Case: A.R. v. Dudek

0:12-cv-60640 | U.S. District Court for the Southern District of Florida

Filed Date: March 13, 2012

Case Ongoing

Clearinghouse coding complete

Case Summary

On March 13, 2012, plaintiffs—medically fragile children or children who need skilled care services—filed a lawsuit in the U.S. District Court for the Southern District of Florida against Florida's Agency for Health Care Administration and Department of Health. After consolidating two similar cases in Spring 2012, plaintiffs' amended complaint sought relief under the ADA, Section 504 of the Rehabilitation Act, and the Medicaid Act, on behalf of two subclasses: children who live at home but are …

On March 13, 2012, plaintiffs—medically fragile children or children who need skilled care services—filed a lawsuit in the U.S. District Court for the Southern District of Florida against Florida's Agency for Health Care Administration and Department of Health. After consolidating two similar cases in Spring 2012, plaintiffs' amended complaint sought relief under the ADA, Section 504 of the Rehabilitation Act, and the Medicaid Act, on behalf of two subclasses: children who live at home but are at risk of future institutionalization, and children placed in geriatric nursing facilities. The plaintiffs also named eQHealth, the organization contracted to serve Florida's Medicaid utilization review entity, as a defendant. The plaintiffs were represented by private counsel, the FSU College of Law Public Interest Law Center, and the North Florida Center For Equal Justice. They sought to compel the state to provide services that would allow them to live in their homes and communities, to cease the practice of denying or reducing plaintiffs' services at recertification where there has been no change in the medical necessity of such services, and to award compensatory services to remedy conditions that had resulted from past failures to provide medically necessary services.

The defendants filed a motion to dismiss on June 1, 2012. The Florida state agency defendants claimed that they had provided services in accordance with state and federal Medicaid requirements and that they had not enacted a policy that favored institutionalization.

The United States sent a Statement of Interest to the Court on June 28, 2012, urging the Court to deny defendants' motion to dismiss. Specifically, the United States stated that plaintiffs had adequately identified a state policy that placed them at risk of unnecessary institutionalization in violation of the ADA, stated a valid claim that defendants violated the "reasonable promptness" provision and EPSDT provisions of the Medicaid Act by unreasonably applying their definition of medical necessity, and alleged a clear violation of PASRR requirements of the Nursing Home Reform Act.

On July 17, Judge William Zloch denied the motion to dismiss in a short order, saying that the issues would be better addressed in a motion for summary judgment.

On September 4, 2012, the U.S. Department of Justice, Civil Rights Division (DOJ) sent a Findings Letter to the attorney general of Florida stating that, based on the DOJ investigation of the state system with respect to six large nursing facilities that housed the majority of children with medically complex or fragile conditions, the State had failed to meet its obligations under Title VII of the ADA and 28 CFR Part 35 by unnecessarily institutionalizing hundreds of children in nursing facilities and by placing many others at risk of such placement.

For instance, although some community-based services were available through the Medicaid State Plan, the State had acted irrationally and placed several restrictions on the availability of these services. The DOJ noted that these children could live at home with their families or in other more integrated community settings if adequate services and support was provided. Specifically, the DOJ recommended that the State increase community capacity by allotting additional waiver slots, amend existing policies, including policies that may lead to inappropriate denial of medically necessary services, and expand other community services to serve children in or at risk of entering nursing facilities. The DOJ also recommended that the State develop and implement an active transition plan to ensure that services and support are available to serve the children. This transition plan should include individuals knowledgeable about community living options, rather than rely on the staff of nursing facilities for such arrangements.

A few weeks later, the Florida Agency for Health Care Administration, the Florida Department of Health, and the Florida Department of Children and Families responded to the Findings Letter. They noted that, upon receiving the Findings Letter, they conducted their own multiagency investigation and found the assertions in the DOJ's letter to be unfounded. They stated their interest in working collaboratively with the DOJ but noted that they required certain documents from the DOJ before they could start working on any issues.

On February 21, 2013, the defendants moved to dismiss the case for lack of subject matter jurisdiction due to mootness because they claimed that they had voluntarily implemented policy changes to the specific rules, practices, and regulations challenged by the plaintiffs. The Court (Judge Ron S. Rosenbaum) denied the motion on August 6, 2013.

On September 25, 2013, Judge Rosenbaum denied without prejudice the plaintiffs' motion for class certification. At issue was whether the plaintiffs were really challenging the state's systematic practice of institutionalizing at-risk children (which would be appropriate for a class action) or whether the plaintiffs were, as defendants contended, just challenging individualized executions of the state's policy (which would be less amenable to class certification). The judge determined that the record was not sufficiently developed to show what kind of case this was. The plaintiffs could move to recertify after they completed more discovery.

On December 6, 2013, Judge Rosenbaum granted the plaintiffs' motion to consolidate their case with one that the Department of Justice had brought against the state for unnecessarily segregating and institutionalizing children with disabilities in violation of the ADA.

On December 19, 2013, the plaintiffs renewed their motion to certify the class. The defendants opposed and renewed their own motion to dismiss the claims for lack of subject matter jurisdiction.

Shortly thereafter, the case was reassigned to Judge William J. Zloch, who referred the parties to mediation on June 17, 2014. On September 9, 2014, Judge Zloch denied the plaintiffs' motion for class certification without prejudice with leave to refile following the Court's ruling on the defendants' renewed motion to dismiss. The defendant's motion was eventually denied on December 29, 2014.

On January 30, 2015, the plaintiffs settled with the defendant eQHealth, the Louisiana non-profit organization that contracted frequently with Florida. The plaintiffs asked that the court retain jurisdiction over eQHealth pending fulfillment of the settlement agreement, but the terms of the settlement were not stipulated.

In April 2015, the plaintiffs renewed their motion for class certification. The defendants, in turn, moved for judgment on the pleadings. On April 17, 2015, the final mediation report was handed into the court. The remaining parties were apparently unable to settle.

On August 7, 2015 the court on the recommendation of the magistrate judge denied the plaintiff's motion for class certification. 2015 WL 11143082. The court found the class was not clearly defined and certification unnecessary.

On September 1, 2015, the court adopted a report and recommendation submitted by Judge Patrick M. Hunt, which suggested to the court to grant in part and deny in part the defendants' motion for judgment on the pleadings. 2015 WL 11143083. At stake was a portion of the plaintiffs' request for an injunction forcing "compensatory services" to make the plaintiffs whole after they were consistently denied medically necessary services. The defendants argued that compensatory damages are only available for plaintiffs for suits arising from the Individuals with Disabilities Education Act (IDEA). The court agreed, judging in favor of the defendants on the request for the injunction seeking compensatory services. However, Judge Hunt noted that the plaintiffs request under the Early and Periodic Screening Diagnostic and Treatment Services (EPSDT provisions) would necessarily require the defendants to provide services to "correct or ameliorate defects and physical and mental illnesses and conditions discovered" by the screenings performed by the defendants.

On February 29, 2016, the court again adopted a report and recommendation by Judge Hunt, which this time recommended denial of the class certification requested by the plaintiffs. 2016 WL 3753705 The reason for the denial was twofold. First, the class was denied was because the definition of the class was overly broad. The plaintiffs sought to certify a class under the following parameters: "All current and future Medicaid recipients in Florida under the age of 21, who are (1) institutionalized in nursing facilities, or (2) medically complex or fragile and at risk of institutionalization in nursing facilities." Judge Hunt noted that this definition included all children who could be institutionalized, as opposed to those who would be unnecessarily institutionalized. Thus, the definition was found to be too broad. Second, the class was found to be unnecessary. The plaintiffs tried to argue that the class was necessary due to the fact that three plaintiffs from the original suit had already passed away, and in order to prevent their case from becoming moot, they needed a class. The court decided that the probability of the case becoming moot was so low that certifying the class would be unnecessary.

On March 21, 2016, the defendants filed a motion for summary judgment, but in September 2016, it was denied as moot.

On June 1, 2016, the defendants moved to dismiss several of the plaintiffs' claims due to their deaths and lack of subsequent parties representing the decedents interests. On June 27, 2016, the court granted the motion to dismiss four of the plaintiffs. Also on June 27, 2016, the court granted the motion to dismiss plaintiff A.R.'s claims as moot per the recommendations of the Magistrate Judge. This matter was reconsidered due to the plaintiffs filing an untimely objection, but this reconsideration was denied on June 30, 2016 with the dismissal of plaintiff A.R. being reaffirmed.

On September 20, 2016, the court dismissed the United States of America as plaintiffs. 209 F. Supp.3 d 1279. The court found that the Attorney General could not file a suit under the plain language of Title II of the ADA.

On January 19, 2017, the court dismissed plaintiff A.G.'s claims for mootness due to him aging out of the Medicaid program. The plaintiffs had previously sought class certification to prevent this issue. Plaintiff A.G. turned 21 years old and as a result became ineligible for the Florida medicaid program, and his claim was ruled moot as a result.

On June 9, 2017, the court granted the defendant's motion to dismiss the three remaining plaintiffs, citing the recommendation of the magistrate judge. The defendants had argued that the plaintiff's claims should be dismissed due to the previously offending policies being changed or removed, rendering the claim moot. The magistrate judge found that while usually a change in policy such as this would not render a claim moot, when it is a government policy being changed there is more consideration given. The magistrate judge determined that the offending policies had been unambiguously terminated, made in good faith with substantial deliberation, and consistently applied. As a result, the remaining plaintiffs claims were moot.

Six plaintiffs appealed this dismissal to the 11th Circuit. On May 16, 2019, the court affirmed the district court's ruling.

The United States also appealed their dismissal to the 11th circuit. On September 17, 2019, the court reversed the District Court's dismissal of the plaintiff and remanded it for further proceedings. The court ruled that the Attorney General could sue under Title II of the ADA as Congress had approved enforcement by any means authorized by law.

This case is ongoing as of November 20, 2019.

Summary Authors

Alice Liu (9/28/2012)

Andrew Junker (10/29/2014)

Megan Brown (10/31/2016)

Carter Powers Beggs (11/20/2019)

Related Cases

United States of America v. State of Florida, Southern District of Florida (2013)



Boggs, Danny Julian (Kentucky)

Hunt, Patrick M (Florida)

Jordan, Adalberto Jose (Florida)

McAliley, Chris M. (Florida)

Rosenbaum, Robin Stacie (Florida)

Zloch, William J. (Florida)

Attorneys(s) for Plaintiff

Annino, Paolo G (Florida)

Chandler, Thomas E. (District of Columbia)

Dietz, Matthew Wilson (Florida)

England, Travis W (District of Columbia)


Boggs, Danny Julian (Kentucky)

Hunt, Patrick M (Florida)

Jordan, Adalberto Jose (Florida)

McAliley, Chris M. (Florida)

Rosenbaum, Robin Stacie (Florida)

Zloch, William J. (Florida)

Attorneys(s) for Plaintiff

Annino, Paolo G (Florida)

Chandler, Thomas E. (District of Columbia)

Dietz, Matthew Wilson (Florida)

England, Travis W (District of Columbia)

Esposito, Beth A (District of Columbia)

Ferrer, Wilfredo A (Florida)

Friel, Gregory (District of Columbia)

Grunewald, Kathy Newman (Florida)

Harrell-James, Veronica Vanessa (Florida)

Ito, Jamie (Florida)

Perez, Thomas E. (District of Columbia)

Raish, Anne Skeels (New York)

Welan, Joy Levin (District of Columbia)

Zaborske, Jill B (Florida)

Attorneys(s) for Defendant

Austin, Michael Garrett (Florida)

Kilinski, Caryl (Florida)

Long, Brittany Adams (Florida)

Lukis, Ashley Hoffman (Florida)

Mawhinney, Allison Goodson (Florida)

Meros, George N Jr. (Florida)

Raleigh, Lisa M. (Florida)

Reynolds, Jay Patrick (Florida)

Romanello, Nicholas William (Florida)

Scoles, Lisa (Florida)

Scott, Angela (District of Columbia)

Sheeran, Andrew T (Florida)

Smith, Beverly H (Florida)

Street, Leslei Gayle (Florida)

Thomas, Harry O. (Florida)

Williams, Stuart Fraser (Florida)

Other Attorney(s)

Robin-­Vergeer, Bonnie I. (District of Columbia)


Barkoff, Alison (District of Columbia)

Foran, Sheila (District of Columbia)

Hill, Eve L. (District of Columbia)

Parker, Marion Drew (Florida)

Tschetter, Jennifer Ann (Florida)

Documents in the Clearinghouse




A. R. v. Dudek

May 16, 2019

May 16, 2019




A.R. v. Sec. Health Care Admin

U. S. Court of Appeals for the Eleventh Circuit

Nov. 20, 2019

Nov. 20, 2019



Statement of Interest of the United States

June 28, 2012

June 28, 2012

Pleading / Motion / Brief


Order Denying Motion to Dismiss

T.H. v. Dudek

July 17, 2012

July 17, 2012




Aug. 15, 2012

Aug. 15, 2012


Re: United States' Investigation of the State of Florida's Service System for Children with Disabilities Who Have Medically Complex Conditions, D.J. No. 204-18-212

No Court

Sept. 4, 2012

Sept. 4, 2012

Findings Letter/Report

Re: D.J. No. 204-18-212 (Response to 9/4/2012 Findings Letter)

No Court

Sept. 28, 2012

Sept. 28, 2012

Findings Letter/Report


Order [Denying Defendants' Motion to Dismiss]

T.H. v. Dudek

Aug. 6, 2013

Aug. 6, 2013



Order [Denying Motion to Certify Class]

T.H. v. Dudek

Sept. 25, 2013

Sept. 25, 2013



Order [Granting Plaintiffs' Motion for Consolidation of Related Cases]

T.H. v. Dudek

Dec. 6, 2013

Dec. 6, 2013




Last updated June 4, 2022, 3:10 a.m.

Docket sheet not available via the Clearinghouse.

Case Details

State / Territory: Florida

Case Type(s):

Public Benefits/Government Services

Special Collection(s):

Olmstead Cases

Post-WalMart decisions on class certification

Key Dates

Filing Date: March 13, 2012

Case Ongoing: Yes


Plaintiff Description:

Initial: Medically fragile children or children who need skilled care services. Subclasses: Institutionalized children in nursing facilities; at-risk children at home, but as risk of institutionalization. Consolidated Plaintiffs: United State of America

Plaintiff Type(s):

Private Plaintiff

Attorney Organizations:

U.S. Dept. of Justice Civil Rights Division

Public Interest Lawyer: Yes

Filed Pro Se: No

Class Action Sought: Yes

Class Action Outcome: Denied


eQHealth Solutions, None

Florida Department of Health, State

Agency for Health Care Administration (Tallahassee), State

Defendant Type(s):

Hospital/Health Department


Case Details

Causes of Action:

42 U.S.C. § 1983

Americans with Disabilities Act (ADA), 42 U.S.C. §§ 12111 et seq.

Section 504 (Rehabilitation Act), 29 U.S.C. § 701

Medicaid, 42 U.S.C §1396 (Title XIX of the Social Security Act)

Availably Documents:

Trial Court Docket

Complaint (any)

Any published opinion


Prevailing Party: Mixed

Nature of Relief:

None yet

Source of Relief:

None yet



Access to public accommodations - governmental

Classification / placement


Family reunification

Government Services

Habilitation (training/treatment)

Individualized planning


Pattern or Practice

Placement in mental health facilities

Public benefits (includes, e.g., in-state tuition, govt. jobs)

Reasonable Accommodations

Reasonable Modifications

Reassessment and care planning

Relative caretakers

Staff (number, training, qualifications, wages)


Disability (inc. reasonable accommodations)

Affected Gender:




Integrated setting

Least restrictive environment

Mental impairment

Mobility impairment

Mental Disability:

Brain injury

Cerebral palsy

Intellectual/developmental disability, unspecified

Medical/Mental Health:

Intellectual/Developmental Disability

Medical care, general

Type of Facility:


Benefit Source: