Memorandum

U.S. v. N.M.

AEP:VH:PSL:pmw DJ 168-49-7

MR NM-002-001

Subject
Recommendation to Investigate Los Lunas Hospital and Training School, Los Lunas, New Mexico

Date
JAN I 3 I987

To
Wm. Bradford Reynolds Assistant Attorney General Civil Rights Division

From
Arthur E. Peabody, Jr. Chief Special Litigation Section

Introduction

Pursuant to the Civil Rights of Institutionalized Persons Act, (CRIPA) 42 U.S.C. §1997-1997j, we recommend initiation of an investigation into conditions of confinement at the Los Lunas Hospital and Training School in Los Lunas, New Mexico. The information which we have compiled indicates a pattern or practice of egregious or flagrant conditions which violate the constitutional rights of the persons residing at Los Lunas. These practices include inadequate medical care, misuse of medications, abuse of residents, neglect of residents, improper food services, inadequate numbers of qualified staff, substandard physical conditions and the denial of minimally adequate training required by Youngberg v. Romeo, 457 U.S. 307 (1982). These practices continue at Los Lunas despite the fact that the Health Care Financing Administration certified Los Lunas in October, 1986. JL/ However, certification came after the institution failed to meet HCFA standards following two prior inspections. 2/

Background 3_/
The Los Lunas State Hospital was established in 1925 by the New Mexico State Legislature to care for "mental defectives" and received its first patient in 1929. In 1955 the legislature

XT Albuquerque Journal, Oct.30, 1986 at A3. Although HCFA certification might be considered prima facie evidence of a facility's adequacy, certification does not conclusively determine whether a facility meets all constitutional standards. See, Woe v. Cuomo, 729 F.2d 96 (2nd Cir. 1984), cert, denied, 105S. Ct. 339 (1984).
2/ Albuquerque Journal, Oct. 30, 1986 at A3.
3/ Ij3. All the information in the Background section comes from this source.

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expanded the scope of the hospital's responsibilities by adding a training school for "trainable mental defectives." In the same session, the hospital was also opened to those who were bedridden and needed 24-hour supervision and care. Currently, the facility serves approximately 350 severely mentally retarded and physically handicapped patients. The hospital has about 650 employees.
i
Sources of Information
We have obtained our information from various sources including an Executive Summary of a Task Force Report compiled by the New Mexico Health and Environment Department (HED), the Albuquerque Office of Protection and Advocacy (P and A ) , a series of local newspaper articles, telephone interviews with a former Protection and Advocacy attorney, Betsy Church, a former Los Lunas Special Education Director, Paul Wirth and a professor at the University of New Mexico in Albuquerque, Ruth Luckasson. Various other local attorneys were also contacted.
Factual Allegations
The information we obtained indicates that numerous deficiencies exist throughout the Los Lunas Hospital and Training School. Recently, Los Lunas was the defendant in a New Mexico state court lawsuit brought by local attorneys on behalf of 45 residents of one cottage at the facility in which two deaths and one rape occurred in September, 1986. On October 29, 1986 a New Mexico District Court Judge, following three days of closed-door testimony, ruled that Los Lunas has failed to properly care for its residents. 4/ Valencia County District Court Judge Tibo Chavez ruled Los Lunas has failed "to provide the level of medical care required by law and some patients have been abused and neglected." 5/ Following the ruling Judge Chavez forbade any of the attorneys or Los Lunas staff members involved to reveal specifics about the testimony. 6/
The hearing which produced the ruling followed a series of incidents, including the rape and death of a 19-year-old female resident in September. ]_/ Hospital administrators, members of
4 / I d . at p. 1.
6/ October 30, 1986 telephone conversation with P and A attorney Ann Harvey.
7/ Albuquerque Journal, Oct. 30, 1986 at p. 1.

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the medical staff, at least five other hospital employees and parents of residents of Los Lunas testified at the hearing. 8/ Judge Chavez ordered increased security at the hospital, independent medical examinations for residents to screen for abuse and required Los Lunas staff to notify a resident's attorney of any abuse reports. 9/ Despite the fact that Judge Chavez's order appears to be in the best interest of Los Lunas residents, HED is bitterly opposing entry of the order. Following the hearing, HED asked the New Mexico Supreme Court for a Writ of Prohibition, challenging the District Court's jurisdiction to enter the order. On December 10, 1986 the Supreme Court denied HED's request. 10/
The next day, December 11, 1986, HED filed notice with the state appellate court that it will formally appeal the Chavez ruling. JL_1/ While the appeal process continues, HED refuses to proceed with medical tests to determine whether residents have sufffered any mental, physical or sexual abuse. \2J Local attorneys expect the appeal process to take over a year, 13/ during which time the Chavez order is automatically stayed and Los Lunas residents will be subjected to continuing deprivations of their constitutional rights.
Thus, the fact that a New Mexico state court judge has sought to alter certain procedures at Los Lunas should not preclude a CRIPA investigation for several reasons. First, the Chavez order is limited in its scope. The order does nothing to address problems of inadequate medical care, misuse of medication, improper food services, inadequate numbers of qualified staff, substandard physical conditions, and the denial of Youngberg training. L4_/ Second, the order pertains to only 45 Los Lunas residents, all of whom reside at the same cottage. The order does not pertain to the majority of Los Lunas patients. Over
8/ :id.
9/ Harvey interview.
10/ Albuquerque Journal, Dec. 11, 1986 at p. 1.
11/ Albuquerque Journal, Dec. 12, 1986.
V2/ Id.
13/ id.
14/ See infra pps. 4-10 and accompanying notes.

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300 residents are excluded from the protection offered by the Chavez order. Third, as noted earlier, the appeal process is expected to take over a year and there is, of course, no guarantee that the Chavez order will survive appeal. Fourth, the state has shown its animosity toward instituting any of the reforms covered in the Chavez order by opposing entry of the order and refusing to proceed on its own with matters suggested by the Chavez order, such as the independent medical examinations to screen for abuse. Finally, our sources have stated that there is some question as to whether the court order would be fully and effectively implemented and whether there would be sufficient local resources available to be continually seeking enforcement of the Chavez order. 15/
The abuse, neglect and lack of proper medical care cited by Judge Chavez as well as the existance of other conditions at Los Lunas, including the lack of minimally adequate training required by Youngberg, deprive Los Lunas residents of their constitutional rights under the Due Process Clause of the Fourteenth Amendment. 16/
I. Abuse
Los Lunas residents are being subjected to physical and sexual abuse from staff and fellow residents. Judge Chavez, in his October 29, 1986 ruling said, "I have found that Mark Delgado, the director of the institution, has instituted reforms which will correct deficiencies. Not withstanding the tightening of the procedures, I also found there has been abuse and neglect of certain residents." 17/
15/ Telephone interviews conducted with Betsy Church, December 2, 1986 and Ruth Luckasson, December 15, 1986.
16/ See, Youngberg v. Romeo, 457 U.S. 307 (1982). Youngberg held the Fourteenth Amendment's liberty interest protects the right to reasonably safe conditions of confinement, freedom from unreasonable bodily restraints and such minimally adequate training as reasonably may be required by these interests.
17/ Albuquerque Journal, Oct. 30, 1986 at p. 1.

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Judge Chavez's ruling came on the heels of two deaths at the hospital. As noted earlier, a 19-year-old female resident died September 26, 1986. She had been raped two days earlier and died as a result of internal wounds. ^ 8 / A 27-year-old male patient died at the facility the same day the woman died, September 26, 1986, when he choked to death. 19_/ The New Mexico State Police, the Valencia County District Attorney's Office and the New Mexico Health and Environment Department are investigating the deaths, but no charges have yet been filed. 20/
There have been six other deaths at the hospital before those in September and three of those deaths occurred at the same cottage (Bashein) as did the September deaths. Zl/ O n e other patient at the cottage received head wounds and three others received puncture wounds in August and early September. 22/
Ms. Luckasson described Los Lunas as a "terrible, vindictive place." 22./ Many Los Lunas patients who require a blended diet are often fed simply ground-up garbage by the kitchen staff. 24/ Staff will feed patients "by filling their mouths with mush, throwing a towel over their faces and holding their heads back." 25/ The tremendous danger such a feeding procedure possesses to medically fragile or immobile patients who experience difficulty in chewing and swallowing is obvious. This feeding procedure is medically unacceptable for the type of patients residing at Los Lunas.
18/ Id. at A3.
19/ Id.
20/ Albuquerque Journal, Oct. 30, 1986 and Harvey interview.
11/ IS*.
22/ id.
23/ Luckasson interviews.
2±/ Id.
25/ Id.

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Los Lunas residents are also denied prompt and appropriate medical care due to the callousness of staff physicians. In one instance, a patient had slipped and fallen, knocking out several of his front teeth. The patient was taken to the staff doctor who said the patient "doesn't need those teeth. Anyway, mentally retarded people don't feel anything." 2j>/ The patient went unattended all day and. at the evening meal was fed hot cereal, causing the patient to' begin screaming in pain. A university student working part-time at the hospital eventually took the patient in the student's own car to a local doctor. 27/
The September rape and death of the 19-year-old woman drew a good deal of local media attention. However, many more rapes take place at the facility than ever draw notice. 2%_/ The attitude of the staff is to "look the other way" when it comes to client-on-client rape or homosexual rape. 29/
Ms. Church told a Section attorney that Los Lunas residents are "definitely being abused." y§J She said one resident, George Chavez, who is afflicted with Parkinson's Disease, has been "abused and beaten" by the staff in the year he has been there. _3J./ Another instance involved the parents of one resident who became concerned that their child was being overmedicated and possibly sexually abused. The boy had been transferred to Los Lunas from a boys' home where he was being sexually abused. For a time the boy's behavioral problems abated but resurfaced later indicating a recurrence of abuse. The boy developed patterns of rectal bleeding, indicating he was again being sexually abused. 32/
26/ II.
11/ Id.
28/ ld_.
29/ Id.
30/ Church interview.
3_1/ Id.
32/ Id.

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Not only are Los Lunas residents being physically and sexually abused but patients are often simply neglected by staff. One summer day several non-ambulatory patients were discovered sitting on the concrete outside one of the cottages. Besides being on the hot concrete, the patients were "covered with flies." 33/
, II. Staffing
Los Lunas has an inadequate number of trained and qualified staff to provide the proper levels of care and services to hospital residents. The HED Task Force noted staffing shortages in several areas of the institution. _3_i/ T n e Report's Executive Summary states the shortage "was determined to be especially acute in the direct care areas where the turnover rate is very high, salaries are low, absenteeism is high, and there is an excessive amount of overtime work and double shifting." 35/ The Summary also notes staff shortages in Psychological Services, in the Housekeeping and Dietary Departments and cites "[s]evere problems of recruitment and retention in professional specialities such as Physical Therapy. J36/ The Task Force also determined staff training at all levels to be of inadequate quality and quantity. 37/
Ms. Church described Los Lunas as having an "incredible staff shortage." 3JL/ This shortage results in a variety of dangerous conditions to patient health and well-being. Staff will often feed patients too quickly in order to feed all
33/ Luckasson interview.
34/ The Los Lunas Task Force was appointed during the first week of October, 1984 by former HED Secretary Joseph Goldberg. The nine-member Task Force issued its Report December 12, 1984. The Special Litigation Section received a copy of the Report from an attorney at the Albuquerque Protection and Advocacy Office
I5/ Id.
21/ id.
38/ Church interview.

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patients within a given time, thus exposing medically fragile patients to the unacceptable risks involved in not having sufficient time to intake and digest food. 39/
The lack of training for staff at Los Lunas also leads to an overuse of undue bodily restraints which is caused primarily by the lack of a qualified staff. The staff is also insufficient to provide basic care. For example, there is a "severe lack" of physical therapists at the facility. A0_/ Bed-ridden patients will often develop painful contractures and will lose use of limbs because "there is no one to train the staff in what to do with bed-ridden patients." £1/ As a probable result of an under-trained staff, two mentally retarded men were mistakenly served oven cleaner instead of fruit juice in October, 1985. 42/
The lack of staff numbers has also created unsanitary conditions at the facility. Los Lunas has been described as a facility where the "whole place reaks of urine and patients are frequently lying around in dirty diapers." 4_3_/ Thus, the lack of adequately trained staff poses an ongoing and continuous danger to the health and safety of Los Lunas residents.
Ill. Medications
Patients at Los Lunas are improperly and overly medicated. The approach to medication is a "shotgun method." £4/ Ms. Church stated that staff will "try a little of this and a little of that; some Valium, some Thorazine." 4_5/ Thus, there is a substantial question whether medication is being prescribed and monitored consistent with the exercise of professional judgment.
£0/ Id.
_41/ Id.
42/ United Press Internal, October 8, 1985. Southwest Regional News Briefs. An Albuquerque private attorney, Lynn Eby, represents the two patients fed the oven cleaner and expects to bring a suit on their behalf in the near future.
43/ Church interview.
44/ ^d.
45/ Id.

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The heavy use of drugs at Los Lunas is in lieu of training and is done strictly "for the convenience of the staff. What you have is basically a bunch of drugged people sleeping all day." 4_6/ Numerous parents have approached the Protection and Advocacy Office concerned about the effects drugs were having on their children. Cases of Tardive Dyskinesia, the result of an over-use of psychot,ropic drugs, also exist at the facility. 47/
The medication review procedure is also abused at Los Lunas. Staff physicians are supposed to review patient medication every 30 days. However, these reviews often amount only to a nurse rewriting an order and a doctor initialing the order or the nurse forging the doctor's initials. 48/
IV. Training
Los Lunas residents are not provided sufficient training to protect their Youngberg established rights to the minimal training necessary to ensure a reasonably safe environment and freedom from undue bodily restraint. Mr. Luckasson told Section personnel that there was no programming to deal with the behavioral or emotional problems of the mentally retarded. 49/ For example, there is nothing done to assist residents witTT~problems such as sleep disorders and thus a patient's health will deteriorate. 50/ Ms. Church stated that there was "absolutely no training going on." ^ 1 / Paul Wirth, a former director of education at Los Lunas, agreed with our other sources that the lack of training for the residents directly contributed to the use of undue bodily restraints and created conditions posing undue risks to the physical safety of residents. 52/
47/ Id.
48/ Church interview and Luckasson interview.
49/ Luckasson interview.
50/ Id.
51/ Church interview.
52/ Telephone interview with Paul Wirth conducted December 3, 1986, Mr. Wirth resigned from Los Lunas in July, 1985. He has worked there for three and one-half years prior to his resignation.

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Wirth stated that, during his tenure, the most training any Los Lunas resident received was during the daytime hours of the facility's 190-day school year for those residents under 21 years of age. 53/ However, nothing is done for any resident after school hours. 547 There are no programs and no activities for the residents after school hours. J_5/ Compounding these problems is again the lack of adequately trained staff and the lack of any coordinated efforts between teachers and direct care staff. 56/
i
Thus, the lack of training afforded Los Lunas residents violates their rights established in Youngberg by not providing the minimal training necessary to ensure a reasonably safe environment and freedom from undue bodily restraints.
Conclusion
Conditions at Los Lunas Hospital and Training Center subject residents to deprivations which violate their Constitutional rights under Youngberg. We believe that the facts stated above show a facility which poses a substantial risk to the safety of its residents, and justifies an investigation of the facility. Therefore, we recommend that an investigation of Los Lunas be instituted under our CRIPA authority.
Accordingly, we have attached for your signature the appropriate letters notifying state and federal officials of our inteqrt«d investigation.
Approved: ( ,
Disapproved:
Comments:

 
 U.S. v. N.M. MR-NM-002-002

U.S. Department o. Justice Civil Rights Division

Office of the Assistant Attorney General

Washington, D.C. 20530

CERTIFIED MAIL
RETURN RECEIPT REQUESTED
i
Honorable Garrey Carruthers Governor State Capitol Building Santa Fe, New Mexico 87503

JAi, 2 I !c -

Re: Investigation of Los Lunas Hospital and Training School, Los Lunas, New Mexico

Dear Governor Carruthers:

I am writing to let you know of our intention to investigate conditions within the Los Lunas Hospital and Training School, Los Lunas, New Mexico. This investigation is pursuant to the Civil Rights of Institutionalized Persons Act, 42 U.S.C. §§ 1997-1997J.

The purpose of the investigation will be to determine whether there exists any violations of the statutory and federal constitutional rights of patients residing at the facility. The investigation will focus on allegations related to the abuse of residents; staffing; use of medication; medical care; environmental conditions; use of physical restraints and the provision of minimally adequate training. The initiation of this investigation in no way evidences any prejudgment on our part that patient federal rights have been violated. If any violations are found, we look forward to conferring with you and your staff concerning corrective actions that might be appropriate.

As a means of commencing this investigation, I wish to propose an initial meeting in the near future between our attorneys and representatives of your office. It has been our experience that such a preliminary conference can substantially expedite the investigation process. We also wish to arrange for our attorneys, consultants, and perhaps agents of the Federal Bureau of Investigation to visit Los Lunas. We shall be in touch with your staff to work out specifics of our meeting and later visits.

Your cooperation in this matter is greatly appreciated,
Sincerely,
Wm. Braatord Assistant Attorney General
Civil Rights Division
cc: Hal Stratton, Esq. Attorney General
Larry Gordon Secretary Health and Environment Department
Mark Delgado Superintendent Los Lunas Hospital and
Training School
William L. Lutz, Esq. United States Attorney

 
 U.S. v. N.M.
II III IIIII illII
MR-NM-002-003
Office of the Assistant Attorney General

U.S. Departmen . Justice
Washington, D.C. 20530

G(\) r, n

SEP-

Honorable Garrey Carruthers / U O ^

Governor State of New Mexico State Capitol Building Santa Fe, New Mexico 87504
Re: Notice of Findings Regarding the Los Lunas Hospital and Training School. 42 U.S.C. Section 1997b(aWl)

Dear Governor Carruthers:

On January 21, 1987, we informed you that, pursuant to the Civil Rights of Institutionalized Person Act (CRIPA), 42 U.S.C. Section 1997, we were commencing an investigation into conditions at the Los Lunas Hospital and Training School (Los Lunas) in Los Lunas, New Mexico. As contemplated by the statute, we are writing to inform you of the findings of our investigation and of the remedial measures required to remedy the unconstitutional conditions at Los Lunas.

During our investigation of Los Lunas, Special Litigation Section attorneys conducted tours of Los Lunas with three private consultants. Our consultants examined resident records, interviewed the facility superintendent and numerous staff members and spoke with residents. We also reviewed numerous documents provided by the facility, concerning a wide range of procedures and activities. During our investigation we were treated graciously by Los Lunas staff and attorneys from the Health and Environment Department and from the Attorney General's Office.

Our extensive investigation reveals that conditions exist at Los Lunas which deprive residents of their constitutional rights. Institutionalized mentally retarded persons have a constitutional right to adequate medical care and such training as an appropriate professional would consider reasonable to ensure their freedom from undue risks to personal safety and unreasonable bodily restraints. Younaberg v. Romeo. 457 U.S. 307, 324 (1982).

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Set out below are our findings and recommendations. The unconstitutional conditions revealed by our investigation include Los Lunas' failure to provide minimally adequate training programs sufficient to ensure residents are free from undue bodily and chemical restraints, failure to provide minimally adequate medical -staff and medical care and failure to provide minimally adequate resident supervision to protect residents from unreasonable risks to their health and safety.
INADEQUATE TRAINING PROGRAMS
Los Lunas fails to provide professionally designed and implemented training programs sufficient to ensure that residents are not subjected to unreasonable bodily restraints. Following a careful review, our consultant psychologist concluded that Los Lunas staff are using physical restraints, isolation and punishment (e.g., forced inhalation of ammonia) to control the behavior of residents in lieu of necessary training programs.
Los Lunas staff do not identify and eliminate circumstances which provoke problem behaviors in residents. Staff intervene only after the onset of a maladaptive episode by restraining the resident. Our consultant noted that certain procedures used in restraining residents are substantial departures from accepted professional practice. Specifically, the use of "papoose boards" as restraint devices are commonplace at Los Lunas; straightjackets and ammonia inhalants are used as a consequence for antisocial behavior. Restrained individuals are in some cases isolated in a room with a closed door out of sight of staff. This practice, absent adequate surveillance, places severely handicapped residents at great risk of injury and is not professionally justifiable.
Further, the use of restraint on individual residents is continued for unacceptable periods of time without any monitoring of the restraint. The lack of appropriate monitoring is the result of insufficient tracking and recordkeeping procedures. Los Lunas lacks an effective system to evaluate the use of restraints, the need for, or the need to, modify a training program.
Finally, Los Lunas lacks a data gathering system necessary to provide information upon which professional decisions can be based regarding all aspects of training for residents who require training programs.
INADEQUATE MEDICAL STAFFING
Los Lunas does not have adequate nursing, physical therapy or occupational therapy staff to adequately meet the needs of Los Lunas residents or to provide sufficient supervision of residents to ensure their safety.

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The number of nursing staff at Los Lunas is inadequate to meet the heavy demands placed upon them. For example, there is only one nurse on the night shift responsible for providing nursing coverage for 18 cottages. This nursing coverage .is unacceptable for -the type of resident population at Los Lunas. Having only one nurse at night exposes residents to unreasonable risks to their health and safety because the signs of incipient -illness which may not be noticed by non-nursing staff and hence may not be reported to a physician in a timely fashion.
Partially as a result of the lack of adequate staff, the safety and security of residents has not always been maintained. The most flagrant case is that of a woman who was raped, developed peritonitis and died. Improved resident supervision may have prevented both the abuse and the subsequent delay in recognizing the developing peritonitis.
Patient safety is also compromised by staffing patterns which expose residents to unreasonable risks. For example, during a visit to Bashein Cottage prior to breakfast, our consultants observed 32 wheelchair bound, profoundly retarded, multiply-handicapped residents lined up in two groups of 16 in the hallway outside the eating area without any staff member in visual contact. Given the constant risk of seizures and other problems generated by medical conditions exhibited by these residents, such a practice places clients at an extreme risk to their health and safety. Again, the need for improved resident superversion is heightened by the large number of multiply-handicapped and physically and medically fragile residents at Los Lunas.
The physical therapy and occupational therapy staffs at Los Lunas consist of one person each. These individuals are unable to meet the health related needs of residents. Physical therapy is necessary at Los Lunas, especially in light of the large number of body deformities present among the resident population, in order to prevent muscular or skeletal breakdown. Occupational therapy is necessary to assist residents with eating disorders. The two individuals currently assigned to physical and occupational therapy duties are spending the majority of their time on wheelchair maintenance rather than resident care.
Finally, the ability of Los Lunas to deliver adequate medical care to its residents is hindered by inadequate recordkeeping practices at the facility. A resident's diagnosis and reasons why certain procedures and medications are proscribed are seldom written into a resident's record. When changes are made, there is little indication in the record as to the reasons for such a change. The medical section of a resident's record should reflect this information. Without such information, professional medical decisions can not be made.

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INADEQUATE PSYCHIATRIC CARE
The administration of psychotropic medications at Los Lunas is_ not sufficiently monitored to protect resident from se'rious risks to their health from the overuse of these medications. Numerous residents of Los Lunas have received neuroleptic or psychotropic medications, for years in some instances, absent adequate monitoring.
In addition, while dosages are often increased in an attempt to control maladaptive behaviors, there are often no similar attempts to decrease medications nor is there a demonstration in the record to support the increased dosages. Further, the records lacked evidence that such drugs are used in conjunction with a training program.
MINIMALLY NECESSARY REMEDIES
The administration and staff at Los Lunas appear committed to providing residents with appropriate care, however the unique population of Los Lunas, combined with deficiencies in behavior management, medical staffing and psychiatric practices have resulted in the creation of an environment which is violative of the constitutional rights of Los Lunas residents. The abovenoted conditions and deficiencies are both egregious and flagrant and are pursuant to a pattern or practice which is causing Los Lunas residents grievous harm.
To rectify the deficiencies at Los Lunas and ensure that constitutionally adequate conditions are maintained thereafter, the following measures, at a minimum, must be undertaken. The State is free, of course, to implement measures beyond those listed below.
1) Design and implement training programs in order to eliminate the use of undue bodily and chemical restraints. Such procedures must include improvements in the current tracking and recordkeeping systems to monitor the effectiveness of behavior management programs and allow programs to be re-evaluated, as appropriate.
2) Increase nursing staff in order to provide adequate resident supervision and detect illness among the resident population.
3) Increase physical and occupational therapy staff to ensure that residents are not at risk from muscular or skeletal breakdown or eating disorders, and associated risks to their health and safety.

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4) Develop and implement side-effect monitoring procedures for residents on neuroleptic and psychotropic medication to eliminate undue risks of harm due to medication side effects.
- We are -willing to make our experts available to the State of New Mexico to provide technical assistance in remedying the deficiencies we have identified. Information about federal financial assistance which may be available to assist with the remediation process can be obtained through the United States Department of Health and Human Services Regional Office and through the United States Department of Education by contacting the individuals listed in the attached information guide.
Our attorneys will be contacting counsel for the State of New Mexico shortly to arrange a meeting to discuss this matter in greater detail. To date, we have been able to conduct this investigation in the spirit of cooperation intended by the Civil Rights of Institutionalized Persons Act, and look forward to continuing to work in the same manner with state officials in that spirit toward an amicable resolution of this matter.
Sincerely

Wm. Bradford Reynolds Assistant Attorney General
Civil Rights Division

cc: Hal Stratton

Q0~~?

Attorney General

'

State of New Mexico

Karolyn Klintworth Superintendent Los Lunas Hospital
and Training School

 
 U.S. v. N.M.

MR-NM-002-004

IN THE UNITED STATES DISTRICT COURT FOR THE

DISTRICT OF NEW MEXICO

CS QCJ £;

<J" i c-

UNITED STATES OF AMERICA,

' CLERK

Plaintiff

)

v.

)

)

STATE OF NEW MEXICO: Garrey

)

Carruthers, Governor; NEW MEXICO )

HEALTH AND ENVIRONMENT DEPARTMENT, )

Dennis Boyd, Secretary, New Mexico )

Health and Environment Department; )

LOS LUNAS HOSPITAL AND TRAINING )

SCHOOL, Miriam Brownstein, Acting )

Administrator, Los Lunas Hospital )

and Training School,

)

Civil Action No
CIV89-1165M

Defendants.

COMPLAINT The UNITED STATES OF AMERICA, by and through its Attorney General, Dick Thornburgh, files this Complaint pursuant to the Civil Rights of Institutionalized Persons Act of 1980, 42 U.S.C. § 1997, to enjoin the named defendants from depriving persons residing at the Los Lunas Hospital and Training School ("LLHTS"), of rights, privileges or immunities secured or protected by the Constitution of the United States. Attached hereto, and incorporated herein by reference, is the Certificate of the Attorney General required by 42 U.S.C. § 1997b.
JURISDICTION. STANDING. AND VENUE 1. This Court has jurisdiction over this action under 28 U.S.C. § 1345.

2. The United States has standing to maintain this action pursuant to 42 U.S.C. § 1997a.
3. Venue in the District of New Mexico is proper pursuant to 28 U.S.C. § 1391. All claims set forth in the Complaint arose in said District.
4. Defendant STATE OF NEW MEXICO owns and operates LLHTS, which is a state residential mental retardation facility.
PARTIES 5. Defendant GARREY CARRUTHERS is the Governor of New Mexico, and, in this capacity, heads the Executive Branch of the State government and, among other duties, reviews and approves budget requests submitted by Executive Branch agencies. He selects and appoints the Secretary of the New Mexico Health and Environment Department ("HED") . 6. Defendant HEALTH AND ENVIRONMENT DEPARTMENT is responsible for the administration and operation of LLHTS. 7. Defendant DENNIS BOYD is the Secretary of HED, and, in this capacity, exercises administrative control of, and responsibility for, LLHTS. 8. Defendant MIRIAM BROWNSTEIN is the Acting Administrator of LLHTS, and, in this capacity, has the responsibility for, and control of, the daily operation of LLHTS. 9. The individual defendants named in paragraphs 5, 7 and 8 above are officers of the executive branch of the State of New Mexico and are sued in their official capacities.
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10. LLHTS, a State mental retardation facility administered and operated by HED; is an institution as that term is defined in 42 U.S.C. § 1997(1)(A) and (1), (B)(i), and is located in Los Lunas, New Mexico.
FACTUAL ALLEGATIONS 11. Defendants and their predecessors in office have been, and are currently, legally responsible, in whole or in part, for the operation of and conditions at LLHTS, as well as for the care and treatment of persons residing at that institution. 12. At all relevant times, defendants or their predecessors in office have acted or failed to act, as alleged herein, under color of state law. 13. Defendants are failing to provide adequate medical care and treatment to LLHTS residents. 14. Defendants are failing to provide patients residing at LLHTS with adequate care, treatment and training necessary to ensure that they are free from unreasonable risks of harm to personal safety and unreasonable use of bodily restraints and seclusion. 15. Defendants are failing to ensure that there is an adequate number of sufficiently trained staff to render and implement professional judgments regarding adequate medical care, psychiatric treatment and training to LLHTS patients. 16. Defendants are failing to ensure appropriate and timely review and evaluation of the medical status, treatment and training needs of patients who reside at LLHTS.
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17. Defendants are failing to employ staff and practices needed to maintain professionally based recordkeeping and record review systems to ensure that patient records contain accurate, up-to-date and relevant information as is necessary to enable staff to exercise professional judgment regarding medical, treatment and training decisions.
18. Defendants are failing to prescribe and administer psychotropic medication safely and pursuant to the exercise of professional judgment by appropriately qualified staff.
19. Defendants are failing to employ effective monitoring and quality assurance measures necessary to identify and correct the deficiencies described in paragraphs 13 through 18.
VIOLATIONS A 20. The acts and omissions alleged in paragraphs 13 through 19 constitute patterns or practices of resistance to the full enjoyment of rights, privileges or immunities secured or protected by the Constitution of the United States, and deprive patients who reside at LLHTS of such rights, privileges or immunities. 21. Unless restrained by this Court, Defendants will continue to engage in the conduct and practices set forth in paragraphs 13 through 19 above that deprive residents of LLHTS of rights, privileges, or immunities secured or protected by the Constitution of the United States, and cause irreparable harm to LLHTS residents.
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PRAYER FOR RELIEF 22. The Attorney General is authorized under 42 U.S.C. § 1997 to seek only equitable relief. WHEREFORE, the United States prays that this Court enter an order permanently enjoining defendants, their agents, employees, subordinates, successors in office, and all those acting in concert or participation with them from continuing the acts, practices and omissions at LLHTS set forth in paragraphs 13 through 19 above, and to require defendants to take such action as will provide constitutional conditions of care to persons who reside at LLHTS. The United States further prays that this Court grant such other and further equitable relief as it may deem just and proper.
Respectfully
CAu.
EDWARD S. G. tiferfNIS, Acting Attorney General of
the United States

WILLIAM A. LUTZ7 United States Attorney District of New Mexico

JXMES P. TURNL~ Acting Assistant Attorney General Civil Rights Division

ARTHUR E. PEABODY,/JR./ Chief Special Litigation Section

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MELLIE H. NELSON Deputy Chief Special Litigation Section JEREMY I. SCHWARTZ VERLIN HUGHES CYNTHIA KATZ Attorneys U.S. Department of Justice Civil Rights Division Special Litigation Section 320 First Street, NW Washington, D.C. 20530 (202) 272-6055
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of % Attnrnpj)
©aahington,!. (C. 2D53D

CERTIFICATE OF THE ATTORNEY GENERAL

I, Edward S. G. Dennis, Jr., Acting Attorney General of the

United States, certify that with regard to the foregoing

Complaint, I have complied with the provisions of 42 U.S.C. §

1997b(a)(l), (2). As required by 42 U.S.C. § 1997b(a)(3), I

further certify that I believe that this action by the United

States, regarding conditions of confinement at the Los Lunas

Hospital and Training Center, Los Lunas, New Mexico, is of

general public importance and will materially further the

vindication of rights, privileges, or immunities secured or

protected by the Constitution of the United States.

Accordingly, having determined that the action here

initiated is fully consistent with section 1997a, I have,

pursuant to subsection 1997a(c), personally signed the fore-

going Complaint. As required under subsection 1997b(b), I

also have personally signed this Certificate.

Finally, I certify that all things that must be done as

prerequisites to my initiating suit under 42 U.S.C. § 1997

have been done.

Signed this Washington, D.C.

16th

day o£~S>ctpber fl /^-T"*t989. at

Acting Attorney General of the United States

 
 U.S. v. N.M.

UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF NEW MEXICO

UNITED STATES OF AMERICA

Plaintiff, '

)

v.

) Civil Action No.

STATE OF NEW MEXICO; Garrey Carruthers,

Governor of the State of New Mexico;

Dennis Boyd, Secretary,

New Mexico Health and Environment

)

Department; Miriam Brownstein,

)

Acting Administrator, Los Lunas

)

Hospital and Training School,

)

F 'L E D ATAtBUOI/B>QUE

Defendants.

)

)_

SETTLEMENT AGREEMENT

Jf?SSE CASAUS CLERK

1. This case was instituted by the United States on

October 27 . 1989, pursuant to the Civil Rights of

Institutionalized Persons Act, 42 U.S.C. Section 1997, et seq.

2. This Court has jurisdiction over this action pursuant to

28 U.S.C. Section 1345.

3. Venue is appropriate pursuant to 28 U.S.C. Section

1391(b).

4. The United States is authorized to institute this civil

action by 42 U.S.C. Section 1997a and has met all the

prerequisites for the institution of this civil action prescribed

by the statute.

5. The defendants are the State of New Mexico, Garrey

Carruthers, Governor of the State of New Mexico; Dennis Boyd,

Secretary, New Mexico Health and Environment Department; Miriam

Brownstein, Acting Administrator, Los Lunas Hospital and Training School, and are sued in their respective official capacities.
6. The defendants have authority and responsibility for the operation of Los Lunas Hospital and Training School and are officers of the Executive Branch of the State of New Mexico.
7. On January 21, 1987, the Attorney General of the United States, through Assistant Attorney General, William Bradford Reynolds, Civil Rights Division, notified the Governor of New Mexico, the New Mexico Attorney General, the Secretary of the New Mexico Health and Environment Department, and the Administrator of the Los Lunas Hospital and Training School of his intent to investigate, pursuant to the Civil Rights of Institutionalized Persons Act, 42 U.S.C. Section 1997, allegations of unconstitutional conditions at the Los Lunas Hospital and Training School, Los Lunas, New Mexico.
8. Following a thorough investigation, the Attorney General of the United States, by and through the Assistant Attorney General, on September 12, 1988, informed the Governor of New Mexico, the New Mexico Attorney General, the Secretary of the New Mexico Health and Environment Department, and the Administrator of the Los Lunas Hospital and Training School that persons residing in or confined to Los Lunas were being subjected to conditions that deprived them of rights, privileges, and immunities secured by the Constitution of the United States.
9. The parties agree that care, confinement, and training of Los Lunas residents implicate rights of these residents that
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are secured and protected by the Constitution of the United States. The parties entering into this Settlement Agreement recognize these constitutional interests and, for the purpose of avoiding protracted and adversarial litigation, agree to the provisions set forth herein. This Settlement Agreement provides for procedures that the United States deems constitutionally required and the State of New Mexico has agreed to implement the procedures.
10. In entering into this Settlement Agreement, the defendants do not admit any violation of law and this Settlement Agreement may not be used as evidence of liability in any other legal proceeding.
11. The provisions of this Settlement Agreement are a fair and appropriate resolution of this case.
12. This Settlement Agreement shall be applicable to and binding upon all of the parties, and their officers, agents, employees, assigns and successors. I. Definitions
As used in this Settlement Agreement, the following definitions shall apply:
1. Physician; A medical doctor lawfully entitled to practice medicine in New Mexico.
2. Psychiatrist: A physician who is either certified by or is eligible for certification by the American Board of Psychiatry and Neurology or who has successfully completed an approved residency program in psychiatry and upon completion of
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post-residency requirements will become eligible for examination for such certification.
3. Psychologist: A person who has attained at least a master's degree in the field of psychology.
4. Direct Care Worker: Staff immediately responsible for implementing training programs and providing care to residents.
5. Qualified Professional: A person who is employed or under contract by the State, and who is competent, whether by education, training, or experience, to make the particular decision at issue.
6. Professional Judgment: A decision shall be deemed to be a reasonable exercise of professional judgment unless it can be shown that the decision is such a substantial departure from accepted professional judgment, practice or standards as to demonstrate that the person responsible actually did not base the decision on such a judgment.
7. Bodily Restraint: (a) Any physical or mechanical device used to restrict the movement of a resident or the movement or normal function of any portion of the resident's body, excluding those devices used only to provide support for the achievement of functional body position or balance and devices used for specific medical and surgical (as distinguished from behavioral) treatment; (b) Chemical substances used solely for the purpose of controlling the behavior of a resident.
8. Papoose Board: Any device consisting of a solid backing upon which a resident is placed in a prone position and
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restrained in any manner thereto for purposes of behavioral control.
9. Psvchotropic medications: Chemical substances used in the treatment of mental illness which affect psychic function, behavior, or experience. Included in this definition are major tranquilizers, and minor tranquilizers and antidepressants to the extent that they are used to affect psychic function, behavior, or experience.
10. Training Programs; A program of steps and activities, developed by qualified professionals pursuant to the exercise of professional judgment which is designed individually to promote a resident's physical, social, emotional or intellectual growth and development. Such programs will be sufficient to protect a resident from unreasonable risks to personal safety and to facilitate his or her ability to function free from undue bodily restraint.
11. Seclusion: Placement of an individual in a locked room, or a room from which the resident is physically prevented from egress.
12. Time Out: A behavior management technique which removes a resident from a situation for a period of time for the purpose of modifying a specific inappropriate behavior.
13. Resident: A person residing at the Los Lunas Hospital and Training School who is receiving services from the New Mexico Health and Environment Department.
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14. The State: The Executive Branch of the Government of the State of New Mexico, specifically including the Governor of the State of New Mexico, the New Mexico Health and Environment Department, the Administrator of the Los Lunas Hospital and Training School, and any of their officials, agents, employees, assigns, and the successors in office of such officials, agents, employees, or assigns. II. REMEDIAL MEASURES A. Evaluation and Training
Defendants shall design professionally based training programs for all Los Lunas residents for whom it is determined by qualified professionals are in need of such programs in order to reduce or eliminate unreasonable risks to personal safety or unreasonable use of bodily restraints.
To this end, defendants shall: 1. professionally evaluate, or reevaluate each
resident in a timely manner to determine training and treatment needs;
2. develop professionally designed training programs, reflected in individualized program plans, for residents, including appropriate behavior management training, training in daily living skills speech, physical and occupational therapy, as necessary to protect residents from unreasonable risks to
x personal safety and to permit them to function free from undue bodily restraint;
- 6-

3. implement the training programs on a consistent basis by staff trained to implement such programs;
4. professionally evaluate each resident no less than annually and each program plan no less than quarterly to ensure the adequacy of training programs;
5. implement on a priority basis training programs for residents exhibiting dangerous aggressive behavior, self injurious behavior, pica behavior, residents subject to the administration of anti-psychotic medication on an emergency or "PRN" basis or placed in seclusion or restraints six times in any 30 day period.
Defendants shall implement paragraph A.I, by October 15, 1989; A.2, by November 15, 1989; A.3, by January 15, 1990; A.4, and A.5, by December 15, 1989. B. Restraint and Seclusion
Defendants shall insure that seclusion, bodily restraint, and time out are administered only pursuant to the judgment of a qualified professional; none shall be used as punishment, in lieu of necessary training programs, or for the convenience of staff.
To this end, defendants shall: 1. Immediately cease and desist from the use of
papoose boards, except as may be medically required based on the exercise of professional judgment, to administer dental or medical treatment;
2. Immediately cease and desist from use of spray mist devices and ammonia capsules for behavioral control purposes;

3. Use seclusion, bodily restraint, and time out for behavior modification only in conjunction with a written behavior modification program;
4. Insure that any program plan utilizing seclusion, bodily restraint, or time out specifies:
a) the behavior to be eliminated, the behavior to trigger use of the method;
b) the method to be used; c) the duration for use of the method, when employed; d) the person responsible for the program; e) the data to be collected to assess progress toward the objectives; and f) justification that other behavior modification techniques have been systematically tried and have been demonstrated to be ineffective. 5. Use seclusion and bodily restraint only when in accordance with the exercise of professional judgment, it is determined they are necessary to protect a resident from injury to self or others. Defendants shall implement paragraph B.3, by January 15, 1990; B.4, by November 15, 1989; and B.5, by July 30, 1990. C. Medical care Each resident shall be provided adequate medical care. To this end, defendants shall:
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1. Provide continuous 24 hour per day coverage by at least one physician who is immediately available to provide medical care and supervise medical emergencies;
2. Immediately ensure in accordance with the exercise of professional judgment, timely identification of symptoms, diagnosis and treatment of illness and communicable disease;
3. Professionally evaluate all residents with physical handicaps and develop and implement based on professional judgment, physical therapy services necessary to prevent or reduce contractures, body deformities, or other threats to the physical health of residents;
4. Based on the exercise of professional judgment, obtain adaptive equipment designed to meet the needs of physically handicapped residents who require such equipment; and
5. Ensure that all physically handicapped residents are fed in a manner which does not expose such residents to undue risks to their physical health and safety; and
6. Professionally evaluate all residents with regard to their occupational therapy needs, and based on the exercise of professional judgment, provide such services or devices which will permit residents to eat safely, communicate or otherwise meet their health needs.
Defendants shall implement paragraph C.I, by January 1, 1990; c.3, 4, and 6 by June 30, 1990 and C.5, by March 30, 1990.
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D. Staffing

1. By no later than March 30, 1990, the State shall ensure

that a sufficient number of physicians, registered nurses,

licensed practical nurses, psychologists, physical therapists,

occupational therapists, and direct care workers are employed or

contracted for to assure attainment and consistent maintenance of

at least the ratios of such staff to residents at the Los Lunas

Hospital and Training School delineated below.

Physicians

1:100

Registered Nurses and Licensed Practical Nurses

1:7 (no fewer than 1 RN shall be present and on duty at each unit on any shift)

Psychologists

1:40

Physical Therapists

1:80

Occupational Therapists 1:80

P.T. and O.T. Aides

1:80

Direct Care 1st shift 1:4 2nd shift 1:4 3rd shift 1:8

2. By no later than October 30, 1989, the State shall

ensure that there is no less than 20 hours per week of

consultation by a psychiatrist available at Los Lunas.

3. By no later than December 31, 1989, the State shall

ensure sufficient consultation or otherwise provide services at

Los Lunas by such medical specialists as may be needed to provide

adequate routine and emergency medical care to each resident.

4. By no later than March 30, 1990, the State shall employ

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at least one psychologist possessing a Ph.D. in the field of psychology, licensed or certified by the State, with a minimum of 2 years of post-doctoral experience in the field of mental retardation, who shall have primary responsibility for supervising, monitoring, and coordinating all psychological services at Los Lunas.
5. At least sixty percent of the full-time equivalent nurses at Los Lunas shall be registered nurses. E. Medications
Psychotropic medications and other medications shall be prescribed and administered to residents only pursuant to the exercise of professional judgment by a qualified professional.
To this end, defendants shall: 1. administer prescription medication only upon order
of a physician; 2. review the drug regimen of each resident every 30
days through team review by all physicians who prescribe medication for the resident;
3. write prescriptions with a 30 day termination date;
4. note in the record of each resident receiving psychotropic medication, the following:
a) the mental illness diagnosis for which the medication is prescribed;
b) the justification for the drug and dosage level;
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c) any changes in medication when made and rationale for the change; and,
d) periodic notes of the effect of such medication on residents behavior;
5. periodically evaluate each resident receiving psychotropic medication for drug induced side effects, including tardive dyskinesia;
6. permit only qualified staff to administer medication;
7. report and record in resident records all medication errors and drug reactions;
8. ensure that psychotropic medications are used pursuant to professional judgment, properly and in a manner that facilitates, and does not interfere with a resident's program, unless medically required; and
9. ensure that all residents with epilepsy are prescribed the fewest combinations of anticonvulsants appropriate for effective seizure management.
Defendants shall implement the requirements of paragraph E by October 15, 1989. F. Recordkeep ing
1. The State shall develop and maintain a professionally based recordkeeping system to insure that necessary information relating to each resident is maintained and readily available to professional and direct care staff to enable them to make
- 12 -

informed judgments with respect to medical care, treatment, and training of residents.
2. The parties agree that the components of an adequate individualized program plan are described in Appendix A. G. Staff Training
The State shall develop and implement a training and inservice training program for all professional and direct care staff sufficient to enable such staff to fully implement the requirements of this Settlement Agreement. III. Plans
In addition to the requirements specified above, the State agrees to file with the Court as provided in Section IV herein, a plan or plans describing the steps it will take to implement certain requirements of this Settlement Agreement.
1. Section II, paragraph D: A description of all strategies that the State intends to implement in order to recruit and retain additional professional and other direct care staff called for under the terms of this Agreement. Strategies may include, but are not limited to, personnel policies, hiring standards and practices, recruitment efforts and techniques, incentives to attract and retain qualified staff, and reduction of the resident population. The State agrees that if it decides to reduce the population of Los Lunas through the transfer of a substantial number of residents to alternate programs, the determination as to which residents shall be transferred or placed elsewhere shall be made by professional staff qualified to
- 13 -

make such decisions. If such transfers or placements are to be made, the state agrees to file a plan for such transfers or placements no later than 3 0 days after it determines that it intends to proceed with such a plan. Any such plan shall become part of this Settlement Agreement and shall be fully enforceable.
2. Section II, paragraph F: a description of the recordkeeping systems, policies, and procedures with respect to each resident's care, training, and medical treatment that shall be utilized to maintain and make readily available in each resident's record and elsewhere, as necessary, such information as is professionally necessary to permit the exercise of professional judgment in each resident's care and training. Such plan shall be implemented by March 30, 1990.
3. Section II, paragraph G; a description of the training and continuing inservice training program(s) necessary to enable all staff to fully implement the requirements of this Agreement. Such plan shall commence no later than November 15, 1989, and continue during the pendency of this Settlement Agreement. IV. Construction and Implementation
In construing and implementing the terms of this Agreement, the following are agreed to by the parties:
1. A. The Defendants shall file the plan(s) required by Section III with the Court and the United States within 30 days of the entry of this Settlement Agreement. The United States shall have thirty (30) days from receipt of any plan in which to file a response to the plan with the Court. If the United States
- 14 -

objects to any plan or portion thereof filed by the State, State and Federal officials shall meet in a good faith effort to resolve their differences. If the State and Federal officials are unable to resolve their differences through negotiation, the adequacy of the contested portions of the proposed plan shall be determined by the Court.
B. If, after a plan is approved, State officials decide to modify that plan or any portion thereof, State officials shall notify the Court and the United States of the proposed modification. The United States shall have thirty (30) days from the receipt of any proposed modification in which to file a response to the proposed modification with the Court. If the United States objects to the modification sought, State and Federal officials shall meet in a good faith effort to resolve their differences concerning the proposed modification. If State and Federal officials are unable to resolve their differences through negotiation, the adequacy of the proposed modification shall be determined by the Court. The Defendants shall have the burden to persuade the Court that the modified plan is adequate.
C. Plans submitted to the Court, including modifications of plans, to which the United States does not timely object, shall be deemed approved by the Court.
D. All plans required under this Agreement, if approved by the Court, shall be issued as orders of the Court and shall be enforceable as such.
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2. If, after the Settlement Agreement is approved, the State seeks to modify the terms of the Agreement, the State shall notify the Court and the United States of the proposed modification. If the United States objects to the modifications sought, State and Federal officials shall meet in a good faith effort to resolve their differences concerning the modification and propose a joint stipulation of modification regarding the proposed changes. If the parties are unable to resolve their differences, the State may move the Court to modify this Settlement Agreement under governing legal or equitable standards. The parties agree that any authoritative change in the substantive law governing the matters at issue in this Settlement Agreement shall lead to a corresponding modification of the terms hereof so that this Agreement shall reflect current constitutional requirements.
3. A. The State shall submit quarterly compliance reports to the United States and the Court regarding the status of the State's compliance with the requirements of this Settlement Agreement.
B. The format and content of these compliance reports is specified in Appendix B.
4. The United States and its attorneys, consultants, and agents shall have reasonable access to the facilities, records, residents, and employees of Los Lunas upon reasonable notice to the State for the purpose of ascertaining compliance with the
- 16 -

Decree. Such access shall continue until this Settlement Agreement is terminated.
5. All parties shall bear their own costs, including attorney fees. V. Termination of Agreement
1. The parties contemplate that the Defendants shall have fully and faithfully implemented all provisions of this Agreement, and plans herein required to be submitted and approved by the Court, on or before December 31, 1990.
2. The Court shall retain jurisdiction of this action for all purposes under this Settlement Agreement until the Defendants shall have fully and faithfully implemented all provisions of the Settlement Agreement and plans submitted pursuant thereto and until the judgment be discharged.
3. Defendants may move to dismiss this Settlement Agreement at such time as they have fully and faithfully implemented all provisions of this Agreement and the plans submitted pursuant thereto. Defendants shall serve any such motion upon the United States which shall have sixty (60) days to respond. If Defendants move to dismiss the Settlement Agreement prior to December 31, 1990, they shall have the burden of persuading the Court that the requirements of this Settlement Agreement and the plans required pursuant to its terms have been fully and faithfully implemented. If defendants move to dismiss this Settlement Agreement after December 31, 1990, dismissal shall be granted unless, within 60 days after receipt of the Defendants'
- 17 -

motion, the United States objects to the motion. If such an objection is made with particularity, and the parties are unable to resolve any dispute regarding dismissal, the Court shall hold a hearing on the motion and the burden shall be on the United States to demonstrate that the Defendants have not fully and faithfully implemented all provisions of this Settlement Agreement or any approved plan(s) or any part thereof. CONSENTED TO BY THE UNDERSIGNED:

XI CO

FOR THE UNITED STATES OF AMERICA

IERS Sta ie of New Mexico

J/MES P. TURNER Acting Assistant Attorney General Civil Rights Division

DENNIS BOYD Secretary Health and Environment
Depe
/Attoriiey General ' State o€ New Mexico
ilMgisU.
CHRIS COPPltf V Assistant Attorney General State of New Mexico

WILLIAM LUTZ United States attorney District of New Mexico
M/l/l/M/Wl/ZARTHUR E. PEABODY,f Chief Special Litigation Section
MELLIE H. NELSON Deputy Section Chief Special Litigation Section

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•//Mar
MIRIAM BROWNSTEIN Administrator Los Lunas Hospital
and Training School
JOEL KLEIN CHRISTOPHER CERF SUSAN COSKEY Attorneys for Defendants Onek, Klein and Farr 2550 M. Street, NW Suite 350 Washington, D.C. 20037

GHES JEREMY 37. SCHWARTZ CYNTHIA L. KATZ Attorneys
Special Litigation Section Civil Rights Division U.S. Deptartment of Justice 320 First Street, NW Washington, D.C. 20530

WHEREFORE, the parties to this action having agreed to the provisions in the Settlement Agreement set forth above, and the Court being advised in the premises, this Settlement Agreement is hereby entered as the JUDGMENT of this Court.
IT IS SO ORDERED, this )*x day of t ~&>~^\ at Albuquerque, New Mexico.
/ c/
UNITED STATES DISTRICT JUDGE

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 Docket: 89cv01165 - USA v. New Mexico, State of, et al.

https://www.nmcourt.fed.us/usdcace?request=view&type=docket&templ...

United States District Court - District of New Mexico
Home | Links | Help Quick Links: Caption, Case Information, Docket, Related Cases

Total Entries: 46 Entries Per Page: 50

Case Title: USA v. New Mexico, State of, et al.

Case Number: 89cv01165

Judge(s):

Presiding: Senior Judge James A. Parker

Office:

Albuquerque

Docket Report
Friday, April 14, 2006
Page 1 of 1

Entered On File Date Docket Document

Description

Reference

03/15/1991 03/15/1991

27 NOTICE of Quarterly Compliance Report by defendant New Mexico, State of, defendant Garrey Carruthers, defendant NM Health & Envrnmt, defendant Dennis Boyd, defendant Los Lunas Hospital, defendant Miriam Brownstein

04/19/1991 04/22/1991

28 MOTION by plaintiff USA to consolidate cases w/Cv-87-839 JP RE: [29] MEMORANDUM by plaintiff USA in support... RE: [37] RESPONSE by defendants to motion to... RE: [38] MEMORANDUM by plaintiff USA in... RE: [40] REPLY by plaintiff USA to Jackson... RE: [41] ORDER by Judge James A. Parker...

04/19/1991 04/22/1991

29 MEMORANDUM by plaintiff USA in support of motion to consolidate cases w/Cv-87-839 JP [28-1]
RE: [28] MOTION by plaintiff USA to consolidate...

05/01/1991 05/02/1991

30 MOTION by New Mexico, State of, Garrey Carruthers, NM Health & Envrnmt, Dennis Boyd, Los Lunas Hospital, Miriam Brownstein to extend time in which to respond to pltfs mtn to consolidate until 5/22/91
RE: [39] ORDER by Judge James A. Parker...

05/01/1991 05/02/1991

31 ENTRY OF APPEARANCE for New Mexico, State of, Garrey Carruthers, NM Health & Envrnmt, Dennis Boyd, Los Lunas Hospital, Miriam Brownstein by Robert T. Booms

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Docket: 89cv01165 - USA v. New Mexico, State of, et al.

https://www.nmcourt.fed.us/usdcace?request=view&type=docket&templ...

Entered On File Date Docket Document

Description

05/13/1991 05/13/1991

32 MOTION to withdraw attorney Joel I Klein counsel for defts RE: [33] MEMORANDUM in support of motion to... RE: [36] ORDER by Judge James A. Parker...

Reference

05/13/1991 05/13/1991

33 MEMORANDUM in support of motion to withdraw attorney Joel I Klein counsel for defts [32-1]
RE: [32] MOTION to withdraw attorney Joel I...

05/13/1991 05/13/1991

34 CERTIFICATE of serrvice of mtn for w/d w/memo to opposing counsel on 5/3/91 by defts

05/13/1991 05/14/1991

35 NOTICE of the quarterly compliance report compiled as required by the settlement agreement

05/16/1991 05/16/1991

36 ORDER by Judge James A. Parker granting motion to withdraw attorney Joel I Klein counsel for defts [32-1] (cc: all counsel)
RE: [32] MOTION to withdraw attorney Joel I...

05/22/1991 05/23/1991

37 RESPONSE by defendants to motion to consolidate cases w/Cv-87-839 JP [28-1]
RE: [28] MOTION by plaintiff USA to consolidate...

05/22/1991 05/28/1991

38 MEMORANDUM by plaintiff USA in opposition to motion to consolidate cases w/Cv-87-839 JP [28-1]
RE: [28] MOTION by plaintiff USA to consolidate...

06/05/1991 06/05/1991

39 ORDER by Judge James A. Parker granting motion to extend time in which to respond to pltfs mtn to consolidate until 5/22/91 [30-1] (cc: all counsel)
RE: [30] MOTION by New Mexico, State of, Garrey...

06/06/1991 06/06/1991

40 REPLY by plaintiff USA to Jackson pltfs' and defts memoranda in opposition to to response to motion to consolidate cases w/Cv-87-839 JP [28-1]
RE: [28] MOTION by plaintiff USA to consolidate...

2 of 6

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Docket: 89cv01165 - USA v. New Mexico, State of, et al.

https://www.nmcourt.fed.us/usdcace?request=view&type=docket&templ...

Entered On File Date Docket Document

Description

06/20/1991 06/20/1991

41 ORDER by Judge James A. Parker denying motion to consolidate cases w/Cv-87-839 JP [28-1] (cc: all counsel)
RE: [28] MOTION by plaintiff USA to consolidate...

Reference

08/13/1991 08/13/1991

42 NOTICE by defendants of filing Quarterly Compliance Report as required in the Settlement Agreement for the period from 5/1/91 through 7/31/91

11/18/1991 11/19/1991

43 NOTICE of filing quarterly compliance report by defendants

02/12/1992 02/12/1992

44 NOTICE of filing quarterly compliance report by defendant

05/14/1992 05/14/1992 45 NOTICE of filing quarterly compliance report by defts

08/13/1992 08/13/1992

46 NOTICE of filing quarterly compliance report May 1, l992 through July 31, l992 by defendant

11/17/1992 11/17/1992

47 NOTICE of filing quarterly compliance report by defts New Mexico, State of, Garrey Carruthers, NM Health & Envrnmt, Dennis Boyd, Los Lunas Hospital, Miriam Brownstein

02/16/1993 02/17/1993

48 NOTICE by defendants of filing Quarterly Compliance Report

05/17/1993 05/17/1993

49 NOTICE by defendant of Quarterly Compliance Report as required in the Settlement Agreement

08/16/1993 08/16/1993

50 NOTICE of filing Quarterly Compliance Report by defts New Mexico, State of, Garrey Carruthers, NM Health & Envrnmt, Dennis Boyd, Los Lunas Hospital and Miriam Brownstein

11/23/1993 11/23/1993

51 NOTICE of Quarterly Compliance Report by defendants

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Entered On File Date Docket Document

Description

02/16/1994 02/16/1994

52 NOTICE of filing Quarterly Compliance Report by defendant
RE: [53] SUPPLEMENT to the Quarterly Compliance...

Reference

02/16/1994 02/16/1994

53 SUPPLEMENT to the Quarterly Compliance Report by defendant [52-1]
RE: [52] NOTICE of filing Quarterly Compliance...

05/24/1994 05/24/1994

54 NOTICE of filing quarterly compliance report by defendants

08/24/1994 08/24/1994

55 QUARTERY COMPLIANCE REPORT by defendants for period 5/1/94 through 7/31/94

11/21/1994 11/22/1994

56 QUARTERLY COMPLIANCE REPORT by defendants for the period 8/1/94 through 10/31/94

02/24/1995 02/24/1995

57 QUARTERLY COMPLIANCE REPORT by defendants for the period 11/1/94 through 1/31/95

05/25/1995 06/01/1995

58 QUARTERLY COMPLIANCE REPORT by defendants for the period of 2/1/95 - 4/30/95

08/17/1995 08/21/1995

59 QUARTERLY COMPLIANCE REPORT by defendants
RE: [60] AMENDMENT by defendant to quarterly...

09/29/1995 10/03/1995

60 AMENDMENT by defendant to quarterly compliance report [59-1]
RE: [59] QUARTERLY COMPLIANCE REPORT by...

12/12/1995 12/14/1995

61 QUARTERLY COMPLIANCE REPORT by defendants from 8/1/95 - 10/31/95

12/13/1995 12/17/1995

62 CERTIFICATE by defendants of service of quarterly compliance report to opposing counsel 12/12/95

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Docket: 89cv01165 - USA v. New Mexico, State of, et al.

https://www.nmcourt.fed.us/usdcace?request=view&type=docket&templ...

Entered On File Date Docket Document

Description

Reference

02/15/1996 02/20/1996

63 QUARTERLY COMPLIANCE REPORT by defendants from 11/1/96 [sic] - 1/31/96

04/29/1996 05/02/1996

64 ENTRY OF APPEARANCE for NM Health & Envrnmt & Los Lunas Hospital by Sally Malave

05/22/1996 05/28/1996

65 QUARTERLY COMPLIANCE REPORT by defendants from 2/1/96 - 4/30/96

08/22/1996 08/22/1996

66 QUARTERLY COMPLIANCE REPORT by defendants from 5/1/96 - 7/31/96

11/22/1996 11/25/1996

67 QUARTERLY COMPLAINT REPORT by defendants from 8/1/96 - 10/31/96

02/24/1997 02/24/1997

68 QUARTERLY COMPLIANCE REPORT by defendants from 11/1/96 - 1/31/97

05/23/1997 05/23/1997

69 QUARTERLY COMPLIANCE REPORT by defendants from 2/1/97 - 4/30/97

08/15/1997 08/15/1997

70 QUARTERLY COMPLIANCE REPORT by defts for period 5/1/97 - 7/31/97

08/29/1997 08/29/1997

71 JOINT MOTION by the parties to terminate consent decree & dismiss case
RE: [72] ORDER by Judge James A. Parker granting...

09/22/1997 09/22/1997

72 ORDER by Judge James A. Parker granting joint motion to terminate consent decree & dismiss case [71-1] dismissing case (cc: all counsel)
RE: [71] JOINT MOTION by the parties to...

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Docket: 89cv01165 - USA v. New Mexico, State of, et al.

https://www.nmcourt.fed.us/usdcace?request=view&type=docket&templ...

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Title of the document and "docket entry" describing the document Document Verification and other information

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4/14/2006 2:36 PM