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Class Certified in FL Medicaid Challenge
Actions challenging uniform practices and seeking injunctive relief by
their nature deal with common issues of law and fact. Here, defendants
argue that plaintiff's due process challenge to Medicaid prescription drug
benefit denial procedures doesn't raise common issues because there are
many individual legal issues involved in each determination. At 671: "The
Court, however, agrees with Plaintiff that the nineteen legal issues and
ten additional separate defenses simply miss the point and do not negate
the overriding common issue of law and fact, namely, is the Defendant
violating the Medicaid Act and regulations, and the Due Process Clause, by
failing to ensure adequate notice and fair hearing rights on a uniform
basis as to all medicaid recipients who are denied prescription benefits?"
The court reaches the same conclusion with respect to typicality. See:
Hernandez v. Medows, 209 F.Supp.2d 665 (S.D.Fla. 2002).
their nature deal with common issues of law and fact. Here, defendants
argue that plaintiff's due process challenge to Medicaid prescription drug
benefit denial procedures doesn't raise common issues because there are
many individual legal issues involved in each determination. At 671: "The
Court, however, agrees with Plaintiff that the nineteen legal issues and
ten additional separate defenses simply miss the point and do not negate
the overriding common issue of law and fact, namely, is the Defendant
violating the Medicaid Act and regulations, and the Due Process Clause, by
failing to ensure adequate notice and fair hearing rights on a uniform
basis as to all medicaid recipients who are denied prescription benefits?"
The court reaches the same conclusion with respect to typicality. See:
Hernandez v. Medows, 209 F.Supp.2d 665 (S.D.Fla. 2002).
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Related legal case
Hernandez v. Medows
| Year | 2002 |
|---|---|
| Cite | 209 F.R.D. 665 (S.D.Fla. 2002) |
| Level | District Court |
| Attorney Fees | 0 |
| Damages | 0 |
| Injunction Status | N/A |
209 F.R.D. 665
United States District Court, S.D. Florida.
Anthony HERNANDEZ, David Burges, Donna Watson, Gwendolyn Smiley, Donna Grissom on behalf of themselves and all others similarly situated, and the Florida Transplant Coalition, Plaintiffs,
v.
Dr. Rhonda MEDOWS, in her official capacity as Secretary, Agency for Health Care Administration of the State Florida, Defendant.
No. 02-20964-CIV.
Aug. 26, 2002.
*666 Anne Lisa Swerlick, Tallahassee, FL, William Henry Fraser, West Palm Beach, FL, Miriam E. Harmatz, Miami, FL, Jane Perkins, Chapel Hill, NC, Lourdes Rivera, Los Angeles, CA, for plaintiffs.
Christa Elizabeth Calamas, Grant Patrick Dearborn, L. William Porter, II, Tallahassee, FL, for defendant.
ORDER ON MOTION FOR CLASS CERTIFICATION
GOLD, District Judge.
THIS MATTER is before the Court on Plaintiffs' motion for class certification pursuant to Fed.R.Civ.P. 23(b)(2) [D.E. # 6]. Plaintiffs seek to certify a class defined as:
All current and future Florida Medicaid recipients who have, or will have their prescription drug coverage denied, delayed, terminated, or reduced without adequate*667 notice and the opportunity for a fair hearing.
Following class discovery and the submission of memoranda, oral argument on class certification was held on July 26, 2002. After considering the matter, the Court concludes that Plaintiffs' motion for class certification under Fed.R.Civ.P. 23(b)(2) should be granted in part in favor of the individual named Plaintiffs but denied as to the Florida Transplant Survivors Coalition. The Court's reasons and analysis are set forth below.
A. CLASS CERTIFICATION STANDARD
The district court has broad discretion in determining whether to certify a class. Heaven v. Trust Co. Bank, 118 F.3d 735, 737 (11th Cir.1997). A class certification order, however, is not a final order and may be reviewed by the district judge "at any time" so that the district court may "redefine[ ] or more narrowly tailor[ ] classes or subclasses." Shin v. Cobb County Board of Education, 248 F.3d 1061, 1065 (11th Cir.2001).
To qualify as a class under Rule 23 of the Federal Rules of Civil Procedure, the Plaintiffs must initially satisfy the four thresholds requirements of Rule 23(a): (1) the class must be so numerous that joinder of all members is impracticable (numerosity); (2) questions of law or fact common to the class must exist (commonality); (3) the claims or defenses of the representative parties must be typical of the claims or defenses of the class (typicality); and (4) the representative parties must fairly and adequately protect the interests of the class (adequacy of representation). Plaintiffs seeking to represent the class bear the burden of establishing that all four requirements have been met. Kirkpatrick v. J.C. Bradford & Co., 827 F.2d 718; 721 n. 2 (11th Cir.1987), cert. denied, 485 U.S. 959, 108 S.Ct. 1221, 99 L.Ed.2d 421 (1988); Gilchrist v. Bolger, 733 F.2d 1551, 1555 (11th Cir.1984) (A class action may only be certified "if the Court is satisfied, after a rigorous analysis, that the prerequisites of Fed.R.Civ.P. 23(a) are met"). These prerequisites are mandatory and the failure to establish any one is fatal to a motion for class action certification.
In addition to meeting the four preliminary requirements in subdivision (a), the plaintiffs also must satisfy one of the subsections of Fed.R.Civ.P. 23(b) in order to certify a class. In the instant case, the Lead Plaintiffs seek class certification under Rule 23(b)(2). Rule 23(b)(2) applies where the parties "opposing the class ha[ve] acted or refused to act on grounds generally applicable to the class, thereby making appropriate final injunctive or corresponding declaratory relief with respect to the class as a whole." Fed.R.Civ.P. 23(b)(2). Rule 23(b)(2) was intended "primarily to facilitate civil rights class actions, where the class representatives typically sought broad injunctive or declaratory relief against discriminatory practices." Penson v. Terminal Transport Co., Inc., 634 F.2d 989, 993 (5th Cir.1981) (citing Advisory Committee Notes, 39 F.R.D. 98, 102 (1966)). FN1
FN1. All Fifth Circuit decisions prior to October 1, 1981 are binding precedent on the Eleventh Circuit. Bonner v. Prichard, 661 F.2d 1206, 1209 (11th Cir.1981).
Moreover, prior to a determination regarding whether a class should be certified pursuant to Fed.R.Civ.P. 23, a district court "must determine that at least one named class representative has Article III standing to raise each class claim. 'Any analysis of class certification must begin with the issue of standing.' " Prado-Steiman v. Bush, 221 F.3d 1266, 1279-80 (11th Cir.2000) (quoting Griffin v. Dugger, 823 F.2d 1476, 1482 (11th Cir.1987)).
B. STANDING
1. Individual Standing
It is well-established that "prior to the certification of a class, and technically speaking before undertaking any formal typicality or commonality review, the district court must determine that at least one named class representative has Article III standing to raise each class claim, '[a]ny analysis of class certification must begin with the issue of standing' " Prado-Steiman, 221 F.3d at 1279-80 (quoting Griffin v. Dugger, 823 F.2d 1476, 1482 (11th Cir.1987)). It is only " 'after the court determines the issues for which the named plaintiffs have standing [that] it *668 should address the question whether the named plaintiffs have representative capacity, as defined by Rule 23(a), to assert the rights of others.' " Id.
The burden is on the Plaintiffs to clearly "allege facts demonstrating that he is a proper party with standing to invoke judicial resolution of a dispute." Anderson v. City of Alpharetta, 770 F.2d 1575, 1582 (11th Cir.1985). "It is not the role of the court to speculate concerning the existence of standing nor to piece together support for the plaintiff." Id.
The Court concludes that each named Plaintiff is a Florida Medicaid recipient whose prescription drug coverage is or will be denied, delayed, terminated, or reduced without notice and the opportunity for a fair hearing. As such, each named Plaintiff has standing to seek the subject declaratory action and injunctive relief. In seeking such relief, Plaintiffs are not challenging the Defendant's authority to implement drug utilization reviews. Nor are they challenging the four brand limit or the preferred drug list. Additionally, they are not challenging the Defendant's authority to deny coverage for a specific prescription drug that requires authorization if a request has not been appropriately filed and approved. Plaintiffs are only challenging the Defendant's purported failure to provide them with adequate and timely notice and fair hearing opportunities when Medicaid denies prescription drug coverage.
2. Associational Standing
An organization may have standing to sue on its own behalf if it satisfies that same standing test that applies to individuals. ACORN v. Fowler, 178 F.3d 350, 356 (5th Cir.1999) (citing Havens Realty Corp. v. Coleman, 455 U.S. 363, 378-79, 102 S.Ct. 1114, 71 L.Ed.2d 214 (1982)). This standing standard, requires that the it has (1) suffered an injury in fact that is "concrete and particularized"; (2) there is a causal connection between the injury and the conduct complained of; and (3) it is "likely" as opposed to "speculative" that the injury will be redressed by a favorable decision. Lujan v. Defenders of Wildlife, 504 U.S. 555, 560, 112 S.Ct. 2130, 119 L.Ed.2d 351 (1992); see also Fowler, 178 F.3d at 356 (injury in fact must be "fairly traceable" to the actions of the defendant and likely to be redressed by a favorable decision) (citing Bennett v. Spear, 520 U.S. 154, 162, 117 S.Ct. 1154, 137 L.Ed.2d 281 (1997) (quoting Lujan, 504 U.S. at 560-61, 112 S.Ct. 2130)).
3. Representational Standing
An association may also sue "to redress injuries suffered by its members without a showing of injury to the association itself and without a statute explicitly permitting associational standing." Doe v. Stincer, 175 F.3d 879, 882 (11th Cir.1999). Specifically, under the test outlined by the Supreme Court in Hunt v. Washington State Apple Advertising Commission, 432 U.S. 333, 343, 97 S.Ct. 2434, 53 L.Ed.2d 383 (1977): an association has standing to bring suit on behalf of its members when: (a) its members would otherwise have standing to sue in their own right; (b) the interests its seeks to protect are germane to the organization's purpose; and (c) neither the claim asserted nor the relief requested requires the participation of individual members in the lawsuit.
United States District Court, S.D. Florida.
Anthony HERNANDEZ, David Burges, Donna Watson, Gwendolyn Smiley, Donna Grissom on behalf of themselves and all others similarly situated, and the Florida Transplant Coalition, Plaintiffs,
v.
Dr. Rhonda MEDOWS, in her official capacity as Secretary, Agency for Health Care Administration of the State Florida, Defendant.
No. 02-20964-CIV.
Aug. 26, 2002.
*666 Anne Lisa Swerlick, Tallahassee, FL, William Henry Fraser, West Palm Beach, FL, Miriam E. Harmatz, Miami, FL, Jane Perkins, Chapel Hill, NC, Lourdes Rivera, Los Angeles, CA, for plaintiffs.
Christa Elizabeth Calamas, Grant Patrick Dearborn, L. William Porter, II, Tallahassee, FL, for defendant.
ORDER ON MOTION FOR CLASS CERTIFICATION
GOLD, District Judge.
THIS MATTER is before the Court on Plaintiffs' motion for class certification pursuant to Fed.R.Civ.P. 23(b)(2) [D.E. # 6]. Plaintiffs seek to certify a class defined as:
All current and future Florida Medicaid recipients who have, or will have their prescription drug coverage denied, delayed, terminated, or reduced without adequate*667 notice and the opportunity for a fair hearing.
Following class discovery and the submission of memoranda, oral argument on class certification was held on July 26, 2002. After considering the matter, the Court concludes that Plaintiffs' motion for class certification under Fed.R.Civ.P. 23(b)(2) should be granted in part in favor of the individual named Plaintiffs but denied as to the Florida Transplant Survivors Coalition. The Court's reasons and analysis are set forth below.
A. CLASS CERTIFICATION STANDARD
The district court has broad discretion in determining whether to certify a class. Heaven v. Trust Co. Bank, 118 F.3d 735, 737 (11th Cir.1997). A class certification order, however, is not a final order and may be reviewed by the district judge "at any time" so that the district court may "redefine[ ] or more narrowly tailor[ ] classes or subclasses." Shin v. Cobb County Board of Education, 248 F.3d 1061, 1065 (11th Cir.2001).
To qualify as a class under Rule 23 of the Federal Rules of Civil Procedure, the Plaintiffs must initially satisfy the four thresholds requirements of Rule 23(a): (1) the class must be so numerous that joinder of all members is impracticable (numerosity); (2) questions of law or fact common to the class must exist (commonality); (3) the claims or defenses of the representative parties must be typical of the claims or defenses of the class (typicality); and (4) the representative parties must fairly and adequately protect the interests of the class (adequacy of representation). Plaintiffs seeking to represent the class bear the burden of establishing that all four requirements have been met. Kirkpatrick v. J.C. Bradford & Co., 827 F.2d 718; 721 n. 2 (11th Cir.1987), cert. denied, 485 U.S. 959, 108 S.Ct. 1221, 99 L.Ed.2d 421 (1988); Gilchrist v. Bolger, 733 F.2d 1551, 1555 (11th Cir.1984) (A class action may only be certified "if the Court is satisfied, after a rigorous analysis, that the prerequisites of Fed.R.Civ.P. 23(a) are met"). These prerequisites are mandatory and the failure to establish any one is fatal to a motion for class action certification.
In addition to meeting the four preliminary requirements in subdivision (a), the plaintiffs also must satisfy one of the subsections of Fed.R.Civ.P. 23(b) in order to certify a class. In the instant case, the Lead Plaintiffs seek class certification under Rule 23(b)(2). Rule 23(b)(2) applies where the parties "opposing the class ha[ve] acted or refused to act on grounds generally applicable to the class, thereby making appropriate final injunctive or corresponding declaratory relief with respect to the class as a whole." Fed.R.Civ.P. 23(b)(2). Rule 23(b)(2) was intended "primarily to facilitate civil rights class actions, where the class representatives typically sought broad injunctive or declaratory relief against discriminatory practices." Penson v. Terminal Transport Co., Inc., 634 F.2d 989, 993 (5th Cir.1981) (citing Advisory Committee Notes, 39 F.R.D. 98, 102 (1966)). FN1
FN1. All Fifth Circuit decisions prior to October 1, 1981 are binding precedent on the Eleventh Circuit. Bonner v. Prichard, 661 F.2d 1206, 1209 (11th Cir.1981).
Moreover, prior to a determination regarding whether a class should be certified pursuant to Fed.R.Civ.P. 23, a district court "must determine that at least one named class representative has Article III standing to raise each class claim. 'Any analysis of class certification must begin with the issue of standing.' " Prado-Steiman v. Bush, 221 F.3d 1266, 1279-80 (11th Cir.2000) (quoting Griffin v. Dugger, 823 F.2d 1476, 1482 (11th Cir.1987)).
B. STANDING
1. Individual Standing
It is well-established that "prior to the certification of a class, and technically speaking before undertaking any formal typicality or commonality review, the district court must determine that at least one named class representative has Article III standing to raise each class claim, '[a]ny analysis of class certification must begin with the issue of standing' " Prado-Steiman, 221 F.3d at 1279-80 (quoting Griffin v. Dugger, 823 F.2d 1476, 1482 (11th Cir.1987)). It is only " 'after the court determines the issues for which the named plaintiffs have standing [that] it *668 should address the question whether the named plaintiffs have representative capacity, as defined by Rule 23(a), to assert the rights of others.' " Id.
The burden is on the Plaintiffs to clearly "allege facts demonstrating that he is a proper party with standing to invoke judicial resolution of a dispute." Anderson v. City of Alpharetta, 770 F.2d 1575, 1582 (11th Cir.1985). "It is not the role of the court to speculate concerning the existence of standing nor to piece together support for the plaintiff." Id.
The Court concludes that each named Plaintiff is a Florida Medicaid recipient whose prescription drug coverage is or will be denied, delayed, terminated, or reduced without notice and the opportunity for a fair hearing. As such, each named Plaintiff has standing to seek the subject declaratory action and injunctive relief. In seeking such relief, Plaintiffs are not challenging the Defendant's authority to implement drug utilization reviews. Nor are they challenging the four brand limit or the preferred drug list. Additionally, they are not challenging the Defendant's authority to deny coverage for a specific prescription drug that requires authorization if a request has not been appropriately filed and approved. Plaintiffs are only challenging the Defendant's purported failure to provide them with adequate and timely notice and fair hearing opportunities when Medicaid denies prescription drug coverage.
2. Associational Standing
An organization may have standing to sue on its own behalf if it satisfies that same standing test that applies to individuals. ACORN v. Fowler, 178 F.3d 350, 356 (5th Cir.1999) (citing Havens Realty Corp. v. Coleman, 455 U.S. 363, 378-79, 102 S.Ct. 1114, 71 L.Ed.2d 214 (1982)). This standing standard, requires that the it has (1) suffered an injury in fact that is "concrete and particularized"; (2) there is a causal connection between the injury and the conduct complained of; and (3) it is "likely" as opposed to "speculative" that the injury will be redressed by a favorable decision. Lujan v. Defenders of Wildlife, 504 U.S. 555, 560, 112 S.Ct. 2130, 119 L.Ed.2d 351 (1992); see also Fowler, 178 F.3d at 356 (injury in fact must be "fairly traceable" to the actions of the defendant and likely to be redressed by a favorable decision) (citing Bennett v. Spear, 520 U.S. 154, 162, 117 S.Ct. 1154, 137 L.Ed.2d 281 (1997) (quoting Lujan, 504 U.S. at 560-61, 112 S.Ct. 2130)).
3. Representational Standing
An association may also sue "to redress injuries suffered by its members without a showing of injury to the association itself and without a statute explicitly permitting associational standing." Doe v. Stincer, 175 F.3d 879, 882 (11th Cir.1999). Specifically, under the test outlined by the Supreme Court in Hunt v. Washington State Apple Advertising Commission, 432 U.S. 333, 343, 97 S.Ct. 2434, 53 L.Ed.2d 383 (1977): an association has standing to bring suit on behalf of its members when: (a) its members would otherwise have standing to sue in their own right; (b) the interests its seeks to protect are germane to the organization's purpose; and (c) neither the claim asserted nor the relief requested requires the participation of individual members in the lawsuit.