Samuel Antrican v. Odom

Several North Carolina Medicaid beneficiaries commenced this
class action under 42 U.S.C. S 1983 against North Carolina State officials to obtain (1) a declaratory judgment that dental screening and
treatment services provided to minors in North Carolina under the
Medicaid program are inadequate and fail to comply with the require-
ments of the Medicaid Act and (2) an injunction requiring the State
officials to comply with the Medicaid Act by making dental screening
and treatment promptly available. The district court, relying on Ex
Parte Young, 209 U.S. 123 (1908), denied the North Carolina State
officials' motion to dismiss based on Eleventh Amendment immunity.
The court also rejected the officials' other jurisdictional challenges.
On this interlocutory appeal, we affirm the district court's ruling on
Eleventh Amendment immunity, and we decline to exercise pendent
appellate jurisdiction over the other grounds on which the State offi-
cials relied to support their motion to dismiss the complaint.

I.

The plaintiffs, who are minors, allege in their complaint that they
have been denied the dental care prescribed by Title XIX of the Social
Security Act, known as the "Medicaid Act." Noting that only 16% of
North Carolina's dentists participate in the Medicaid program, they
allege that they are unable to locate local dentists who are willing to
treat them in exchange for Medicaid reimbursement. They assert that
Medicaid beneficiaries in North Carolina generally must conduct
extensive searches and travel long distances to locate and utilize the
services of a dentist who will accept Medicaid reimbursement.

Describing their own experiences, Emani Tatum, 3, alleges that she
has had to travel two hours each way to utilize the services of a den-
tist. While a dental clinic closer to her provided an initial screening,
that clinic was unable to provide ongoing care. As a result of the inac-
cessibility of prompt and adequate care, she has had to have extensive
dental care, including three fillings and two crowns. JeShod Hughes,
9, alleges that he has had similar difficulties in obtaining treatment.
Arielle McCree, 6, alleges that her mother contacted the local Depart-
ment of Social Services to find a dentist, only to be referred to the
public health clinic, which was unable to provide dental services. The
Department of Social Services then could not provide the name of any
dentist for McCree who would accept Medicaid reimbursement.
McCree's mother eventually located a dentist an hour away. Austin
Brooks, 6, alleges that his grandmother contacted numerous dentists
in his area, but none would accept Medicaid. Because he could not
locate a dentist in his area, he could not receive preventive dental
treatment. When he began experiencing oral pain, his grandmother
located a dentist three hours away. Because of the lack of preventative
dental care, Brooks has had to have four of his front teeth pulled and
several of his remaining teeth capped.1

Because of their inability to receive adequate dental care, these
plaintiffs, through their parents, guardians, or next friends, com-
menced this action on behalf of themselves and on behalf of others
similarly situated against Carmen Hooker Buell, Director of the North
Carolina Department of Health and Human Services, and Nina M.
Yeager, Director of the North Carolina Division of Medicaid Assis-
tance, in their official capacities.2 Plaintiffs allege that the defendants
have: (1) denied North Carolina Medicaid beneficiaries equal access
and quality care, in violation of 42 U.S.C. S 1396a(a)(30)(A) and 42
C.F.R. S 447.204; (2) failed to ensure statewide availability of dental
services, in violation of 42 U.S.C. S 1396a(a)(1) and 42 C.F.R.
S 431.50; (3) denied North Carolina Medicaid beneficiaries timely
dental care, in violation of 42 U.S.C. S 1396a(a)(8) and 42 C.F.R.
S 435.930; (4) denied Medicaid beneficiaries a free choice of dental
care providers, in violation of 42 U.S.C. S 1396a(a)(23) and 42 C.F.R.
S 431.51; (5) denied Medicaid beneficiaries dental care that is compa-
rable to the care available to non-Medicaid patients, in violation of 42
U.S.C. S 1396a(a)(10)(B) and 42 C.F.R. SS 440.230, 440.240; and (6)
denied Medicaid beneficiaries proper access to early screening and
treatment services, in violation of 42 U.S.C. SS 1396a(a)(10)(A),
1396a(a)(43), 1396d(a)(4)(B), 1396d(R), and 42 C.F.R. S 441.50 et
seq.

For relief, the plaintiffs request (1) a judgment declaring that "the
Defendants' failure to insure the availability of dental services vio-
lates Plaintiffs' rights under the Social Security Act . . . and its imple-
menting rules and regulations" and (2) an injunction requiring the
defendants to "make needed dental services immediately available to
Medicaid beneficiaries in their respective localities" and requiring the
defendants "to comply with the Federal statutes, rules, and regula-
tions" governing Medicaid programs.

The North Carolina officials filed a motion to dismiss the plain-
tiffs' complaint, asserting Eleventh Amendment immunity, a lack of
standing, and the failure of the complaint to state a claim under 42
U.S.C. S 1983 upon which relief can be granted. From the district
court's order denying their motion, the North Carolina officials filed
this interlocutory appeal, challenging the district court's ruling deny-
ing them Eleventh Amendment immunity. They also ask this court to
exercise pendent appellate jurisdiction over the other rulings made by
the district court.

* * *

The district court's order denying State officials Eleventh Amend-
ment immunity is an immediately appealable order, see Puerto Rico
Aquaduct & Sewer Auth. v. Metcalf & Eddy, Inc., 506 U.S. 139, 144
(1993), and our review of this order is de novo, see CSX Transp., Inc.
v. Bd. of Pub. Works, 138 F.3d 537, 541 (4th Cir. 1998).

The North Carolina officials contend that, because they have been
sued in their official capacities, they are entitled to sovereign immu-
nity under the Eleventh Amendment to the Constitution. They argue
that the exception to such immunity, described in Ex Parte Young,
209 U.S. 123 (1908), is not applicable.

* * *

Click the case caption above for the full text of the Court's opinion.

For the foregoing reasons, we affirm the district court's order denying the North Carolina officials' motion to dismiss this case on the
basis of Eleventh Amendment immunity. We conclude, as did the district court, that this action, as defined by the complaint, falls within
the exception to that immunity provided by Ex Parte Young.

We decline to consider the other jurisdictional questions raised by
the defendants at this stage of the proceedings. These issues are not
"inextricably intertwined" with North Carolina's Eleventh Amendment immunity claim, nor is consideration of these issues "necessary
to ensure meaningful review of the . . . immunity question." Taylor
v. Waters, 81 F.3d 429, 437 (4th Cir. 1996); see also Swint v. Chambers County Comm'n, 514 U.S. 35, 50-51 (1995).

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