U.S. v. New York

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK

MH NY 002-002

UNITED STATES OF AMERICA,

cv 93 4807 res

••>•!.— \V * » • V

Plaintiff,
- against -
STATE OF NEW YORK; MARIO M. CUOMO, Governor, NEW YORK STATE OFFICE OF MENTAL HEALTH; Dr. RICHARD C. SURLES, Commissioner; PEGGY O'NEIL, Executive Director, Pilgrim Psychiatric Center,

Civil Action No.
SPATT, 1

Defendants.

COMPLAINT Plaintiff, United States of America, by the Attorney General, brings this Complaint pursuant to the Civil Rights of Institutionalized Persons Act of 1980, 42 U.S.C. § 1997 et seq., to enjoin the named Defendants from depriving persons residing at the Pilgrim Psychiatric Center ("Pilgrim") of rights, privileges or immunities secured or protected by the Constitution of the United States. The United States alleges upon information and belief as follows: 1. This Court has jurisdiction over this action under 28 U.S.C. § 134b. 2. The United States has standing to maintain this action pursuant to 42 U.S.C. § 1997a. 3. The Attorney General has certified that all the prefiling requirements specified in 42 U.S.C. § 1997b have been met.

The Certificate of the Attorney General is appended to this Complaint and is incorporated herein.
4. Venue in the Eastern District of New York is proper pursuant to 28 U.S.C. § 1391(b). All claims set forth in the Complaint arose in said District.
5. Defendant STATE OF NEW YORK owns and operates Pilgrim, a state facility for the mentally ill located in West Brentwood in New York.
6. Defendant MARIO M. CUOMO is the Governor of New York, 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 Director of the New York Office of Mental Health.
7. Defendant NEW YORK STATE OFFICE OF MENTAL HEALTH is the New York State Agency with the responsibility for the operation of Pilgrim.
8. Defendant RICHARD C. SURLES is the Commissioner of the New York Office of Mental Health and, in this capacity, exercises administrative control of, and responsibility for, Pilgrim.
9. Defendant PEGGY O'NEIL is the Executive Director of Pilgrim and is responsible for its day-to-day operation.
10. The individual Defendants named in paragraphs 6, 8, and 9 are officers of the Executive Branch of the State of New York and are sued in their official capacities.
11. Pilgrim is an institution within the meaning of 42 U.S.C. § 1997(1).
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12. Persons residing at Pilgrim include individuals who are mentally ill.
13. Defendants are legally responsible, in whole or in part, for the operation of, and conditions at Pilgrim, as well as for the care and treatment of persons residing at that institution.
14. At all relevant times, Defendants have acted or failed to act, as alleged herein, under color of state law.
15. Defendants have failed and are continuing to fail to provide adequate medical care to Pilgrim residents.
16. Defendants have failed and are continuing to fail to ensure that medications are prescribed and administered to persons confined at Pilgrim pursuant to the exercise of professional judgment.
17. Defendants have failed and are continuing to fail to provide residents of Pilgrim with that level of individualized psychiatric care and treatment and behavioral programming necessary to ensure that residents are free from undue bodily restraint, including chemical restraint, and unreasonable risks to their personal safety.
18. Defendants have failed and are continuing to fail to ensure that there is an adequate number of sufficiently trained direct care and professional staff to render and implement professional judgments regarding care and treatment of Pilgrim residents and to protect Pilgrim residents from unreasonable risks to their personal safety.
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19. Defendants have failed and are continuing to fail to

maintain professionally based recordkeeping and record review

systems to ensure that resident records contain accurate, up-to-

date and relevant information necessary to enable staff to

exercise professional judgment regarding treatment and training

of Pilgrim residents.

20. The acts and omissions alleged in paragraphs 15 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

Pilgrim residents of such rights, privileges or immunities.

21. Unless restrained by this Court, Defendants will

continue to engnge in the conduct and practices set forth in

J

paragraphs 15 carough 19 which deprive residents of Pilgrim of

rights, privileges, or immunities secured or protected by the

Constitution of the United States and which are causing

irreparable harm to Pilgrim residents.

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 Pilgrim set forth in paragraphs 15

through 19 above, and to require Defendants to take such action

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as will provide constitutional conditions of care to persons who reside at Pilgrim. The United States further prays that this Court grant such other and further equitable relief as it may deem just and proper.

Res

itted,

J^NETRENO /Attorney General of the
United States

ZACH/fRY W. CARTER United States Attorney Eastern District of
New York

JAMES P. TURNER Acting Assistant Attorney
General Civil Rights Division

ARTHUR E. PEABOD"i Chief Special Litigation Section

MELLIE H. NELSON

Deputy Chief

x.

Special Litjlgation Section

VERLIN^HUGHES ROBINSUE FROHBOESE Attorneys U.S. Department of Justice Civil Rights Division Special Litigation Section 320 First Street, N.w. Washington, DC 20534 (202) 514-6260 (202) 514-6259

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©fftce of ttje AttornEQ General
fi.C 20530

CERTIFICATE OF THE ATTORNEY GENERAL

I, Janet Reno, Attorney General of the United States, certify that with regard to the foregoing Complaint, I have complied with all subsections of 42 U.S.C. §1997b(a)(1). I certify as well that I have complied with all subsections of 42 U.S.C. §1997b(a)(2). I further certify, pursuant to 42 U.S.C. §1997b(a)(3), my belief that this action by the United States 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.

I further certify that I have the "reasonable cause to believe" set forth in 42 U.S.C. §1997a to initiate this action. Finally, I certify that all prerequisites to the initiation of suit under 42 U.S.C. §1997 have been met.

Pursuant to 42 U.S.C. §1997a(c), I have personally signed the foregoing Complaint. Pursuant to 42 U.S.C. §1997b(b), I am personally signing this Certificate^

Signed this Washington, D.C.

day of

, 1993, at

JANET RENO /Attorney General / of the United States

AFFIDAVIT OF MAILING
ATE OF NEW YORK COUNTY OF KINGS EASTERN DISTRICT OF NEW YORK, ss:

, being duly sworn, says that on the

day of

, I deposited in Mail Chute Drop for mailing in the U.S. Courthouse,

Cadman Plaza East, Borough of Brooklyn, County of Kings, City and State of New York, a

of which the annexed is a true copy, contained in a securely

enclosed postpaid wrapper directed to the person hereafter named, at the place and address stated below:

i <rn to before me this day of

AFFIDAVIT OF PERSONAL SERVICES
STATE OF NEW YORK COUNTY OF KINGS EASTERN DISTRICT OF NEW YORK, ss:

, being duly sworn, says that he is employed in the office of

the United States Attorney for the Eastern District of New York. That on the

day of.

he served a true copy of th< annexed

on the office of

attorney for ,

herein, located at

, Borough of

, City of New York, by leaving

-ue copy of same with his clerk or other person in charge of said office.

Sworn to before me this

*

.

Form No. USA-52»-6a

 
 U.S. v. New York

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK

MH-NY-002-003
gV-93 4807

UNITED STATES OF AMERICA,
Plaintiff,
- against -
STATE OF NEW YORK; MARIO M. CUOMO, Governor; NEW YORK STATE OFFICE OF MENTAL HEALTH, Dr. RICHARD C. SURLES, Commissioner; PEGGY O'NEIL, Executive Director, Pilgrim Psychiatric Center,
Defendants.
-X
STIPULATION

IFATJ. J.
Civil Action No.

I. INTRODUCTION Plaintiff, the United States of America, and defendants, the
State of New York, et a_l. , in order to ensure the protection of the constitutional rights of patients of the Pilgrim Psychiatric Center ("Pilgrim") and to avoid adversarial litigation hereby agree and stipulate, pursuant to Fed. R. Civ. P. 41(a)(2), as follows:
A. This case was filed by the United States of America, pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA), 42 U.S.C. § 1997 et seg.
B. This Court has jurisdiction over this action pursuant to 28 U.S.C. § 1345. Venue is appropriate pursuant to 28 U.S.C. § 1391(b).
ORIGINAL

C. The United States is authorized to initiate this action pursuant to 42 U.S.C. § 1997a and has'-.satisf ied all prerequisites for the initiation of a civil action prescribed by that statute.
D. The Defendants are the State of New York; the Honorable Mario M. Cuomo, Governor of the State of New York; the New York State Office of Mental Health; Dr. Richard C. Surles, Commissioner; and Peggy O'Neil, Executive Director, Pilgrim Psychiatric Center. All individual defendants are sued in their respective official capacities.
E. The Defendants have authority and responsibility for the operation of Pilgrim and are officers of the Executive Branch of the State of New York.
F. On September 30, 1987, the Attorney General of the United States, by and through the Assistant Attorney General, notified Governor Cuomo of his intent to investigate, pursuant to CRIPA, alleged unconstitutional conditions of confinement at Pilgrim.
G. Following the investigation, on June 9, 1992, the Attorney General of the United States, by and through the Assistant Attorney General, notified Governor Cuofno of the claimed unconstitutional conditions of confinement at Pilgrim and the minimal measures necessary to remedy these conditions, pursuant to 42 U.S.C. § 1997b(a)(l). The parties agree that the confinement, care and treatment of residents at Pilgrim implicate rights secured and protected by the United States Constitution.
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H. The purpose of this Stipulation is to ensure constitutional conditions of confinement, care and treatment at Pilgrim, and its provisions shall be construed in a manner consistent with, and to further, that purpose.
I. Defendants do not admit to any violation of law, and this Stipulation may not be used as evidence of liability in any other proceeding.
J. The provisions of this Stipulation are a reasonable, lawful and fundamentally fair resolution of this case.
K. This Stipulation shall be applicable to and binding upon all of the parties, their officers, agents, servants, employees, assigns, and their successors. II. DEFINITIONS
As used in this Stipulation, the following definitions apply to the terms below:
A. "State": The Executive Branch of the government of the State of New York, specifically including the Governor of New York, the New York Office of Mental Health, the administration of Pilgrim Psychiatric Center, and any and all of their officials, agents, employees, or assigns, and the successors in office of such officials, agents, employees, or assigns.
B. "Pilgrim": Pilgrim Psychiatric Center, Long Island, New York.
C. "Physician": A medical doctor lawfully entitled to practice medicine in the State of New York.
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D. "Psychiatrist": A physician who is certified by or is eligible for certification by the American Board of Psychiatry and Neurology.
E. "Psychologist": A person who has attained at least a master's degree in the field of psychology.
F. "Direct care worker": Staff immediately responsible for implementing treatment and providing care to residents (Mental Health Therapy Aides)•
G. "Qualified professional": A person competent, whether by education, training, or experience, to make the particular decision at issue.
H. "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.
I. "PRN": A treatment modality ordered on a pro re nata or "as needed" basis.
J. "Stat": A treatment modality ordered on an immediate basis.
K. "Psychotropic medication": Chemical substances used in the treatment of mental illness which exert an effect on the mind and are capable of modifying mental activity or behavior.
L. "Polypharmacy": Concurrent use of two or more psychotropic medications of a single class.
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M. "Treatment Plan": A program of therapeutic steps and activities, including psychological and-psychiatric services and medications, determined by qualified professionals consistent with professional judgment to be appropriate to protect a patient from unreasonable risks to personal safety and necessary to enable a patient to function free from undue bodily restraint or seclusion and/or to prevent regression or deterioration of skills.
N. "Training program": A program of steps and activities, including behavior management and the teaching of basic self-care skills, determined by qualified professionals consistent with professional judgment to be appropriate to protect a patient from unreasonable risk to personal safety and necessary to enable a patient to function free from undue bodily restraint or seclusion and/or to prevent regression or deterioration of skills.
O. "Office of Mental Health Psychotherapeutic Drug Manual": The Third Edition of the Office of Mental Health Psychotherapeutic Drug Manual, as Revised 1990-1991, and any subsequent additions or revisions to the Manual issued during the pendency of this agreement. III. MEASURES TO BE TAKEN
A. Protection from Harm. Upon filing this Stipulation, the State shall take steps to eliminate preventable injuries to patients by taking adequate measures to protect them from harm. These steps shall include, at a minimum, the following actions:
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1. Ensuring that there are sufficient numbers of staff, particularly nursing staff and direct care workers, present and on duty on each shift to ensure adequate supervision of patients, to prevent otherwise preventable injuries, and to provide adequate health, care, safety and treatment of each Pilgrim patient. Further, Pilgrim staff shall, at a minimum, conduct a monthly review of accident and/or injury reports to determine if sufficient staff, particularly nursing and direct care staff, are in place to ensure the requirements of this paragraph are satisfied. If a staffing shortfall is identified, Pilgrim shall take those measures necessary to ensure sufficient staff are available to provide adequate care and treatment of Pilgrim patients. The requirements of this Paragraph shall be accomplished without the resort to excessive use of overtime or the excessive temporary reassignment of staff from regularly assigned wards.
2. Taking adequate steps to protect patients who are targets of aggression by other patients.
3. Identifying patients who frequently fall and, for each such patient, developing and implementing protection measures to prevent injuries due to falls.
4. For each patient who sustains frequent injuries, identifying the medical, behavioral, and environmental factors causing such injuries, and devising and implementing a plan to avoid further injuries.
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B. Staffing Requirements. 1. Upon filing this Stipulation') the State shall consistently maintain at Pilgrim such qualified staff, including physicians, psychiatrists, psychologists, social workers, and occupational and recreational therapists, in direct patient service positions, necessary to ensure full implementation of the provisions of this Stipulation and compliance with all constitutional standards of care. 2. Within nine months of the filing of this Stipulation, the State shall employ and retain at least one behavioral psychologist to design and implement appropriate treatment, training and programming for patients exhibiting aggressive, self-injurious or destructive behavior, or those patients who are treatment-resistant, suicidal or dually diagnosed. Alternatively, the State may initiate a training program in behavioral techniques to selected Pilgrim psychologists, other appropriate professionals, and direct care staff in order to meet the requirements of this Paragraph. 3. Within six months of the filing of this Stipulation, the State shall employ and retain at least one individual with demonstrated expertise in the area of geriatric medicine and at least one individual with demonstrated expertise in the area of geriatric psychiatry who will be responsible for supervising and coordinating medical and psychiatric services to the geriatric patients at Pilgrim.
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C. Development and Implementation of Treatment Plans. By no later than one year from the"filing of this Stipulation, the State shall provide adequate treatment plans and/or training programs to patients at Pilgrim. This shall include, at a minimum, the following actions: 1. Assessment and Diagnosis:
a. Ensuring that each patient at Pilgrim has a current, accurate diagnosis according to the Third Revised Edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM - III) published by the American Psychiatric Association, or such revisions of said manual as may subsequently be issued.
b. Ensuring that each patient's diagnosis is based on professionally developed psychiatric, nursing, medical and social work assessments, as well as psychological and other assessments required by the patient's individual condition and status. Psychological assessments shall be done, at a minimum, in all cases where, (i) a patient appears to have impairment in intellectual or cognitive functioning and neuropsychological testing is indicated in order to make a differential diagnosis; and/or (ii) there is uncertainty about the patient's clinical diagnosis which projective and/or neuropsychological testing might resolve.
c. Ensuring, when warranted, that each patient has appropriate secondary diagnoses, particularly organic brain syndrome and substance abuse.
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d. Ensuring that any change in a patient's diagnosis comports with accepted professional standards and the justification for the change in diagnosis is documented in the patient's record.
e. Ensuring that each patient's diagnosis forms a basis for the patient's treatment plan.
2. Developing for each patient an individualized treatment plan and/or training program, consistent with professional judgment, by an interdisciplinary team of professional staff, including psychiatrists, medical physicians, nurses, psychologists, social workers, physical therapists, occupational therapists, and direct care workers, as appropriate. Each treatment plan shall contain at least the following elements:
a. statements describing the nature of the specific problems and needs of the patient;
b. a description of clear, objective, and measurable goals and objectives for each patient, including time-frames for the achievement of each;
c. a delineation of the specific individualized treatment and or training programs to be afforded to each patient, including a schedule(s) for the conduct of such programs and the individual(s) responsible for such treatment;
d. a statement and rationale for the planned course of treatment, including treatment and/or training programs, designed to achieve the goals specified in the plan; and
e. criteria for release and/or discharge.
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3. Reviewing and revising each patient's treatment plan and/or training program by gualified professionals when necessary in accordance with professional judgement due to behavioral episodes, use of seclusion or bodily restraints, use of PRN or "stat" medications for behavior-related reasons, or occurrence of an injury, but in no event less than quarterly. Policies and procedures must be developed and implemented to ensure meaningful evaluation of the effectiveness of patient treatment and/or training programs based on pertinent clinical data so that appropriate review and revision of such programs can be made.
4. The treatment and/or training programs shall be consistently implemented by adequately trained staff who are qualified to implement such programs.
D. Medication Practices. Psychotropic medication shall be prescribed and administered to patients only pursuant to the professional judgment of a qualified professional. Psychotropic medication shall not be used for the convenience of staff, to compensate for inadequate staff, as punishment, or in lieu of professionally developed treatment and/or training programs. This shall include, at a minimum, the following actions, effective with the filing of this Stipulation: 1. Ensuring that psychotropic medications are used only as an integral part of a patient's treatment and/or training program and are not used for periods longer than professionally justifiable;
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—
2- Ensuring that a specific and appropriate psychiatric diagnosis justifies the use of each medication; such justification shall be specified in the patient's medical record;
3. Ensuring that, when medications are used in combination, that such combinations are not known to pose undue health and safety risks to patients.
4. Ensuring that medications are not used in patients where the presence of other medical conditions dictate, in the exercise of professional medical judgement, against the use of a specific medication.
5. Ensuring that: a. psychotropic drug prescribing and monitoring is
undertaken in accordance with clinical principles outlined in Section II of the Office of Mental Health's Psychotherapeutic Drug Manual, attached hereto as Appendix A;
b. polypharmacy is used only when medically indicated and is clinically approved or authorized using the severity scale system set forth in the Psychotherapeutic Drug Manual;
c. prescribing rationales, target symptoms, and patient responses are documented in the patient's clinical record, and is further accompanied by a notation that the use of polypharmacy will not adversely affect the patient's medical condition or other medication regimen;
d. monitoring for compliance with the forementioned practices shall be the responsibility of Pilgrim's Drug Monitoring Committee; and
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e. a second concurring opinion is recorded in a patient's record for all drug interactions of Severity Level 1 or 2, as required by the Office of Mental Health Psychotherapeutic Drug Manual.
6. Ensuring that all medications are administered in a manner which does not unduly:
a. sedate or otherwise interfere with the patient's cognitive functioning; or
b. interfere with the patient's ability to participate in programming and other therapies.
7. Ensuring that each patient's medication is not administered in dosages (including PRNs and "stat" orders) that exceed professionally justifiable levels.
8. Ensuring that the minimum effective dose of medication is administered and that the dose is appropriate to achieve therapeutic blood levels.
9. Ensuring that appropriate safeguards are used when "stat" medications are administered, including that such medications:
a. are not used as a means of chemical restraint where less intrusive therapies would be effective;
b. are not used in a manner which exposes patients to the risks associated with using varying medications of "stat" orders; and
c. are documented by both the ordering physician and the responsible nurse in the patient's chart on a timely basis
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following their administration, including the reason for their use and the effects of their use. ' •
10. Regularly monitoring each patient receiving psychotropic medication for drug induced side-effects, taking appropriate action to reduce or eliminate such side-effects; and
11. Developing and maintaining a data collection system sufficient to determine for each patient receiving psychotropic medication whether Pilgrim is adhering to the medication practices consistent with the parameters outlined in Section III, ID, (1 - 10).
E. Routine, Specialized, and Emergency Medical Care. All patients shall be afforded adeguate medical care. This shall include, at a minimum, the following actions within six months after filing this Stipulation: 1- Ensuring that a patient's medical needs are identified in and addressed as part of the patient's overall treatment plan. 2. Ensuring that all patients have adeguate and timely access to necessary diagnostic and treatment services, either ongrounds or at medical facilities outside Pilgrim, as appropriate. Facility administrators shall ensure that appropriate documentation of a patient's physical illness accompanies the transfer of the patient and that, upon return to Pilgrim, the record of the course of treatment afforded the patient returns to Pilgrim with the patient and is immediately made a part of the patient's Pilgrim medical record.
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3. With specific regard to Pilgrim's geriatric population, the State shall:
a. Implement and maintain policies and practices to ensure adequate morbidity prevention, and specifically that geriatric patients at risk of developing pneumonia are so identified and vaccinated, as appropriate;
b. Implement and maintain policies and practices to ensure the adequate assessment of the causes of patient agitation and further to ensure that psychotropic medications are used only in conjunction with an appropriate medical evaluation, and that such medications are not used for the convenience of staff or in lieu of less intrusive behavior therapies;
c. Implement and maintain policies and practices to ensure the adequate evaluation of the medical, pharmacological or environmental factors involved in incidents of patient falls and take those measures necessary to eliminate unreasonable risks to patients as a result of falling;
d. Implement and maintain policies and practices to ensure that Pilgrim medical staff are provided in-service training on the specialized medical needs, including medication practices, of a geriatric patient population to ensure that medical staff are trained in current standards of geriatric care; and
e. Implement and maintain policies and practices to ensure that incidents of trauma and/or injuries are adequately evaluated, diagnosed and treated.
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WmWlW .'iiJJHMJIJL P.ilHM t MB—"—»

vamm

4. Ensure that each patient has an appropriate nursing care plan, which is incorporated into the patients' comprehensive treatment plan, and that Pilgrim nursing staff are adequately trained in the assessments, writing, integration and documentation practices necessary to develop and implement nursing care plans.
5. Ensure that policies and practices are developed, implemented, and maintained to adequately track patients with decubiti, or at risk of developing decubiti, that such policies and practices are amended to include patients with stasis ulcers; and that necessary medical and nursing care is provided to such patients.
F. Staff Training. The State shall ensure that all staff who provide services to Pilgrim patients are adequately trained to fully implement the provisions of this Stipulation by the required dates and are thereafter provided with in-service training on a regular basis. IV. STATUS REPORTS A. The State shall provide to the United States quarterly status reports on progress made toward implementation of this Stipulation, beginning with the calendar-quarter reporting period during which this Stipulation is filed. The status reports shall be submitted to the United States no later than four weeks after the end of each reporting period. The status reports shall continue until the parties agree otherwise or until dismissal of this action.
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B. Each status report shall include: 1. The patient population for the first day of each month of the quarter and a listing of all professional, nursing, direct care and rehabilitation staff providing patient care in accordance with Section III - «[(B) (1) . 2. A narrative summary of the status of the State's compliance with Section III, Paragraphs A - F, including the steps the State has taken, or intends to take, to meet the requirements thereof. 3. The name and age of every patient who has died during the reporting period, along with the date and cause of death. In addition, any autopsies, death review summaries and investigative findings related to the death will be forwarded with the status report for the calendar quarter in which they become available. 4. The text of any policies and procedures promulgated to achieve the requirements of this Stipulation. 5. All staff training plans developed to implement the requirements of this Stipulation, the frequency with which training has been provided, the duration and content of the training, and the categories and numbers of staff to which it has been provided. 6. A summary of injuries sustained by patients, noting ward and shift of occurrence and minutes of Pilgrim's Incident Review Committee or other such entity, however named, charged with the responsibility of monitoring injuries and taking corrective action.
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ami
7. A listing of all patients transferred to acute care hospitals and the reasons for those transfers.
8. A summary of the use of restraint and seclusion, noting ward and shift.
C. Upon written request by the United States, the State shall provide additional information or documents relating to the State's compliance with this Stipulation.
D. Within 30 days of receipt of written questions from the United States relating to the State's compliance with the Stipulation, the State shall provide to the United States specific written answers and any requested documents regarding the State's compliance with requirements of the Stipulation.
E. Nothing in this Stipulation precludes the United States from conducting discovery pursuant to the Federal Rules of Civil Procedure on matters relating to enforcement of or compliance with this Stipulation. V. ACCESS TO PILGRIM
A. The United States and its attorneys, consultants, and agents shall have reasonable access to the facilities, records, patients, and employees of Pilgrim upon reasonable notice to the State for the purpose of ascertaining compliance with this Stipulation. Such access shall continue until this Stipulation is terminated.
B. Representatives of the State, including facility staff and counsel, may be present during tours or inspections of facilities and records.
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C. Pilgrim employees may be interviewed by the counsel for the United States or consultants retained by the United States during tours of Pilgrim. At the employee's option, such interviews may be private or conducted in the presence of the representative of the State. VI. CONSTRUCTION
A. The parties agree that the State may, during the pendency of this Stipulation, modify policies and procedures referred to herein, including the Office of Mental Health Psychotherapeutic Drug manual attached hereto as Appendix A, provided that such revision is consistent with the terms and conditions of this Stipulation. The State shall provide the United States with a copy of any such revisions as they are nade.
B. The parties expect that the State shall fully and faithfully implement all provisions of this Stipulation on or before January 1, 1995. This Stipulation shall conclude on January 1, 1995, provided the parties file with the Court a stipulated order of final dismissal.
c. The Court shall retain jurisdiction of this action for all purposes under this Stipulation until the State shall have fully and faithfully implemented all provisions of the Stipulation and until this case is dismissed.
D. The State may move to dismiss this Stipulation at such time as it has fully and faithfully implemented all provisions of this Stipulation and the plans submitted pursuant thereto. The State shall serve any such motion upon the United States which
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shall have 60 days to respond. If the State moves to dismiss the

Stipulation, it shall have the burden of persuading the Court

that the requirements of this Stipulation have been fully and

faithfully implemented.

E. The parties agree that Plaintiff may move to enforce

this Stipulation if it believes that the State has failed to

implement any or all the provisions of this Stipulation. The

parties agree that prior to any enforcement motion, the parties

shall negotiate in good faith in an attempt to resolve those

areas of alleged noncompliance.

F. All parties shall bear their own costs, including

attorney fees.

Agreed to:

FOR THE STATE OF NEW YORK

FOR THE UNITED STATES

ROBERT ABRAMS Attorney General

JAMES P. TURNER Acting Assistant Attorney
General Civil Rights Division

XRNOLD FLEISCHER Assistant Attorney General New York State Department
of Law 12 0 Broadway New York, NY 10271 (212) 416-8634

VERLIN HUGHES ROBINSUE FROHBOESE Attorneys United States Department
of Justice Special Litigation Section 320 First Street NW Washington, D.C. 20534 (202) 514-6260

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The above Stipulation is in the general public interest, is

a fair and equitable resolution of this action, and is

specifically conditioned upon the fulfillment of the terms

therein. Jurisdiction is retained until a final Order of

Dismissal is granted.
11 IT IS SO ORDERED this

day of dCTP&tX . 1993 at

New York.

UNITED STATES ZOSTRldS JU

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 Case 9:93-cv-04807-ADS-MLO Document 14 Filed 03/22/2005 Page 1 of 1

IN THE UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK

UNITED STATES OF AMERICA, Plaintiff,
v. STATE OF NEW YORK, et al.,
Defendants.

Civil Action No. 93-4807 (SPATT)

ORDER

Upon consideration of the Joint Motion for Termination of

Stipulations and Dismissal of Case submitted and signed by the

Parties and based upon Defendants' full implementation of all of

the provisions of the Stipulation and Supplemental Stipulations

as represented by the parties, this Court dismisses the 1993

Stipulation and the Supplemental Stipulations entered in this

case. This case is hereby dismissed and jurisdiction of this

Court is terminated.

,...A

IT IS SO ORDERED this vV day of tJ..p,gcf/ , 2005.

r -(J'Vf/rY
ARTHUR D. SPATT UNITED STATES DISTRICT COURT

- - - - - - - --....--------.-----

 
 U.S. v. New York

T. 5-21-92 JRD:AEP:MHN:RF:VH:JAV:drb DJ 1 6 8 - 5 2 - 1 6
REGISTERED MAIL
RETURN RECEIPT REQUESTED

~™ m mm • • mm m ••! '
MH-NY-002-001
P
I
G-

JIM 0 9

The Honorable Mario M. Cuomo Governor State of New York State Capitol Building Executive Chamber Albany, New York 12224
Re: Findings Letter Regarding Investigation of Pilgrim Psychiatric Center
Dear Governor Cuomo:
I am writing in reference to our investigation of the Pilgrim Psychiatric Center (Pilgrim), in Suffolk County, New York, pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA), 42 U.S.C. §§1997 et seg. While I am pleased to advise you that State officials are proceeding to implement agreed upon fire safety improvements at Pilgrim, recent investigatory activities undertaken in response to widespread allegations of deteriorating conditions at the facility have identified serious deficiencies regarding the provision of patient care. Consistent with the requirements of CRIPA, the purpose of this letter is to advise you of our findings by identifying the conditions at Pilgrim that deprive patients of their constitutional rights, the facts supporting our determination of constitutional violations, and the necessary remedial measures to correct these violations.
Conditions at Pilgrim
Based upon our extensive investigation, we have concluded that the following conditions at Pilgrim violate the constitutional rights of patients:
1) Inadequate protection of Pilgrim patients from injury and undue risks of harm;
2) Inadequate development, implementation, and monitoring of patient treatment plans and programs, including behavior programs-;
cc: Records ^Chrono Peabody Nelson Frohboese Hughes Yost Hold

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3) Dangerous or inappropriate medication practices, including the use of chemical restraints in lieu of treatment programs;
4) Inadequate medical care; and
5) Inadequate staffing, including psychiatrists, psychologists, registered nurses, therapists, and direct care staff.
We have concluded that Pilgrim patients are being subjected to egregious or flagrant conditions that deprive them of their constitutional rights pursuant to a pattern and practice of resistance to the full enjoyment of those rights. Specifically, we have concluded that these conditions at Pilgrim deprive patients of their constitutional rights to adequate medical care, reasonable safety, and such treatment programs as an appropriate professional would consider reasonable to ensure their safety and freedom from undue bodily or chemical restraints. See Youngberq v. Romeo. 457 U.S. 307, 324 (1982). Each of the conditions or practices identified in this letter as being deficient represents a substantial departure from generally accepted professional judgment or is inconsistent with commonly accepted psychiatric and medical standards. The facts supporting our findings regarding these constitutional violations are set forth in the Attachment accompanying this letter.
Minimally Necessary Remedies'"
To eliminate the violations identified above and to ensure that constitutionally adequate conditions are maintained in the future, at a minimum, the State must implement the following remedial measures at Pilgrim:
1. Take immediate steps to adequately protect patients from injury and undue risks of harm, including increasing supervision by staff who are familiar with the needs of the patients for whom they are responsible and who are knowledgeable about appropriate interventions for agitated and assaultive patients. In addition, Pilgrim must take immediate steps to eliminate safety hazards that contribute to patient falls.
2. Hire and deploy sufficient qualified staff, including psychiatrists, registered nurses, psychologists, therapists, and direct care staff to ensure that patients are adequately supervised and receive appropriate mental health services.
3. Develop and implement professionally designed treatment programs, including behavioral programs for patients who need them;

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4. Implement recordkeeping practices sufficient to ensure that professional judgment can be exercised regarding all aspects of patient care;
5. Revise medication practices to reflect generally accepted medical and psychiatric standards;
6. Cease using chemical restraints in lieu of adequate treatment programs;
7. Implement medical care practices that ensure adequate diagnosis and follow-up of the acute and chronic health care needs of patients;
8. Respond to the specialized needs of elderly patients by: (a) ensuring that staff implement current practices of care in geriatrics; and (b) implementing adequate prevention programs to decrease morbidity, mortality, and the risk of harm to patients who are susceptible to falling by assessing and addressing underlying physiological risks.
We appreciate the cooperation extended to us thus far during our CRIPA investigation by the Executive Director and the staff of the Pilgrim Psychiatric Center, officials of the New York Department of Mental Health, and counsel for the State. We hope that the cooperative spirit which has existed between the Department and the State will continue. My staff will be in contact with the Attorney General's*office shortly to discuss this matter in greater detail. In the meantime, should you or your staff have any questions regarding this matter, please contact Arthur E. Peabody, Jr., Chief, Special Litigation Section, at (202) 514-6255. I hope and trust that we will be able to resolve this matter in an amicable and reasonable manner.
Sincerely,
John R. Dunne Assistant Attorney General
Civil Rights Division
Enclosures
cc: The Honorable Robert Abrams Attorney General State of New York
Andrew J. Maloney, Esquire United States Attorney

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Dr. Richard C. Surles Commissioner New York State Office of Mental Health
Ms. Peggy O'Neil Executive Director Pilgrim Psychiatric Center
Mr. Anthony Tirone Director Office of Survey and Certification

ATTACHMENT
Facts Supporting Findings of Constitutional Violations at Pilgrim Psychiatric Center
The Department's investigation of Pilgrim Psychiatric Center, initiated on September 30, 1987, has consisted of a series of tours of Pilgrim with a variety of expert consultants accompanied by our attorneys.
On January 29, 1990, we met with representatives of the State of New York to discuss fire safety deficiencies at various New York psychiatric facilities, including Pilgrim. During this meeting, we advised state officials that we accepted the State's plan to remedy significant fire safety deficiencies at Pilgrim as well as three other psychiatric facilities. Thereafter, we monitored progress in implementing this plan at Pilgrim and continued to investigate other areas.
In response to widely reported allegations that conditions of confinement at Pilgrim had seriously deteriorated, we most recently conducted tours of the facility during November 1991 and March and April 1992 with a psychiatrist, a psychologist, a psychiatric registered nurse, a geriatrician, and a fire safety expert. These tours included: 1) observations of conditions at Pilgrim; 2) interviews with Pilgrim administrators, staff, and patients; 3) review of a large number of patient records; and 4) examination and analysis of numerous other documents, including facility incident reports^and analyses, committee meeting minutes, mortality reviews, staffing patterns, and policies and procedures.
The facts disclosed during these most recent tours supporting the Department's findings are set forth below.
I. Failure to Protect Patients from Harm
Due in large part to staffing shortages, Pilgrim has not and cannot ensure the safety of its patients from injury and unreasonable risks of harm resulting either from the effects'of their own serious illnesses or from injuries inflicted by other patients, our review of Pilgrim records showed a high rate of patient injuries occurring from acts of aggression and other events. During the last quarter of 1991, the rate of patient abuse, self-abuse, assaults, accidental injury, unauthorized leaves and escapes, as well as the overall incident rate at Pilgrim, were well above the facility's rates for the fourth quarter of 1990 and 1989. Significantly, the rate of patient assaults was considerably higher than it has been at any point during the past two years.
The harm reflected in Pilgrim's incident statistics is serious and often life-threatening. Patients are suffering countless fractures of their limbs, ribs, noses, and skulls,

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lacerations requiring sutures, burns, and other injuries requiring emergency treatment. Pilgrim's Incident Review Committee has repeatedly concluded that closer staff supervision is necessary, particularly of frail and elderly patients. A review of Pilgrim records indicates significant numbers of serious injuries to patients and demonstrates Pilgrim's failure to provide a safe environment in contravention of their basic right to protection from harm.
There are also a number of elderly patients who fall and suffer fractures or lacerations requiring sutures. Pilgrim is failing to take sufficient steps to protect these patients through adequate staffing and necessary safety precautions. For example, we observed geriatric patients wearing ill fitting shoes or socks without shoes, thus increasing their susceptibility to falling.
In sum, injuries are occurring because there are too few staff to adequately observe and supervise patients and to eliminate safety hazards. Adding to this problem is the lack of sufficient staff to provide treatment programs and other essential mental health services. Without necessary treatment programs and other services, patients are left idle with the inevitable result that aggression, and related injuries, increase.
II. Inadequate Assessment and Development, Implementation, and Monitoring of Treatment Plans and Programs
There are major deficiencies at Pilgrim in the development and implementation of patient treatment programs. Adequate assessment and diagnosis, which are crucial to the formulation of an appropriate treatment plan, are often missing from patient evaluations. In some cases, diagnoses have been abruptly changed with no rationale reflected in the patient's record. In addition, numerous patient charts list symptoms that are either inconsistent with the patient's assigned psychiatric diagnosis or list symptoms that are not addressed by the diagnosis. In other cases, psychiatrists fail to identify an obvious secondary diagnosis, such as organic brain syndrome or substance abuse. Moreover, there is a widespread failure to include adequate psychological and nursing assessments in formulating patient diagnoses.
Treatment plans, themselves, fail to meet generally accepted professional standards for such plans. Indeed, plans reviewed at Pilgrim substantially depart from such standards. The plans do not reflect an inter-disciplinary approach by involving the appropriate professional disciplines, especially necessary involvement by nursing and psychological disciplines. As recognized by Pilgrim, medical needs are also often not incorporated into the treatment plan. Additionally, treatment

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plans frequently do not address significant and obvious patient problems, are not individualized and relevant to patient needs, and contain treatment strategies so deficient as to be meaningless. For example, psychiatric interventions often consist primarily of the rote phrase that the patient should "take medications as prescribed." Procedures and practices regarding the review, monitoring, and revision of treatment plans are likewise inadequate.
Treatment programs which are developed for patients also fail to meet generally accepted professional standards. Implementation of even these programs has been inadequate to prevent deterioration and regression. While the new Rehabilitation Center that Pilgrim plans to open soon will provide opportunities for increased off-ward activities and programs, significant professional enhancement of treatment programs will be necessary. There is also a critical lack of any behavioral programming at Pilgrim. Many patients, especially those who are both mentally retarded and mentally ill and who have self-injurious, aggressive, or pica (the ingestion of nonedible substances) behaviors, need specific behavioral programs. Pilgrim, however, fails to provide them.
Overall, our consultants concluded that treatment plans and programs at Pilgrim are so deficient that long term hospitalization with resulting regression is the only prognosis for many patients.
III. Inappropriate Medication Practices
Medication practices at Pilgrim represent substantial departures from accepted professional judgment. The problems noted above in formulating proper diagnoses lead to inappropriate medication choices. Proper medication practices are per se not possible where the underlying diagnosis, the foundation of the entire treatment scheme, is not accurate or reliable. Even where accurate diagnoses may exist, our consultant observed that prescribed medications often do not correspond to the diagnoses. Some medications are given in doses exceeding professionally justifiable levels or absent professional justification. For instance, our consultants found that Pilgrim physicians are prescribing large amounts of inappropriate drugs for patient agitation and restlessness. Based on Pilgrim's data on patient medication regimens, our consulting psychiatrist concluded that too many patients are on large amounts of neuroleptics, the most potent form of psychotropic medications. He further found that Pilgrim physicians tend to start patients on large doses and when they convert patients to other medications, they switch from one large dose to another. In some instances, patients are continued on medications for years without any evidence of the medication's utility. In other instances, clinical trials of medications are far too short to determine the efficacy of the medications.

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Patient chart reviews also revealed medications being changed without any written justification and without adherence to professional standards.
Due to long-term usage of neuroleptics, a number of Pilgrim patients have tardive dyskinesia, an irreversible neurological syndrome resulting in involuntary and sometimes incapacitating movements of the body. This condition is not being consistently charted or addressed in patient treatment plans by Pilgrim physicians. Not identifying, charting, or planning treatment for tardive dyskinesia represents a substantial departure from accepted practice and subjects Pilgrim patients to harm.
General recordkeeping deficiencies at Pilgrim also directly contribute to the poor medication practices found by our consultants. Recordkeeping that reflects the efficacy of medications through charting a patient's progress, or lack thereof, and sets forth the reason for medication decisions is necessary for a professionally based medication system; yet Pilgrim's recordkeeping practices fail to meet such a standard.
While mechanical restraint usage is relatively low at Pilgrim and camisole and other forms of mechanical restraints have recently been eliminated at the facility, patients are being chemically restrained by immediate ("stat") orders of a variety of medications which unduly impair -the cognitive ability of patients. These medications are frequently ordered as a means to sedate agitated or unruly patients during nights and weekends, when staffing is at its lowest, to compensate for an inadequate number of personnel. Our psychiatric consultant found that stat chemical restraints are often ordered over the phone by an oncall physician. He further found that different on-call physicians frequently prescribe stat orders of varying psychotropic medications on successive days for the same patient. Moreover, there is often no follow-up by either the ordering physicians or nurse on duty, who frequently fail to record patient reactions to these stat medications. In one such , instance, a patient was found dead the morning after a telephone stat order for a psychotropic medication. While the precise role the administration of the stat order played, if any, in the death of this patient cannot be determined, it is significant to note that there were no progress notes, in the patient's record documenting the effect of the medication. In addition, there were no monthly medical notes in this patient's record for the five months preceding her death. Pilgrim's practices with regard to stat orders of medications, particularly anti-anxiety medications, are dangerous, depart substantially from accepted professional standards, and constitute undue use of restraints.

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In sum, the lack of adequate medication practices at Pilgrim violates the constitutional rights of patients by exposing them to dangerous medications without appropriate justification and by denying them appropriate medical intervention which leads to continuing harmful conditions, deterioration, and inappropriate chemical restraint of patients.
IV. Inadequate Medical Care
Based upon our review of patient records at Pilgrim, particularly those records of patients who either died or were transferred to other hospitals for acute medical care, it is evident that there are deficiencies in responding adequately to acute and chronic illnesses. Many of these deficiencies persist despite having been identified by Pilgrim as problematic through peer review, quality assurance activities, or mortality reviews. For instance, physicians are failing to order necessary diagnostic tests in response to serious illnesses. In other situations, there is a failure on the part of the physician to follow up on abnormal test results by providing prompt clinical action. There are problems, as well, in the accuracy and timeliness of diagnostic tests, particularly initial readings of x-rays. In addition, Pilgrim physicians are failing to provide consultants and acute care hospitals to which Pilgrim patients are temporarily transferred with sufficient background information about the patient to enable appropriate treatment. Further, in several recent cases involving patient deaths, Pilgrim's Mortality Review Committee has cited physician failure to take expedited action in emergency situations where patients are critically ill.
Medical care for geriatric patients at Pilgrim is particularly inadequate. As of April 1992, 637 Pilgrim patients, or more than 40% of the facility's total population, ranged in age from 65 to 105. Pilgrim does not have a geriatric psychiatrist or geriatrician on its staff and its current complement of ward psychiatrists and physicians lack the experience and training to provide adequate treatment to mee£ the complex psychiatric and health care needs of Pilgrim's elderly patients, most of whom have multiple physical and mental health problems. Our consultant in geriatrics concluded that the medical care Pilgrim is providing to its geriatric patients does not comport with accepted professional standards of care in geriatric medicine. In fact, our expert described the level of medical care for geriatric patients at Pilgrim to be at least ten years behind current practices.
The lack of expertise at Pilgrim in the specialized needs of geriatric patients is evident in a number of areas. For example, our geriatric consultant found cases where physicians treated agitated elderly patients with sedatives or tranquilizers instead of conducting a full medical assessment of the underlying cause

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of the agitation. This is particularly important given that agitation in geriatric patients can be a non-specific manifestation of a variety of illnesses. In addition, medical care of geriatric patients at Pilgrim lacks an adequate focus on prevention of morbidity. For example, Pilgrim fails to provide geriatric patients with a vaccine for pneumonia, as required by generally accepted professional standards of care.
Further, as noted earlier, there is a high rate of elderly patients who fall and suffer fractures or lacerations requiring sutures. Although Pilgrim has created a Fracture Review Committee, the facility is not taking a sufficiently aggressive approach to address this problem. For instance, an assessment tool to guide the physician's analysis of reasons why a patient has fallen has been in draft form for the past year. In the meantime, physicians are failing to take basic diagnostic and preventive steps to prevent falls. For example, physicians are not routinely reviewing medication regimens and measuring orthostatic hypotension, a basic diagnostic procedure measuring blood pressure, in patients who fall. In addition, physicians are prescribing inappropriate drugs for elderly patients, which has resulted in instances of serious falls. Moreover, as acknowledged by Pilgrim staff in record reviews, physicians have failed to conduct neurological exams and to adequately review incidents of trauma when patients fall or are injured.
In sum, medical care at Pilgrim fails to meet constitutional standards.
VI. Inadequate Staffing
Pilgrim does not have a sufficient number of psychiatrists, psychologists, nurses, therapists, and direct care staff (mental health therapy aides - "MHTA's") to provide sufficient supervision and adequate mental health services to its patients. We were advised by Pilgrim administrators that staff has been significantly reduced during the past year. Lack of adequate staff is responsible for many of the deficiencies at Pilgrim, identified here. Pilgrim is unable to implement needed remedial measures because it lacks adequate resources to accomplish them.
The number of mental health therapy aides currently assigned to wards at Pilgrim is insufficient to provide adequate patient supervision, to protect patients from harm, and to implement treatment plans. During February 1992, direct care staff were frequently responsible for up to 17 patients on a ward. These staff-to-patient ratios are too low to ensure patients' safety, much less provide patients with needed treatment for their disabilities.

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Further, Pilgrim is acutely understaffed in registered nurses who provide direct patient care. The shortage of registered nursing staff is most serious on nights and weekends. For example, our nursing consultant noted that during November 1991, one registered nurse was often assigned to cover an entire building on nights or weekends. Although the nursing ratios improved somewhat during 1992 due to downsizing and ward consolidation, nursing coverage remains inadequate. It is not uncommon to find one nurse responsible for three wards of up to 100 patients during weekends. In fact, in one building during a two week span in February 1992, one nurse was responsible for three wards nearly 50% of the time. As recently as April 1992, two nurses were responsible for 263 patients during the night shift. During our April 1992 tour, Pilgrim's Director of Nurses indicated that seven new nurses had been hired and funds had been allocated to hire twenty-five additional nurses. Even with these planned additions, however, there will be an insufficient number of nurses to meet significant patient needs.
Pilgrim also has an inadequate number of psychiatrists to provide necessary mental health services. Because of the lack of psychiatrists, it is common for a psychiatrist to have a caseload of 60 or more patients. We were also informed by Pilgrim staff that the State does not intend to replace any psychiatrists who leave the facility or retire. It is simply impossible to provide adequate and appropriate psychiatric care to the large number of patients for whom Pilgrim psychiatrists are responsible, especially given the fact that the Pilgrim clinical staff acknowledge that their patients have multiple, complex psychiatric problems that must be addressed. Although Pilgrim has an arrangement with Mt. Sinai Hospital to provide psychiatric consultation for patients with specialized needs, funding has been inadequate to support this program.
Finally, there are an insufficient number of psychologists and therapists to develop and implement necessary treatment programs, including behavioral programs, required by Pilgrim, patients. These staffing deficiencies result in inadequate programs.
Overall, Pilgrim's deficiencies in professional and direct care staffing pose serious risks to patients' safety and wellbeing and impede appropriate treatment of their mental disabilities.

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Additional Recommendation Regarding Fire Safety Renovations at Pilgrim Psychiatric Center
While each of our- monitoring tours of Pilgrim has identified significant progress in the implementation of the State's overall plan to remedy fire safety deficiencies, our most recent tour disclosed several deficiencies which our consultant recommends should be addressed as soon as possible. Our consultant noted the absence of required door closing mechanisms and various doors in a state of* significant disrepair. Moreover, he noted combustible materials stored in areas which were not adequately separated from egress routes. As the State continues to implement its overall plan for major renovations to remedy fire safety deficiencies at Pilgrim, it should address the type of maintenance deficiencies that our consultant identified during his most recent tour.

 
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CLOSED, MAG
U.S. District Court Eastern District of New York (Uniondale) CIVIL DOCKET FOR CASE #: 9:93-cv-04807-ADS-MLO

USA v. State of New York, et al Assigned to: Judge Arthur D. Spatt Referred to: Magistrate Michael L. Orenstein Demand: $0 Cause: 28:1345 USA Plaintiff

Date Filed: 10/25/1993 Nature of Suit: 440 Civil Rights: Other Jurisdiction: U.S. Government Plaintiff

Plaintiff United States of America

represented by Christopher Lehmann United States Attorny's Office Civil Division One Pierrepont Plaza Brooklyn, NY 11201 (718) 254-7000 LEAD ATTORNEY ATTORNEY TO BE NOTICED

V. Defendant The State of New York

represented by Arnold D. Fleischer New York State Attorney General's Office Law Department 120 Broadway New York, NY 10271 (212) 416-8625 TERMINATED: 01/31/2003 LEAD ATTORNEY ATTORNEY TO BE NOTICED
William Benjamin Jaffe New York State Attorney General Litigation Bureau 120 Broadway, 24th Floor New York, NY 10271 (212)416-8556 Fax: 212-416-6075 Email: william.jaffe@oag.state.ny.us LEAD ATTORNEY ATTORNEY TO BE NOTICED
William B. Jaffee

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Defendant George E. Pataki
Defendant New York State Office of Mental Health
Defendant James L. Stone commissioner

Attorney General of the State of New York 120 Broadway 24th Floor New York, NY 10271 (212) 416-8556 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Arnold D. Fleischer (See above for address) TERMINATED: 01/31/2003 LEAD ATTORNEY ATTORNEY TO BE NOTICED
William Benjamin Jaffe (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
William B. Jaffee (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Arnold D. Fleischer (See above for address) TERMINATED: 01/31/2003 LEAD ATTORNEY ATTORNEY TO BE NOTICED
William Benjamin Jaffe (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
William B. Jaffee (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Arnold D. Fleischer (See above for address) TERMINATED: 01/31/2003 LEAD ATTORNEY ATTORNEY TO BE NOTICED

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Defendant
Alan M. Weinstock Executive Director, Pilgrim Psychiatric Center

William Benjamin Jaffe (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
William B. Jaffee (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Arnold D. Fleischer (See above for address) TERMINATED: 01/31/2003 LEAD ATTORNEY ATTORNEY TO BE NOTICED
William Benjamin Jaffe (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
William B. Jaffee (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Date Filed 10/25/1993
10/25/1993 10/31/1993 10/31/1993 06/28/1996
09/03/1996

#

Docket Text

1 COMPLAINT filed and summons(es) issued for State of New York, Mario M. Cuomo, New York State Offic, Richard C. Surles, Peggy O'Neil (Crotty, Mary) (Entered: 10/29/1993)

CASE REFERRED to Magistrate Michael L. Orenstein (Crotty, Mary) (Entered: 10/29/1993)

2 STIPULATION/ORDER, dismissing ( signed by Judge Arthur D. Spatt ) (McMahon, Carol) (Entered: 11/01/1993)

Case closed (McMahon, Carol) (Entered: 11/01/1993)

3 SUPPLEMENTAL STIPULATION AND ORDER dated 6/28/96, to ensure the protection of the constitutional rights of patients at Pilgrim Psychiatric Center, and to avoid adversarial litigation (see order for further details) ( signed by Judge Arthur D. Spatt ) (Rooney, Tim) (Entered: 07/01/1996)

4 STIPULATION dated 9/3/96, extending defendants' time to comply with paragraph 5 of the Supplemental Stipulation and order dated 6/28/96, up to and including 9/30/96 ( signed by Judge Arthur D. Spatt ) (Rooney, Tim) (Entered: 09/04/1996)

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05/17/1999
07/29/1999 07/29/1999 01/31/2003 02/07/2003 02/19/2003
02/25/2003

5 STIPULATION and ORDER amending [3-1] supplemental stipulation and order to permit Pilgrim to continue patient L.B. on a standing order of Sodium Amytal, following the recommendation of the University Hospital consultants, for so long as the Pilgrim clinicians in the exercise of their professional judgment, may deem this to be clinically appropriate Except as modified, the provisions of the Stipulation entered by this Court on 6/28/96 shall remain in full force and effect unless and until amended by further order of this Court. (signed by Judge Arthur D. Spatt, dated 5/17/99) c/m (Toritto, James) (Entered: 05/26/1999)
6 LETTER dated 7/28/99 from William Jaffe to Judge Spatt RE: Parties request that the enclosed stipulation be so ordered. (Toritto, James) (Entered: 08/03/1999)
7 SECOND SUPPLEMENTAL STIPULATION and ORDER, amending [3-1] order to ensure the protection of the constitutional rights of patients at Pilgrim Psychiatric Center, and to avoid adversarial litigation (see order for further details) ( signed by Judge Arthur D. Spatt, on 7/29/99) c/m (Toritto, James) (Entered: 08/03/1999)
8 NOTICE of attorney appearance for Peggy O'Neil, Richard C. Surles, New York State Office, State of New York, Mario M. Cuomo by William B. Jaffee (Fagan, Linda) (Entered: 02/07/2003)
9 LETTER dated 2/7/03 from Sena Kim-Reuter, Law Clerk to USDJ Spatt to William B. Jaffe Re: The enclosed papers, Third Supplemental Stipulation, are being returned to you without docketing or filing as they violate Judge Spatt's Individual Rules. The papers do not bear the full caption and docket number of the case. You may re-file upon compliance with the Court's individual rules. (Coleman, Laurie) (Entered: 02/21/2003)
10 NOTICE OF AMENDED CAPTION; Purs. to Fed. R. Civ. P. 25(d)(1) the parties to this action, the United States of America and the State of New York et al., agree and stipulate that the following public officers are substituted for their formerly named counterparts to this action: George E. Pataki is substituted for Mario M. Cuomo as Governor, James L. Stone is substituted for Richard C. Surles as Commissiner of the New York State Office of Mental Health, and, Alan Weinstock is substituted as Executive Director of the Pilgrim Psychiatric Center. (Fagan, Linda) (Entered: 02/26/2003)
12 THIRD SUPPLEMENTAL STIPULATION and ORDER; That Pltff, the United States of America, and Defts, the State of New Yrok, et al., in order further to ensure the protection of the consitutuional rights of patients at Pilgrim Phychiatric Center ("PCC"), and to avoid advesarial litigation, hereby further agree and stipulate, purs. to Fed. R. Civ. P. 41 (a) (2), as follows: I. PROVISION OF CARE AND TREATMENT Defts shall provide an adequate number of professional and direct care staff to provide care and treatment for all Pilgrim patients, as further set forth herein; II. DEVELOPMENT AND IMPLEMENTATION OF TREATMENT PLANS - Defts shall redesign treatment planning to

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02/26/2003 03/21/2005
03/22/2005

provide sufficiently focussed and individualized treatment to give patients realistic opportunities to improve their mental condition, as further set forth herein; III. MEDICATION PRACTICES - Defts shall ensure that a purposeful and systematic medication portion of the treatment plan is included as part of the patient's overall treatment plan, as clinically appropriate; and as further set forth herin; IV. ROUTINE, SPECIALIZED, AND EMERGENCY MEDICAL CARE - In order to maintain and improve the quality of the medical care provided to PPC patients at the core general hospital used by the facility for outside medical care, Defts shall take reasonble steps to continue to have one or mor members of the PCC medical staff with privileges at the core general hospital for the purpose of coordinating or providing general medical care to PPC patients at the said hospital; and as further set forth herein; V. REHABILITATION - Defts shall ensure that patients receive services in the most integrated setting their clinical condition permits; and as further set forth herein; VI. CONTINUING FORCE AND EFFECT OF JULY 29, 1999 STIPULATION, JUNE 28, 1996 STIPULATION, AND OCTOBER 31, 1993 STIPULATION - All provisions of the October 31, 1993 Stipulation, the First Supplemental Stipulation and Order, and the Second Supplemental Stipualtion and Order that do not otherwise conflict with the terms of this Third Supplemental Stipulation and Order shall remain in full force and effect; VIII. ADDITIONAL QUARTERLY REPORTS - Beginning with the calendar-quarter reporting period during which this Third Supplemental Stipulation is enterd, Defts shall provide the United States with additional information, as further set forth herein, as part of their Quarterly Status Reports required by Section IV of the October 31, 1993 stipulation, Paragraph 26 of the Second Supplemental Stipulation and Order . ( signed by Judge Arthur D. Spatt, on 2/25/03) c/m (Fagan, Linda) (Entered: 02/26/2003)
11 ANSWER to Complaint (Fagan, Linda) (Entered: 02/26/2003)
13 First MOTION to Dismiss (joint motion for dismissal of case) by all defendants. (Attachments: # 1 Text of Proposed Order)(Jaffe, William) (Entered: 03/21/2005)
14 ORDER upon consideration of the 13 First MOTION to Dismiss (joint motion for dismissal of case) filed by The State of New York,, New York State Office of Mental Health,, George E. Pataki,, James L. Stone,, Alan M. Weinstock,this court dismisses the 1993 stipulation and the supplemental stipulations entered in this case. This case is hereby dismissed and jurisdiction of this Court is terminated. . Signed by Judge Arthur D. Spatt on 3/22/05. cm(Mierzejewski, Elizabeth) (Entered: 03/30/2005)

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