United States District Court, S.D. Indiana, Indianapolis Division
KAREN D. VAUGHN, Plaintiff,
JOHN J. WERNERT, M.D. in his official capacity as Secretary of the Indiana Family and Social Services Administration, YONDA SNYDER in her official capacity as Director of the Division of Aging of the Indiana Family and Social Services Administration, JOSEPH MOSER in his official capacity as Director of the Office of the Medicaid Planning and Policy of the Indiana Family and Social Services Administration, Defendants.
JANE MAGNUS-STINSON, CHIEF JUDGE UNITED STATES DISTRICT
American Vice President once spoke about the treatment of
certain members of American society as a reflection of its
government: “the ultimate moral test of a government is
the way it treats three groups of its citizens. First, those
who are in the dawn of life-our children. Second, those in
the shadows of life-our needy, our sick, our handicapped.
Third, those in the twilight of life-our elderly.” Vice
President Hubert Humphrey, remarks at the dedication of the
Hubert H. Humphrey Building, November 1, 1977, Congressional
Record, November 4, 1977, vol. 123, p. 37287.
Order on summary judgment in this case, the Court concluded
that Defendants have failed that moral test, and that their
actions violated the Americans with Disabilities Act, the
Rehabilitation Act, and the Medicaid Act. Karen Vaughn has
been institutionalized for nearly three years, and she
remains institutionalized. The Court sought briefing from the
parties and conducted a hearing as to the issuance of
injunctive relief. Briefing was completed on January 8, 2019.
Having considered the evidence adduced at the hearing and the
briefs of the parties, the Court concludes that a permanent
injunction is appropriate and GRANTS Ms.
Vaughn's request for a permanent injunction.
Vaughn has lived with quadriplegia since 1976. [Filing No.
36-2 at 27.] Between 1981 and 2016, Ms. Vaughn lived in her
own apartment, where she received Medicaid-funded services
from home healthcare providers to assist in nearly all of her
activities of daily living. [Filing No. 36-2 at 9.] After a
several-week hospitalization from pneumonia in January 2016,
Ms. Vaughn was medically approved for discharge home. [Filing
No. 36-2 at 20.] Despite efforts by several individuals
working within the parameters imposed by the state Medicaid
plan and its waiver programs, no home healthcare agencies
were located that were willing and able to provide Ms.
Vaughn's home-based care. [See, e.g., Filing No.
62-1 at 12-27; Filing No. 36-1.] As a result, Ms. Vaughn
remained at Methodist Hospital, despite her medical
providers' agreement that she would be better served by
receiving care at home. [See, e.g., Filing No. 36-2
at 20; Filing No. 62-1 at 25-26.] Over the following months,
Ms. Vaughn's treating physicians at Methodist continued
to support her return home, and a licensed clinical social
worker and a nurse case manager attempted to locate an agency
or agencies that would provide Ms. Vaughn's care under
the regime established by Defendants. [Filing No. 62-1 at
several months of failed attempts to locate a provider, on
April 12, 2016, Ms. Vaughn sent a letter to Indiana's
Family and Social Services Administration
(“FSSA”) stating that she was being
institutionalized at Methodist against her will. [Filing No.
36-2 at 114.] In that letter, she requested that FSSA provide
her with one or more reasonable accommodations pursuant to
the Americans with Disabilities Act that would, in her view,
enable her to receive care at home. [Filing No. 36-2 at 114.]
Ms. Vaughn received no response to that letter. [Filing No.
36-2 at 45; Filing No. 118 at 89.] On July 26, 2016, FSSA
Division of Aging staff met with Ms. Vaughn, hospital staff
and doctors, Ms. Vaughn's advocates, and her legal
counsel to discuss a care plan that included finding a home
healthcare provider for Ms. Vaughn. [Filing No. 36-1 at 2.]
But again, within the bounds of the current Medicaid
programs, as administered by FSSA, no healthcare providers
were found. [Filing No. 36-2 at 60.]
having found no home healthcare provider, in mid-November
2016, Ms. Vaughn was discharged to North Capitol nursing
home. [Filing No. 36-2 at 60.] She filed a Complaint in this
Court on November 30, 2016 alleging violations of the
Americans with Disabilities Act, the Rehabilitation Act, and
the Medicaid Act arising from Defendants' alleged failure
to provide her with reasonable accommodations that would
allow her to return home. [Filing No. 1.] Ms. Vaughn resided
at North Capitol through February 2017, when she was
hospitalized at Methodist after developing a decubitus ulcer
that required surgery. [Filing No. 36-2 at 23-24.] After that
surgery, Ms. Vaughn was again medically cleared for discharge
home, but again, no home healthcare providers were found.
[Filing No. 36-2 at 25; Filing No. 36-1 at 3-4.] In December
2017, Ms. Vaughn was discharged to Ambassador Healthcare
nursing home in Centerville, Indiana, where she still resides
today. [Filing No. 36-2 at 23; Filing No. 47-1 at 1; Filing
No. 118 at 84-85.]
early 2018, the parties filed cross-motions for summary
judgment on Ms. Vaughn's claims. [Filing No. 36; Filing
No. 47.] The Court granted Ms. Vaughn's Motion for
Summary Judgment, concluding that Defendants failed to
provide a reasonable accommodation that would allow for Ms.
Vaughn's placement at home, in violation of the ADA and
the Rehabilitation Act. [Filing No. 68 at 27.] The Court also
concluded that Defendants violated the Medicaid Act's
requirement that medical assistance be provided with
reasonable promptness to all eligible individuals. [Filing
No. 68 at 31.]
made this finding as to liability, the Court converted the
trial in this matter to a remedy hearing, and it encouraged
the parties to reach an agreement as to the injunctive relief
that should be implemented. [Filing No. 68 at 32-33.] The
parties were unable to do so, and the Court held a remedy
hearing on December 3, 2018. [Filing No. 114.] The parties
presented evidence and legal argument, and they have
submitted their post-hearing briefing, as ordered by the
Court. The issue of remedy is now ripe for the Court's
Propriety of Injunctive Relief
determining whether injunctive relief is appropriate, a Court
generally considers “(1) whether the plaintiff has
suffered or will suffer irreparable injury, (2) whether there
are inadequate remedies available at law to compensate for
the injury, (3) the balance of hardships, and (4) the public
interest.” Sierra Club v. Franklin Cty. Power of
Illinois, LLC, 546 F.3d 918, 935 (7th Cir. 2008). Ms.
Vaughn seeks only injunctive relief through this lawsuit, and
the parties in their cross-motions for summary judgment
addressed the issue of the propriety of injunctive relief
alongside (and largely overlapping with) their arguments
regarding liability. [Filing No. 55 at 22; Filing No. 61 at
14-15.] As such, the Court's discussion of liability, and
its decision on the merits at summary judgment
“essentially embraced the remedy and the injunctive
relief factors” that a Court routinely considers.
Sierra Club, 546 F.3d at 937. The parties,
therefore, have focused their attention (in both their
briefing and at the remedy hearing) on the substance of the
response to Ms. Vaughn's post-hearing briefing, however,
Defendants argue that Ms. Vaughn has failed to “meet
her burden of proof” as to the propriety of injunctive
relief by failing to present argument as to the four
injunctive relief factors. [Filing No. 120 at 7.] Defendants
argue, therefore, that the Court “must deny her request
for injunctive relief.” [Filing No. 120 at 7.] The
Court disagrees, and in the interest of clarity and
completeness, the Court details its findings regarding the
propriety of injunctive relief.
Court concludes, based on the undisputed evidence, that Ms.
Vaughn has suffered and would continue to suffer irreparable
injury as the result of continued institutionalization. Ms.
Vaughn has presented undisputed medical testimony as to the
dangers that institutionalization poses to her health, and
she has already suffered demonstrable physical harm. In
addition to the increased risk of nosocomial infections she
faces, she is also prone to developing decubitus ulcers
(bedsores) while institutionalized. As highlighted in the
Court's summary judgment Order, while Ms. Vaughn had not
developed a bedsore in the twenty years preceding her January
2016 hospitalization, since her institutionalization, she has
undergone several surgeries as the result of recurrent
decubitus ulcers. Moreover, Ms. Vaughn has experienced the
adverse mental and emotional consequences associated with the
institutional segregation and isolation that the ADA
prohibits. See Olmstead v. L.C. ex rel.
Zimring, 527 U.S. 581 (1999). This factor weighs heavily
in favor of injunctive relief.
Adequate Remedies at Law
contend that Ms. Vaughn has not argued that she lacks an
adequate remedy at law. But Ms. Vaughn has made clear
throughout the course of this lawsuit that the only relief
she seeks is to receive care at home. Defendants have not
identified, and the Court is unaware of, any remedy at law
that could accomplish that result. There is no remedy at law
to compensate Ms. Vaughn for her injuries, and this element
weighs heavily in favor of injunctive relief.