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Olmstead v. L.C.L.C. and E.W. v. Olmstead case was brought in 1995 by the Atlanta Legal Aid Society on behalf of Lois Curtis and Elaine Wilson, women with mental retardation and psychiatric conditions who were patients in a state psychiatric hospital. The treating professionals in the hospital all agreed that they were appropriate for discharge into community programs, but slots were not made available. While the case worked its way through the courts, both women were placed in the community, where they have been doing very well. The case continued because the situation could arise again. Final settlement was reached in July 2008. The state of Georgia asked the Supreme Court to decide "[w]hether the public services portion of the federal Americans with Disabilities Act compels the state to provide treatment and habilitation for mentally disabled persons in a community placement, when appropriate treatment and habilitation can also be provided to them in a State mental institution." The case turned on the meaning of a regulation that the U.S. Department of Justice adopted to enforce Title II of the ADA, stating that:
The Department of Justice has interpreted this regulation as requiring the community placement of institutional residents when the state's own treating professionals have recommended such placement. In allowing the women's right to community placement, the 11th Circuit set a very high standard for a holding of "fundamental alteration" while also giving substantial deference to the Justice Department's analysis. It held that "by definition, where, as here, the State confines an individual with a disability in an institutional setting when a community placement is appropriate, the State has violated the core principle underlying the ADA's integration mandate." The circuit court made two arguments that, having been upheld, are useful to advocates. First, it specifically rejected the state's claim that the ADA was limited to discrimination between disabled and non-disabled people and that institutional services were provided only to disabled individuals. The court noted that the ADA specifically recognizes that discrimination existed in insitutionalization and that this finding would have been superfluous under the state's analysis. Second, it recognized that, during the course of litigation, there may be times when a person can be treated in the community and others when institutionalization is necessary. However, where the evidence shows that all experts agree that at a given time a patient could be served in the community, then the ADA mandates such a placement, unless it would be a fundamental alteration in the state's provision of services. Finally, the circuit court remanded L.C.'s case for determination whether providing the community-based services would be a fundamental alteration in the state's services. The court set a very high standard, holding that "unless the State can prove that requiring it to make these additional expenditures would be so unreasonable given the demands of the State's mental health budget that it would fundamentally alter the service it provides, the ADA requires the state to make these additional expenditures." The court set forth three non-exhaustive factors for the district court to consider: 1) the reasonableness of the expenditures in light of the entire budget for mental health, 2) whether it would be unreasonable to require the state to expand its waiver program to minimize the financial burden, and 3) whether any difference in the cost of providing community-based services will lessen the state's burden. This was addressed in detail by the Supreme Court. The Bazelon Center, which organized an amicus brief in the 11th Circuit written pro bono by the law firm of Howrey & Simon, mobilized organizations to file Supreme Court briefs as friends of the court, to assure the justices that states are already committed to providing services in the community instead of in institutional settings, and that they can comply with the integration mandate at a reasonable cost. Twenty-two states filed a brief urging the Supreme Court to accept the case for review: AL, CA, CO, DE, FL, HI, LA, MD, MI, MS, MT, NE, NH, NV, PA, SC, SD, TN TX, UT, WY, WV. After the Court accepted the case, all of these and four additional states signed on to an amicus brief making the argument against federal court interference in states' operation of mental health and developmental disability systems. However, 15 of the original 22 states withdrew from the group, announcing that they would not oppose the 11th Circuit ruling. The 15 are: Alabama, California, Delaware, Florida (the organizer of the earlier brief), Louisiana, Maryland, Michigan, Mississippi, Nebraska, New Hampshire, Pennsylvania, South Carolina, South Dakota, Utah and West Virginia. And all four new states that had joined in support of Georgia's position—Indiana, Massachusetts, Minnesota and Washington—later wrote to the Court to withdraw. More on the DecisionIn a 6-3 opinion authored by Justice Ruth Bader Ginsburg, the court affirmed a ruling by the United States Court of Appeals for the Eleventh Circuit that unjustified isolation of individuals with disabilities is properly regarded as discrimination based on disability. The court held that unjustified segregation in institutions is discrimination not only because it perpetuates unwarranted assumptions that people with disabilities are incapable or unworthy of participating in community life, but also because confinement in an institution severely curtails everyday life activities, such as family relations, social contacts, work, educational advancement and cultural enrichment. Nonetheless, the Supreme Court held, the states' need to maintain a range of facilities for the care and treatment of individuals with diverse mental disabilities must be recognized. In determining whether a state can successfully assert a "fundamental alteration" defense (i.e., claim that providing community-based services to an individual would fundamentally alter the state's service-delivery system), courts must consider not only the cost of providing community-based care to the litigants, but also the state's obligation to mete out services to others with mental disabilities in an equitable manner. If the state can show that immediate relief for the plaintiffs would be inequitable "given the responsibility the state has undertaken for the care and treatment of a large and diverse population of persons with mental disabilities," it will meet the fundamental alteration defense. For example, Justice Ginsberg wrote, if the state demonstrates that it has a "comprehensive, effectively working plan for placing qualified persons with mental disabilities in less restrictive settings, and a waiting list that move[s] at a reasonable pace not controlled by the State's endeavors to keep its institutions fully populated," an individual cannot skip to the top of the waiting list by filing a lawsuit to obtain community services; such a move would not be a reasonable modification. Finally, the court held that a state may generally rely on the "reasonable assessments of its own professionals" in determining whether a community-based placement is appropriate. Additionally, the ADA does not require that community-based treatment be imposedonn individuals who oppose it. The Olmstead decision should encourage states to begin planning implementation strategies to comply with the ADA's integration mandate, spelled out in regulations requiring that services be provided "in the most integrated setting appropriate to the needs" of people with mental or physical disabilities. All states have already begun moving in the direction of providing more mental health services in community-based settings. Nonetheless, to comply with the integration mandate, state mental health officials will need to take significant steps to move institutionalized people more quickly into more integrated settings. The court heard the Georgia case on April 21, 1999. The suit had been brought by two women with both mental retardation and psychiatric conditions who were patients in a state hospital. Their treating professionals agreed that the women should be served in community programs, but no slots were available for them. Supporting Georgia's appeal to the Supreme Court, some states argued that, while "virtually any person can safely and appropriately be served in his or her home (or in the most integrated community setting)," the cost of doing so would be unduly burdensome. Publications, Articles and ReportsJust Like Where You and I Live: Integrated Housing Options for People with Mental Illnesses Last in Line - Barriers to Community Integration of Older Adults
with Mental Illnesses Merging
System of Care Principles with Civil Rights Law: Olmstead Planning
for Children with Serious Emotional Disturbance Under Court Order Article on states' implementation of Olmstead by Bazelon Center staff attorney Jennifer Mathis from the November-December 2001 issue of Clearinghouse Review: Journal of Poverty Law and Policy. |
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