Salazar v. Dc

CourtDistrict Court, District of Columbia
DecidedFebruary 18, 2010
DocketCivil Action No. 1993-0452
StatusPublished

This text of Salazar v. Dc (Salazar v. Dc) is published on Counsel Stack Legal Research, covering District Court, District of Columbia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Salazar v. Dc, (D.D.C. 2010).

Opinion

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

OSCAR SALAZAR, et al., : : Plaintiffs, : : v. : Civil Action No. 93-452 (GK) : DISTRICT OF COLUMBIA, et al., : : Defendants. :

MEMORANDUM OPINION

The District of Columbia has filed a Motion to Vacate the Court’s Order Granting Injunctive

Relief Dated October 18, 2004 (“Motion to Vacate the Dental Order”) [Dkt. No. 1153]. Upon

consideration of the Motion, Opposition, Reply, Surreply, Supplemental Brief, the many exhibits

submitted by the parties, and the long, tangled, and complex history of this important case which

focuses on the provision of medical services to poor children in the District of Columbia,

Defendants’ Motion is denied.

I. PROCEDURAL HISTORY

In 1993, Plaintiffs brought this far-reaching class action to provide and arrange for a range

of medical services, guaranteed under the federal Medicaid statute, 42 U.S.C. § 1396, et seq., to poor

children in the District of Columbia. During lengthy pre-trial proceedings before Judge Norma

Holloway Johnson, to whom the case was originally assigned, discovery was completed, and many

motions (both dispositive and non-dispositive) were decided. Thereafter the parties settled several

claims prior to trial with the help of a mediator appointed under the Court’s Alternative Dispute

Resolution Program. In July of 1994, the case was re-assigned to this Judge. After a seven-day trial in April of

1996, this Court issued a 56-page opinion finding Defendants to be in violation of several provisions

of the Medicaid statute. See Salazar v. District of Columbia, 954 F. Supp. 258, 334 (D.D.C. 1996).

By the time of trial, many of the issues pled in the original Complaint had been substantially

narrowed and the trial itself focused primarily on whether Defendants were complying with the

statute’s requirement to provide EPSDT services (“early and periodic, screening, diagnostic, and

treatment services”) to children entitled to them. Since that time, the parties have focused virtually

all their attention on the EPSDT issue.

The District of Columbia took an appeal from the decision. On the eve of oral argument in

the Court of Appeals, the parties entered into a detailed and complex agreement. A public hearing

was held. On January 25, 1999, after various proceedings, the Court approved and entered the

parties’ final settlement as an Order Modifying the Amended Remedial Order of May 6, 1997 and

Vacating the Order of March 27, 1997 (“the Settlement Order”) [Dkt. No. 663]. Since that date,

January 25, 1999, the Settlement Order, which contains several provisions relating to dental services

for class members, has been the governing document in this case.1

On April 23, 2004, Plaintiffs filed a Motion to Enforce the Settlement Order of January 25,

1999 and the Order of February 28, 2003, Concerning Dental Services [Dkt. No. 1010]. After full

briefing, on October 18, 2004, the Court granted the Motion in large part and issued its

Memorandum Opinion and Dental Order (“Dental Order of October 18, 2004” or “ Dental Order”)

[Dkt. No. 1034]. The District of Columbia took an appeal on December 4, 2004; however, on

1 Over the years, the parties have agreed upon a number of relatively minor and technical changes to the Settlement Order. Those changes have always been incorporated into the Settlement Order by Consent Orders.

-2- January 27, 2005, it requested the Court of Appeals to hold its appeal in abeyance as it “expect[s]

to file in the near future a motion [in the district court] to dissolve that injunction.” Motion to Hold

Appeal in Abeyance, Court of Appeals, District of Columbia Circuit, No. 04-7200. No such motion

was ever filed in this Court. On December 2, 2005, the District of Columbia withdrew its appeal of

the Dental Order.

On May 26, 2006, the District of Columbia filed the present Motion to Vacate the Dental

Order. Plaintiffs filed their Opposition on July 7, 2006, Defendants replied on September 12, 2006,

Plaintiffs filed a Sur-Reply on December 14, 2006 and a Supplemental Brief on April 4, 2008. Oral

argument was held on January 12, 2007.2

2 The Court is well aware that the District of Columbia has filed a Petition for Mandamus in the Court of Appeals because its Motion to Vacate has not been decided. That is certainly its procedural right, and the Court understands and sympathizes with its desire to resolve as soon as feasible the extent and scope of the Government’s obligation to provide dental care to class members.

However, in brief explanation of what has admittedly been a very lengthy delay, the Court must note that the underlying Dental Order, the enforcement issues relating to it, and the Motion to Vacate, have never been ignored. There have been extensive and frequent informal discussions with the parties, the Court’s Monitor Dr. Henry T. Ireys, and the Court, about resolution of the substantive issues, of the administrative difficulties in carrying out the provisions of the Dental Order, and of the profound technical problems concerning measurement of compliance with the Dental Order as well as with other provisions of the Settlement Order. Dr. Ireys has issued three reports regarding dental services in the District of Columbia. See June 17, 2003, Methods Used by the District of Columbia and the Managed Care Organizations to Inform Medicaid Recipients about Preventive Dental Services; January 27, 2006 Strategy to Achieve Implementation of Paragraph 2 of the Dental Order of October 18, 2004; and February 2008 Report on the District of Columbia’s EPSDT Program with a focus on dental services for children. On page 1 of the 2006 Report, Dr. Ireys noted that the “parties in this case agree that the majority of children in the District of Columbia’s EPSDT program are not receiving adequate dental care.” He also stated at page 1 that according to official reports which Defendants have filed with the federal Government (although the parties have always acknowledged that the accuracy of these official reports is questionable), “73 percent of the EPSDT- eligible children aged 3 to 20 years received no preventive dental care and 68 percent received no dental services at all” (emphasis added). (continued...)

-3- II. ANALYSIS

In its Motion to Vacate, the Defendants argue that the Dental Order is not supported by

evidence that the Settlement Order was violated or that the District of Columbia has failed to provide

and arrange for appropriate dental services when requested, and that the injunctive relief ordered is

not tailored to cure a Constitutional or statutory violation. In addition, the Defendants make the

curious argument that by mandating the provision of dental services which are required by the

Medicaid statute, the Dental Order is “imping[ing] upon the free will of the Medicaid recipient to

force dental care participation. The District cannot and should not be ordered to ensure that every

District child who may be eligible for EPSDT services actually receive these services.” Mot. to

Vacate, at 8.

A. There Is No Federal Rule of Civil Procedure Authorizing Defendants’ Motion at this Late Date, More than 19 Months after Entry of the Dental Order

Defendants have failed, in their opening Motion papers, to cite any authority whatsoever

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