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The Right to Treatment

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Kenley Street

on 24 January 2014

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Transcript of The Right to Treatment

The Right to Receive Treatment
Pennhurst State School and Hospital
Pop Quiz!
Battle of the Experts
Wyatt v. Stickney

by: C. Belliston, L. Cramer, & K. Street
1.) What was the average staff to patient ratio at mental health hospitals in the early to mid-20th century?
A.) 1:5
B.) 1:25
C.) 1:50
D.) 1:100
E.) 1: 1,000

2.) On average, a mental hospital in the early to mid-20th century would house ________ as many patients as it was designed to house.
A.) One-fourth
B.) Half
C.) Exactly
D.) Twice
E.) 4 times
3.) Which of the following do you think were common occurrences at mental health hospitals in the early to mid-20th century?
A.) Illness
B.) Funding
C.) Clothing
D.) Abuse
E.) A and C
F.) A and D
G.) A, B, and D
H.) B, C, and D
I.) All of the Above
J.) None of the Above
344 F. Supp. 373 (M.D. Ala. 1972)
Bryce Hospital
Tuscaloosa, Alabama
Dr. Peter Bryce
250 --> 5,200
In the 20th century, the number of patients increased while the staff members decreased.
Alabama- #50
Concentration Camp
1971 Continued...
The Lawsuit
Class Action
Ricky Wyatt
Laid-off Employees
a revolutionary idea:
"a realistic opportunity to be cured"
"obtain his release at will"
The Wyatt Standards
• Humane psychological and physical environment

• Qualified and sufficient staff for administration of treatment

• Individualized treatment plans

• Minimum restriction of patient freedom

First opened on November 23, 1908.

Located in Southeastern Pennsylvania.

Originally known as the "Eastern Pennsylvania State Institution for the Feeble-Minded and Epileptic".

Within four years of Operation, Pennhurst was already overcrowded and under pressure to admit more patients

Residents were classified into mental categories of imbecile or insane, into physical categories of epileptic or healthy, and into dental categories of good or poor teeth when admitted

Segregation and Eugenics
In 1913, the legislature appointed a Commission for the Care of
Disabled were “unfit for citizenship and posed a menace to the peace.”

Desired to prevent the intermixing of the genes of those imprisoned with the general population

Pennhurst’s Chief Physician
Biennial Report to the Legislature

Quoted Henry H. Goddard, a leading eugenicist:

“Every feeble-minded person is a potential
criminal. The general public, although more
convinced today than ever before that it is a
good thing to segregate the idiot or the
distinct imbecile, they have not as yet been
convinced as to the proper treatment of the
defective delinquent, which is the brighter and
more dangerous individual.”

Pennhurst Exposed
In 1968, conditions at Pennhurst were exposed in a 5-part television news report anchored by local CBS10 correspondent Bill Baldini.

In 1983, nine employees were indicted on charges ranging from slapping and beating patients to assaulting patients.
Closing Pennhurst
A class-action was filed v. Pennhurst State School and Hospital on behalf of its patients in 1977
Halderman v. Pennhurst State School & Hospital
, 446 F. Supp. 1295 (E.D. Pa. 1977)
District Court ruled that the patients’ Constitutional rights had been violated under the 8th and 14th Amendments
However, the U.S. Supreme Court vacated the judgment

Pennhurst was finally closed in 1987 pursuant to a settlement agreement
The remaining 460 patients were discharged or transferred to other facilities as part of the deinstitutionalization movement

Willowbrook State School
State-supported institution for children with intellectual disability.

Located in Staten Island, NY.

Built in 1947.

Designed for 4,000.

By 1965, it had a population of 6,000.

Poor conditions, improper medical practices, and understaffing was prevalent.

Sen. Robert Kennedy referred to it as a “snake pit” during a tour in 1965.

Hepatitis and Disease
Outbreaks of hepatitis, primarily hepatitis A, were common.

Donna J. Stone, an advocate for mentally disabled children and victims of child abuse, gained access to the school by posing as a recent social work graduate so she could observe the conditions.

Press Coverage of Willowbrook
A series of articles in local newspapers described the crowded, filthy living conditions at Willowbrook, as well as the negligent treatment of its residents.

In 1972, Geraldo Rivera, an investigative reporter for WABC-TV in NY, conducted a series of investigations at Willlowbrook to uncover the deplorable conditions.

Geraldo Rivera’s Findings of Willowbrook
Physical and sexual abuse of residents by staff.

Unsanitary facilities

Insufficient funding

Insufficient staff

Youngberg v. Romeo
, 457 U.S. 307 (1982).

Nicholas Romeo: mentally retarded, with an infant level IQ.
Committed to a PA state hospital
Restrained for many hours of the day and repeatedly injured

Defendants, management personnel at Pennhurst State School,
did not dispute Romeo’s right to care, habilitation, training and security

Whether the defendants had violated the standard of care for treating mentally ill patients in violation of Romeo’s civil rights
Procedural History:
The trial court jury found for the defendants.

The 3rd Circuit reversed and ordered a new trial, explaining that the standard of care should have been based on the 14th rather than the 8th Amendment

The Supreme Court vacated the 3rd Circuit's decision and remanded for further proceedings

Involuntarily committed residents and mentally ill patients have constitutionally protected liberty interests 14th Amendment Due Process clause.

Liberty interests include: reasonably safe conditions of confinement, freedom from unreasonably bodily restraints, and such minimally adequate training as may be required by these state interests.

Results & Outcome
Pennhurst was closed in 1986, along with most other mental health institutions.

The Right to Treatment doctrine died with Youngberg.

Today, any cases seeking to improve institutional conditions proceed under the ADA or under a 14th Amendment Due Process theory.


Donaldson v. O’Connor
, 493 F.2d 507 (5th Cir. 1974)

Kenneth Donaldson
• 1943: first schizophrenic episode at
age of 34.

• Employed and married with children.
• Received mental health treatment, including electroshock therapy.

• Had increased paranoid delusions (i.e. he was being poisoned).

• Father petitioned for civil commitment.

• Committed to Florida State Hospital on Jan. 3, 1957, diagnosed as “paranoid schizophrenic.”

• 42 U.S.C. § 1983 action alleging deprivation of constitutional right to receive treatment.
• Defendants: five hospital and state mental officials, but only two hospital staff members appealed.
• Donaldson was released on July 31, 1971, after initiating the suit.
• During first ten years of committed, he requested grounds privileges and occupational therapy; his requests were denied.
• He refused to take any medication, or to submit to electroshock treatments. No other therapy was offered.

Issue: Does the 14th Amendment guarantee a right to treatment for persons involuntarily civilly committed to state mental hospitals?

Holding: Yes. Those who are involuntarily civilly committed to a state mental hospital have a constitutional right to receive such individual treatment that will grant them reasonable opportunity to be cured or to improve their mental condition. Donaldson’s was denied the right to receive proper treatment, including (1) grounds privileges; (2) occupational therapy; and (3) patient talk with his treating psychiatrist.

• Civil commitment involves a “massive curtailment of liberty.”

• Civil commitment is comparable, and in some ways “a more serious abridgement from personal freedom” than imprisonment for criminal offenses.

• 14th Amendment invoked for deprivations of liberty.

4.) Right to receive treatment cases generally involve plaintiffs who invoke federal rights under what U.S. Constitution amendments?
A.) Fourteenth Amendment

B.) Eighth Amendment

C.) Both

O’Connor v. Donaldson
, 42 U.S. 563 (1975)

• Plaintiff-Appellee: Donaldson has a constitutional right to receive treatment or to be released from the state hospital.

• Defendants-Appellants: a right to treatment cannot be governed by judicially manageable or ascertainable standards.

A State cannot constitutionally confine a non-dangerous individual who is capable of surviving safely in freedom by himself, or with outside assistance, without additional justifications. Ample evidence existed that the State confined Donaldson, thus the jury properly concluded that the State violated Donaldson’s right to liberty.
State law authorizing confinement does not itself establish a constitutionally adequate purpose for the confinement.

Constitutionally adequate confinement initially also not enough- could become unconstitutional after that basis no longer existed.

No constitutional basis for confining such persons involuntarily if they are dangerous to no one and can live safely in freedom.

Mere presence of mental illness does not disqualify a person from preferring his home to the comforts of an institution.

Public intolerance or animosity cannot constitutionally justify the deprivation of a person's physical liberty.

Clermont County, Ohio Corrections: Mentally Ill Inmates
Statistics of Mentally Ill Inmates
• Around 40% of 300 total inmates are mentally ill.

• Most of individuals at initial assessment are abusing drugs or alcohol, preventing their mental illness from showing until later.

• About 60% of inmates previously served in Clermont County, even higher amount for mentally ill.

• Higher percentage of mentally ill in Clermont County than in previous decades.

Process for Incoming Mentally Ill Inmates
• Step 1: General Booking
o includes medical questionnaire that address mental health
o findings: even if inmates are on medication they do not possess proper medical proof.

• Step 2: Any inmates suspected of possessing mental health issues requires the medical unit to do a more in-depth evaluation.
o evaluation is called “Initial Nursing Assessment”.
o involves one-on-one evaluation with a nurse.

Medical Unit
• Has its own medical staff, consisting of L.P.N.’S and a R.N. who oversees the medical department.

• R.N. has contact with social services, doctors, and psychiatrists 24 hours a day, seven days a week.

• Places many inmates on medication, either medication provided by families due to previous prescription or by starting inmates on medication at the jail.

• Does not dispense the actual medication. Medication is distributed by an accredited private party, Southern Health Partners, who has contract with the county.

Issues for Facing the Correctional Dept.
• Great increase in mentally ill inmates from previous decades.

• Medications can be too risky or too expensive.

• Mental health medications are difficult to replicate and replace.

• Medical staff can only provide medications to inmates twice a day, thus requiring some inmates to adjust their schedules.

• Inmates’ family members often disapprove of the staff making adjustments to medications.

• Inmates may not want to take medication due to belief that he does not need it.

Treatment Available to Inmates
• Medication

• Private sessions with social workers

• Private sessions with psychiatrists

What type of mental health services should be available at local county jails?
5.) What percentage of Clermont County Jail inmates are mentally ill?
A.) ~30%
B.) ~40%
C.) ~50%
D.) ~60%
Issue and Holding
Arguments on Appeal
Issue and Procedural History
Clue: Hospital
Full transcript