Title: Judge Rotenberg Educational Center, Inc. v. Commissioner of Dep't of Developmental Services

State: massachusetts

Issuer: Massachusetts Supreme Court

Document:

NOTICE:  All slip opinions and orders are subject to formal 
revision and are superseded by the advance sheets and bound 
volumes of the Official Reports.  If you find a typographical 
error or other formal error, please notify the Reporter of 
Decisions, Supreme Judicial Court, John Adams Courthouse, 1 
Pemberton Square, Suite 2500, Boston, MA, 02108-1750; (617) 557-
1030; SJCReporter@sjc.state.ma.us 
 
SJC-13298 
 
JUDGE ROTENBERG EDUCATIONAL CENTER, INC.,1 & others2  vs.  
COMMISSIONER OF THE DEPARTMENT OF DEVELOPMENTAL SERVICES 
& another.3 
 
 
 
Bristol.     May 3, 2023. - September 7, 2023. 
 
Present:  Budd, C.J., Gaziano, Lowy, Cypher, Kafker, 
& Wendlandt, JJ. 
 
 
Developmentally Disabled Person.  Department of Developmental 
Services.  Probate Court, Revocation of decree, Judicial 
discretion.  Judgment, Relief from judgment.  Practice, 
Civil, Relief from judgment.  Regulation.  Administrative 
Law, Regulations.  Constitutional Law, Separation of 
powers. 
 
 
 
 
1 Formerly known as Behavior Research Institute, Inc. 
 
 
2 Leo Soucy, individually and as parent and next friend of 
Brendon Soucy; Peter Biscardi, individually and as parent and 
next friend of P.J. Biscardi; and both as representatives of the 
class of all patients at Judge Rotenberg Educational Center, 
Inc. (JRC), their parents, and their guardians.  The former 
executive director of JRC was originally listed as a plaintiff 
as well. 
 
3 Commissioner of the Department of Early Education and 
Care.  The director of the Office for Children, the predecessor 
in interest to the defendants, was originally listed as a 
defendant in her ex officio capacity. 
2 
 
Civil action commenced in the Bristol Division of the 
Probate and Family Court Department on February 28, 1986. 
 
A motion to terminate a consent decree, filed on February 
14, 2013, was heard by Katherine A. Field, J. 
 
The Supreme Judicial Court granted an application for 
direct appellate review. 
 
 
Timothy J. Casey, Assistant Attorney General (Christine 
Fimognari, Assistant Attorney General, also present) for the 
defendants. 
Max D. Stern (Joseph M. Cacace, Alexandra H. Deal, & C. 
Michele Dorsey also present) for Leo Soucy & others. 
Michael P. Flammia (Christian B.W. Stephens, Matthew D. 
Rodgers, & Trevin C. Schmidt also present) for Judge Rotenberg 
Educational Center, Inc. 
 
Kathryn Rucker, Mona Igram, Steven J. Schwartz, & Richard 
M. Glassman, for The Arc of Massachusetts & others, amici 
curiae, submitted a brief. 
 
Felicia H. Ellsworth & Charles C. Kelsh, for American 
Academy of Pediatrics & others, amici curiae, submitted a brief. 
 
 
KAFKER, J.  The instant appeal concerns a long-standing 
controversy over the treatment and welfare of a particularly 
vulnerable population living within our Commonwealth.  These 
individuals suffer from severe developmental and intellectual 
disabilities that, left untreated, cause them to engage in 
grievous self-harm, maiming, and other life-threatening 
behaviors.  They reside in small group homes under the care of 
Judge Rotenberg Educational Center, Inc. (JRC), a facility that 
employs the use of aversive interventions -- most notably, 
electric skin shock -- as part of its treatment approach to 
severe behavioral issues.  JRC, which stands as the sole 
3 
 
facility in the country to use electric skin shock on the 
developmentally disabled, currently operates under the 
protection of a thirty-six year old consent decree.  That decree 
was entered, and has remained in place, after State agencies 
resorted to pretextual and bad faith regulatory practices to 
disrupt JRC's operations in the 1980s and 1990s.  The State 
agencies that remain bound by the decree have since moved for 
its termination.  That motion was denied by a judge in the 
Probate and Family Court (Probate Court), and the matter now 
comes before us on appeal. 
For many mental health advocates, the controversial 
interventions used by JRC sound reminiscent of the 
institutionalization and abuse inflicted on the developmentally 
disabled in decades past.  Yet the families of these clients 
claim that JRC has been singularly effective in preventing their 
children from engaging in severely self-injurious and 
destructive behaviors, such as gouging their own eyes, 
puncturing their own bodily orifices, and violently attacking 
others.  These families characterize JRC's methods as a 
treatment of last resort -- one sought after alternative 
treatments either failed to protect their children from self-
harm or left them continually sedated and restrained.  This case 
thus involves a heart-wrenching issue:  continue to protect a 
controversial practice that has widely been criticized, or pave 
4 
 
the way for its prohibition at the risk of subjecting these 
vulnerable patients to a life of sedation and restraint, or 
extreme self-injury. 
The propriety of this controversial treatment does not 
reach us in a vacuum, however.  The record before us contains 
extensive findings of fact made by the judge below, based on a 
forty-four day evidentiary hearing that closed in 2016, with 788 
exhibits and nearly thirty witnesses.  Among those findings was 
the judge's conclusion that the Commonwealth had yet again 
resorted to bad faith regulation of JRC in 2010, and that, as of 
2016, the medical community remained divided as to whether JRC's 
treatment approach fell outside the professional standard of 
care for the most severely disabled patients. 
It is particularly troubling that the case is before us on 
an evidentiary record that closed seven years ago, especially 
given the fact-intensive nature of the issues at stake.  
Nonetheless, because the parties have urged us to decide this 
appeal without remanding for additional findings, we assess the 
parties' arguments on the record we have been given.  That 
record compels us to conclude that the defendants have failed to 
demonstrate that the judge's findings were clearly erroneous, 
based on the evidence before her in 2016. 
We stress, however, that our conclusion does not foreclose 
the possibility that new developments will occur, or have 
5 
 
occurred, bearing on these factual issues.  Moreover, nothing in 
our decision or the consent decree prevents the Department of 
Developmental Services (department) from exercising its existing 
authority to contest the use of electric skin shock on 
individual JRC patients at their yearly substituted judgment 
hearings in the Probate Court.  Nor is the department precluded 
from enforcing the consent decree's requirement that electric 
skin shock be used only where it is the least intrusive, most 
appropriate treatment.  The fact that the department has largely 
chosen not to do so informs the context within which we rule on 
this issue.  That being said, today we decide only the narrow 
question of whether the judge below abused her discretion in 
concluding that the department failed to establish that the 
consent decree should be terminated based on the evidentiary 
record before the Probate Court in 2016.  We conclude that she 
did not, and thus affirm the denial of the defendants' motion.4 
 
4 We acknowledge the amicus brief submitted by the American 
Academy of Pediatrics, the American Association on Intellectual 
and Developmental Disabilities, the National Association of 
State Directors of Developmental Disabilities Services, the 
National Association of State Directors of Special Education, 
the International Association for the Scientific Study of 
Intellectual and Developmental Disabilities, the National 
Association for the Dually Diagnosed, and the Massachusetts 
Chapter of the American Academy of Pediatrics, as well as the 
amicus brief submitted by The Arc of Massachusetts, the 
Disability Policy Consortium, the Massachusetts Developmental 
Disability Council, the Federation for Children with Special 
Needs, and MassFamilies.  In addition, we allow the plaintiffs' 
joint motion for leave to respond to the briefs of the amici 
6 
 
1.  Background.  We summarize the relevant factual findings 
of the judge below, supplemented where necessary by undisputed 
evidence in the record.  See Connor v. Benedict, 481 Mass. 567, 
568 (2019).  Because the record before the Probate Court closed 
in 2016, any references to "current" practices, procedures, or 
statistics is only current as to that date, unless otherwise 
noted. 
a.  JRC and its treatment methods.  Since 1975, JRC5 has 
operated a residential program in the Commonwealth to provide 
treatment and educational services for individuals with 
intellectual disabilities, developmental disabilities, and 
behavior disorders.  At present, JRC operates forty-four houses 
in the Commonwealth, where clients live in a residential 
setting.  The judge below credited testimony that patients are 
housed in a very humane environment and the staff is well 
trained.  As of March 2015, the total number of clients enrolled 
at JRC was 244. 
Many of the developmentally disabled patients at JRC suffer 
from severely problematic behaviors, including aggressive, 
 
curiae.  See Mass. R. A. P. 17 (b), as appearing in 481 Mass. 
1635 (2019). 
 
5 At the time of its founding, JRC was known as Behavior 
Research Institute, Inc.  See note 1, supra.  For the sake of 
consistency, we shall refer to the facility as JRC throughout 
this decision. 
7 
 
destructive, and self-injurious behaviors.  Indeed, a number of 
patients have come to JRC after being expelled from other 
facilities unable to address the severity of their behavioral 
issues.  For some of these patients, prior programs had resorted 
to restraint or heavy sedation in an attempt to manage their 
harmful behaviors.  Because JRC generally does not turn patients 
away, for numerous families, JRC was the only program willing to 
accept their son or daughter. 
Unlike other facilities, JRC has a policy of avoiding or 
minimizing the use of psychotropic medication to treat its 
patients.  Instead, JRC has long relied upon applied behavior 
analysis (ABA) to treat patients.  This involves conducting a 
"functional behavior assessment," i.e., studying the 
relationship between problematic behaviors and the conditions 
that precede them.  JRC then uses positive reinforcement, e.g., 
rewards, to encourage desirable behaviors and negative 
consequences, or "aversives," to discourage undesirable 
behaviors.  Typically, JRC relies in the first instance on 
positive reinforcement procedures alone.  However, if JRC's 
positive programming fails to accomplish a patient's treatment 
goals, or if it does not effectively treat the patient's 
problematic behavior, the family is given the option of 
including aversives as part of their son or daughter's treatment 
plan.  At the evidentiary hearing, several former JRC patients 
8 
 
and parents credited JRC's aversive treatments with 
significantly improving these patients' problematic behaviors. 
At the time this litigation first began in 1986, JRC 
employed a variety of physical aversives in a hierarchical 
fashion with increasing levels of intrusiveness.  See Natrona 
County Sch. Dist. No. 1 v. McKnight, 764 P.2d 1039, 1045 n.4 
(Wyo. 1988) (listing hierarchy of aversives utilized at JRC in 
1985).  In the years after the consent decree was entered, JRC 
shifted away from this existing hierarchy of aversives in favor 
of using the "Graduated Electronic Decelerator" (GED), a device 
that administers a two-second electric shock to the surface of 
the skin, usually on the arm or the leg.  At present, the GED is 
the primary physical aversive used at JRC.  JRC utilizes two 
versions of the device:  the GED-3A and the GED-4.  The former 
delivers a current of 15.25 milliamps, and the latter delivers a 
current of 41 milliamps. 
JRC administers the GED to discourage specific problematic 
behaviors.  When a JRC staff member observes one of these 
behaviors, a second staff member verifies that the behavior is 
one for which use of the GED has been authorized pursuant to a 
substituted judgment action, see note 6, infra, and the first 
staff member then activates the GED.  Normal application of the 
device results in transient pain. 
9 
 
Before a patient may be treated with the GED, a JRC 
clinician must first develop a treatment plan.  Each plan is 
reviewed and approved by JRC clinicians, as well as a human 
rights committee and a peer review committee.  After JRC 
develops the treatment plan, it must petition the Probate Court 
for substituted judgment6 authorization to use the GED on that 
patient.  Once the Probate Court has approved the plan, JRC must 
petition for reauthorization on an annual basis to continue 
treating the patient with the GED.  In the treatment plan 
provided to the Probate Court, JRC is required to identify the 
behaviors that it intends to target with the GED, and a JRC 
clinician must aver that the GED is the least intrusive, most 
effective treatment for the patient in question.  The department 
has the ability to oppose the use of the GED on a particular 
patient at these yearly substituted judgment proceedings, but, 
in practice, the department rarely does so.  In one 2014 
proceeding where the department did choose to participate, the 
 
6 Substituted judgment proceedings are used as a "means by 
which incompetents may exercise their right to refuse or 
terminate treatment. . . .  The judge, after hearing, must try 
to identify the choice which would be made by the incompetent 
person, if that person were competent, taking into account the 
present and future incompetency of the individual as one of the 
factors which would necessarily enter into the decision-making 
process of the competent person" (quotation and citation 
omitted).  Guardianship of Doe, 411 Mass. 512, 518 (1992). 
10 
 
Probate Court ultimately sided with the department and declined 
to authorize the use of the GED on that patient. 
As of 2014, thirty percent of JRC's patients had treatment 
plans that included the use of court-authorized aversives.  The 
remaining seventy percent were treated using positive 
programming alone.  As of the close of evidence in 2016, few JRC 
patients treated with the GED were minors.  Counsel for the 
defendants has since represented to this court that there are 
currently no children receiving the GED as part of their 
treatment plan. 
b.  History of current litigation.  The procedural history 
of this litigation began almost forty years ago, and the matter 
last came before this court in 1997.  See Judge Rotenberg Educ. 
Ctr., Inc. v. Commissioner of the Dep't of Mental Retardation 
(No. 1), 424 Mass. 430 (JRC I), S.C., 424 Mass. 471, 424 Mass. 
473, and 424 Mass. 476 (1997).  We need not repeat the entire 
history of this case, much of which is covered in our prior 
decision.  See id. at 433-442.  In short, this litigation began 
after the Office for Children (OFC) issued a set of emergency 
orders in 1985 requiring JRC to immediately cease the use of 
physical aversive treatments and to halt the intake of new 
patients.7  A judge in the Probate Court would later find that 
 
7 Because JRC provided treatment to children with special 
needs, in a full-time residential setting, it was at that time 
11 
 
OFC had issued these orders "based upon no medical foundation," 
and that OFC attempted to hide this fact by retroactively 
altering a report that had been "laudatory to [JRC] in all 
substantial respects." 
In response to the emergency orders, JRC and a class 
consisting of all JRC patients and their parents and guardians 
filed suit, alleging various constitutional and civil rights 
violations.  Thereafter, a judge in the Probate Court entered a 
preliminary injunction enjoining OFC from enforcing its orders 
and found that OFC had engaged in bad faith regulation of JRC.  
The parties subsequently reached a settlement agreement, and on 
January 7, 1987, the Probate Court approved and incorporated the 
agreement as an order of the Probate Court (consent decree).  As 
part of the settlement agreement, licensing responsibility for 
JRC was transferred from OFC to the Department of Mental Health; 
later, that responsibility was transferred to the Department of 
Developmental Services.8 
 
required to obtain a license from the Office for Children (OFC).  
See G. L. c. 28A, §§ 9, 11, as amended through St. 1981, c. 726, 
§ 1.  OFC is now known as the Department of Early Education and 
Care (DEEC).  See Commonwealth v. Power, 76 Mass. App. Ct. 398, 
400 n.2 (2010).  DEEC is the other named defendant in this 
appeal. 
 
8 At the time that the Department of Developmental Services 
(department) became a party to the case, it was known as the 
Department of Mental Retardation.  See G. L. c. 19B, § 1, as 
amended through St. 2008, c. 182, § 9. 
12 
 
The consent decree contained a number of provisions, which 
are discussed at length in JRC I, 424 Mass. at 433 n.5, 443-445, 
448, and included a requirement that both parties act in good 
faith.  Another provision required JRC to obtain authorization 
from the Probate Court, by way of substituted judgment 
proceedings, before it could employ physical aversives in the 
individual treatment plan of a client unable to give consent.  
This was the only provision that was explicitly designed to 
survive the termination of the consent decree.  The decree 
called for compliance reviews to occur at six-month intervals, 
with the decree to terminate automatically after the second such 
review "unless the [Probate] Court, for good cause shown related 
to the terms or substance of [the settlement] agreement, orders 
otherwise."  The Probate Court subsequently issued an order on 
July 7, 1988, extending the settlement agreement indefinitely.  
No party objected to this extension. 
Shortly after the consent decree was entered in 1987, 
regulations were promulgated to govern the appropriate use of 
physical aversives.  The regulations classified aversive 
interventions into one of three "levels," depending on severity.  
See 104 Code Mass. Regs. § 20.15(3) (1987).  Level three was 
comprised of the most severe aversive treatments, including any 
intervention that "involve[d] the contingent application of 
physical contact aversive stimuli" or "pose[d] a significant 
13 
 
risk of physical or psychological harm to the individual."  See 
104 Code Mass. Regs. § 20.15(3)(d).  Any program seeking to use 
level three aversives was required to apply for a special 
certification from the department.9  See 104 Code Mass. Regs. 
§ 20.15(4)(f) (1987).  After conducting a review and inspection 
of the program, the department would grant, grant with 
conditions, or deny the program a level three certification for 
a period not to exceed two years.  See 104 Code Mass. Regs. 
§ 20.15(4)(f)(7),(9). 
The regulations further specified that a program would only 
be eligible to receive a certification for the use of level 
three aversives if, "prior to the effective date of this 
regulation, . . . the program had been using one or more level 
III interventions pursuant to a Behavior Modification plan for 
one or more clients of the program."  See 104 Code Mass. Regs. 
§ 20.15(4)(f)(11).  Additionally, and in accord with the consent 
decree, level three interventions could not be used on a patient 
unable to provide consent, absent authorization from the Probate 
Court, obtained by way of a substituted judgment proceeding.  
See 104 Code Mass. Regs. § 20.15(4)(e) (1987).  Moreover, these 
 
9 At the time the regulations were first promulgated, the 
Department of Mental Health was the agency responsible for 
certifying programs for use of level three aversives.  See 104 
Code Mass. Regs. §§ 2.02(2), 20.15(4)(f) (1987).  This 
responsibility was subsequently transferred to the Department of 
Developmental Services. 
14 
 
interventions could only be used "to address extraordinarily 
difficult or dangerous behavioral problems that significantly 
interfere with appropriate behavior and or the learning of 
appropriate and useful skills and that have seriously harmed or 
are likely to seriously harm the individual or others."  See 104 
Code Mass. Regs. § 20.15(4)(b)(5) (1987).  JRC is the only 
program in the Commonwealth certified to use level three 
aversives.10 
In 1993, six years after the consent decree was entered, 
the department launched a campaign to "disrupt the operations of 
JRC by every conceivable means," with the intent of putting JRC 
out of business.  See JRC I, 424 Mass. at 454.  This included 
"interfering with JRC's relationships with funding agencies and 
JRC's fiscal operations," as well as imposing "a severe and 
essentially constant burden on the JRC staff by having to 
respond to an unrelenting stream of bad faith regulatory 
 
10 It should be noted, however, that there are references in 
the record to other facilities that have, at various times, used 
a level three aversive because they employed time-outs beyond 
fifteen minutes.  See 104 Code Mass. Regs. § 20.15(3)(d)(2) 
(1987) (defining level three aversives to include time-outs in 
excess of fifteen minutes).  See also Judge Rotenberg Educ. 
Ctr., Inc. v. Commissioner of the Dep't of Mental Retardation 
(No. 1), 424 Mass. 430, 447 n.20 (JRC I), S.C., 424 Mass. 471, 
424 Mass. 473, and 424 Mass. 476 (1997) (noting that department 
had permitted use of aversive therapies on individual patients 
at various facilities, even though department official conceded 
that "there is no authority in the regulations for approval of 
Level III procedures 'in the absence of a certification as a 
program'"). 
15 
 
demands" made without justification.  Id. at 456-457.  At one 
point, the department ordered JRC to discontinue level three 
aversives for six patients, and later, it decertified JRC as a 
provider of level three aversives altogether.  The department's 
actions led JRC to file a complaint alleging that the department 
was in contempt of the consent decree. 
After a thirteen-day trial, a judge in the Probate Court 
found that the department had engaged in bad faith regulation of 
JRC, held the department in contempt of the consent decree, and 
placed it in receivership to oversee and manage its interactions 
with JRC.  This court affirmed the finding of contempt on 
appeal, but narrowed the scope of the receivership.  See id. at 
463, 466-467.  In 2003, the parties agreed to a winding down of 
the receivership.  By order of the Probate Court, the 
receivership came to an end in 2006, thereby restoring the 
department's regulatory oversight of JRC.  The order did not, 
however, terminate the consent decree. 
c.  Department's regulatory conduct postreceivership.  In 
August 2007, a former JRC resident called the facility, 
impersonated a staff member over the telephone, and ordered JRC 
employees to administer dozens of electric shocks to two 
patients in the middle of the night.  The caller also ordered 
the employees to place a third patient on a four-point restraint 
16 
 
board, despite the fact that this was not authorized by the 
patient's treatment plan. 
In the wake of the incident, JRC was investigated by the 
department, along with a number of other entities, including the 
Department of Social Services, the Department of Early Education 
and Care, the Disabled Persons Protection Commission, and an 
independent monitor.  These investigations identified a number 
of issues that contributed to this horrible incident, and the 
department issued an action plan to JRC in early 2008 requiring 
the facility to, inter alia, ensure that staff personally 
witness the targeted behavior before using the GED, and minimize 
the time between observing the behavior and administering the 
GED. 
In January 2008, the Secretary of the Executive Office of 
Health and Human Services (EOHHS), JudyAnn Bigby, sent a 
memorandum to Governor Deval Patrick with recommendations for 
ways in which the administration could "change the State's 
policy toward JRC without running afoul of the [consent 
decree]."  Bigby made clear that she was "personally outraged by 
the continued practice of electric skin shock therapy" and 
believed it to be outside the current standard of care.  She 
tasked EOHHS Assistant Secretary Jean McGuire with forming and 
leading a clinical advisory group on the use of aversives.  The 
initiative resulted in a memorandum authored by one of its 
17 
 
members, Dr. Charles Hamad (Hamad memo or memo), a psychologist 
at University of Massachusetts Medical School (UMass Medical). 
Upon receiving Hamad's draft of the memo, McGuire suggested 
a number of edits, including the minimization of one expert's 
opinion that she felt "looked like a rationale for keeping one 
place [that uses electric skin shock] open in the country (which 
would be the one we already have)."  Hamad approved McGuire's 
edits, which included a new sentence stating, "In brief, our 
conclusion is that neither the professional literature nor the 
practice arena supports the use of aversive contingent 
interventions for behavior management of people with 
intellectual or other disabilities that may involve serious 
behavioral problems."  The final version of the Hamad memo was 
attached to a subsequent policy review memorandum that McGuire 
drafted and sent to Bigby in December 2008, which listed various 
political and regulatory options for changing the 
administration's policy toward the use of electric skin shock. 
One year later, Bigby sent a memorandum to the Governor 
with an update on the status of JRC since the August 2007 
incident.  She noted that there had been "considerable 
improvement in Executive agency collaboration and oversight of 
JRC, which in turn has led to noteworthy progress in JRC's 
performance."  She also stated that the department's level three 
"certification team has recently completed a monitoring review 
18 
 
and found JRC to be in substantial compliance with previously 
imposed conditions."  Although Bigby reiterated her belief that 
the use of aversives "does not reflect the community standard of 
care or best practices," she concluded that, "at least for now," 
the administration should "continue the current close monitoring 
and regulation of JRC and . . . not pursue any other options at 
this time." 
In May 2010, the Governor's chief legal counsel met with 
representatives of advocacy groups opposed to aversive 
treatments.  McGuire subsequently informed the department of the 
issues discussed at the meeting, including the advocates' 
recommendation that the department "make every use of the 
upcoming certification to assure that we are tough on / 
responsive to those areas where he [sic] continues to be non-
compliant or has slipped." 
The following month, the department's 2010 certification 
team, headed by Dr. Philip Levendusky, completed its report on 
JRC's most recent application for level three certification.  
The team concluded that JRC was in "substantial compliance" with 
prior conditions imposed by the department and recommended that 
JRC be given a one-year recertification to use level three 
aversives with certain conditions of compliance.  However, in a 
subsequent series of communications between Levendusky, the 
department's general counsel, and the department's commissioner, 
19 
 
the 2010 report was further revised without consulting the 
remaining team members.  In the course of these revisions, the 
department's general counsel removed the "substantial 
compliance" language from the report as well as the 
recommendation that JRC be issued a one-year certification.  The 
final, revised version of the report instead extended JRC's 
existing certification by fourteen working days.  Within that 
time, JRC was required to submit a corrective action plan for 
obtaining compliance with all of the report's conditions, and to 
submit additional progress reports at forty-five-day intervals. 
Following the issuance of this report, and in the course of 
complying with the deadlines contained therein, JRC exchanged a 
number of reports and correspondences with the department in 
which JRC challenged the department's ability to impose certain 
conditions, and the department rejected various of JRC's 
assertions of compliance.  Eventually, in the summer of 2011, 
JRC and the department agreed to mediation before the former 
receiver.  The parties ultimately reached an agreement in July 
2012 resolving their dispute. 
While the mediation was still ongoing, the department 
amended its behavior modification regulations to prohibit the 
use of level three aversives, except for "individuals who, as of 
September 1, 2011, [had] an existing court-approved treatment 
plan" authorizing their use.  See 115 Code Mass. Regs. 
20 
 
§ 5.14(4)(b)(4) (2011).  In effect, these regulations imposed a 
prospective ban on the use of level three aversives for new JRC 
patients.  After the regulations went into effect, the 
department convened a group of experts to serve on an advisory 
subcommittee charged with promulgating new guidelines for the 
Statewide implementation of the department's favored treatment 
approach, Positive Behavior Supports (PBS).11  In advance of the 
subcommittee's discussions of the ABA literature concerning the 
efficacy and acceptability of using specific procedures to 
decelerate problematic behaviors, a representative of the 
department informed the subcommittee co-chair that "it won't 
matter whats [sic] in the literature if [the commissioner] does 
not like it."  Some members of the subcommittee nonetheless went 
on to voice support for the use of level three aversives in 
certain limited circumstances, and the group expressed 
discomfort with draft guidelines that would ban specific 
interventions.  The department subsequently instructed the 
 
11 Positive Behavior Supports (PBS) focuses on the 
conditions that precede problem behaviors and the environmental 
changes that can be made to improve a client's quality of life.  
The judge below found that PBS was more accurately described as 
a philosophy or general approach to treatment, rather than a 
subdiscipline within the field of psychology. 
 
21 
 
subcommittee not to address the issue of level three aversives 
as part of their work.12 
d.  Procedural history leading to instant appeal.  In 2013, 
while the advisory subcommittee's discussions remained ongoing, 
the defendants filed a motion in the Probate Court to terminate13 
the consent decree, pursuant to Rule 60 of the Rules of the 
Probate Court (2013) and Mass. R. Civ. P. 60 (b) (5), 365 Mass. 
828 (1974).  The department argued that termination of the 
decree was warranted because the department had long since 
abandoned its history of bad faith regulation, and because the 
 
12 The department went on to amend its regulations that year 
to remove certain level two aversives, including procedures 
requiring significant physical exercise, unpleasant sensory 
stimuli like loud noises or bad tastes, and meal delays.  See 
115 Code Mass. Regs. § 5.14(3)(c)(1) (2013).  However, it was 
not until 2020 that new regulations went into effect replacing 
the existing regulations governing behavior modification with a 
PBS framework.  See 115 Code Mass. Regs. §§ 5.14, 5.14A (2020). 
 
13 The parties have characterized the defendants' pleading 
as a motion to "vacate" the consent decree.  However, the 
defendants' motion "did not challenge the grounds on which [the 
consent decree] was earlier entered," but "sought only to 
prevent its prospective application."  MacDonald v. Caruso, 467 
Mass. 382, 384 n.4 (2014).  Accordingly, the motion is most 
appropriately understood as a request to terminate, rather than 
vacate, the decree.  See id.  See also Inmates of Suffolk County 
Jail v. Rouse, 129 F.3d 649, 662 (1st Cir. 1997), cert. denied, 
524 U.S. 951 (1998) ("While terminating a consent decree strips 
it of future potency, the decree's past puissance is preserved 
and certain of its collateral effects may endure.  Vacating a 
consent decree, however, wipes the slate clean, not only 
rendering the decree sterile for future purposes, but also 
eviscerating any collateral effects and, indeed, casting a 
shadow on past actions taken under the decree's imprimatur"). 
22 
 
primary physical aversive used by the facility, electric skin 
shock, was outside the professional standard of care. 
A judge in the Probate Court held an evidentiary hearing on 
the motion, which took place over the course of forty-four days 
between October 2015 and October 2016.  On June 20, 2018, the 
judge issued a written memorandum of decision denying the 
motion.  The judge found that the department had engaged in bad 
faith regulation of JRC in 2010, just as it had in prior 
decades.  On this basis, the judge concluded that, as of 2018, 
the consent decree remained necessary to protect JRC from bad 
faith conduct such as had occurred eight years prior.  The 
judge's 2018 decision also concluded that the department had 
failed to demonstrate a significant change in circumstances that 
would warrant termination of the consent decree.  In reaching 
this conclusion, the judge found that the department had failed 
to show that, as of the close of evidence in 2016, there was a 
professional consensus that level three aversives were outside 
the standard of care.  The defendants timely filed a notice of 
appeal, and the case was entered in the Appeals Court in August 
23 
 
2021.14  Thereafter, this court granted the parties' joint 
application for direct appellate review.15 
2.  Standard of review.  Rule 60 (b) (5) permits the court 
to grant relief from a judgment with prospective effect where 
"it is no longer equitable" for the judgment to remain in place.  
This requires the moving party to demonstrate a significant 
change in circumstances since the entry of the judgment that 
would warrant its modification or termination.  See MacDonald v. 
Caruso, 467 Mass. 382, 388 (2014), and sources cited.  This 
standard is a flexible one, and its application depends upon the 
individual facts of the case and the nature of the judgment at 
issue.  See Rufo v. Inmates of Suffolk County Jail, 502 U.S. 
 
14 The three-year delay between the department's notice of 
appeal and the entry of this case in the Appeals Court appears 
to have been due to the size of the record, compounded by delays 
in receiving searchable copies of the electronic transcript 
files, as well as lapses in communication between the clerk's 
office of the Probate and Family Court (Probate Court), the 
parties, and the stenographers. 
 
15 JRC has argued that DEEC's appeal should be dismissed 
because DEEC failed to file a brief after the case had been 
entered in this court.  DEEC, which joined in the notice of 
appeal and docketing statement, has since moved to join the 
department's appellate brief.  DEEC has argued that it failed 
join the department's brief at the time of filing because 
counsel for the defendants "mistaken[ly]" believed that DEEC had 
no further obligations under the decree, given that no children 
enrolled at JRC are approved for use of level three aversives.  
JRC has failed to articulate any prejudice that would stem from 
allowing DEEC's motion to join the department's briefing.  
Accordingly, we allow DEEC's motion to join the department's 
brief and decline JRC's invitation to dismiss DEEC's appeal. 
24 
 
367, 380-381 (1992).  See also Alexis Lichine & Cie. v. Sacha A. 
Lichine Estate Selections, Ltd, 45 F.3d 582, 586 (1st Cir. 
1995).  Thus, consent decrees that implicate "the supervision of 
changing conduct or conditions," which "are thus provisional and 
tentative," are more likely to warrant modification than consent 
decrees that "give protection to rights fully accrued upon facts 
so nearly permanent as to be substantially impervious to 
change."  Rufo, supra at 379, quoting from Justice Cardozo's 
often-cited articulation of the standard in United States v. 
Swift & Co., 286 U.S. 106, 114-115 (1932). 
The decision whether to grant relief from judgment under 
rule 60 (b) rests within the sound discretion of the trial 
judge.  See Atlanticare Med. Ctr. v. Division of Med. 
Assistance, 485 Mass. 233, 247 (2020) (Atlanticare).  
"Accordingly, the denial of a motion under Rule 60 (b) will be 
set aside only on a clear showing of an abuse of discretion" 
(quotation and citation omitted).  Id.  In effect, this means 
that the decision will be affirmed unless the judge below "made 
a clear error of judgment in weighing the factors relevant to 
the decision . . . such that the decision falls outside the 
range of reasonable alternatives" (citation omitted).  Dacey v. 
Burgess, 491 Mass. 311, 317 (2023).  Here, the department's 
argument that the judge abused her discretion is focused 
primarily upon contesting two factual findings derived from the 
25 
 
evidentiary record before the Probate Court in 2016:  (1) the 
department's continued bad faith regulatory conduct toward JRC; 
and (2) the absence of a professional consensus whether level 
three aversives fall outside the accepted standard of care. 
"To prevail on appeal on the basis of an assault on a 
judge's factual findings is no easy matter, for we accept the 
judge's findings of fact as true unless they are 'clearly 
erroneous'" (citation omitted).  Millennium Equity Holdings, LLC 
v. Mahlowitz, 456 Mass. 627, 636 (2010).  Under this "clearly 
erroneous" standard, "the judge's findings come here well armed 
with the buckler and shield" (alteration, quotation, and 
citation omitted).  JRC I, 424 Mass. at 452.  That is, any 
finding based partly or wholly on oral testimony will be upheld, 
unless there is no evidence to support it or the reviewing court 
"is left with the definite and firm conviction that a mistake 
has been committed" (citation omitted).  Kendall v. Selvaggio, 
413 Mass. 619, 620-621 (1992).  See Demoulas v. Demoulas Super 
Mkts., Inc., 424 Mass. 501, 510 (1997) ("So long as the judge's 
account is plausible in light of the entire record, an appellate 
court should decline to reverse it").  It is not enough that 
other evidence exists to support a different finding, or even 
that this court might have weighed the evidence differently in 
the first instance.  See Brandao v. DoCanto, 80 Mass. App. Ct. 
151, 154 (2011). 
26 
 
3.  Timeliness of department's motion.  JRC argues, as a 
threshold matter, that we need not reach the merits of this 
appeal because the defendants' motion to terminate the consent 
decree was untimely.  Although the judge below did not deny the 
motion on this basis, she observed, in accord with the 
plaintiffs' argument, that the motion had been filed "long after 
the existence of both reasons that Defendants proffer" as 
necessitating termination of the consent decree. 
Motions under rule 60 (b) (5) must be filed "within a 
reasonable time," determined in light of all the circumstances 
of the case.  Atlanticare, 485 Mass. at 247-248, quoting Mass. 
R. Civ. P. 60 (b).  In making this determination, "a judge may 
consider the reasons for delay; the ability of the movant to 
learn of the grounds earlier; prejudice to the parties, if any; 
and the important interest of finality" (citation omitted).  
Atlanticare, supra at 248.  Where, as here, the judgment at 
issue binds public officials, the court also considers the 
governmental and public interests at stake.  See id.  See also 
Shakman v. Chicago, 426 F.3d 925, 934 (7th Cir. 2005) (under 
Federal analog, "any consideration of a 'reasonable time' for 
filing a [Fed. R. Civ. P.] 60(b) motion with respect to the 
. . . Consent Decree must take into account the nature of that 
litigation as well as the resulting prejudice, if any, to the 
present elected officials and the public they represent").  At 
27 
 
bottom, however, "[t]here is no set formula" for determining 
reasonableness in this context.  Atlanticare, supra.  Compare 
id. at 247-249 (seven-year delay did not render motion untimely 
in "highly unusual circumstances" of case, including conflicting 
decisions between United States Court of Appeals for First 
Circuit and this court that would otherwise "lead to confusion 
and administrative deadlock"), with Owens v. Mukendi, 448 Mass. 
66, 76-77 (2006) (listing cases where delays of two or three 
years rendered motion untimely). 
Applying these principles, we find that the department's 
motion to terminate the decree was timely.  The governmental 
interests are significant, as denial on the grounds of 
untimeliness "would effectively 'bind all future [regulatory 
officials]' . . . to the decree's proscriptions," solely because 
their predecessors failed to bring the motion at the earliest 
available opportunity.  Doe v. Briley, 562 F.3d 777, 781 (6th 
Cir. 2009), quoting Rufo, 502 U.S. at 392.  Additionally, the 
prejudice to the plaintiffs is comparatively limited.  Indeed, 
any delay inures to the advantage of JRC.  As long as the decree 
remains undisturbed, JRC continues to benefit from the decree's 
limitation on the regulatory authority that the department may 
exercise over the facility.  Cf. Doe, supra (rejecting argument 
that motion to terminate decades-old consent decree was untimely 
where, inter alia, "the only apparent consequence of the delay, 
28 
 
so far as [the nonmovant was] concerned, [was] that the decree 
remained in place for some [thirty] years longer than it 
probably should have"). 
Further, while we recognize that some of the grounds for 
relief raised in the motion date back to the 1990s, the 
department's primary arguments -- the department's record of 
good faith compliance and a new medical consensus -- concern 
gradual developments.  Moreover, given that the department 
sought to argue that it had a long-standing record of acting in 
good faith, any delay in raising the argument was a reasonable 
response to the decree itself; the delay allowed the department 
time to demonstrate that it had learned from its mistakes and 
had made the necessary institutional reforms.  Cf. Associated 
Bldrs. & Contrs. v. Michigan Dep't of Labor & Economic Growth, 
543 F.3d 275, 279 (6th Cir. 2008), cert. denied, 556 U.S. 1127 
(2009) ("An unduly strict reading of the reasonable-time 
requirement, moreover, would tend to force premature [Fed. R. 
Civ. P.] 60(b)(5) motions due to a State's fear of losing 
forever the opportunity to correct an injunction or consent 
decree").  Accordingly, we turn to the merits of the defendants' 
motion. 
4.  Satisfaction of purpose underlying consent decree.  
Changed circumstances exist to warrant termination of a consent 
decree, as opposed to its mere modification, where the moving 
29 
 
party demonstrates that the purpose of the decree has been 
achieved.  See 12 Moore's Federal Practice § 60.47[2][c], at 60-
178 & n.22 (3d ed. 2023).  Although we have not provided 
specific guidance on how to determine whether the purpose of a 
consent decree binding public officials has been satisfied, 
Federal courts have looked to whether the State has demonstrated 
that it is currently in "substantial, good-faith compliance" 
with the fundamental purpose of the consent decree and "unlikely 
. . . [to] return to its former ways."  Peery v. Miami, 977 F.3d 
1061, 1075 (11th Cir. 2020), quoting Board of Educ. of Okla. 
City Pub. Sch. v. Dowell, 498 U.S. 237, 247 (1991).  See Shakman 
v. Pritzker, 43 F.4th 723, 728 (7th Cir. 2022) ("A party 
claiming to have satisfied the terms of a consent decree must 
show that it has achieved the objectives of that decree . . . 
and implemented a durable remedy").  To assess whether 
termination is warranted on that basis, we look first to the 
underlying purpose of the decree. 
a.  Purpose of consent decree.  When this case was last 
before this court on appeal, we explained the context and over-
all function of the consent decree as follows: 
"The action that resulted in the settlement agreement was 
brought because the parents and guardians of JRC patients 
alleged that OFC was denying individual patients their 
constitutional rights to certain treatments and was not 
regulating JRC in good faith.  The settlement agreement 
sought to remedy this situation while allowing the 
30 
 
department to continue to fulfil its statutory duties to 
regulate mental health facilities." 
 
JRC I, 424 Mass. at 450.  In describing the decree, we did not 
go so far as to state that its purpose was to guarantee the 
right of access to aversives, as the plaintiffs' claims to that 
effect were never actually adjudicated and determined by the 
court.  That being said, the terms of the consent decree, along 
with the underlying proceedings, do reveal two main purposes. 
First, the consent decree was intended to ensure that the 
department's predecessor in interest, OFC (and later, the 
department itself), would regulate JRC in good faith and avoid 
engaging in unauthorized, "unilateral interference" with 
individual treatment plans.  Id. at 445-447.  Second, the 
consent decree was intended to permit JRC to continue using 
aversives on individual patients, but only subject to judicial 
supervision, by way of substituted judgment proceedings.  See 
id. at 444.  The decree contemplated that the department would 
be allowed to participate in these proceedings, and that JRC 
would only receive authorization where the proposed treatment 
was the least intrusive and most appropriate to the client's 
needs.  See id. at 444 n.15.  The consent decree otherwise 
preserved the department's regulatory authority.16  See id. at 
 
16 We recognize that the consent decree contained a 
provision calling for a court monitor to evaluate JRC's 
compliance with department regulations that did not concern 
31 
 
445 ("Indeed, there is no provision in the agreement that 
provides the department gave up any regulatory authority").  
Whether these purposes have been fulfilled remains hotly 
disputed.  We address each one in turn.17 
b.  Findings of bad faith regulation.  Here, the judge 
below found that the purpose of the decree had not been 
fulfilled because the department engaged in bad faith regulation 
 
level three aversives.  We previously declined to address the 
permissibility of this provision, stating: 
"We do not consider whether the portion of the agreement 
providing that it was the court monitor, not the 
department, that was to oversee compliance with all other 
applicable State regulations except those related to Level 
III aversives and undertake general monitoring of JRC's 
treatment and educational program constituted an 
impermissible delegation of regulatory authority.  The 
findings of the judge with respect to this portion of the 
settlement agreement are not necessary for our decision 
here; we note, moreover, that neither side disputes that 
JRC was required to be certified according to the 
department's regulations, and it is that certification 
process and its relationship to the settlement agreement 
that is before us." 
 
JRC I, 424 Mass. at 445 n.19.  Regardless, the winding down and 
eventual termination of the receivership resulted in these other 
regulatory functions being returned to the department. 
 
17 Because the second purpose -- concerning JRC's ability to 
use aversives pursuant to court authorization -- implicates the 
interplay between the consent decree and the department's 
residual regulatory authority, we address it as part of our 
discussion of the separation of powers argument raised by the 
defendants. 
 
32 
 
in 2010.18  In support of this finding, the judge relied upon 
three subsidiary findings:  (1) the alterations made by McGuire 
to the 2008 Hamad memo concerning the use of aversives; (2) the 
alterations made by the department's commissioner and general 
counsel to the 2010 certification report; and (3) the 
department's decision to accept certain conditions proposed by 
the 2010 certification team concerning the acceptable use of the 
GED that the judge concluded were "impermissibl[e] . . . 
treatment decisions." 
On appeal, the department asserts that the Hamad memo did 
not affect the department's regulation of JRC because the 
department was not involved in the creation of the memo and did 
not rely on it in any way.  The department further argues that 
the changes made to the 2010 certification report were largely 
nonsubstantive, and that the alterations made were "reasonable 
exercises of the [c]ommissioner's ultimate authority to approve, 
approve with conditions, or disapprove a Level III program," 
citing 115 Code. Mass. Regs. § 5.14(4)(f)(7) (2011).  Finally, 
the department claims that the conditions in the 2010 
certification report concerning the acceptable use of the GED 
 
18 We note that this bad faith finding is based on conduct 
that occurred thirteen years ago and an evidentiary hearing that 
concluded in 2016.  We stress again that our analysis does not 
foreclose the possibility that new developments have occurred 
since the record closed here bearing on these factual issues. 
33 
 
were properly within the purview of the department's regulatory 
authority.  We conclude that the department's alterations to the 
2010 certification report, particularly the removal of the 
team's substantial compliance finding and the dramatic reduction 
in certification length, support the judge's finding of bad 
faith.  This finding of bad faith is further supported by the 
department's unilateral decision, without first assessing the 
scientific evidence, to impose a regulatory change that would 
prohibit JRC from using level three aversives on new patients. 
"Bad faith is a 'general and somewhat indefinite term' that 
goes beyond 'bad judgment' or 'negligence,' suggesting 'a 
dishonest purpose or some moral obliquity,' a 'conscious doing 
of wrong,' or a 'breach of a known duty through some motive of 
interest or ill will'" (citation omitted).  Buffalo-Water 1, LLC 
v. Fidelity Real Estate Co., 481 Mass. 13, 25-26 (2018).  See 
JRC I, 424 Mass. at 454.  In the context of State action, this 
includes the use of an otherwise lawful power for an improper 
purpose.  See Pheasant Ridge Assocs. Ltd. Partnership v. 
Burlington, 399 Mass. 771, 776 (1987).  In effect, bad faith 
requires an inquiry into the subjective intent behind a party's 
actions, in addition to the actions themselves.  See Bank of 
Am., N.A. v. Prestige Imports, Inc., 75 Mass. App. Ct. 741, 754-
755 (2009), and cases cited (discussing "foundational 
34 
 
definition" of bad faith, which involves "subjective focus" on 
"knowing and conscious wrongdoing"). 
i.  Hamad memo.  The judge below found that the Hamad memo, 
in its final form, "was shaped significantly by [EOHHS] 
Assistant Secretary McGuire herself and did not represent an 
independent, objective review."  The judge then cited the Hamad 
memo in her discussion of bad faith, describing the document as 
the primary source for a memorandum from McGuire that was 
"intended to create a justification for [the department] to 
pursue a path that would eventually end with the elimination of 
contingent aversive treatment at JRC."  Although we do not 
discount the Hamad memo, we do not consider it as significant as 
the judge for the reasons discussed infra.  It does, however, 
provide further, albeit limited, support for the more compelling 
evidence of bad faith relating to the department's manipulation 
of the 2010 certification report. 
We recognize, as did the judge below, that McGuire made 
numerous alterations in the Hamad memo.  This included 
downplaying one expert's opinion that "contingent electric shock 
might conceivably be needed . . . for a very, very small number 
of exceptional cases where the individual's behavior was so 
extreme as to be life threatening" and adding a statement that 
"neither the professional literature nor the practice arena 
supports the use of aversive contingent interventions for 
35 
 
behavior management of people with intellectual or other 
disabilities that may involve serious behavioral problems."  
However, McGuire's revisions are largely in accord with the 
thrust of Hamad's original draft.  The original memo contained a 
list of policy recommendations for consideration by EOHHS, 
including a recommendation to file legislation banning 
aversives, which the original memo described as "reflect[ing] a 
consensus view reached after completion of various review 
activities conducted under your direction over that [sic] last 
[six] months."  Moreover, both versions of the memo effectively 
contain the same conclusion that "alternatives to contingent 
aversive techniques are not only the preferred methods to treat 
extreme behavior disorders but have clearly become the practice 
standard in the field of developmental disabilities." 
It is nonetheless apparent from the record that the Hamad 
memo did not provide an independent, objective review of 
aversives.  Notably, Hamad did not seek to interview either of 
the independent psychologists who evaluate and prepare reports 
on the patients for whom JRC seeks use of the GED.  Nor did 
Hamad follow up on information he received about clinicians at 
Johns Hopkins University and the University of Florida, as well 
as psychologists in Boston, who supported considering aversives 
where alternative treatments had failed.  These shortcomings 
support the judge's finding that the Hamad memo did not 
36 
 
constitute an independent, objective review of the standard of 
care. 
However, as the department emphasizes, the record does not 
contain evidence to support the finding that the Hamad memo 
played a role in the department's subsequent regulatory actions 
toward JRC.  Although the advisory group in which Hamad 
participated included several department clinicians, it does not 
appear that department officials were involved in the drafting 
of the Hamad memo, let alone McGuire's subsequent revisions.  
Nor was any evidence presented indicating that the department 
was influenced by, or even aware of, the contents of the Hamad 
memo at the time of the 2010 certification process.  That said, 
the memo's origin, revisions, and methodology suggest a result-
oriented approach that lends some contextual support for the 
more significant basis for the judge's finding of bad faith:  
the department's revisions to the 2010 certification team 
report. 
ii.  Revisions to 2010 certification team report.  Firmer 
support for the judge's finding of bad faith can be found in the 
revisions to the 2010 certification team report.  The judge 
found that "many parts of the final report . . . were entirely 
rewritten" by the department's general counsel and the 
commissioner, including "significant substantive changes" made 
without the approval or knowledge of team members other than 
37 
 
Levendusky.  The judge further concluded that even though 
Levendusky approved the changes, he was not the "driving force" 
behind them, and that the involvement and influence of the 
commissioner was akin to the bad faith regulation of the 1980s 
and 1990s. 
Although we agree with the judge's over-all conclusion that 
these changes support a finding of bad faith, we do not agree 
that "many" parts of the report were "entirely rewritten."19  The 
important substantive changes to the report, which totaled more 
than thirty pages, consisted of (1) the deletion of the 
"substantial compliance" language and the team's recommendation 
for a one-year recertification; (2) the revised recommendation 
to extend JRC's existing certification by only fourteen days; 
and (3) the addition of burdensome documentation requirements, 
with short turn-around times, contained within the summary of 
conditions.20 
It is readily apparent that these three changes were both 
significant and improper.  The impetus for removing the 
 
19 While language was removed from the "Safety Review of GED 
and GED-4 Device" section, as well as the "Peer Review" section, 
and small revisions were made to the "Level II Interventions in 
Use" section, these edits appear to be more stylistic than 
substantive. 
 
20 We also note the alteration of condition (2) (g) from 
requiring JRC to engage a "multidisciplinary" team to instead 
requiring an "external" one comprised of at least three 
clinicians with ABA expertise. 
38 
 
"substantial compliance" language and the one-year certification 
recommendation both originated from the commissioner and her 
general counsel, not Levendusky.  While Levendusky was the first 
to suggest adding deadlines, he was not considering changing the 
one-year certification recommendation at the time the report was 
drafted, and he did, in fact, find JRC to be in substantial 
compliance with prior certification conditions.  Further, the 
removal of the "substantial compliance" language was far from 
mere semantics.  The commissioner admitted at the hearing that 
under the department's own policies, a finding of substantial 
compliance would have resulted in a one-year certification 
recommendation, and thus, removal of that language was necessary 
to justify the department's decision to grant a shorter 
certification length.  Accordingly, the commissioner's decision 
to extend JRC's existing certification by only fourteen days was 
improper under the department's own policies, given the 2010 
certification team's actual finding of substantial compliance.  
And by limiting JRC's certification extension to only fourteen 
days, the department put JRC under significant undue and 
unjustified pressure, placing all of its patients' aversive 
treatment plans in jeopardy.  Further compounding this pressure 
was the additional requirement that JRC provide substantial 
documentation reflecting compliance within relatively tight 
deadlines. 
39 
 
Considering these improper revisions within their 
surrounding context, the judge's finding of bad faith in 2010 
was not clearly erroneous.  Prior to the events in question, 
Bigby had sent a memorandum to the Governor indicating that the 
certification team had "recently completed a monitoring review 
and found JRC to be in substantial compliance with previously 
imposed conditions," noting that "JRC staff [had] been very 
cooperative and improvement in the program [was] evident" and 
that "[b]y all accounts, the situation at JRC [was] as good as 
it [had] ever been."  Things appear to have changed when, four 
months later, the Governor's chief legal counsel met with 
disability advocates who recommended "mak[ing] every use of the 
upcoming certification to assure that [the administration is] 
tough on / responsive to those areas where [JRC] continues to be 
non-compliant or has slipped."  McGuire relayed this message to 
the department's commissioner and general counsel, indicating 
that the Governor's chief legal counsel would expect "an update 
on this certification process, once the team's work is done but 
before we issue the decision."  McGuire would later remark in an 
e-mail message that she also told the commissioner that McGuire 
"did not think [the administration] would support another six 
month certification."  And when the department finally sent the 
revised certification report to EOHHS, the department's general 
counsel made a point of highlighting to McGuire that, with the 
40 
 
limited fourteen-day extension, JRC's certification "could be 
pulled at day [fourteen] or day [forty-five] if [JRC's] response 
isn't sufficient."  The department's general counsel did so 
despite acknowledging that, for some of the report's findings of 
noncompliance, "these are really professional judgment issues." 
On the whole, this evidence supports the judge's inference 
that the removal of the substantial compliance language, the 
dramatic reduction in certification length from one year to 
fourteen days, and the imposition of burdensome and time-
sensitive follow-up requirements did not amount to a good faith 
assessment of JRC's regulatory compliance, but an attempt to 
appease advocates opposed to JRC and maximize the 
administration's ability to justify a revocation of JRC's 
certification.  See Lynch v. Crawford, 483 Mass. 631, 644 
(2019), quoting Commonwealth v. Casale, 381 Mass. 167, 173 
(1980) ("intent is a matter of fact, which is often not 
susceptible of proof by direct evidence, so resort is frequently 
made to proof by inference from all the facts and circumstances 
developed at the trial").  This improper motive supports a 
finding of bad faith.21 
 
21 In light of our conclusion that the department's 
revisions to the 2010 certification report supported the judge's 
finding of bad faith, we need not address the third basis for 
the judge's finding of bad faith -- namely, her determination 
that "by accepting certain recommendations of the 2010 Level III 
Certification Team, [the department] impermissibly made 
41 
 
c.  Whether purpose of consent decree was satisfied given 
passage of time.  We next consider the judge's holding that this 
bad faith conduct demonstrated that the purpose of the consent 
decree had not been fulfilled as of 2018, and whether that 
ruling was an abuse of discretion given the passage of time.  
For the reasons discussed infra, we conclude that it was not.  
In reaching this conclusion, we recognize that the basis for the 
judge's finding of continued bad faith relies heavily on conduct 
that occurred in 2010, eight years prior to the denial of the 
motion in 2018.  Further, it is apparent that after the parties 
mediated their dispute concerning the 2010 recertification 
process, the department went on to issue a new one-year 
certification, with conditions, to JRC in 2013.  As of the close 
of evidence in this case, JRC's 2014 application for 
recertification was still outstanding, but as far as we are 
aware, there have been no additional allegations of bad faith by 
the department in the course of performing its regulatory 
oversight duties between 2010 and the commencement of the 
hearing in the instant case.  Moreover, it has now been over ten 
years since the department's motion to terminate was filed. 
 
treatment decisions for JRC clients."  We further note that the 
complex interplay between the consent decree and the 
department's residual regulatory authority is an issue we 
address separately in our discussion of the department's 
separation of powers argument. 
42 
 
To be sure, the passage of time, combined with the turnover 
of administrations and leadership in an agency, as well as the 
cessation of bad faith regulatory misconduct, can provide 
support for the eventual termination of a consent decree that 
binds public officials.  See Frew v. Hawkins, 540 U.S. 431, 441-
442 (2004); Inmates of Suffolk County Jail v. Rouse, 129 F.3d 
649, 656-657 (1st Cir. 1997), cert. denied, 524 U.S. 951 (1998).  
The Legislature delegates power to an executive agency to make 
and enforce rules in accordance with that agency's expertise in 
light of changing conditions.  See Borden, Inc. v. Commissioner 
of Pub. Health, 388 Mass. 707, 723-724, cert. denied sub nom. 
Formaldehyde Inst., Inc. v. Frechette, 464 U.S. 936 (1983); 
Mostyn v. Department of Envtl. Protection, 83 Mass. App. Ct. 
788, 797 (2013).  Consent decrees enmesh the judiciary in 
ongoing oversight of such policy-making decisions, and may serve 
to "improperly deprive future officials of their designated 
legislative and executive powers."  Frew, supra at 441.  These 
risks are compounded for decrees that last decades, requiring 
ongoing judicial supervision over subsequent actors who are far 
removed from the original actors' bad faith misconduct.  See 
Rufo, 502 U.S. at 392 ("To refuse modification of a decree is to 
bind all future officers of the State, regardless of their view 
of the necessity of relief from one or more provisions of a 
decree that might not have been entered had the matter been 
43 
 
litigated to its conclusion").  Thus, to the extent that a 
consent decree is based on agency misconduct, evidence 
establishing that the improper conduct of the past has been 
abandoned, and that the agency has been acting in good faith, 
would support termination of the consent decree.  See Peery, 977 
F.3d at 1075.  Contrast MacDonald, 467 Mass. at 388-389 (where 
court order at issue binds private parties, neither passage of 
time nor movant's ongoing compliance are normally sufficient, 
without more, to justify termination). 
Here, however, the issue of bad faith regulation as of the 
judge's ruling in 2018 arises not only from the manipulation of 
documents in 2010 or expert opinion in 2008, but also from the 
department's continued insistence on using the regulatory 
process to achieve a predetermined outcome regarding level three 
aversives -- namely, to eliminate a treatment protocol that the 
Legislature has repeatedly declined to ban,22 that judges in the 
Probate Court have regularly authorized through substituted 
 
22 Although there has been no shortage of legislative 
proposals to ban aversive treatments, none has passed.  See, 
e.g., 2023 House Doc. No. 180; 2021 House Doc. No. 225; 2019 
House Doc. No. 123; 2017 House Doc. No. 93; 2015 House Doc. 
No. 89; 2015 Senate Doc. No. 80; 2013 House Doc. No. 106; 2013 
Senate Doc. No. 30; 2011 Senate Doc. No. 51; 2011 House Doc. 
No. 77; 2009 House Doc. No. 154.  Other proposals to restrict or 
study aversive treatments have similarly failed.  See 2023 House 
Doc. No. 170; 2022 House Doc. No. 4956; 2015 Senate Doc. No. 79; 
2013 Senate Doc. No. 28; 2011 Senate Doc. No. 49; 2009 House 
Doc. No. 183; 2009 Senate Doc. No. 45. 
44 
 
judgment, and that the department itself had agreed to permit 
when it chose to bind itself to the consent decree -- without an 
objective consideration of the evidence concerning the use of 
the aversives, and without adhering to the legal requirements 
imposed upon the department by the courts.  In the instant case, 
we conclude that the judge could reasonably find that the 
consent decree remained necessary in 2018 to prevent bad faith 
regulation because the regulations promulgated by the department 
in 2011 again demonstrated its intention to reach this 
predetermined outcome without first objectively evaluating the 
medical evidence or moving to terminate the consent decree. 
The record indicates that, in 2010, after recent 
legislative efforts to ban electric skin shock had failed, Bigby 
sent a memorandum to the Governor with other policy options to 
restrict or eliminate electric skin shock.  At that time, she 
cautioned that a regulatory ban could be construed as bad faith 
regulation, and recommended tabling any policy proposals until 
the Attorney General completed a criminal investigation into the 
August 2007 incident.  After the completion of that 
investigation, Bigby authored a memorandum in April 2011 with 
EOHHS's "recommendations for next steps in our regulatory 
relationship with JRC."  The first recommendation was to move 
for termination of the consent decree.  The second 
recommendation, made "alternatively, or concurrently" to the 
45 
 
first, was for the department to promulgate regulations to 
prospectively ban level three aversives. 
Two months later, the department proposed the 2011 
regulations.  These regulations were proposed only a year after 
the 2010 certification report, and while the dispute about JRC's 
compliance with the conditions contained in that report remained 
ongoing.  From the record, it also appears that there was no 
effort by the department to undertake an independent objective 
review of level three aversives prior to the passage of these 
regulations.  The department apparently did not convene experts 
who considered the issue until after the regulations had already 
gone into effect. 
Most importantly, by choosing to pass the 2011 regulations 
before moving to terminate the consent decree -- which, as 
explained infra, the department was required to do -- the 
department effectively sought to use its regulatory power as an 
"end run" around the consent decree.  In so doing, the 
department again demonstrated that it was determined to alter 
its policy toward aversives, regardless of the existence of the 
consent decree and the legal constraints contained therein.  It 
was only later, nearly one and one-half years after those 
regulations were promulgated, that the department chose to come 
before the Probate Court to seek termination of the consent 
decree.  All of this supports the judge's conclusion that the 
46 
 
consent decree remained necessary in 2018, despite the passage 
of time, to preclude bad faith regulation by the department.  We 
therefore turn to the issue of changed circumstances of fact and 
the judge's finding that no such change had occurred to warrant 
termination of the decree. 
5.  Existence of changed circumstances of fact.  In 
entering the consent decree in 1987, the Probate Court found 
that JRC's use of physical aversives was safe, effective, and 
professionally acceptable.  At that time, the Probate Court also 
referenced earlier findings in which the Probate Court had 
determined that JRC's use of physical aversives was "consistent 
with professional practice" and was employed "in lieu of 
antipsychotic medication and other more restrictive procedures, 
such as seclusion and painful electric-shock."  The department 
contends that this is no longer the case, both because JRC now 
employs electric skin shock and because the use of electric skin 
shock is not within the professional standard of care.  The 
department also asserts that, regardless of whether electric 
skin shock falls within the general standard of care, its 
practical implementation at JRC does not.  We address each 
contention in turn. 
a.  Invention of GED.  Although the judge did not 
explicitly address whether the invention of the GED constituted 
a change in circumstances, her failure to do so was not an abuse 
47 
 
of discretion.  While the consent decree predates the use of 
electric skin shock treatment at JRC, the decree concerns the 
use of "all aversive procedures which are presently used or 
which may be proposed for use at [JRC]," apart from exceptions 
not relevant here.  The consent decree also explicitly states 
that "[n]othing in this agreement shall preclude [JRC] from 
developing new . . . aversive procedures."  Given that the 
consent decree patently contemplated the development of new 
aversives, the fact that the GED was not in use at that time is 
clearly insufficient, without more, to warrant termination of 
the decree.  See Rufo, 502 U.S. at 385 ("modification should not 
be granted where a party relies upon events that actually were 
anticipated at the time it entered into a decree"). 
In reaching this conclusion, we recognize that the findings 
of fact in support of the consent decree referenced earlier 
findings in which the Probate Court had determined that JRC's 
aversive techniques were less restrictive than "painful 
electric-shock."  That finding was derived from uncontroverted 
testimony offered at the preliminary injunction hearing in 1986, 
wherein one of JRC's expert witnesses testified about 
"contingent electroshock."  Despite JRC's assertion to the 
contrary, this does appear to be a reference to electric skin 
shock akin to the GED.  At the 1986 hearing, the expert 
described "electroshock" as consisting of shocks that "would be 
48 
 
administered for a very, very brief period[,] sometimes, merely 
seconds," and explicitly distinguished it from electroconvulsive 
therapy. 
Nonetheless, this does not alter our analysis.  The same 
expert -- whose testimony was credited by the Probate Court in 
1986 -- stated that contingent electric shock remained "less 
aversive than . . . large dosages of drugs, [or] . . . 
electroconvulsive shock therapy."  The expert further offered 
that he would consider using contingent electroshock if a 
patient was "likely going to kill [him- or herself]" and nothing 
else had "proved to be effective."  Another expert, quoting from 
professional literature, offered testimony at one of the six-
month review hearings in 1987 that "very intense punishment such 
as shock . . . should be considered for immediate inclusion in 
treatment" where there is "imminent and extreme physical danger 
or when the self-injurious behavior is so intrusive as to 
prevent participation in habilitative and humanizing 
activities," or when other interventions have not reduced the 
self-injurious behavior.  Accordingly, the invention of an 
electric skin shock device by JRC does not constitute an 
unforeseen change in circumstances that would warrant 
termination of the consent decree. 
This is not to say that JRC's turn toward electric skin 
shock as a physical aversive does not require specific 
49 
 
consideration.  As stated, in entering the consent decree, the 
Probate Court found that, as of 1987, JRC's use of physical 
aversives was safe, effective, and professionally acceptable.  A 
change in the safety, efficacy, or professional acceptability of 
the physical aversives used by JRC would constitute a 
significant and unforeseen change in circumstances.  Thus, 
although the mere invention of the GED, and its use by JRC, is 
not a change in circumstances, a finding that its usage is not 
safe or professionally acceptable would be.  With these 
principles in mind, we turn to the judge's findings as to the 
standard of care and assess whether those findings were clearly 
erroneous based on the evidentiary record before the Probate 
Court in 2016. 
b.  Electric shock and standard of care.  In denying the 
defendants' motion, the judge below found that, as of the close 
of evidence in 2016, there was still no professional consensus 
that the use of level three aversives fell outside the standard 
of care to treat severely self-injurious and violent behavior.  
The department argues that the judge improperly conflated 
evidence as to the acceptability of aversive treatments in 
general with evidence as to the acceptability of electric skin 
shock in particular.  On the latter subject, the department 
asserts that the evidence is clear:  there is "no serious 
dispute" as to the professional consensus that electric skin 
50 
 
shock is outside the standard of care for individuals with 
developmental disabilities. 
We recognize, of course, that a professional consensus does 
not require unanimity.  In any profession, on the most difficult 
issues, unanimity of opinion is often nearly impossible to 
achieve.  See Planned Parenthood Fed'n of Am., Inc. v. Gonzales, 
435 F.3d 1163, 1172 (9th Cir. 2006), rev'd sub nom. Gonzales v. 
Carhart, 550 U.S. 124 (2007) ("By medical consensus, we do not 
mean unanimity or that no single doctor disagrees, but rather 
that there is no significant disagreement within the medical 
community").  That said, our inquiry is limited to whether, 
based on the evidence before the Probate Court in 2016, the 
judge's finding that no professional consensus existed at that 
time as to JRC's use of physical aversives was clearly 
erroneous. 
Our review of the record indicates that there was support 
for the judge's finding as of the close of evidence in 2016.  In 
fact, it appears that when the department filed its motion to 
terminate the decree in early 2013, now a decade ago, there was 
an ongoing debate about the potential necessity of level three 
aversives among the very experts that the department elected to 
consult in formulating practitioner guidelines.  Separate and 
apart from any clinicians tasked with reviewing JRC's regulatory 
51 
 
compliance or treatment plans,23 experts that the department 
selected to serve on its PBS advisory subcommittee expressed 
ambivalence in 2012 and 2013 about whether electric skin shock 
was outside the acceptable standard of care.  Indeed, the 
subcommittee was nearly unanimous24 in its rejection of draft PBS 
guidelines on the use of procedures to "decelerate challenging 
behavior," which included language prohibiting electric skin 
shock and other level two and three aversives, because members 
were "uncomfortable with banning specific procedures."  The co-
chair of the subcommittee, Dr. Christopher Fox, suggested an 
alternative set of guidelines that would call for 
individualized, evidence-based treatments, with rigorous 
training and monitoring requirements.25  Another member of the 
 
23 There was also testimony, which the judge below 
referenced in her findings, to indicate that the independent 
clinicians who monitor JRC's regulatory compliance and treatment 
plans believed that the GED remained within the professional 
standard of care. 
 
24 Although the subcommittee co-chair described the 
subcommittee's opinion as "unanimous" on this issue, he also 
noted that three members were absent from the portion of the 
meeting in which the issue was discussed. 
 
25 In a later e-mail message, Fox went on to acknowledge 
that the 2011 regulations, which predated the formation of the 
subcommittee, had already served to limit the use of electric 
shock to those patients with existing GED treatment plans; he 
nonetheless opined that, "[i]n an ideal world I would like all 
interventions to be available," even though "in the world as it 
exists currently that is not the case." 
52 
 
subcommittee, Dr. Steve Woolf, expressed a similar sentiment, 
writing: 
"[Level three interventions] should be implemented based on 
three ethical considerations:  1) client's right to safe 
and humane treatment, 2) the behavior analyst's 
responsibility to use the least restrictive procedure, and 
3) the client's right to effective treatment.  In my 
experiences, [there] is a very small minority of clients 
that may require . . . a level three intervention.  Banning 
these evidenced-based [sic] positive punishment treatments 
raises very important ethical concerns when serving clients 
with chronic life-threatening problem behaviors.  Failing 
to use these procedures that research has shown to be 
effective in suppressing self-destructive behavior that 
have [sic] not responded to positive reinforcement, 
extinction, or less intrusive intervention is unethical 
because doing so withholds potentially effective treatment 
and risks maintaining a dangerous state. . . . 
 
"I would agree to stronger regulation, oversight, and 
quality assurance monitoring of these punishment based 
procedures.  However, the outright prohibition of level 
three [interventions] requires more time to study."26 
 
Other members of the subcommittee similarly expressed 
concerns that more work was necessary on this issue, with one 
member stating that "practices regarding the most severely 
behaviorally challenged individuals requires a much greater 
degree of collaboration, specification, research and consensus 
than has been achieved thus far." 
 
26 The department points out that this e-mail message was 
subject to an evidentiary objection, and the judge admitted it 
for a limited purpose.  However, the judge later admitted the 
same e-mail message as a separate exhibit, without limitation, 
and the department did not object. 
53 
 
The department seeks to downplay these discussions by 
highlighting the fact that the experts did not explicitly 
identify electric skin shock in their comments, and argues that 
they were instead referencing other level three aversives.  
However, the theme that emerges from all of these communications 
is a discomfort with banning any specific procedures in that 
category, which would include electric skin shock, without 
additional evidence and research.  And importantly, when the 
concerns of these experts were relayed to the department, the 
department responded by silencing any further debate among the 
subcommittee as to level three aversives.  Indeed, from the 
outset of the subcommittee's consideration of this topic, the 
department bluntly informed the co-chair that "it [wouldn't] 
matter" if the ABA literature supported the efficacy and 
professional acceptability of specific decelerative procedures 
when it came to procedures that the commissioner "[did] not 
like." 
There was also evidence that this debate was not isolated 
to experts consulted by the department.  The 2016 edition of the 
ABA textbook "Contemporary Behavior Therapy (Sixth Edition)," 
excerpts of which were admitted at trial, states that "mild 
electric shock often is an effective and efficient means of 
significantly reducing self-injurious behaviors."  Additionally, 
Dr. Richard Foxx, a national expert in this area, believed that 
54 
 
the use of electric skin shock may be necessary to treat a 
"very, very small number of exceptional cases where the 
individual's behavior was so extreme as to be life 
threatening."27 
Testimony provided by the plaintiffs about the efficacy of 
JRC's treatment methods formed another source of evidence that 
the judge could reasonably consider in assessing this issue.  
Although the department dismisses this evidence as "anecdotal," 
the testimony credited by the judge reflects that, for many 
families with children at JRC, its treatment methods were not 
only effective, but also considered more humane than the course 
of restraint and pharmacological sedation to which their 
children had previously been subjected.  One mother testified 
that, prior to JRC, her daughter had a long history of school 
expulsions and hospitalizations due to her severe aggressive 
behaviors.  The daughter had previously been prescribed Abilify 
 
27 While not necessary to our analysis, we also note that 
two separate Federal court cases involving JRC from 2010 and 
2012 reference the existence of such a debate within the context 
of addressing claims brought under the Individuals with 
Disabilities Education Act, 20 U.S.C. §§ 1400 et seq.  See 
Bryant v. New York State Educ. Dep't, 692 F.3d 202, 215 (2d Cir. 
2012), cert. denied, 569 U.S. 958 (2013) (referencing "ongoing 
debate among the experts regarding the advantages and 
disadvantages of aversive interventions and positive-only 
methods of behavioral modification"); Alleyne v. New York State 
Educ. Dep't, 691 F. Supp. 2d 322, 332 (N.D.N.Y. 2010) ("It is 
readily apparent that the use and benefits of aversives in an 
educational setting is a divisive issue among educational 
professionals"). 
55 
 
and Risperdal, among upwards of twenty other medications, and 
had been subject to long periods of seclusion and restraint at 
prior placements.  All were unsuccessful in treating her violent 
behaviors.  By the time she enrolled at JRC, it was the only 
facility in the Commonwealth that was willing to take her.  And 
in contrast to the prior treatment inventions she had received, 
JRC's treatment protocol was effective in minimizing her 
behavioral problems, allowing her to go on field trips and other 
outings.  As her mother testified, "[My daughter] says her whole 
world opened up. . . .  She has gone from a person that is 
isolated and medicated and injured and unhappy to a young person 
that is happy and able to live in a world and experience what 
other people experience."  A father testified that his son came 
to JRC with incredibly harmful behavioral issues, including 
rectum and throat gouging, eye picking, and self-induced 
vomiting.  After being placed at JRC and treated with the GED, 
and in contrast to prior pharmacological treatments, the 
dangerous behaviors substantially decreased.  The father 
testified that his son is "happier now than he's ever been" and 
engages in hobbies and field trips. 
A former JRC patient who testified at trial described 
experiencing a similar journey.  Prior to JRC, she had 
repeatedly been expelled from residential placements, and had 
been rejected from as many as thirty-seven programs, due to 
56 
 
extremely violent behaviors that she exhibited toward herself 
and others.  During this time, she was treated with numerous 
medications, which she testified had the effect of making her 
feel like a "zombie," and was repeatedly placed in physical 
restraints, including straightjackets.  When she finally came to 
JRC and began treatment with the GED, her self-injurious 
behaviors drastically decreased, until they went away 
completely.  She eventually went on to receive her high school 
diploma, obtained gainful employment, and now has children of 
her own.  These testimonials are also echoed in a description 
offered by one of the independent clinicians tasked with 
evaluating JRC treatment plans, in an e-mail message sent to the 
department's general counsel: 
"Having visited institutions and programs all over the 
country, and in some foreign countries, I have rarely, if 
ever, seen clients with the degree of disability seen at 
JRC dressed in shirts and ties, living in community housing 
and earning weekends at community recreation, shopping, and 
dining activities." 
 
To be sure, despite these examples, and as the judge below 
appropriately recognized, the use of level three aversives 
remains bitterly contested and controversial, even when it is 
limited to a class of patients for whom other treatment 
protocols have failed, and authorized only through substituted 
judgment proceedings.  As the judge acknowledged, JRC stands 
alone in using electric skin shock to treat such patients, when 
57 
 
other facilities would decline to do so.  And as the department 
highlights, the National Association of State Directors of 
Developmental Disabilities Services has rejected the use of 
electric skin shock, many clinicians regard electric skin shock 
as a treatment that does not fall within the standard of care, 
and as the judge found, approximately one-half of States have 
banned its use on the developmentally disabled.  Nonetheless, we 
cannot conclude that the judge's finding regarding the use of 
aversives was clearly erroneous based on the evidentiary record 
before the Probate Court in 2016.  See Demoulas, 424 Mass. at 
510 ("Where there are two permissible views of the evidence, the 
factfinder's choice between them cannot be clearly erroneous" 
[citation omitted]). 
In reaching this conclusion, however, we remain troubled 
that we do so based on a record that is nearly a decade old.  
The correspondence between members of the PBS subcommittee in 
2012 and 2013 reflects a concern that additional evidence, 
research, and dialogue would be necessary to achieve a 
consensus.  Yet, in response to those concerns, the department 
decided that "it was not appropriate" for the subcommittee to 
consider the issue further.  We also do not know whether these 
experts later changed their mind based on additional 
information, or whether other significant research and treatment 
developments have taken place since the close of evidence in 
58 
 
2016.  And when asked at oral argument whether this case should 
be remanded for further findings in this regard, the department 
was adamant that it not be.  Thus, we do not reach the propriety 
of electric skin shock treatment in 2023, as we do not have the 
record to do so, and we therefore do not foreclose the 
possibility that new scientific developments or a more recent 
evidentiary record would suffice to demonstrate a change in the 
standard of care.  See MacDonald, 467 Mass. at 394 ("Although we 
conclude that the judge here, on this record, did not abuse her 
discretion in denying the defendant's motion to terminate the 
abuse prevention order, we leave open the possibility that the 
defendant might be able to meet his burden if he were to renew 
his motion with a stronger evidentiary foundation"). 
c.  JRC's implementation of GED.  The department contends 
that, regardless of whether the use of electric skin shock is 
acceptable as a general matter, its use at JRC is improper 
because it is not employed solely as the least restrictive 
method of treatment.  The department points to expert testimony 
and video footage admitted at trial, which shows eleven specific 
instances in which the GED was applied to seemingly minor 
behaviors, as proof that "JRC regularly misuses GED." 
Importantly, the department does not appear to be arguing 
that JRC is violating or subverting the authorization provided 
by its court-approved treatment plans.  Rather, the department 
59 
 
principally takes issue with some of the behaviors for which JRC 
has been granted court approval to use the GED.  Yet the 
department retains the authority to participate in the annual 
substituted judgment proceedings in which those individual 
treatment plans are approved.  And as we have previously stated, 
if the department's monitoring of JRC "reveals any problems [in 
an individual treatment plan], that information should be 
brought to the judge who has authorized the use of aversive 
treatments."  JRC I, 424 Mass. at 447 n.20.  However, as the 
judge below found, the department regularly declines to do so, 
despite being given the opportunity to weigh in on a yearly 
basis, and despite having access to the materials that JRC uses 
in support of its substituted judgment petitions.  See 115 Code 
Mass. Regs. § 5.14(4)(d)(6) (2011).  Given the department's 
failure to utilize these existing means of preventing any 
unjustified application of the GED in particular circumstances, 
we cannot discern why those existing corrective measures are 
inadequate and why elimination of the consent decree in total is 
an appropriate remedy.  The department can and should raise 
these specific concerns in the yearly substituted judgment 
proceedings before the Probate Court. 
6.  Whether continued enforcement of consent decree 
violates separation of powers.  The department further argues 
that the decree interferes with the department's regulatory 
60 
 
authority, in violation of the separation of powers expressed in 
art. 30 of the Massachusetts Declaration of Rights.  We 
disagree. 
This is not the first time that we have considered the 
relationship between the consent decree and the department's 
constitutional regulatory authority.  In response to a similar 
argument raised by the department in JRC I, 424 Mass. at 445, we 
indicated that "to read the [consent decree] as a delegation of 
all regulatory authority" would raise constitutional concerns.  
However, the consent decree contained no such provision to this 
effect, and we concluded that it was reconcilable with art. 30.  
See id.  In so doing, we distinguished those regulatory powers 
that the department retains from those actions that must give 
way to the consent decree and judicial enforcement.  In 
explaining that distinction, we stated that the department 
retained "authority regarding certification requirements [and] 
compliance with applicable regulations," but that the consent 
decree reserved "the ultimate decision on an individual's 
treatment" to the judiciary, via substituted judgment.  See id. 
at 445-446.  We also explained more specifically that the 
department was precluded from using "bad faith regulatory 
practices . . . [to] ensure that no individual . . . receive[s] 
aversive therapies at JRC."  Id. at 449. 
61 
 
We address this "bad faith" regulatory constraint first, 
and its relevance to the evidentiary record before the court as 
of 2016.28  Given the department's history of using its 
regulatory power in bad faith to halt the use of physical 
aversives and interfere with JRC operations, it was 
constitutionally permissible to impose certain restrictions on 
regulatory changes by the department that would limit the use of 
level three aversives.  This is not a separation of powers 
problem.  Rather, the department's own bad faith regulatory 
practices (and those of its predecessor) justified imposing 
limitations on its regulatory authority, by way of a consent 
decree, as a form of remedial action.  See JRC I, 424 Mass. at 
461; Matter of McKnight, 406 Mass. 787, 807 (1990) (Liacos, 
C.J., dissenting) (general practice of judicial deference to 
agency expertise "is not absolute; it gives way in the face of 
agency misbehavior").  By agreeing to be bound by the decree, 
the department agreed to additional restrictions on its own 
ability to regulate level three aversives in any manner that 
would exceed the constraints imposed by the consent decree.  The 
department also bound itself to the requirement of demonstrating 
 
28 In so doing, we note that we have not been presented with 
any allegations or evidence of bad faith since that date and do 
not purport to address whether any bad faith conduct has 
occurred in the seven years that have elapsed since the close of 
evidence. 
62 
 
a change in circumstances before it could escape the constraints 
contained within the decree. 
These constitutionally permissible constraints precluded 
the regulatory change proposed by the department in the 2011 
regulations.  The use of level three aversives was authorized by 
the Probate Court, pursuant to the substituted judgment process, 
when it was found to be the least intrusive and most appropriate 
means of preventing significant harm for an individual patient.  
The 2011 regulations took that power away from the Probate 
Court, and thus constituted an impermissible end run around 
substituted judgment proceedings.  Further, the department was 
well aware of the existing consent decree at the time it chose 
to promulgate the 2011 regulations, and yet made no attempt to 
terminate the decree prior to doing so.  It is not a separation 
of powers problem to enforce the consent decree and its 
constraints in this context or to consider the 2011 regulations 
as another example of bad faith regulatory misconduct. 
Nor do we find persuasive the department's contention that 
a prospective regulatory ban on level three aversives is 
permissible because it does not interfere with any existing 
patient's treatment plan or the substituted judgment process 
overseen by the judiciary.  This is far too narrow a reading of 
our prior decision in JRC I.  The consent decree's limitation on 
the regulatory powers of the department, which came about as a 
63 
 
result of the bad faith conduct of the department's predecessor, 
was not limited to existing JRC patients but extended to the 
department's supervision over JRC's operations more generally.  
Nor were these constraints limited to interference with the 
substituted judgment process in an individual patient's 
treatment plan.  See JRC I, 424 Mass. at 449 ("it would be 
absurd to conclude that, although the agreement was intended to 
settle claims that the department's predecessor was improperly 
denying the patients needed aversive therapy, the department 
could, through bad faith regulatory practices, ensure that no 
individual could receive aversive therapies at JRC"). 
Thus, the department may not prospectively ban the use of 
level three aversives for all new patients, in the absence of 
changed circumstances, without running afoul of the consent 
decree.  The existence of such a change in circumstances 
requires a judicial determination to that effect, not a 
unilateral decision by the department.  If the department could 
simply pass a new regulation at any point to prospectively ban 
the use of level three aversives, the consent decree would be a 
pointless paper tiger, ignoring the department's past misconduct 
and the resulting consequences. 
This does not mean that the department is powerless to 
prevent the improper use of the GED.  The judge below found that 
"physical aversive treatment has not been effective for all JRC 
64 
 
students and may not be the least restrictive procedure 
available to treat every student receiving physical aversive 
treatment."  To the extent that the department agrees that this 
is the case for any particular patient, it can and should 
register those objections with the Probate Court.  We believe 
this division of authority is in keeping with JRC I and 
separation of powers principles. 
Finally, we address the department's argument that failing 
to terminate the consent decree violates the department's 
statutory mandate.  The department is charged with "mak[ing] 
regulations for the operation" of providers of residential 
services like JRC, see G. L. c. 19B, § 15 (a), as well as 
"adopt[ing] regulations . . . which establish procedures and the 
highest practicable professional standards for the reception, 
examination, treatment, restraint, transfer and discharge of 
persons with an intellectual disability in departmental 
facilities," see G. L. c. 123B, § 2.  The statutory scheme 
requires that this latter type of regulation "be adaptable to 
changing conditions and to advances in methods of care and 
treatment and in programs and services for persons with an 
intellectual disability."  Id. 
Such a mandate must certainly be respected.  Further, we 
note that the department's ability to pass regulations unrelated 
to level three aversives is totally unaffected by the consent 
65 
 
decree.  The only issue is whether the department can change 
regulations related to level three aversives.  In this regard, 
evidence of changing conditions and advances in methods of care 
and treatment are critical considerations in assessing whether 
changed circumstances justify termination of the consent decree 
and its limitation on the department's regulatory authority.  
The judge's fact findings, however, reject the conclusion that 
advances in methods of care and treatment as of the close of 
evidence in 2016 supported the elimination of level three 
aversives for these deeply troubled patients.  Rather, the 
expert testimony from 2015 and 2016, or at least the judge's 
fact finding regarding that testimony, supported preservation of 
level three aversives as an option of last resort for this 
particular group at that time.  We express no opinion whether 
further medical advances since the hearing, or a better 
evidentiary record regarding such advances, would justify 
lifting the consent decree now or in the future. 
7.  Existence of changed circumstances of law.  Finally, we 
address the department's remaining arguments as to changes of 
law that would warrant termination of the consent decree.  For 
the reasons discussed infra, the judge did not abuse her 
discretion in declining to grant relief on this basis. 
a.  Change in Federal reimbursement policy for JRC 
services.  The department highlights that the Centers for 
66 
 
Medicare & Medicaid Services, a division of the Department of 
Health and Human Services that oversees the Federal 
administration of Medicaid and Medicare, indicated in 2012 that 
it would no longer deem JRC's services eligible for 
reimbursement from its Home and Community-Based Services waiver 
program.29  As a result, the Commonwealth has expended additional 
funds to make up for the shortfall in Federal reimbursement.  
From 2012 to 2015, this amounted to $7.7 million. 
Although the judge did not address this change in Federal 
policy, her failure to do so was not an abuse of discretion.  
Even though financial constraints "are a legitimate concern of 
government defendants," they are normally assessed within the 
context of "tailoring a consent decree modification," rather 
than its wholesale termination.  Rufo, 502 U.S. at 392-393.  
This is not to say that financial constraints could not warrant 
termination, but only that the department has not sought to 
explain the impact of this funding burden or what strain it has 
placed on State resources.  Without any such information, we are 
 
29 The Home and Community-Based Services (HCBS) waiver is a 
program that enables States to receive Federal funding for 
community-based services provided to individuals who would 
otherwise be institutionalized. 
 
67 
 
unable to conclude that this is evidence per se to warrant 
termination of the decree.30 
b.  2011 regulations.  The 2011 regulations, through which 
the department prospectively sought to ban the use of level 
three aversives on new patients, do not constitute a change in 
circumstances either.  These regulations were promulgated by the 
department, a party bound by the decree, and cannot form the 
basis for permitting the department to escape, extrajudicially, 
the obligations it voluntarily agreed to assume, for the reasons 
discussed supra.  That much should have been clear from our 
prior opinion.  See JRC I, 424 Mass. at 449 (observing that it 
would be "absurd" to conclude that department could sidestep 
obligations under consent decree by resorting to "bad faith 
regulatory practices" for purpose of "do[ing] indirectly what 
[the] order makes clear [it] cannot do directly").  See also 
Delaware Valley Citizens' Council for Clean Air v. Pennsylvania, 
533 F. Supp. 869, 876 (E.D. Pa.), aff'd, 678 F.2d 470 (3d Cir. 
1982) ("A party should not be permitted, however, to obtain a 
 
30 As the department appears to acknowledge in its reply 
brief, the decision by the Centers for Medicare & Medicaid 
Services (CMS) to stop reimbursements for JRC services was not 
competent evidence of a change in the professional standard of 
care, as the department presented evidence of CMS's decision 
only for the limited purpose of showing that Federal funding for 
HCBS waiver participants at JRC had been revoked. 
68 
 
modification of a consent decree because of changed 
circumstances of its own creation"). 
By contrast, a legislative ban on the use of electric skin 
shock would constitute a change in circumstances.31  See Rufo, 
502 U.S. at 388.  And indeed, it is apparent that, during the 
relevant period at issue in this case, EOHHS's preferred 
strategy for changing the Commonwealth's policy toward electric 
skin shock was a legislative ban.  It was only in 2010, after no 
legislative solution materialized, that Bigby provided the 
Governor with other policy options to restrict or eliminate 
 
31 The department and the amici also make reference to a 
rule promulgated by the Food and Drug Administration (FDA) in 
2020 that banned the use of electric shock devices for treatment 
of severe self-injurious or aggressive behavior.  See 85 Fed. 
Reg. 13,312 (2020).  This rule -- which was promulgated after 
the judge issued her decision below -- was later vacated by the 
United States Court of Appeals for the District of Columbia 
Circuit as exceeding the FDA's authority.  See Judge Rotenberg 
Educ. Ctr., Inc. v. United States Food & Drug Admin., 3 F.4th 
390, 393 (D.C. Cir. 2021).  We note, however, that in December 
2022, Congress amended the statutory language that formed the 
basis for the District of Columbia Circuit's decision to vacate 
the rule.  See Pub. L. No. 117-328, § 3306, 136 Stat. 4459, 5834 
(2022).  In a letter filed pursuant to Mass. R. A. P. 16 (l), as 
appearing in 481 Mass. 1628 (2019), the department indicates 
that the FDA has recently announced its intent to issue a 
proposed rule that would again ban the use of devices like the 
GED.  If the FDA does, in fact, promulgate the same rule again, 
that may well warrant termination of the decree.  See 
Atlanticare Med. Ctr. v. Division of Med. Assistance, 485 Mass. 
233, 247 (2020).  See also Rufo v. Inmates of Suffolk County 
Jail, 502 U.S. 367, 388 (1992) ("A consent decree must of course 
be modified if, as it later turns out, one or more of the 
obligations placed upon the parties has become impermissible 
under federal law"). 
69 
 
aversives.  However, Bigby's first instinct was correct -- any 
change in circumstances cannot be manufactured by way of 
regulatory changes promulgated by the very agency bound by the 
decree. 
If the department seeks to get out from under the decree, 
it must either wait for a legislative solution, provide more 
robust evidence that electric skin shock is outside the standard 
of care than the record it relied upon in 2016, or establish an 
ongoing record of good faith regulatory conduct toward JRC.  In 
the interim, of course, the department is always free to 
intervene in any individual substituted judgment proceeding 
where it objects to the use of the GED for a particular patient.  
Indeed, in the one recent case where the department chose to do 
so, it prevailed.  The wisdom of the department's decision not 
to avail itself of this option for any other patient is not 
before us. 
Judgment affirmed.