Case: U.S. v. Vermont

On July 5, 2005, the U.S. Department of Justice's Civil Rights Division ("DOJ") sent its "findings letter" to Vermont's governor, advising him of the results of the late summer 2004, DOJ investigation of conditions and practices at the Vermont State Hospital ("VSH"), a facility housing mentally ill persons. The investigation occurred under the authority of the Civil Rights of Institutionalized Persons Act ("CRIPA"), 42 U.S.C. § 1997. DOJ and expert consultants visited the facility, reviewed a wide array of documents there, and conducted interviews with personnel and residents. The letter commended VSH staff for providing a high level of cooperation during the investigation, as well as the dedication many showed for patient well-being. Nevertheless, the investigation found deficiencies in patient care at VSH, in that conditions and services at VSH substantially departed from generally accepted standards of care. Constitutional and federal statutory rights of patients at VSH were violated in several respects, according to the DOJ.

DOJ concluded that deficiencies in conditions of patient care and treatment at VSH existed as to three topic areas, including VSH's: (1) failure to protect patients from harm and undue restraints (e.g., inadequate suicide prevention measures; use of seclusion and restraints for staff convenience and initial punishment, rather than in patients' best interests; excessive duration and failure to document use of seclusion and restraints); (2) failure to provide adequate psychiatric and psychological services (inadequate and dated treatment planning, psychiatric and psychological assessments and diagnoses; poor medication management and monitoring; rudimentary or non-existent behavior plans) and (3) failure to ensure adequate discharge planning and placement in the most integrated setting appropriate to each patient's individualized needs (e.g., failure to initiate, maintain, monitor, or adjust adequate discharge criteria or to maintain an adequate utilization review process necessary to ensure appropriate lengths of stay). The letter provided details of deficiencies for all three of these categories. Moreover, the findings letter stated that these shortcomings were at times historical problems, rather than sporadic recent failures.

Minimally-acceptable remedial measures for each of these categories were outlined in the letter, which concluded by inviting continued further collaboration in implementing the remediation and by providing notice that, absent a resolution of federal concerns, the DOJ would file a CRIPA lawsuit to compel correction of the identified deficiencies at VSH.

On July 21, 2006, DOJ simultaneously filed both a CRIPA complaint against Vermont and a consent judgment between the parties, the latter setting out an agreed-upon settlement including obligations by the state to implement the remedial measures set out in the findings letter. The lawsuit set out that the state's practices at VSH violated its' patients' Fourteenth Amendment due process rights and their rights under the Americans with Disabilities Act ("ADA"), 42 U.S.C § 12101 et seq., and the ADA's implementing regulations, 28 C.F.R. Part 35.

The settlement obligated the state to ensure (depending on the component of the plan, within six, eighteen, twenty-four, or thirty months) improvements that would bring the facility up to generally accepted professional standards of care, including integrated treatment planning, adequate and complete mental health assessments, and improved discharge planning and community integration. The settlement also set out time frames for psychiatric, psychological, and pharmacy services improvements, documentation improvements, and implementation of modern practices in the use at VSH of restraints, seclusion and emergency use of psychotropic medications, as well as reporting and supervision measures to provide protection from harm and adoption of an integrated incident management system. Improvement in quality assurance and environmental conditions were also mandated by the agreement. The parties' settlement appointed Mohamed El-Saabawi and Jeffrey Geller as jointly-selected experts to monitor the implementation of the agreement, with the federal and state governments, respectively, paying each monitor's reasonable costs and expenses. Every six months, the monitors would produce to the parties a joint report on compliance. The agreement would terminate in four years, unless earlier compliance could be established. District Judge William K. Sessions III approved the settlement and issued a conditional dismissal of the case on July 31, 2006.

Shortly before the settlement agreement was set to expire, the parties agreed to extend the term of the agreement from July to October 2010 in order to continue working together to address conditions at the hospital. Following the parties' Joint Motion for Final Dismissal, on October 28th, 2010, the court dismissed the case with prejudice.