On May 30, 2008, the United States Department of Justice (DOJ) conducted a CRIPA investigation of the Georgia Regional Hospital in Atlanta (GRHA) and recorded several statutory violations. The DOJ concluded that numerous conditions and practices at GRHA violated the constitutional and statutory rights of its residents. In particular, the DOJ found that GRHA: (1) failed to adequately protect its patients from harm; (2) failed to provide appropriate mental health treatment; (3) failed to use seclusion and restraints appropriately; (4) failed to provide adequate nursing and health care; (5) failed to provide adequate services to populations with specialized needs; and (6) failed to provide adequate discharge planning to ensure placement in the most integrated setting. Then, on January 15, 2009, the DOJ conducted another CRIPA investigation, this time of the Northwest Georgia Regional Hospital in Rome. In this investigation, it established the same list of violations it found in its May 30, 2008 investigation.

As a result, the DOJ filed this lawsuit against the State of Georgia on January 15, 2009 in the Northern District Court of Georgia. The case was assigned to Judge Charles A. Pannell, Jr. The U.S. alleged that the services, protections, support, and treatment provided by the GRHA, which housed individuals with developmental disabilities, mental illness, and addictive diseases, was below professional standards and standards required by federal law. The complaint sought injunctive relief to remedy several areas in which the facility's services departed from acceptable standards, including the prevention of abuse and neglect, the provision of mental health services, general healthcare, nutrition, and the provision of physical therapy.

The U.S. brought claims under the Americans with Disabilities Act ("ADA"), alleging that Georgia had failed to meet its obligation to provide appropriate services to individuals with disabilities in the most integrated setting possible, to provide adequate special education services where appropriate, or to ensure the inclusion of those with limited English skills. The U.S. also brought claims under the Due Process Clause of the Fourteenth Amendment, Titles XVIII and XIX of the Social Security Act ("SSA"), the Individuals with Disabilities Education Act ("IDEA"), and Title VI of the Civil Rights Act of 1964.

On the same day the U.S. filed its complaint, the parties submitted a negotiated settlement agreement. The proposed Agreement applied to all Georgia Psychiatric Hospitals and included extensive provisions aimed at the following: 1) protecting patients from harm; 2) improving mental health care; 3) improving treatment planning; 4) eliminating the use of seclusion or restraint except in the case of specific emergencies; 5) improving medical and nursing care; 6) developing service programs for patients with specialized needs, such as limited English proficiency; and 7) pursuing discharge planning whenever possible. The Agreement proposed several methods through which these areas would be improved, including staff training, the creation and implementation of protocols and policies, and monitoring. The parties asked the court to retain jurisdiction over the matter during the period of enforcement.

On February 11, 2009, Judge Charles A. Pannell issued an order adopting the proposed settlement agreement on a temporary basis.

Soon afterward, on March 2, 2009, private individuals and Georgia Advocacy, Inc. filed objections to the proposed Agreement. In sum, these stakeholders argued that the Agreement failed to indicate any plan through which the State would reach the goals it set out to achieve. As such, the stakeholders argued that it was nothing but a promise by the State to "do better." Accordingly, they sought that the parties include a "meaningful and concrete corrective action plan" before approving the Settlement Agreement. The parties and stakeholders met to discuss the issue and, on June 12, 2009, the United States filed a status report explaining that all interested parties had agreed the State would work with the U.S. and stakeholders to create an implementation plan, which it would submit along with its first compliance report.

Given these new terms, on September 30, 2009, the court ordered that the parties submit a new proposed agreement, prompting another round of negotiations.

On January 28, 2010, the U.S. filed a motion for a preliminary injunction. The U.S. alleged that defendant continued to fail to serve individuals in their hospitals in the most integrated setting possible and that those individuals continued to face an unacceptable risk of serious physical harm—including death, suicide, and assault—due to inadequate services. Among other things, the U.S. asked that the State be required to immediately take steps to place individuals in the most integrated setting possible, that an independent monitor be appointed promptly to monitor the State's progress toward implementing the proposed Order, and that the monitor issue an action plan within one month of appointment.

The motion also indicated that, given the uncertain status of the Settlement Agreement and the defendant's failure to implement its terms, the U.S. did not intend to renew the motion to finalize the Settlement Agreement. Instead, along with the motion for a preliminary injunction, it filed a Complaint in a separate case (PB-GA-0004) and moved to file an Amended Complaint in the ongoing case. The U.S. sought to consolidate the two cases and indicated that together, they would provide relief the U.S. requested. The Complaint in the new case was brought under the ADA, while the proposed Amended Complaint in the existing case was brought under CRIPA.

In response, on February 15, 2010, the defendant filed to enforce the Settlement Agreement, arguing that it was binding as a temporary order of the court.

While all of these motions were pending, on August 9, 2010, Judge Pannell ordered the parties to begin discovery.

On September 23, 2010, Judge Pannell denied plaintiff's motions to amend the Complaint and consolidate the cases. The court ordered that the 2009 proposed Settlement Agreement would be adopted as a final order, and explained that the issues the U.S. sought to remedy through an Amended Complaint could instead be addressed through the Complaint filed under the new case in January 2010 ("the 2010 case"). The court also explained that the two cases should remain separate to maintain judicial efficiency and avoid confusion. As for the motion for a preliminary injunction, the court found that because the Settlement Agreement did not address issues related to the immediate relief requested, the U.S. should refile the motion in the 2010 case.

On October 19, 2010, the parties jointly moved to return the case to the court's inactive docket and retain jurisdiction only to enforce the Settlement Agreement. The court granted the motion on October 21.

On February 5, 2014, the parties notified the court that the Settlement Agreement had terminated on January 15, 2014. The parties indicated that the State had achieved substantial compliance with the terms of the Agreement and explained that they would continue to pursue discharge and planning goals through the Agreement reached in the 2010 case. The court dismissed the case with prejudice on February 28, 2014. The case is now closed.

Lauren Latterell Powell - 01/08/2018
Jake Parker - 06/29/2018


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