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HENRIETTA D. v. GIULIANI
September 18, 2000
HENRIETTA D., NIDIA S., SIMONE A., EZZARD S., JOHN R., AND PEDRO R., ON BEHALF OF THEMSELVES AND OTHERS SIMILARLY SITUATED, PLAINTIFFS,
RUDOLPH GIULIANI, MAYOR OF THE CITY OF NEW YORK, MARVA HAMMONS, ADMINISTRATOR OF THE NEW YORK CITY HUMAN RESOURCES ADMINISTRATION AND COMMISSIONER OF THE NEW YORK CITY DEPARTMENT OF SOCIAL SERVICES, AND MARY E. GLASS, COMMISSIONER OF THE NEW YORK STATE DEPARTMENT OF SOCIAL SERVICES, DEFENDANTS.
The opinion of the court was delivered by: Johnson, District Judge.
This class action is brought by New York City residents with
AIDS or HIV-related illnesses seeking equal and meaningful access
to publicly subsidized benefits. Plaintiffs sued city and state
officials, claiming violations of the Americans with Disabilities
Act ("ADA"), the Medicaid Act, Section 504 of the Rehabilitation
Act of 1974, and other violations of state and federal laws.
After a lengthy period of discovery and motion practice, this
Court held a bench trial on the merits of this case on May 1,
2000, May 2, 2000, June 20, 2000, June 21, 2000, and June 22,
2000. Based on the evidence and testimony presented at trial, the
Court makes the following findings of fact and conclusions of
1. Plaintiffs commenced this action against defendants for
failure to provide meaningful and equal access to public benefits
and services as required by the Americans with Disabilities Act
and the Rehabilitation Act, and for failure to comply with
numerous federal and state laws, including the Social Security
Act, the Medicaid Act, the New York Social Services Law, and
various regulations under these acts. Second Am. Compl. ¶¶ 1-2.
3. The Division of AIDS Services and Income Support ("DASIS"),
a division of the New York City Human Resources Administration
("HRA"), is the means for indigent individuals living with AIDS
or clinical/symptomatic HIV to access critical subsistence
benefits and services offered by City and State defendants.
Rather than requiring persons with AIDS or clinical/symptomatic
HIV illness to access the many programs administered by HRA on
their own, DASIS case managers are responsible for assisting
clients in applying for and maintaining public assistance,
Medicaid, Food Stamps, housing, Social Security benefits, and
other benefits and services. DASIS was known as the Division of
AIDS Services ("DAS") until it was consolidated with HRA's Income
Support division in 1997.
4. This Court certified the original named plaintiffs as
representatives of a class of "all DAS-eligible persons" who seek
public assistance benefits and services. In order to be a DASIS
client, an individual must be: a New York City resident who is
"Medicaid eligible," and has been diagnosed with
clinical/systematic HIV illness or AIDS. Henrietta D. v.
Giuliani, 1996 U.S. Dist. LEXIS 22373 at *47; Tr. at 662: 9-12.
5. Pursuant to stipulation between the parties, Henry Bradley,
Owen-Pahl Greene and Richard Torres intervened in this action "as
representative named plaintiffs." Pre-Trial Odr. at 10 and Ex.
AIDS and the Need for Reasonable Modifications
6. People living with HIV and AIDS develop numerous illnesses
and physical conditions not found in the general population, and
experience manifestations of common illnesses that are much more
aggressive, recurrent, and difficult to treat. Infections and
cancers spread rapidly in a person whose immune system has been
compromised, and the effectiveness of medicine is diminished by
nutritional problems that limit the body's ability to absorb what
is ingested. Illnesses that are not lethal to the general
population can kill an HIV-infected person. For all these
reasons, persons with AIDS and HIV-related disease experience
serious functional limitations that make it extremely difficult,
if not impossible in some cases, to negotiate the complicated
City social service system on their own. See Henrietta D. v.
Giuliani, 1996 U.S.Dist. LEXIS 22373 at *4-5; Tr. at
7. As the immune system deteriorates, persons infected with HIV
progress from being asymptomatic to developing symptoms such as
weight loss, severe gynecological infections, chronic diarrhea,
and fatigue. Eventually, HIV and AIDS strips the body of all
defenses, leaving the infected person unable to fend off or
combat new and existing infection and illness. At this later
stage of HIV infection, patients commonly develop "opportunistic
infections" such as PCP pneumonia, cryptococcal meningitis, and
Kaposi's Sarcoma, diseases particular to persons with compromised
immune systems. These illnesses and infections eventually cause
death. Tr. at 435:12-444:21.
8. The opportunistic infections and chronic conditions that
result from a weakened immune system limit the HIV-infected
person's ability to engage in regular activities of daily life
such as traveling, standing in line, attending scheduled
appointments, completing paper work, and otherwise negotiating
medical and social service bureaucracies. Some examples of these
conditions include: cytomegalovirus (CMV) retinitis, a visual
impairment that often results in blindness; severe wasting
syndrome, which causes chronic diarrhea, extreme fatigue and, in
some instances, gait impairment; peripheral neuropathy, a
disturbance of the peripheral nervous system that causes numbness
or tingling of the hands and feet, weakness in the legs, arms and
hands, and severe pain that can interfere with the ability to
walk; and AIDS dementia complex, a neurocognitive dysfunction
that can interfere with the ability to understand written
materials and/or fill out forms. Tr. at 435:12-444:21.
9. Functional limitations also develop from the primary drugs
used to combat AIDS and HIV-related disease, among them AZT, DDI,
ddC, protease inhibitors, and anti-neoplastic agents. These
medications result in anemia and other side effects, with
concomitant fatigue, shortness of breath, and other physical
limitations. An individual receiving this common regime of
prescription drugs likely will be restricted in his or her
ability to walk, stand, or travel. Other side effects include
enhanced neuropathy, diarrhea, nausea, and vomiting. Tr. at
10. The latest medical development in the fight against HIV
disease is the prescription of so-called "drug cocktails," which
consist of two older AIDS drugs, such as AZT and 3TC, and the
latest antiviral drugs, protease inhibitors. These drugs create
added complications for patients including extremely cumbersome
treatment regimens and serious side effects, such as nausea and
gastrointestinal symptoms. The drugs must be taken several times
a day, some on an empty stomach and some after meals, and
treatment regimens can include up to sixty pills a day.
Additionally, some of these drugs require refrigeration. Tr. at
11. People living with AIDS and HIV also have a particularly
hard time obtaining adequate nutrition. Illness and infection
often limit the appetite and the body's ability to absorb
nutrients, and common HIV-related conditions like oral thrush can
physically limit the ability to swallow. Nausea, a common side
effect of drugs used to treat AIDS and HIV infection, can also
result in an inability to eat properly. Due to HIV-related
disease, many HIV-infected persons have dietary restrictions.
These nutritional restrictions can be difficult or impossible to
maintain. Poverty, limited mobility, and limited resources result
in limited access to fresh, high-quality food, and necessary
dietary supplements. Pl.Ex. 13, at 3-4.
12. Stress is another critical problem faced by people living
with AIDS and HIV. HIV-infected persons necessarily struggle with
many stresses in their lives, including the likelihood of early
death, management of a multitude of symptoms and medications, the
future welfare of their children, rejection of friends and
family, stigma, and discrimination. The added stress of lack of
housing, food, medical care, or other basic survival services
that indigent people face poses a serious threat to health.
Medical evidence suggests that stress causes further weakening of
the immune system in HIV-infected persons, making it even more
difficult to fight illnesses and infections. Tr. at 444:12-21.
13. The requirement that persons with AIDS and advanced HIV
disease travel to and wait in infection-ridden public waiting
rooms can be dangerous, and even life-threatening, for this
population, all of whom suffer from severely weakened immune
systems. Persons with AIDS, for example, are highly susceptible
to tuberculosis and other infectious diseases. Thus, persons with
AIDS and advanced HIV disease require medically appropriate
conditions in which to establish, receive, and maintain their
benefits, as well as medically appropriate housing. Tr. at
14. Henry Bradley is a fifty-one year old man who has been
disabled with AIDS since 1983. Tr. at 40:15-22. As a result of
his disability, he suffers from symptoms including numbness in
his extremities, fungal infections that cause his teeth and nails
to fall out, and severe rashes. To control
the disease, Mr. Bradley currently follows a medication regimen
that requires taking fifty-one different tablets, plus liquid
supplements, daily. Mr. Bradley experiences certain side effects
from the medication, including loss of bowel control, blurred
vision, and occasional loss of short-term memory. Tr. at
41:6-43:9. While a DASIS client, Mr. Bradley has slept poorly,
suffering from chills and sweats during the night, and he has
lost over thirty pounds. See Def. Ex. S at ¶ 24.
15. In 1993 and 1994, Mr. Bradley resided at 775 Riverside
Drive. Tr. at 45:7-9. After initially funding Mr. Bradley's
housing, DASIS closed his case without notice in February, 1994.
Tr. at 50:16-51:1. See P.Ex. 33. Mr. Bradley sought a
conference with DASIS, but was refused and instead had to file
for a fair hearing. The fair hearing decision in his favor
ordered DASIS to reopen the case, pay the benefits due
retroactively, and to notify Mr. Bradley about any further
decisions. Tr. at 51:20-53:2.
16. Despite the fair hearing decision, DASIS did not pay the
rent arrears and Mr. Bradley lost his apartment. Tr. at 53:9-14.
During this time, Mr. Bradley's Medicaid was not active, and he
was unable to maintain his medication regimen. Tr. at 54:1-4.
17. In November 1994, DASIS did pay the overdue benefits to Mr.
Bradley. However, DASIS then immediately closed his case again
without notice.*fn2 Tr. at 54:14-55:23. During this time, DASIS
knew where to reach Mr. Bradley. 56:7-14. See Pl.Ex. 33.
18. From November 1994 to April 1995, Mr. Bradley was without
shelter allowance, cash assistance, food stamps, or medical
assistance. During this time without public benefits, Mr. Bradley
relied primarily on church charity in order to live. Again he was
unable to maintain his medication regimen for this time period,
and his health deteriorated from the constant worry about
day-to-day survival. Tr. at 56:25-57:20. See Def. Ex. S at ¶¶
19. Each time Mr. Bradley won a fair hearing decision, DASIS
employees would direct Mr. Bradley to take his complaints to a
noncompliance center to file a complaint. Mr. Bradley was forced
to wait upon arrival and would eventually receive a computer
printout that would describe what should be done to achieve
DASIS' compliance. Then, he would be instructed by the staff to
take the printout to the liaison office and to await further
contact. This further contact never occurred. Mr. Bradley would
do this once every twenty or thirty days with no result. Tr. at
20. Although Mr. Bradley sought DASIS' assistance in securing a
permanent apartment, no help was forthcoming. When he
independently found an apartment, he brought the lease to his
case manager at DASIS shortly before mid-August 1995; Mr. Bradley
understood that his application would be processed. Tr. at
59:17-60:12. Instead, his case was closed for a third time,
without notice, on August 14, 1995. Mr. Bradley did not learn of
this closure until he discovered that he lost the apartment
because DASIS had not processed the application. Tr. at
22. Mr. Bradley sought a fair hearing and received a favorable
determination in July, 1996. DASIS was ordered to restore his
benefits retroactively, reversing the discontinuance of his
medical assistance benefits and food stamps. However, in
September 1996 DASIS complied with the decision for only one day
and then closed the case the next day for a fourth time without
notice to Mr. Bradley. Tr. at 69:14-70:15.
23. Mr. Bradley did not know why his case was closed yet again.
Tr. at 71:6-15. In questioning different people at DASIS, he
received different answers regarding his case status. Tr. at
71:25-72:12. When he sought help from the noncompliance unit, he
received the same chain of instructions as before: receive a
computer printout from the noncompliance unit, deliver it to the
liaison unit and await contact. As before, that contact never
came. Tr. at 73:2-25. See Pl.Ex. 69.
24. Mr. Bradley's complaints to the noncompliance unit in
Albany did not resolve the issue. Tr. at 77:16-20; 78:1-9. See
Pl.Ex. 70. Mr. Bradley did not seek another fair hearing in 1996
or 1997 because DASIS employees told him that it was unnecessary
and useless to seek a new fair hearing merely to enforce the
original decision. Tr. at 78:24-79:21.
25. In 1996, DASIS approved rental assistance for an apartment
for Mr. Bradley but failed to make payments after he moved into
the apartment. Tr. at 85:12-24. As a result, Mr. Bradley was
forced to pay the rent out of his social security payments, and
to get by otherwise with almost no income. Tr. at 88:3-19.
Finally in April 1998, Mr. Bradley received notice from DASIS
that they would comply with the 1996 fair hearing order and repay
part of the back rent that had accrued. Tr. at 89:13-20.
Defendants were compelled to reimburse Mr. Bradley $7,132.00 in
public assistance benefits that defendants wrongfully withheld
during the period from July 1, 1995 to April 12, 1998, almost
three years of welfare benefits. Tr. at 121-22. However, DASIS
did not repay over four thousand dollars in rent that Mr. Bradley
paid out of his SSI payments.*fn3 Tr. at 89:13-20, 121:8-122:6.
See Pl. Exs. 73, 51, 38.
26. The same April 1998 letter from the noncompliance unit
stated that Mr. Bradley would receive the food stamps due from
August 1996 until March 1998. During this time without food
stamps, Mr. Bradley was forced to go from church to church in
search of food. However, even after April 1998, Mr. Bradley did
not receive his food stamps consistently. Tr. at 89:25-90:19.
See Pl.Ex. 73.
28. Before Mr. Bradley was allowed back to DASIS, he received
another letter from a Mark Limerick of DASIS stating that, in
order to become a client, he had to resubmit documents he had
already submitted to DASIS. Mr. Limerick arranged to meet Mr.
Bradley at his home to get the paperwork but failed to show up
for the appointment. Mr. Bradley then went to DASIS' office in
person and resubmitted the documents. Tr. at 96:24-97:24.
Although Mr. Limerick told Mr. Bradley that the transfer back to
DASIS would take a week, Mr. Bradley was not transferred back for
three to four weeks. 99:1-3. See Pl.Ex. 56.
29. In 1998, DASIS sent Mr. Bradley notice of an award of food
stamps for the month of September only. Tr. at 104:10-12. The
same day, Mr. Bradley received a letter stating that DASIS
intended to terminate his public assistance on September 11,
1998, and to reduce his food stamps to only ten dollars per
month. Tr. at 105:17-106:16. No one at DASIS could explain to Mr.
Bradley why the notices were sent. Tr. at 107:7-10. See Pl.
Exs. 64, 62.
30. In response, Mr. Bradley requested a fair hearing. On
September 8, 1998, the hearing officer reversed DASIS'
computation of benefits and directed DASIS to restore lost public
assistance and food stamp benefits retroactive to August 1996.
Tr. at 110:9-23. Despite the fair hearing decision, DASIS did not
restore the lost housing benefits, and has not paid for the lost
benefits since then. Nor did DASIS pay a nutrition and
transportation allowance following this decision. Tr. at
114:11-20. See Pl.Ex. 67 at 5.
31. Mr. Bradley then received a notice informing him that DASIS
intended to close his public assistance case yet again on
September 15, 1998, for reason "21-5." Tr. at 111:9-14,
111:21-112:6. No one at DASIS could explain what the numerical
notation meant. Tr. at 112:13-113:14. See Pl.Ex. 66.
32. Mr. Bradley first sought to gain compliance with the 1998
fair hearing decision by following instructions to contact the
noncompliance unit and take their printouts to the liaison
office, where he was told that he would be contacted. Mr. Bradley
was never contacted. Tr. at 114:9-115:9. After he contacted the
State compliance unit, a director at that unit told him that he
would be contacted when compliance was achieved. Mr. Bradley was
never again contacted about compliance with the fair hearing, and
the retroactive benefits were never paid. Tr. at 117:18-118:6.
See Pl.Ex. 74.
33. DASIS' own records noted that in May 1998 Mr. Bradley's
case was open and "in fine shape," but then closed as of October
1998. This notation added that sufficient income to meet needs
should not have caused the closure, since Mr. Bradley's income
had not changed. The discrepancy was not explained. Tr. at
119:8-120:5, 120:9-21. See Pl.Ex. 45.
34. In 1999, Mr. Bradley brought in a lease with a request for
moving expenses, and a supervisor at DASIS accompanied him to
view the apartment. However, a few weeks later, in May 1999, Mr.
Bradley's case was closed without notice for a fifth time. Tr. at
125:9-23. Again Mr. Bradley ...