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Judge: FSSA must allow quadriplegic to receive home care

June 4, 2018

An elderly quadriplegic who has been confined to a hospital or nursing home since February 2016 could soon return home after a district judge ruled the Indiana Family and Social Services Administration violated her rights by failing to provide her with home-based care.

Indiana Southern District Chief Judge Jane Magnus-Stinson denied summary judgment to the defendants in Karen D. Vaughn v. John J. Wernert, M.D., et al., 1:16-cv-03257, which include a group of three FSSA employees. Karen Vaughn sued FSSA for failing to provide her with home-based services beginning in February 2016, when she was cleared to be released from the hospital after a bout of pneumonia. Before her hospitalization, Vaughn received home-based care — including assistance with basic activities such as bathing and eating — pursuant to Indiana’s Medicaid program, enabling her to live at home and continue her social life.

Vaughn’s medical team and FSSA contacted roughly 40 agencies, but none would agree to provide the care Vaughn requested because Indiana’s Medicaid plan would not provide sufficient reimbursement. To remedy that issue, Vaughn requested that FSSA allow her to receive some treatment from nonskilled medical workers, a request her doctors said would be reasonable because “(a)ny lay person could be taught how to safely provide for Ms. Vaughn’s care.” 

FSSA however, maintained that the Medicaid Policy Manual required the skilled professionals provide the type of home-based services Vaughn required. Because of that requirement and because FSSA could not find anyone to provide those services, the organization maintained that Vaughn could no longer receive home-based care.

Thus, Vaughn was subsequently housed in nursing facilities and has not yet been permitted to return home. She sued the FSSA defendants, alleging violations of the Americans with Disabilities Act, the Rehabilitation Act and the Medicaid Act caused by her exclusion from FSSA services and its failure to provide her with those services in a reasonably prompt manner. Both parties filed cross-motions for summary judgment, but Magnus-Stinson ruled in Vaughn’s favor under each of the federal laws.

Turning first to the ADA and Rehabilitation Act, Magnus-Stinson said Vaughn’s request for home-based treatment is appropriate given her doctors’ opinions and testimony in favor of allowing her to return home. That request is also reasonable under Steimel v. Wernert, 823 F.3d 902 (7th Cir. 2016),  because FSSA’s reasons for denying her request were a matter of policy under the Medicaid Policy Manual, not state law or statute.

The chief judge pointed to inconsistencies in how the manual classifies the need for skilled versus non-skilled care. Some care was listed under both categories, she said, while other types of care were listed as non-skilled in one part of the manual and skilled in another.

“The Court simply cannot make heads or tails of these designations, and Defendants have offered no explanation whatsoever as to the basis for their categorizations in the first place, or the inconsistencies among them in the second,” Magnus-Stinson wrote in an order issued Friday. “… As Steimel explained, Defendants ‘cannot avoid the integration mandate by binding (their) hands in (their) own red tape.”

Further, the FSSA defendants failed to prove how Vaughn’s request would constitute a “fundamental alteration” of a state program, Magnus-Stinson wrote, especially considering that Vaughn received home-based services prior to her hospitalization. All of those factors meant the denial of Vaughn’s request for home care was a violation of her rights under the ADA and Rehabilitation Act.

Similarly, the chief judge found FSSA violated her rights under the Medicaid Act by using its manual-based policies to deny her reasonably prompt care.

“As the Court described at length above, Defendants’ own administrative choices – namely, the restrictions they have imposed on Ms. Vaughn’s home healthcare provision pursuant to their Medicaid Policy Manual – have resulted in their inability to find a caregiver, or combination of caregivers, who can provide Ms. Vaughn’s care in a home-based setting,” Magnus-Stinson wrote. “It may be the case that other factors, such as the nursing shortage or inadequate reimbursement rates, contribute to or exacerbate the difficulty in finding a provider. But, at a minimum, Ms. Vaughn has established that Defendants’ administrative choices, in addition to their denials of her reasonable accommodation requests, have resulted in her remaining institutionalized.”

Thus, Magnus-Stinson converted the scheduled July 30 bench trial to a remedy hearing and ordered the parties to meet with Magistrate Judge Doris L. Pryor before that date to find the appropriate remedy to enabled Vaughn to return home. If a remedy cannot be reached before the hearing, then both parties must provide briefing on the appropriate injunctive relief.

 

 

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