UNITED STAT ES DIS TRICT COURT F OR THE D ISTRIC T OF CO LU M BIA OSCAR SALAZAR, e t al., : : P lai nt iffs, :

: v. : Ci vi l A cti on No. 93 -45 2 (GK) : DISTRICT OF COLUMBIA, et al., :

: De fend ant s. : M EM OR

AN DU M OP IN ION The District of Columbia has filed a Motion to Vac ate the Court’s Orde r Gra nting Injunctive Relief Dated Octobe r 18, 2004 (“ Motion to Vacate the Denta l O rder”) [Dkt. No. 1153]. Upon

c on sid e ratio n o f t

he Mo tio n, Op po sit ion , Re ply , Surr e ply , Su pp le me nta l B ri e f, the many e xhibi ts submitt ed by the parties, and the long, tang led, and complex history of this important cas e w h ich focuse s on the provision of medica l service s to p o o r children in the District of Columbia, De fe nd ants ’ M oti on

is denied

. I. P ROCEDURAL HISTORY I n1 9 9 3 , P l ai n t i ff

s b ro u gh t t h i s fa r- re ac h i n g cl as s ac t i o nt o p ro v i d e a n d arra n ge f o r a ra n ge of medica l service s, g uara nteed unde r the fe dera l Medicaid statute, 42 U.S.C. § 1396, et seq., to poor

c hil dr e n in

the Di str ic t of

Col umb ia . D ur ingle ng thy pr e -t ri a l pr oc e e din g s b e for e J ud g e No rm a Holloway J ohnson, to whom the case was orig inally assig ned, discovery was completed, a nd many motions (both dispositi ve and non-dispositive) wer e decide d. There afte r the parties settled sever al

c la ims pr ior to tr ia l wi th the he lp of a me diator a pp oin te d un de r the Court ’s Al ter nat iv e Di sp ute Re so lut ion

Pr og ra m.Over the y ear s, the parties ha ve ag ree d u p o n a n u m ber of relatively

minor and 1 technica l chang es to the Settlement Orde r. Those chang es have alway s been inc orporated into the Se ttl e me nt O rd e r b y

Con se nt O rd e rs . -2- I n Ju ly o f 1 9 9 4 , th e c a s e w a s r e - a s s ig n e d to th is Ju d g e . A f te r a s e v e n - d ay tr ia l in April of 1996, this Court issued a 56-pa g e opinion finding Def endants to be in violation of seve ral provisions of the Medic aid statute. See Salazar v. District of Columbia, 954 F. Supp. 258, 334 (D.D.C. 1996). B y the tim e of

tr ia l, m any

of t he issue s p le d in

the or ig ina l Co mpl a int

ha d b e e n s ub sta

nti a lly

narr owed an d t h e trial it self foc used primar ily on whether

Def endants we re c omply ing w ith the statute’s re quirement to provide E PSDT services ( “ea rly and per iodic, scre en ing, dia g nostic, and tr e a tme nt s e rv ic e s” ) t o c hil dr e n e nti tle d to the m. Sin c e that time , th e pa rt ie s h a ve fo c us e d v ir

tua lly all their attention on the EPSDT issue. Th e Di str ic t of

Col umb ia too k an a

pp e a l fr om t

he de c isi on . O n th e e ve of or a l argume nt i n the Court of Appe als, the parties enter ed int o a detailed and complex ag ree ment. A public hea ring was he ld. On J anuar

y 25, 1999, afte r var ious procee dings, the Court approve d and ente red the parties’ final settlement as a n Orde r Modify ing the Amended Remedial Orde r of May 6, 1997 and Vac ating the Orde r of Ma rch 27, 1997 ( “the S et t l ement Or der” ) [Dkt. No. 663] . Since that date, J anuar y 25, 1999, the S ettlement Order, which contains seve ral provisions re lating to de ntal service s for c lass members, ha s been the g overningdocument in this case. 1 On April 23, 2004, Plaintiffs filed a Motion to Enforc e the Settlement O rder of January

25, 19 99 and the Or de r of F e br

ua ry 28 , 200 3, Con c e rn ing De nta l Ser vic e s [Dkt. No . 101 0]. Af te r f ull br ie fi ng , o n O c tob e r 1 8, 2004 , th e Court g ra nte d th e Mo tio n in

larg e pa rt and iss ue d it s Memorandum Opinion and D ental Or der ( “De ntal Orde r of October 18, 2004” or “ De ntal Orde r”) [Dkt. No. 1034] . The District of Columbia took an a ppeal on De cembe r 4, 2004; howeve r, onThe Court is well aware that the District of Columbia has filed a Petition for 2 Mand a mus in t

he Court of Ap pe a ls b e c a

us e its Mo tio n to Vacate has no t bee n d e c ide d. Th a t is cer tainly its procedur al rig ht, and the Court under stands and sy mpathizes with i ts desire to re solve as so on as feasibl e the e xten t and sc op e of the Go ve rnme nt’ s o bli g a tio n to pr ov ide de nta l c a re to c la ss m e mbe rs . Howeve r, in brief

explanation of what has admittedly been a very leng thy delay , the Court mus t no te that the un de rl y ingDe nta l O rd e r, the e nf or c e me nt i ssu e s r e la tin g to i t, a nd the Mo tio n to Va c a te , h a ve ne ve r b e e n ig no re d. Th e re have be e n e xten siv e and fr e qu e nt i nf

or ma l di sc us sio ns wi th the par ties, the Court’s Monitor Dr. He nry T. I rey s, and the Court, about re solution of the substantive issues, of the administrative diff iculties in carr

y ing out the p ro v i sions of the Denta l Order , and of the profound technica l pr oblems conce rning measure ment of complianc e with the De ntal Orde r as well as with other pr ovisions of the Settlement Orde r. Dr. I rey s has i ssued t hree repor ts reg arding dental ser vices in the District of Columbia. See June 17, 2003, Meth o d s Used by the District of Columbi a and the Manag ed Care Org anizations to I n form Medic aid Recipients about Pre ventive Dental Ser

vices; January

27, 2006 Strateg y to A chieve I mplementation of Parag raph 2 of the De ntal Orde r of Oc tober 18, 2004; and Febr uary 2008 Report on the District of Columbia’s EPSDT Prog ram with a f

ocus on dental ser

vices for children. O n pag e 1 of the 2006 Report, Dr. I rey s noted that the “pa

rties in this case a g ree that the majority of childre n in the District of Columbia’s EPSDT prog ram a

re not re ceivingadequate dental car e.” He also stated at pag e 1 that ac cordingto official r e p o rt s w h i c h D e f

e n d an t s h a v e f

i l e d w i t h t h e f e d e r a l G o v e r

n m e n t( a l t h o u g h t h e p art i e s h a v e a l w a ys acknow ledg ed that the a ccur acy of these of

ficial re ports is questionable), “ 73 perc ent of the EPS DTelig ible children a g ed 3 to 20 y ear s rec eived no preve ntive dental ca re a nd 68 perc ent re ceive d no dental ser vices at all” (e mphasis added)

. (continued...) -3- Janu ary 27 , 2 00 5, it re qu e ste d the Court of Ap pe a ls to hold its a pp e a l in a be y anc e a s it

“ e xpe c t[s] to f ile in t he ne ar f utu re a mot ion [in the dis tr ic t c ourt ] t o d iss olv e that in jun c tio n. ” Mo tio n to Ho ld Appea l in Abey ance , Court of Appea ls, District of C olumbia Circuit, No. 04-7200. No such motion

was e ver f

iled in this Court. On Dec ember 2, 2005, the District of Columbia withdrew its appea l of the Denta l Order

. On May 26, 2006, the District of Columb i a fi l ed t h e present Motion to Vacate the De ntal Orde r. Plaintiffs filed t heir Oppositi on on J uly 7, 2006, Def endants re plied on September 12, 2006, Plaintiffs filed a Sur-Reply on Dec ember 14, 2006 and a Supplemental Br ief on Apr il 4, 2008. Oral argument was he ld on J anuar y 12, 2007. 2(...continued) 2 At times the parties -- sometimes on their own and sometimes with Dr. Irey s’ help -- have ma de g oo d f

a ithe ff or ts t o r e so lve the ir

dif fe re nc e s. Th e Cou

rt str on g ly e nc oura g e d a ll of

the pa rt ie s’ informal ef

forts bec ause of

the complexity

of the c om p l i an ce issues, the importance of providing such ser vices to the c hildren of the D istri ct o f Columbi a who a re e ligible f

or them and a

re not rec eiving them, and its belief that it was f ar better for the parties to c raf t a solution they

could live with rather

than have one imposed on them by court orde r. All of these eff orts took time. -4- II. AN AL YSI S I n its Moti on to Vacate, the De fenda nts arg ue that th e Dental Orde r is not supported by evidenc e that the Settlement Orde r was violated or that the D istrict of Columbia has failed to provide

and arr ang e fo r a

pp ro pr ia te de nta l se rv ic e s w he n r e qu e ste d, and that th e inj un c tiv e re lie f o rd e re d is not tailored to cure a Constituti onal or statutory violation. I n ad d i t i on, the Def endants make the curious ar g ument that by mandating the provision of dental s er v i ces w hich ar e re quired by the Me dic a id s ta tut e , th e De nta l Ord e r is “ imp ing [ing ] upo n th e fr e e wi ll o f t he Me dic a id r e c ipi e nt t o forc e denta l car e participation. The District cannot and should not be order ed to ensure that ever y Di str ic t c hil d wh o may

be e lig ibl e fo r E PSD T s e rv ic e s a c tua lly re c e ive the se se rv ic e s. ” Mo t. t o Vac ate, at 8. A. There Is No F ederal Rule of Civil Pr ocedure A uthorizing Defend ants’ Motion at this Late Date , More than 19 Months af terEntry of the Dental Order Def endants have fa iled, in their opening Motion pap er s , t o cite any authority whatsoeve r under e ither the F eder al Rules of Civil P roce dure or case law which w ould aut h o ri z e the filing of their Motion to Vacate the De ntal Orde r, more tha n 19 months after its entry . They had numer ous

o p p o rtu n i t i e s t o s e e k

r e c o n s i d e r a t i o n , r e v e r s a l , o r m o d i f i c a t i o no f t h e O r d e r

an d f a i l e d t o d o s o . It is now simply

too late, bec ause of

Def endants’ ine x plic ab l e d el ay , to relitigate issues which we re fully briefe d and dec ided more tha n five y ear s ag o.I n 2009, the dea dline was e x tended to 28 day s. Fe d. R. Civ. P . 52(b). 3 -5- I n their Reply

to Plainti ffs’ pr ocedur al arguments, Def endants argue, for

the first time, that “re sulting orde rs [from mot i o n s to enforc e a c onsent dec ree ] do not take on the c hara cter of a jud g e me nt” and

the re fo re the Court ha s “ e qu ita ble po we r” to va c a te the m fo r re a so ns no t sp e c if ic a lly provided in the Fede ral Rul es of Civil Procedur e. There is no leg al s upport for that proposition, nor would the fa cts justify

its application in this i nstance if such leg al support exist ed. 1. The Fe deral Rules of Civil P roce dure An e xami natio n o f t

ho se F e de ra l Ru le s w hic h mi g ht a uth or ize the Mo tio n t o Va c a te de mon str a te s w hy

De fe nd ants have fa ile d to c ite any of the m: D e fe nd ants ha

ve fa ile d to me e t th e ir

re qu ir e me nts

. a. Rules 52 and 59 Rul e 52 (b ) a llo ws a

pa rt y to f ile a mot ion to a me nd a c ourt ’s fi nd ing s, bu t su c h mo tio n mu st be “f iled no later tha

n 10 day s after

the entry of judg ment.” District of Columbi a v. Stackhouse,

3 239 F.2d 62, 65 ( D.C. Cir. 1956). See Ha rvest v. Cast ro, 531 F .3d 737, 745 n. 5 (9th Cir. 2008); Ver ma v. Unit ed S t at es, C iv. No. 87-2294, 1992 WL 611259, at *1 (D.D .C. Aug . 26, 1992). Ob vio us ly , f

ili ngthe Mo tio n 1 9 mo nth s a ft e r en tr y of jud g me nt f

a ils to m e e t th e 10 -d ay

re qu ir e me nt. Moreove r, use of

Rule 52 cannot be a subst itute for an a ppeal. “ A par

ty who fa iled to prove his [or her] strong est ca se is not e ntitled to a second opportunity to litig ate a point, to present evidenc e that

was available but not pre viously offe red, or

to advanc e new theories by moving to ame nd a par

ticular finding of fa ct or conclusion of law.” 9C Wright, et al., Feder al P rac tice and Procedur e, § 2582 (3d ed. 2009). G uiterre z v. Ashcroft, 289 F . Supp. 2d 555, 561 (D.N.J. 2003). Nor c an Defenda

nts rely on Rule 59. Once ag ain, t he Rule provides that any motion to alterI n 2009, the dea dline was e x tended to 28 day s. Fe d. R. Civ. P . 59(b). 4 -6- or ame nd a judg ment “must be filed no late r than 10 day s afte r entry of the judg ment.” Fe d. R. Civ. 4 P. 59(e). Ag ain, Def

endants fa iled to meet t h e 1 0-day require ment. As with Rule 52, Rule 59 motions “[ m] ay not be used to relitig ate old matter s, or to raise a rg uments or pre sent evidenc e that

c o u ld h a v e b e e n r a is e d p r io r to th e e n tr y o f ju d g me n t. ” 1 1 Wr ig h t, e t a l. , F e d e r a l Practice and Procedur e, § 2810.1 (2d ed. 2009). Ex x on Shipping C o. v. Ba ker, 128 S. Ct. 2605, 2617 n. 5 (2008); Kattan by Thomas v. District of C olumbia, 995 F.2d 274, 276 (D.C. Cir. 1993); Klay man v. J udicial Watch, I nc., Civ. No. 06-670, 2007 WL 1034936, at *2-3 (D.D.C. Apr. 3, 2007); United S tates v. Western Elec . Co., I nc., 690 F . Supp. 22, 25 (D.D.C. 1988). Thus , n e ith e r R

ule 52 no r Rul e 59 c an su

pp or t the fi lin g of the Mo tio n to V a c a te . D e fe nd a nts have missed the f

iling dea dlines, and ar e makingthe s ame arg uments which they made - - and lost-- in the underlying Motion to Enforc e.

b. Rule 60 Rul e 60 (b ) p ro vid e s si x potent ial ave nu e s f or re lie f f or De fe nd ants , n on e of

wh os e require ments they can satisfy

. Above all, Rule 60(b), like Rules 52 and 59 “ is not a substit ute for

a pp e a l, a n d m o t i o n s u n d e r t h e r

u l e h a v e b e e n d e n i e d w h e n m a d e t o a v o i d t h e p art y ’ s d e c isi on to settle the litigation or fore g o an appe al, af t er a deliberate dismissal, or whe n the def endant voluntarily

elec ts not to appeal.” 11 Wright, et a l., Fede ral Prac tice and Proc edure , § 2851 (2d ed. 20 09 ) ( e mph a sis a dd e d) . H e re , th e Di str ic t of Col umb ia

c ho se to ap pe a l th e Or de r, a s is its ri g ht, and then voluntar ily chose to seek a stay from the Court of Appeals until it could fil e some unnamed mot ion wi th t his Court , ne ve r fi le d any su c h mot ion , and the n v olu nta ri ly c ho se to d ism iss its a

pp e a l. Such actions ar e har dly

within the purview of Rule 60( b) which, in addition to prec luding its use as-7-

a substitute for appe al, also re quires that such m o t i o n s be filed “ within a rea sonable time” a nd “within a y ear

afte r the e ntry

of the judg ment” for

motions broug ht pur suant to Rule 60(b)(1) , (2), and (3) . See Ac kerma

nn v. United States, 340 U.S. 193, 198 (1950); Twelve J ohn Does v. District of Columbi a, 841 F.2d 1133, 1141 (D.C. Cir. 1988) ; F riedman v. Wilson Fre ight F orwa rding Co., 320 F.2d 244, 247 (3d C ir. 1963) (failure to raise an available contention by a dire ct appe al, followed by an attempt to litigate the matter unde r Rule 60(b), is not a pr oper use of that Rule). Plainly , Subsections 1-4 of Rule 60(b) do n o t ap p l y ; nor do De fenda nts assert that any

of t h e s e p r o v i s i o n s d o a

p p l y. Rul e 60 (b )( 5) a

uth or ize s a mot ion fo r re lie f fr om a fi na l jud g me nt wh e n “ a pp ly in g it prospec tively

is no longe r equitable.” Rule 60(b) moti ons “shall be made within a re asonable time.” As rec ently as last y ear , in H orne v. Flore s, 129 S. Ct. 2579, 2596-97, (2009) the Supreme Court re

aff irmed the vitality

of Rufo v. I nmates of Suffolk County J ail, 502 U.S. 367, 368 (1992), the le ading

case setting forth the s tandar ds for modify ing a final judgme nt under Rule 60( b)(5) in insti tutional ref orm ca ses. I n Rufo, the Supreme Court he ld that the “par ty seekingmodification of a c onsent dec ree ” bear s the burden of

establishing “ t h at a s i gn i fica nt chang e in fa cts or law w arr ants revision of the decr ee and that the proposed modific ation is suitably tailored to the c hang ed cir cumstance .” I d. at 393. I n discussing Rufo, the Flore s opinion noted that “[s] atisfac tion of an ea rlier judg ment is one of the e nume rate d b a se s f

or Rul e 60 (b )( 5) re lie f, ” a lth ou g h it ma de c le ar that it wa s not the on ly ba sis for suc h relief

. Flore s, 129 S. Ct . at 2597 (e mphasis in origina l). I np arti c u la

r , th e Su p r e me Co u rt in Rufo e xp la in e d th a t R u le 6 0 ( b ) ( 5 ) d o e s n o t a

u th o r iz e relief just because “ it is no longe r convenient to live with the t erms of a consent de cre e.” I d. at 383.I t is tr ue tha t Ru fo inv olv e d mo dif

ic a tio n o f a

con sen t de c re e , w he re a s in thi s c a se 5 Def endants see k modification of a final court orde r ente red in orde r to ac hieve c ompliance with the underlying consent decree (the S ettlement Order). Howeve r, t here is nothing in Rufo to sug g est that its Rul e 60(b) (5) requireme nts would not apply to the proc edura l posture of this case . I ndeed, the Court specifica lly

noted that conse nt decr ees a re a g ree ments that “will be re flected in, and be e nf or c e a ble a s, a jud ic ia l de c re e that is su

bje c t to the ru le s g e ne ra lly a pp lic a ble to o the r j ud g me nts and dec ree s.” I d. at 378. Whi l e Defenda

nts arg ue that ther e is a distinction betwee n an orde r enf orcinga conse nt de c re e and the c on se nt d e c re e its e lf , a nd that th e Cou

rt ha s th e “ inh e re nt e qu ita ble a uth or ity to int e rp re t and e nf

or c e the c on se nt de c re e ou tsi de the c on te xt of Rul e 60 ,” De fs .’ Re ply , at 2, the y c ite only one ca se for

that proposition, Pi g ford v. Ve neman, 292 F .3d 9 1 8 , 9 2 3 (D.C. Cir. 2002). Howeve r, that ca se say s nothing of the ki nd. Rather, it say s that “[d] istrict courts possess two ty pes of authority

over c onsent dec ree s. First, they m ay interpre t and enf

orce a dec ree to the extent authorized either b y

the dec ree or by

the re lated orde r . . . . Second, the y may modify a dec ree pursuant to Fe dera l Rule of C ivil Procedur e 60(b)(5).” Pigfor d, 292 F.3d at 923 (citing Rufo, 502 U.S. at 378-79). The re is no mention in Pigfor d of the “ inhere nt equitable author ity to interpret a

nd enfor ce the consent de cre e outside the c ontext of Rule 60.” Quite the contra ry -- Pig ford r ever sed the district court’s g rant of a Rule 60(b)(5) mot ion and held that “the district cour t’s interpre tive and enfor ceme nt authority

depends on the terms of the de cre e and r elated c ourt order , rathe r than on some ‘anc illary ’ or ‘ inhere nt power.’ ” Pigf ord, 292 F .3d at 925. Def endants a lso arg ue that the De ntal Orde r is a modification of the Settlement Order . That is simpl y not c orre ct. The Dental Orde r resulted from Plaintiffs’ Motion to Enforc e the Settlement order of J anuar y 25, 1999 and the Or der of Fe bruar y 28, 2003 ConcerningDental Ser vices. I t was wh a t it wa s ti tle d - - a

Mo tio n to e nf

or c e Para g ra

ph37 of the Se ttl e me nt O rd e r, no t to mod if y it. -8- Nor, it continued, sh o u l d m o d i fication ordinarily be g rante d when a

party relies upon e vents that

wer e anticipated when the decr ee w as ente red. I d. at 385. Rather, the Rufo Court c are fully delineate d the t hree conditions under w hich modification of a conse nt decr ee unde r Rule 60(b)( 5) may be appr opriate: (1) “whe n chang ed fa ctual conditions [or law] m ake compliance with the decree substantially more onerous,” (2) “whe n a dec ree proves to be unworka

ble because of unfore seen obstacles,” or (3) “when enforc ement of the decr ee w ithout modification would be de trimental to the public interest.” I d. at 384. Def endants do not ar g ue that 5

any of the c on dit ion s h a ve be e n me t - - b e c a us e the y c ann ot.I t is undisput ed that ther e has be en no chang e in the g overningMedica id statute or 6 any possibly rele vant ca se law. Th e De fe nd ants c on c e de that “ [i ]t is a fa c t th a t ut ili zat ion

rate s are no t w hat th e Court , 7 Plaintiffs or the District would like.” De fs.’ Mot. to Vac ate, at 16. -9- First, there is no question that there has bee n no chang e in conditions “which w ould make 6 compliance with the decr ee substantially more one rous.” De fenda nts have alway s known t hat the District of Columbia’s poor children wer e not g etting any wher e nea r the amount of preve ntive dental

c are or tr e a tme nt t o w hic h th e y

we re e nti tled (al bei t ther e have a lw ay s b e e n g re a t di ff ic ult ie s in obtaining tr

uly reliable and ac curate data a bout the number of visits children ma de fo r b o t h kinds of ser vices). See J anuar

y 27, 2006 Strateg y

to Achieve I mplementation of Parag raph 2 of the De ntal Or de r o f O c tob e r 1 8, 2004 (“ Janu ary 27 , 2 00 6 Ire y s Re po rt ” ), a t 1, 14 , 2 2. De fe nd ants have a lso alway s known that there was a n insufficient number of pediatric dentists either ava ilable or willing to treat Medica id children, and that ce rtain ac tions, such as raising reimburse ment rate s, would have to be taken to ameliorate that problem. I d., at 5-8. F inally , Def endants have also a lway s known that pare nts, c ustodians, a

nd g uardia

ns of the childre n would have to be educated about the importanc e of routine pr eventive c are , and that substantial outrea ch would be necessar y to acc omplish t hat task. I d., at 8-10. I n short, Def

endan t s point to no new fac ts or conditions which would meet the Rufo de fi nit ion of “ c ha ng e d f a c tua l c on dit ion s” so a s to “make c omp lia nc e wi th t he de c re e su

bs tanti a lly

more one rous.” Rufo, 502 U.S. at 384. Second, De fenda

nts point to no “unfor esee n obstacles” which would make enforc ement of t h e D e n t a l O r d e r “ u n w o r k a b l e . ” A g a i n , t h e o b s t a c l e s a l r e a dy d i s c u s s e d h a v e e x i s t e d f o rm a n y, 7 many y ear s in the District of Columbia. For e x ample, we have not sudde nly lost a substantialI t mu st b e re me mbe re d th a t D ist ri c t of Col umb ia

law r e qu ir e s th e Ma

y or to e sta bli sh 8 require ments for pe riodic denta l examinations for c hildren ente ring school and to deve lop the nece ssary standard forms for documenting the re sults of the oral hea lth assessments. D.C. Code § 38-602 (2009)

. -10- number of pe diatric de ntists who are willing to treat c lass m em b er s -- a situation which could, arguably , fall under

this ex ception to the g ener al rule. N or, it must be noted, does the District of Columbi a base its Moti on to Vacate on such a justification. Third, the Rufo opinion does state t hat modification of a consent de cre e is appropr iate whe re its enforc ement “w ould be detrimenta l to the public in t er es t .” Rufo, 502 U.S. at 384. Can the Gover nment rea lly

be ar g uing that it would be “ detrimental to the public’s interest” to e nsure that poor childre n see a

dentist once a y ear for pr eventive c leaning s (as the D ental Or der pr ovides) and obtain treatment if neede d? See ¶ 49 of the Denta l Order

. 8 Whil e the Di s t r i c t o f C o l u mb i a d o e s n o t b a s e i t s M o t i o n t o V a c a t e o n t h i s j u s t i f i c a t i o n , it do e s r a ise an argume nt wh ic h mig ht

-- c on c e iva bly

-- fi t un de r t

his ru br ic . T he Di str ic t of

Col umb ia pa int s an Or

we lli an pic tur e in w hic h e nf or c e me nt o f t

he De nta l O rd e r w ou ld r e qu ir e a pate rn a lis tic and author i t ar i an go v ernme nt to, lit era lly , forc e unwilling pa rents to pre sent their childre n for preve ntive dental care and treatment. Such conduct, the Def endants arg ue, would interf ere with the pare nts’ rig ht to participate or not participate in the EPSDT prog ram a nd substitut e the Gover nment’s judg ment for that of pare nts. Def

s.’ M ot. to Vacate, at 8, 19; Def s.’ Reply , at 9-10. This picture is patently

ridiculous. There is not a word in the Dental Or der w hich would interfe re wi th pa re nts ’ Con sti tut ion a l ri g hts to make me dic a l de c isi on s f or the ir c hil dr e n o r t o f

or c e the m to take a dvantag e of de ntal service s that are being made available. What the Dental Or der doe s do is enforc e, with g reat specificity , Parag raphs 36, 49, 52, a nd-11-

5 7 o f t h e u n d e r l yi n g S e t t l e m e n t O r d e r . T h e r e c an b e n o qu e s t i o n t h a t t h e C o u rth a s s u c h a u t h o r i t y. Be ckett v. A i r L ine Pilots Ass’n, 995 F .2d 280, 286 (D.C. Cir. 1993) (it is a “w ell-established princi p l e t h at a t ri al co u rt re t ai n s j u ri s d i ct i o nt o en fo rc e c o n s en td ec re es an d s et t l ement ag

ree ments”). Even if a party is able t o s at i s fy o n e of the three c onditions under which Rufo allows mod if ic a tio n o f a

c on se nt d e c re e , it

mus t th e n s ho w that th e pr op os e d mo dif icati on is s uit a

bly tailored to the c hang ed cir cumstance

. Rufo, 502 U.S. at 383. Putti ng aside the f act that ther e ar e no such cha ng ed cir cumstance s in this case, it is c lear that the Def endants’ proposal to va cate the Denta l Orde r i n its entirety

is certa inly

not “suitably

tailored” to enforc ement of the provisions of the Settlement Order

. P l ai n tiffs corr ectly state that g ranting Def

endants’ Motion to Vac ate the e ntire Dental Or der “ would result in the per petuation of the D istrict’s violation of fede ral EPS DT law a nd para g raph 36 of

the Settlement Orde r.” Pls.’ Opp’n, at 13. F ina lly , Ru le 60 (b )( 5) mot ion s mu st a lso be ma de “ wi thi n a re a so na ble tim e .” I n a

c a se wi th a proc edural p o s t u re simil ar to ours, the Court of Appea ls for this Circuit held that a subsequent mot ion to v a c a te wa s p ro pe rl y

dis mis se d as “s ixte e n mont hs is not ‘a re a so na

ble tim e ’ u

nd e r t he se circ umstances.” Gilmore v. Hinman, 191 F. 2d 652, 652-653 (D.C. Cir. 1951). Give n the circ umstances of this case , wher e an appea l was filed in a timely manner , but then, at the re quest of the Def endants, wa s allowed to ling er f or 10 months before being withdrawn, w ith a total of 19 months elapsing betwee n the i ssuance of t he Dental Orde r and the filing of the pre sent Motion, the Motion is clearly

untimely . What is particularly disturbing is t he fa ilure of De fenda nts to provide any justification or explanation f or their extended delay

. The 19-month delay , combined with the total lack of e x planation, establish that the Motion was not made “ within a rea sonable time.” Rule 60(b)(6) is a catch-a ll provision providing that a motion for modification may be made-12-

for “ any other re ason t h at j u s t i fies re lief.” The Supreme Court has he ld that only exceptional or extraordinary

circ umstances c an justify relief under this subsection of Rule 60. Ac kerma nn v. United States, 340 U. S

. 1 93, 199-202 (1950) ; Twelve John Does, 841 F.2d at 1141. As alrea dy dis c us se d, De fe nd ants have c ite d no su c h e xce pti on a l or e xtra or din ary

c ir c ums tanc e s w hic h w ou ld justify vacating the D ental orde r. Moreove r, just as with the other subsec tions of Rule 60, the moving party can not avoid the

c on se qu e nc es of its fa ilure to a pp e a l “ be c a

us e hin ds ig ht s e e ms t o in dic a te to h im that hi s decision not to appea l was proba bly wrong ,” Acke rmann, 340 U.S. at 198. See also 11 Wrig ht, et

a l., F e de ra l Pr a c tic e and

Pr oc e dure , § 28 64 (2 d e d. 20 09 ) (“ [I ]t or din ari ly is not pe rm iss ibl e to u se this mot ion to remedy

a fa ilure to take a

n appea l.”). Thus, for all the foreg oing rea sons, none of the provisi ons of Rule 60 authorize the bring ing of this Motion t o Vac ate 19 months afte r issuance of the De ntal Orde r. B. Defendan ts’ Ar gum ents Have Bee n P reviously Made an d Rej ect ed by the Court Virtually all the ar g uments made by Def endants in their Motion to Vac ate the D ental Or der

we re ma de , e xami ne d, and re je c te d in the Court ’s Op ini on

of Oc tob e r 1 8, 20 04 , g ra

nti ngPla int if

fs ’ Mo tio n to En fo rc e the Se ttl e me nt O rd e r a s to de nta l se rv ic e s. Specifica lly , Plaintiffs arg ued that De fenda nts were in v i o l at i o n of Para g raph 36 of the Settlement Order

and De fenda

nts denied it. The Court ruled, at p p . 5 -6 o f i t s Opinion, that De fe nd ants ’ a

rgume nt w a s unp e rs ua siv e , a nd sq ua re ly re jected the ir

argume nt t

hat th e Me dic a id statute was no t violated beca use the District of Columbia had ne ver r efuse d to provide denta l service s “whe n reque sted.”Para g ra ph79 of the Se ttl e me nt O rd e r c le arl y pr ov ide s th a t th is C ourt

“ sh a ll r e ta in 9 (continued...) -13- I n addition, the Def

endants a rg ued that the Court ha d no discretion to enter those provisions of the propose d Orde r re qui ri n g d evelopment of a denta l periodicity schedule , development of a compre hensive a

nd detailed Correc tive Action Plan to reme dy the violations of Parag raph 36 of the Settlement Order , and pre paration of an annual oral health assessment of EPSDT-elig ible children wh ic h w ou ld i de nti fy

the numbe r o f s uc h c hil dr e n w ho ha d r e c e ive d pre ve nti ve c are and tr e a tme nts

. Th e Court

ru le d, a t pp . 7 -1 5 o f i ts O pin ion , th a t it ha d a uth or ity to i ssu e su c h a

n orde r t o enfor ce the Settlement Order (citing Fr ew v. Ha

wkins, 540 U.S. 431, 439 ( 2004) and B ecke tt, 955 F.2d at 286), and that the pr ovisions propose d by Plaintiffs were appropr iate to re medy the fa ilure to comply with the underly

ing Settlement Or der. C. The C ourt Has A uthority to Order Relief Exceeding F ederal Statutor y and/ or Adm inis trat ive Agency Standards and Had Auth ority to Issue the Dental Order Th e on e ne w a

rgume nt t hat D e fe nd ants make in the ir Mo tio n is that the De nta l O rd e r s ho uld be vac ated be cause the re lief mandated exceeds the f eder al standar ds established by the Centers f

or Medica re a nd Medica id Services ( “CMS”). Def endants a re c orre ct that there is no feder ally -established ma ndate r eg ardingutiliz ation rate s of dental se rvice s. The De partment of H ealth and H uman Service s has set a spe cific national

“ g oa l” of a 57 % p art ic ipatio n r a te fo r p re ve nti ve de nta l se rv ic e s by thi s y e ar, 20 10 . O bv iou sly , th is g oal is much lower tha

n the par ticipation rates c ontained in the De ntal Orde r. The sim p l e an swer to De fenda nts’ argument is provided in Fr ew. B eca use the Settlement O r d e r e mb o d i e s ana g r e e m e n tb e t w e e n t h e p art i e s , t h e y ar e h e l d t o c o mp l yi n g w i t h t h a tv o l u n t a r i l yenter ed into ag ree ment. As the S upreme Court said in Fre w, in words par ticularly applicable to the 9(...continued) 9 jurisdiction of this matter to make any nece ssary

order s enfor cing or construingthis Order.” See also c ases c ited in Pls .’ Opp’n, at 20-21. 10 Th e ov e rw he lmi ngpr ob le m, as no te d in thi s O pin ion , h a s b e e n th e se e min g ly 11 unsolvable inability

to obtain reliable data re g ardingcompliance with the Settlement Order

. -14- fac ts of this case:

The decr ee does implement the Medica id statute in a hig hly detailed wa y , r e quir in g t he state of

fi c ia ls t o ta

ke so me ste ps that th e statut e does not specif

ically re q uire. The same c ould be said, howe ver, of any eff ort to i m p l em ent t he g ener al EPSDT statute in a particula r wa y . T he de c re e re fl e c ts a

cho ice a mon g va

ri ou s w ay s th a t a

State could implement the Medica id A ct. As a re sult, enforc ing the decr ee vi nd icate s an a g re e me nt t hat th e state of

fi c ia ls r e a c he d to c omp ly with fede ral law

. 10 540 U.S. at 439. III . CO NC LU SION This Court fully

rec og niz es that district courts must “defe r to local g overnme nt administrators who have the ‘primar y responsibility

for e lucidating , ass essi ng and solving ’ the problems of institutional reform.” Rufo, 502 U.S. at 392. Throug hout the very l o n g pendenc y

of this case, the Court ha s consistently tried to work with the pa rties on a co l l ab o ra tive, rathe r than adver sarial, ba sis because of t h e p r a c ti c a l a d

ministrative pr oblems in enforc ing the Settlement Order

. That appr oach ha s been mode rate ly succe ssful until chang es we re m ad e i n the leade rship of the Attorney Gene ral’s O ffice

. 11 As to the pending Mot ion, the bot tom line is that the Defenda nts have f ailed to establish any chang e in circ umstances, no less sig nificant one s, which would war rant vacating the Dental Order , a s th e Sup re me Court

mand a te d in

Ruf o a nd jus t th is p a st y e ar i n F lor e s.-15-

The Def endants have prese nted all their arg uments in pr evious proce eding s and t h ey have been reje cted. Def

endants had an opportunity to f urther te st the streng th of those ar g uments befor e the Cou rt of Ap pe a ls an d, ine xplic a

bly , a ft e r w a iti ngte n mo nth s, c ho se to w ith dr aw t he ir a pp e a l. Th e y have pr e se nte d n o e xplanatio n f or thi s ta c tic a l de c isi on . A s th e S up rem e Co urt sa id i n Acke rmann, 340 U.S. at 199, the litig ant ’s “c hoice wa s a risk, but ca lculated a nd deliberate . . . . There must be an end to li t i gat i o n s omeday , and fr ee, c alculate d, deliberate choice s are not to be relieve d from.” For all the re asons set for

th here i n , the Court conclude s that there is no justification -- no chang e in the law or

the fa cts, no unfore seen obstacles which have made the Orde r unworka ble, and no evidenc e that its enfor ceme nt would be detrimenta l to the public interest -- that wo u l d support

va c a tin g the De nta l O rd e r. Con se qu e ntl y , D e fe nd ants ’ M oti on to V a c a te is denied

.

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