Filed Date: Dec. 3, 2018
Case Ongoing
Clearinghouse coding complete
This case is about accessibility of health care information for blind individuals. On December 3, 2018, two blind individuals—along with the National Federation of the Blind (NFB) and Disability Rights North Carolina (DRNC)—filed this lawsuit against the University of North Carolina Health Care System (UNC Health) and Nash Hospitals, Inc. (Nash) in the U.S. District Court for the Middle District of North Carolina. Represented by private counsel and lawyers from Disability Rights North Carolina, the plaintiffs alleged that UNC Health and Nash were denying blind individuals equal opportunity to access their health care information in violation of the Americans with Disabilities Act Title II (against UNC Health) and Title III (against Nash), Section 504 of the Rehabilitation Act (against both), and Section 1557 of the Patient Protection and Affordable Care Act (against both). Specifically, the plaintiffs alleged that UNC Health and Nash provided information critical to the health of their patients in standard print only, without a statutorily required accessible alternative. The plaintiffs sought a declaratory judgment, injunctive relief, compensatory damages, and attorneys’ fees. The case was assigned to Magistrate Judge L. Patrick Auld and Chief District Judge Thomas D. Schroeder.
Title II of the Americans with Disabilities Act (ADA) bans discrimination against people with disabilities by public entities, while Title III bans disability-based discrimination by places of public accommodation. Section 504 of the Rehabilitation Act bans disability-based discrimination in federally funded programs. Section 1557 of the Patient Protection and Affordable Care Act (ACA) similarly prohibits disability-based discrimination in federally funded health programs.
The plaintiffs amended their complaint on January 24, 2019 to correct the name of Nash Hospitals, Inc. (from “Nash Health Care Systems”).
On February 7, 2019, UNC Health moved to dismiss each of the plaintiffs’ claims, arguing that there was no subject matter jurisdiction because the plaintiffs lacked standing to sue, and that the plaintiffs failed to state a claim. Nash filed its own motion to dismiss on March 28, 2019, arguing that there was no subject matter jurisdiction because the plaintiffs lacked standing and because the claims were moot, and that the plaintiffs failed to state a claim.
Magistrate Judge Auld issued a report and recommendation on both motions on September 13, 2019, finding that all the plaintiffs had standing and alleged facts sufficient to pursue their claims against UNC Health. However, he recommended dismissing the ADA Title III claim against Nash, as well as all claims against Nash by NFB and DRNC, for lack of associational standing. 2019 WL 4393531.
UNC Health argued that it lacked control of—and therefore lacked responsibility for—Nash's actions; that it did not violate any clearly established statutory right of the plaintiffs; that the statutes in question did not require UNC Health to “fundamentally alter the nature of its services programs or make additional modification sought by the plaintiffs"; that the plaintiffs did not allege disability-based discrimination , suffer any current injury, or state a claim for prospective relief; and that plaintiffs NFB and DRNC did not state a claim for nonparties. Magistrate Judge Auld either disagreed with each of these arguments or found that they were not appropriate for decision on a motion to dismiss.
In regard to Nash, the plaintiffs conceded that one of the individual plaintiffs had not stated a claim against the hospital. As to the other individual plaintiff's claim, Magistrate Judge Auld concluded that, while that plaintiff could pursue a claim against Nash based on an injury in fact, Title III of the ADA did not allow for compensatory damages, only injunctive relief. He further found that this plaintiff failed to establish a likelihood of return to Nash in the future, and so injunctive relief was unavailable, which meant that the plaintiff's Title III claim against Nash should be dismissed. This plaintiff did possess standing to pursue compensatory damages against Nash under the Rehabilitation Act and the ACA. Based on the standing analysis, Magistrate Judge Auld also rejected Nash's argument that this plaintiff's claims were moot. Nash had also argued that the plaintiffs failed to state ACA claims because the statute did not require it to provide Braille documents; Magistrate Judge Auld concluded that this was technically true but that the ACA did require some accessible format, which—according to the complaint—Nash failed to provide.
Magistrate Judge Auld also recommended that the court dismiss NFB and DRNC’s claims against Nash. These two plaintiffs were not seeking compensatory damages against Nash under the Rehabilitation Act or the ACA. Since Magistrate Judge Auld had concluded that the Title III claim against Nash should be dismissed, and because NFB and DRNC were not seeking damages under the other statutes, Magistrate Judge Auld concluded that they lacked associational standing with respect to claims against Nash.
On September 27, 2019 and October 3, 2019 respectively, the plaintiffs and defendants objected to Judge Auld’s recommendation. On March 5 of the following year, Chief Judge Schroeder overruled the objections and adopted Magistrate Judge Auld’s recommendation. UNC Health had argued that the ADA claim against it should be dismissed because it was based on the same operative facts as the claim against Nash, but Judge Schroeder pointed out that different forms of relief are available under Titles II and III of the ADA. 2020 WL 1062421.
On June 16, 2020, UNC Health motioned for judgment on the pleadings, arguing that a United States Supreme Court decision in an analogous case, issued after Magistrate Judge Auld’s ruling on the motion to dismiss, made clear that the magistrate judge applied the wrong causation standard in his discrimination analysis. UNC Health also moved to stay its discovery obligations pending resolution of the motion. Nash similarly filed a motion for judgment on the pleadings and stay of discovery on June 30, 2020. Two months later, August 27, Magistrate Judge Auld recommended denying the motion to stay discovery because there was not sufficient basis to resolve the motions for judgment on the pleadings before discovery proceeded.
On February 4 of the following year, Magistrate Judge Auld also recommended denying UNC Health’s motion for judgment on the pleadings. Magistrate Judge Auld concluded that the Supreme Court case UNC Health cited as dispositive of the previous motion was about § 1981 of the Civil Rights Act of 1866, which was designed with different goals in mind than the ADA or the Rehabilitation Act. He also rejected arguments that UNC Health had previously raised about a Fourth Circuit decision about causation. 2021 WL 395547.
The parties did not object to this report and recommendation, and the court adopted it on March 31, 2021 and denied UNC Health's motion. 2021 WL 3196437.
Nash’s motion for judgment on the pleadings was mooted when, on November 30, 2020, the plaintiffs moved to dismiss their claims against the hospital after reaching a settlement agreement. Nash agreed to pay $150,000 to one of the individual plaintiffs—a combination of damages and attorneys’ fees—and to forgive his medical debts. In exchange, the NFB and DRNC agreed not to sue Nash again for not providing accessible documents in the past. On December 1, 2020, the court dismissed all claims against Nash.
The plaintiffs and UNC Health each filed motions for summary judgment on March 30, 2021 and March 31, 2021, respectively. On January 14 of the following year, Magistrate Judge Auld recommended granting summary judgment to the plaintiffs on some claims, and denying summary judgment to either side on others. The magistrate judge recommended granting summary judgement to the plaintiffs as to many of the documents because the record established that the defendants had violated the relevant statutes. It also held that the settlement with Nash did not deprive one of the plaintiffs of standing to sue UNC Health, though the money that Nash paid might be deducted from money that UNC Health would eventually have to pay. 2022 WL 138644.
Magistrate Judge Auld recommended denying summary judgment for either party as to the plaintiffs' claims for monetary damages because winning damages would require showing intentional discrimination, which requires deliberate indifference by a defendant. The magistrate judge concluded that there was a genuine dispute as to whether UNC Health had exhibited deliberate indifference. Further, as to one of the individual plaintiffs, the magistrate judge recommended denying summary judgment concerning documents sent during a particular time period because the parties disputed whether MyChart, an online health portal, was sufficiently accessible and whether the plaintiff had properly communicated with UNC Health about the accessibility issue.
Magistrate Judge Auld also concluded that though NFB and DRNC lacked organizational standing, they did both have associational standing, and this standing was not just limited to the individual plaintiffs' claims, as the organizations had argued they also had associational standing based on an additional member who had been allegedly discriminated against. The magistrate judge also recommended that the court not grant injunctive relief to the plaintiffs at this point because a trial could better establish the current state of UNC Health's compliance with accessibility law, and because it was unclear whether the plaintiffs' requested relief was based on incorrect legal standards that exceeded the actual requirements UNC Health had to meet.
UNC Health filed objections to the report and recommendation on January 28, 2022. A couple weeks later, on February 8, the parties engaged in a settlement conference with Magistrate Judge Auld which resulted in a partial settlement agreement. In the agreement, UNC Health admitted to violating the ADA and agreed to pay $125,000 in damages. One individual plaintiff agreed to dismiss his claims, but the other—and the two organizations—agreed to dismiss their claims for damages but not those for injunctive relief. UNC Health also agreed that one of the plaintiffs did not owe it any medical debt. Finally, UNC Health agreed that they had to pay attorneys' fees under the ADA for the claims that had been settled. Because of the settlement, the court did not rule on the motions for summary judgment.
However, on March 11, 2022, the parties sent a joint letter to the court informing it of a dispute that had arisen in formally executing the agreement. The issue was that UNC Health had inserted language regarding Medicare liens, which UNC Health’s insurer insisted on after the settlement agreement in order to comply with their understanding of the Medicare Secondary Payer Act. On March 22, 2022, the plaintiffs filed a motion to enforce the settlement agreement as it was agreed upon on February 8, 2022. UNC Health argued that the new terms they wanted to add would not prejudice the plaintiffs and were necessary for compliance with federal laws.
Magistrate Judge Auld issued a report and recommendation on May 6, 2022, concluding that UNC Health’s added language was a material term that would prejudice the plaintiffs and was not necessary to comply with the Medicare Secondary Payer Act. Therefore, he recommended that the court grant the plaintiffs' motion to enforce the agreement. 2022 WL 1444406. The parties did not object, and Judge Schroeder granted the motion on May 23, 2022.
With the damages portion of the lawsuit resolved, the remaining individual plaintiff, along with NFB and DRNC, moved for a permanent injunction on August 12, 2022. The plaintiffs sought a number of improvements to UNC Health's accessibility procedures, as well as reporting requirements. On June 22, 2023, Judge Schroeder granted the motion in part and denied it in part. The court held that the plaintiffs had won on their ADA claims because UNC Health had admitted to violating the ADA as part of the settlement. It also found that the plaintiffs demonstrated ongoing irreparable harm because UNC Health was still not properly meeting accessibility requirements. Therefore, the court issued an injunction requiring UNC Health to provide accessible documents to the individual plaintiff and the person whose interests NFB and DRNC were representing. However, the court denied the plaintiffs' request for a broader systemic injunction because it held that the plaintiffs had established individualized rather than systemic harms caused by UNC Health, and that UNC Health had made positive systemic changes already. It also concluded that NFB and DRNC's requested relief was limited to the harm caused to their members, and therefore they were not entitled to broad relief either. The court also held that some of the plaintiffs' requested relief involved accommodations that went beyond what the law required. The court's injunction was set to last three years. 2023 WL 4144277.
On August 4, 2023, the plaintiffs moved for attorneys' fees. As of September 24, 2023, that motion was still pending.
Summary Authors
Terry Howard (12/21/2022)
Micah Pollens-Dempsey (9/24/2023)
For PACER's information on parties and their attorneys, see: https://www.courtlistener.com/docket/8439484/parties/bone-v-university-of-north-carolina-health-care-system/
CRAWFORD, CHELSEA J. (North Carolina)
GRAFSTEIN, LISA (North Carolina)
BROUGHTON, ROBERT T. (North Carolina)
DAUGHERTY, MELISSA T. (North Carolina)
DONGRE, MILIND KUMAR (North Carolina)
Schroeder, Thomas D. (North Carolina)
See docket on RECAP: https://www.courtlistener.com/docket/8439484/bone-v-university-of-north-carolina-health-care-system/
Last updated Feb. 19, 2024, 3:10 a.m.
State / Territory: North Carolina
Case Type(s):
Key Dates
Filing Date: Dec. 3, 2018
Case Ongoing: Yes
Plaintiffs
Plaintiff Description:
Two blind individuals from North Carolina, The National Federation of the Blind, and Disability Rights North Carolina
Plaintiff Type(s):
Non-profit NON-religious organization
Public Interest Lawyer: Yes
Filed Pro Se: No
Class Action Sought: No
Class Action Outcome: Not sought
Defendants
The University of North Carolina Health Care System (Chapel Hill, Orange), Non-profit or advocacy
Nash Hospitals, Inc. (Rocky Mount, Nash), Non-profit or advocacy
Defendant Type(s):
Case Details
Causes of Action:
Americans with Disabilities Act (ADA), 42 U.S.C. §§ 12111 et seq.
Section 504 (Rehabilitation Act), 29 U.S.C. § 701
Available Documents:
Injunctive (or Injunctive-like) Relief
Outcome
Prevailing Party: Plaintiff
Nature of Relief:
Injunction / Injunctive-like Settlement
Source of Relief:
Form of Settlement:
Amount Defendant Pays: $150,000 and $125,000 respectively
Order Duration: 2023 - 2026
Content of Injunction:
Issues
Disability and Disability Rights:
Screen readers and similar accessibility devices
Discrimination-basis:
Disability (inc. reasonable accommodations)
Medical/Mental Health:
Type of Facility: