Grant Ex Rel. Family Eldercare v. Gilbert

In the United States Court of Appeals for the Fifth Circuit _______________ m 01-51120 _______________ ERNEST GRANT, BY HIS GUARDIAN, FAMILY ELDERCARE, INDIVIDUALLY AND ON BEHALF OF ALL OTHERS SIMILARLY SITUATED, Plaintiff-Appellant, VERSUS DON R. GILBERT, IN HIS OFFICIAL CAPACITY AS THE COMMISSIONER OF THE TEXAS HEALTH AND HUMAN SERVICES COMMISSION; KAREN HALE, IN HER OFFICIAL CAPACITY AS THE COMMISSIONER OF THE TEXAS DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATION; AND ERIC M. BOST, IN HIS OFFICIAL CAPACITY AS THE COMMISSIONER OF THE TEXAS DEPARTMENT OF HUMAN SERVICES, Defendants-Appellees. _________________________________ Appeal from the United States District Court for the Western District of Texas _________________________________ March 24, 2003 Before GARWOOD, SMITH, and BARKSDALE, nursing home care, that he did need “special- Circuit Judges. ized services,” and that he was not competent. Because Grant was a “long-term resident,” JERRY E. SMITH, Circuit Judge: these findings entitled him to choose whether to remain in the nursing facility or to opt for an Ernest Grant, a mentally retarded nursing alternative placement. 42 U.S.C. § 1396r(e)- home resident, sued three Texas state officers (7)(C)(i). Grant claims that, in each of those in their official capacities for failing to provide years, the state failed in its statutory obligation him with adequate information about com- to provide him with sufficient information munity-based placement alternatives to nursing about the placement options available to him, home care. Grant claims that without this and therefore prevented him from making a information, he and others similarly situated reasoned choice. In particular, he claims that are unable to make fully informed decisions the state should have provided him with more regarding their living options. Before con- information about its Home and Community sidering Grant’s motion for class certification, Services-OBRA (HCS-O) waiver program, the district court found that Grant lacked through which it provides community-based standing. Because Grant since has applied for, alternatives to nursing home care for develop- and is now receiving, community-based care, mentally disabled individuals. we dismiss the appeal as moot, concluding that The state provided Grant with a letter, Grant likewise is ineligible to proceed as class called a “CHO-1” letter, informing him that he representative. had a choice to (1) remain in the nursing home or (2) select a community-based placement. I. Grant, who claims to have an IQ of about 24, Congress passed the Nursing Home Reform did not have a legal guardian at the time. The Amendments to “quell overutilization of nurs- state sent the letter directly to him, containing ing home care for those who are not in need of a three-page attachment explaining commun- institutionalization.” Rolland v. Cellucci, 52 ity-based placements, including the HCS-O F. Supp. 2d 231, 234 (D. Mass. 1999). The waiver program, informing Grant that the NHRA creates a “Preadmission Screening and “1915(c) Medicaid waiver for mentally retard- Annual Resident Review” (“PASARR”) pro- ed clients provides in-home and out-of-home cess by which an appropriate state agency, services for a limited number of SSI eligible following federal statutes and regulations, mentally retarded clients who qualify for assesses the level of care required by “mentally ICF/MR institutional care. Available in 15 lo- ill and retarded individuals . . . who are admit- cations.” ted to nursing facilities . . . .” 42 U.S.C. § 1396r(e)(7)(A)(i). The statute also requires Grant claims this language is too vague and that the state “inform the resident of the insti- legalistic to satisfy the state’s obligation, under tutional and noninstitutional alternatives cov- the statue and federal regulations, to provide ered under the State plan for the resident.” 42 him with information about his alternatives to U.S.C. § 1396r(e)(7)(C)(i)(I). remaining in a nursing home. He also alleges that a separate federal statute, 42 U.S.C. § The state’s annual reviews in 1991, 1992, 1396n(c)(2)(C), required the state, when it and 1993 revealed that Grant did not need initially found him eligible for nursing home 2 care and placed him in the nursing facility, to that the district court erred in stating that he provide him with information abo ut lacks standing to pursue one of his informa- community-based alternatives. tional claims, we nevertheless dismiss the ap- peal as moot, finding Geraghty inapposite. Grant seeks, for himself and others similarly situated, information regarding community- II. based placements, a declaration of retroactive Standing, as “an essential and unchanging eligibility, and an injunction requiring the state part of the case-or-controversy requirement of to provide access to waiver services. Fol- Article III,” Lujan v. Defenders of Wildlife, lowing Grant’s motion for class certification, 504 U.S. 555, 560 (1992), determines the the court, sua sponte, became concerned that courts’ “fundamental power even to hear the Grant lacked standing, because he never had suit.” Ford v. NYLCare Health Plans, Inc., applied to the HCS-O program. Grant’s suit 301 F.3d 329, 333 (5th Cir. 2002) (citation ultimately was dismissed without prejudice, omitted), petition for cert. filed, 71 U.S.L.W. with the provision that he could re-file his 3489 (Nov. 22, 2002) (No. 02-1042). If Grant complaint later if he applied for the waiver did not have standing when he sued, whether program and was denied. The court also de- the expiration of his claims makes him ineligi- nied his class certification motion without ble to proceed as class representative becomes, reaching the merits.1 Grant appeals the deci- for lack of better description, a moot issue. sion that he lacks standing. Regarding Grant’s standing as to his infor- Before oral argument in this appeal, Grant mational claims, the district court stated that applied for, and began receiving, waiver ser- “[b]ased on the record and the pleadings on vices.2 He concedes that his claims are moot file, the Court cannot agree with plaintiff’s as to his own asserted injury, but he contends contention that he has not received adequate he still may pursue the claims on behalf of the notice and information from the defendants proposed class. He argues that should we regarding the HCS-O waiver program.” The conclude, contrary to the decision of the dis- court then determined that Grant lacked stand- trict court, that he had standing when he sued ing to seek eligibility and waiver services re- and that, under United States Parole Comm’n lief, because he had never applied for HCS-O v. Geraghty, 445 U.S. 388 (1980), we should services. The court dismissed the case, stating remand for reconsideration of his class certifi- that Grant could refile his complaint if he ap- cation motion. Although we agree with Grant plied for waiver services and was rejected. A. 1 The court erred in holding Grant lacked The order states that the district court “ex- standing to bring his § 1396r(e)(7)(C)(i)(I) in- pressly declines addressing the issue of whether formational claim. The adequacy of the infor- class certification is proper,” noting that it “simply mation provided by the CHO-1 letter relates to cannot intervene in the absence of actionable injury and standing to sue.” the merits of Grant’s suit, not his standing, so the decision to address the merits as part of the 2 Grant’s enrollment in the Mental Retardation Local Authority (MLRA) program, an HCS-O program, was approved December 31, 2002. 3 standing inquiry was premature.3 “This rea- stitutional and noninstitutional living soning misconstrues the purpose and elements alternatives covered under the state waiver of standing. ‘In essence the question of stand- plan.5 The state sent Grant a CHO-1 letter in ing is whether the litigant is entitled to have 1991, 1992, and 1993, after he was the court decide the merits of the dispute or of determined to have met the requirements of § particular issues.’ Warth v. Seldin, 422 U.S. 1396r(e)(7)(B). The state was not required to 490, 498 (1975). It is inappropriate for the provide Grant a letter in 1994 and 1995 after court to focus on the merits of the case when he was deemed to require nursing facility care. considering the issue of standing.” Hanson v. In 1996, the NHRA’s requirement for annual Veterans Admin., 800 F.2d 1381, 1385 (5th assessments of residents was repealed.6 So far Cir. 1986) 4 as we can tell, the state has not been obligated to provide Grant information since 1993. Grant, as the party invoking federal jurisdiction, bears the burden of establishing The “inability to obtain information” the three elements of Article III standing. required to be disclosed by statute constitutes Lujan, 504 U.S. at 561. First, he must show a sufficiently concrete and palpable injury to that he has “suffered an ‘injury in fact’SSan qualify as an Article III injury-in-fact. Fed. invasion of a legally protected interest which is Election Comm’n v. Atkins, 524 U.S. 11, 21 (a) concrete and particularized . . . and (b) (1998). Section § 1396r(e)(7)(C)(i)(I), actual or imminent not conjectural or however, entitles only those nursing care hypothetical.” Id. at 560. He also must residents satisfying the conditions of demonstrate a causal connection between his subparagraph B to the information Grant injury and defendants’ conduct, and a “likely” claims he has been denied.7 Grant has shown probability that his injury will be redressed by a favorable decision. Id. at 560-61. 5 Defendants do not dispute that Grant has a Grant has sufficiently alleged an injury-in- private right of action under § 1396r(e)(7)(C)(i)(I) fact under § 1396r(e)(7)(C)(i)(I), which of the NHRA. Therefore, we assume, without requires the state to inform residents no longer deciding, that Grant has stated a claim. Roscello in need of nursing facility services of the in- v. Southwest Airlines Co., 726 F.2d 217, 220 (5th Cir. 1984). At least two courts have determined that § 1396r(e)(7)(C) creates a private right of ac- 3 The district court did not address whether the tion. Rolland v. Romney, 318 F.3d 42, 51-56 (1st information (or lack thereof) given to Grant during Cir. 2003); Martin v. Voinovich, 840 F. Supp. his admittance to the nursing facility satisfied the 1175, 1197-1201 (S.D. Ohio 1993). requirements of § 1396n(c)(2)(C). 6 Change in Medicaid Nursing Facility Resident 4 After reviewing the pleadings and the remain- Review Requirements, Pub. L. No. 104-315, 110 der of the record, the district court found the CHO- Stat. 3824 (1996). 1 letters provided “adequate” information. Be- 7 cause, however, the entire case, including the See Selden, 422 U.S. at 500 (“The standing informational claims, was dismissed without pre- question in such cases is whether the constitutional judice, we do not construe the disposition of or statutory provision on which the claim rests Grant’s informational claims as a decision on the properly can be understood as granting persons in merits. (continued...) 4 that he was entitled to state-provided Grant raises a second informational injury information from 1991 to 1993. But because claim under § 1396n(c)(2)(C), contending that, he seeks only declaratory and injunctive relief, during his admittance to the nursing care he must “demonstrate either continuing harm facility in 1989, the state failed to provide him or a real and immediate threat of repeated in- sufficient information regarding alternative res- jury in the future.” Soc’y of Separationists, idential placements. A Medicaid waiver shall Inc. v. Herman, 959 F.2d 1283, 1285 (5th Cir. not be granted unless the States provides 1992) (citation omitted). His failure to allege assurances that that he currently meets the requirements of subparagraph B suggests that any abstract such individuals who are determined to informational injury as contemplated by Atkins be likely to require the level of care pro- is not continuous. vided in a hospital, nursing facility, or intermediate care facility for the Nevertheless, Grant alleges that the state’s mentally retarded are informed of the failure to provide adequate information from feasible alternatives, if available under 1991 to 1993 has inhibited him from making the waiver, at the choice of such an informed decision regarding whether to ap- individuals, to the provision of inpatient ply for waiver services. Indeed, an affidavit hospital services, nursing facility by a supervisor of state employees who make services, or services in an intermediate eligibility determinations confirms that Grant care facility for the mentally retarded. was eligible to apply for waiver services when he sued. Though his right to information al- 42 U.S.C. § 1396n(c)(2)(C). legedly was infringed by the state only from 1991 to 1993, the injury is accompanied by We agree with defendants that, at most, the “continuing, present adverse effects.” City of plain language of § 1396n(c)(2)(C) affords a Los Angeles v. Lyons, 461 U.S. 95, 102 right of information only for waiver applicants. (1983). To decide that Grant lacks In Wood v. Tompkins, 33 F.3d 600, 608 (6th informational standing would require others in Cir. 1994), the court noted that under his position to apply for services before § 1396n(c)(2), “states must provide the obtaining information, a result that, in his various enumerated assurances in order to words, puts the cart before the horse. obtain a home care waiver.” Id. (emphasis in original). In 1989, Grant was admitted to the nursing care facility; he has not alleged that he applied for waiver services then or at any time 7 before the pendency of this appeal. This (...continued) deprives him of standing. the plaintiff’s position a right to judicial relief.”). In other words, a claimed informational injury must “arguably [falls] within the zone of interests to be B. protected by the statute . . . in question.” Atkins, Grant also lacks standing to seek 524 U.S. at 20 (internal citations omitted). The declaratory and injunctive relief for a NHRA arguably is designed to provide people like determination of eligibility and state-provided Grant and their guardians sufficient information to waiver services. In his complaint, he appears make reasoned decisions about which alternative to assume that, because he did not exercise his form of care they should select. 5 choice in 1991, 1992, or 1993, he and the informational claim. Therefore, even if the other putative class members became ineligible Geraghty exception permits a reconsideration for the HCS-O waiver program. As we have of certification, Grant cannot seek relief for the said, he remained eligible to apply for waiver proposed class. services after 1993, an option he exercised fol- lowing the district court’s dismissal. Given In Geraghty, the representative plaintiff, a that he could have been admitted to a waiver federal prisoner, brought a proposed class ac- program at the time he sued, he did not suffer tion challenging parole guidelines. The district an injury redressable by a judicial de- court denied class certification, and Geraghty termination of eligibility or an injunction re- appealed that decision as class representative. quiring the state to provide him access to the While the appeal was pending, Geraghty was HCS-O program. Lujan, 504 U.S. at 563. released from prison, and defendants sought to dismiss the appeal as moot. The Court held III. that, despite the expiration of Geraghty’s Grant concedes that his move to a com- claim, the class’s claim remained live. munity-based waiver program renders his claims moot. We turn to whether he A plaintiff bringing a class action presents nevertheless maintains a case in controversy in two claims for reviewSSone on the merits and his right to represent the proposed class on the one that he is entitled to represent a class. § 1396r(e)(7)(C)(i)(I) claim, the only cause of Geraghty, 445 U.S. at 402. In Zeidman, we action as to which he originally had standing. explained that Geraghty established that “the As a general rule, “a purported class action be- mootness doctrine has two aspects: a comes moot when the personal claims of all justiciable case must continue at each stage of named plaintiffs are satisfied and no class has the litigation (1) to present a ‘live been properly certified.” Zeidman v. J. Ray controversy,’ and (2) to be urged before the McDermott & Co., 651 F.2d 1030, 1045 (5th court by parties who have a ‘personal stake’ in Cir. Unit A July 1981). If this rule applies, that controversy.” Zeidman, 651 F.2d at Grant’s motion for class certification, which 1042. Despite the mootness of the the district court denied after it partially erred representative plaintiff’s claims in Geraghty in determining that he lacked standing, is moot and Zeidman, both reviewing courts found that in light of the expiration of his informational a live controversy existed for at least some claim. class members. The Geraghty Court observed this was demonstrated by the fact that other Grant argues that Geraghty establishes a prisoners affected by the guidelines had moved bright-line exception that permits a named to substitute, or intervene, as class plaintiff whose claims have expired to continue representatives. 445 U.S. at 396. In Zeidman, litigating class certification issues if the denial 651 F.2d at 1042, we observed that the of his certification motion was presented while controversy was “undoubtedly still live,” his claims were still live. Assuming arguendo because the proposed classes “contain at least that Grant reads Geraghty correctly, we some number of persons who sold B&W conclude that, at the time he presented his securities during the periods at issue.” motion for class certification, Grant had standing only as to his § 1396r(e)(7)(C)(i)(I) Though no parties have sought to intervene 6 or substitute in Grant’s place, we assume a live ongoing interest in certification creates an controversy still exists. The proposed class Article III controversy. Id. at 403 (citations definition refers to all nursing home residents omitted). It goes without saying that before who, inter alia, “because of Defendants’ seeking certification, representative plaintiffs failure to provide them or their legally still must establish standing.9 authorized representatives with a clear explanation about available community-based Given that Grant had standing to bring only Medicaid waiver placements, remain confined the § 1396r(e)(7)(C)(i)(I) informational claim, in nursing facilities.” Grant’s counsel, a legal he lacks a personal stake in certifying the pro- service agency, assures us that it represents posed class. That proposed class seeks a de- other clients, with a continuing live interest in claration of eligibility for waiver services and the case, who can represent the class if injunctive relief forcing the state to provide necessary. Reed v. Heckler, 756 F.2d 779, services, so Grant, as a party who never had 786 n.9 (10th Cir. 1985). This is not a case in standing, cannot be said to be “self-interested” which the entire class’s claims are mooted or capable of presenting the claims as “sharply because of the defendant’s general policy presented issues.”10 change. See Singleton v. Apfel, 231 F.3d 853, 854-55 (11th Cir. 2000); Sze v. Immigration & It may be that the majority of class Naturalization Serv., 153 F.3d 1005, 1009- members, like Grant, have never applied for 1010 (9th Cir. 1998). In fact, defendants con- tend the information provided in the CHO-1 9 letter is adequate. See Lewis v. Casey, 518 U.S. 343, 357 (1996) (stating that “even named plaintiffs who represent a class must allege and show that they personally Whether, in light of our finding that Grant have been injured, not that the injury has been suf- had standing to bring only one of his proposed fered by other, unidentified members of the class to claims, he possesses a “personal stake” in cer- which they belong and which they purport to tifying the class is a different matter. The represent” (internal quotation marks omitted)); Ri- Geraghty Court relied on the “flexible vera v. Wyeth-Ayerst Labs., 283 F.3d 315, 319 character of the Art. III mootness doctrine” (5th Cir. 2002) (stating that standing is an and the pragmatic justifications underlying the “inherent prerequisite to the class certification class action device to find that the inquiry”). representative plaintiff maintained a personal 10 stake in certifying the class. 445 U.S. at 400- Grant’s situation is analogous to that of a 03.8 So long as there “are sharply presented plaintiff who never seeks class certification but ar- issues in a concrete factual setting and self- gues his right to represent others following the interested parties vigorously advocating mooting of his claim. In Sannon v. United States, 631 F.2d 1247, 1251 (5th Cir. 1980), we found opposing positions,” the representative’s Geraghty inapplicable to such a situation, because the plaintiff “never moved the court for class cer- tification and thus never solidified the requisite 8 Consistent with this view is Sosna v. Iowa, Article III adverseness between members of the 319 U.S. 393, 402 (1975), holding that a named would be class” and the defendants. Similarly, plaintiff whose claim on the merits expires after Grant’s failure to establish standing as to his non-§ class certification may still adequately represent the 1396r(e)(7)(C)(i)(I) claims means he cannot class. proceed with certification. 7 waiver services and consequently lack standing to bring the additional claims. If so, and class members still wish to proceed with a § 1396r- (e)(7)(C)(i)(I) informational claim, a class rep- resentative not currently receiving waiver services must file a new complaint. A plaintiff who never had standing to pursue the full claims of the class lacks a personal stake in litigating certification; therefore, the class claims are moot.11 The appeal is DISMISSED as moot. 11 This is not a case in which the relation back doctrine favors Grant’s proceeding as class representative. That doctrine is applied to inherently transitory claims, Gerstein v. Pugh, 420 U.S. 103 (1975), and cases in which defendants tender plaintiffs their personal claims, Zeidman, 651 F.2d at 1048. In both, the plaintiff’s claim is prematurely mooted, thus justifying his continuance as class representative. Grant contends that defendants will “have the option of providing information necessary for new plaintiffs to make an informed choice, thereby preventing this issue from ever reaching the certification stage.” This point ignores the fact that Grant’s own actions, not the state’s, mooted his claim, and overlooks the ability of future class representatives to invoke Geraghty should they have standing as to all claims for which they seek certification. 8