Olmstead v. L.C.

527 U.S. 581 (1999)
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The Respondents, L. C. and E. W., both mentally disabled women, brought proceedings against the State alleging that the State’s failure to place them in a community-based program, after their treating professional had determined that such a placement was appropriate, violated Title II of the Americans with Disabilities Act of 1990 (ADA).

Title II of the ADA read:

“Subject to the provisions of this subchapter, no qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity.”

Relevant parts of the Attorney General’s Regulations implementing Title II provisions stated that:

  • “A public entity shall administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities”; and that
  • “a public entity must make reasonable modifications in policies, practices, or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program, or activity.”

The Respondents had been voluntarily admitted at different times to the Georgia Regional Hospital at Atlanta. Both were confined for treatment in a psychiatric unit, and when their conditions improved, both received psychiatric evaluations concluding that they could be treated appropriately in a community based setting. When they remained institutionalized despite these evaluations, they brought this challenge. The State contended that “requiring immediate transfers in cases of this order would fundamentally alter the State’s activity.” The State also claimed that “it was already using all available funds to provide services to other persons with disabilities.”

The District Court granted partial summary judgment for the respondents, holding that “unnecessary institutional segregation of the disabled constitute[d] discrimination” under Title II and could not be justified by a lack of funding.  The Court of Appeals affirmed the judgment, but remanded the case for reassessment of the State’s cost-based defense, and whether the additional cost for treatment of L. C. and E. W. in community-based care would be unreasonable given the demands of the State’s mental health budget.

The Court held that under certain circumstances the ADA required placement of persons with mental disabilities in community settings rather than in institutions. The Court held that under the ADA individuals with disabilities had the right to live in community-based settings rather than in institutions when: (1) the State’s treatment professionals had determined that community placement was appropriate; (2) the transfer from institutional care to a less restrictive setting was not opposed by the affected individual; and (3) the placement could be reasonably accommodated, taking into account the resources available to the State and the needs of others with mental disabilities.

In deciding the issue, the Court resolved the following questions:

  • Whether unjustified institutional isolation of persons with disabilities was a form of discrimination under the ADA?

The Court held that under the ADA undue institutionalization qualified as discrimination “by reason of . . . disability.” It explained that the ADA “both require[d] all public entities to refrain from discrimination . . . and specifically identifie[d] unjustified segregation of persons with disabilities as a form of discrimination.”

The Court based its decision on two additional findings:

  1. That “institutional placement of persons who [could] handle and benefit from community settings perpetuate[d] unwarranted assumptions that persons so isolated [were] incapable or unworthy of participating in community life”; and that
  2. “confinement in an institution severely diminishe[d] the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment.
  • How did the Court interpret the State’s “fundamental-alteration” defense?

The Court held that in evaluating a State’s fundamental-alteration defense, a court “must consider, in view of the resources available of the State, not only the cost of providing community-based care to the litigants, but also the range of services the State provides others with mental disabilities, and the State’s obligation to [distribute] those services equitably.” It added that a State must show that “in the allocation of available resources, immediate relief for the plaintiffs would be inequitable, given the responsibility the State ha[d] undertaken for the care and treatment of a large and diverse population of persons with mental disabilities.”

“Recognition that unjustified institutional isolation of persons with disabilities is a form of discrimination reflects two evident judgments. First, institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life. Cf. Allen v. Wright, 468 U. S. 737, 755 (1984) (‘There can be no doubt that [stigmatizing injury often caused by racial discrimination] is one of the most serious consequences of discriminatory government action.’); Los Angeles Dept. of Water and Power v. Manhart, 435 U. S. 702, 707, n. 13 (1978) (‘ ‘In forbidding employers to discriminate against individuals because of their sex, Congress intended to strike at the entire spectrum of disparate treatment of men and women resulting from sex stereotypes.’’ (quoting Sprogis v. United Air Lines, Inc.,444 F. 2d 1194, 1198 (CA71971)).” 527 U.S., pp. 600 - 601.

“Second, confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment. See Brief for American Psychiatric Association et al. as Amici Curiae 20-22. Dissimilar treatment correspondingly exists in this key respect: In order to receive needed medical services, persons with mental disabilities must, because of those disabilities, relinquish participation in community life they could enjoy given reasonable accommodations, while persons without mental disabilities can receive the medical services they need without similar sacrifice. See Brief for United States as Amicus Curiae 6-7, 17.” 527 U.S., p. 601.

“Dissimilar treatment correspondingly exists in this key respect: In order to receive needed medical services, persons with mental disabilities must, because of those disabilities, relinquish participation in community life they could enjoy given reasonable accommodations, while persons without mental disabilities can receive the medical services they need without similar sacrifice. See Brief for United States as Amicus Curiae 6-7, 17.” 527 U.S., p. 601.

“The State's responsibility, once it provides communitybased treatment to qualified persons with disabilities, is not boundless. The reasonable-modifications regulation speaks of ‘reasonable modifications’ to avoid discrimination, and allows States to resist modifications that entail a ‘fundamenta[l] alter[ation]’ of the States' services and programs. 28 CFR § 35.130(b)(7) (1998). The Court of Appeals construed this regulation to permit a cost-based defense ‘only in the most limited of circumstances," 138 F. 3d, at 902, and remanded to the District Court to consider, among other things, "whether the additional expenditures necessary to treat L. C. and E. W. in community-based care would be unreasonable given the demands of the State's mental health budget,’ id., at 905.” 527 U.S., p. 603.

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