VII. Irreparable Harm

Although Plaintiffs have not shown a better than negligible likelihood of success on the merits of their claims, we continue our analysis of the preliminary injunction motion. We turn to the irreparable harm element, which resolves "the case where although the ultimate relief that the plaintiff is seeking is equitable, implying that he has no adequate remedy at law, he can easily wait till the end of trial to get that relief."28 Roland Mach. Co., 749 F.2d at 386. In other words, "[o]nly if [the plaintiff] will suffer irreparable harm in the interim-that is, harm that cannot be prevented or fully rectified by the final judgment after trial-can he get a preliminary injunction." Id.; Girl Scouts of Manitou Council, Inc., 549 F.3d at 1086. Plaintiffs contend that Murray residents face injury to their health and well-being, both physical and mental, because of "the predetermined placements which . . . [result] from going through the [ACCT process]" as well as because of the "lack of meaningful choice" under § 1396n(c)(2)(C). (Post-Hr'g Mem. at 25-26; see also Mem. ISO Prel. Inj. Mot. (Dkt. No. 9) at 20-21.)

Plaintiffs argue that the CILA placements, as predetermined through the ACCT process, are dangerous. Plaintiffs introduced troubling evidence of problems with certain CILA placements, causing their concerns about future (though speculative) errors, which could result in serious harm. (Supra Part V.) For their part, Defendants offered evidence that other former SODC residents have succeeded in the community and that similar problems arise at Murray as well. (Id.) While we are sympathetic to Plaintiffs' fears, and do not condone the mistakes made at certain CILAs, the record before us does not establish any level of likelihood that SODC residents "will suffer" irreparable harm in the absence of an injunction. See Winter v. Natural Res. Defense Council, Inc., 555 U.S. 7, 22, 129 S. Ct. 365, 375-76 (2008) (clarifying that the plaintiff must show "that irreparable harm is likely in the absence of an injunction," not just possible); East St. Louis Laborers' Local 100 v. Bellon Wrecking & Salvage Co., 414 F.3d 700, 704 (7th Cir. 2005) ("Speculative injuries do not justify this extraordinary remedy.").

Even if we accept Plaintiffs' assertion that residents transferred into CILAs are likely to suffer irreparable harm, such harms would not occur as a result of the much-maligned ACCT process. Neither Defendants, nor the ACCT process, require guardians to choose a CILA placement. Accordingly, granting an injunction to curtail the ACCT process during the pendency of this action, as Plaintiffs suggest, would not give Plaintiffs any relief or authority that they do not already possess.

Yet Plaintiffs also contend that the ACCT "process itself presents an irreparable harm." (Post-Hr'g Mem. at 25.) Plaintiffs have not introduced any evidence whatsoever that the ACCT process itself inflicts irreparable harm. Kelly testified that her son "might be upset" if required to meet strangers during the ACCT process. (1/7/14 Hr'g Tr. (Kelly) at 250.) While Kelly's concern is understandable, this evidence hardly establishes that either Murray residents or their guardians will suffer harm, let alone irreparable harm, simply by participating in the ACCT process. Plaintiffs' criticisms of Defendants' reliance on CRA staff and the Murray ISPs similarly do not reveal harm, irreparable or otherwise. (See Supra Part III.B.2.) Plaintiffs may feel that the ACCT process is a waste of their time and taxpayer money, but we cannot find that it causes irreparable harm.

28 The parties did not separately address whether Plaintiffs lack an adequate remedy at law necessitating injunctive relief. Plaintiffs seek only injunctive relief, and we assume for present purposes that they have met this requirement. See Roland Mach. Co., 749 F.2d at 386.