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RODRIGUEZ v. DEBUONO
April 19, 1999
JUANA RODRIGUEZ, ET AL., PLAINTIFFS,
BARBARA DEBUONO, COMMISSIONER OF THE NEW YORK STATE DEPARTMENT OF HEALTH, ET AL., DEFENDANTS.
The opinion of the court was delivered by: Scheindlin, District Judge.
I. Procedural Background .............................. 605
II. Legal Standard for a Permanent Injunction .......... 607
III. Discussion ......................................... 607
A. Plaintiffs' Medicaid Claim ..................... 608
1. Legal Standard for a Private Right of
Action Under 42 U.S.C. § 1983 ............
2. Application of Standard .................. 611
a. 42 U.S.C. § 5 1396a(a)(10)(B) .......... 611
b. Medicaid Act Regulations ............. 612
3. The Merits of Plaintiffs' Medicaid
Claims ................................... 613
a. 42 U.S.C. § 1396a(a)(10)(B) ..........
b. Plaintiffs' Regulatory Claims ........ 614
B. Plaintiffs' Claims Under the Americans With
Disabilities Act and the Rehabilitation
Act ........................................ 614
1. Applicability of Anti-Discrimination
Statutes to This Case .................... 615
2. The Merits of Plaintiffs' ADA and § 504
Claims ................................... 618
a. "Qualified Individual" With a
Disability ........................... 618
b. Plaintiffs Are Excluded From Benefits
Because of Discrimination Based on
Disability ........................... 619
c. Reasonable Accommodation ............. 619
i. Essential Nature of Program ...... 619
ii. Undue Burden ..................... 621
C. Irreparable Harm ............................... 623
IV. Conclusion ........................................... 624
This class action, involving the level of care provided to
mentally impaired individuals, arises out of a challenge to New
York State's design and implementation of its task-based
assessment ("TBA") programs. TBA programs are used throughout
the State to determine the amount of personal care services
hours provided to eligible Medicaid applicants and recipients.
Plaintiffs, New York State Medicaid home care applicants and
recipients, suffer from mental disabilities, such as
that cause them to require assistance with the activities of
daily living ("ADL"). Defendants are Barbara A. DeBuono,
Commissioner of the New York State Department of Health, and
Brian Wing, Acting Commissioner of the New York State
Department of Social Services, ("the State"), and the
respective Departments of Social Services of the City of New
York (the "City"), Nassau County ("Nassau"), Westchester County
("Westchester") and Suffolk County ("Suffolk") (collectively
with the State, "Defendants").*fn1
Plaintiffs allege that defendants' refusal to include "safety
monitoring" as an independent task discriminates against
otherwise eligible cognitively impaired individuals in
violation of: (1) the Medicaid Act, 42 U.S.C. § 1396 et seq.
and its regulations; (2) § 504 of the Rehabilitation Act; and
(3) the Americans with Disabilities Act ("ADA"). Plaintiffs now
move for permanent injunctive relief on all three grounds. For
the reasons that follow, plaintiffs' motion is granted.
Over two years ago, plaintiffs filed a class action complaint
and an order to show cause to preliminarily enjoin the State's
operation of TBA programs.*fn2 Following a two week hearing,
this Court entered an Amended Order ("August 25 Order"),
granting in part and denying in part, plaintiffs' request for
class certification pursuant to Rule 23 of the Federal Rules of
Civil Procedure ("Fed. R. Civ. P.").*fn3 See Rodriguez v.
DeBuono, supra. The plaintiffs' motion for a preliminary
injunction was also granted in part, based on a finding that
plaintiffs had demonstrated a substantial likelihood of success
on the merits of: (1) their safety monitoring claim pursuant to
the Medicaid Act, 42 U.S.C. § 1396a(a)(10)(B), and its
regulations, 42 C.F.R. § 440.240(b); and (2) plaintiffs' claim
that due process requires the City's notices of TBA
determinations for applicants and recipients to include the
number and allocation of authorized hours. See id. at 157,
164-65.*fn4 However, the Court found that plaintiffs failed to
make the required showing with regard to their "span of
time"*fn5 claims against the City and Nassau County as well as
with the remainder of their notice claims. See id. at 161-63,
165, 167. The Court declined to
address plaintiffs' ADA and § 504 claims at that time because
the preliminary injunctive relief was based on plaintiffs'
other claims. See id. at 161 n. 23.
In September 1997, defendants appealed and sought an order
staying the portion of the preliminary injunction requiring
them to provide safety monitoring relief pending appeal. This
Court granted defendants' motion for a stay. On November 16,
1998, the Second Circuit vacated the preliminary injunction,
without reaching the merits of the appeal, finding that
"imminent irreparable harm," an essential requirement for
interim relief, had not been shown in light of the District
Court's stay pending appeal. See Rodriguez v. DeBuono,
162 F.3d 56, 62 (2d Cir. 1998), opinion amended and superseded by
Rodriguez v. DeBuono, 175 F.3d 227 (2d Cir. 1999).
On remand, the parties requested further discovery and
settlement negotiations regarding plaintiffs' span of time
claim.*fn6 See Transcript of December 2, 1998 ("Dec. 2 Tr.")
at 16-17. However, all parties sought a swift resolution of the
remaining claims. The parties and the Court agreed that the
litigation would take "two tracks" — one being a final
resolution of the safety monitoring claim, and the other a
settlement track for the span of time claim. See id. at 11.
Accordingly, the span of time claim was bifurcated from the
safety monitoring claim, and the parties moved for final
resolution of the safety monitoring claim pursuant to
Rule 54(b) provides in relevant part:
When more than one claim for relief is presented
in an action, whether as a claim, counterclaim, or
third-party claim, or when multiple parties are
involved, the court may direct the entry of a
final judgment as to one or more but fewer than
all of the claims or parties only upon an express
determination that there is no just reason for
delay and upon an express direction for the entry
Fed.R.Civ.P. 54(b). While the language of the rule does not
require the trial court to make either formal findings of fact
or conclusions of law in order to certify the judgment under
Rule 54(b), I shall nontheless state the reasons justifying the
entry of a final order on the safety monitoring claim.
See 10 Moore's Federal Practice, § 54.23 (Matthew Bender 3d
First, "a certification under Rule 54(b) should be granted
only if there are `interest[s] of sound judicial
administration' and efficiency to be served." Harriscom Svenska
AB v. Harris Corp., 947 F.2d 627 (2d Cir. 1991) (quoting
Curtiss-Wright Corp. v. General Elec. Co., 446 U.S. 1, 8, 100
S.Ct. 1460, 64 L.Ed.2d 1 (1980)). A court should not enter
final judgment on fewer than all the claims in an action if the
same or closely related issues remain to be litigated. See
Nat'l Bank of Washington v. Dolgov, 853 F.2d 57, 58 (2d Cir.
1988) (per curiam). Second, "[n]ot all final judgments on
individual claims should be immediately appealable, even if
they are in some sense separable from the remaining unresolved
claims." Curtiss-Wright, 446 U.S. at 8, 100 S.Ct. 1460. The
district court must determine that the final decision on
certain claims is ready for appeal, taking into account the
equities involved as well as judicial administrative interests.
I find that the safety-monitoring claim is separable from
plaintiffs' span of time claim. Both claims arise from
defendants' implementation of the TBA program. The claim
adjudicated in this opinion, however, involves defendants'
refusal to provide safety monitoring as an independent task to
otherwise qualified mentally impaired Medicaid applicants and
recipients. The span of time claim, on the other hand, concerns
defendants' alleged failure to authorize sufficient hours of
care to cover the span of time during which unscheduled or
recurring needs occur. While the claims share some of the same
underlying legal issues, for example, Medicaid comparability
law, the safety monitoring and span of time claims are
The parties have now briefed the safety monitoring issue
twice, and the Court has conducted two weeks of hearings. At
this juncture, no further evidence is required. Moreover, the
parties themselves are ready to resolve this issue. Finding no
just reason for delay, a Rule 54(b) certification is
II. Legal Standard for a Permanent Injunction
Generally, to obtain a permanent injunction, a party must
show the absence of an adequate remedy at law and irreparable
harm if the relief is not granted. See New York State, National
Organization for Women v. Terry, 886 F.2d 1339, 1362 (2d Cir.
1989) (citing Rondeau v. Mosinee Paper Corp., 422 U.S. 49, 57,
95 S.Ct. 2069, 45 L.Ed.2d 12 (1975)). The standard for a
permanent injunction is essentially the same as for a
preliminary injunction, except that the plaintiff must actually
succeed on the merits. See Amoco Production Co. v. Village of
Gambell, 480 U.S. 531, 546 n. 12, 107 S.Ct. 1396, 94 L.Ed.2d
542 (1987). However, entry of a permanent injunction requires a
less stringent standard than that for a preliminary
injunction.*fn7 Although a showing of irreparable harm is
required for the imposition of any injunctive relief,
preliminary or permanent, see Sierra Club v. Hennessy,
695 F.2d 643, 647 (2d Cir. 1982), the imminent aspect of the harm is not
crucial to granting a permanent injunction.See Rodriguez 175
F.3d at ___ n. 9.
The law in this Circuit requires a showing that irreparable
damages are likely, not merely possible. See JSG Trading Corp.
v. Tray-Wrap, Inc., 917 F.2d 75, 79 (2d Cir. 1990); Jackson
Dairy. Inc. v. H.P. Hood & Sons. Inc., 596 F.2d 70, 72 (2d Cir.
1979). Irreparable injury is one that cannot be redressed
through a monetary award. Where money damages are adequate
compensation, a preliminary injunction will not issue. See JSG
Trading Corp., 917 F.2d at 79.
In addition, where, as here, "`public consequences' are
implicated, it is incumbent upon a district court in exercising
its discretion to `balance [ ] the conveniences of the parties
and possible injuries to them according as they may be affected
by the granting or withholding of the injunction.'" Sierra
Club, 695 F.2d at 649 (quoting Weinberger v. Romero-Barcelo,
456 U.S. at 305, 311, 102 S.Ct. 1798 (1982)).
A. Plaintiffs' Medicaid Act Claim
Medicaid is a cooperative federal-state program through which
the federal government provides financial assistance to states
so that they may furnish medical care to those whose income and
resources are insufficient to procure such services for
themselves. States are not required to participate in all
aspects of the Medicaid program, but if they do participate in
a given program they must comply with the federal Medicaid
statute and regulations in administering that program.
See 42 U.S.C. § 1396a; Alexander v. Choate, 469 U.S. 287, 105
S.Ct. 712, 83 L.Ed.2d 661 (1985); Himes v. Shalala,
999 F.2d 684, 686 (2d Cir. 1993).
The Medicaid Act, 42 U.S.C. § 1396 et seq., provides "medical
assistance" to individuals whose income and resources are
insufficient to meet the costs of medical care, and who are
either age 65 or over, blind, disabled, or members of families
with dependent children. "Medical assistance" is defined to
include "personal care services furnished . . . in a home or
other location." 42 U.S.C. § 1396d(a)(xi)(24); N.Y. Soc. Serv.
L. § 365-a(2)(e) New York State has chosen to include the
federal option for home care services, including "personal care
services", in its State Medicaid plan. See N.Y. Soc. Serv. L. §
365-a(2)(e); 42 C.F.R. § 440.170(f). "Personal care services"
include assistance with tasks associated with the ADL, such as
bathing, toileting, assistance with medications, personal
hygiene, dressing, feeding and light housekeeping and shopping.
See 18 N.Y.C.R.R. §§ 505.14(a)(6)(i)(a), (ii)(a). Such
assistance must be medically necessary and "essential to the
maintenance of the patient's health and safety in his or her
own home." N.Y. Soc. Serv. L. § 365-a(2)(e); 18 N.Y.C.R.R. §§
Plaintiffs argue that defendants' implementation of TBA
violates the Medicaid comparability provision,
42 U.S.C. § 1396(a)(10)(b), which requires that a state plan provide:
that the medical assistance made available to any
individual described in sub-paragraph (A) —
(i) shall not be less in amount, duration, or
scope than the medical assistance made available
to any other such individual, and
(ii) shall not be less in amount, duration, or
scope than the medical assistance made available
to individuals not described in subparagraph (A).
42 U.S.C. § 1396a(a)(10)(B)(i) and (ii).
1. Legal Standard for a Private Right of Action Under
42 U.S.C. § 1983
Section 1983 imposes liability on anyone who, acting under
color of state law, deprives a person of "any rights,
privileges, or immunities secured by the Constitution and laws"
of the United States. 42 U.S.C. § 1983. Section 1983 can be
used to vindicate violations of federal statutory rights, Maine
v. Thiboutot, 448 U.S. 1, 4-8, 100 S.Ct. 2502, 65 L.Ed.2d 555
(1980), and its coverage is to be "broadly construed." Golden
State Transit Corp. v. City of Los Angeles, 493 U.S. 103, 105,
110 S.Ct. 444, 107 L.Ed.2d 420 (1989). However, not every
violation of a federal law amounts to a violation of a federal
right. See Golden State, 493 U.S. at 106, 110 S.Ct. 444.
To determine whether a private right of action exists under
a federal statute, plaintiffs must show that the statute is:
(1) "intended to benefit" the plaintiffs seeking to enforce it;
(2) a "binding obligation on the governmental unit," rather
than "merely a congressional preference for a certain kind of
conduct;" and (3) not so "vague and amorphous" as to be "beyond
the competence of the judiciary to enforce." Wilder v. Virginia
Hospital Ass'n, 496 U.S. 498, 509, 110 S.Ct. 2510, 110 L.Ed.2d
455 (1990) (quotation marks and citations omitted).
Once plaintiffs have satisfied this test, they are entitled
to a rebuttable presumption that their statutory right is
enforceable under § 1983. Blessing v. Freestone, 520 U.S. 329,
117 S.Ct. 1353, 137 L.Ed.2d 569 (1997). The burden then shifts
to the defendants to demonstrate that Congress "by express
provision or other specific evidence from the statute itself .
. . intended to foreclose such private enforcement." Wilder,
496 U.S. at 520-21, 110 S.Ct. 2510 (quoting Wright v. City of
Roanoke Redev. and Hous. Auth., 479 U.S. 418, 423, 107 S.Ct.
766, 93 L.Ed.2d 781 (1987)).
In 1992, the Supreme Court departed from earlier precedent
finding that no private right of action existed to enforce
§ 671(a)(15) of the Adoption Assistance Act. Suter v. Artist
M., 503 U.S. 347, 364, 112 S.Ct. 1360, 118 L.Ed.2d 1 (1992).
There, the Court found that § 671(a)(15) was too vague and
amorphous to create the private remedy sought by the
plaintiffs. See id. at 362-64, 112 S.Ct. 1360. Defendants argue
that this holding superimposed an additional threshold inquiry
upon the standards established in Golden State and Wilder. This
so-called Suter-overlay would require that when Congress acts
pursuant to its spending power, any condition imposed on
federal monies must be set forth "unambiguously." Suter, 503
U.S. at 355-56, 112 S.Ct. 1360. A determination of what is a
"mandatory" condition requires an examination of "exactly what
is required of states" by the statutory provision sought to be
enforced. See id. at 358, 112 S.Ct. 1360.
Subsequently, Congress expressed its disapproval of
Suter, amending the Social Security Act in 1994 to state:
42 U.S.C. § 1320a-2 (hereinafter "Amendment"). Plaintiffs argue
that this Amendment shows Congress' intent to reject the
Supreme Court's reasoning in Suter and to require courts to
return to the pre-Suter approach when deciding whether to
recognize a private right of action to enforce provisions other
than § 671(a)(15). Defendants, on the other hand, argue that
courts should continue to apply a Suter-overlay to any analysis
of the existence of a private right of action. In support of
their position, defendants point to the fact that ...