On May 15, 1996, the Civil Rights Division of the U.S. Department of Justice (DOJ) sent notice to the Governor of Puerto Rico that it was conducting an investigation into the conditions of confinement at Integral Services ("CIS") in Rio Piedras, Puerto Rico, pursuant to its authority under the Civil Rights of Institutionalized Persons Act ("CRIPA"), 42 U.S.C. § 1997 et seq. CIS was a one of six state-operated residential facilities serving persons with developmental disabilities in Puerto Rico. The DOJ advised the Governor that it would be examining resident safety, the adequacy of medical care, training, staffing, the use of psychotropic medication, and issues involving community placement. The investigation included a tour of the facility in February 1994 by the DOJ and its retained expert consultants in behavioral psychology and psychopharmacology. The DOJ also interviewed Department of Health officials, facility personnel, residents and their family members. Pertinent documents and records were collected and reviewed.
On June 11, 1997, the DOJ issued a findings letter outlining the deficiencies it uncovered at CIS, which included: inadequate food, medicine, shelter and basic care; inadequate psychological, behavioral and psychiatric care and services; inadequate health care; and lack of any integrated community setting. The DOJ also noted that it discovered that similar conditions may have existed at the five other state-operated mental retardation facilities. The DOJ outlined minimum remedial measures to correct the problems at CIS and the other state-operated facilities.
Apparently Puerto Rico didn't undertake those remedial measures to the satisfaction of the federal government; on April 21, 1999, the U.S. Attorney General brought this action against the Commonwealth of Puerto Rico, its Governor, and other state officials. The complaint alleged violations of the Americans with Disabilities Act and the Rehabilitation Act. The complaint was largely a restatement of the DOJ findings listed above. The complaint requested a preliminary injunction enjoining defendants from continuing the practices described in the complaint.
Nine days later, an interim settlement agreement was reached. Under the agreement, the Commonwealth was ordered to improve living conditions at its mental health facilities (e.g. clean drinking water, adequate meals, access to medication, protection of patients' personal belongings). Each element of the agreement had a different effective date. For example, the Commonwealth was to assure immediately that its staff did not neglect or abuse patients, but the Commonwealth had 90 days to provide adequate wheelchairs. Under this agreement, the U.S. had the right to inspect facilities in Puerto Rico as well as request documents, provided that the U.S. gives adequate notice prior to any investigation. Under this agreement, the Commonwealth was also to develop a community-based service plan (CBSP) for individuals with mental disabilities. This interim agreement would be in effect until a comprehensive agreement was reached and a CBSP was filed with the court. Three months later the defendants filed a motion to extend time to "file with plaintiff their draft community based system plan in accordance with the settlement agreement."
On September 6, 2001, a the Commonwealth filed a CBSP with the court. The U.S. filed a motion in support of the agreement on October 10. This plan was created with the goal of placing qualified individuals with mental disabilities who had been previous institutionalized into "the most integrated settings in the community" or "least restrictive settings."
According to the DOJ congressional reports filed annually under CRIPA, monitoring of conditions in the covered facilities and community-based settings continued throughout the decade. In 2008, a "transition order" was entered to ensure that Puerto Rico continued making progress on its obligations during the transition of executive authority following the election. In the order, Puerto Rico was required to continue its efforts on a wide number of objectives including job training, medical care access, and payment for services. On August 17, 2009, the District Court ordered the Commonwealth to adequately fund programs and services required by persons with developmental disabilities, as required in the December 2008 Transition Order. In addition, the Court emphasized the need for the Commonwealth to address the vocational needs of such persons by hiring additional job coaches and job promoters, as well as to ensure better programs, services, and protections to persons with developmental disabilities in the Commonwealth.
Puerto Rico requested that the court monitor enter into a contract with the government of Puerto Rico, but the request was denied by Judge Gelpí in an order on June 27, 2014. The court was concerned that having the monitor in contract with the government of Puerto Rico would undermine the monitor's independence. The CRIPA congressional reports then show continued monitoring through 2014, the last one of them available. Dan Dalton - 03/19/2007
Kate Craddock - 11/08/2015