In 1973, a lawsuit challenging conditions at the Lima State Hospital (LSH) in Lima, Ohio, was filed against Ohio mental health officials in the United States District Court for the Northern District of Ohio. The plaintiffs, represented by the Advocates for Basic Legal Equality, sought injunctive and declaratory relief, alleging numerous constitutional violations. The plaintiffs raised at least twenty-three separate claims, including minimum standards for physical and psychiatric care, individualized planning, the quality of mental health services and facilities, diagnostic techniques and clinical evaluation, staff levels, staff qualifications, staff training, and the right to refuse medication.
Two hundred seventy-two attendants and eighty-two specialized professionals, including medical doctors and psychologists, served approximately 750 mentally ill patients at LSH. According to the court, the facility more closely resembled a prison than a therapeutic hospital. A thirteen-foot high fence, topped with barbed wire, and seven guard towers surrounded LSH's twenty-four locked wards. Patients were routinely chemically or physically restrained and placed in seclusion. Psychotropic medication dosages were adjusted by direct care staff, instead of by a physician. A single-judge court adjudicated most of the claims, but one claim, that staff numbers at the mental hospital violated the patients' Fourteenth Amendment due process rights, was determined appropriate for a three-judge panel. The single-judge court issued four orders between 1974 and 1980.
On September 9, 1974, the court issued an order which (1) delineated minimal constitutional standards for care, including physical care and hygiene, (2) recognized the right to individualized planning, (3) acknowledged the right to treatment in a humane and therapeutic environment, (4) and articulated the right to keep and use personal property. On December 9, 1974, the court issued a second order, which mandated that clinical evaluation and diagnoses meet with the requirements of the Fourteenth Amendment. On September 24, 1978, the court issued a third order, which addressed the role of security in a mental hospital.
On September 16, 1980, the district court (Judge Nicholas J. Walinski, Jr.) ruled on all remaining issues including the right to refuse medications, the connection between staff and treatment, and conditions of the institution. Davis v. Hubbard, 506 F. Supp. 915 (N.D. Ohio 1980). The majority of the court's opinion focused on the individual's right to refuse psychotropic medication. Citing a litany of litigation and legal theory about bodily integrity, the court concluded that the negative side effects of psychotropic medications and the decreased efficacy of forcibly administered drugs argued strongly for the recognition of individual rights. The court, however, held that the individual's right to refuse was tempered when there is probable cause to believe that the patient presents a present danger to self or others.
The court recognized that the right to treatment presupposes the existence of trained professionals. The court ordered Ohio to (1) determine staffing levels using a statistical time-study rather than fixed ratios, (2) implement new minimum qualifications for psychologists, requiring either a Ph.D. or licensure and four years of experience, and (3) implement a comprehensive skills training program for both new and seasoned employees. The court declined, however, to require that the racial composition of staff mirror that of patients.
In considering the remaining issues, specifically the constitutionality of conditions at the institution, the court differentiated between optimal mental health care and minimum constitutional standards. The court recognized that a federal court had the authority to require a State to meet minimum constitutional standards, but could not compel best practices. As such, the court held that the Fourteenth Amendment (1) does not require independent professional review of individualized programming, (2) requires only 50 square feet of individual living space per patient, (3) requires adequate shower, bathroom, and laundry facilities, (4) requires that patients have control over an adequate light source, and (5) necessitates visitation and reintegration programs and facilities.
The remainder of the court's order dealt with implementing and monitoring institutional changes. The court delegated monitoring duties to the Special Master but declined to set specific deadlines for compliance. We do not have the docket in this case and, therefore, do not know whether litigation continued following this order. It appears, however, that LSH became a correctional facility in 1982.Elizabeth Chilcoat - 07/06/2006