From: adapt@adapt.org
Subject: Summary of Olmstead decision
Date: Wed, 23 Jun 1999 09:34:00 -0500
Here is a summary of the decision by the Supreme Court yesterday. To see the whole thing you can go to the Cornell U. Law School web site:
The decision says unnecessary segregation is discrimination, it upholds the regulation's integration mandate and supports that Congress wanted the ADA to improve on 504, etc. call for integration of people with disabilities which is very positive.
States must provide a range of services (institution through community) available, and treat these options "with an even hand"; in most states the even handedness among options is quesitonable at best and the range of options is quite limited and institution oriented. Treatment professionals assessment will be given consideration, and relied on. States will need to have a comprehensive, effective, working plan and a waiting list that moves at a reasonable pace that is not influenced by keeping the instiutions full.
The need for MiCASSA is very clear after reading this opinion, and many of the
concerns raised will be addressed by this bill. Now that the decision is out,
the urgency for MiCASSA is even more than before!
Stephanie
OLMSTEAD v. L. C. (98-536)
138 F.3d 893, affirmed in part, vacated in part, and remanded.
SUPREME COURT OF THE UNITED STATES
OLMSTEAD, COMMISSIONER, GEORGIA DEPARTMENT OF HUMAN RESOURES, et al. v. L. C.,
by zimring, guardian ad litem and next friend, et al.
CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE ELEVENTH CIRCUIT
----------------
No. 98?536.
Argued April 21, 1999
Decided June 22, 1999
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In the Americans with Disabilities Act of 1990 (ADA), Congress described the
isolation and segregation of individuals with disabilities as a serious and
pervasive form of discrimination. 42 U.S.C. ? 12101(a)(2), (5). Title II of
the ADA, which proscribes discrimination in the provision of public services,
specifies, interalia, that no qualified individual with a disability shall,
by reason of such disability, be excluded from participation in, or be denied
the benefits of, a public entity?s services, programs, or activities.
12132. Congress instructed the Attorney General to issue regulations
implementing Title II?s discrimination proscription. See ?12134(a).
One such regulation, known as the integration regulation,requires a public
entity [to] administer program in the most integrated setting appropriate
to the needs of qualified individuals with disabilities. 28 CFR 35.130(d).
A further prescription, here called the ?reasonable-modifications regulation,
requires public entities to make reasonable modifications to avoid discrimination
on the basis of disability, but does not require measures that would
fundamentally alter the nature of the entity's programs. ?35.130(b)(7).
Respondents L. C. and E. W. are mentally retarded women; L.
C. has also been diagnosed with schizophrenia, and E. W., with a personality
disorder. Both women were voluntarily admitted to Georgia Regional Hospital at
Atlanta (GRH), where they were confined for treatment in a psychiatric unit.
Although their treatment professionals eventually concluded that each of the
women could be cared for appropriately in a community-based program, the women
remained institutionalized at GRH. Seeking placement in community care, L. C.
filed this suit against petitioner state officials (collectively, the State)
under 42 U.S.C. ? 1983 and Title II. She alleged that the State violated Title
II in failing to place her in a community-based program once her treating
professionals determined that such placement was appropriate. E. W. intervened,
stating an identical claim. The District Court granted partial summary judgment
for the women, ordering their placement in an appropriate community-based
treatment program. The court rejected the State?s argument that inadequate
funding, not discrimination against L. C. and E. W. ?by reason of [their]
disabilit[ies],? accounted for their retention at GRH. Under Title II, the
court concluded, unnecessary institutional segregation constitutes
discrimination per se, which cannot be justified by a lack of funding. The
court also rejected the State?s defense that requiring immediate transfers in
such cases would ?fundamentally alter? the State?s programs. The Eleventh
Circuit affirmed the District Court?s judgment, but remanded for reassessment
of the State?s cost-based defense. The District Court had left virtually no
room for such a defense. The appeals court read the statute and regulations to
allow the defense, but only in tightly limited circumstances. Accordingly, the
Eleventh Circuit instructed the District Court to consider, as a key factor,
whether the additional cost for treatment of L. C. and E. W. in community-based
care would be unreasonable given the demands of the State?s mental health
budget. Held: The judgment is affirmed in part and vacated in part, and the
case is remanded. 138 F.3d 893, affirmed in part, vacated in part, and
remanded.
Justice Ginsburg delivered the opinion of the Court with respect to
Parts I, II, and III?A, concluding that, under Title II of the ADA, States are
required to place persons with mental disabilities in community settings rather
than in institutions when the State?s treatment professionals have determined
that community placement is appropriate, the transfer from institutional care
to a less restrictive setting is not opposed by the affected individual, and
the placement can be reasonably accommodated, taking into account the resources
available to the State and the needs of others with mental disabilities. Pp.
11?18.
(a) The integration and reasonable-modifications regulations issued by
the Attorney General rest on two key determinations: (1) Unjustified placement
or retention of persons in institutions severely limits their exposure to the
outside community, and therefore constitutes a form of discrimination based on
disability prohibited by Title II, and (2) qualifying their obligation to avoid
unjustified isolation of individuals with disabilities, States can resist
modifications that would fundamentally alter the nature of their services and
programs. The Eleventh Circuit essentially upheld the Attorney General?s
construction of the ADA. This Court affirms the Court of Appeals decision in
substantial part. Pp. 11?12.
(b) Undue institutionalization qualifies as discrimination ?by
reason of ? disability.? The Department of Justice has consistently advocated
that it does. Because the Department is the agency directed by Congress to
issue Title II regulations, its views warrant respect. This Court need not
inquire whether the degree of deference described in Chevron U.S. A. Inc. v.
Natural Resources Defense Council, Inc., 467 U.S. 837, 844, is in order; the
well-reasoned views of the agencies implementing a statute constitute a body of
experience and informed judgment to which courts and litigants may properly
resort for guidance. E.g., Bragdon v. Abbott, 524 U.S. 624, 642. According to
the State, L. C. and E. W. encountered no discrimination ?by reason of? their
disabilities because they were not denied community placement on account of
those disabilities, nor were they subjected to ?discrimination,? for they
identified no comparison class of similarly situated individuals given
preferential treatment. In rejecting these positions, the Court recognizes that
Congress had a more comprehensive view of the concept of discrimination
advanced in the ADA. The ADA stepped up earlier efforts in the Developmentally
Disabled Assistance and Bill of Rights Act and the Rehabilitation Act of 1973
to secure opportunities for people with developmental disabilities to enjoy the
benefits of community living. The ADA both requires all public entities to
refrain from discrimination, see ?12132, and specifically identifies
unjustified ?segregation? of persons with disabilities as a ?for[m] of
discrimination,? see ??12101(a)(2), 12101(a)(5). The identification of
unjustified segregation as discrimination reflects two evident judgments:
Institutional placement of persons who can handle and benefit from community
settings perpetuates unwarranted assumptions that persons so isolated are
incapable or unworthy of participating in community life, cf., e.g., Allen v.
Wright, 468 U.S. 737, 755; and institutional confinement severely diminishes
individuals? everyday life activities. Dissimilar treatment correspondingly
exists in this key respect: In order to receive needed medical services,
persons with mental disabilities must, because of those disabilities,
relinquish participation in community life they could enjoy given reasonable
accommodations, while persons without mental disabilities can receive the
medical services they need without similar sacrifice. The State correctly uses
the past tense to frame its argument that, despite Congress? ADA findings, the
Medicaid statute ?reflected? a congressional policy preference for
institutional treatment over treatment in the community. Since 1981, Medicaid
has in fact provided funding for state-run home and community-based care
through a waiver program. This Court emphasizes that nothing in the ADA or its
implementing regulations condones termination of institutional settings for
persons unable to handle or benefit from community settings. Nor is there any
federal requirement that community-based treatment be imposed on patients who
do not desire it. In this case, however, it is not genuinely disputed that L.
C. and E. W. are individuals ?qualified? for noninstitutional care: The State?s
own professionals determined that community-based treatment would be
appropriate for L. C. and E. W., and neither woman opposed such treatment. Pp.
12?18.
Justice Ginsburg, joined by Justice O?Connor, Justice Souter, and
Justice Breyer, concluded in Part III?B that the State?s responsibility, once
it provides community-based treatment to qualified persons with disabilities,
is not boundless. The reasonable-modifications regulation speaks of ?reasonable
modifications? to avoid discrimination, and allows States to resist
modifications that entail a ?fundamenta[l] alter[ation]? of the States?
services and programs. If, as the Eleventh Circuit indicated, the expense
entailed in placing one or two people in a community-based treatment program is
properly measured for reasonableness against the State?s entire mental health
budget, it is unlikely that a State, relying on the fundamental-alteration
defense, could ever prevail. Sensibly construed, the fundamental-alteration
component of the reasonable-modifications regulation would allow the State to
show that, in the allocation of available resources, 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. The ADA is not reasonably read to impel
States to phase out institutions, placing patients in need of close care at
risk. Nor is it the ADA?s mission to drive States to move institutionalized
patients into an inappropriate setting, such as a homeless shelter, a placement
the State proposed, then retracted, for E. W. Some individuals, like L. C. and
E. W. in prior years, may need institutional care from time to time to
stabilize acute psychiatric symptoms. For others, no placement outside the
institution may ever be appropriate. To maintain a range of facilities and to
administer services with an even hand, the State must have more leeway than the
courts below understood the fundamental-alteration defense to allow. If, for
example, the State were to demonstrate that it had a comprehensive, effectively
working plan for placing qualified persons with mental disabilities in less
restrictive settings, and a waiting list that moved at a reasonable pace not
controlled by the State?s endeavors to keep its institutions fully populated,
the reasonable-modifications standard would be met. In such circumstances, a
court would have no warrant effectively to order displacement of persons at the
top of the community-based treatment waiting list by individuals lower down who
commenced civil actions. The case is remanded for further consideration of the
appropriate relief, given the range of the State?s facilities for the care of
persons with diverse mental disabilities, and its obligation to administer
services with an even hand. Pp. 18?22. Justice Stevens would affirm the
judgment of the Court of Appeals, but because there are not five votes for that
disposition, joined Justice Ginsburg?s judgment and Parts I, II, and III?A of
her opinion. Pp. 1?2.
Justice Kennedy concluded that the case must be remanded for a
determination of the questions the Court poses and for a determination
whether respondents can show a violation of 42 U.S.C. ? 12132?s ban on
discrimination based on the summary judgment materials on file or any further
pleadings and materials properly allowed. On the ordinary interpretation and
meaning of the term, one who alleges discrimination must show that she received
differential treatment vis-?-vis members of a different group on the basis of a
statutorily described characteristic. Thus, respondents could demonstrate
discrimination by showing that Georgia (i) provides treatment to individuals
suffering from medical problems of comparable seriousness, (ii) as a general
matter, does so in the most integrated setting appropriate for the treatment of
those problems (taking medical and other practical considerations into
account), but (iii) without adequate justification, fails to do so for a group
of mentally disabled persons (treating them instead in separate, locked
institutional facilities). This inquiry would not be simple. Comparisons of
different medical conditions and the corresponding treatment regimens might be
difficult, as would be assessments of the degree of integration of various
settings in which medical treatment is offered. Thus far, respondents have
identified no class of similarly situated individuals, let alone shown them to
have been given preferential treatment. Without additional information, the
Court cannot address the issue in the way the statute demands. As a
consequence, the partial summary judgment granted respondents ought not to be
sustained. In addition, it was error in the earlier proceedings to restrict the
relevance and force of the State?s evidence regarding the comparative costs of
treatment. The State is entitled to wide discretion in adopting its own systems
of cost analysis, and, if it chooses, to allocate health care resources based
on fixed and overhead costs for whole institutions and programs. The lower
courts should determine in the first instance whether a statutory violation is
sufficiently alleged and supported in respondents? summary judgment materials
and, if not, whether they should be given leave to replead and to introduce
evidence and argument along the lines suggested. Pp. 1?10.
Ginsburg, J., announced the judgment of the Court and delivered the
opinion of the Court with respect to Parts I, II, and III?A, in which
Stevens, O?Connor, Souter, and Breyer, JJ., joined, and an opinion with
respect to Part III?B, in which O?Connor, Souter, and Breyer, JJ., joined.
Stevens, J., filed an opinion concurring in part and concurring in the
judgment. Kennedy, J., filed an opinion concurring in the judgment, in which
Breyer, J., joined as to Part I. Thomas, J., filed a dissenting opinion, in
which Rehnquist, C. J., and Scalia, J., joined.