Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Shaughnessy v. Wellcare Health Insurance, Inc.

United States District Court, D. Hawaii

February 16, 2017

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

          ORDER GRANTING DEFENDANT WELLCARE HEALTH INSURANCE INC. dba OHANA HEALTH PLAN'S MOTION TO DISMISS

          DERRICK K. WATSON DISTRICT JUDGE.

         INTRODUCTION

         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, breach of contract, and emotional distress based on the denial of medical services and benefits under his Medicaid plan administered by Ohana. Because the allegations in the Complaint are factually deficient and fail to state a claim for relief, Ohana's Motion to Dismiss is GRANTED. Shaughnessy is GRANTED LEAVE to file an amended complaint, with instructions below.

         BACKGROUND

         I. Plaintiff's Complaint

         Shaughnessy is a quadriplegic covered under an Ohana health plan within the State of Hawai‘i, and alleges that “[p]hysicians['] services, [a]ides, medical equipment and prescription medicines were to be provided to [him] under the [p]lan.” Complaint ¶¶ 4, 6. Ohana is a managed care organization that contracted with the State of Hawai‘i under its Medicaid program for the aged, blind and disabled, known as QUEST Expanded Access (“QExA”). Ohana Mem. in Supp. at 1. According to Shaughnessy, Ohana failed for six months to provide aides for more than 130 hours per week; that aides provided by Aloha Habilitation are waiting to be approved by Ohana; and that he has had to either spend his own money or go without the services prescribed. Complaint ¶ 6. Shaughnessy further asserts that medical equipment that was supplied was “not usable, ” yet Ohana “refused to replace the equipment.” Complaint ¶ 6.

         The Complaint sets forth the following causes of action: (1) a Section 1983 claim for “violation of duty under Hawaii Medicaid” (Count I); (2) “breach of agreement” (Count II); (3) “compensation for pain and suffering” and “emotional distress” (Count III); (4) preliminary injunctive relief (Count IV); and (5) costs pursuant to Federal Rule of Civil Procedure 54(d)(1) (Count V).

         II. Motion For Temporary Restraining Order

         On December 1, 2016, concurrent with the filing of the Complaint, Shaughnessy filed a Motion for Temporary Restraining Order (“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. Dkt. No. 2. The Court denied the Motion for TRO in a December 5, 2016 order, both acknowledging the gravity of Shaughnessy's allegations of imminent harm, while also finding that he had not met his burden of justifying the relief sought. Significantly, the Court found that the Complaint and Motion for TRO lacked sufficient factual details to determine whether Shaughnessy is likely to succeed on his Section 1983 and breach of contract claims because Shaughnessy provided no information regarding communications between himself, Ohana, and his doctor to support the assertions in his pleadings. Moreover, the Motion for TRO pointed to no statute, regulation, or other provision of Medicaid law violated by Ohana, nor to any contract or contract provision that Ohana allegedly breached. The Court concluded that the failure to provide this basic information made it impossible to determine whether any claims were likely to succeed, and accordingly, denied the Motion for TRO. Dkt. No. 7 at 8-10.

         Ohana now seeks dismissal of the Complaint for failure to state a claim, a request that Shaughnessy did not oppose.

         STANDARD OF REVIEW

         Federal Rule of Civil Procedure 12(b)(6) authorizes the Court to dismiss a complaint that fails “to state a claim upon which relief can be granted.” Rule 12(b)(6) is read in conjunction with Rule 8(a), which requires only “a short and plain statement of the claim showing that the pleader is entitled to relief.” Fed.R.Civ.P. 8(a)(2). The Court may dismiss a complaint either because it lacks a cognizable legal theory or because it lacks sufficient factual allegations to support a cognizable legal theory. Balistreri v. Pacifica Police Dep't., 901 F.2d 696, 699 (9th Cir. 1988). Pursuant to Ashcroft v. Iqbal, “[t]o survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.'” 555 U.S. 662, 678 (2009) (quoting Bell Atlantic Corp. v. Twombly, 550 U.S. 554, 570 (2007)). “[T]he tenet that a court must accept as true all of the allegations contained in a complaint is inapplicable to legal conclusions.” Id. Accordingly, “[t]hreadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice.” Id. (citing Twombly, 550 U.S. at 555). Rather, “[a] claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Id. (citing Twombly, 550 U.S. at 556). Factual allegations that only permit the court to infer “the mere possibility of misconduct” do not constitute a short and plain statement of the claim showing that the pleader is entitled to relief as required by Rule 8(a)(2). Id. at 679.

         DISCUSSION

         Because the Complaint provides only the barest allegations, lacking sufficient factual matter to satisfy the elements of the enumerated causes of action, Shaughnessy's claims for violation of Section 1983 (Count I), breach of contract (Count II), and pain and suffering/emotional distress (Count III) are dismissed with leave to amend. Shaughnessy's claims for preliminary injunctive relief (Count IV) and costs (Count V), however, are remedies that may be available to a prevailing party, but are not properly brought as stand-alone claims. Counts IV and V are accordingly dismissed with prejudice.

         I. Count I: Section 1983

         Count I alleges that a “Medicaid recipient has a private cause of action to enforce his right to treatments and services. Defendant has failed to provide prescriptions by the doctor to the plaintiff.” Complaint ¶ 8. Although the Complaint does not specifically address the elements of a Section 1983 claim or the provisions of the Medicaid Act that Ohana allegedly violated, Count I does include an excerpt from a case out of this district, J.E. v. Wong, referencing Section 1396a(a)(10):

In Watson [v. Weeks, 436 F.3d 1152, 1159-60 (9th Cir. 2006)], the Ninth Circuit Court of Appeals recognized that a Medicaid recipient has a private cause of action to enforce his or her right to certain treatments or ...

Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.