WASHINGTON – Maryland did the best it could in caring for brain-damaged or developmentally disabled patients over the past decade and cannot be forced to provide community placement for those patients, a federal court has ruled.
In a case that took more than seven years to decide, U.S. District Judge Catherine Blake ruled Thursday that the state did not violate the Americans with Disabilities Act or the due process rights of a dozen patients in the class- action suit.
Advocates for the disabled, who brought the suit, called the decision “an indictment on our healthcare system.”
“We’re really troubled and saddened that the court accepts the state’s mode of health care delivery in a manner that holds the everyday civil liberties of the patients hostage,” said Lauren Young, legal director of Maryland Disability Law Center.
The plaintiffs were 12 patients, the majority of whom suffered brain injuries rather than developmental problems. They argued that they, and dozens like them, were kept in mental institutions despite recommendations by medical professionals that they be moved to community settings.
Blake examined their due process rights in terms of the their medical treatment, their safety and the level of physical restraint to which they were subjected. On all counts, she found that the state met the standard.
“The plaintiffs’ pain and frustration was genuine and understandable; the defendants’ efforts to provide a stable, safe and caring environment also were genuine and commendable, if now always successful,” Blake wrote in the conclusion of her 83-page opinion.
“In the end, the plaintiffs have not shown sufficient reason for the court to order the state of Maryland to do more,” she wrote.
J.B. Hanson, a spokesman for Maryland Department of Health and Mental Hygiene, said the decision provides clear guidance to the state concerning its obligations under the Americans with Disability Act.
Throughout the case, state officials argued that they met their legal obligations to the plaintiffs by treating them in state psychiatric institutions and by placing them in community-based programs when fiscally and logistically possible.
“We are grateful that the court recognized the state clinicians and treatment staff can continue the necessary care for persons suffering from serious disabilities,” he said.
But Young said the chaotic environments of psychiatric institutions are particularly harmful to the plaintiffs, who often exhibit the aggressive and unmanageable behavior of the mentally ill.
“They don’t simply have a mental illness, but that is the service mode they receive,” she said. “If they move them to quieter, more meaningful settings, you’re not going to see that kind of behavior.”
Young also said that the state’s tendency to confine these patients to state mental hospitals makes no fiscal sense. It costs about $175,000 per year to keep such patients in mental hospitals, she said, but if they are discharged to community care, the federal government can contribute half the cost.
She could not say whether Blake’s decision would be appealed until after all the attorneys involved in the years-long litigation have had a chance to study the opinion.