United States District Court, S.D. Indiana, Indianapolis Division
ORDER ON PENDING MOTIONS
SARAH EVANS BARKER,
This cause is before the Court on Defendant Xerox Corporation’s Motion for Summary Judgment [Docket No. 138], filed on January 6, 2015 pursuant to Federal Rule of Civil Procedure 56(a), and Plaintiff’s Motion for Clarification [Docket No. 125], filed on October 30, 2014. For the reasons set forth below, Defendant’s motion for summary judgment is granted, and Plaintiff’s motion for clarification is denied as moot.
Factual and Procedural Background
Plaintiff, who is proceeding pro se, has not complied with the Court’s Local Rules by filing a statement of disputed material facts in response to this motion for summary judgment. See S.D. Ind. L.R. 56-1(b). While accordingly we must consider as undisputed all uncontroverted facts for which Defendant has provided evidentiary support, we shall nonetheless endeavor to construct an account of the facts as favorable to Plaintiff as possible using the available evidence.
The essence of Plaintiff’s complaint is that Defendant Xerox Corporation, which she claims plays a central role in administering Indiana’s Medicaid program, harmed her by giving her access to delayed and inadequate medical care in the aftermath of a leg injury.
Xerox’s involvement in Indiana Medicaid stems from the efforts of then-governor Mitch Daniels, beginning more than a decade ago, to privatize and streamline the administration of the state’s social services programs. On December 27, 2006, the state signed a “Master Services Agreement” with a coalition of private contractors headed by International Business Machines Corporation (IBM), setting forth a framework under which the contractors would process program applications and determine claimant eligibility through a remote, centralized system, obviating the need for in-person meetings with case workers. ACS Human Services, LLC (“ACS”) was a subcontractor to the IBM coalition and a party to the agreement; Xerox subsequently acquired ACS and has assumed its role. The rollout of this “remote eligibility” system was plagued with difficulties that were exacerbated by the 2008 recession, and in 2009 Governor Daniels announced that some of the planned reforms would be curtailed. However, private entities, including Xerox, continued to perform contract work on behalf of the state’s Family and Social Services Administration (FSSA)-including work in connection with Indiana’s Medicaid program-through the period giving rise to Plaintiff’s claims. See generally Pl.’s Ex. A, Indiana v. Int’l Business Machines Corp., Cause No. 49D10-1005-PL-021451, at 1– 36 (Ind. Super. Ct., Marion Cnty. July 18, 2012); Def.’s Br. 3 at ¶ 1 & n.1.
Xerox’s role in the administration of Medicaid has not been an all-encompassing one. Pursuant to its contract with the state, Xerox’s “Indiana Eligibility Project” processes Medicaid applications from Indiana residents and performs various customer service and training functions. According to the uncontroverted affidavit of Indiana Eligibility Project vice president Andrew Hunkin, Xerox does not administer, process, or otherwise manage the provision of medical services to Indiana Medicaid beneficiaries, nor does the company assign doctors or other health care providers to Indiana Medicaid beneficiaries. Def.’s Ex. A (Hunkin Aff.) at ¶ 6. Rather, once Xerox has performed an eligibility determination, responsibility for a patient’s care passes to a managed care organization (MCO), such as Anthem or MDWise, which then assists beneficiaries in managing their health care and selecting their health care providers. Id. at ¶ 7. Beneficiaries either choose an MCO on their own, or receive an MCO assignment from the state’s enrollment broker-Xerox, however, has no role in that process. Once a Medicaid beneficiary is assigned to an MCO and receiving treatment from a care provider, Xerox has no role in the authorization of payment or the payment of invoices for care provided. Id. at ¶¶ 13– 14.
In October 2010, Plaintiff Pauli Coffey suffered an injury to her right leg that she has consistently described as a “crushed” or “shattered” femur. On October 20, 2010, she applied for Medicaid, and was subsequently approved as a Medicaid beneficiary with coverage retroactive to October 1, 2010. Def.’s Ex. B at 1–5; Def.’s Ex. I (Dec. 9, 2014 Coffey Dep.) at 82. MDWise was assigned as Plaintiff’s MCO. It sent her a letter, dated January 20, 2011, informing her that it was her “Hoosier Healthwise health plan” and providing her with the name and contact information of her assigned primary care physician. Def.’s Ex. C. Shortly after her injury and her Medicaid application-and before she received her primary care physician assignment-Plaintiff visited several emergency rooms in the Indianapolis area seeking treatment for the pain caused by her leg injury. According to Plaintiff, she made these visits on the advice of MDWise’s 24-hour on-call nurse. Def.’s Ex. H (Nov. 18, 2014 Coffey Dep.) at 35, 40; Dec. 9 2014 Coffey Dep. at 84. Plaintiff received some emergent care, such as taping and braces for her leg and prescriptions for pain medication, during these emergency room visits, and she also underwent what she considered to be an unsafe number of X-ray scans. As Plaintiff has acknowledged, Medicaid paid for these emergency room visits. Dec. 9, 2014 Coffey Dep. at 106–107. Even after receiving her primary care physician assignment from MDWise, Plaintiff never contacted her assigned physician or received treatment from her.
Unsatisfied with the options made available to her by her MCO, Plaintiff sought out an orthopedic surgeon, Dr. Carlos Berrios, without referral. Dr. Berrios agreed to perform an outpatient arthroscopy on her right knee, and he did so on February 1, 2011. Id. at 86, 103; Def.’s Ex. J (Ireland Report) at 2–3. After pain developed in her left knee, Dr. Berrios performed another arthroscopy on that knee on April 28, 2011. Id. at 2; Def’s Ex. K (Berrios visit notes 4/14/2011). Medicaid paid for the first surgery, but Plaintiff maintains that she was not reimbursed for the second. Dec. 9, 2014 Coffey Dep. at 106–107. Two years later, Dr. Berrios performed another arthroscopy of Plaintiff’s left knee. Ireland Report at 3.
In August 2011, the FSSA Division of Family Resources notified Plaintiff that her Medicaid benefits would be terminated because of her failure to provide the necessary pay stubs. Def.’s Ex. B at 9. Plaintiff initially indicated that she wanted to appeal this termination, but she withdrew her appeal on October 26, 2011. Id. at 20. As of September 30, 2011, her benefits were terminated. Id. at 14.
Plaintiff filed a notice of tort claim with the State of Indiana on September 15, 2011, listing a loss date of February 1, 2011. Docket No. 1, Ex. B. She subsequently filed suit under 42 U.S.C. § 1983 against the State of Indiana. See Coffey v. State of Indiana et al, Case No. 1:13-cv-00117-JMS-TAB (S.D. Ind. 2013). Judge Magnus-Stinson of our Court dismissed her claim on the grounds that a state and its agencies are not “persons” susceptible to suit under Section 1983. Plaintiff then filed this suit against Xerox Corporation on January 16, 2013. See Docket No. 1. We dismissed her initial complaint without prejudice, concluding that Plaintiff had failed to satisfy the pleading requirements imposed by Federal Rule of Civil Procedure 8(a). See Docket No. 87. Plaintiff filed her Amended Complaint [Docket No. 88] on March 14, 2014, and Defendant moved for summary judgment on January 6, 2015.
Standard of Review
Federal Rule of Civil Procedure 56 provides that summary judgment should be granted when the record evidence shows that “there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed. R. Civ. Pro. 56(a); Celotex Corp. v. Catrett, 477 U.S. 317, 322–323 (1986). The purpose of summary judgment is to “pierce the pleadings and to assess the proof in order to see whether there is a genuine need for trial.” Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986). Disputes concerning material facts are genuine where the evidence is such that a reasonable jury could return a verdict for the non-moving party. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). In deciding whether genuine issues of material fact exist, the court construes all facts in a light most favorable to the non-moving party and draws all reasonable inferences in favor of the non-moving party. See Id. at 255. However, neither the “mere existence of some alleged factual dispute between the parties, ” id., 477 U.S. at 247, nor the existence of “some metaphysical doubt as to the material facts, ” Matsushita, 475 U.S. at 586, will defeat a motion for summary judgment. Michas v. Health Cost Controls of Ill., Inc., 209 F.3d 687, 692 (7th Cir. 2000).
Here, the Defendant as the moving party Abear[s] the initial responsibility of informing the district court of the basis for [its] motion, ” and identifying those portions of the record that it believes demonstrate the absence of a genuine issue of material fact. Celotex, 477 U.S. at 323. Because Plaintiff, the non-moving party, will bear the burden of proof at trial, Defendant may discharge its burden at this stage of the proceedings by showing an absence of evidence to support Plaintiff’s case. Id. at 325.
Summary judgment is not a substitute for a trial on the merits, nor is it a vehicle for resolving factual disputes. Waldridge v. Am. Hoechst Corp., 24 F.3d 918, 920 (7th Cir. 1994). Therefore, after drawing all reasonable inferences from the facts in Plaintiff’s favor, if genuine doubts remain and a reasonable fact-finder could find for Plaintiff, summary judgment is inappropriate. See Shields Enters., Inc. v. First Chicago Corp., 975 F.2d 1290, 1294 (7th Cir. 1992). But if it is clear that Plaintiff will be unable to satisfy the legal requirements necessary to establish her case, summary judgment is not only appropriate, but mandated. Ziliak v. AstraZeneca LP, ...