Two Important Alabama Two Important Alabama CasesCases

R.C. v. FullerR.C. v. Fuller

R.C. v. FullerR.C. v. Fuller

Bill Fuller, Commissioner of the Bill Fuller, Commissioner of the Alabama Department of Human Alabama Department of Human Resources (DHR)Resources (DHR)

Case has changed names as new Case has changed names as new commissioners are appointedcommissioners are appointed

Originally filed in 1988Originally filed in 1988

Who was R.C.?Who was R.C.?

Emotionally disturbed child Emotionally disturbed child Removed from the family home due to Removed from the family home due to

allegations of abuse and neglectallegations of abuse and neglect Though he had never been diagnosed Though he had never been diagnosed

as psychotic or seriously mentally ill, as psychotic or seriously mentally ill, Given large doses of psychoactive Given large doses of psychoactive

medications while in the state's medications while in the state's custody.custody.

What did DHR do?What did DHR do?

First, DHR placed R.C. in a psychiatric First, DHR placed R.C. in a psychiatric hospital for a few weeks. hospital for a few weeks.

Next, they transferred him to the psychiatric Next, they transferred him to the psychiatric unit of a second hospital for six months. unit of a second hospital for six months.

R.C. left the psychiatric unit for a few days R.C. left the psychiatric unit for a few days then returned for another six-month stay. then returned for another six-month stay.

Next stop was a home for children who are Next stop was a home for children who are psychotic or suffer serious behavioral psychotic or suffer serious behavioral disorders.disorders.

Medicated, restrained, and isolatedMedicated, restrained, and isolated

What did DHR do?What did DHR do?

R.C.'s father tried to visit and was denied R.C.'s father tried to visit and was denied access to his sonaccess to his son

Institutional authorities labeled R.C.'s Institutional authorities labeled R.C.'s father a troublemaker due to his protests father a troublemaker due to his protests regarding R.C.'s treatment and lack of regarding R.C.'s treatment and lack of access of family visitationaccess of family visitation

After the lawsuit was filed on R.C.'s behalf, After the lawsuit was filed on R.C.'s behalf, DHR returned R.C. to his father but offered DHR returned R.C. to his father but offered no assistance to the familyno assistance to the family

Plaintiffs asserted that DHR violated Plaintiffs asserted that DHR violated their constitutional rights to: their constitutional rights to:

Family integrity Family integrity Proper care while in state custodyProper care while in state custody Adequate mental health careAdequate mental health care Reasonable efforts toward reunificationReasonable efforts toward reunification Freedom from discrimination on the basis Freedom from discrimination on the basis

of their disabilitiesof their disabilities

ResultsResults Solve problems instead of simply removing children Solve problems instead of simply removing children

from the home;from the home; Investigating allegations of abuse and neglect Investigating allegations of abuse and neglect

faster;faster; Providing appropriate and stable placements for Providing appropriate and stable placements for

children removed as a last resort;children removed as a last resort; Reducing caseloads for social workers and Reducing caseloads for social workers and

investigators;investigators; Devoting more resources to the DHR county Devoting more resources to the DHR county

agencies; andagencies; and Providing appropriate mental health services for Providing appropriate mental health services for

children with special needs.children with special needs.

Consent DecreeConsent Decree Required the creation of a "system of care" Required the creation of a "system of care" Principles emphasizing placement prevention, Principles emphasizing placement prevention,

family reunification, permanency, and home-based family reunification, permanency, and home-based and community-based services. and community-based services.

Designed to assist children (1) with emotional or Designed to assist children (1) with emotional or behavioral disorders who are in foster care; (2) with behavioral disorders who are in foster care; (2) with emotional or behavioral disorders who are at emotional or behavioral disorders who are at imminent risk of foster care placement; and/or (3) imminent risk of foster care placement; and/or (3) at imminent risk of foster care placement who are at imminent risk of foster care placement who are at high risk of developing emotional or behavioral at high risk of developing emotional or behavioral disorders.disorders.

Consent DecreeConsent Decree Protect children from abuse and neglectProtect children from abuse and neglect Enable the children to live with their familiesEnable the children to live with their families Achieve permanency and stabilityAchieve permanency and stability Become stable, gainfully employed adults Become stable, gainfully employed adults

pursuant to an individualized service plan. pursuant to an individualized service plan. Structured to ensure that family preservation Structured to ensure that family preservation

services are provided to most children at services are provided to most children at imminent risk of foster placement.imminent risk of foster placement.

Wyatt v. StickneyWyatt v. Stickney

Wyatt v. StickneyWyatt v. Stickney Ended December 5, 2003 after 33 Ended December 5, 2003 after 33

yearsyears Longest running mental health lawsuit Longest running mental health lawsuit

in U.S. historyin U.S. history The ruling decreed that people with The ruling decreed that people with

mental disabilities had a constitutional mental disabilities had a constitutional right to personal treatment with right to personal treatment with minimum standards of care. minimum standards of care.

Included staffing, diet and nutrition, Included staffing, diet and nutrition, safety, physical plant adequacy, etc.safety, physical plant adequacy, etc.

Wyatt v. StickneyWyatt v. Stickney 9 Alabama governors9 Alabama governors 14 state mental health 14 state mental health

commissionerscommissioners Litigation expenses at over $15 Litigation expenses at over $15

millionmillion

Lessard v. Schmidt Lessard v. Schmidt Changed involuntary commitment policy.Changed involuntary commitment policy. 1971 Federal Court in Milwaukee struck 1971 Federal Court in Milwaukee struck

down Wisconsin's commitment law as down Wisconsin's commitment law as unconstitutional.unconstitutional.

Traditional parens patriae grounds for Traditional parens patriae grounds for commitment abolished.commitment abolished.

Commitment statutes in most states were Commitment statutes in most states were too broad and vague and procedural too broad and vague and procedural protections absent.protections absent.

Could be committed if considered "a proper Could be committed if considered "a proper subject for custody and treatment." subject for custody and treatment."

Lessard v. Schmidt Lessard v. Schmidt Established dangerousness standard for Established dangerousness standard for

involuntary commitment.involuntary commitment. ““Extreme likelihood that if the person is Extreme likelihood that if the person is

not confined he will do immediate harm to not confined he will do immediate harm to himself or others.”himself or others.”

Individual to be accorded all the Individual to be accorded all the procedural protections of the criminal law.procedural protections of the criminal law.

““The enormity of what this case has The enormity of what this case has accomplished cannot be overstated. accomplished cannot be overstated. The principles of humane treatment The principles of humane treatment

of people with mental illness and of people with mental illness and mental retardation embodied in this mental retardation embodied in this litigation have become part of the litigation have become part of the fabric of law in this country and, fabric of law in this country and,

indeed, international law.”indeed, international law.”

- - Judge Myron ThompsonJudge Myron Thompson

So what started all of this?So what started all of this?

A cut in Alabama's A cut in Alabama's cigarette tax.cigarette tax.

The BeginningsThe Beginnings

Filed in October of 1970 on behalf of Filed in October of 1970 on behalf of Ricky WyattRicky Wyatt

Patient at Bryce HospitalPatient at Bryce Hospital a fifteen-year-old who had always a fifteen-year-old who had always

been labeled a "juvenile delinquent“been labeled a "juvenile delinquent“ Was not diagnosed with a mental Was not diagnosed with a mental

illnessillness Aunt was a Bryce employeeAunt was a Bryce employee

The BeginningsThe Beginnings

Initial suit response to layoffs of Initial suit response to layoffs of employees due to budget constraintsemployees due to budget constraints

Over 100 employees including over Over 100 employees including over 20 professional staff20 professional staff

Mental health employees filed suit, Mental health employees filed suit, including the superintendent, Dr. including the superintendent, Dr. Stonewall StickneyStonewall Stickney

The BeginningsThe Beginnings Argued that lay-offs of professional staff would Argued that lay-offs of professional staff would

preclude even minimal treatment of patients preclude even minimal treatment of patients at Bryceat Bryce

Adding the patient enabled the suit to allege Adding the patient enabled the suit to allege that patients' treatment suffered as a result of that patients' treatment suffered as a result of the layoffs. the layoffs.

Federal District Judge Frank M. Johnson Federal District Judge Frank M. Johnson dismissed the part of the suit brought by the dismissed the part of the suit brought by the professionals.professionals.

Consented to hear the part of the suit dealing Consented to hear the part of the suit dealing with the patients' grievances. with the patients' grievances.

Conditions in 1970Conditions in 1970

Three psychiatrists to serve over 5,000 Three psychiatrists to serve over 5,000 patientspatients

Other professional staffing deplorably Other professional staffing deplorably lowlow

Discharge was virtually impossibleDischarge was virtually impossible Intolerable conditions and improper Intolerable conditions and improper

treatments designed only to make the treatments designed only to make the patients more manageablepatients more manageable

Food budget at 50 cents a dayFood budget at 50 cents a day

““Human feces were caked on the toilets Human feces were caked on the toilets and walls; urine saturated the aging oak and walls; urine saturated the aging oak

floors; many beds lacked linen; some floors; many beds lacked linen; some patients slept on floors. Archaic shower patients slept on floors. Archaic shower stalls had cracked and spewing shower stalls had cracked and spewing shower

heads. One tiny shower closet served 131 heads. One tiny shower closet served 131 male patients; the 75 women patients male patients; the 75 women patients also had but one shower. Most of the also had but one shower. Most of the

patients at Jemison were highly patients at Jemison were highly tranquilized and had not been bathed in tranquilized and had not been bathed in

days. All appeareddays. All appearedto lack any semblance of treatment. The to lack any semblance of treatment. The

stench was almost unbearable."stench was almost unbearable."

Photographs by Chip CooperPhotographs by Chip Cooper

By Chip CooperBy Chip Cooper

The CaseThe Case Judge Johnson gave the state six months to Judge Johnson gave the state six months to

implement fully the "right to treatment" at Bryce implement fully the "right to treatment" at Bryce Hospital.Hospital.

When state failed, he laid out specific When state failed, he laid out specific requirements the hospital would have to meet.requirements the hospital would have to meet.

Assumption was that if these objectively Assumption was that if these objectively measurable conditions were met, treatment would measurable conditions were met, treatment would necessarily follow.necessarily follow.

Included such things as how often linen had to be Included such things as how often linen had to be changed, how many showers a patient should changed, how many showers a patient should receive, and what furniture should be in the receive, and what furniture should be in the dayroom.dayroom.

The CaseThe Case State appealed but circuit court held up State appealed but circuit court held up

decisiondecision In June 1977, complaining that the state In June 1977, complaining that the state

was still not living up to the mandated was still not living up to the mandated standards, the plaintiffs succeeded in standards, the plaintiffs succeeded in obtaining a federal court office to monitor obtaining a federal court office to monitor state compliance with Wyatt standards.state compliance with Wyatt standards.

Office abolished in 1986Office abolished in 1986 Case ended December 5, 2003Case ended December 5, 2003

ResultsResults Court-ordered agreements formed the basis Court-ordered agreements formed the basis

for federal minimum standards for the care of for federal minimum standards for the care of people with mental illness or mental people with mental illness or mental retardation who reside in institutional settings.retardation who reside in institutional settings.

Seminal case in achieving drastic Seminal case in achieving drastic deinstitutionalization of previously committed deinstitutionalization of previously committed patients.patients.

Population at state psychiatric hospitals Population at state psychiatric hospitals reduced by almost two-thirds between 1970 reduced by almost two-thirds between 1970 and 1975 (even while expenditures were and 1975 (even while expenditures were increased by 327%)increased by 327%)

ResultsResults Set minimum standards of careSet minimum standards of care Established patient rightsEstablished patient rights Fostered the downsizing of state institutions Fostered the downsizing of state institutions Proliferation of community servicesProliferation of community services Consumers now sit on boardsConsumers now sit on boards Led to Olmstead v. L.C. decisionLed to Olmstead v. L.C. decision ADA may require states to provide community-ADA may require states to provide community-

based services rather than institutional based services rather than institutional placements for individuals with disabilitiesplacements for individuals with disabilities

Least restrictive environmentLeast restrictive environment

Unfortunate ResultsUnfortunate Results State invested an enormous sum of money on State invested an enormous sum of money on

improvements to outmoded buildings which improvements to outmoded buildings which were promptly abandoned as large numbers of were promptly abandoned as large numbers of patients were releasedpatients were released

Throughout the country, patients were dumped Throughout the country, patients were dumped from hospitals, supposedly to be cared for in the from hospitals, supposedly to be cared for in the community without alternative facilities in place community without alternative facilities in place to care for them.to care for them.

Community mental health not properly fundedCommunity mental health not properly funded Many who would have gotten care in mental Many who would have gotten care in mental

institution now “warehoused” in prisons and jailsinstitution now “warehoused” in prisons and jails

"Wyatt Standards""Wyatt Standards"

Humane psychological and physical Humane psychological and physical environmentenvironment

Qualified and sufficient staff for Qualified and sufficient staff for administration of treatmentadministration of treatment

Individualized treatment plansIndividualized treatment plans Minimum restriction of patient Minimum restriction of patient

freedom.freedom.

““There can be no legal or moral There can be no legal or moral justification for the State of Alabama's justification for the State of Alabama's failing to afford adequate treatment for failing to afford adequate treatment for persons committed to its care from a persons committed to its care from a medical standpoint. Furthermore, to medical standpoint. Furthermore, to

deprive any citizen of his or her liberty deprive any citizen of his or her liberty upon the altruistic theory that the upon the altruistic theory that the

confinement is for humane therapeutic confinement is for humane therapeutic reasons and then fail to provide adequate reasons and then fail to provide adequate treatment violates the very fundamentals treatment violates the very fundamentals

of dueof dueprocess.”process.”

—Federal Judge Frank M. Johnson, Jr.—Federal Judge Frank M. Johnson, Jr.