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Shaughnessy v. Wellcare Health Insurance, Inc.

United States District Court, D. Hawaii

December 5, 2016

BRIAN SHAUGHNESSY, Plaintiff,
v.
WELLCARE HEALTH INSURANCE, INC. DBA OHANA HEALTH PLAN, Defendant.

          ORDER DENYING MOTION FOR TEMPORARY RESTRAINING ORDER

          Derrick K. Watson United States District Judge

         INTRODUCTION

         On December 1, 2016, Plaintiff Brian Shaughnessy, proceeding pro se, filed a Complaint against WellCare Health Insurance, Inc., dba Ohana Health Plan (“Ohana”), alleging claims for violation of 42 U.S.C. § 1983 and breach of contract based on the denial of medical services and benefits under his Medicaid plan administered by Ohana. Shaughnessy also filed a Motion for Temporary Restraining Order and Preliminary Injunction (“Motion for TRO”), seeking a court order directing Ohana to provide the services and benefits ordered by his doctor and to award him costs in the amount of $25, 000.00. Because Shaughnessy's conclusory assertions are insufficient to establish a likelihood of success on the merits of his claims or that the balance of relevant factors weighs in his favor, the Motion for TRO is DENIED.[1]

         DISCUSSION

         I. Legal Standard

         The standard for issuing a temporary restraining order is identical to the standard for issuing a preliminary injunction. See, e.g., Hawaii v. Gannett Pac. Corp., 99 F.Supp.2d 1241, 1247 (D. Haw. 1999). A “plaintiff seeking a preliminary injunction must establish that he is likely to succeed on the merits, that he is likely to suffer irreparable harm in the absence of preliminary relief, that the balance of equities tips in his favor, and that an injunction is in the public interest.” Winter v. Natural Res. Def. Council, Inc., 555 U.S. 7, 20 (2008) (citation omitted). “That is, ‘serious questions going to the merits' and a balance of hardships that tips sharply towards the plaintiff can support issuance of a preliminary injunction, so long as the plaintiff also shows that there is a likelihood of irreparable injury and that the injunction is in the public interest.” Alliance for the Wild Rockies v. Cottrell, 632 F.3d 1127, 1135 (9th Cir. 2011). Winter emphasized that plaintiffs seeking preliminary relief must demonstrate that “irreparable injury is likely in the absence of an injunction.” 555 U.S. at 22; see also Stormans, Inc. v. Selecky, 586 F.3d 1109, 1127 (9th Cir. 2009).

         II. Analysis

         Shaughnessy fails to set forth sufficient supporting facts or legal argument demonstrating that he is likely to succeed on the merits, that the balance of equities tips in his favor, and that an injunction is in the public interest. The Court acknowledges that he alleges the likelihood of suffering irreparable harm in the absence of the preliminary relief requested. On balance, however, the Motion for TRO fails to establish that Shaughnessy is entitled to the requested TRO, an “extraordinary remedy that may only be awarded upon a clear showing that the plaintiff is entitled to such relief.” Winter, 555 U.S. at 22.

         A. Requested Relief

         Shaughnessy seeks, on an expedited basis,

a temporary restraining order and a preliminary injunction compelling the Defendant to fulfill its obligations under Medicaid and providing the prescriptions of the doctor and the Aides to the Plaintiff along with reimbursement for monies spent.

Motion for TRO at 3.

         According to Shaughnessy, Ohana manages Medicaid benefits for Hawaii's aged, blind, and disabled residents. Shaughnessy is a quadriplegic, and under his plan, he is entitled to certain aides, medical equipment and prescription medicines. For over six months, Ohana has failed to provide aides for 130-plus hours allotted per week, as needed. Motion for TRO at 1. He alleges that two aides were recently hired after waiting weeks for approval by Ohana, but Ohana has not paid them because of “coding” mistakes by healthcare providers. According to Shaughnessy, Ohana is, in fact, “lying and blaming agencies to keep money indefinitely. As a result, either the Plaintiff has to spend money from his limited resources or go without the services.” Motion for TRO at 1-2.

         Shaughnessy's doctor wrote prescriptions for the following equipment: shower chair; sling for lift; hospital bed; and specialized mattress. Motion for TRO at 2. Although Shaughnessy's doctor provided manufacturer and model numbers associated with these items, Ohana refused to provide the requested, prescribed equipment. Instead, it provided equipment that was “not usable” and “not the ...


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