Circuit Court Not Taking Up ‘Medically Fragile’ Children Ruling


The 11th U.S. Circuit Court of Appeals recently decided not to hear a case relating to “medically fragile” children being placed in nursing homes. A three-panel judge in 2019 ruled in favor of the U.S. Department of Justice’s (DOJ) authority to pursue a lawsuit against the State of Florida.

The issue originally began after the DOJ found Florida was institutionalizing children with severe medical conditions in nursing homes in 2012 and that Florida’s Medicaid program put more children at risk of being put into a home.

In 2013, the Tampa Bay Times reported on the effects of Florida’s Medicaid program for children with the need for medical care. The program is facilitated by the Agency for Health Care Administration.

“There are many children who require services in the state of Florida,” pediatrician Ian Nathanson said in 2013. “There are many requests for services. And there are, in my view, just not enough resources to provide for every single child and every single request.”

However, a 2017 ruling backed the state because of changes it made to its Medicaid program, and with the changes the DOJ did not have standing. That ruling was quickly appealed and overturned in the 2019 ruling.

Two dissenting judges, Judge Kevin Newsom and Judge Elizabeth Branch said the DOJ was granted their authority to pursue legal action by Congress.

“At the end of the day, there simply is no cause of action authorizing the government’s non-contract suit here,” Newsom wrote. “And we aren’t at liberty to conjure one, no matter how sympathetic the plaintiffs’ case.”

Newsom also fears the decision could come at a cost to “the core principles of federalism.”

“The upshot of the panel’s holding is that the attorney general can enforce Title II of the ADA by suing state governments,” the 25-page dissent said. “That’s a big deal.”

Judge Jill Pryor wrote the opinion backing the most recent decision to decline the court hearing.

“Under the (dissent’s) interpretation, upon receiving a complaint that a non-federally-funded public entity has discriminated against a person with a disability, a federal agency pours resources into investigating the complaint and attempting to reach an informal settlement,” Pryor wrote. “But if that process ultimately proves unsuccessful, the federal government must give up – because it may not sue the public entity to enforce the law. Without any enforcement teeth, such a regulatory process would be utterly ineffectual.”

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Grant Holcomb is a reporter at the Florida Capital Star and the Star News Network. Follow Grant on Twitter and direct message tips.
Photo “Eleventh Circuit Court of Appeals” by United States Court of Appeals for the Eleventh Circuit.






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