Santaniella-Townsend v. Arizona Healthcare Cost Containment System

1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Theresa Angela Santaniello-Townsend, No. CV-25-00583-TUC-RCC 10 Plaintiff, ORDER 11 v. 12 Arizona Healthcare Cost Containment System, et al., 13 Defendants. 14 15 After this case was removed from Pima County Superior Court in October 2025 16 (Doc. 1), Plaintiff filed a Second Motion for Preliminary Injunction (Doc. 40), a Notice of 17 Supplemental Evidence and Supplemental Declaration (Doc. 42), a Notice and Declaration 18 in Support of the Motion for Preliminary Injunction (Docs. 43–44), and a Notice of 19 Supporting Authority for the Second Amended Complaint (Doc. 49). Defendants Arizona 20 Complete Health (“AzCH”), City of Tucson, Community Bridges, Inc. (“CBI”), Marana 21 Healthcare, and Arizona Healthcare Cost Containment System (“AHCCCS”) responded, 22 and filed five motions to dismiss and separate replies. (Docs. 50–58, 79–84.) Plaintiff 23 responded and replied. (Docs. 58, 62–66, 68–78.) Plaintiff also filed several supplemental 24 exhibits to her Motion for Preliminary Injunction. (Docs. 85–90, 92.) Again, Defendants 25 responded (Docs. 94–96, 98) and Plaintiff replied (Doc. 99). 26 Now, after fifty-some filings, Plaintiff asks this Court to hasten its decision on her 27 Second Motion for Preliminary Injunction. (Doc. 100.) She claims, “compliance is required 28 by April 25, 2026, or eviction paperwork will be filed” and that “[w]ithout Court 1 intervention, Plaintiff faces the imminent start of eviction proceedings.” (Id. at 1.) 2 Plaintiff’s request for a preliminary injunction asks the Court to order that Defendants: 3 1. Provide Plaintiff with nondiscriminatory police protection and public 4 safety services; 2. Cease all retaliation against Plaintiff for protected activity; 5 3. Produce all requested medical, behavioral health, crisis, SMI, and 6 housing records; 4. Provide reasonable disability accommodations and engage in an 7 interactive process; 8 5. Restore and protect Plaintiff’s grievance and appeal rights; and 6. Refrain from initiating or pursuing involuntary psychiatric detention 9 or evaluation absent lawful, non-retaliatory grounds. 10 (Doc. 40 at 4.) The Court will expedite its decision, deny the request for preliminary 11 injunction, and grant the motions to dismiss. 12 I. PRELIMINARY INJUNCTION STANDARD 13 “A preliminary injunction is ‘an extraordinary and drastic remedy, one that should 14 not be granted unless the movant, by a clear showing, carries the burden of persuasion.’” 15 Lopez v. Brewer, 680 F.3d 1068, 1072 (9th Cir. 2012) (quoting Mazurek v. Armstrong, 520 16 U.S. 968, 972 (1997) (per curiam)); see also Winter v. Natural Res. Def. Council, Inc., 555 17 U.S. 7, 24 (2008) (citation omitted) (“[a] preliminary injunction is an extraordinary remedy 18 never awarded as of right”). A plaintiff seeking a preliminary injunction must show that 19 (1) she is likely to succeed on the merits, (2) she is likely to suffer irreparable harm without 20 an injunction, (3) the balance of equities tips in her favor, and (4) an injunction is in the 21 public’s interest. Winter, 555 U.S. at 20. “But if a plaintiff can only show that there are 22 ‘serious questions going to the merits’—a lesser showing than likelihood of success on the 23 merits—then a preliminary injunction may still issue if the ‘balance of hardships tips 24 sharply in the plaintiff’s favor,’ and the other two Winter factors are satisfied.” Shell 25 Offshore, Inc. v. Greenpeace, Inc., 709 F.3d 1281, 1291 (9th Cir. 2013) (quoting Alliance 26 for the Wild Rockies v. Cottrell, 632 F.3d 1127, 1135 (9th Cir. 2011)). The movant “has 27 the burden of proof on each element of the test.” See Envt’l Council of Sacramento v. 28 Slater, 184 F. Supp. 2d 1016, 1027 (E.D. Cal. 2000). 1 II. FACTUAL AND PROCEDURAL HISTORY 2 Plaintiff sues AHCCCS, AzCH, Community Bridges, Marana Health, and the City 3 of Tucson. She brings claims under 42 U.S.C. § 1983, Americans with Disabilities Act 4 Title II, and Section 504 of the Rehabilitation Act. (Doc. 39.) Plaintiff claims she qualifies 5 as seriously mentally ill (“SMI”). (Id. ¶ 6.) Plaintiff alleges that Defendants AHCCCS, 6 AzCH, CBI, and Marana Health Center provide services for mentally ill individuals, 7 maintain medical records, and handle corresponding grievances and appeals. (Id. at 1–3.) 8 In addition, Defendant City of Tucson acts through Tucson Police Department (“TPD”), 9 Housing and Community Development, and other entities for law enforcement, housing 10 administration, and crisis coordination. (Id. at 3.) 11 Plaintiff claims that she repeatedly sought help from TPD for “stalking, harassment, 12 domestic violence,” assaults, and theft. (Id. at 4.) She claims TPD failed to meaningfully 13 respond to her reports, denying her police protection. (Id.) She alleges she “requested 14 medical, behavioral health, crisis, SMI, and housing records from AHCCCS, AzCH, CBI, MHC, and City of Tucson,” which were necessary to secure housing, social security, and 15 continued medical care, and to pursue grievances. (Id. ¶¶ 17–18.) Plaintiff alleges 16 Defendants either did not provide the records or provided altered records. (Id. ¶ 19.) 17 Plaintiff filed grievances related to the failure to provide records. (Id. ¶ 22.) Defendants 18 retaliated against Plaintiff because of her grievances “by delaying services, obstructing 19 appeal process, withholding records, and escalating adverse actions.” (Id. ¶ 23.) Plaintiff 20 claims CBI, City of Tucson, and Marana Health Care “initiated additional retaliatory 21 petitions for inpatient psychiatric evaluation” without cause, resulting in a February 2024 22 involuntary psychiatric detention. (Id. at ¶ 26; see also Doc. 65 at 3.) Plaintiff claims “CBI 23 again petitioned Plaintiff on or about March 5, 2024.” (Doc. 65 at 3.) 24 Plaintiff claims the City of Tucson also “failed to provide Section 8 documentation, 25 relocation notices, and housing records required for recertification and appeals.” (Doc. 39 26 ¶ 28.) Because of the City’s failure, Plaintiff believes she may lose her housing benefits. 27 (Id. ¶ 29.) 28 Finally, Plaintiff claims that Defendants maintained her medical, mental health, and 1 disability records, unlawfully transmitted her records “through unsecured and 2 inappropriate communication methods” and disclosed them to “law enforcement, housing 3 entities, and other non-treating third parties without authorization or necessity.” (Id. ¶¶ 34– 4 35.) She claims the inappropriate disclosure was used to support her involuntary detention. 5 (Id. ¶ 38.)1 6 After the Motion for Preliminary Injunction had been fully briefed, Plaintiff 7 submitted a Supplement to Motion for Preliminary Injunction on February 16, 2026, 8 allegedly notifying the Court of “material and time-sensitive changes”; addressing 9 AHCCCS eligibility termination; noting SNAP/Lifeline disruptions; including Section 8 10 housing communications, disability documentation, accommodation requests, utility bills 11 allocation notices, and grievance filings. (Docs. 85, 86–91.) The exhibits include an 12 AHCCCS termination notice ending coverage effective January 31, 2026 for failure to 13 verify income, DES and Lifeline records reflecting benefit interruptions, City of Tucson 14 communications stating a fixed $203 utility allowance not adjusted for individual usage, property manager notices explaining common-area utility allocation and increased 15 electricity after a chiller replacement, and Conservice bills reflecting rising monthly 16 charges in 2025–2026. (Id.) Plaintiff later filed a Third Supplemental Notice on February 17 26, 2026, again asserting escalating harm tied to Medicaid coverage and disability status 18 and repackaging prior arguments. (Doc. 92.) 19 III. STANDARD MOTION TO DISMISS 20 A complaint must contain a “short and plain statement of the claim showing that the 21 pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2). While Rule 8 does not require detailed 22 factual allegations, “it demands more than an unadorned, the-defendant-unlawfully- 23 harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). “[A] complaint must 24 contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible 25 on its face.’” Id. (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007)). The 26 27 1 Plaintiff makes more specific allegations in her supplemental filings, however, for the motion to dismiss, the Court considers only the allegations properly considered in the 28 Second Amended Complaint. See Swartz v. KPMG LLP, 476 F.3d 756, 763 (9th Cir. 2007); Fed. R. Civ. P. 8(a). 1 complaint must contain more than “a statement of facts that merely creates a suspicion [of] 2 a legally cognizable right of action.” Bell Atl. Corp., 550 U.S. at 555. Moreover, conclusory 3 and vague allegations will not support a cause of action. Ivey v. Bd. of Regents of the Univ. 4 of Alaska, 673 F.2d 266, 268 (9th Cir. 1982); Hill v. Kernan, No. 19-16759, 2021 WL 5 4870832, at *1 (9th Cir. Oct. 19, 2021). 6 “Determining whether a complaint states a plausible claim for relief [is] . . . a 7 context–specific task that requires the reviewing court to draw on its judicial experience 8 and common sense.” Iqbal, 556 U.S. at 679. So, although a plaintiff’s specific factual 9 allegations may be consistent with a constitutional claim, a court must assess whether there 10 are other “more likely explanations” for a defendant’s conduct. Id. at 681. In determining 11 the sufficiency of the complaint, the court takes a plaintiff’s factual allegations as true, and 12 makes any reasonable inferences in favor of the nonmoving party. Caltex Plastics, Inc. v. 13 Lockheed Martin Corp., 824 F.3d 1156, 1159 (9th Cir. 2016). 14 “In ruling on a 12(b)(6) motion, a court may generally consider only allegations contained in the pleadings, exhibits attached to the complaint, and matters properly subject 15 to judicial notice. . . . [A] court may consider a writing referenced in a complaint but not 16 explicitly incorporated therein if the complaint relies on the document and its authenticity 17 is unquestioned.” Brown, No. CV-19000025-TUC-JGZ, 2019 WL 3838983, at *1 (D. Ariz. 18 Aug. 15, 2019) (quoting Swartz v. KPMG LLP, 476 F.3d 756, 763 (9th Cir. 2007)); see 19 also Biltmore Assocs., LLC v. Twin City Fire Ins. Co., 572 F.3d 663, 665 n.1 (9th Cir. 20 2009) (“A court may consider documents, such as the insurance policies, that are 21 incorporated by reference into the complaint.”). 22 IV. AHCCCS 23 Plaintiff’s motion and supplements seek a preliminary injunction compelling 24 “police protection and public safety services,” the production of records, disability 25 accommodations to aid communication with AHCCCS, and access to AHCCCS’s grievance 26 and review processes, as well preventing retaliation and any pursuit of future involuntary 27 psychiatric detention. (Doc. 40 at 4; Doc. 77 at 2.) 28 In the Second Amended Complaint, the factual allegations against AHCCCS are 1 minimal. Plaintiff claims she “requested medical, behavioral health, crisis, SMI, and 2 housing records from AHCCCS,” (Doc. 39 ¶¶ 17, 33–35), that AHCCCS conceded 3 Plaintiff’s medical information had not been securely protected from disclosure, (id. ¶ 36), 4 and that she requested accommodations to assist her with access to services (id. ¶ 21). 5 First, AHCCCS is not considered a person under § 1983 and has not consented to 6 being sued. Wennihan v. AHCCCS, 515 F. Supp. 2d 1040, 1049 (D. Ariz. 2005) (finding 7 AHCCCS is a state entity subject to Eleventh Amendment immunity). Moreover, Plaintiff 8 has not sued any individual AHCCCS employees nor included individual actions. See Va. 9 Office for Prot. & Advocacy v. Stewart, 563 U.S. 247, 255 (2011) (concluding the limitation 10 on sovereign immunity stated in Ex Parte Young, 209 U.S. 123 (1908), only applies where 11 a state official is sued for their individual conduct, not “when the state is the real, substantial 12 party in interest”) (citations omitted). Because Plaintiff’s § 1983 claims for monetary, 13 injunctive, and declaratory relief are against an arm of the state, as a matter of law, Plaintiff’s 14 § 1983 claims against AHCCCS fail in their entirety. Second, Plaintiff’s claims under the ADA and RA are not sufficiently plead and 15 cannot withstand a 12(b)(6) motion. Plaintiff’s Second Amended Complaint lacks 16 allegations of specific AHCCCS conduct that violated the RA and ADA and caused Plaintiff 17 injuries. Insofar as there are any facts alleged against AHCCCS, her conclusory statements 18 do not provide enough information for AHCCCS to meaningfully respond, nor do the 19 conclusory statements show how granting the preliminary injunction would prevent any 20 harm. See Herb Reed Enters., LLC v. Fla. Ent. Mgmt., Inc., 736 F.3d 1239, 1250 (9th Cir. 21 2013). 22 Third, because Plaintiff’s assertions of harm at the hands of AHCCCS are advanced 23 in generalized and conclusory terms, she has not shown a likelihood of irreparable injury 24 attributable to AHCCCS. Issuing a preliminary injunction based on conclusory allegations 25 is not in the public’s interest and the balance of equities does not weigh in favor of an 26 injunction. Therefore, a preliminary injunction is not appropriate. 27 V. CITY OF TUCSON 28 Plaintiff alleges on October 28, November 17 & 20, December 10 & 18, 2025, she 1 was denied services relating to housing assistance, food assistance, and documentation 2 required for food-stamp eligibility were denied or withheld. (Doc. 43 ¶ 3; Doc. 39 ¶ 17.) 3 “These denials involved actions by . . . City of Tucson” including “refusals or failures to 4 provide support or documentation” to maintain her benefits. (Doc. 43 ¶ 3.) The City of 5 Tucson “failed to provide Section 8 documentation, relocation notices, and housing records 6 required for recertification and appeals.” (Doc. 39 ¶ 28.) In addition, on December 18, 7 2025, City of Tucson employees discussed Plaintiff’s confidential medical information 8 during an Adult Recovery Team meeting. (Doc. 43 ¶ 18.) As a result of the disclosure and 9 failure to provide records, Plaintiff claims she lost her housing benefits. (Doc. 39 ¶ 28.) 10 The City argues that Plaintiff’s filings do not identify specific actions by the City 11 that, if true, would entitle her to relief. (Doc. 83 at 1.) Moreover, the City claims Plaintiff 12 has not pleaded a viable Monell claim. (Id.) 13 Upon dismissal of the First Amended Complaint, Plaintiff was warned that her 14 Second Amended Complaint must contain: 15 short, plain statements telling the Court: (1) the right Plaintiff believes was 16 violated; (2) the name of the Defendant who violated the right; (3) exactly what that Defendant did or failed to do; (4) how the action or inaction of that 17 Defendant is connected to the violation of Plaintiff’s constitutional right; and 18 (5) what specific injury Plaintiff suffered because of that Defendant’s conduct. See Rizzo v. Goode, 423 U.S. 362, 371–72, 377 (1976). 19 (Doc. 38 at 3.) Plaintiff has no facts surrounding her request for records, nor has she 20 explained how the City’s discussion in the Adult Recovery Team meeting resulted in her 21 losing her housing. Like the allegations against AHCCCS, those against the City are 22 conclusory, and the Court is “not ‘required to accept as true allegations that are merely 23 conclusory, unwarranted deductions of fact, or unreasonable inferences.’” Doe v. City of 24 Concord, 22-15384, 2024 WL 62949, at *1 (9th Cir. Jan. 5, 2024) (quoting Sprewell v. 25 Golden State Warriors, 266 F.3d 979, 988 (9th Cir. 2001), opinion amended on denial of 26 reh'g, 275 F.3d 1187 (9th Cir. 2001)). Because of this, Plaintiff has not shown that she will 27 suffer irreparable harm absent a preliminary injunction, and it is not in the public’s interest 28 to grant one here. 1 In addition, Plaintiff asserts the City had an unconstitutional policy, but fails to 2 elaborate. Under Monell, a governmental entity may be sued when an “official policy [is] 3 the moving force of the constitutional violation . . .” Monell v. Dep’t of Soc. Servs. of City 4 of New York, 436 U.S. 658, 694 (1978). This barren assertion cannot withstand a motion 5 to dismiss. 6 VI. ARIZONA COMPLETE HEALTH 7 The facts alleged against AzCH in the Second Amended Complaint are equally 8 lacking. Plaintiff claims only that she requested records from AzCH, and there was some 9 sort of breach and her medical information was not secured. (Doc. 39 ¶ 17, 36.) The Court 10 cannot discern how these events are related to any harm Plaintiff suffered. Although pro se 11 pleadings are liberally construed, Haines v. Kerner, 404 U.S. 519, 520–21 (1972), 12 conclusory and vague allegations will not support a cause of action, Ivey v. Bd. of Regents 13 of the Univ. of Alaska, 673 F.2d 266, 268 (9th Cir. 1982). 14 VII. COMMUNITY BRIDGES, INC. Plaintiff’s Second Amended Complaint contains no factual allegations as to 15 Defendant Community Bridges. While she has added allegations in response to 16 Community Bridges’ Motion to Dismiss, the Court will not consider facts presented outside 17 of the Second Amended Complaint. See Swartz v. KPMG LLP, 476 F.3d 756, 763 (9th 18 Cir. 2007). Again, conclusory and vague allegations will not support a cause of action. 19 Ivey v. Bd. of Regents of the Univ. of Alaska, 673 F.2d 266, 268 (9th Cir. 1982). 20 VIII. MARANA HEALTHCARE 21 Likewise, there are no allegations against Marana Healthcare in the Second 22 Amended Complaint, and the Court will dismiss these claims. This Court is not “required 23 to parse the complaint searching for allegations . . . that could conceivably form the basis 24 of each of [the complainant’s] claims.” Ferrell v. Durbin, 311 F. App'x 253, 259 (11th Cir. 25 2009). 26 IX. SUPPLEMENTARY FILINGS 27 First, the Court will not consider the supplementary filings for the Preliminary 28 Injunction Motion because, when filed, the preliminary injunction motion was already fully 1 briefed. Second, Plaintiff’s submissions operate as improper, renewed requests restating 2 previous arguments and injecting materials outside the operative pleadings and proper 3 evidentiary scope. Third, the supplements include conclusory factual and legal assertions 4 and compilations of miscellaneous notices and correspondence that do not satisfy 5 Plaintiff’s heavy burden for extraordinary injunctive relief. Fourth, it is not incumbent upon 6 the Court to parse through thousands of pages of documents to locate Plaintiff’s claims— 7 under Rule 8, Plaintiff must present “a short and plain statement of the claim showing that 8 the pleader is entitled to relief . . . .” Fed. R. Civ. P. 8(a)(2) (emphasis added); see Indep. 9 Towers of Wash. v. Washington, 350 F.3d 925, 929 (9th Cir. 2003) (“[J]udges are not like 10 pigs, hunting for truffles buried in briefs.”) (quoting United States v. Dunkel, 927 F.2d 955, 11 956 (7th Cir. 1991)). 12 In conclusion, Plaintiff has not viably pleaded her § 1983, RA, or ADA claims 13 against any Defendant. Moreover, Plaintiff cannot sue AHCCCS under § 1983. Because 14 Plaintiff has failed to state a claim against any Defendant, she has not demonstrated either that (1) there is a likelihood of success on the merits, (2) the balance of equities weighs in 15 her favor, or (3) an injunction is in the public’s best interest. Therefore, a preliminary 16 injunction is unwarranted. 17 X. LEAVE TO AMEND 18 If the plaintiff “fails to state a claim on which relief may be granted,” the district 19 court must dismiss. 28 U.S.C. §1915(e)(2)(B)(ii). However, if the pleading can be 20 remedied through the addition of facts, the claimant should be granted an opportunity to 21 amend the complaint prior to final dismissal. Lopez v. Smith, 203 F.3d 1122, 1127–29 (9th 22 Cir. 2000), overruled on other grounds by, Peralta v. Dillard, 744 F.3d 1076 (9th Cir. 23 2000). 24 If Plaintiff files a Third Amended Complaint, Plaintiff must clearly designate on the 25 face of the court-approved form that it is the “Third Amended Complaint.” The Third 26 Amended Complaint must be retyped or rewritten in its entirety on the court approved 27 form and may not incorporate any part of the original, First Amended Complaint, or Third 28 Amended Complaint by reference. In it, Plaintiff must write short, plain statements telling 1) the Court: (1) the right Plaintiff believes was violated; (2) the name of the Defendant who 2|| violated the right; (3) exactly what that Defendant did or failed to do; (4) how the action or inaction of that Defendant is connected to the violation of Plaintiffs constitutional right; 4|| and (5) what specific injury Plaintiff suffered because of that Defendant’s conduct. See || Rizzo v. Goode, 423 U.S. 362, 371-72, 377 (1976). Plaintiff must repeat this process for 6 || each person Plaintiff names as a defendant. If Plaintiff fails to affirmatively link the 7|| conduct of each named defendant with the specific injury suffered by Plaintiff, the 8 || allegations against that defendant will be dismissed for failure to state a claim. Conclusory || allegations that a defendant or group of defendants violated a constitutional right are not 10 || acceptable and will be dismissed. 11 IT IS ORDERED: 12 1) Plaintiff's Second Motion for Preliminary Injunction is DENIED. (Doc. 40.) 13 2) Defendant Arizona Complete Health’s Motion to Dismiss is GRANTED. (Doc. 50.) 14 3) Defendant City of Tucson’s Motion to Dismiss is GRANTED. (Doc. 52.) 15 4) Defendant Community Bridges, Inc.’s Motion to Dismiss is GRANTED. (Doc. 54.) 16 5) Defendant Marana Health Care’s Motion to Dismiss is GRANTED. (Doc. 56.) 7 6) Defendant Arizona Healthcare Cost Containment System’s Motion to Dismiss is 18 GRANTED. (Doc. 57.) Plaintiff's § 1983 claims against AHCCCS are DISMISSED 19 WITH PREJUDICE. 20 7) Plaintiff has 30 days from the date this Order is filed to file a Third Amended Complaint in compliance with this Order. If Plaintiff fails to file a Third Amended 59 Complaint within 30 days, the Clerk of Court must enter a judgment of dismissal of 33 this action without prejudice and deny any pending unrelated motions as moot. 54 Dated this 24th day of April, 2026. 25 26 DL IL L 27 FAK - □ 28 Honorable Raner C. Collins merior United States District Judge -10-