COLSON ON BEHALF OF COLSON v. Sillman

852 F. Supp. 1183, 1992 U.S. Dist. LEXIS 22174, 1992 WL 509928
CourtDistrict Court, W.D. New York
DecidedDecember 9, 1992
Docket85-CV-1815A
StatusPublished
Cited by5 cases

This text of 852 F. Supp. 1183 (COLSON ON BEHALF OF COLSON v. Sillman) is published on Counsel Stack Legal Research, covering District Court, W.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
COLSON ON BEHALF OF COLSON v. Sillman, 852 F. Supp. 1183, 1992 U.S. Dist. LEXIS 22174, 1992 WL 509928 (W.D.N.Y. 1992).

Opinion

DECISION AND ORDER

ARCARA, District Judge.

INTRODUCTION

Plaintiffs brought this action seeking declaratory, injunctive and monetary relief against defendants for alleged procedural and substantive deficiencies in the administration of the Erie County Physically Handicapped Childrens’ Program (“PHCP”). The alleged deficiencies concern defendants’ failure to provide program applicants with timely written notice of the outcome of their application and the lack of an administrative appeal procedure, which allegedly violate plaintiffs’ due process rights under the Fifth and Fourteenth Amendments to the United States Constitution. Jurisdiction is conferred on this Court by 28 U.S.C. §§ 1343(a)(3) and (4) and 42 U.S.C. § 1983.

Plaintiffs moved for summary judgment pursuant to Fed.R.Civ.P. 56. The Court ordered the parties to brief the issue of whether applicants for a government benefits program have an “entitlement” implicating due process rights under the United States Constitution. After reviewing the papers and hearing oral argument from counsel, the Court grants plaintiffs partial summary judgment for the reasons stated herein.

BACKGROUND

This lawsuit arises out of the manner in which Erie County and New York State manage the PHCP. The PHCP is a program, operated by the Erie County Department of Health pursuant to N.Y.Pub.Health Law § 2582 (McKinney, Supp.1992), which provides medical services for children who suffer from physical disabilities. In order to qualify for aid under the PHCP, specific criteria must be satisfied as to age, family income, diagnosis and exhaustion of other potential sources of payment. Additionally, the requested services must be medically necessary.

Once the PHCP determines that a child is eligible for coverage under the program, a request for specific services and medical equipment can be filed. Accompanying the request can be supporting documents from, among others, the child’s physician or therapist. The Medical Director of the PHCP then decides whether to grant or deny the request based in part on whether the child’s diagnosis and requested medical treatment are listed by the New York State Department of Health (“DOH”) as eligible services. Where the requested medical services are not listed or there is ambiguity concerning *1185 the appropriateness of the requested relief, the County Medical Director can seek the assistance of the DOH in determining whether to grant the request. 1 The County Medical Director may decide to deny PHCP funding if he or she believes, in his or her professional opinion, that the medical treatment sought will not assist the rehabilitative progress of the child. In the present case, all parties agree that plaintiffs met all of the threshold requirements for PHCP funding at the inception of the lawsuit. 2

Laura Colson

Plaintiff Laura Colson alleges that she suffers from cerebral palsy and a severe degenerative disease of the brain, which has resulted in profound mental retardation. 3 Colson’s condition has rendered her completely disabled and totally dependent upon her mother as she has no “use of her legs, arms or hands. She cannot talk. She can barely hold her head up.” Item No. 33, ¶ 5. She often has grand mal seizures in which she becomes uncontrollable. Colson’s medical condition requires frequent visits to doctors and to the Center for the Handicapped in Cheektowaga, New York for physical, occupational and language therapy. “On many occasions she has experienced grand mal seizures while being transported in her mother’s automobile. Such uncontrollable and unrestrained violent thrashing about while laying down in the back seat of her mother’s automobile is extremely dangerous.” Item No. 35, p. 4.

In May 1985, Dowd Service and Sales submitted an application on Colson’s behalf requesting that the PHCP provide Laura with a Britax Car Seat with Stroller Base because her condition precluded her from safely traveling in automobiles equipped with conventional car seats. “Accompanying this request was information about the car seat and stroller base, including price, and a letter signed by a physician and physical therapist, explaining Laura’s need for these items.” Item No. 5, ¶ 24. The Britax car seat, when attached to the stroller base, also acts as a stroller that would make transporting Laura more practicable since she is too heavy to be carried by her mother.

The PHCP denied Colson’s request for the car seat in August 1985. Colson’s mother contacted Eugene Sillman, Medical Director of Erie County and requested a written confirmation of the denial of the request. Sill-man refused to provide written confirmation. Mrs. Colson then contacted State Senator William Stachowski. Senator Stachowski wrote to Sillman on Colson’s behalf, and Sill-man responded with a letter in which he acknowledged that the PHCP had denied Colson’s request. The letter stated that Col-son may appeal the matter by requesting “a Fair Hearing through the usual New York State process.” Item No. 35, p. 5.

In October 1985, Colson’s lawyer, James Sheldon, wrote to Sillman seeking a clarification of the status of the request for a car *1186 seat. He requested a written confirmation of the denial of the request, an explanation of the reasons for the denial and a statement setting forth the availability of any appeal procedure. Sillman advised Sheldon that any concerns should be addressed to Alan Gerstman, Assistant Erie County Attorney. Sheldon wrote to Gerstman on November 7, 1985 requesting a hearing or other review. Gerstman responded by stating that there was no available administrative appeal and that the sole avenue of appeal would be through an Article 78 proceeding to the New York State Supreme Court pursuant to New York’s Civil Practice Law and Rules. During a telephone conversation in November 1985, Gerstman told Sheldon that no final decision had been made on Colson’s request for the car seat. Finally, in a letter of November 12, 1985, Sillman stated that the request was denied because the car seat was not medical equipment 4 and was therefore ineligible for funding by PHCP. 5 Id. at 5-7.

Valerie White

Plaintiff Valerie White is wheelchair bound because of spastic cerebral palsy. PHCP paid for an electrically powered stairglide in the front of her home thereby allowing her access to and from her home. 6 White asserts that she subsequently requested that a protective cover be provided for the stairglide so that it could be used in inclement weather, and for funds so that certain repairs could be made to the stairglide. Without use of the stairglide, White was unable to attend school or receive medical care outside her home.

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852 F. Supp. 1183, 1992 U.S. Dist. LEXIS 22174, 1992 WL 509928, Counsel Stack Legal Research, https://law.counselstack.com/opinion/colson-on-behalf-of-colson-v-sillman-nywd-1992.