Opinion ID: 3014337
Heading Depth: 1
Heading Rank: 2

Heading: relief sought by plaintiffs –

Text: a c c e le ra te d c o m m unity APPLICATION TO THIS CASE placements – were granted in this case. Appellants, along with Amici, argue that the District Court erroneously Frederick L., 217 F. Supp. 2d at 593 construed the fundamental-alteration (internal citations omitted). Appellants defense with respect to three primary a r gue that th e C ommonw e alth ’s factors: 1) cost constraints and articulation of additional costs that would consideration of institutionalized persons; attend deinstitutionalization does not 2) past progress in deinstitutionalization; automatically give rise to a fundamental- a n d 3 ) l o ng-te r m p l a n n i n g fo r alteration defense. Fu rthermore , deinstitutionalization. Appellants continue, these cost concerns 9 do not automatically make a requested to the recipient’s overall modification unreasonable. In sum, budget, but a “case-by-case Appellants urge that the Commonwealth’s analysis weighing factors fiscal concerns, without more, cannot that include: (1)[t]he overall provide the sole basis for a fundamental- size of the recipient's alteration defense. DPW acknowledges program with respect to that government agencies frequently must number of e m ployees, spend money in order to meet their ADA n u m b e r an d t yp e o f and RA obligations, absent a windfall of facilities, and size of cost-savings. budget; (2)[t]he type of the r e c i p i e n t ’ s o p e r a t io n , We have not previously considered including the composition the extent to which states may assert a a n d str uctur e of th e fundamental-alteration defense based on recipient’s workforce; and fiscal concerns alone, but now hold that if (3)[t]he nature and cost of the District Court’s opinion is read as the accommodation focusing only on immediate costs, as n e e d e d.” 2 8 C FR § Ap pellants contend, it would be 42.511(c) (1998); see 45 inconsistent with Olmstead and the CFR § 84.12(c) (1998) governing statutes. First, Olmstead lists (same). several factors that are relevant to the fundamental-alteration defense, including Id. at 606 n.16. but not limited to the state’s ability to continue meeting the needs of other Second, at least one court of institutionalized mental health patients for appeals and one district court have held whom community placement is not that a singular focus upon a state’s shortappropriate, whether the state has a term fiscal constraints will not suffice to waiting list for community placements, establish a fundamental-alteration defense. and whether the state has developed a In Fisher v. Oklahoma Health Care comprehensive plan to move eligible Authority, 335 F.3d 1175 (10th Cir. 2003), patients into community care settings. the plaintiffs challenged the state’s Olmstead, 527 U.S. at 605-06. The Court decision to limit the number of noted that Section 504 of the RA specifies prescriptions provided for outpatients with that: disabilities who received Medical Assistance, irrespective of medical [the fundamental-alteration necessity, while it continued providing and undue hardship] inquiry unlimited prescriptions to disabled inrequires not simply an patients in nursing homes. The Fisher assessment of the cost of the plaintiffs argued that because the policy accommodation in relation would require low-incom e disabled 10 persons to move to nursing homes in order F. Supp. 2d 1017 (D. Haw. 1999), a class to continue receiving full coverage of all of mentally retarded persons on a waiting of their prescriptions, the state had violated list for Hawaii’s community-based the ADA integration mandate. Id. at 1177- program sued the state for violations of the 78. Oklahoma countered that granting ADA and the RA, seeking additional plaintiffs’ requested relief would have com mu nity place men ts and the required a fundamental alteration in light development of a program to encourage of its fiscal crisis. Id. at 1178, 1182. The movement on the waiting list at a district court entered summary judgment reasonable pace. Hawaii attempted to against the plaintiffs because they were not assert a fundamental-alteration defense currently institutionalized nor did they face based on the theory that increased a risk of institutionalization. Id. at 1181. community placements would require the state to ignore state and federal funding After holding that limits and alter its existing programs by institutionalization was not a prerequisite establishing an “unlimited” state fund for to plaintiffs’ ADA claim, the Court of community mental health services. Id. at Appeals for the Tenth Circuit rejected the 1034. The district court rejected the state’s fundamental-alteration defense, state’s defense, noting that a potential stating that Oklahoma’s fiscal problems funding problem, without more, did not did not establish a per se fundamental- give rise to a fundamental-alteration alteration defense. Id. at 1182. The court defense. Id. We agree with the Makin reviewed the legislative history of the court and with Appellants that states ADA and concluded that Congress cannot sustain a fundamental-alteration contemplated that states sometimes would defense based solely upon the conclusory be required to make short-term financial invocation of vaguely-defined fiscal outlays, even in the face of mounting fiscal constraints. problems. Id. at 1183. The court thus decided that such financial obligations did We do not read the District Court’s not automatically relieve the state from opinion in this case as relying solely on the meeting Congress’ integration mandate. increased short-term costs that additional Id. Because the court found that the community placements would entail, plaintiffs may have had a meritorious notwithstanding the sentence in its opinion claim under the ADA, it reversed the that suggests a lack of cost-savings alone district court’s grant of summary judgment will sustain Pennsylvania’s fundamentaland remanded for consideration of whether alteration defense. Although the court the plaintiffs’ requested modifications noted the absence of cost-savings and the would fundamentally alter the program. requisite spending that new community Id. at 1186. placements would entail, it undertook more comprehensive analyses that focused Similarly, in Makin v. Hawaii, 114 upon DPW’s unsuccessful attempts at fund 11 procurement through the Governor’s First, Appellants dispute the District budget. App. at 20-21. It recognized that Court’s factual conclusion that moving DPW had submitted evidence that it had currently institutionalized persons into responsibly spent its budgetary allocation, community settings wo uld req uire re-allocated overtime savings to increase significant capital outlay by the funding for community-based mental Commonwealth. Because Appellants health services, and had a favorable bed anticipate that the lion’s share of the closure rate when compared with western community care costs would be offset by Massachusetts, which is considered to be the savings reaped from hospital bed a model region for deinstitutionalization. closures, they estimate that the additional App. at 7, 20-21, 30. Moreover, the community placements requested would D i s t r ic t C o u r t e m p h a s i ze d t h at have a net cost of $1 million. Appellants’ OMHSAS’s ability to increase the number of community care placements was hampered by community opposition to budget; that is, that the District Court further expansion in the neighborhoods erred in concluding that it should where the community centers were consider DPW’s mental health budget, located, App. at 23, and that increasing the rather than the entire budget for DPW. number of community placements would Frederick L., 217 F. Supp. 2d at 592 eventually lead to a diminution of services (“The resources available to the State for institutionalized persons under the refers to the state's mental health budget Commonwealth’s care. App. at 24. and nothing beyond that budget.”) (internal quotation and citation omitted). Appellants c h a l le n g e th e Although there are a few references to Common wealth’s position on cost “resources available to the State,” constraints, arguing that 1) the relief they DPW’s myriad non-mental health request would require only negligible cost responsibilities, which include cash increases; 2) DPW could increase its welfare distribution, medical assistance, community care budget by simply food stamps provision, youth centers, requesting additional funds from the forestry camps, and chaplaincies, have no legislature; and 3) DPW could shuffle its nexus to the “care and treatment” of the current budget to favor increased mentally ill described in Olmstead. Id. at community care programs. We consider 587. Upon examination of the language and reject each argument. 6 used in Olmstead, we agree with the District Court that it is DPW’s mental health budget, rather than DPW’s more 6 Appellants also argue that, in general budget, that must be considered. undertaking its cost analysis of the See Olmstead, 527 U.S. at 595, 596, 597, “resources available to the State,” the 603 (referring to state’s “mental health District Court focused upon the wrong budget” six times). 12 cost comparisons, however, are precisely funding amounts beyond that which is the sort of reductive cost comparisons p e r m i t te d unde r the Gov e r n o r ’ s proscribed by the Olmstead plurality, 527 Guidelines. U.S. at 603-04, as well as by Justice Finally, Appellants argue that the Kennedy. Id. at 612-13 (Kennedy, J., District Court erred by concluding that concurring). In following Olmstead and DPW responsibly used its budgeted r e j e ct i n g A p p e l l a n ts’ d i s f a v o r e d monies because DPW should have shifted methodology, the District Court did not money from other programs to fund err. additional com mu nity placem ents . Assuming a limited pool of budgetary Second, Appellants argue that the resources, if DPW had siphoned off District Court erred by not considering monies appropriated for institutional care DPW’s ability to lobby the legislature for for mental health patients in order to additional funds during the budgetary increase community placements, DPW process. Under the budget process in the would have run afoul of Olmstead Commonwealth, DPW must submit a prohibition on favoring those “who report to the Commonwealth requesting an commenced civil actions” at the expense operating budget for the upcoming year of institutionalized mental health patients before DPW receives its budgetary who are not before the court. Any effort to allocation. The Governor may then accept institute fund-shifting that would or reject DPW’s request. Appellants disadvantage other segments of the contend that DPW does not request the full mentally disabled population would thus amount necessary to fund all of the fail under Olmstead. 527 U.S. at 604-06. community placements requested. The District Court concluded that the pre- However, Appellants argue that budgetary process “is beyond judicial DPW should re-allocate its funds to favor scrutiny.” Frederick L., 217 F. Supp. 2d at additional community placements to the 593. We agree. This is not an issue of detriment of budget items that are not legislative immunity, which DPW has not associated with community care or the care claimed, but a recognition of the realities of institutionalized persons. For example, of the budgetary process. DPW explains the parties’ stipulations explain that DPW that it would not have been able to request requested additional funding for several the full amount required to fund all of the non-community care items, such as community placements needed because it approximately $9.5 million for a general must make its budget request pursuant to 3.5% salary increase for state psychiatric the Governor’s Guidelines, which limit the services personnel; $2.5 million for percent-increase that it may request. That contracted repairs; $186,000 for consultant process is unchallenged here. We cannot fees; $5.7 million for specialized services; hold, as Appellants would have us do, that $420,000 for contracted personnel DPW should have requested additional services; $372,000 for travel; $47,000 for 13 out-service training travel; $1.1 million for had a comprehensive, motorized and other rentals; $75,000 for effectively working plan for library materials and supplies; $116,000 placing qualified persons for other services and supplies; and $60.6 with mental disabilities in million for information systems. App. at less restrictive settings, and 730-32. The Commonwealth explains that a waiting list that moved at some of the aforementioned increases are a reasonable pace not mandated under the terms of the controlled by the State’s employees’ union contract and the other endeav ors to keep its costs assist in providing “a safe and secure institutions fully populated, environment” in which to provide “active t h e treatment” to institutionalized patients. reasonable-modificatio ns Appellees’ Br. at 53-54. standard would be met. Because the judiciary is not well- Olmstead, 527 U.S. at 605-06. Appellants suited to superintend the internal and Amici argue that DPW did not budgetary decisions of DPW or evaluate main tain a waiting list or have its physical plant needs, we decline to rely comprehensive, strategic plans to continue on Appellants’ assertion that the deinstitutionalization. aforementioned costs are not essential to the upkeep of DPW’s care-giving The District Court found that DPW apparatus. Our rejection of Appellants’ begins discharge planning as soon as a challenges to the District Court’s analysis patient is admitted, with DPW holding of the cost issues does not mean that we monthly meetings to determine which similarly adopt the court’s acceptance of patients are ready for discharge. However, the Commonwealth’s fundamental- the Court acknowledged that, while the alteration defense. Southeast Region Mental Health Planning Task Force, which is composed of B. Past Progress and Future Planning OMHSAS administrators, mental health for Deinstitutionalization care consumers and providers, had developed a five-year plan for integration In setting forth the circumstances in 1994, the Commonwealth has not under which a state might be relieved of its demonstrated that it has a comprehensive responsibility to provide ADA relief on the or actionable plan to support increased basis of the fundamental-alteration integration through community placements defense, the Olmstead plurality provided or any other mechanisms. App. at 18. the following hypothetical: S o m e c o u r t s h a v e giv e n If, for example, the State considerable weight to the presence of a were to demonstrate that it planning and/or waiting list referred to by 14 the Olmstead plurality as examples of indicates that the Supreme factors to be considered in connection with Court intended to shield the fundamental-alteration defense. The States that had focused on Makin plaintiffs had alleged that the state and planned for the need to affirmatively “mismanag[ed] the wait list” place peop le into the for community care and the court found no community on a statewide evidence of any “comprehensive plan[s] to basis, prior to and apart keep the waiting list moving.” Makin, 114 from the litigation before F. Supp. 2d at 1035 (internal quotation and the Court. A comprehensive citation omitted). The court thus rejected plan is more than an annual the state’s fundamental-alteration defense inquiry into whether there in light of the absence of a comprehensive are extra funds left over in integration plan, a slow-moving waiting the budget to fund creation list, and the state’s vague protest of of community beds. It is general fiscal problems. long-term and central to the State’s mental health policy, In contrast, a Maryland district not an “add-on” or “extra court noted that Maryland maintained a funding” item subject to waiting list and a waiting list equity fund elimination at the first chill and also prioritized categories of crisis of budget difficulties. resolution for services; further, there was “no indication that the failure to move Amici’s Br. at 23. Appellants argue that people off the waiting list result[ed] from the District Court should have rejected the an endeavor to keep the State’s institutions Commonwealth’s fundamental-alteration fully populated,” as proscribed in defense based on DPW’s failure to Olmstead. Williams v. Wasserman, 164 F. develop comprehensive plans or a waiting Supp. 2d 591, 633 n.37 (D. Md. 2001). list. The Commonwealth responds that Based in part on these factors, the court Olmstead does not require the existence of sustained the state’s fundamental- a comprehensive plan nor does it state that alteration defense. Id. at 630-38. a non-stagnant waiting list is the only way that a state can avoid liability. Appellees’ Appellants, joined by Amici, urge Br. at 41 n.27. that we adopt long-term planning as a new factor that should be used in determining Appellants also contend that under whether a state is entitled to an affirmative the facts of this case the District Court defense to an ADA or RA claim. Amici erred in crediting DPW’s past progress in argue as follows: deinstitutionalization. The District Court initially noted that “[t]he declining state T he emp hasis on a hospital population is an important aspect c o m prehensive plan of this changing healthcare environment. 15 In the 1950s, Pennsylvania housed d e v e l o p m e n t a l d i s a b il i ti e s ,” a n d approximately 40,000 people in its state M a r y l a n d ’ s l o n g - s t an d i n g p ol i c y mental hospitals; at the time of trial [in leadership in supporting community-based 2002], fewer than three thousand patients mental health treatment. Williams, 164 F. were housed in the ten remaining Supp. 2d at 633. The Williams court noted OM HSAS-operated facilities.” Frederick that Maryland had “been gradually closing L., 217 F. Supp. 2d at 583 n.4. At the institutions and expanding the number and close of its opinion, the District Court range of community-based treatment concluded that “the record as a whole programs it offers for people with severe convincingly demonstrates that, over time, disabilities” and Maryland decreased its DPW has used its mental health budget to mental hospital population from 7,114 in establish more and more community-based 1970 to 1,200 in 1997. Id. at 634. As programs, and DPW will continue to do noted above, the District Court in the case so, to the extent possible given fiscal before u s a l s o cre d ited th e realities.” Id. at 593. Commonwealth’s past progress. See Frederick L., 217 F. Supp. 2d at 593. There is no reference in Olmstead to a state’s past progress in Although the District Court did not deinstitutionalization as relevant to err in ta king in to acc oun t the analyzing a fun dam ental-a lteration Commonwealth’s past progress in defense. As Appellants argue, past evaluating its fundam ental-alteration progress is not necessarily probative of defense, it was unrealistic (or unduly future plans to continue optimistic) in assuming past progress is a deinstitutionalizing. For example, reliable prediction of future programs. One although DPW funded more than 200 of our principal concerns is the absence of community placements in the past two anything that can fairly be considered a fiscal years, only 33 placements are slated plan for the future. The District Court for next year. As such, Appellants argue made a finding that “Defendants have not that DPW’s past progress should not d e m o n s t r a te d that th e y ha ve a provide grounds for relieving DPW of its comprehensive effectively working plan responsibility to continue providing for placing qualified persons with mental community care in the future. disabilities in less restrictive settings.” Id. at 587. The court continued, “At trial, one It is true that the district court in of Defendants’ witnesses, Gerald Radke, Williams, which accepted Maryland’s Deputy Secretary for OMHSAS, admitted fundamental-alteration defense, relied such a plan is not in place.” Id. The most upon the state’s “role in the course of representative of the Commonwealth de-institutionalization[, the] development arguing before us disagreed with the of community-based treatment programs District Court’s conclusion that there was for all Maryland citizens with mental and no such plan. She stated that “the district 16 court recognized several indicia of a plan vulnerable. It is a gross injustice to keep at Norristown that we submit show that these disabled persons in an institution there is a plan.” Tr. of Argument at 31. notwithstanding the agreement of all She conceded, however, that there is no relevant parties that they no longer require piece of paper that represents that plan but institutionalization. We must reflect on her explanation of a plan (policies and that more than a passing moment. It is not procedures at NSH utilized for ongoing enough for DPW to give passing review of patients from the minute they acknowledgment of that fact. It must be come in and for discharge planning for prepared to make a commitment to action each patient individually) falls far short of in a manner for which it can be held the type of plan that we believe the Court accountable by the courts. referred to in Olmstead.