Friday, June 24, 2011

Arkansas v. DOJ: Federal Court supports parents and guardians and defines integration under the ADA

The U.S. Department of Justice spent years trying to prove that the Conway Human Development Center in Arkansas (an Intermediate Care Facility for the Mentally Retarded - ICF/MR) violated the rights of its residents under the U.S. Constitution and the Americans with Disabilities Act by providing substandard care and failing to integrate residents into the community.  The Court resoundingly disagreed and dismissed the case.

Why is this case important? The Americans with Disabilities Act and its interpretation by the Supreme Court in the Olmstead decision have been cited by many professionals and advocates to argue against all forms of congregate living and specialized services provided in group settings. They incorrectly claim that grouping people with disabilities together is segregating and therefore discrimination under the ADA. This case shows that even in a larger facility, the needs of the individual, the appropriateness of care, and the voices of parents and guardians are paramount in defining the least restrictive environment for each person. Non-institutional settings do not inherently guarantee the greatest integration possible for any individual. To limit services and residential options to "non-disability" settings does nothing to assure that a particular individual will be integrated into the community to the extent appropriate or possible for that person.

Here is a summary of the case from VOR, the only national organization that supports a full range of services and residential options for people with intellectual and developmental disabilities, including home and community based services and ICFs/MR. VOR (of which I am a member) is supporting legislation, H.R. 2032, to restore individual and family decisionmaking in cases such as this one.


U.S. v. Arkansas: Victory for Choice

In an 85-page ruling, Chief U.S. District Judge J. Leon Holmes dismissed a U.S. Department of Justice (DOJ) case finding that the DOJ failed to prove its claims that the Conway Human Development Center violated its residents’ rights under the U.S. Constitution by providing substandard care, as well as under the Americans with Disabilities Act (ADA) (community integration). Judge Holmes questioned the authority, expertise and methods of several expert witnesses used to support the federal government’s arguments. He extensively cited testimony of residents’ parents and guardians who he noted were “overwhelmingly satisfied” with the treatment the residents receive at Conway and “believe that the Center is the least restrictive, most integrated placement appropriate for their children and wards.”  (U.S. v. Arkansas, p. 8)

Family / Guardian Decisionmaking
“Most lawsuits are brought by persons who believe their rights have been violated. Not this one . . . All or nearly all of those residents have parents or guardians who have the power to assert the legal rights of their children or wards. Those parents and guardians, so far as the record shows, oppose the claims of the United States. Thus, the United States [Department of Justice] is in the odd position of asserting that certain persons’ rights have been and are being violated while those persons – through their parents and guardians disagree.”  (Id., p. 1).

Defining Integration
“’Community placement’ is a term that implies a more integrated, less restrictive setting than does the term “institution,” but it does not follow from the use of these terms that a resident automatically will have a greater degree of interaction in community placement, i.e., with a waiver provider, than in an institution such as Conway Human Development Center.  The evidence establishes that residents of Conway Human Development Center do interact with nondisabled persons – the Center is not a prison with inmates barred from interaction with the outside world; and conversely, the evidence establishes that placement with a waiver provider does not guarantee any amount of interaction with nondisabled persons.” (Id., p. 61; see also, p. 81, citing Olmstead, “[DOJ] Failed to prove that Conway Human Development Center is not the most integrated setting appropriate to the needs of any specific resident.”)

The “oddity” of a federal agency suing itself
[DOJ cases = DOJ v. HHS (CMS); compare to, P&A cases = HHS (ADD) v. HHS (CMS)].
“It is another oddity of this case that the institution at issue is funded and regulated by one department  of the executive branch of the federal government while another department of the executive branch contends that its conditions are so deplorable as to violate rights guaranteed to the institution’s residents by the United States Constitution. More pointedly, the United States simultaneously funds Conway Developmental Center, certifies it as eligible for those federal funds, and contends that the conditions there are so deplorable as to be unconstitutional.” [Id., p. 4 (fn 2)].

Compare to H.R. 2032
Just as the federal judge in the Conway case recognized, families and guardians are a necessary and important voice in matters impacting their family members with significant intellectual and developmental disabilities, including where they receive services and the quality of those services (see also, DD Act and Olmstead). 

H.R. 2032 aims to restore individual and family decisionmaking in federally funded class action lawsuits and DOJ actions. Specifically, H.R. 2032 provides that residents of ICFs/MR, or where appointed, their legal guardians, receive notice of a federally-funded class action lawsuit involving the ICF/MR before it is filed, and be given a time limited opportunity to opt out.  H.R. 2032 also requires that DOJ consult with families as part of any action, and if a lawsuit is filed provides residents of the affected ICF/MR or where appointed, their legal guardians, a right of intervention. The Conway case helps demonstrates both the value of family/guardian input and DOJ’s history of excluding their input. Similar examples include cases in Virginia, Georgia, Illinois and Tennessee

Read the full decision here.

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