, 501 F.3d at 360.
In fact, § 1396a(a)(23) of the Medicaid Act “is clearly drawn to
give Medicaid recipients the right to receive care from the
Medicaid provider of their choice, rather than the government’s
12
choice.” 3 Silver v. Baggiano, 804 F.2d 1211, 1217 (11th Cir.
1986).
The district court, in granting summary judgment for
Defendants relied upon the Seventh Circuit’s definition of
“medical assistance” in 42 U.S.C. § 1396a(a)(8). In Bruggeman,
the plaintiffs sought a court order requiring Illinois to build
and operate facilities for the provision of actual medical
services for Medicaid recipients in the northern part of the
state. 324 F.3d at 909. Narrowly construing the phrase
“medical assistance,” the Seventh Circuit held that it is a
reference to “financial assistance rather than to actual
services.” Id. at 910 (emphasis added). The Seventh Circuit
therefore held that Illinois was only required to pay for
appropriate medical services, and was not obligated to actually
construct hospitals or manage medical care. Id. at 910-11.
Unlike the district court, we cannot see how our adoption
of Bruggeman would change the outcome of this case. Even
3
42 U.S.C. § 1396a(a)(23) states, in relevant part, that “A
State plan for medical assistance must provide that (A) any
individual eligible for medical assistance (including drugs) may
obtain such assistance from any institution, agency, community
pharmacy, or person, qualified to perform the service or
services required . . . who undertakes to provide him such
services, and (B) an enrollment of an individual eligible for
medical assistance . . . shall not restrict the choice of the
qualified person from whom the individual may receive services
under section 1396d(a)(4)(C) of this title, except as provided
in subsection (g) of this section and in section 1396n of this
title . . . .” (emphasis added).
13
assuming we were to agree with the Seventh Circuit, Defendants
obligations as to Doe, the 2003 plan, and the authorization
letter would not change. As we outlined in Doe I, the Medicaid
program requires Defendants to “select[] the appropriate setting
for the provision of waiver services. Once a setting is
selected, recipients have a choice of qualified providers among
those who offer services in the setting DDSN has approved.” 501
F.3d at 359. Bruggeman itself also suggests that the
distinction Defendants try to draw between duties to provide
funding-for-care versus actual-direct-care is of no importance
here, since the Medicaid regulations ensure the “prompt
provision of funds to eligible individuals to enable them to
obtain the covered medical services that they need . . . .” 324
F.3d at 910-11 (emphasis added). It therefore cannot suffice
that Defendants have paid for another, albeit similar, type of
residential habilitation service that Defendants themselves do
not believe Doe needed or was even entitled to.
Here, per the 2003 plan and the authorization letter, DDSN
found that Doe’s placement at a CTH I facility would best meet
her medical need for residential habilitation services in the
least restrictive environment. See 42 C.F.R. § 441.301(b)(1)(i)
(requiring states providing services through the waiver program
to do so pursuant to a “written plan of care subject to approval
by the Medicaid agency”). Therefore, “Doe had a right to choose
14
among providers of CTH I services, not a right to choose to live
in any CTH II setting she wished.” Doe I, 501 F.3d at 359.
The provision of different CTH II respite services by
Defendants did not somehow relieve them of their legal
responsibility to subsidize Doe’s placement in a suitable CTH I
setting, nor did it negate her freedom of choice among CTH I
providers. Thus, the ongoing failure of Defendants to pay for
the CTH I residential habilitation services is the same as a
failure to provide any services.
ii.
Similarly, although the parties appear deeply concerned
about the subtle difference between residential habilitation and
respite services, we do not believe that parsing out these
distinctions will alter the outcome of this case. We continue
to believe that Doe I was correct in so far as it held that
respite services and residential habilitation services are, to
some extent, distinct:
Respite care, which Doe is currently receiving, “is
furnished on a short-term basis due to the regular
care giver’s absence or need for relief.” Benjamin H.
v. Ohl, No. 3:99-0338, 1999 WL 34783552, at *2
(S.D.W.Va. July 15, 1999). Residential habilitation,
which Doe has requested, “helps recipients with the
skills needed for daily living, such as eating and
performing personal hygiene, household chores, and
food preparation. It also focuses on the social and
adaptive skills which enable an individual to avoid
institutionalization.” Id. at *3.
15
Doe I, 501 F.3d at 354 n.3. The 2003 plan only required DDSN to
provide “residential habilitation services.” J.A. 625. State
regulations define residential habilitation services as “the
care, skills training and supervision provided to individuals in
a non-institutional setting.” J.A. 656. We therefore agree
with Defendants that this definition includes any of those
services provided in a SLP II, CTH I, CTH II or other “non-
institutional” settings.
Nevertheless, this debate is inconsequential because both
parties concede the more important point: that the CTH II
respite services currently being provided for Doe are not
equivalent to the SLP II or CTH I residential habilitation
services approved by the 2003 plan and the authorization letter.
(Appellant’s Br. at 34-35; Appellees’ Br. at 42-45.) Defendants
were obligated under the Medicaid Act and its regulations to
provide Doe with the needed services in the least restrictive
environment. Doe I, 501 F.3d at 359. As conveyed in the
authorization letter, after evaluating Doe and consulting with
her representatives in the development of the 2003 plan, DDSN
determined that Doe should receive residential habilitation
services in either a SLP II or CTH I setting. Both parties
concede that Doe has never actually received these services in
the designated setting. (Appellant’s Br. at 34-36; Appellees’
Br. at 43-45.) It is also undisputed that, after Doe rejected
16
the Babcock center in 2003, Defendants have never offered Doe
any other satisfactory CTH I placements. (Appellant’s Reply Br.
at 17; Appellees’ Br. at 45.) Instead, since 2003, Doe has only
received “temporary” or respite services at a more restrictive
CTH II facility. (Appellant’s Br. at 34-35; Appellees’ Br. at
43-45.)
Notwithstanding Defendants’ arguments to the contrary or
even Doe’s own insistence that a CTH II setting may be more
desirable, we reaffirm the holding of Doe I as to Defendants’
obligations and Doe’s rights under the Medicaid Act:
(1) Defendants were to make a determination as to the proper
level of care, here, a CTH I setting; (2) Doe was then within
her rights to refuse to accept the Babcock center, the first
suggested CTH I facility; and (3) Defendants were then obligated
to present her with “feasible alternatives” for the provision of
residential habilitation services at a suitable care facility of
her choice. 42 U.S.C. § 1396n(c)(2)(C); see also 42 C.F.R.
§ 441.302(d)(2) (waiver program participants are to be “[g]iven
the choice of either institutional or home and community-based
services.”). Despite these unambiguous legal mandates,
Defendants never presented Doe with any alternative SLP II or
CTH I placements.
Indeed, Defendants admit that they abdicated their
responsibility to furnish Doe with the necessary services in the
17
least restrictive environment, i.e., a SLP II or CTH I setting,
based upon the whims of Doe’s representatives. (Appellee’s Br.
at 49-50.) However, as Defendants successfully argued in Doe I,
it was ultimately Defendants’ responsibility to decide the
appropriate setting for Doe and to execute the 2003 plan within
that setting. 501 F.3d at 359. Neither of these matters fell
upon Doe or her representatives to decide or implement. Thus,
it is irrelevant that, after DDSN refused to upgrade services at
the only CTH I placement proposed by it or to recommend another
CTH I setting, Doe’s representative sought a more restrictive
CTH II level of care. The law places the burden on Defendants
to work with Doe to find or establish an acceptable SLP II or
CTH I setting, which, so far, they have utterly failed to do.
We therefore hold that, as a matter of law, Defendants have
violated the Medicaid Act through their ongoing refusal to
finance residential habilitation services at an acceptable CTH I
placement of her choice.
iii.
Even with the abandonment of her damages claim on appeal,
it is still within the equitable powers of the courts to order
Defendants to place Doe in an appropriate SLP II or CTH I
program of her choice. In actions brought under § 1983 in the
context of the Medicaid Act, the district courts are invested
with broad equitable powers to style any appropriate remedial
18
relief. See Alexander v. Hill, 707 F.2d 780, 783 (4th Cir.
1983) (permitting a district court to exercise its broad
equitable powers in fashioning a remedy to address the
continuing failure of a state to comply with Medicaid
regulations); Smith v. Miller, 665 F.2d 172, 175 (7th Cir. 1981)
(concluding that no provision of the Medicaid Act or the
Constitution restricts the authority of the courts to award
equitable relief).
Since 2005, DDSN has declared Doe ineligible for Medicaid
benefits, but continues to provide her with services pending her
administrative appeal. Accordingly, Defendants assert that any
equitable relief provided to Doe would be futile since she is no
longer entitled to benefits, and that, even if her benefits were
later reinstated, any judgment finding that her benefits had
been provided with unreasonable delay would be meaningless.
(Appellees’ Br. at 27-28.) However we note that, even now, Doe
continues to receive services. And, if Doe were to ultimately
win her state appeal, she would be entitled to future services.
We therefore find that it would be quite appropriate and
within the equitable powers of the district court to order
Defendants to finance a SLP II or CTH I placement of Doe’s
choice pending the resolution of the state appellate process.
Alternatively, the district court may issue a declaratory
19
judgment consistent with this opinion that may guide Defendants
should Doe ever become eligible for Medicaid services again. 4
iv.
Thus, having dispensed with all of Defendants’ arguments,
we hold: (1) that Defendants never provided Doe with residential
habilitation services in a SLP II or CTH I setting; (2) that the
CTH II respite services that have been provided to Doe since
July 2003 are not the equivalent of the SLP II or CTH I
residential habilitation services to which she is entitled; and
(3) that, given Defendants’ continuing violations of the
timeliness provisions of the Medicaid Act and its regulations,
they are ordered to provide Doe with services in a SLP II or CTH
I facility of her choice (at least pending the outcome of her
state appeal).
B.
“Ordinarily, we review an award of attorney’s fees for
abuse of discretion.” Smyth ex rel. Smyth v. Rivero, 282 F.3d
268, 274 (4th Cir. 2002). However, a determination of whether
4
Because Doe seeks only prospective relief to end the
ongoing violation of the Medicaid Act by state officials, there
is no danger that the issuance of an injunction or a declaration
would disturb State sovereignty. See Bragg v. West Virginia
Coal Ass’n, 248 F.3d 275, 292 (4th Cir. 2001) (“[T]he Eleventh
Amendment does not preclude private individuals from bringing
suit against State officials for prospective injunctive or
declaratory relief designed to remedy ongoing violations of
federal law.”).
20
Doe is the “prevailing party” for purposes of 42 U.S.C. § 1988is a question of law to be considered de novo. Id. “A person
may not be a ‘prevailing party’ plaintiff under 42 U.S.C. § 1988except by virtue of having obtained an enforceable judgment,
consent decree, or settlement giving some of the legal relief
sought in a § 1983 action.” S-1 and S-2 By and Through P-1 and
P-2 v. State Bd. of Educ. of N. Carolina, 21 F.3d 49, 51 (4th
Cir. 1994) (en banc) (citing Farrar v. Hobby, 506 U.S. 103(1992)).
Because we now reverse the district court, and direct it to
grant summary judgment in her favor, there can be no question
that Doe is the “prevailing party” for purposes of § 1988. She
is therefore entitled to reasonable attorney’s fees as
determined by the district court. See Hanrahan v. Hampton, 446
U.S. 754, 758 (1980) (“Congress intended to permit the interim
award of counsel fees . . . when a party has prevailed on the
merits of at least some of his claims.”).
C.
Denial of leave to amend is subject to appellate review for
abuse of discretion. US Airline Pilots Ass’n v. Awappa, LLC,
615 F.3d 312, 320 (4th Cir. 2010). We agree with the district
court’s decision to deny Doe’s motion to amend the complaint.
Doe’s proposed amended complaint would have added three
causes of actions based upon the Due Process Clause, Equal
21
Protection Clause, and Supremacy Clause. These ostensibly new
causes of action sought to revive her earlier “freedom of
choice” claim, i.e., that she should be allowed to choose
between CTH I and CTH II services, and to collaterally attack
the now pending state administrative proceedings as to her
Medicaid eligibility.
Given our prior dismissal of her “freedom of choice” claim,
we find that the first proposed due process claim, in so far as
it alleges that state administrative hearings failed to consider
certain medical evidence as to the suitability of a CTH I
placement, would be futile. See GE Inv. Private Placement
Partners II v. Parker, 247 F.3d 543, 548 (4th Cir. 2001) (“Leave
to amend may properly be denied where amendment would be
futile.”). Moreover, this proposed amendment was brought before
the court in 2008, long after the allegedly faulty hearing
occurred in 2006. See Deasy v. Hill, 833 F.2d 38, 41 (4th Cir.
1987) (“[A] motion to amend should be made as soon as the
necessity for altering the pleading becomes apparent.” (quoting
6 Wright & Miller, Federal Practice and Procedure § 1488
(1971)).
The district court also did not abuse its discretion when
it rejected the amendments that would have added a second due
process claim challenging the timeliness of the hearing
officer’s decision making process, and a third claim arising
22
under the Equal Protection Clause and Supremacy Clause, wherein
Doe alleged that Defendants and the state proceedings somehow
misapplied federal law. “[L]ower federal courts possess no
power whatever to sit in direct review of state court
decisions.” Atlantic Coast Line R. Co. v. Engineers, 398 U.S.
281, 296 (1970). This rule is particularly important where “the
constitutional claims presented to a United States District
Court are inextricably intertwined with the state court’s denial
in a judicial proceeding” of a plaintiff’s request for relief.
Dist. of Columbia Court of Appeals v. Feldman, 460 U.S. 462, 482
n.16 (1983); see also Johnson v. DeGrandy, 512 U.S. 997, 1005-06
(1994) (noting that the Rooker-Feldman doctrine prevents an
unsuccessful state court party “from seeking what in substance
would be appellate review of the state judgment in a United
States district court, based on the losing party’s claim that
the state judgment itself violates the loser’s federal rights”).
In Feldman, the plaintiffs sought to challenge a D.C. Court
of Appeals decision denying them permission to sit for the local
bar exam. Id. at 468-469. The Supreme Court allowed the
plaintiffs to proceed with a constitutional challenge to the
local bar rules generally. Id. at 486-87. However, it held
that the plaintiffs could not ask the district court to directly
review the D.C. Court of Appeals’ judicially made determination
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that the plaintiffs were ineligible to sit for the bar exam.
Id.
Here, the district court could not have adjudicated Doe’s
constitutional claims without also reviewing the propriety of
the judicial rulings of the hearing officer, the South Carolina
administrative law judge, and any subsequent state appellate
courts. Unlike Feldman, these new claims did not challenge the
constitutionality of a particular procedure or law related to
Medicaid eligibility. See id. at 486 (holding that district
courts may review state law or those rules promulgated by a
state executive or judiciary acting in a non-judicial or
legislative manner). Doe merely alleges that the hearing
officer -- who clearly acted in a judicial capacity by issuing
an opinion in which he weighed the evidence and applied the
applicable law -- and the administrative law court judge made
their decisions in an arbitrary and capricious manner. Thus,
she seeks to collaterally attack these state court judicial
proceedings by asking the federal courts to again review the
evidence and to then overturn these state court judgments. This
we cannot and will not do. See id. (holding that district
courts “do not have jurisdiction . . . over challenges to state
court decisions in particular cases arising out of judicial
proceedings even if those challenges allege that the state
court’s action was unconstitutional”).
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Doe was permitted under S.C. Code Ann. § 1-23-380(5)(a) to
raise her constitutional claims before the South Carolina
administrative law court. She also could have raised her
concerns about the purported retaliatory nature of Defendants’
reevaluation. If, following these state proceedings, her
Medicaid eligibility continues to be denied in a way she deems
unconstitutional, then appellate review by the state courts and,
perhaps, ultimately, the United States Supreme Court is her only
recourse. We are confident that the South Carolina courts will
thoughtfully and thoroughly consider these claims.
For these reasons, we believe that the court did not abuse
its discretion when it declined to allow Doe to amend her
complaint.
III.
We reverse the district court’s grant of summary judgment,
and hold that Defendants violated Doe’s rights under the
Medicaid Act by failing to provide her with any of the
residential habilitation services in a SLP II or CTH I setting,
as authorized by DDSN and the 2003 plan, with reasonable
promptness. Because Defendants have failed to demonstrate any
disputed issue of material fact, we grant Doe’s motion for
summary judgment. We also find that Doe is entitled to
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attorney’s fees. However, we affirm the district court’s denial
of Doe’s motion to amend the complaint.
Thus, the order of the district court granting summary
judgment for Defendants is reversed; Doe’s motion for summary
judgment is granted; the district court’s denial of the motion
to amend is affirmed; and we remand the case to the district
court to devise appropriate remedial relief, and to determine
reasonable attorney’s fees pursuant to § 1988.
REVERSED IN PART, AFFIRMED IN PART,
AND REMANDED WITH INSTRUCTIONS
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