Doxzon v. Dep't of Human Servs.

MIRANDA DOXZON, Plaintiff, v. DEPARTMENT OF HUMAN SERVICES OF THE COMMONWEALTH OF PENNSYLVANIA, et al., Defendants.

1:20-CV-00236

UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA

July 15, 2020

(Chief Magistrate Judge Schwab)

MEMORANDUM OPINION AND ORDER

I. Introduction.

Currently pending is the plaintiff Miranda Doxzon's motion for a preliminary injunction. For the reasons that follow, we will grant that motion.

II. Background and Procedural History.

Doxzon is 21 years old. Doc. 62 (Joint Statement) at ¶ 2. She has cerebral palsy, depression, and epilepsy, and she requires a motorized wheelchair for mobility. Id. at ¶¶ 3, 4. She also requires a Hoyer lift for transferring into and out of her wheelchair. Id. at ¶ 5. Doxzon needs assistance with activities of daily living, such as transferring to the toilet and shower and to her bed, meal preparation, cooking, dressing, cleaning, transportation, and doing laundry. Id. at ¶ 12. And due to her epilepsy, she occasionally has seizures requiring an aide to call 9-1-1 and place her on her side until help arrives. Id. at ¶ 13.

Doxzon is enrolled in Medical Assistance, which is also known as Medicaid. Id. at ¶ 6. She is enrolled in the Pennsylvania Department of Human Services' Community HealthChoices ("CHC") waiver program. Id. at ¶ 7. She was enrolled in the CHC waiver program on November 4, 2019. Id. at ¶ 8. DHS administers the CHC waiver program, which provides long-term, community-based supports and services for individuals who are at least 21 years old and have been determined to need the level of care offered in a nursing facility, but who wish to remain in the community. Id. at ¶¶ 9, 10. DHS is a recipient of federal financial assistance in connection with its CHC waiver program. Id. at ¶ 11.

From June 2018, until December 18, 2019, Doxzon was living in the community in an apartment and with services provided by Spectrum Community Services, Inc. Id. at ¶ 14. On December 18, 2019, Doxzon was taken to Inglis House, a skilled nursing care facility with capacity to house 252 adults who range in age from 20 to 90 and have an average age of 47. Id. at ¶¶ 15, 16.

Ms. Doxzon testified that she did not like living at Inglis House, and she told everyone that she wanted to live in the community. She was not, however, givenoptions that would allow her to live in the community. She became suicidal at Inglis House, and she was hospitalized several times. After one hospitalization, instead of returning to Inglis House, Doxzon moved into a friend's basement. Although her friend's house needed modifications to make it accessible to her and she needed services to support her living at her friend's house, those modifications and not all those supports were provided. See doc. 18-3 (Doxzon Decl.) at ¶¶ 26-28. This made it untenable for Doxzon to continue to live at her friend's house. Id. at ¶ 26; doc. 36-3 (Burell Decl.) at ¶ 18.

Ms. Doxzon was admitted to the hospital on June 29, 2020. Doc. 62 (Joint Statement) at ¶ 17. After Doxzon was admitted to the hospital, Doxzon's friend told her could she not return to her home. Id. at ¶ 18.

In this case, Doxzon brings claims under the Americans with Disabilities Act ("ADA"), the Rehabilitation Act ("RA"), and Title XIX of the Medicaid Act. The defendants are the Department of Human Services of the Commonwealth of Pennsylvania ("DHS"); Teresa D. Miller, the Secretary of DHS; and Kevin Hancock, the Deputy Secretary of DHS's Office of Long-Term Living. Defendant Miller is sued in her official capacity and her individual capacity, and defendant Hancock is sued in his individual capacity.

Doxzon alleges that the defendants failed to plan for her transition from the child welfare system to independent living, and as a result she was placed in anursing home. And, according to Doxzon, because the defendants failed to provide her with the services and supports to which she is entitled to under the CHC waiver, she is at serious risk of re-institutionalization.

On April 27, 2020, Doxzon filed a motion for a preliminary injunction and a brief in support of that motion. The parties subsequently consented to proceed before a magistrate judge pursuant to 28 U.S.C. § 636(c), and the case was referred to the undersigned.

During a conference with court and at the court's suggestion, the parties agreed to meet and confer about the proper placement for Doxzon. We treated the discussions between the parties and with the court as settlement discussions, and given those settlement discussions, we stayed further briefing on the motion for a preliminary injunction.¹

On June 30, 2020, we were informed that Doxzon was at the hospital and about to be released with nowhere to go. We had a conference call with the parties to try to work out that issue, but we were unable to do so. On July 1, 2020, Doxzon filed a motion for a temporary restraining order ("TRO") and a brief in support of that motion asserting that she was at imminent risk of re-institutionalization or homelessness because her friend would no longer allow herstay in her basement. Although the defendants received notice of the motion for a TRO, given the emergency nature of Doxzon's situation, there was not time for the defendants to brief the issues or for the court to hold a hearing. And after concluding that Doxzon met the requirements for a TRO, on July 1, 2020, at 8:43 p.m., we granted her motion and entered a TRO requiring the following:

1. By 5:00 p.m. July 2, 2020, Defendant DHS and Defendant Miller shall provide Plaintiff Miranda Doxzon with round-the-clock aide services in a safe, wheelchair accessible, community-based location acceptable to Ms. Doxzon in the Philadelphia area.

2. By 5:00 p.m. July 2, 2020, Defendants shall transport Ms. Doxzon to the location.

3. By 3:00 p.m. July 2, 2020, Defendants' counsel shall advise Ms. Doxzon's counsel as to the name and address of the location, the names of the personal assistants who will provide her with personal assistant services.

4. Under no circumstances shall Ms. Doxzon be sent to a congregate care setting, including a nursing facility, shelter or other facility or institution that has multiple people in a single bedroom.

5. In addition to the aides, Defendants shall ensure that all requested transportation and adequate food is available to Ms. Doxzon during this temporary placement.

Doc. 38 at 1-2. The TRO provides that it "shall expire 14 days after it is entered, unless before that time the Court, for good cause, extends the Order." Id. at 2. We also scheduled a telephone status conference with the parties for July 6, 2020, at9:00 a.m., and we ordered the defendants to respond to Doxzon's most recent settlement demand before then. Doc. 37 at 4.

The following day, July 2, 2020, we lifted the stay on briefing as to the motion for a preliminary injunction. Also on July 2, 2020, the defendants appealed the issuance of the TRO to the United States Court of Appeals for the Third Circuit. They also motioned us to stay the TRO. We scheduled a hearing (by videoconference) on that motion to stay for July 7, 2020.

During the telephone conference on July 6, 2020, we were informed that Doxzon had been moved to a hotel and the defendants were endeavoring to provide the services and supports to comply with the TRO. Later on July 6, 2020, the defendants withdrew their motion to stay the TRO, asserting that "Adult Protective Services ("APS") conducted an investigation and determined that Plaintiff met the criteria for need under 35 P.S. §§ 10210.302 and 10210.303," and "APS has since placed [Doxzon] in a hotel." Doc. 47 at ¶¶ 4, 5.

The parties finished briefing the motion for a preliminary injunction, and we held a hearing on the motion for a preliminary injunction on July 14, 2020. At that hearing, Doxzon testified as did Randolph Nolen, who is employed by DHS as a director in the Bureau of Coordinated and Integrated Services, Office of Long-Term Living. Based on the evidence presented and the briefs and arguments of the parties, we will grant Doxzon's motion for a preliminary injunction.

III. Preliminary Injunction Standards.

Federal Rule of Civil Procedure 65 governs temporary restraining orders and preliminary injunctions. The standard for deciding motions for temporary restraining orders and motions for preliminary injunctions are generally the same. "The difference is that a TRO may be issued with little or no notice and may dissolve on its own accord." Ameriprise Fin. Servs., Inc. v. Koenig, No. CIV.A. 11-6140-NLH, 2012 WL 379940, at *4 (D.N.J. Feb. 6, 2012); Fed.R.Civ.P. 65(b) (providing that the court may issue a temporary restraining order "without written or oral notice to the adverse party" if certain conditions are met). A motion for preliminary injunctive relief is judged against exacting legal standards.

Preliminary injunctive relief "is not granted as a matter of right." Kershner v. Mazurkiewicz, 670 F.2d 440, 443 (3d Cir. 1982). Rather, it "is an 'extraordinary remedy.'" Doe by & through Doe v. Boyertown Area Sch. Dist., 897 F.3d 518, 526 (3d Cir. 2018) (quoting Kos Pharm., Inc. v. Andrx Corp., 369 F.3d 700, 708 (3d Cir. 2004)). A motion for such is properly granted only if such relief is the "only way of protecting the plaintiff from harm." Instant Air Freight Co. v. C.F. Air Freight, Inc., 882 F.2d 797, 801 (3d Cir. 1989). "It has been well stated that upon an application for a preliminary injunction to doubt is to deny." Madison Square Garden Corp. v. Braddock, 90 F.2d 924, 927 (3d Cir. 1937).

"When evaluating a motion for preliminary injunctive relief, a court considers four factors: (1) has the moving party established a reasonable likelihood of success on the merits (which need not be more likely than not); (2) is the movant more likely than not to suffer irreparable harm in the absence of preliminary relief; (3) does the balance of equities tip in its favor; and (4) is an injunction in the public interest?" Fulton v. City...