Oct 2010 DOJ Georgia Case

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Alerts and Updates

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Breaking News

Justice Department Obtains Comprehensive Agreement Regarding the State of Georgia's Mental

Health and Developmental Disability System

WASHINGTON - The Justice Department today announced that it has entered into a comprehensive

settlement agreement that will transform the state of Georgias mental health and developmental disability

system and resolve a lawsuit the United States brought against the state. The lawsuit alleged unlawful

segregation of individuals with mental illness and developmental disabilities in the states psychiatric

hospitals in violation of the Americans with Disabilities Act (ADA) and the Supreme Courts landmark

decision in Olmstead v. L.C.

The U.S. District Court for the Northern District of Georgia will retain jurisdiction to enforce todays

settlement agreement, which supersedes a 2008 agreement between the state and the Office for Civil Rightsof the U.S. Department of Health and Human Services (HHS) concerning Georgias provision of community

services for individuals with mental illness and developmental disabilities. In light of todays agreement and

the progress the state has made in complying with an earlier agreement regarding the conditions in the

psychiatric hospitals, the United States has agreed to withdraw its motions to enforce that earlier agreement.

More than a decade ago, in Olmstead v. L.C., the Supreme Court found that one of Georgias state hospitals

was impermissibly segregating two individuals with disabilities in that hospital when they could have been

served in more integrated settings. The Supreme Court ordered states to serve individuals with disabilities

in the most integrated settings appropriate to their needs.

The Olmstead decision strongly affirmed that people with disabilities have a right to live and receiveservices in the most integrated setting appropriate for them as individuals, said Thomas E. Perez, Assistant

Attorney General for Civil Rights. Under this agreement, the state of Georgia will provide services in the

community to hundreds of people with developmental disabilities and thousands of people with mental

illness. The promises of the ADA and Olmstead will finally become a reality for individuals in Georgia with

mental illness and developmental disabilities.

Georgia is the home of the Supreme Courts Olmstead decision, said Sally Quillian Yates, U.S. Attorney for

the Northern District of Georgia. With this agreement, the state begins to make good on Olmsteads

promise to end the inappropriate segregation of people with disabilities in state hospitals that set apart from

the community.

The expansion of community living opportunities is critical to protecting the civil rights of individuals withdisabilities under Olmstead, said Georgina Verdugo, Director of the Office for Civil Rights at HHS. The

specific requirements and timelines in this agreement will ensure that Georgians with mental illness and

developmental disabilities have the services they need to live full lives in the community and achieve their

goals.

The Justice Department began its investigation in 2007, and found that preventable deaths, suicides and

assaults occurred with alarming frequency in the state hospitals. In January 2009, the department entered

into a settlement agreement with the state of Georgia regarding conditions in the hospitals. Further

investigation found that the state also failed to serve individuals with mental illness and developmental

ntitled Document http://www.thegao.org/Aler

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disabilities in the most integrated setting appropriate to their needs, in violation of the ADA and the Olmstead

decision. In January 2010, the department filed a freestanding complaint under the ADA and a motion for

immediate relief seeking to protect individuals confined in the hospitals from continued segregation and from

threats of harm to their lives, health and safety. The department subsequently entered into extensive

settlement negotiations with Georgia, the Office for Civil Rights and local mental health advocates.

The agreement signed today resolves the ADA lawsuit. The agreement expands community mental health

services so that Georgia can serve individuals with mental illness and developmental disabilities in the mostintegrated setting appropriate to those individuals needs. Under todays agreement, over the next five

years, Georgia will increase its assertive community treatment, intensive case management, case

management, supported housing and supported employment programs to serve 9,000 individuals with

mental illness in community settings. The agreement will also increase community crisis services to

respond to and serve individuals in a mental health crisis without admission to a state hospital, including

crisis services centers, crisis stabilization programs, mobile crisis and crisis apartments; create at least

1,000 Medicaid waivers to transition all individuals with developmental disabilities from the state hospitals to

community settings; and increase crisis, respite, family and housing support services to serve individuals

with developmental disabilities in community settings.

The Civil Rights Division enforces the ADA which authorizes the attorney general to investigate whether a

state is serving individuals in the most integrated settings appropriate to their needs. Please visitwww.justice.gov/crt to learn more about the Olmstead decision, the ADA and other laws enforced by the

Justice Departments Civil Rights Division.

The agreements in this case protecting the rights of individuals with mental illness and developmental

disabilities in Georgia are due to the efforts of the following Special Litigation Section attorneys: Judy

Preston, Acting Chief; Mary Bohan, Deputy Chief; Timothy Mygatt, Special Counsel; Robert Koch, Max

Lapertosa, Richard Farano, Aaron Fleisher, Jeffrey Murray, Jennifer Mondino, David Deutsch, Emily

Gunston, Samantha Trepel, and Amin Aminfar, Trial Attorneys. In addition, the division received support and

assistance from Aileen Bell-Hughes and Mina Rhee, Assistant U.S. Attorneys for the Northern District of

Georgia.

REMARKS AS PREPARED FOR DELIVERY BY ASSISTANT ATTORNEY GENERAL FOR THE CIVIL

RIGHTS DIVISION THOMAS E. PEREZ ON A CONFERENCE CALL REGARDING THE STATE OF

GEORGIAS MENTAL HEALTH AND DEVELOPMENTAL DISABILITY SYSTEM

Good afternoon, and thank you for joining us today. The purpose of this call is to inform you about a

landmark settlement with the State of Georgia that will allow thousands of people with disabilities to receive

services and support to live in their communities, rather than in institutions.

More than a decade ago, in the landmark Olmstead v. L.C. decision, the Supreme Court determined it wasillegal to unnecessarily segregate in institutions people with disabilities who could appropriately receive

services in community-based settings. The decision was hailed as the Brown v. Board of Education of the

disability rights movement a recognition that unnecessarily segregating people with disabilities in

institutions can be just as destructive as segregating children in schools. The Courts decision acknowledged

that segregating individuals with disabilities in institutional settings deprives them of the opportunity to

participate in their communities, interact with individuals who do not have disabilities and make their own

day to day choices.

Unfortunately, in Georgia, where the Olmstead case originated, and in many other states, the promise of the


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/USEOPWHPO/2010/10/19/file_attachments/10775

/Settlement_Agreement_signed_2010_10_19.pdf>

Fact Sheet:

United States v. Georgia

Civil No. 1:10-CV-249-CAP

Settlement Agreement fact sheet

October 19, 2010The Settlement Agreement resolves the Civil Rights Divisions complaint against the State of Georgia

regarding the States failure to serve individuals with developmental disabilities and mental illness in the

most integrated setting appropriate to those individuals needs. Under the Agreement:

DD

Georgia will cease all admissions of individuals with developmental disabilities to their State Hospitals by

July 1, 2011

Georgia will transition all individuals with developmental disabilities in the State Hospitals from the

Hospitals to community settings by July 1, 2015

Georgia will create 1150 home and community based waivers for individuals with developmental disabilities

by July 1, 2015: 750 waivers to help transition individuals from the State Hospitals to community settings,

and 400 waivers to help prevent the institutionalization of those individuals currently living in the community Georgia will serve those individuals receiving home and community based waivers under the Agreement in

their own home or their familys home consistent with each individuals informed choice

Georgia will provide those individuals receiving home and community based waivers under the Agreement

with support coordination to assist them in gaining access to medical, social, education, transportation,

housing, nutritional, and other needed services

Georgia will provide family supports to 2350 families of individuals with developmental disabilities by July 1,

2015, to help those families continue to care for a family member with developmental disabilities at home

Georgia will have six mobile crisis teams by July 1, 2012, to respond to individuals with developmental

disabilities experiencing a crisis anywhere in the community

Georgia will establish 12 crisis respite homes by July 1, 2014, to provide respite services to individuals with

developmental disabilities and their families

MH Georgia will serve in community settings by July 1, 2015, 9000 individuals with serious and persistent

mental illness who currently are served in the State Hospitals, frequently readmitted to the State Hospitals,

frequently seen in Emergency Rooms, chronically homeless, and/or being released from jails or prisons

Georgia will have 22 Assertive Community Treatment (ACT) teams by July 1, 2013, that operate with

fidelity to the Dartmouth ACT model

Georgia will have eight Community Support Teams (CST) by July 1, 2014, that provide services to

individuals in their own home and ensure that community resources needed for the individual to remain in

the community are in place

Georgia will have 14 Intensive Case Management teams by July 1, 2015, comprising 10 full-time case

managers per team, that coordinate treatment and support services and assist individuals with accessing

community resources Georgia will have 45 Case Management service providers by July 1, 2015, that coordinate treatment and

support services and help maintain services and supports already in place

Georgia will establish six Crisis Services Centers by July 1, 2015, to provide walk-in psychiatric and

counseling services in a center that is clinically staffed 24 hours per day, 7 days per week, to receive

individuals in crisis

Georgia will establish three additional Crisis Stabilization Programs by July 1, 2014, to provide psychiatric

stabilization and detoxification services in a community-based setting

Georgia will fund 35 community-based psychiatric hospital beds in non-State community hospitals

Georgia will operate a toll-free statewide telephone system for persons to access information about


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resources in the community to assist with a mental health crisis

Georgia will have mental health mobile crisis teams to respond to individuals experiencing a crisis

anywhere in the community in every county in the State by July 1, 2015

Georgia will have 18 crisis apartments by July 1, 2015, to serve as an alternative to crisis stabilization

programs and to psychiatric hospitalization

Georgia will have the capacity by July 1, 2015, to provide supported housing to any of the 9000 individuals

with serious and persistent mental il lness served under the Agreement who need such support, with 50% of

the supported housing units being provided in scattered-site housing where no more than 20% or two of theunits,

whichever number is greater, are used to provide supported housing under this Agreement

Georgia will provide by July 1, 2015, housing supports to 2000 individuals who are deemed ineligible for

any other benefits

Georgia will provide bridge funding to 540 individuals by July 1, 2014, to support a transition to supported

housing during the time needed for those individuals to become eligible and a recipient of other

supplemental income

Georgia will provide supported employment to 550 individuals by July 1, 2015, in accordance with an

evidence-based supported employment model

Georgia will provide peer support services to individuals receiving ACT and CST services and, by July 1,

2014, to an additional 835 individuals

Georgia will have one case manager and one transition specialist per State Hospital by July 1, 2012, tohelp coordinate the transition of individuals from State Hospitals to community settings

Implementation and Quality Assurance

Georgia will begin performing by July 1, 2012, an annual network analysis to assess the availability in the

community of supports and services for individuals with developmental disabilities and serious and

persistent mental illness

Georgia will institute a quality management system by July 1, 2012, to perform annual quality service

reviews of the community services provided under the Agreement

The Parties selected Elizabeth Jones to serve as an Independent Reviewer to assess the States

compliance with the terms of the Agreement

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Preventing Abuse and Neglect

Crisis in Georgias state institutions Many people have read the series of articles in the Atlanta Journal

Constitutions titled "A Hidden Shame: Death in Georgia's Mental Hospitals." (Click here if you would like

to read the series of articles.) Like most of you, our initial reaction is to be horrified at the loss of life and at

the conditions reported. Through the routine monitoring that GAO engages in, GAO advocates have an

opportunity to witness many of these neglectful conditions within institutional settings. When advocates

witness incidents of abuse and serious neglect we investigate the situation and step in to protect the

vulnerable individual from further harm. GAO believes that the only way to prevent abuse and neglect is by

involving vulnerable people in the life of the community. The highest threat that any group of people can

face is to be congregated and separated away from the rest of society. Some people have concluded that

the current problems with Georgias institutions can be fixed with more funding more staff, larger facilities,

etc. It is our belief, based on experience, that the problem of abuse in institutional settings cannot be fixed

with any amount of funding. GAO recently sent a letter to key State Legislators to express our concerns

about the current crisis in Georgias mental health system. Click here to read the letter outlining our

concerns about the current crisis in Georgias state institutions.

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GAO Objects to Settlement Ending DOJ Lawsuit

As a result of the ongoing dialogue between the Georgia Advocacy Office (GAO) and the United States

Department of Justice (DOJ) regarding the unsafe conditions and practices at the States seven (7)

Psychiatric Hospitals, the AJC "Hidden Shame" series (Click here if you would like to read the series of

articles.), and complaints from other mental health advocates and concerned citizens, the United States filed

a complaint against the State of Georgia. The DOJ alleged that the protections, supports, services, andtreatment at the Hospitals substantially depart from generally accepted professional standards of care and

applicable federal law, thereby exposing the individuals residing there to significant risk of harm, and in

some cases, to actual harm and death. The DOJ and the State of Georgia reached a Settlement Agreement

that would end the lawsuit.The United States found that Georgia's institutions have failed to ensure safety,

failed to provide adequate treatment, have inappropriately used seclusion and restraints, failed to provide

adequate medical care, failed to provide adequate services to people with special needs, and failed to

provide adequate discharge planning to assure placement in the most integrated setting. Georgia confines

persons of all ages with mental illness and developmental disabilities in institutions without specific

standards of care or adequate supervisory, professional and direct care staff. A coalition of stakeholders,

including the Georgia Advocacy Office, Cynthia Wainscott, the Carter Center, Mental Health America, Mental

Health America of Georgia, Georgia Mental Health Consumer Network, Atlanta Legal Aid Society, Georgia

Parent Support Network, Depression and Bipolar Support Alliance, John J. Gates, Ph.D., and GeorgiaCouncil on Substance Abuse, have asked Judge Charles A. Pannell Jr., United States District Court,

Northern Division of Georgia in Atlanta, to withhold approval of the settlement.To view the full documents,

GAOs objections and expert affidavit, stakeholders' objections and Susan Jamieson's affidavit, please click

on this link to the Bazelon Law Center.

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Olmstead / ADA News

On June 22, 1999 the United States Supreme Court held in Olmstead v. L.C. that unjustified isolation of

individuals with disabilities is properly regarded as discrimination based on disability. Click on this link for abrief history of the Olmstead decision. and the most recent news about the decision

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General letter from Lois Curtis to those currently institutionalized or in recovery

3.15.2010

Hello to Everyone -

I remember you. Give me a prayer.

Sometimes I feel good about my life. When I feel bad about my life, I name my country, sing the gospel, and

bring my mind back home.

I will sing with you again. My life is home.

Have a beautiful day.

Lois Curtis

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Its Our Story is a project that is designed to record the power, pride, and personal struggles of living with a

disability. It's a uniquely American story and challenges our most fundamental values of freedom, autonomy,

and independence.

The journey began with Justin Dart, Jr. (1930-2002), who spent much of the 1980's traveling across America

collecting records of the struggles of people with disabilities. Working with hundreds of disability leaders, Mr.

Dart compiled documents from all 50 states into the most comprehensive collection yet assembled of the

history of the disability community. Click here to learn more about Its Our Story and to contribute your ownstory.

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July 26, 2010 marked the 20th anniversary of the signing of the Americans with Disabilities Act into law.

Washington (CNN) -- President Barack Obama commemorated Monday's 20th anniversary of the

Americans with Disabilities Act by signing an executive order to increase government employment of

disabled people.

"Not dependence but independence: That's what the ADA was all about," Obama said at a White Housereception attended by several hundred guests, including Cabinet members, legislators and activists for the

disabled.

The law, which President George H.W. Bush signed July 26, 1990, is credited with smashing barriers and

creating opportunities for the disabled in a nation where more than 3 million people 15 and older use

wheelchairs.

It prohibits discrimination against disabled people, guaranteeing them equal opportunity in employment,

transportation, government services and other areas.

Although some critics say the act can be burdensome, costly and an overextension of the government's

authority over the private sector, others say it could be stronger.

The executive order signed by Obama calls for strategic planning, mandatory training and other steps to

increase federal hiring of people with disabilities.

In addition, Obama said, the Department of Justice was publishing rules to prohibit disability-based

discrimination by state and local governments as well as private businesses.

He called the 1990 law "one of the most comprehensive civil rights bills in the history of this country" and

cited examples of people who faced discrimination for their disabilities or overcame them.

"When told you can't, you responded with that age-old American creed, 'yes, we can,' " Obama said;

applause and cheers greeted his 2008 campaign theme.

The outdoor commemoration featured a presentation in sign language by actress Marlee Matlin, who starred

in the film "Children of a Lesser God," and musical performances by Nathaniel Anthony Ayers, the subject of

the film "The Soloist," and Patti LaBelle.

Also Monday, Democratic Rep. James Langevin of Rhode Island, who is a quadriplegic, became the first

person in a wheelchair to preside over the House of Representatives.


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Restraint and Seclusion

Restraint and Seclusion in Educational Settings

The Georgia Advocacy Office is investigating abuse, neglect, and deaths on a daily basis and working with

people with disabilities, family members, schools, advocates, and the state to end the most harmful

practices.

The National Disability Rights Network (NDRN) published a paper in January, 2009 reporting on the use of

restraint and seclusion in educational settings. NDRN collected information from Protection and Advocacy

organizations around the country, including the Georgia Advocacy Office. Many states have laws and

regulations concerning the use of restraint and seclusion in educational settings. Georgia currently does not

have any such regulations. The use of restraint and seclusion has led to psychological harm, physical harm,

and even death. Click here to read the full report and to learn about the efforts of NDRN to advocate for

national legislation around the use of restraint and seclusion in educational settings. If you know of a

student who is experiencing restraint and seclusion and would like to discuss the individual situation, please

contact our Resource Advocacy Unit by calling 404.885.1234 or 800.527.2329 (both number are voice or

TTY), via email at [email protected], or writing to Georgia Advocacy Office, Resource Advocacy Unit, 150 E.

Ponce de Leon Ave. NE, Suite 430, Decatur, GA 30030.

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Safe Schools Initiative

July 8, 2010 was a historic day for Georgia public school students, as the State Board of Education voted

unanimously to enact Rule 160-5-1-.35 which prohibits the use of seclusion, prone restraint, mechanical

restraint, and chemical restraint. The Rule limits the use of physical restraint to those situations involving

imminent danger. Additionally, the Rule requires schools to notify parents within one school day that theirchild has been restrained. Before this historic vote, schools could restrain or seclude any student, at any

time, for any reason.

The Safe Schools Initiative commends the Department of Education and the State Board of Education on

this inaugural action to limit these dangerous practices. However, one key safeguard is noticeably missing:

there are no provisions for reporting incidents of restraint beyond informing parents. Oversight, data

collection and analysis are pivotal in identifying schools that need additional support to appropriately

maintain a safe educational environment. After receiving overwhelming public support for data collection, the

Board decided to withhold data collection about individual districts until the federal government mandates

such practice. The Board publicly announced its eventual intent to collect outcome data; but the timeline,

methodology, and stakeholder access to information are all unknown.

The Safe Schools Initiative is a collaborative effort of five organizations the Georgia Advocacy Office, the

Georgia Council on Developmental Disabilities, the Center for Leadership in Disability at Georgia State

University, the Institute on Human Development and Disability at the University of Georgia, and Parent to

Parent of Georgia to end the restraint and seclusion of students in Georgia schools.

For more information about the Safe Schools Initiative, please contact Jenny Holland (voice or TTY) at (404)

885-1234, (800) 537-2329 or via email [email protected].


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PREVIOUSLY IN GEORGIA, students in public schools could be restrained and secluded for any reason, at

anytime, by any employee of a school district, without telling the students family. On May 13, 2010, the

Georgia State Board of Education initiated Rule 160-5-1-.35 Seclusion and Restraint for All Students,

which bans seclusion and greatly limits the use of restraints for all students in Georgia public schools.

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Call to Action to End the Use of Aversive Treatments and Updates

A letter was sent in September of 2009 to the Office of Disability, Department of Health and Human

Services; the Secretary of the Department of Health and Human Services; the Secretary of the U.S.

Department of Education; the Attorney General of the United States; the U.S. Department of Justice; the

House Committee on Education and Labor; the Senate Committee on Health, Education, Labor, and

Pensions; Amnesty International; Human Rights Watch; and Physicians for Human Rights asking that the

agencies organizations take action to put an end to the use of all inhumane and unnecessary methods of

behavior modification used in some schools and residential facilities for children and adults with disabilities

in the United States. Click here to read the letter and follow up correspondnce.

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Georgia Senate Bill 507

In the 2008 legislative session, the Georgia General Assembly passed Senate Bill 507, a bill that is certain

to impact the provision of services to Medicaid-eligible children in Georgia.Click hereto read an article that

will explain the relationship between this new legislation and the Early and Periodic Screening, Diagnostic,

and Testing (EPSDT) provisions of the federal Medicaid Act and a report on a Spring 2008 decision from a

federal court in Georgia in a case brought to enforce these EPSDT provisions.

Click here to read the text ofSenate Bill 507.

Click here to read a basic explanation ofEPSDT

Click here to read a copy of the Opinion and Order entered by Judge Thrash dated February 17, 2010,

granting GAO's Second Motion for a Temporary Restraining Order and Preliminary Injunction in Hunter v,

Medows, Civil Action File No. 1:08-cv-2930-TWT. Hunter is a companion case to Moore v. Medows. Both

cases involve EPSDT and the respective roles of the treating physician in prescribing treatment and the

states role in reviewing the doctors order for treatment of children under age 21 years who are Medicaid-

eligible. Both cases involve the states partial denial of nursing services ordered for these children by their

treating physicians. The gist of the Opinion and Order is that the state may review a treating physicians

order for fraud, abuse of the Medicaid system, or whether the treatment prescribed is within the reasonable

standards of medical care. Otherwise, the state may not second guess a physicians prescribed treatment

for his patient.

More information on Living in Community using Medicaid Waivers

The Children's Freedom Initiative - a collaboration to ensure that children live in permanent, family homes

and not in institutions and nursing facilities - has a website which you can view at www.georgiacfi.org . GAO

has worked on this Initiative since 2005. The site includes video from the Commissioner of the

Administration on Developmental Disabilities, a historical timeline of the CFI, and resources in Georgia that

can help families find services for their children to stay out of facilities.


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Voting Rights

Register to Vote!

Click here to read about Voter Rights or for general Voter Information.

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Accessibility Guidelines Published on July 23, 2004. For details visit the Access Board website and read

individual chapters or download the entire 161 pages.

Date: Tuesday, November 16, 2010 11:52 AM

Subject: Justice Department Makes the 2010 ADA Standards for Accessible Design Available to Online

Viewers Nationwide

WASHINGTON - The Justice Department today made available online the 2010 ADA Standards for

Accessible Design (2010 Standards or Standards). These standards were adopted as part of the revised

regulations for Title II and Title III of the Americans with Disabilities Act of 1990 (ADA). The standards can be

found at www.ada.gov/2010ADAstandards_index.htm .

When the standards go into effect on March 15, 2012, they will set minimum requirements - both

scoping and technical - for new construction and alterations of the facilities of more than 80,000 state and

local governments and over seven million businesses. Until the 2012 compliance date, entities have the

option to use the revised standards to plan current and future projects so that their buildings and facilities

are accessible to more than 54 million Americans with disabilities.

"To protect the right of people with disabilities to participate in everyday life with family, friends, andcolleagues, we must ensure access to buildings and facilities," said Thomas E. Perez, Assistant Attorney

General of the Civil Rights Division. "This online version of the 2010 ADA Standards for Accessible Design

will enable architects, contractors, local government service providers, small business owners, disability

rights advocates, and others to find in one place the information they need to provide that accessibility.

Whether they search the standards on laptops, desktops or smart phones, in offices, in the field or at home,

they can find answers to their questions quickly and efficiently."

On July 26, 2010, the 20th anniversary of the ADA, President Obama announced newly revised ADA

regulations. The final regulations were published in the Federal Register on Sept. 15, 2010. The 2010

Standards, which were adopted as part of the revised regulations, consist of regulatory text and the 2004

ADA Accessibility Guidelines, originally published in the Federal Register as 36 CFR part 1191, appendices

B and D. To make it easier for readers to find the necessary requirements for their projects, the departmentassembled this online version that brings together the information in one easy-to-access location and

enables viewers to search the text efficiently with their Internet browsers.

In addition to the official version of the 2010 Standards, the department has also posted on the website

important guidance about the standards that is compiled from material in the Title II and Title III regulations.

This guidance provides detailed information about the department's adoption of the 2010 Standards,

including changes to the standards, the reasoning behind those changes, and response to public comments

received on these topics.


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Oct 2010 DOJ Georgia Case

Documents

Transcript of Oct 2010 DOJ Georgia Case