Opinion ID: 3014337
Heading Depth: 1
Heading Rank: 1

Heading: official capacity as Pennsylvania’s

Text: Secretary of Public Welfare. The Office FACTS AND PROCEDURAL of Mental Health and Substance Abuse HISTORY Services (“OM HSAS”), is a department of DPW that has the responsibility to ensure Appellants represent approximately local access to mental health and substance 300 class members with serious and abuse treatment. App. at 712. OMHSAS operates nine psychiatric facilities and one nursing facility throughout Pennsylvania. 1 NSH is one such facility. App. at 717. The class includes all qualified Amici curiae represent fourteen former and willing “persons institutionalized at state mental health agency administrators Norristown State Hospital at any time and have submitted a brief in support of after September 5, 2000 with the appellants. following exceptions: persons who, at the time of final adjudication, are: 1) Appellants filed this class action confined in the Regional Forensic Unit lawsuit in September 2000, claiming that, and Juvenile Forensic Unit; 2) are because the class members are qualified involuntarily committed . . . ; 3) have and prepared for community-based criminal charges pending who have been services, their continued found to be incompetent to stand trial; or institutionalization violates the anti- 4) otherwise are subject to the discrimination and integration mandates of jurisdiction of the criminal courts.” App. the Americans with Disabilities Act at 711 (Jt. Stipulation). (“ADA”), 42 U.S.C. §§ 12131-12134 and 2 28 C.F.R. § 35.130(d) (1998), and Section concerns alone do not provide the 504 of the Rehabilitation Act (“RA”), 29 Commonw ealth grounds for a U.S.C. § 794 and 28 C.F.R. § 41.51(d) fundamental-alteration defense to their (1998).2 They claim that DPW has failed claims. to provide services to them in the most integrated setting appropriate to their On May 6, 2002, the parties filed needs and has developed no plan to assure extensive joint stipulations regarding the that this be done. They also claim that facts underlying this case. App. at 710-39. DPW has failed to require treatment teams In pertinent part, they stated that between to prepare appropriate individualized 1976 and 1998, DPW closed thirteen stateassessments of the service needs of the operated psychiatric facilities, including class members that are a prerequisite for two facilities in southeastern Pennsylvania community placement. In their answer, in 1990 and 1998. App. at 717. defendants admit some of the detailed allegations of the amended complaint and The joint stipulations explain that deny others. Essentially, defendants assert one way in which DPW closed hospitals is as an affirmative defense the analysis in by moving qualified patients into Olmstead v. L.C., 527 U.S. 581 (1999), community care programs. In order to where a plurality of the Supreme Court determine when a patient is ready for allowed the states to resist modifications community care, NSH county program that would effect a fundamental alteration officers hold “monthly Hospital/County of the states’ services and programs. Discharge Planning meetings,” at which Although Appellants acknowledge that the staff and county representatives conduct statutes would not require additional “independent, ongoing assessments of community placements if the increase each consumer’s discharge readiness and would require a fundamental alteration of aftercare needs,” and address “unresolved the Commonwealth’s policy and budget, impediments to discharge.” App. at 715. Appellants argue that the cost of providing However, NSH does not maintain formal the additional placements would be waiting lists for community services. App. defrayed by cost-savings from bed closures at 722. in NSH. They further argue that cost The parties also stipulated that DPW receives the bulk of its mental health 2 funding from the Commonwealth through The language and implementing a budgetary process set out in 71 P.S. §§ regulations of the ADA and the RA are 229-240. App. at 723. Under Pa. Code § virtually the same and the parties 4215.21, county programs must annually acknowledge the congruence of their develop and submit to DWP and integration mandates. Frederick L. v. OMHSAS an assessment of needs for Dep’t of Pub. Welfare, 217 F. Supp. 2d community-based mental health services 581, 591 (E.D. Pa. 2002). 3 and budget estimates. App. at 724. 581 (E.D. Pa. 2002). The District Court OMHSAS submits a proposed budget to held that Appellants were not entitled to DPW, which can modify it, and DPW the requested relief because it would have submits the budget to the Governor’s required a fundamental alteration of the Office of Budget. The Governor then Commonwealth’s programming and formulates a comprehensive budget and budgetary allocations. The District Court submits it to the Legislature, which also found that providing additional ultimately enacts DPW’s budget. App. at community placements would have 724. negatively affected other state residents with mental disabilities who received DPW’s primary funding mechanism services in an institutional setting. for new community care placements has been the Community Hospital Integration Appellants contend that the District Projects Program (“CHIPP”) and the Court erred by stating that the immediate Southeastern Integration Projects Program extra cost coupled with a lack of (“SIPP”). App. at 15, 725. The number of immediate cost-savings associated with community care placements has varied their requested relief, without more, widely from year to year: 38 in 1996-97; provided DPW with a fundamental155 in 1997-98; 82 in 1998-99; 121 in alteration defense. Appellants further 1999-2000; 43 in 2000-01; and 60 argue that the District Court erred in (proposed) in 2001-02. App. at 726-27. finding that DPW’s pre-budgetary involvement in the legislative process was The stipulations describe instances “beyond judicial scrutiny.” Frederick L., in which DPW did not request the full 217 F. Supp. 2d at 593. amount of mental health monies requested by the counties and instances in which II. DPW initially requested add itional community placements, but the Governor DISCUSSION informed DPW that no funding would be available or rejected the request. App. at We may set aside the District 725, 729. However, apart from the budget Court’s conclusions of fact only for clear process, DPW has funded 48 additional error, but we subject its conclusions of law community care slots through savings in to plenary review. See, e.g., Goldstein v. overtime. App. at 730. Johnson & Johnson, 251 F.3d 433, 441 (3d Cir. 2001). Following a three-day bench trial in May 2002, the District Court issued a A. Statutory Framework memorandum opinion on September 5, 2002 in favor of DPW. Frederick L. v. This case arises under Title II of the Dep’t of Pub. Welfare, 217 F. Supp. 2d ADA and Section 504 of the RA. Title II 4 of the ADA provides that “no qualified individuals with disabilities.” 28 C.F.R. § individual with a disability shall, by 35.130(d). “[T]he most integrated setting reasons of such disability, be excluded appropriate to the needs of qualified from participation in or be denied the individuals with disabilities” is “a setting benefit of services, programs, or activities that enables individuals with disabilities to of a public entity, or be subjected to interact with nondisabled persons to the discrimination by any such entity.” 42 fullest extent possible.” 28 C.F.R. pt. 35, U.S.C. § 12132. The ADA largely mirrors App. A, p. 450 (1998). In short, where Section 504 of the RA, which states as appropriate for the patient, both the ADA follows: and the RA favor integrated, community- based treatment over institutionalization. No otherwise qualified Significantly, none of the parties contests individual with a disability . that proposition. . . shall, solely by reason of her or his disability, be B. Olmstead v. L.C. excluded f ro m the participation in, be denied The parties agree that this case is the benefits of, or be governed by the Supreme Court’s decision subjected to discrimination in Olmstead v. L.C., 527 U.S. 581 (1999). under any program or In Olmstead, two mental health patients activity receiving Federal alleged that the State of Georgia violated financial assistance or under the ADA integration mandate by any program or activity unnecessarily segregating them in mental conducted by any Executive health institutions and failing to place agency or by the United them in community-based treatment States Postal Service. programs. Id. at 593-94. The Court found that the ADA reflects the congressional 29 U.S.C. § 794(a). We have construed conclusion that unjustified the provisions of the RA and the ADA in institutionalization perpetuates prejudice light of their close similarity of language against mental health patients and severely and purpose. See Helen L. v. DiDario, 46 diminishes their quality of life. Id. at 600- F.3d 325, 330-32 (3d Cir.), cert. denied, 01. The Olmstead plurality held that, 516 U.S. 813 (1995). under certain circumstances, unnecessary institutionalization and segregation may The ADA and RA’s anti- constitute discrimination. Id. at 597. discrimination principles culminate in their integration mandates, which direct states Justice Ginsburg, writing for the to “administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified 5 plurality, 3 emphasized that the integration mo difica tions would mandate “is not boundless.” Id. at 603. It fundamentally alter the is quali fied by the “reasonable nature of the service, modifications” and “fundamental- program, or activity. alteration” clauses, which provide that: 28 C.F.R. § 35.130(b)(7) (1998). In light [a] public entity shall make of these qualifications, the plurality held reasonable modifications in that unnecessary institutionalization only policies, practices , or violates the ADA when the following procedures wh en th e conditions are met: modifications are necessary to avoid discrimination on [1] the State’s treatment the basis of disability, unless p r o f e s s io n als have the public entity can determined that community demonstrate that making the placement is appropriate, [2] the transfer fro m institutional care to a less 3 restrictive setting is not Justice Ginsburg’s plurality opposed by the affected opinion was joined by Justices individual, and [3] the O’Connor, Souter, and Breyer. Although placement can be reasonably Justice Kennedy concurred in the accommodated, taking into judgment of the Court, he wrote account [a] the resources separately to explore the question of available to the State and [b] whether plaintiffs should have been the needs of others with required to prove that they had been mental disabilities. treated differently than similarly-situated persons. See Olmstead, 527 U.S. at 611- Olmstead, 527 U.S. at 587. The Olmstead 15 (Kennedy, J., concurring). Justice plurality thus made clear that a state may Kennedy agreed with the plurality that defend against disability discrimination States have a responsibility to provide claims by establishing that the requested community-based mental health services, community services would require a but characterized the responsibility as a fundamental alteration of the state’s limited one and emphasized that States mental health system. Id.4 are entitled to considerable deference in allocating their budgets. Id. at 615. Justice Stevens also joined the judgment 4 of the plurality, but did not believe the Under this scheme, the plaintiff first question was properly before the Court. bears the burden of articulating a See Olmstead, 527 U.S. at 607-08 reasonable accommodation. The burden (Stevens, J., concurring). of proof then shifts to the defendant, who 6 Here, the parties do not dispute that fundamental- alteratio n Appellants have satisfied the first two component of the Olmstead requirements. The District reasonable-modificatio ns Court found that one-third of the regulation would allow the Appellants were qualified for community- State to show that, in the based mental health services and an even allocation of available larger portion of the class expressed resources, immediate relief affirmative interest in being placed in for the plaintiffs would be community-based care. The point of inequitable, given the contention instead arises from the responsibility the State has interpretation of Olmstead’s third prong undertaken for the care and regarding reasonable accommodation and treatment of a large and the fundamental-alteration defense. diverse popula tion of p e r s o n s w i th m e n t a l C. Reasonable Modifications and the disabilities. Fundamental-Alteration Defense Id. at 604. The plurality thus characterized The Olmstead plurality explained the state’s available resources and the reasonable-modifications clause and responsibility to other institutionalized fundamental-alteration defense as follows: mental health patients as primary c o n s i d e ra t i o n s i n e v a lu a t i n g a Sensibly construed, the fundamental-alteration defense. Although Olmstead permits courts to consider a state’s financial burdens in must establish that the requested relief evaluating the fundamental-alteration would require an unduly burdensome or defense, the Olmstead plurality expressly fundamental alteration of state policy in proscribed two methods of cost-analysis. light of its economic resources and its First, courts may not simply compare the obligations to other mentally ill persons cost of providing the plaintiffs with in the institutional setting. Although immediate relief against the entirety of the Appellants argue that the District Court state’s mental health budget because the reversed the burden of proof by requiring state’s mental health budget will almost Appellants to demonstrate that their always dwarf the requested relief. Id. at requested relief did not require a 603. Second, courts may not merely fundamental alteration, this contention is compare the cost of institutionalization belied by the fact that the District Court against the cost of community-based expressly acknowledged the appropriate health services because such a comparison burdens of proof in its memorandum would not account for the state’s financial opinion. See Frederick L., 217 F. Supp. obligation to continue to operate partially 2d at 592 n.12. 7 full institutions with fixed overhead costs. State’s choices in basic Id. at 604 n.15. It is notable for our matters such as establishing purposes that the plurality did not envision or declining to establish new the fundamental-alteration defense to be a programs. It is not rare one that states would seldom be able reasonable to read the ADA to invoke. See id. at 603 (eschewing to permit court intervention formulation of fundamental-alteration in these decisions. defense as one permitted “only in the most limited of circumstances”). Id. at 612-13 (Kennedy, J., concurring).5 Justice Kennedy further stated that states In his concurrence, Justice Kennedy have considerable latitude in analyzing the underscored his opposition to judicial “comparative costs of treatment”: involvement in political and/or budgetary decisions outside the province of the law. The State is entitled to wide He stated that federal courts should accord discretion in adopting its deference to state policym akers’ o w n systems of cost programmatic and political funding analysis, and, if it chooses, decisions regarding mental health funding: to allocate health care resources based on fixed No State has unlimited and overhead costs for resources, and each must wh ole institutions and make hard decisions on how programs. We must be m u c h t o a ll o c a te to cautious when we seek to treatment of diseases and infer specific rules limiting disabilities. If, for example, S t a t e s ’ choic es w h e n funds for care and treatment Congress has used only of the mentally ill, including general language in the the severely mentally ill, are controlling statute. reduced in order to support programs directed to the Id. at 615 (Kennedy, J., concurring). treatment and care of other disabilities, the decision may be unfortunate. The judgment, however, is a 5 Justice Kennedy further opined political one and not within that a state without any community the reach of the statute. treatment programs in place would not be G r a v e c o n st i tu t i o n al required to create such programs under concerns are raised when a the ADA. Id. at 613 (Kennedy, J., federal court is given the concurring). We express no opinion on authority to review the this view. 8 D. Needs of Other Mentally Ill Persons A. Budget Constraints and Needs of Others Olmstead explains that the ADA does not compel states to provide relief As mentioned above, Olmstead where the requested relief would require directs courts to evaluate the fundamentalthe state to neglect the needs of other alteration defense in light of the state’s segments of the mentally disabled resources and its responsibility to continue population who are not litigants before the providing services to mental health court. Id. at 597 (recognizing “States’ patients other than those seeking need to maintain a range of facilities for community care. the care and treatment of persons with diverse mental disabilities, and the States’ The bulk of Appellants’ objections obligation to administer services with an have focused on the following statement in even hand”). the “Conclusions of Law” section of the District Court’s opinion: In addition, the plurality reasoned that a state may avoid liability by Even if cost savings may providing “a comprehensive, effectively eventua lly be achieved working plan for placing qualified persons t h r o u g h with mental disabilities in less restrictive deinstitutionalization, the settings, and a waiting list that moved at a immediate extra cost, and reasonable pace [and was] not controlled the concomitant lack of by the State's endeavors to keep its immediate aggregate cost institutions fully populated.” Id. at 605-06. saving, is sufficient to It is this language that informs our establish that a decision in this case. “fundamental alteration” would be required if the