Opinion ID: 480752
Heading Depth: 1
Heading Rank: 5

Heading: the constitutional standard of care for the mentally retarded

Text: 22 The district court's uncertainty about the scope of federal support for a least restrictive environment was not misplaced. Appellees suggest, as a threshold matter, that the existence of a generalized constitutional right to community services for institutionalized mentally retarded people is not at issue before this Court. On the other hand, they contend that the constitutionally-based rights to enjoy safe conditions and to be free from harm, the right to be free from unnecessary institutionalization, and to have commitment bear some reasonable relation to its purpose are coextensive with the rights conferred in paragraphs 7 and 8 of the Resolution and Settlement. The distinction appellees seek to draw eludes us. Appellees are aware that the Supreme Court cases they cite do not cut such a swath. 8 In fact, the lower court cases on which appellees rely for their due process argument are precisely those which have considered, and uniformly rejected, a constitutionally-founded right to receive treatment in the least restrictive alternative setting. 9 23 In Society for Good Will to Retarded Children v. Cuomo, 737 F.2d 1239 (2d Cir.1984), the court stated, we may consider only whether there is an entitlement to community placement or a 'least restrictive environment' under the federal Constitution. We hold that there is no such entitlement. Id. at 1248. The Second Circuit based its decision on the holding of Youngberg v. Romeo, 457 U.S. 307, 102 S.Ct. 2452, 73 L.Ed.2d 28 (1982), which confirmed the state's duty under the Fourteenth Amendment to provide adequate food, shelter, clothing, reasonable safety, and such training as an appropriate professional would consider reasonable to ensure [a person's] safety and to facilitate his ability to function free from bodily restraints. Id. at 324, 102 S.Ct. at 2462. Youngberg also held that in determining whether the state has met its obligations in these respects, decisions made by the appropriate professional are entitled to a presumption of correctness. [L]iability may be imposed only when the decision by the professional 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. Id. at 323, 102 S.Ct. at 2462. The constitutional minimum standard of habilitation thus relates, not to the qualitative betterment of a retarded person's life, but only to the training necessary to afford him safety and freedom from bodily restraint. Whether that training is adequate must be determined in light of expert testimony; no constitutional violation exists unless the level of training is such a substantial departure from accepted professional judgment or standards as to demonstrate that the person responsible actually did not base the decision on such a judgment. 24 Reinforcing this view of Youngberg is Society for Good Will, supra, which further stated that we may not look to whether the trial testimony established the superiority of a 'least restrictive environment' in general or of community placement in particular. Instead, we may rule only on whether a decision to keep residents at SDC [Suffolk Developmental Center] is a rational decision based on professional judgment. Society for Good Will, 737 F.2d at 1249. The court in Society for Good Will therefore concluded that while experts disagreed on the appropriateness of institutionalization, retaining residents at the institution did not violate the professional judgment standard enunciated in Youngberg. Other courts have agreed with this conclusion. See Rennie v. Klein, 720 F.2d 266 (3d Cir.1983); Phillips v. Thompson, 715 F.2d 365, 368 (7th Cir.1983); Ass'n for Retarded Citizens of North Dakota v. Olson, 561 F.Supp. 473, 486 (D.N.D.1982), aff'd on other grounds, 713 F.2d 1384 (8th Cir.1983); Garrity v. Gallen, 522 F.Supp. 171, 237-39 (D.N.H.1981). 25 Appellees would distinguish Society for Good Will with the suggestion that the district court there ordered wholesale transfer of patients from an institution to community facilities, irrespective of individualized professional treatment recommendations. This observation is only partially correct. The Second Circuit noted that the number of placements ordered by the district court was virtually irreconcilable with the profound retardation of the majority of the institution's patients. On the other hand, the Second Circuit criticized the district court's willingness to substitute the judgment of plaintiffs' experts for that of the state's experts, in contravention of Youngberg. Critically, appellees' focus on the individual optimum habilitation plans misperceives the real issue, which was articulated by Society for Good Will, following Youngberg. The real issue is whether the existing level of habilitation represents a gross and unwarranted departure from the minimum standard necessary to preserve an individual's safety and freedom from physical restraint. Appellees' evidence in support of community placement in the district court concerned the optimum habilitation of each class member rather than the constitutional minimum standard. There is no evidence in the record concerning whether the State, at the time of the hearing leading to the June 5, 1985 Order, was denying class members the constitutional minimum standard. Moreover, the appellees never requested enforcement of the R & S to correct alleged failures to adequately protect clients from abuse or neglect or to remedy alleged inadequacies in adaptive equipment for physical therapy. The court never ordered any remedial action to improve these areas of care. No effort was made by any party to the Joint Motion for Community Placement, the expert consultant, or the district court to affect a substantive level of care, only its locale. 26 It is also worthwhile to observe that should the optimum standard of habilitation afforded class members by state law become coextensive with federal constitutional requirements, the emphasis of Youngberg on the judgment of the State's professionals will be thoroughly undermined. The constitutional standard in that instance would be determined by the views of expert witnesses, and outside consultants could effectively overrule state programs, contrary to Youngberg. While Youngberg may eventually have to be squared with the duty of a state to prevent deterioration of skills of the retarded committed to its institutions (see Youngberg, 457 U.S. at 327-29, 102 S.Ct. at 2464-65 (Blackmun, J. concurring)) this is by no means the same as requiring the State to provide the best care possible or the optimum location to improve the client's physical, mental and emotional conditions. As the Second Circuit aptly noted in Society for Good Will, the due process clause only forbids deprivations of liberty without due process of law. Where the state does not provide treatment designed to improve a mentally retarded individual's condition, it deprives the individual of nothing guaranteed by the Constitution; it simply fails to grant a benefit of optimal treatment that it is under no constitutional obligation to grant. Society for Good Will, 737 F.2d at 1250. 27 It is therefore our conclusion that the federal constitution does not confer on these class members a right to habilitation in the least restrictive environment. There being no constitutional scope to paragraphs 7 and 8 of the R & S, the district court's decree purporting to enforce them may not rest on that authority and is unauthorized. 10 28