January 1, 1999

Sometime this spring, mentally disabled individuals will learn whether they have a legally guaranteed right to be sent to community placement before they can be confined in a psychiatric hospital.

The decision will be handed down by the U.S. Supreme Court, which announced on December 14, 1998, that it would hear an appeal from the state of Georgia of a federal appeals court ruling on the rights of mentally disabled patients. The appeals court affirmed a ruling that the state had discriminated against two mentally disabled persons. The state sent them to psychiatric hospitals rather than arranging community placement as their initial treatment setting.

The two original plaintiffs, psychiatric patients identified only as L.C. and E.W. to protect their confidentiality, maintained that the Americans With Disabilities Act (ADA) requires that their treatment should have been provided in "the most integrated setting appropriate" to their particular treatment needs.

The state contended, however, that an initial hospital placement matching these patients' care requirements was a legitimate alternative to community placement, especially when community placement would require a much greater investment of state funds than would a hospital confinement.

Georgia was joined in its appeal to the Supreme Court by 22 other states. They argue that if the high court upholds the appeals court's decision, it would make them easy targets for a host of lawsuits charging that they discriminated against psychiatric patients by treating them in "segregated institutions" instead of "integrated community-based programs."

Justifying its decision to hospitalize rather than arrange community placement, Georgia told a lower court that its "choice of setting for an individual requiring public care depends on the individual's mental condition, on the fact and extent of his dangerousness and inability to care for himself, and on fiscal and administrative consideration."

In April a federal appeals court upheld a lower court's ruling that supported the arguments of the two plaintiffs. It rejected the state's contention that the considerable expense of placing a mentally ill individual in a community-based treatment program is a valid reason for choosing to hospitalize a patient and does not violate ADA regulations.

In its ruling on the state's appeal from a lower court, the U.S. 11th Circuit Court of Appeals found merit in the plaintiffs' argument that they were put in a psychiatric hospital rather than a community facility because they were disabled. The court found erroneous the state's insistence that "the ADA requires a comparison of the treatment of individuals with disabilities against that of healthy nondisabled persons. However, as the state must concede," the justices said, "the confinement of L.C. and E.W. at [the state psychiatric hospital] is attributable to their disabilities, thereby proving the very element the State argues is missing." The appeals court concluded that "reduced to its essence, the State's argument is that Title II of the ADA affords no protection to individuals with disabilities who receive public services designed only for individuals with disabilities."

The ADA's Title II ensures that individuals will not be discriminated against in public services provided by state and local governments because of either a physical or a mental disability.

When a state "confines an individual with a disability in an institutionalized setting when a community placement is appropriate," the appeals court wrote, that state has violated the principles in this section of the ADA. The law's regulations also mandate that all jurisdictions and programs that receive federal funds treat disabled individuals "in the most integrated setting appropriate to the needs of" those people.

The state eventually transferred both L.C. and E.W. to community-based treatment facilities.

The Supreme Court is expected to issue its decision in Olmstead v. L.C., et al., by the end of June.