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John B. v. Goetz

Connor, a medically fragile child and John B. class member. Photo courtesy of Connor's family

• You are a 14-year-old girl who has been placed in foster care after being sexually abused by your stepfather, and you desperately need mental health counseling.  Your TennCare plan won’t pay for such care, however, unless you become sexually abusive yourself. Because you are not acting out towards others, your serious, documented mental health needs go unmet. 

• You are a medically fragile teenager whose devoted mother has cared for you from birth. You require constant bedside care. Your TennCare HMO discontinues payment for the home health services you have been receiving since infancy. Since it is impossible for your mother to meet all of your needs alone, she is advised to place you in foster care.

• You are a parent of a 6-year-old child with a serious and painful illness.  Your child’s TennCare plan tells you that you can only go to doctors in their network.  There are no specialists who take TennCare in your area and you cannot afford to continue traveling five hours on a regular basis to a specialist to make sure your child does not have a serious complication.

• You are the parent of a teenager with severe diabetes. Your daughter’s doctor recommends an insulin pump to keep her blood sugar regulated. Your HMO denies the pump.

John B. v. Goetz is a class action settlement that was filed (see complaint) and settled the same day in 1998. It protects the health care of 640,000 children. The court settlement is a 50 page document written by the Tennessee Justice Center and visionary state officials. The settlement is based upon and incorporates a federal law that promises children regular check-ups and the health care they need to reach their potential. This law is called Early Periodic Screening Diagnosis and Treatment, or EPSDT. (see consent decree)

Every state in the nation has been under an obligation to meet federal EPSDT standards since 1968. Tennessee state officials decided that the “blue print” provided by the consent decree for meeting EPSDT mandates would ensure that our state’s children receive the health care upon which their futures depend.

As state officials and priorities changed, the state neglected to implement these promises to children. In 2001, after three weeks of testimony, the federal Court found the state had violated every aspect of the federal law and the 50 page order. This ruling was based on testimony from state officials and courageous mothers and foster mothers who traveled from across the state to testify. In court, these mothers explained how the system had failed their children. Two mothers told of their children dying due to denials of medical care by TennCare HMOs.

The Court attempted to “appeal to the light” in state officials and did not hold the state in contempt despite its finding of complete non-compliance. The Court appointed a special master to help the state develop and implement a plan for compliance with the law. (See Court’s Dec. 20, 2001 order and findings) A special master serves the role of being the “eyes and ears” of the court.

John B. v. Menke, 176 F. Supp. 2d 786 (M.D. Tenn. 2001)

From 2002 until 2004, the special master repeatedly attempted to engage the state around complying with the law. In October 2004, the Court found that the state was still failing children and that the state did not even have a plan for developing a system that would meet children’s medical needs. (see Oct. 22, 2004 order). The Court attached a plan to its ruling and ordered the Tennessee Justice Center and the state to respond to the special master’s plan with their objections.

Instead of responding to the substance of the plan, the state attacked the Court and the special master. The state asked for discovery, alleging that the Court and the special master may have acted improperly. The state still refuses to produce a plan. The state continues to attack the special master and is asking for discovery from the court and the special master.

In February 2006, Judge Nixon recused himself from the case in a scathing opinion about the state's efforts thus far to provide children the health care their lives depend on. In early 2006, the state declared itself in compliance and the Special Master was relieved. Judge Haynes took the case and appointed five monitors to evaluate whether the state has a system for children. (see Feb. 2006 Memorandum Order)

In January 2007, the five court-appointed monitors released their findings, which showed the state's ongoing problems and non-compliance with the Consent Decree or EPSDT. (see Jan. 26, 2007 executive summary and monitors' reports on Screening, Diagnosis and Treatment, Outreach, Department of Children's Services: Part 1 and Part 2, and Coordination)

Getting all the relevant documents needed to prove that the state is non-compliant has been the focus of ongoing dispute. In October 2007, Judge Haynes, in a very positive order for Tennessee's children, ordered the state and its contractors to produce all electronic documents from June 2004 - present. (see Oct. 10, 2007 Order)

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