## In the



# U n ited S ta tes Co urt o f Ap p ea ls

F o rth eS e v e n th C ir cu it

N o. 08

- 3592 L A M ONT G. B AIL EY, et al., P laint if f-A ppell ants , v. E. M IT CHELL R OO B , J R ., etal. , D efend a nts-A pp ellees.

A pp eal from the United S t ates Di strictC our t fo r the S outhernDi stricto f Indian a, Indian apolisDiv isi on. No . 1:94- cv-00089- S EB-JM S

— Sarah EvansBarker, Judge
.
A RGUED M AR CH 31, 2009

— D ECI DE D J UNE 8, 2009

Befo re F LA UM, M A NI ON, an d R OV NER, C ircu it Judges . F LA UM, Cir cu i tJudg e . Years ago, a gr o u p o f p lai nt iffs an d the Ind iana M ed icaid p rogram ’s adm inistrators agr eed to cer tain ter m s f or the hand l i ng o fappli cati ons to the dis ab i l i ty prog ra m i n Ind i ana: m ostr el evantf or prese nt purpose s w as a conces si on that the pro gr am w oul d com pil e a co m ple te tw el ve- m onth m edi cal h i s t o r y b e f o r e r e a c h i n ga d e c i s i o n o n th e a p p l i c a t i o n . No w, se ve r almem be r s ofthe a ffec te d c l as s wantt o ho l d the2 N o. 08

- 3592 pr o g r am admi ni st r at o r s i n civ i lc o nt empt fo r v i o l at i ng that port ion ofthe conse nt decr ee. They c l ai m thati n to o ma n y c a s e s th e p r o g r a m i s r e l y i n go n s u mma r y f o r ms ra therthan com pil i ng an appli cant’ s co m ple te m edi cal hi sto ry . The di st r i ct co ur t r ej ec te d th e m o ti o n b ec au se the pl aintiffs h ad n otd em on st ra te d b y c l e ar an d co n vin c in g e vid e n c e th a tth e d e fe n d a n t s w e r e i n v i o l a t i o n o fth e t e r ms ofthe conse n t d ecr ee. A pp el l ants now chal l enge that rul i ng, ci ti ng thr ee er ro rs . Fi rs t, th ey cl ai m the dist ri ct cour t i m prop erl y t ask ed them with dem onst ra ti ng tha t the pla i nti ff s had no t been re aso nabl y dil i gent in f ol l owing the dem ands of the conse nt decr ee. S eco nd , they ar g u e th a t th e d i s t r i c t c o u r t s h o u l d h a v e h e l d th a t th e ev i den ce pr o ffer ed be l o w w as a c l ea r a nd c o nvincing d em ons tration th at th e progra m ad m inistrators w ere vi ol ating the decree

. Thir d, they ar gue that the d ist ric t co ur t er r ed as a matt ero fl aw b y ho l d ing th at 20 C. F

. R. § 4 1 6

. 9 1 2 ( d) , a p r o v i s i o n o fthe r e g ul a t i o ns f o r the S up p lem en ta l Sec u rit y In c om e d isa b ility p ro gr am i ncor pora ted by re fer ence i nto the c onse nt decr ee, di d not re quir e a fullco l l ecti on o fm edi calr eco rds. For the foll ow ing reason s, w e affirm the d istri ct cou rt’s rul i ng.

I . B a c kg r o und The M edi ca i d f o r the Di sabl ed pr o g r am i n Indi an a p ro vid es m ed ica l co ve ra ge an d be n efit s t o in d ivid u als w ho s ufferfro m a quali fyi ng d i sabi l i ty. The pre sent caseN o. 08

- 3592 3 g r ew o uto fa c l as s ac ti o n l aws ui t fi l ed ag ains t th e I ndi an a M edi cai d disabi l i ty pla n i n the 1990 s. That l aw su i t was settled by a c ons en t d ecree req uiring th e ad m inistrators ofthe pla n to co l l ect cer tain evi dence befor e m aking a dec i si o n o n a n a ppl i ca ti o n fo r di sabi l i tyb en efi ts. The co ns en t dec r ee r equi r ed th e I ndi an a pl ant o o bt ain a nd ev alua te e vi den ce us ed f o r M edi ca i d e l i g ibi li tyi n the sam e way that the Code o fFe deralRegul ati ons re quir es the S up ple m en talS ecuri ty I ncom e a dm i ni str ato rs to ob t a i n a nd e v a l ua t e e v i de nc e . S pe c i fi c a l l y, the de c re e pr o vi ded th at, “ th e S ta te o fIndi an a m us t o bt ain a nd evaluate evid ence i n deter m i ni ng M edi cai d el i gibi l i ty i n th e s a me w a y th a t S u p p l e me n t a lS e c u r i t y In c o me disabi l i ty deter m i nati ons are m ade under 20 C. F. R. 41 6. 901 th ro u gh 41 6.9 88 .” I n f ac t, the co ns en t dec r ee s i m pl y i nc o r po r at ed 20 C. F

. R. § 41 6. 90 1- 41 6. 98 8 as r egul at i o ns f o r ho w the Indi an a M edi cai d progr am should g o about col l ecting and eva l uati nga ppl i ca ti o ns . As the di st r i ctc o ur t su m m ar ized i t, the conse nt decr ee re quir ed the In d i ana M edi cai d progr am t o d o th r e e th i n g s : F i r s t, o b t a i n c o mp l e t e hi s t o r i e s fr o m a M edi cai d app l i cant’ s t re atm ent pr ovi ders, co ver i ng at least the tw e lv e m ont hs prior to the ap p li cation, before m aking anydeter m i nati on ab out M edi cai d el i gibi l i ty; seco nd , o btain additi onalm edi cali nfo rm ation fro m an appli c an t’ s t re ating physi ci an o r othe r m edi calso urce w he n n eces sary; third, ensu r e t ha t m ed ical record s are com ple te and d et ail ed enough t o al l ow fo r a pro per deter m i nati on r ega rdi ng el i gibi l i ty. T h e In d ian a M ed ica id for th e D isa b led p ro gr a m is supp ose d to f ol l ow a d efi ned set ofpro cedures w hen4 N o. 08

- 3592

m aki ng el i gi bi l i ty de t e r mi na t i o ns . A pp l i cants f or M edi cai d fo r the Di sabl ed fi rs t m eetwith a n as signed ca se wor k er . Th e ca se wor k erhe l ps ana ppl i ca ntfi l lo ut Fo rm 25 1B , in w h ich an ap p lica n t list s h er m ed ica l co n d iti ons and any i nfo rm at i on about tr eat m ents she’ s r ece i ve d i n th e l as t twe l ve months , i nc l udi nghe r t r ea ting phy si ci an s. The c as ewo r k er i s r es po ns ibl e f o r c o l l ec ting an ap pl i c a nt ’ s me di c a lh i s t o r y b a s e d o n the i nfo r mat i on pro v i de d i n F o r m 2 5 1 B. I f the c a s e wo r k e r i s un abl e t o co l l ec t th i s i nf o r m at i o n, he i s su ppo se d to no te th at i n the a p p l i c a n t ’ s fi l e . Aft e r th e c a s e wo r k e r h a s p r o c e s s e d th e m, appli cati ons ar e for w ar ded to the M edi cai d M edi c al Rev iew T eam ( M M RT). The M M RT is r esponsibl e for gath er i ng anyi nfo rm ati on that the cas ew or kerhas not tr ac k ed do wn. The I nd i a na Med i c a i d p l a n us e s a F o r m 2 5 1 A t o co l l ect inform ation from a ph ysician abou t an ap p lic a nt ’s m edi ca l hi st o r y . The F o r m 25 1A i nc l ude s a se ct i o n a sk i ng for info rm at ion ab ou t t h e p at ien t’s tre at m en ts , d iag n os tic tes ts, and m edi cati ons go i ng ba ck f oratl eas t tw el ve m ont hs , a “M ed ical E vide nc e” sect ion asking for inform ati on o n the pati ent’ s physi calsy ste m s, and a “ D i agno s i s / Pr o g no s i s ” s e c t i o n a s k i ngf o r the do c t o r ’ s o pi ni on re gar ding the a pp l i cant’ s r epor ted i m pai rm ent. O n Apr i l1 3, 1 99 9, pl aint i ff s fi l ed a pet i ti o n t o ho l d the defen dan ts i n c i vi lc o nt empt fo r v i o l at i ngthe t er m s o fthe conse nt decr ee. The parti es set tl ed by enter i ng i nto a se co nd c o ns en t dec r ee tha t i nc l ude d the sa m e t er m s as the or i ginal and al l owed anyo ne wh o had been deni ed M edi c aid b enefi ts i n the prece ding thre e y ear s t o re apply f orbene fi ts.N o. 08

- 3592 5

T hi s pr oc edur e ra i s es s om e obvi ous c onc er ns abo uts am ple 1 si ze and concentr ati on, but app el lan ts contend thatapp el le es stipu lated tha t the y w o u l d no t raise tho se issues in d efense of the a ction , an d they ha v e no t. Seven years later, on Sep tem ber 26, 2006, p lai nt iffs f i l ed a s e c o n d p e t i t i o n t o h o l d d e fe n d a n t s i n c i v i lc o ntem pt, al l eging t hat the Ind i ana M edi cai d progr am was aga i n i n vi ol ati on o fthe conse nt d ec re e. I n re sponse to a disc ove ry r equest, the M edi cai d adm i ni str ato rs ag re ed to p ro d u c e a rep re se n ta tiv e s am p le of d isa b ility be n efit appli cati ons. That s am ple co nsi sted oftwenty- si x fi l es i n al l, r epres enti ng ev er y a pp l ica tio n fro m M ar i on C o u n ty, In d i a n a w i th a n a p p l i c a n tw h o s e l a s tn a me bega n w i th “C ” an d wh ose appli cati on was deni ed betw ee n S ept embe r 1 , 2 00 6 an d Oct o be r 1 , 2 00 6. The 1 p a r t i e s j u d g e d t we l v e o fth e s e a p p l i c a t i o ns t o b e c o mple te und erany sta nd ar d, but appe l l ants conte nd that the re m ai ni ng f ourt een a re i ncom ple te and dem onst ra te th e I ndi an a M edi ca i d p rogr am’ s vi o l at i o n o fthe c o ns en t decree

. Appe l l a nt s c o nt e nd th a tin s o me c a s e s Ind i a na i s i mpr o per l y using thi s for m as a p ro xy f orthe “co m ple te m edi calhi sto ry ” r equi re d i n 20 C.F

. R. § 416. 912. A pp el l ees conte nd thatthe c onse nt decr ee does not al w ays re quir e th em to o btain copi es ofa physi ci an’ s m edi cal re cor ds and that For m 25 1A i s a “co m ple te” m edi cal hi sto rywithi n the m eani ng o fthe decree

. The dis tr i ct c ourtco nd ucted i ts ow n r evie w o fthe fi l es. I t co ncl ud ed that fi ve ofthe f ourt een a l l ege dlyi ncom ple te6 N o. 08

- 3592 fi l es w er e co m ple te und erany st an d ar d. W i th r espectto the re m ai ni ng ni ne, the di str i ct c ourtf ound that “ [ f ] our of these ni ne app licat i ons ar e cl ear l y l ess co m ple te than th e o th er five ,” an d t h at t h e o th er five files c on ta in ed on ly th e su m m ar y F o r m 2 51 A, b utdi d no t fi nd the a dm i ni st r at o r s o fI nd i an a M edi ca i d i n c o nt empt fo r v i o l at i ng the c onse nt decr ee. The cr ux ofthe dist ri ct c ourto pini on is th at th e a p p ella n ts h ad n otm et th e b u rd en for a civ il conte m pt pe titi on: N ei thersi de pres ented adequate evi dence on w hat co n st itu ted a “co m ple te” m edi cal hi sto ry, and thus ne ith erthe f our ar guabl y incom ple te ap p lica tio n s n or th e fiv e a p p lica tio n s c o n ta in in g on ly the F or m 251A was cl earand convinci ng ev i dence that th e a pp el l ees vi ol ate d the co nsent decree

. The di str i ct co ur t i nv i te d the appe l l an ts to re - fi l e the i r m o ti o n, a sk i ng them to pro du ce “ [e]xpert tes ti m ony, o r i nfo rm ati on o n h o w th e a g e n c y c h a r g e d w i th r e s p o n s ib i l i t y f o r c o mpli ance with the Decree in terpret s the defi ni ti on P lain tiffs offe r” an d “fa c tu al ex p lica tio n of w h at p re c ise ly the M edi cai d syst em i nstr ucts physi ci ans t o do and tak e accou n t ofi n com ple ti ng F or m 25 1A

. ” The a pp el l ants in st ea d ap p ea led th e d ist ric t c o u rt ’s d en ial of t h eir m oti on t o thi s co urt.

I I . Discussi on W e r ev i ew the di st r i ctc o ur t’ s dec i si o n n o t to hol d the sta te i n ci vi lco ntem pt defer enti al l y. “I t i s wel les tabl i shed that the deci si on bya dist ri ct c ourtto e n te r a fi nd i ng o f ci vi lco ntem pt i s di scr eti onar y a nd we re vi ew it o nl y t o d eterm ine ifthere w as an abu se of discretion or i ts en tryN o. 08

- 3592 7

w as cl ear l y e rr oneo us. ” Fe l t ne rv. Ti t l eSe ar ch Co. , 283 F. 3d 8 3 8 , 8 4 1 ( 7th C i r . 2 0 0 2 )

. T he c a s e l a w o n c o nt e mpt sa nc ti o ns di vi d es th em i nt o t wo c at eg o r i es : c o er ci ve a nd re m ed ial. Se eJone s v. Li nc ol n El e c. Co. , 18 8 F.3 d 70 9, 73 8 ( 7 th C i r . 1 9 9 9 )

. C o e r c i v e s a n c t i o n s i n d u c e a p a r t y ’ s c o mpli ance with a c ourto rderi n the future, wh i l e r em edi al san ctions com p en sate an i njured pa rty f o r an op p one nt ’s past no n-c om pli an c e. Id. T h e c on te m p t p et itio n h er e is co er ci ve ; the a ppel l an ts wer e se ek i ngt o e nj o i n the I nd i a na Med i c a i d p r o g r a m t o c o nt r a c twi th a n outsi de au di tor t o r ev i ew i ts de ci si o ns e ve r y thr ee months , a nd to re c or d each and eve ryi nstance i n w hi ch a case w orker requ ests m ed ical inform ation from an ap p li can t’s m ed ical care p rovide r. A pp el l ants ar gue that the di str i ct c ourtm ade thr ee er ro rs . Fi rst, i t i m proper l y pl aced upon them the burden of d em on st ra tin g t h at In d i a n a h ad n otbe en rea so n ab ly dil i gent i n car ry i ng o ut the conse nt decr ee’ s r equi re m ents. They c ontend thatr eas onabl e di l i gence i s a n affi rm ati ve d efense on w hich Ind iana bea rs th e b urd en of p roof. Se cond, th ey ar gue that the di str i ct c ourtabuse d i ts di sc r et i o n b y no t i m po singc i vi lc o nt em pt sa nc ti o ns bec au se of the fou r app li cation s tha t the district cou rt ch ar ac te r i ze d a s l es s than c o m pl et e. Thi r d, the y a r g ue th a t the di s t r i c t c o ur t i mpr o pe r l y de c l i ne d t o ho l d that the c onse nt d ec ree r equi re s that Ind i ana obtain actual co pi es o fa t r ea tingphy si ci an ’ s m ed icalr ec o r ds an d thus th at th e fi ve ap p li cation s w ith only a Form 251A are e v i d e n c e o fIn d i a n a ’ s v i o l a t i o n o fa c o u r to r d e r . We ta k e ea chc l ai m i n tur n.8 N o. 08

- 3592 A. W he t he r t he di s t r i c tc o urti mpr o pe r l ya l l o c a t e d the bu r den ofpr oof The appell ants fi rs t co ntend that the di str i ct c ourtabuse d i ts di sc r et i o n b ec au se i t im p rop er l y pl ac ed o n the m the b u rd en of p ro vin g t h at th e a p p elle es w er e n ot“re as on ab ly dil i gent” i n executing the co nsent decree

. The di str i ct cour t char acte rized the burden ofpro ofas , “whether Pl ainti ff s hav e s how n, bycl earand c on vinci ng ev i dence, th atDe fen dan ts ha ve no t been ‘ r ea so nabl y di l i g en t an d e ne r g e t i c i n a t t e mpt i ngt o a c co mpl i s h wha twa s o r de r e d’ i n the Consent Decr ee. ” They conte nd th at thi s was an error ofl aw and nec essarily an a bu se of the d istri ct cou rt’s d isc re tio n . Se eU ni t e d S t at e s v. Jade r any, 22 1 F

. 3d 989, 99 4 (7t h Ci r. 20 00)

. A pp el l ants conte nd thattheyneed o n ly show a violat ion o fthe ter m s o fthe conse nt decr ee; “r eas onabl e di l i gence , ” they c onte nd , i s a n affi rm ati ve d efense o n w hi ch the appell ees ’ bea r the b urden ofpro duct i o n. A pp el l ants ci te U ni t e d S t at e s v. Ry la nd er, 46 0 U.S

. 75 2 ( 1983 ) , wh i ch theyar gue s quarel y pl aces th e b u rd en o f dem onst ra ting rea so n ab le d ilige n c e o n th e p arty d efe n d in g a ga in st th e c on te m p t p et itio n . R yla nd erdoes ho l d tha t a d ef en dan t i n a c o nt empt pr o ce edingb ea r s th e bur deno fpr o ducinge vi den ce i fhe i s as se r tinga pr es en t in ab ility to co m p ly w ith t h e t er m s o f a c ou rtord er . Id. at 75 7. T h e d efe n se th at th e Su p r e m e C ou rtd isc u ss ed in R yla nd eris d iffer en t fro m a n y d efe n se th at th e s ta te w ou ld presen t i n the pr es en t ca se , ho wev er . In R yla nd er, the re sp on d en t w as su bj ec t t o a n IRS su m m o n s ord er in g h im to tur n o ve r c er ta i n c o r po r at e books a nd r ec o r ds to theN o. 08

- 3592 9 ag en c y. Id. at75 3. A pri m a f aci e ca se f orcontem pt sancti ons i n that case co nsi ste d ofa showing that Rylan d er ha d no t sa ti sfied the t er m s o fthe s um m o ns

— that i s, that he had not tu rned over the book s a n d r e c o rd s. T he Cou rt h eld th at R yla n d er co u ld d efe n d ag ain st a fin d in g o fciv il conte m pt by dem onst ra ti ng “that com pli ance i s n ow f actual l y i m possibl e. ” Id. at75 7. R yla nd er thus pl aces a burden ofpro ofo n the defe nd an t, but i t doe s s o w hen th e d efe n d an t is alleg in g th at “ c om p lian c e is im p os sib le.” Id. R yla nd er addre ss ed a ca se wher e a par tyde fen di ng agains t a civi l con te m p t p etition forviol ating a cou rt or d er req u irin g a on e-t im e-o n ly a c t i o n o n h is p ar t, bu t in doi ng so i t d id n ot address wh at evi dence a party s e e ki ng sancti ons m ust pro du ce in the fi rs t instance
. The part i es agr ee t h at thi s ci rcui t’ s ca se l aw r equi re s the par ty see ki ng sa ncti ons to dem onst ra te t hat the o pp osing par ty i s i n v i o l at i o n o fa c o ur t o r derb y c l ea r a nd c o nv i nc i ng ev id en c e. Se e, e . g. , S E Cv . Ho ma , 514 F.3d 661 , 676 (7th C ir. 20 08 ). They disa gr ee ove r w hat e vi dence a partyhas to p rod uc e to de m o n strate an opp one nt ’s vi olation of a cou rt order. I n Golu b a v. School D i s t
. of Ripon , 45 F.3d 103 5 (7 t h C ir. 1 9 9 5 ) , we n o t e d whendi s c us s i ngc i v i lc o nt e mpt san ctions that, “[t] he district cou rt doe s not, how ev er, ‘or d in ar ily h av e t o fin d th at th e v iola ti o n w a s “ w illfu l” ‘ and m ay fi nd a partyin ci vi lco ntem pt i fthatparty ‘ has no t bee n r e a s o nab l y di l i g e nt a nd e ne r g e t i c i n a t t e mpt i ng to acco m pli sh wh at w as o rd ered. ’ ” Id. at10 37 ( ci ti ng Sto tler and C o. v. A ble, 870 F.2 d 11 58 , 11 63 (7t h C ir. 19 89 )). A p p el-10 N o. 08

- 3592 l ees co ntend that thi s pass age pl aces the burden of pr o o fo n thi s i s s ue o n the p a r t y s e e k i ngthe co nte mpt sancti on; the ap p el l ants conte nd thatthei r burden of pr o o fi s ac tu al l y s pel l ed o ute ar li er in th e sa m e o pi ni o n, w here the cour t no ted thatin or der t o preva i l, “ a p ar ty m us t pr o ve ‘ byc l ea r and c onvi nc i nge vi den ce ’ tha t th e opposi ng par ty vi ol ate d a co urt or der. ” Id. ( ci ti ng Sto tler, 870 F.2d at 1163). G oluba do es no t ex p l i ci tlys aywhi chpa r tyb ea r s th e bur deno fde m o ns tr ati ng“ r ea so nabl e di l i g en ce ” o r the abse nce there of

. Our di scussi on o f“r eas onabl e di l i gence ” i n that case re fer s to w hat a cour t m ust f i ndr atherthan to w hat a party t o the a cti on m ust pr ove . H ow ever, G oluba s pel l ed o utwhate vi den ce mustb e be f o r e th e cour t bef or e i t can i m pose sancti ons: ev i dence thata party has wil l fully r efused to com plywith a co urt or der, o r evi denc e th at a par ty w as not “r eas onabl y di l i gent” i n car ry i ng o ut the ter m s o fthe cour t o rder

. W e hav e subse qu e nt l y u s e d a t e s tf o r c i v i lc o nt e mptp e t i t i o ns tha t ex pl i ci tly r equi r es a pe ti tione r t o de m o ns tr at e th atthe alle ge d co n te m n or w as n o t rea so n ab ly d ilige n t. See Pr i ma Te k II

, L L C v

. Kl e rk’s Pl as t i cIn du st ri es, B. V. , 52 5 F

. 3 d 5 3 3 , 5 4 2 ( 7th C i r. 2 0 0 8 ) ( “ To s us t a i n i t s c o nt e mpt cl ai m , PTI I h as the b ur deno fpr o vinga l lo fthe f o l l o wi ng el em en ts by cl earand convinci ng ev i dence: ( 1) the Order set s for th an unam biguous com m and; ( 2) Kler ks vi ol ate d that com m and; ( 3) Kler ks’ s v i ol ati on was si gni fi c an t, m ean ing it d id n ot su bsta nt ial ly com p ly w ith th e O rd er; an d ( 4) Kl er k s f ai l ed to take s te ps to r ea so nabl [ y ] a nd dil i gently c om plywith the Order

. ”) ( ci ti ng G oluba a nd Sto tler ). Li k ewi se , the S upr eme Co ur t ha s di sc us se d theN o. 08

- 3592 11 pr i m a f ac i e ca se i n a c i vil co nt empt pr o ce edinga s th e b u r d e n o f sh ow in g a w illfu l failu re . Se eM cPhau l v. U nited Sta tes , 364 U

. S. 372, 379 (1960 ) (“Th e G overn m en t’s proo fatthe tr i althus e stabl i shed a pr i m a f aci e ca se of w i l l f ul f ai l ure to com plywith the subpoena. ”) ( em pha sis add ed). A t l eas t o ne o therci rcui t has u se d a si m i l ar phr as e i n e l ab o r at i ngthe c o nt empt s ta nda r d, r equir i ng that the e vi dence be suffi ci ent t o f or eclo se a fi nd i ng o f re as on ab le d ilige n c e. SeeU nite d State s v. Local 1804-1, Int’l Long shore m an’s A ss ’n, AFL-C IO , 44 F

. 3d 1 091, 1096 (2d Cir. 19 95 ) ( “In a c i vi lc o nt empt pr o ce eding, l i k e the pr es en t case , a conte m pt hol ding w il lf al lunl ess the or der vi o l at ed by th e co nt emno r i s ‘ cl ea r a nd un ambi g uo us , ’ the proo fi s ‘ cl earand convinci ng, ’ and th e c ontem norwas not re aso nabl y di l i gent i n att em pting to co m ply

. ”)

. Thus, the di str i ct c ourtd id n ot c om m i t a cl earl ega ler ro r by re quir i ng appel l ants to dem onstrat e Ind i ana’ s l ack of re aso nabl e di l i gence . F ur th er m o r e, w e cou l d r ej ec t th e co nt en ti o n tha t th e dist ri ct c ourter re d i n sta ti ng the burden ofpro ofbec ause i t i s no t cl earfro m r ead in g the o pini on that the di str i ct co ur t ac tu al l y pl ac ed th e bur deno fd em o ns tr at i ngthe l ac ko fr ea so nabl e di l i g en ce o n a p p ell an ts
. The s ta te m en t quoted abo ve cer tainl y s ugges ts th at the cour t r equi re d as part ofthe pri m a f aci e case ev i dence thatthe appell ants had not be en rea so n abl y di l i gent. H owever, the dist ri ct cour t ult i m ate l y rej ecte d the ci vi l conte m pt p etit i on because o ne se t o fal l ege dlyi ncom ple te appli cati ons w as i n f ac t co m p le te , a nd “ th ei r c o m pl et en es s sh o ws ‘ r ea so nab l e di l i g en ce ’ o n the pa r t o fDe fendan ts t o f o l l o w the Court’ s o rderand the re gul ati ons that supp ort i t. ” W i th12 N o. 08

- 3592

r es pec t to the o th eral l eg edly i nc o m pl et e a ppl i ca ti o ns , the cour t decl i ned to i m pose ci vi lco ntem pt sanct ion s no t because appel l an ts had not dem onst ra ted an absence o f re aso nabl e di l i gence but because “i t r em ai ns u n cl ear w hat c onst i tutes a ‘ com ple te’ m edi cal hi sto ry ” and consequentl y a pp el l ants had “ fail ed to m eetthei r burden on the r em ai ni ng app li cati ons, bec ause the s tandard f or conte m pt r equi re s cl earand convinci ng ev id en ce that Defe nd ants vi ol ate d the decr ee. ” Ap pe ll ants did not pr ev ai lb ec au se the y s i m pl y f ai l ed t o pr o duce c l ea r a nd convinci nge vi den ce tha t I ndi an a ha d v i o l at ed th e c on se n t d ec re e. T h e y h av e n ow lat c h ed on to a sin gle phrase fro m the opi ni on and insi st that i t m an d at es re ver sal, bu t w e thi nk this is an un chari tabl e cha ra cter i zatio n of th e d ist ric t c ou rt ’s o p in ion an d , at a n y ra te , i s n eit h er an err or n or gro u n d s fo r re ve rs al.

B . W heth er a p p ella n ts p roduced suf f i ci ent evi den ce o f non-comp l i ance The b ur deno fpr o o fa si de, a pp el l an ts a l so c o nt en d t h a t the eviden ce th ey p resen ted to the d istri ct cou rt ad eq u at ely d em on st ra te d Ind ian a M ed ica id ’s n on -c om p lia nc e wi th th e c o ns e ntde c r e e a nd j us t i fi e d c i v i lc o nt e mpt sancti ons. A s the di str i ct c ourtsum m ar ize d i t, appel l ants mad e the f o l l o wi ngf a c t ua la l l ega t i o ns i n the c o nt e mpt proc e e di ng, b a s e d o n the i rr a nd o m s a mpl i ngo fa pp l i cati ons: ( 1) In ni ne, or 35% , o fthe appli cati ons, Defendants f ai l ed to r equest tw el ve- m onth m edi calhi sto ries; ( 2) i n s e v e n, o r 2 5 %, o fthe a pp l i c a t i o ns , De fe nd a ntsN o. 08

- 3592 13 f ai l ed to c o l l ec t i nf o r m at i o n tha t w as “c o m pl et e an d det ai l ed e no ug h” t o make a di sabi l i tyde te r m i na ti o n; ( 3) i n thr ee, o r 12% , o ft h e ap pli cati ons, Defendants f ai l ed to co l l ect a l i st ofany m ed icalf aci l i ti es that tr eat ed the appli cant; ( 4) i n ei ght, o r 53% , o ffi ftee n appli cati ons, the county offi ce fo rwarded the a pp l i catio n to th e M M R T w ith ou t a n y m ed ica l rec or d s; (5) in fou r, or 2 7% , of fiftee n a p p lica tio n s, th e M ed ica id appl i ca ti o n was de ni ed o n the sam e d ay th atthe M edi cai d M edi calRevi ew Team r equeste d add i ti onal i nfo rm ati on about the a pp lica nt; ( 6) i n one offi ftee n appli cati ons, the onl y m edi calin for m ati on incl ud ed i n the appli cati on was ga ther ed bya re gi ste re d nurse, r atherthan a doct or ; ( 7) in none ofthe appli cat i o n s d id th e p ac ke t c on ta inFor m 20 32 , w h ich is supp ose d to be pr ese nt anyti m e a n a pp l i cant was as k ed to r ec ei ve a p hy si ca le xa m i na ti o n; ( 8) i n n o ne ofthe appli cati ons did the county case w or ker m ake a re c or d of re q u es ts for m ed ica l in for m at ion ; an d (9) in nei ther of the tw o appli cati ons i n w hi ch a p hysi ci an r eque st ed th atthe a ppl i ca ntr ec ei ve fur th ert es ting wa s the t e s t i nga c t ua l l y p e r f o r med b e f o r e the a ppl i c a t i o n wa s de ni e d. The dis tr i ct c ourtco nd ucted i ts own r evi ew o fthe fi l es and concl ud ed that at l eas t fi ve ofthe al l ege dlyi ncom ple te appl i ca ti o ns i n f ac t con ta i ne d de ta i l ed r ec o r ds. The cour t di d note that oft h e rem ai ni ng ni ne appli cati ons,
“ [ f ] o u r o fth e s e n i n e a p p l i c a t i o n s a r e c l e a r l y l e s s c o mp lete than the oth er fi ve,” ei th er beca us e thos e fi les w ere m i ssing F or m 25 1A al tog ethero r because Fo rm 25 1A was m i ssing page s o r w as ot herwis e incom ple te. A pp el l ants14 N o. 08

- 3592

c laim th at th is s ta te m en t re ga rd in g t h e fo u r c as e fil e s is ev i den ce o f I ndi an a’ s no n- co m pl i an ce wi th th e co ns en t d ecree an d a s u fficient basis for hold ing the program ’s adm i ni str ato rs i n ci vi lco ntem pt. A pp el l ants ci te case l aw fro m thi s a nd o therci rcui ts est abl i shi ng tha t M edi cai d progr am s a re subj ect to a st r i ctc o m pl i an ce s ta nda r d wi thr es pec t to r egul at o ry proce du re s a nd deadl i nes forr eac h in g deci si ons on i ndi vi duala ppl i ca ti o ns . The y re l y he av i l y o n Sm i t h v

. M iller, 66 5 F

. 2d 172 ( 7th Ci r. 19 81) , a case i nvol vi ng a su it for inju n c tiv e re lief ag ain stt h e Illin ois M ed ica id p ro gr am . S mi t h c ontained bro ad l anguage thatse em s t o su ppo r t appe l l an ts ’ po si ti o n: “I t i s unc o nt es te d that the di st r i ctc o ur t po ss es se d the e qui tabl e po werto e nj o i n the Dep ar tm ent’ s v i ol ati on offedera ll aw s a nd r egul ati ons. W h il e a st ate ’ s par ti ci pati on in the M edi cai d progr am i s purely v ol untaryand it s accepta nce o fsubst anti al federal fund s uncoe rce d, once el ecting to part i ci pate, i t m ust fully c om plywith fed er al statutes and regula

ti ons i n i ts adm i ni str atio n of the pr ogr am . ” Id. at175. A pp el l ants al so ci te case l aw fro m o therci rcui ts to su p p or t a fu ll com p lian c e s ta n d ar d

. Se e Wi t hrow v. Conca nno n , 942 F. 2d 1385 , 1387 (9 th C i r. 1991) (fi nd i ng tha t “[t ] h e la n gu ag e o f th e fe d er al re gu lat ion s is u n eq u ivo c al . . .”); A lexand erv. H il l , 707 F. 2d 78 0, 78 4 (4 th C ir. 1983) (“[ t]he law i tself com p els 100% com p li an ce . . . ”). In d ee d , ap p ella n ts arg u e t h at ev en if th is c irc u it accepte d som e k i nd o fde m i ni m i s am ou nt o fdevi ati on fr o m r egul at o r y o r s ta tu to r y r equi r e me n t s , the r at es o fno ncom pli ance in their sam ple would be suffi ci ent t o r equi r e so m e k i nd o fr emedi ala ct i o n.N o. 08

- 3592 15 W e a re pre sente d, then, with the questi on o fhow m uch non- com pli ance i s needed bef or e a dist ri ct cour t can im p ose civilcont em p t san ctions

. A fe w prelim inary poi nts wil lshar pen our anal ysi s o n this issue. Other cour ts have obs er ved thati n ci vi lco ntem pt proc ee d ings, “c on te x t is ex tr em ely im p or ta n t to ap p ella te ov er sig h t .
. .” Lan gt on v. Johns t on , 928 F.2d 12 06 , 122 0 (1 st C ir. 19 91 ). In co nt empt pr o ce eding s be twe enpr i va te pa r ti es , the c o n s e n td e c r e e o p e r a t e s l i k e a c o n t r a c tb e t we e n th e t wo and a r evi ew i ng co urt has co m parat i vel y g re ate r fre edom to re vi si t the di str i ct c ourt ’ s inter preta ti on o fthe decree

. Id. at12 20 -21 . W h en th e c on se n t d ec re e i n vo lve s a p u b lic agen cy, how ever, “th e d istri ct cou rt’s const ruc tion of a c on se nt decr ee shoul d be a ccor ded co nsi derable defe re nce, bec ause bro ad l eeway is often ne cess ar y t o secur e co m pli c ate d, som eti m es confl i cti ng, pol i cy obj ecti ves. ” Id

. at12 21. The Suprem e Cour t has al so cauti oned d i str i ct c ourt s th at in u s i n g t h eir co n te m p t p ow er s a ga in st a p u b lic ag en cythe y s ho ul d se l ec t a r emedy ca r eful l y t ai l o r ed to the p ro p os ed en d

. Sp a llo ne v . U n i t ed S ta tes , 49 3 U.S

. 26 5, 27 6 (19 90 ); s e e al s o M i s s our i v. Jenk i ns , 49 5 U.S

. 33 , 51 ( 1990 ) ( “[ O] ne of the mos t i m po r ta ntc o ns i der at i o ns g o ve r ni ng the e xerci se ofequi tabl e power is a properr espectf or th e i n t e g r i t y a n d fu n c t i o n o fl o c a lg o v e r n me n ti n st i tu
ti ons. ”)

. Thi s w ar n in g r eco gni zes thatwh en a dist ri ct cour t use s i ts re m edi alpow er s ( i ncl u d i ng the pow erto enf or ce a co nsent decree ) i n the publ i c l aw co ntext, di str i ct c ou rt s “ ty p ica lly p lay a p ro ac tiv e ro le

— a r ol e which ca n have near l y e nd l ess per m utati ons. ” Lan gton , 92 8 F

. 2d at 12 21

. A di st r i ctc o ur t i n s uchc ircum sta nc es c anfi nd16 N o. 08

- 3592 i tse l fdeepl y entangl ed w i th the d eve l opm ent and m anage m en t of a ci ty orst ate ag ency. Thi s ci rcui t’ s e xperi ence w i th the r em edi aldecr ee i n the l ong- runni ng ca se of G autre aux v. Chicago Housing Authority ( o f whi c h 491 F. 3d 649 ( 7th Cir

. 2007 ) i s onl y the m ost re cent ite ra tio n ina for ty -ye ar law su it) illu st ra t e s t h e m an y w ay s in w hi ch such a decree can deepen a d i str i ct court ’ s invol vem ent w i th a case and r equi re i t to re sol ve m an y s u bse q u e n t d isp u te s b et w ee n th e p ar tie s, ra th er th an te rm inati ng i t thro ugh the sor t o fo ne- shottr ansferthata conse nt decr ee between pri vate part i es often invol ves. The prese nt cas e i s a notherexam ple ; i t has twice bee n se tt l ed th r o ug h co ns en t dec r ee s an d ha s be enon th e d oc ke t o f th e S o u th er n D ist ric t o f Ind ian a in te rm itt en tly sinc e 19 94

. W e ca n s ta te the po i nto fthe se o bs er vat i o ns si m ply : W e a re se nsi ti ve to the di str i ct cou rt’ s nee d not to ex tend i ts equi tabl e powers too f arand to r equi re a persuas i ve showing ofco n te m pt befor e t aking such ser i ous a cti on a gainst a st ate adm i ni str ati ve age ncy. W e co ncl ud e that the di str i ct c ourt d id not abuse i ts disc re tion by rul i ng tha t a pp el l ants had not pr oduced cl earand convinci ng ev i dence ofInd i ana’ s v i ol ati on o f the c ourto rder

. The fi rs t p ro b lem f orappel l ants i s that th e di s t r i c tc o u r td i d n o tma k e a f a c t u a lfi n d i n gth a ta ny o fthe a ppli cation s ar e i nc o m pl et e an d in v i o l at i o n o fthe co ns en t dec r ee. T he di st r i ctc o ur t di d no te s o m ethi ng that ap p ellants s tr ess i n thei r bri ef, wh i ch i s that four of th e fi l es a r e l es s co m pl et e th anthe o th er s. H o wev er, due to the inconcl usi ve nature o fthe parti es’ ar gu m ents ab o utwhatc o ns ti tu tes a “ co m pl et e” medi ca lhi st o r y, the dist ric t co urt w as unabl e t o m ake any f actualfi nd i ngsN o. 08

- 3592 17

O ne p ro b lem com p licating this categ or iza tion is tha t th o se 2 f our fil es ar e a ll at vari ous s tages ofi ncom plet enes s. O ne fil e, d es ig n a te d F ile M , co n ta in s n o m ed ic a l h ist o ry o u tsi d e o f a cop y of a p rescrip tion refill ; F ile E con tain s a F or m 251 A tha t is m is si ng pages; Fil e L cont ains only one incom plet e F o rm 251A and nothi ng f rom otherm edical prov id ers ; and File H w as denied on the s am e day that the M M R T request ed ad ditional r e c or ds whi c h the y a ppa r e nt l y ne ve r r e c e i ve d. Wi t hro w i s a p articu larly p ro b lem atic citatio n for a p p ellan ts, 3 as the Ninth C i rc ui ts pec i fi c al l y di s t i ngui s he d bet weenthe i ni t i a l r e me d y a n d e n f o r c e me n to fth a tr e me d y i n c o n t e m pt p ro ce ed in g s. Wi t hro w , 9 4 2 F .2d at 1388 ( “A s w ith any p rogram o fth i s s i z e , a fe w i n a dv e r t e n t err or s ar e i n e v i t a b l e , a n d we (co n tin u ed ...) about w hetherthe fi l es w er e o r w er e no t in com pli ance wi ththe regul at o r y s ta nda r d i nc o r po r at ed i nt o the co ns en t dec r ee . ( The di st r i ctco ur t’ s unc er ta i nty abo utthe appl i cabl e r egul at o r y s ta nda r d i s co ve red in the ne xt sect ion.) A p p ell an ts urge us to read the d istri ct cou rt’s i den ti fi cati on o ff our l ess - than- com ple te appli cati ons as an i m pli ci t fi nd i ng tha t Ind i ana M edi cai d i s no t col l ecting co m ple te m edi calhi sto ries a nd i s in vi ol ati on o f the c o ns e nt de c r e e . W e wi l l no t b a s e a c i v i lco ntem pt 2 or der o n an i m pli ci t fin ding w hen the dist ri ct c ourtdecl i ne d t o make tha t fi ndi ngo n the r ecord o r b as e a co ntem p t orde r up on it, how ever. Se cond, w ith r esp ect to the l ega lst andard, the case l aw tha t appe l l a nt s c i t e d o c c ur r e d o ut s i de the c i v i lc o nt e mpt conte xt; tho se case s s ought i nj uncti ve orequi tabl e reli ef f o r uns et tl ed ca se s. The y a r e thus s wappi ngthe 318 N o. 08

- 3592

(

. . . c on t i nu e d) 3 are con fide nt th at the d istrict cou rt w ill not exe rcise its equit abl e po we r s t o ho l d the s t a t e i n c on t e m ptf ore ve ry m inor, i nad vertenti nf ract ion oft h e A cti fthe court is s ati sfie d tha t t h e o fficials are co m p lyin g w ith th e A ct as strictly as is h u m a n ly p o ssi b le .”). sta nd ar d fo r ci vi lco ntem pt w i th the st anda rd fo r i ni ti al i nj unc ti ve r el i ef

. Appel l an ts anti ci pat e th i s o bj ec ti o n, a nd ar gue in a foo tn ot e in thei r bri efthatthi s co urt cannot f ai r l y s ubj ec t m o ti o ns s ee k i ngt o e nf o rce th e co ns en t dec r ee t o a hi g he r b ur deno fpr o o ftha n the l aws ui t se ek i ng re l i efi n the firs t i nstance
. That a rgum ent c onfl ate s a stan d ard used to d e term ine an i njury w ith a stan d ard us ed to me asu re the e ffi ca cyo fa r emedy, ho wev er . The appell ants’ posi ti on i s that the f ai l ure to f ol l ow r egul at o r y pr o ce dur es i nfl i ct s ani nj ur y o n the m ; t o the extent that thei r al l eg at ions ar e t rue, thei r i nj ury does en ti tl e th em to e qui tabl e r el i ef

. The e xistence o fthe conse nt decr ee i n thi s ca se, howev er, m eans that they al re ady have that r elief

. The i ssue at thi s s tag e i s whether w e ca n hol d the Ind i ana pro gr am i n ci vi lco ntem pt f or no tt a k i nga dequate s t e ps t o i mpl e men ttha tr e med y an d , for the re aso ns disc ussed abov e, a dist ri ct cour t is enti tl ed to r equi re cl ear erand m or e co nvi nci ng ev i dence ofnon- com pli ance bef or e i m posi ng co er ci ve sancti ons. Thus , e ve n i fwe di d whata ppel l an ts ask us t o do a nd took the four “l ess than com ple te” appli cati ons as an i m pl i ci t fi ndi ngthat Ind i an a fel ls ho r t o fthe t er m s o fthe conse nt decr ee i n so m e ca ses , thatfi nd i ng would not ne c e s s a r i l y j us t i fy the c i v i lc o nt e mptsanc t i o ns tha ta p-N o. 08

- 3592 19 pel l ants see k. W e a gr ee w i th the di str i ct c ourtthat, gi ven the pr ese nt co ntext, tho se sancti ons ar e no t warr anted b a s e d o n the e v i de nc e p r e s e nt e d.

C. W he t he rt he di s t r i c tc o urte r r e d b yno ti nt e r pr e t i ng
“ c o mpl e t e me di c a l hi s t o ry ” a s a l wa y s r e qui r i ng c o pi e s o fa t r e a t i ngph y s i c i a n’ s r e c o r ds Appel l an ts ’ fi nal is su e i n thi s appe ali s whethe r the d ist r i ctc o ur t m ade a n e r r o r o fl aw b y i nt er pr et i ngthe phrase “co m ple te m ed ica l hist or y” i n the conse nt decr ee to m ea n som ethi ng l ess than copi es ofthe m edi cal re c or d s of ea c h tr ea tm en t sou rc e of a g ive n ap p lica n t. T h is iss u e p er ta in s t o th e fiv e a p p l i c at ion files t h at co n ta in com ple ted co pie s o fFo rm 25 1A but do not conta i n copi es ofthe tr eat i ng physi ci an’ s m edi calrec or d. A pp el l ants ar gue no w tha t th e d istri ct c o ur t er r ed byno t co nc l udi ng th at t h ose fi l es do not conta i n the com ple te m edi cal hi sto ryr equi re d by the r egul ati ons. Once a g ain, the c o ns en t dec r ee r equi r es tha t th e admi nist ra to rs of Ind ian a M ed i c aid d ev elo p rec or d s u se d in el i gibi l i ty deci si ons i n the sam e w ay that the S SIpro gr am devel ops r eco rds foreli gibi l i ty deci si ons. The Code of Feder al Regul ati ons provi si ons f o r that prog ra m prom i ses appli cants that, “we w i l ldevel op yo ur co m ple te m edi ca lhi st o r y f o r a t l ea st th e 12 months pr ec edingthe m on th in w h ich you file yo u r ap p lica tio n u n l e s s t h e re is a r eason to bel i eve thatdevel opm ent o fan e ar l i erper i od i s nec ess ar y o r unle ss you saythatyo ur di sabi l i ty bega n les s t h an 12 m on th s b efo re you filed you r ap p l i c a tio n .” 2 0 C

. F

. R

. § 4 1 6

. 9 1 2 ( d )

. Wi th r e s p e c tt o th e p h r a s e “ c o m-20 N o. 08

- 3592 ple te m edi calhi sto ry, ” the r egul ati ons define thatas f ol l ows: By com ple te m edi calhi sto ry, we m ean the r eco rds o f y o urmedi ca ls o ur ce ( s) c o ve r i ngatl ea stthe 12 months pr e c e di ngthe mo nth i n whi c h y o u fi l e y o ura pp l i cati on. I fyo u saythatyo ur di sabi l i ty beg an l ess than 12 m on th s b efo re you filed y ou r ap p lica tio n, w e w ill d e v e l o p y o u r c o mpl e t e me d i c a lh i s t o r y b e g i n n i ng w ith the m onth y ou sa y y our disabi l i ty bega n unle ss w e hav e r eas on t o bel i eve thatyo ur di sabi l i ty began earli er. 20 C.F.R . § 41 6. 912( d)( 2)

. A pp el l ants cl ear l y b el i eve that the phra se “com ple te m edi calhi sto ry ” m eans physi cal copi es ofthe physi ci an’ s o w n reco rd s, go i ng ba ck at l eas t twe l ve months bef o r e th e dat e o fthe a ppl i ca ti o n. Indi an a cl ear l y o perat es und erthe i ncom patibl e be l i efthat F o r m 2 5 1 A s uffi c e s a s a c o mpl e t e med i c a l hi s t o r y, si nce i t g ather s info rm ati on from e ach o fthe appli cants’ tr eat
m ent pr ovi ders f oratl eas t the p re vious tw el ve m onths. The dis tr i ct c ourtwas unabl e t o sor t o ut thi s di sag re em en t b as ed on th e p ar tie s’ p re se n ta tio n s. It in vit ed ap p ell ants to re - fi l e thei r conte m pt peti ti on a l ong w i th ev i dence ela b or at in g on th e m ea n in g of “ c om p let e m ed ica l his to ry .” S pec i fi ca l l y, the di st r i ct courtwas i nt er es te d i n r ec ei ving ex per t o r o th ert es ti m o ny o n “ whethe r the a ppl i ca ti o ns th ati n c l u d e d o n l y F o r m 2 5 1 A, o r th e o th e r a p p l i c a t i o ns that w er e o ther w i se l ess co m prehensi ve, ar e ‘ com ple te’ en ou gh to co nfo rm to the conse nt decr ee. Fur ther m or e, we r equi r e a fa ctua le xpl i ca ti o n o fwhatpr ec i se l y the M edi cai d syst em i nstr ucts physi ci ans t o d o and take ac c ou n t o f in c om p let in g F or m 25 1A .”N o. 08

- 3592 21 T h e a p p ella n ts u rg e u s t o re ve rs e t h i s p ar t o f th e d ec isi on, cl ai m i ng tha t thi s inter preta ti on o fthe conse nt decr ee vi o l at es the p lai n mea ni ngo fthe t er m s as wel la s th e dec i si o ns ofco ur ts tha t ha ve re vi ewe d the mean i ngo fthe re l evantC. F. R. pro vi si ons. They ci te, am ong othe r thi ngs, th e di ct i o na r y de fi ni tion o fc o m pl et e ( m ea ni ng“ ha ving al l par ts o r el ement s; l ac k i ng no th i ng ”) , a nd t wo o pi ni o ns fro m the Se cond Cir cui t r eve rs i ng a n agency’ s e l i gibi l i ty deter m i nati on because som e m edi cal re cor ds w er e m i ssin g. Se eRos a v. Cal l ahan , 1 68 F.3d 72 ( 2d Cir. 1999); Pr at t s v. C ha ter, 94 F. 3d 34 (2d C ir. 1996). A co ur t i nt er pr et s th e m ea ni ng o f a co ns en t dec r ee i n the s a me wa y i ti nt e r pr e t s the me a ningo fa cont r a c t, a nd a re vi ew i ng co urt exam i nes that inter preta ti on de no vo. G oluba , 45 F. 3d at 1037 -38. Of cour se, bec ause these r egu lat ion s w er e o n ly gr aft ed on to th e In d i an a M ed ica id p ro gr am as p ar t o f a c on se n t d ec re e, n o c ou rth as p re viousl y inter prete d w hat “ com ple te” m eans i n thi s e xact contex t, and the dist ri ct c ourto bvi ousl y fel t unabl e t o re ach a c oncl usi ve i nter preta ti on ba sed o n the evi dence prese nted i n the conte m pt peti ti on. This c irc uithas not re ad “co m ple te” in the stri ct ter m s that the app el l ants do, how eve r. In past case s, wh er e S SIappli cants w hose appli cati on was deni ed by an A L J cl ai m ed a v i ol ati on o f the du t y t o de v e l o p a c o mpl e t e r e c o r d, we ha v e s a i d that o urco ur t “ g en er al l y uphol ds th e r ea so ne d j udg m en t o fthe Com m i ssi onero n h ow m uch evi dence to ga ther, ev en w hen the cl ai m ant l acks r epres entat i on. ” Ne l m s v. A st r ue, 55 3 F .3 d 10 93 , 109 8 (7 th C ir. 20 09 ); se e also Luna v. Shalala , 2 2 F

. 3 d 6 8 7, 6 9 2 ( 7 th C i r . 1 9 9 4 ) ( “ T h i s c o u r th a s c o mm ented o n the diffi cul ty ofhaving a ‘ com ple te’ r eco rd as22 N o. 08

- 3592

‘ one m ay al w ays obtai n anothe r m edi calexam i nati on, se ek the vi ew s of one m or e consul tant, w ai t si x m onths to see w he th er the claim an t’s cond iti on ch an ges, and so on.’ ”). The re gul ati ons al so pla ce a t l eas t par t o fthe burden f or g athe r i ng th e r el ev an t m edi ca l r ec o r ds o n th e a ppl i ca nt ra therthan on the ag ency. “In gene ra l, yo u have to prove to us thatyou a re bl i nd o r disabl ed. Thi s m eans that you m ust furni sh m edi caland other evi dence thatwe c an use to rea c h co n c l u sio n s a b ou t y ou r m ed ica l im p air m en t(s ).” 20 C. F

. R. § 4 16

. 91 2( a)

. W hi l e th e r egul at i o ns t askthe agen cy w ith th e resp ons ibi li ty to d evelop an ap p li can t’s m edi calhi sto ry, theydi scuss thi s in ter m s o fa du ty to m ake a “reason able e ff ort” to d o t his. “W e w il l m ake every re asonable ef

fort to he lp y o u g etmedi ca lr epo r ts fr o m y o ur own m edi calso urces wh en yo u gi ve us p er m i ssi on t o re q u es t t h e re p or ts .” 20 C .F.R . § 41 6.9 12 (d ) (em p h as is adde d)

. Indi an a, i n rel i an ce o n the se po r ti o ns o fthe regu lations, interp rets th e con sen t d ecree m uc h m ore narr owly, and a rgues that bytr ai ni ng ca se w or ker s t o in te rv iew M ed ica id ap p lica n ts an d re q u es tin g a n ap p licant’ s m edic al h i sto rytheyfulfi l lthei r burden und er th e re gu lat ion s w ith res p ec t t o th e c olle c tio nof a p h ys ici an’ s r eco rds. A pp el l ants’ p osi ti on that a Form 251A d oes notsuffi ce a s ana ppl i ca nt ’ s “c o m pl et e m edi ca lhi st o r y ” wi th i n the m ea n in g of20 C. F. R. § 416. 912( d)( 2) i s ba sed o n an as sum pti on that the d oc u m en t i s defi ci ent in so m e r espect, orthata physi ci an’ s r eco rds c ontain m at er iali nfo rm a-N o. 08

- 3592 23

A p p ellan ts arg u e tha t a Fo rm 251 A is d eficient b e c a u se it i s 4 no ta “ r e c or d” un de r I nd i a na l a w, be c a use the I nd i a na Co de d efines “m ed ical reco rd s” as files “p ossessed ” b y h e alth c a r e pr ov i de r s be f or e the y a r e tur ne d o ve r t o the s t a t e . I nd

. Code. § 1- 1- 4- 5( 6)

. Fi rs t, appe l l ant s do n ote xpl ai n why I ndi ana law should in f orm the m eaning ofa t erm used i n the federal r e gu l a t i on s. W e un de r s t a nd tha tl oo ki nga tthe I nd i a na Co de m ay i l l um i nat e how th e p ar t i es unde rs t ood the t er m , but appe l l ant s othe rwi s e u rg e thi s c our tt o a dopta s t ri c tr ea di ng ofthe te rm as i t i s const rued b y courts i nter pre tin g t he federal regulat ions the m se lves

. The Indiana Cod e wo uld b e ofl im it ed val ue i n thate xe rc i s e. Se c ond, appe l l ant s d o note xpl ai n h ow the f ac tofpos s es s i on m ake s a s ubs t ant i ve di ffer en c e i n the com p leten ess of an a p p lican t’ s file if, for instan ce, the fil e c ont ai ne d a f or m c om pl et ed by a h ea l th c ar e pro vi der c ontain ing all of the relev an t inform atio n in the p ro v id er’s fil es. tion not cap tu red i n Form 2 5 1 A

. A s the district cou rt 4 not ed , how ever, th ere is not en ou gh inform atio n before th e co ur t to r eac h a de te r m i na ti o n o n tha t i ss ue . The re gul ati ons re quir e bo th the ap p licant and the a gencyto devel op a re cor d suffi ci ent forthe age ncy t o m ake an i nfo rm ed d ete rm i nati on about the a pp l i cant’ s di sabi l i ty. B as ed on th is rec or d w e are n ot p re p ar ed to h old ca te go rical l y that an age ncy can neveru se a sum m ar y fo rm wh en dev el o pi ngtha t r ec o r d o rtha t th e ab se nc e o fa ny do cum ent fro m a physi ci an withi n the l asttw elv e m onths, w hatev eri ts re l evance , i s a vi ol ati on o fthe re gul ati ons. W hi l e the cas e i s s i m plyunderdevel op ed on thi s point, ou r ru lin g d oe s n otfore c los e a l l fu tu re cla im s o n th is i ssu e fr o m a pp e l l a nt s . T he di s t r i c tc o ur ti nd i c a t e d a w i l l i ngness to enter tain furtherpeti ti ons and to e ngage24 N o. 08

- 3592 i n gr eat erf act- fi nd i ng on t h e m eani ng o f“co m ple te m edi cal hi sto ry ” und er the ter m s of the conse nt d ec ree, i ncl ud i ng g ather i ng i nfo rm ati on about how tho ro ugh he alth care p rovide rs hav e been w he n filling out Form 25 1A. Thi s m atte r pr es en tly c o m es b efo r e us a s a co nte m p t p e tit ion, ho w ev er , w h er e t h e s alie n t is su e is w h etherappel l ants have prese nted suffi ci ent e vi dence th at th e In d ian a M ed icaid p rogram has violated a court or der. W e a gr ee w i th the di str ict co urt that they have not sat i sfi ed that burden atthi s point.

I I I . Concl usio n Forth e for ego i ng r eas ons, we A FFIRM the deci si on o f the di str i ct c ourt
.

6- 8- 09