Document: 457 U.S. 307 102 S.Ct. 2452 73 L.Ed.2d 28 Duane YOUNGBERG, etc., et al., Petitioners,v.Nicholas ROMEO, an Incompetent, by his mother and next friend, Paula Romeo. No. 80-1429. Argued Jan. 11, 1982. Decided June 18, Syllabus Respondent, who is mentally retarded, was involuntarily committed to a Pennsylvania state institution. Subsequently, after becoming concerned about injuries which respondent had suffered at the institution, filed action as friend in Federal District Court for damages under 42 U.S.C. § 1983 against petitioner institution officials. She claimed that constitutional rights safe conditions of confinement, freedom from bodily restraint, training or "habilitation" petitioners knew, should have known, but failed take appropriate preventive procedures, thus violating Eighth Fourteenth Amendments. In ensuing jury trial, instructed on assumption Amendment proper standard liability, verdict returned petitioners, judgment entered. The Appeals reversed remanded new holding Fourteenth, rather than Eighth, provided basis asserted rights. Held : Respondent has constitutionally protected liberty interests Due Process Clause reasonably unreasonable restraints, such minimally adequate may be required these interests. Whether respondent's been violated must determined balancing relevant determining whether State adequately professional fact exercised. And what "reasonable," courts show deference exercised qualified professional, whose decision presumptively valid. Pp. 314-325. 3d Cir., 644 F.2d 147, vacated remanded. David H. Allshouse, Harrisburg, Pa., petitioners. Edmond A. Tiryak, Philadelphia, respondents. [Amicus Curiae Information page 308 intentionally omitted] Justice POWELL delivered opinion Court. 1 question presented respondent, substantive (i) confinement; (ii) restraints; (iii) "habilitation."1 sued three administrators claiming alleged breach 2 * Nicholas Romeo profoundly retarded. Although 33 years old, he mental capacity 18-month-old child, with I.Q. between 8 10. He cannot talk lacks most basic self-care skills. Until 26, lived parents Philadelphia. But death father May 1974, unable care him. Within two weeks father's death, sought temporary admission nearby hospital. 3 Shortly thereafter, she asked Philadelphia County Common Pleas admit facility permanent basis. Her petition court explained control violence.2 As part commitment process, examined physician psychologist. They both certified severely retarded himself. App. 21a-22a 28a-29a. On Pennhurst School Hospital, pursuant applicable involuntary provision Mental Health Retardation Act, Pa.Stat.Ann., Tit. 50, 4406(b) (Purdon 1969). 4 At Pennhurst, injured numerous occasions, own violence reactions other residents Respondent's became injuries. After objecting treatment several times, this complaint November 4, 1976, United States Eastern friend. "[d]uring period July, 1974 present, plaintiff least sixty-three occasions." originally injunctive relief Pennhurst's director supervisors;3 it officials suffering they institute 5 Thereafter, late transferred ward hospital broken arm. While infirmary, order doctor, physically restrained during portions each day.4 These restraints were ordered Dr. Gabroy, not defendant here, protect others hospital, some whom traction being treated intravenously. 7 Tr. 40, 49, 76-78. normally would when arm healed, parties litigation agreed remain due pending lawsuit. id., 248; 6 57-58 137. Nevertheless, December 1977, second amended alleging defendants restraining prolonged periods routine also added claim compensate defendants' failure provide him "treatment programs retardation."5 All claims dropped prior trial because member class seeking another action.6 An 8-day held April 1978. Petitioners introduced evidence participated teaching skills.7 A comprehensive behavior-modification program designed staff members reduce Romeo's aggressive behavior,8 never implemented mother's objections.9 unit.10 close "if any all aware reasonable steps prevent repeated attacks upon Romeo," deprived 73a. if shackled denied "as punishment filing lawsuit," Amendment. Id., 73a-75a. Finally, only found "deliberate[ly] indifferen[t] serious medical [and psychological] needs" could find violated. 74a-75a.11 defendants, Third Circuit, sitting en banc, trial. 147 (1980). Amendment, prohibiting cruel unusual those convicted crimes, source committed. Rather, interest applying retain movement personal security. "fundamental liberties" can limited "overriding, non-punitive" interest. 157-158 (footnote omitted). It further habilitation "treat" their retardation. 164-170.12 9 banc did not, however, agree used violated.13 Because physical restraint "raises Presumption punitive sanction," majority concluded justified "compelling necessity." 159-160 somewhat different resident's safety. considered showing "substantial 164. administered, responsible are liable "acceptable light present scientific knowledge." 166-167 173.14 10 Chief Judge Seitz, concurring judgment, standards articulated indistinguishable malpractice claims. Seitz' view, Constitution "only requires make certain exercised." 178. conduct "such substantial departure accepted practice, demonstrate base judgment." Ibid.15 11 We granted certiorari importance administration institutions 451 982, 101 2313, 68 838 (1981). II 12 consider here first time persons Constitution.16 case, laws Pennsylvania, does challenge commitment. argues safety, movement, within institution; infringed failing confinement. 13 mere procedures deprive See, e.g., Vitek v. Jones, 445 480, 491-494, 100 1254, 1262-1264, 63 552 Indeed, concedes right food, shelter, clothing, care.17 decide exist training. If do exist, we case. 14 involve recognized decisions Court, proceedings extinguish.18 conditions. past, noted security constitutes "historic interest" substantively Clause. Ingraham Wright, 430 651, 673, 97 1401, 1413, 51 711 (1977). extinguished lawful even penal purposes. See Hutto Finney, 437 678, 98 2565, 57 522 (1978). hold criminals unsafe conditions, unconstitutional confine committed—who punished all—in 15 Next, restraint. contexts, existence clear "[l]iberty always core arbitrary governmental action." Greenholtz Nebraska Penal Inmates, 442 1, 99 2100, 2109, 60 668 (1979) (POWELL, J., dissenting part). This survives criminal conviction incarceration. Similarly, survive B 16 remaining more troubling. words, asserts "constitutional habilitation." Brief 8, 23, 45. process said grounded component Amendment.19 term "habilitation," psychiatry, defined precisely consistently opinions below briefs amici.20 previously n. supra, refers "training development needed skills." emphasizes "minimal" training, see 34, leave type extent case-by-case "in knowledge," 17 addressing start established principles. general matter, no duty services its border. Harris McRae, 448 297, 318, 2671, 2689, 65 784 (1980) (publicly funded abortions); Maher Roe, 432 464, 469, 2376, 2380, 53 484 (1977) (medical treatment). When person institutionalized—and wholly dependent State—it conceded although then necessarily considerable discretion nature scope responsibilities. Richardson Belcher, 404 78, 83-84, 92 254, 258-259, 30 231 (1971); Dandridge Williams, 397 471, 478, 90 1153, 1158, 25 491 (1970). Nor "choose attacking every aspect problem all." 486-487, S.Ct., 1162-1163. 18 severe character retardation, amount will possible release. argue still home, obligation expense. Oral Arg. 33. record reveals primary needs safety minimum clearly related needs.21 there 315-316, necessary avoid infringement before us, quite uncertain seeks unrelated restraints. brief indicates behavior. 21-22, 50. offer proof court, repeatedly indicated that, allowed testify, experts additional programs, including Pet. Cert. 98a-104a.22 If, seems case difficult person, per se, lead freedom.23 19 language apparently adopted observed: 20 "I believe treatment. longer novel legal proposition." F.2d, 176. 21 Seitz identify otherwise define—beyond "minimally treatment" appropriately respondent.24 circumstances developed date, view conclude require ensure undue kinds record, need go case.25 III 22 retains Yet absolute; indeed conflict. operating occasions restrain residents—for example, them well violence.26 Similar program. danger permit movement. simply lack absolute violate process. 23 violated, balance "the individual" demands organized society." Poe Ullman, 367 497, 542, 81 1752, 1776, 989 (1961) (Harlan, dissenting). cases, weighed individual's State's reasons individual liberty. Bell Wolfish, 441 520, 1861, 447 (1979), pretrial detainees' confinement detainees, yet crime charged, punished. upheld restrictions legitimate government objectives tantamount punishment.27 539, 1874. taken similar approach deciding procedural challenges civil proceedings. Parham J. R., 584, 2493, 61 minor parental consent. mandate adversarial hearing, State, fiscal administrative burdens entail.28 599-600, 2502-2503. 24 Accordingly, uniformity protecting interests, left unguided judge jury. therefore turn think affords guidance reflects specify professionally acceptable choices made." Persons entitled considerate punish. Cf. Estelle Gamble, 429 97, 104, 285, 291, 50 251 (1976). same time, lower "compelling" "substantial" necessity tests meet justify use less requirement place burden restrict unnecessarily exercise residents. 26 Moreover, "reasonable" presenting emphasize professional. By so limiting judicial review institutions, interference federal judiciary internal operations minimized.29 certainly reason judges juries better professionals making decisions. 607, 2506-2507; bell V. WOLFIsh, supRa, 544, s.ct., 1877 (courts shoulD " 'second-guess expert matters informed' "). For reasons, decision, made professional,30 valid; liability imposed actually judgment.31 capacity, satisfy normal budgetary constraints; situation, good-faith immunity bar liability. 13, supra. IV 27 postcommitment cognizable constraints operate. repeat care. essentials provide. unquestioned personnel except deems assure therefore, facilitate ability function free significantly likelihood violence. enjoys nonrestrictive Such comport fully purpose Jackson Indiana, 406 715, 738, 1845, 1858, 32 435 (1972); 27, met obligations respects, presumption correctness. enable type—often, unfortunately, overcrowded understaffed—to continue function. single respect number widely varying problems course day. administrators, particularly personnel, shadow damages. 29 erroneously vacate remand consistent decision. So ordered. 31 BLACKMUN, BRENNAN O'CONNOR join, concurring. I join Court's opinion. write separately, why properly leaves unresolved important issues. Commonwealth accept "care treatment," Act 1966, 1969), refuse "treatment," law. Were my issue whether, matter refuse. "frivolous" one, THE CHIEF JUSTICE does, post, 330, n.1 34 (1972), unanimous vote participating Justices, suggested evaluating civilly person's confinement: "At least, duration bear relation committed." 1858. Under standard, "safekeeping," without goal confined. 35 orders might bind goals. "treatment" whatsoever purposes 36 principal "[b]y basing [respondent's] deprivation partially promise treatment, ineluctably community's resources providing minimal treatment." 168 (CA3 1980).2 Neither clarified, totally To addressed question, contradictory, suggests much total treat inadequacy Ibid. 37 reading ante, 311-312, n.7, supports conclusion. today finds entitlement law raised below. 316, 19. Given uncertainty am accord address constitutionality 38 open independent claim, preserve skills possessed entered Pennhurst—for dress himself hygiene. reasoning include Constitution," 322, pre-existing deteriorating 39 makes clear, 315-316 324 losses result confinement—for institutional skills, lost refusal then, me, loss distinct from—and as—the many people, difference things themselves dependence ever know. 40 kind, "[o]n [in fact] 'habilitation' restraints."3 Ante, 318. Since [his] restraints," claim. 41 merely tendencies, maintain autonomy assert Like willing defer extent, 321-323. notes, "[p]rofessionals disagree strongly effective individuals possible." 20. testimony preserve, preserved whatever have, establishes sufficiently educable maintained degree prepared listen seriously argument mobility imminently threatened so. 43 premature resolve record. conclusion, concur 44 BURGER, judgment. 45 However, flatly se. parties, acknowledge outside assistance relatives. now neither nor family discharge circumstances, care, living inherent environment allows, serves custody respondent. seek respondent; understandably aid need. 46 instruction restraint; me affirmative particular kind habilitation—even encompassed essentially standardless rubric training," refers. 319, 24. 176 1980) (Seitz, C.J., judgment). adequate" "[q]uite apart relationship decent care," unlike way issue.* 47 point out standards, largely irrelevant "additional behavior," ibid.—a prescription far easier "spectators" give implement. devised was, according opinion, "presumptively valid"; "liability 323. Thus, inconsistent generally prevailing practice—if such—this avail long regimen prescribed institution's staff. 48 worth noting instructions whole today; indeed, overly generous erred giving incorporating "deliberate indifference" instructed, "were upon" 312. Certainly took "all steps" either achieve American Psychiatric Association explains: "The word 'habilitation,' . commonly refer mentally-retarded retardation learning disability impairment illness. [T]he focus Amicus 1. Mrs. stated: "Since husband's handle becomes violent—kicks, punches, breaks glass; can't speak—wants express can't. [a] constant hr. [W]ithout husband him." 18a. Petitioner Youngberg Superintendent Pennhurst; supervisory authority over entire facility. Richard Matthews Director Resident Life Pennhurst. Marguerite Conley Unit unit lived. According doctors. 2. described "shackles," "soft" arms only, used. 53-55. uses synonymous "training." 21-23. Hospital Halderman, 1531, 67 694 (1981) (remanded proceedings). Prior transfer ward, dealing feeding, showering, drying, dressing, self-control, toilet interaction members. Defendants' Exhibit 10; 69-70; 44-56, 242-250; 162-166; 41-48. Some continued while 227, 248, 256; 162-166, 32, 41-48, reduced behavior 7; 88-90; 88, 200-203; p. 9. called short separation "muffs" plaintiff's hands i.e., five minutes, harming others. 53; 25; 204. refused allow witnesses—trained professionals—indicating benefited programs. advantages alternative forms suit, 1983. 101. (1976), prisoners' "cruel unusual" Gamble charging jury, deliberate-indifference 45a, 75a. synonymous, though regarded accurate describing 165, 40. defense appeal. received defense, 76a, challenged 173, citing Pierson Ray, 386 547, 87 1213, 288 (1967), Scheuer Rhodes, 416 232, 94 1683, (1974), given again remand. 171-172. Actually, divided right-to-treatment into categories text stated unless compelling explanation discuss precise appear facts addition, "least intrusive" analysis intrusions dignity alteration surgical intervention, 165-166 Aldisert joined wrote separately Judge. conceptual level, thought abandoning common-law method articulating broad principles unconnected meaning. 182-183. And, pragmatic warned administering receive "amorphous tenets" 184. 183-185. Garth criticize issues 186. pertinent part, provides "any life, liberty, property, ." U.S.Const., Amdt. 14, relies direct 12. 12, 15-16. Connecticut al. Amici 8. contrary. 27-31. habilitation, substantive, procedural, protection advanced below, argued ground reversing court. courts, decline now. Dothard Rawlinson, 433 321, 323, 2720, 2724, 786 (1977); Duignan States, 274 195, 200, 566, 568, 71 L.Ed. 996 (1927); Old Jordan Milling Co. Societe Anonyme des Mines, 164 261, 264-265, 113, 114-115, 427 (1896). Professionals possible. Favell, Risley, Wolfe, Riddle, & Rasmussen, Limits Habilitation: How Can Identify Them Change Them?, Analysis Intervention Developmental Disabilities (1981); Bailey, Wanted: Rational Search Limiting Conditions Habilitation Retarded, Kauffman Krouse, Cult Educability: Searching Substance Things Hoped For; Evidence Not Seen, description 310. Appellant 78-1982, pp. 11-14, 20-21, (CA3). "state afford opportunity acquire life cope effectively capacities permit." 94a-95a. sweeping se thereafter. and, oral argument, counsel explicitly disavowed "to maximum potential." 46-48. habilitation. 181. feasible, evident variety formulations various define generalization adequacy, terms familiar identifiable course, predicate imposition State. cases patients vary widely, essential Aldisert, critical "majority's abandonment incremental decision-making favor promulgation [that] lac[k] utility groups affected decision." 183-184. reaching articulate rules absence benefit analysis, briefing" times. 2, 192 (1972) (holding incompetent detainee cannot, competency indefinitely commitment; requires, minimum, rational purpose). differs respects Jackson, involving validity Here, averred condition N. available Addington Texas, 418, 1804, 323 (1979). prove "clear convincing" evidence. 431-432, 1812-1813. reached weighing 608, 16, 2507, (In professionals, "it incumbent design unduly burdening efforts states deal social problems"). Rhodes Chapman, 452 337, 352, 2392, 2402, 69 59 ("[C]ourts assume legislatures prison insensitive requirements perplexing sociological how best goals justice system ."); 1874, context "[c]ourts mindful inquiries spring answers reflect court's idea operate detention facility"); Wolff McDonnell, 418 556, 2963, 2974-2975, 935 (1974) considering prison, "there mutual accommodation provisions application"). Townsend Mattson, Interaction Law Special Education: Observing Emperor's New Clothes, 75 (judicial resolution handicapped adverse positive effects change). "professional" decisionmaker, mean competent, education, experience, issue. Long-term degrees medicine nursing, areas psychology, therapy, Of day-to-day regarding care—including delay—necessarily instances employees formal subject supervision persons. admitted. included questions certiorari, admissible. petitioners' requisite page. Garvey, Freedom Choice Constitutional Law, Harv.L.Rev. 1756, 1787-1791 Welsch Likins, 550 1122, 1126, (CA8 1977); Wyatt Aderholt, 503 1305 (CA5 1974), aff'g Stickney, 325 F.Supp. 781, 785 (MD Ala.1971). judges, contest placed [respondent] law, indicative purpose. confining undoubtedly violates clause fail fulfill purpose." attorney requested "[u]nder Amendments, 94a-95a (emphasis added). "without habilitative efforts—basic fundamental skills—institutionalized develop independently lose brought putting aside increased risks harm, loses acquired through neglect, worked injury Once [retarded persons] confined one help gaining or, preserving abilities have." 22-23 offered remand, primarily 100a (respondent's "when learn behavior, dressing forth, [their] aggression decreases"); (training "a inappropriate, self-destructive behaviors"). [would] [him] 94a. maintains purportedly creates enforcement right. contention obviously frivolous; created enforceable Clause, distinction quickly obliterated.

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