Opinion ID: 513498
Heading Depth: 2
Heading Rank: 3

Heading: This Case Requires Reversal.

Text: 131 In this case, the district court held that the only question to be resolved with regard to the substantive due process issue was whether the plaintiffs' conditions of confinement were consistent with minimum standards of professional judgment. Because three affidavits filed by the defendants indicated generally that institutionalization of the mentally retarded is professionally acceptable, the court concluded that the defendants had not abridged the due process rights of the plaintiffs. The court's conclusion rests on a doubly erroneous reading of Youngberg. First, the court failed to consider the existence of any liberty interest that might entitle the plaintiffs to treatment that is more beneficial than that which they receive as residents of institutions. Second, the court so magnified and misapplied Youngberg 's professional judgment standard as to write the remainder of that opinion, as well as prior law of this circuit, out of existence. 132 As explained above, Youngberg suggests that the first question for the court in a case such as this is the identification of a constitutional predicate for the imposition of [the] affirmative duty that the plaintiff class seeks to impose on the State. Stated differently, the court must identify the liberty interests at stake that are alleged to be unconstitutionally abridged. This analysis must necessarily take into account the specific facts concerning these plaintiffs. The plaintiffs have urged the court to recognize three distinct liberty interests: the right not to be unduly confined when there is no purpose advanced by such confinement; the right to free from the long-term effects of institutionalization, such as skill deterioration; and the right to exercise certain associational freedoms consistent with the plaintiffs' capacities. 133 The linchpin of the major decisions in this field--Youngberg, Donaldson, and Wyatt --is that there must be a rational relationship between the nature and duration of confinement and its purpose. See Jackson v. Indiana, 406 U.S. 715, 738, 92 S.Ct. 1845, 1858, 32 L.Ed.2d 435 (1972). Here, the undeniable purpose of the plaintiffs' confinement is care and habilitation. 10 Under our case law, the defendants are under a duty to provide such care and habilitation once it undertakes to confine the mentally disabled for this purpose. The plaintiffs have argued vigorously that confinement in institutions constitutes an undue restraint on their liberty because, as is suggested by the recommendations of their treatment professionals, their institutionalization is unnecessary and their habilitation needs would be more properly served in a residential setting. 134 The district court did not assess the validity of this asserted liberty interest. Relying on Phillips v. Thompson, 715 F.2d 365 (7th Cir.1983) and Society for Good Will to Retarded Children v. Cuomo, 737 F.2d 1239 (2d Cir.1984), it concluded only that there is no substantive right to placement in the State's community-based alternatives to institutionalization. 11 135 To hold that the plaintiffs have no substantive right to community placement is to misstate the question before the court. The question here is whether, given (1) the needs of the individual plaintiffs, (2) the nature of the confinement which they face in institutions, and (3) the State's asserted reasons for so confining them, their liberty interest is being unconstitutionally abridged. Whether the plaintiffs were entitled to something better than permanent confinement in institutions depends entirely on the answer to these questions. Whether the State was required to place the plaintiffs into its community-based alternatives as the only viable alternative to institutionalization was a question the court could not answer without considering the facts relative to the members of the class. Such consideration was aborted by the grant of summary judgment. Had the district court permitted the plaintiffs to proceed, and had the plaintiffs demonstrated that institutionalization is inconsistent with their individual habilitation needs, the district court would have had facts before it that would have required the district court to hold that Georgia is obligated to alter the conditions of the plaintiffs' confinement. Whether this would require placement in the State's community-based alternatives depends on facts that needed to be developed at a trial. 136 The second liberty interest asserted by the plaintiffs is the interest in being free from the effects of prolonged institutionalization--most importantly skill deterioration. Nowhere did the district court consider the validity of this claim, a claim clearly made out in the plaintiffs' amended complaint. After reading the record in this case, I am persuaded that a material question of fact remains as to whether members of the plaintiff class are suffering skill deterioration as a result of their continued institutionalization. If such facts established skill deterioration to the satisfaction of the fact finder, the district court might well have held in accordance with the views of Justice Blackmun, that the plaintiffs have suffered a loss of liberty distinct from that inherent in their confinement. Instead, the district court viewed the case too simplistically and cut off plaintiffs' claims prematurely. 137 If the plaintiffs have the skill or capacity to live in a community setting, and actually living in such a setting--as opposed to residing permanently in an institution--is the only means through which the plaintiffs can exercise this capacity, the continued confinement in an institution constitutes a distinct loss of the liberty inherent in the free exercise of this capacity. The recommendations of certain of the plaintiffs' treatment teams indicate that they do have this capacity. Were such facts developed at trial, I would be prepared to hold that the state is under an affirmative duty to place the plaintiffs in the community. As Judge Rubin has written, 138 The constitutional right to [training] is a right to a program of [training] that affords the individual a reasonable chance to acquire and maintain those life skills that enable him to cope as effectively as his own capacities permit with the demands of his own person and his environment and to raise the level of his physical, mental and social efficiency. 139 Gary W. v. State of Louisiana, 437 F.Supp. 1209, 1219 (E.D.La.1976). It is possible, however, that the habilitation needs of the plaintiff class are--or could be--met in the institutions where they reside. Again, this determination depends on facts--facts which were precluded by a summary judgment. 140 The third liberty interest asserted to be abridged by the defendants is that which resides in being able to associate with family and friends, rooted in the fundamental tenets of the First Amendment. I have concluded that there is no support in the record for a claim that the plaintiffs' associational freedoms are being abridged by their continued institutionalization. In addition, I note that Ga.Code Ann. Sec. 37-4-102 grants to clients in State institutions the right to communicate freely and privately with persons outside the facility and to receive visitors inside the facility. 141 Yet in light of the first two liberty interests described above, it is clear that the district court erred in granting summary judgment before even attempting to consider whether the plaintiffs possess liberty interests beyond those of the most profoundly retarded individual. As it stands, this case instructs state authorities in this circuit that they need only meet the most basic needs of the most profoundly retarded persons when caring for the mentally retarded as a whole, regardless of the particularized needs of individual retarded persons. 142 As I have explained, one of the most important principles to be distilled from Youngberg and our earlier decisions is that the treatment to which a civilly committed person is entitled must be properly related to that person's condition. See, e.g., Donaldson, 493 F.2d at 520 (treatment must be individualized); Youngberg, 457 U.S. at 322-23, 102 S.Ct. at 2461-62 (professional judgment standard not satisfied unless judgment actually exercised). For Judge Rubin, this is the quintessential element of the inquiry: What the constitution requires as the state's due to the individual it confines is a program that is proper for that individual. Gary W., 437 F.Supp. at 1219 (emphasis added). After Youngberg, it is clear that a State must demonstrate fully the presence of a counterbalancing due process interest by showing that the level of treatment provided to the involuntarily confined is consistent with individualized professional judgment. 143 It is undisputed that members of the plaintiff class have not been receiving the treatment recommended by those professionals responsible for their care. Yet the district court apparently thought that the State could satisfy the burden of showing that no constitutionally protected interests are being abridged by merely filing three affidavits which express general approval of the institutionalization of the mentally retarded. None of these affidavits is longer than three pages. None refers expressly to any member of the class. None indicates that the affiant is familiar with the case histories of the members of the class. Instead, each contains a broad statement indicating generally that institutionalization of the mentally retarded is not outside the bounds of generally accepted professional judgment. 12 It is simply absurd to suggest that the professional judgment standard contemplated by the Supreme Court in Youngberg can be satisfied in this manner. See Thomas S. v. Morrow, 601 F.Supp. 1055, 1058 (W.D.N.C.1984) (court must look for guidance to the professional judgment and decision of those who examined [plaintiff]), aff'd as modified, 781 F.2d 367 (4th Cir.), cert. denied sub nom. Kirk v. Thomas S., 476 U.S. 1124, 106 S.Ct. 1992, 90 L.Ed.2d 673 (1986) (emphasis added). 144 The district court's professional judgment analysis derived fromSociety for Good Will to Retarded Children v. Cuomo, 737 F.2d 1239 (2d Cir.1984), which held that the mentally retarded have no constitutional right to placement in the community. The Society for Good Will court held that the professional judgment standard requires only that a decision as to a patient's treatment be consistent with professionally accepted minimum standards. Id. at 1248. Citing Society for Good Will, the district court held that the defendants' affidavits were sufficient to discharge the their burden of proving that the level of care being provided to every member of the class was constitutionally adequate. Apparently, the fact that these affidavits correspond to the language in [Society for Good Will ] was sufficient for the district court. 145 In affirming these rulings, the majority has disregarded Youngberg. The majority has instructed defendants situated similarly to the defendants in this case that they need only find a few experts willing to aver summarily that institutionalization provides a professionally acceptable treatment environment for the mentally retarded to overcome any allegations that such environment is constitutionally inadequate to meet the needs of individual retarded citizens. 146 Our court has a distinguished tradition of sensitivity to the liberty interests of the mentally disabled and the obligations that the State must meet once it takes such persons into custody. This case will be properly read as a significant departure from that tradition since the majority has not even undertaken to consider whether mentally retarded persons may ever have any constitutionally protected liberty interests that go beyond those inherent in the most basic needs. Our case law has recognized, and I would again hold, that the mentally retarded who are capable of appreciating more than the most rudimentary liberty are entitled to expect that the State shall not confine them in a manner inconsistent with their individual needs.