I. Introduction and Overview
The Attorney General has authority to investigate conditions in public residential facilities (1) and to take appropriate action if a pattern or practice of unlawful conditions deprive persons confined in the facilities of their constitutional or federal statutory rights pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA), 42 U.S.C.ï½§ï½§ 1997- 1997j (2). Protecting the rights of institutionalized persons is an important part of the Department's civil rights law enforcement effort. From May 1980, when CRIPA was enacted, through September 2001, the Department investigated conditions in 355 jails, prisons, juvenile correctional facilities, mental retardation and mental health facilities, and nursing homes. As a result of the Department's CRIPA enforcement, thousands of persons residing in public institutions across our country emerged from living in dire, often life-threatening, conditions to now enjoying adequate care and services.
The Attorney General has delegated day-to-day responsibility for CRIPA activities to the Special Litigation Section of the Civil Rights Division. During fiscal year 2001, the Section was active in CRIPA matters and cases involving more than 187 facilities in 33 states and the District of Columbia, as well as the Commonwealths of Puerto Rico and the Northern Mariana Islands, and the Territories of Guam and the Virgin Islands. (3) The Section initiated investigations of eleven facilities, continued its investigations of 53 additional facilities, and monitored the implementation of consent decrees, settlement agreements, and other court orders involving 105 facilities. The Attorney General filed two CRIPA suits involving a total of three facilities during the fiscal year. Both of these suits were settled during the fiscal year. During fiscal year 2001, the Section closed two investigations of two facilities and joined with defendants to dismiss four cases involving 20 facilities.
In keeping with the statutory requirements of CRIPA and the Attorney General's initiative, the Section engaged in negotiations and conciliation efforts to resolve a number of CRIPA matters both before and after filing CRIPA cases. The Section maximized its impact and increased its efficiency by continuing to focus on multi-facility investigations and cases, obtaining widespread relief whenever possible.
II. Filing of CRIPA Complaints/Resolution of Lawsuits
A. Cases Filed
1. On December 29, 2000, we filed a complaint and settlement agreement in United States v. Indiana (S.D. Ind.), concerning two state operated facilities serving approximately 560 persons with developmental disabilities, Muscatatuck State Developmental Center in Butlerville, Indiana, and at Fort Wayne State Developmental Center in Fort Wayne, Indiana. The settlement agreement was entered by the court. The agreement requires defendants to take steps to ensure not only the safety of persons at the two facilities, but also the safety of those persons placed in alternative community settings. Within the facilities, the state is required to improve training, clinical and medication practices, ensure that use of restraints is appropriate, and increase efforts to place individuals with developmental disabilities from these facilities in the most integrated setting possible which is appropriate to their individual needs. The Department will continue to monitor progress toward full implementation of the agreement.
2. On January 19, 2001, the Department filed a complaint and settlement agreement in United States v. McCracken County, Kentucky (W.D. Ky.) concerning conditions of confinement at the McCracken County Jail, a 350-bed facility. The agreement requires numerous improvements to inmate health and psychiatric care, including intake procedures, medication management, infection control and crisis intervention, as well as improvements regarding inmate housing, safety, protection from harm and environmental practices. The Department will continue to monitor progress toward full implementation of the agreement.
B. Settlements in Cases Filed in Prior Fiscal Years
1. On October 3, 2000, the court approved our settlement agreement in United States v. Louisiana (M.D. La.), which involved conditions of confinement in four of Louisiana's secure juvenile facilities. As a result of the agreement, Louisiana State University School of Medicine will assume responsibility for the provision of medical, dental, and mental health services in the facilities. The state also will take steps to improve conditions for incarcerated youth in Louisiana relating to abuse and excessive force as well as to provide better protection from harm while they are confined. This agreement culminated almost five years of investigation and discovery in this matter.
2. On April 21, 2001, the court in United States v. Commonwealth of Virginia (E.D. Va.) approved a modification of the consent decree pertaining to Central State Hospital in Dinwiddie County, Virginia. This agreement reset the dates for compliance monitoring and resolution of any disputes.
3. On September 20, 2001, the court in United States v. Hawaii (D. Haw.) entered a stipulated order regarding space utilization. This order establishes a procedure to address overcrowding issues at Hawaii State Hospital, the mental health facility which is the main subject of this case. Defendants will evaluate current space availability, short term repair projects, discharge planning, transfer criteria and the feasibility of purchasing modular buildings to provide space for patient residential and program needs. The order establishes patient census ranges by month and requires defendants to seek contracts for additional space if those ranges cannot be met for three consecutive months. The United States will continue to monitor compliance with this order.
III. Compliance Evaluations
During fiscal year 2001, the Special Litigation Section monitored defendants' compliance with CRIPA consent decrees, settlement agreements, and other court orders designed to remedy unlawful conditions in publicly operated facilities throughout the United States. (4) These facilities are:
1. Mental retardation facilities: Southbury Training School (United States v. Connecticut (D. Conn.)); Embreeville Center (United States v. Pennsylvania (E.D. Pa.)); (5) Arlington Developmental Center (United States v. Tennessee (W.D. Tenn.)); Clover Bottom Developmental Center, Greene Valley Developmental Center, and Harold Jordan Center (United States v. Tennessee (M.D. Tenn.)); Southern Wisconsin Developmental Center and Central Wisconsin Developmental Center (United States v. Wisconsin (W.D. Wis.)); and Center for Integral Services, Centro de Servicios Multiples de Camaseyes, Hogar de Grupo Las Mesas, Facilidad de Cuidado Intermedio, Centro de Reeducacion para Adultos, and Centro de Servicios Multiples Rosario Bellber (United States v. Commonwealth of Puerto Rico (D. P. R.)).
2. Mental health facilities: Hawaii State Hospital and children and adolescent residential services at Castle Medical Center and Kahi Mohala (United States v. Hawaii (D. Haw.)); Guam Adult Mental Health Unit (United States v. Guam (D. Guam)); Pilgrim Psychiatric Center (United States v. New York (E.D. N.Y.)); Memphis Mental Health Institute (United States v. Tennessee (W.D. Tenn.)); and Central State Hospital (United States v. Commonwealth of Virginia (E.D. Va.)).
3. Nursing homes: Philadelphia Nursing Home (United States v. City of Philadelphia (E.D. Pa.)).
4. Juvenile Correctional Facilities: thirty-two juvenile correctional facilities in Georgia (United States v. State of Georgia (N.D. Ga.)); Essex County Youth House (United States v. Essex County (D. N. J.)); 19 Puerto Rican juvenile correctional facilities (United States v. Puerto Rico (D. P. R.)); Kagman Youth Facility (United States v. Commonwealth of the Northern Mariana Islands (D. N.Mar.I.)); and educational services in four facilities in United Stated v. Louisiana (M.D. La.).
5. Jails: Crittenden County Jail (United States v. Crittenden County (E.D. Ark.)); Hagatna Detention Center and Fibrebond Detention Facility (United States v. Guam (D. Guam)); Grenada County Jail (United States v. Grenada County (N.D. Miss.)); Tupelo City Jail (United States v. Tupelo City (N.D. Miss.)); Forest City Jail (United States v. Forest City (S.D. Miss.)); Harrison County Jail (United States v. Harrison County (S.D. Miss.)); Simpson County Jail (Rainier and United States v. Jones (S.D. Miss.)); Sunflower County Jail (United States v. Sunflower County (S.D. Miss.)); Gila County Jail (United States v. Gila County, Arizona (D. Ariz.)), four jails in Northern Mariana Islands (United States v. Commonwealth of the Northern Mariana Islands (D. N.Mar.I.)); Muscogee County Jail (United States v. Columbus Consolidated City/County Government (M.D. Ga.)); and Morgan County Jail and Sheriff's Department (United States v. Morgan County, Tenn. (E.D. Tenn.)).
6. Prisons: Guam Adult Correctional Facility (United States v. Guam (D. Guam)); Montana State Prison (United States v. Montana (D. Mont.)); Golden Grove Adult Correctional Institution (United States v. Virgin Islands (D. V. I.)); and Saipan Prison Complex (United States v. Commonwealth of the Northern Mariana Islands (D. N.Mar.I.)).
7. Other Facilities: New Mexico School for the Visually Handicapped (United States v. New Mexico (D. N. Mex.)).
IV. Enforcement Activities
The Department took enforcement action during the fiscal year where state and local officials failed to meet their legal obligations under consent decrees and other court orders in CRIPA cases to improve conditions of confinement.
On May 17, 2001, in United States v. Hawaii (D. Ha.), following agreement by the parties, the court appointed a federal magistrate as Special Master as a vehicle to bring the State into compliance with previous court orders. The Special Master ordered the State to develop a comprehensive plan for the delivery of both hospital and community-based mental health services. The Special Master also chairs monthly status conferences during which the parties update the court on progress being made in developing the comprehensive plan as well as addressing immediate concerns in the case. One such immediate concern involves the remedial plan to correct patient overcrowding issues at the Hawaii State Hospital. On September 20, 2001, the parties filed a stipulation and proposed order which calls for a reduction in the hospital census as well as the transfer of patients to private hospitals.
On June 28, 2001, in Johnson and United States v. Murphy ( M.D. Fla.), after a two month trial in August and September 2000, the court decided the case in favor of defendants. However, largely as a result of this litigation, the state made substantial changes to the services it provides to persons with mental illness in central Florida. On the first day of the trial, defendants announced that the G. Pierce Woods Memorial Hospital (GPW), the subject facility in the case, would close on January 1, 2002. Further, the state allocated $37 million in new money for community mental health services to former patients of GPW.
V. Prison Litigation Reform Act
The Prison Litigation Reform Act (PLRA), 18 U.S.C. ï½§ 3626, which was enacted on April 26, 1996, covers prospective relief in prisons, jails, and juvenile correctional facilities. The Department has defended the constitutionality of the PLRA and has incorporated the PLRA's requirements in the new remedies it seeks regarding improvements in correctional facilities.
VI. Termination of CRIPA Consent Decrees and Partial Dismissals of Complaints
When jurisdictions comply with settlement agreements or court orders and correct unlawful conditions in the institution, the Section joins defendants in a motion to dismiss the underlying action. During fiscal year 2001, the Department joined with defendants to seek dismissal of four cases covering twenty facilities. On November 27, 2000, the court granted a joint motion for dismissal of United States v. Maricopa County (D. Ariz.) which ended litigation involving medical and mental health services in five jails in Phoenix, Arizona. On January 16, 2001, the court granted a joint motion to dismiss United States v. Kentucky (E.D. Ky.) regarding thirteen state operated juvenile facilities throughout Kentucky. On June 29, 2001, the court granted the parties' joint motion to dismiss United States v. Dooly County, Georgia (M.D. Ga.). County officials made substantial improvements to the jail's physical plant, fire and life safety, medical and mental health care, and ongoing correctional procedures. Substantial compliance with the settlement agreement, including the building of a new jail, formed the basis for the joint motion by the parties. On July 5, 2001, the court approved the joint motion to dismiss United States v. Commonwealth of Virginia (E.D. Va.), our case involving care and treatment at the Northern Virginia Mental Health Institute (NVMHI) in Fairfax, Virginia. Significant remedial measures at NVMHI included development and implementation of a comprehensive treatment process, increased protection from harm and discharge planning for community placement.
VII. Responsiveness to Allegations of Illegal Conditions
During fiscal year 2001, the Special Litigation Section reviewed allegations of unlawful conditions of confinement in public facilities from a number of sources, including individuals who live at the facilities and their relatives, staff and ex-staff of facilities, advocates, concerned citizens, media reports, and referrals from within the Department and other federal agencies. The Section received approximately 7700 incoming citizen letters and 1000 telephone complaints during the fiscal year. The majority of these citizen contacts related to CRIPA complaints. In addition, the Division responded to over 17 CRIPA-related inquiries from Congress.
The Section prioritized these allegations by focusing on facilities where allegations revealed systemic, serious deficiencies. In particular, with regard to mental health and mental retardation facilities and nursing homes, the Section focused on allegations of abuse and neglect; adequacy of medical and mental health care; use of restraints and seclusion; and services to institutionalized persons in the most integrated setting appropriate to meet their needs as required by Title II of the Americans with Disabilities Act and its regulations, 42 U.S. C. ï½§ï½§ 12132 et seq.; 28 C.F.R. ï½§ 35.130(d). With regard to juvenile correctional facilities, the Section focused on allegations of abuse, adequacy of mental health and medical care, and provision of adequate rehabilitation and education, including special education services. In jails and prisons, the Section placed emphasis on allegations of abuse, sexual misconduct, adequacy of medical care and psychiatric services, and grossly unsanitary and other unsafe conditions.
VIII. New CRIPA Investigations
The Department initiated CRIPA investigations of eleven institutions during the fiscal year. These new investigations involved the following facilities:
- Wicomico County Detention Center, Maryland;
- Baltimore City Detention Center, Maryland;
- Los Angeles County, California: Eastlake Juvenile Hall, Los Padrinos Juvenile Hall, and Sylmar Juvenile Hall;
- Banks-Jackson-Commerce Medical Center and Nursing Home, Georgia;
- North Carolina mental health facilities: John Umstead Hospital, Dorothea Dix Hospital, Cherry Hospital, and Broughton Hospital; and
- Oakwood Developmental Center, Kentucky.
IX. Findings Letters
The Department issued written findings of the results of its investigations, pursuant to Section 4 of CRIPA, 42 U.S.C. ï½§ 1997b, regarding two facilities:
- Bergen Regional Medical Center, New Jersey; and
- Shelby County Jail, Tennessee.
X. Investigation Closures
During the fiscal year, the Section closed investigations involving two facilities:
- Scioto/Riverview Joint Juvenile Correctional Center, Ohio; and
- Hamilton County Nursing Home, Tennessee.
XI. Technical Assistance
Where federal financial, technical, or other assistance is available to help jurisdictions correct deficiencies, the Department advises responsible public officials of the availability of such aid and arranges for assistance, where appropriate. During FY2001, the Section provided expert consultants to both Central State Hospital and Northern Virginia Mental Health Institute in Virginia regarding community placement, discharge planning, and treatment planning with particular emphasis on planning for persons with specialized needs. At Central State Hospital, we evaluated policies and procedures; provided advice on how to improve staffing, nursing plans, and patient safety; provided feedback on medication practices, and counseled staff and administrators on ways to improve their participation in treatment plan meetings; and offered guidance on behavioral data-collection, treatment planning, and staffing issues. In our mental health case involving Pilgrim Psychiatric Center in New York, we provided technical assistance on the development of constitutionally adequate restraint and seclusion policies. In connection with our case involving two mental retardation facilities in Indiana, we provided technical assistance to state officials regarding community placement issues involving persons who are medically fragile, available resources to enhance vocational training, mortality review policy development, biopsychosocial psychiatry model, assistive technology communication services, psychotropic medication, residential provider development, behavioral supports, and seizure management as well as the most effective techniques to investigate allegations of abuse. As part of our investigation of Los Angeles County juvenile facilities, we offered technical assistance regarding modern equipment to evaluate the adequacy of sanitation, the design and reorganization schemes in the medical units; care and inspection of heating and air conditioning, refrigeration and laundry systems; and education issues. In our investigation of Jackson County Correctional Center, our consultants provided technical guidance in the development of new medical policies and procedures, quality assurance plans, and new correctional policies and procedures.
1. Institutions covered by CRIPA include nursing homes, mental health facilities, mental retardation facilities, residential schools for children with disabilities, jails, prisons, and juvenile correctional facilities.
2. CRIPA does not cover the federal statutory rights of inmates in jails or prisons.
3. Fiscal year 2001 began on October 1, 2000, and ended on September 30, 2001. This report is submitted to Congress to supplement the Attorney General's report on Fiscal Year 2001 Department activities by providing additional details about CRIPA actions during the fiscal year pursuant to 42 U.S.C. ï½§ 1997f.
4. As noted on page 2, supra, the Department joined with defendants to seek full or partial dismissal of four cases covering twenty facilities; those facilities are not listed here, but are discussed infra at pages 8-9.
5. Embreeville Center closed during FY 1998 but, under the terms of the consent decree, the Section continues to monitor conditions in community placements from the facility.>