The 7th Circuit Court of Appeals was presented with the question in an Indiana case of how much non-compliance of a consent decree involving Medicaid applications is needed before a District Court can impose civil contempt sanctions. The issue is before the 7th Circuit because plaintiffs believed Indiana's Medicaid program administrators violated a portion of a consent decree in the handling of applications for the disability program.

The case, LaMont G. Bailey, et al. v. E. Mitchell Roob, Jr., et al., No. 08-3592, has been before the U.S. District Court, Southern District of Indiana, off and on since 1994 when the plaintiffs and the program administrators agreed to certain terms for the handling of disability applications. Part of the agreement stated the program would compile a complete 12-month medical history before reaching a decision on the application, but it didn't define "complete." The plaintiffs claimed the program violated the decree by relying on summary forms rather than compiling an applicant's complete medical history; they filed a petition to hold the administrators in contempt in 2006.

The District Court determined that only nine of the 26 sample files introduced by administrators were less than complete than others presented and that five contained only a summary form 251A that physicians complete but no medical records. The District Court didn't find administrators in contempt because the plaintiffs didn't meet the burden for a civil contempt petition and invited them to re-file their motion with more information, but the plaintiffs instead appealed to the 7th Circuit.

The 7th Circuit ruled the District Court didn't commit a clear legal error by requiring the plaintiffs to demonstrate Indiana Medicaid's lack of reasonable diligence because the Circuit's caselaw requires the party seeking sanctions to demonstrate that the opposing party is in violation of a court order by clear and convincing evidence. Also, there must be evidence a party willfully refused to comply with a court order or wasn't "reasonably diligent" in carrying out the terms of the order, wrote Judge Joel M. Flaum.

On the issue how much non-compliance is needed to impose civil contempt sanctions, the 7th Circuit concluded the District Court didn't abuse its discretion by ruling the plaintiffs hadn't produced clear and convincing evidence of the state's violation of the court order. Due to the inconclusive nature by the parties as to what makes a "complete" medical history, the District Court couldn't make any factual findings about whether or not they were incompliance with the consent decree. In addition, the plaintiffs cited caselaw outside the civil contempt context by using cases seeking injunctive or equitable relief. Based on the lack of evidence, sanctions aren't warranted, Judge Flaum wrote.

Finally, on the issue of whether the District Court erred by not interpreting "complete medical history" as always requiring copies of a treating physician's records, Judge Flaum wrote, "Based on this record we are not prepared to hold categorically that an agency can never use a summary form when developing that record or that the absence of any document from a physician within the last twelve months, whatever its relevance, is a violation of the regulations."

The 7th Circuit's ruling doesn't foreclose all future claims on this issue from the plaintiffs, and the District Court did indicate it would be willing to hear future claims with a greater fact-finding on the meaning of "complete medical history," he wrote.