Transcript Durkin Wyatt_RC Presentation

Two Important Alabama
Cases
R.C. v. Fuller
R.C. v. Fuller
Bill Fuller, Commissioner of the Alabama
Department of Human Resources (DHR)
 Case has changed names as new
commissioners are appointed
 Originally filed in 1988
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Who was R.C.?
Emotionally disturbed child
 Removed from the family home due to
allegations of abuse and neglect
 Though he had never been diagnosed as
psychotic or seriously mentally ill,
 Given large doses of psychoactive
medications while in the state's custody.
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What did DHR do?
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First, DHR placed R.C. in a psychiatric hospital
for a few weeks.
Next, they transferred him to the psychiatric unit
of a second hospital for six months.
R.C. left the psychiatric unit for a few days then
returned for another six-month stay.
Next stop was a home for children who are
psychotic or suffer serious behavioral disorders.
Medicated, restrained, and isolated
What did DHR do?
R.C.'s father tried to visit and was denied access
to his son
 Institutional authorities labeled R.C.'s father a
troublemaker due to his protests regarding
R.C.'s treatment and lack of access of family
visitation
 After the lawsuit was filed on R.C.'s behalf, DHR
returned R.C. to his father but offered no
assistance to the family
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Plaintiffs asserted that DHR violated their
constitutional rights to:
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Family integrity
Proper care while in state custody
Adequate mental health care
Reasonable efforts toward reunification
Freedom from discrimination on the basis of
their disabilities
Results
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Solve problems instead of simply removing
children from the home;
Investigating allegations of abuse and neglect
faster;
Providing appropriate and stable placements for
children removed as a last resort;
Reducing caseloads for social workers and
investigators;
Devoting more resources to the DHR county
agencies; and
Providing appropriate mental health services for
children with special needs.
Consent Decree
Required the creation of a "system of care"
 Principles emphasizing placement prevention,
family reunification, permanency, and homebased and community-based services.
 Designed to assist children (1) with emotional or
behavioral disorders who are in foster care; (2)
with emotional or behavioral disorders who are
at imminent risk of foster care placement;
and/or (3) at imminent risk of foster care
placement who are at high risk of developing
emotional or behavioral disorders.
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Consent Decree
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Protect children from abuse and neglect
Enable the children to live with their families
Achieve permanency and stability
Become stable, gainfully employed adults
pursuant to an individualized service plan.
Structured to ensure that family preservation
services are provided to most children at
imminent risk of foster placement.
Wyatt v. Stickney
Wyatt v. Stickney
Ended December 5, 2003 after 33 years
 Longest running mental health lawsuit in
U.S. history
 The ruling decreed that people with
mental disabilities had a constitutional
right to personal treatment with minimum
standards of care.
 Included staffing, diet and nutrition,
safety, physical plant adequacy, etc.
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Wyatt v. Stickney
9 Alabama governors
 14 state mental health commissioners
 Litigation expenses at over $15 million
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Lessard v. Schmidt
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Changed involuntary commitment policy.
1971 Federal Court in Milwaukee struck down
Wisconsin's commitment law as unconstitutional.
Traditional parens patriae grounds for
commitment abolished.
Commitment statutes in most states were too
broad and vague and procedural protections
absent.
Could be committed if considered "a proper
subject for custody and treatment."
Lessard v. Schmidt
Established dangerousness standard for
involuntary commitment.
 “Extreme likelihood that if the person is not
confined he will do immediate harm to himself
or others.”
 Individual to be accorded all the procedural
protections of the criminal law.
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“The enormity of what this case has
accomplished cannot be overstated. The
principles of humane treatment of people
with mental illness and mental retardation
embodied in this litigation have become
part of the fabric of law in this country
and, indeed, international law.”
- Judge Myron Thompson
So what started all of this?
A cut in Alabama's
cigarette tax.
The Beginnings
Filed in October of 1970 on behalf of Ricky
Wyatt
 Patient at Bryce Hospital
 a fifteen-year-old who had always been
labeled a "juvenile delinquent“
 Was not diagnosed with a mental illness
 Aunt was a Bryce employee
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The Beginnings
Initial suit response to layoffs of
employees due to budget constraints
 Over 100 employees including over 20
professional staff
 Mental health employees filed suit,
including the superintendent, Dr.
Stonewall Stickney
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The Beginnings
Argued that lay-offs of professional staff would
preclude even minimal treatment of patients at
Bryce
 Adding the patient enabled the suit to allege
that patients' treatment suffered as a result of
the layoffs.
 Federal District Judge Frank M. Johnson
dismissed the part of the suit brought by the
professionals.
 Consented to hear the part of the suit dealing
with the patients' grievances.
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Conditions in 1970
Three psychiatrists to serve over 5,000
patients
 Other professional staffing deplorably low
 Discharge was virtually impossible
 Intolerable conditions and improper
treatments designed only to make the
patients more manageable
 Food budget at 50 cents a day
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“Human feces were caked on the toilets and
walls; urine saturated the aging oak floors;
many beds lacked linen; some patients slept on
floors. Archaic shower stalls had cracked and
spewing shower heads. One tiny shower closet
served 131 male patients; the 75 women
patients also had but one shower. Most of the
patients at Jemison were highly tranquilized and
had not been bathed in days. All appeared
to lack any semblance of treatment. The stench
was almost unbearable."
Photographs by Chip Cooper
By Chip Cooper
The Case
Judge Johnson gave the state six months to
implement fully the "right to treatment" at Bryce
Hospital.
 When state failed, he laid out specific
requirements the hospital would have to meet.
 Assumption was that if these objectively
measurable conditions were met, treatment
would necessarily follow.
 Included such things as how often linen had to
be changed, how many showers a patient
should receive, and what furniture should be in
the dayroom.
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The Case
State appealed but circuit court held up decision
 In June 1977, complaining that the state was
still not living up to the mandated standards, the
plaintiffs succeeded in obtaining a federal court
office to monitor state compliance with Wyatt
standards.
 Office abolished in 1986
 Case ended December 5, 2003
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Results
Court-ordered agreements formed the basis for
federal minimum standards for the care of
people with mental illness or mental retardation
who reside in institutional settings.
 Seminal case in achieving drastic
deinstitutionalization of previously committed
patients.
 Population at state psychiatric hospitals reduced
by almost two-thirds between 1970 and 1975
(even while expenditures were increased by
327%)
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Results
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Set minimum standards of care
Established patient rights
Fostered the downsizing of state institutions
Proliferation of community services
Consumers now sit on boards
Led to Olmstead v. L.C. decision
ADA may require states to provide communitybased services rather than institutional
placements for individuals with disabilities
Least restrictive environment
Unfortunate Results
State invested an enormous sum of money on
improvements to outmoded buildings which
were promptly abandoned as large numbers of
patients were released
 Throughout the country, patients were dumped
from hospitals, supposedly to be cared for in the
community without alternative facilities in place
to care for them.
 Community mental health not properly funded
 Many who would have gotten care in mental
institution now “warehoused” in prisons and jails
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"Wyatt Standards"
Humane psychological and physical
environment
 Qualified and sufficient staff for
administration of treatment
 Individualized treatment plans
 Minimum restriction of patient freedom.
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“There can be no legal or moral justification for
the State of Alabama's failing to afford
adequate treatment for persons committed to
its care from a medical standpoint.
Furthermore, to deprive any citizen of his or her
liberty upon the altruistic theory that the
confinement is for humane therapeutic reasons
and then fail to provide adequate treatment
violates the very fundamentals of due
process.”
—Federal Judge Frank M. Johnson, Jr.