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Case Name U.S. v. California MH-CA-0004
Docket / Court 2:06-cv-02667-GPS-E ( C.D. Cal. )
State/Territory California
Case Type(s) Disability Rights-Pub. Accom.
Mental Health (Facility)
Attorney Organization U.S. Dept. of Justice Civil Rights Division
Case Summary
On May 2, 2006, the United States Department of Justice, Civil Rights Division, filed this lawsuit in the U.S. District Court for the Central District of California against California and state officials responsible for operation of two California mental hospitals: the Metropolitan State Hospital ... read more >
On May 2, 2006, the United States Department of Justice, Civil Rights Division, filed this lawsuit in the U.S. District Court for the Central District of California against California and state officials responsible for operation of two California mental hospitals: the Metropolitan State Hospital and the Napa State Hospital. The United States sued under the Civil Rights of Institutionalized Persons Act ("CRIPA"), 42 U.S.C. § 1997, and the Americans with Disabilities Act, 42 U.S.C § 12101. The United States sought declaratory and injunctive relief to end the substantial departures from generally accepted professional standards of care at each hospital that the Department of Justice had identified in multiple CRIPA investigations during the proceeding years.

The first investigation involved the Metropolitan State Hospital ("MSH"). On May 13, 2003, the U.S. Department of Justice's Civil Rights Division ("DOJ") sent a findings letter to California's governor, advising him that it had identified "significant and wide-ranging" deficiencies in child and adolescent patient care at MSH, a state facility housing children, adolescents, and adults who suffered from mental illness. The letter resulted from a CRIPA investigation of MSH that occurred during June and July 2002. The letter listed minimally-acceptable remedial measures for each of these categories. It also invited continued collaboration toward resolving the many deficiencies and alerted the state that, absent improvement, a CRIPA lawsuit would be filed to compel correction of the deficiencies and protection of MSH patients' rights.

During the investigation, DOJ and expert consultants visited the facility, reviewed a wide array of documents, and conducted interviews with personnel and residents. The letter commended MSH staff for providing a high level of cooperation during the investigation, as well as the dedication many showed for patient well-being. Nevertheless, the DOJ concluded that deficiencies at MSH existed in a dozen topic areas, including (1) psychiatry; (2) nursing services; (3) psychology; (4) pharmaceutical services; (4) general medical care, including deficiencies in vision services, x-ray reviews, and incontinence and headache evaluation; (5) infection control; (7) dental care; (8) dietary services; (9) placement in the most integrated setting; (10) special education; (11) protection from harm; and (12) First Amendment and due process rights to confidentially communicate with investigators.

On February 19, 2004, the DOJ sent another findings letter to the governor that focused on adult patient care at MSH. The letter described the investigation process as essentially the same as used in reviewing the younger patients' situations; however, the larger number of adult patients (and of programs housing them) made for lengthier investigative and evaluative processes. The findings, however, were equally gloomy. Overall, the DOJ identified significant and wide-ranging deficiencies in MSH's provision of care to adult patients. The letter set out categories of deficiency as follows: (1) substandard integrated treatment planning; (2) inadequate psychiatric, psychological, rehabilitative, and social history assessments; (3) poor to almost-nonexistent discharge planning for placement in the most integrated setting; (4) substantial departures from generally accepted professional standards of care in each of MSH's psychiatric, psychological, nursing and unit-based, pharmaceutical, general medical, infection control, dental, physical and occupational therapy, and dietary treatment services; (5) insufficient documentation of patient care and progress; (6) excessive and unnecessarily restrictive use of seclusion, restraints, and "as-needed" medications; (7) failure to protect patients from harm, stemming from ineffective incident management and quality assurance systems and from multiple environmental hazards; and (8) denial of patients' First Amendment and due process rights to confidentially communicate with investigators.

This second findings letter listed almost twenty pages of minimally-acceptable remedial measures addressing each of these categories. It invited continued collaboration toward resolving the many deficiencies and again alerted the state that, absent improvement, a CRIPA lawsuit would be filed to compel correction of the deficiencies and protection of MSH patients' rights.

A third DOJ findings letter dated June 27, 2005, addressed deficiencies found at the Napa State Hospital ("NSH"), another California mental health facility. The letter began by noting that the state had stopped cooperating with DOJ investigators, denying them and their consultants access to NSH and other state mental health facilities the DOJ was then investigating (Patton and Atascadero state hospitals). The DOJ advised that it drew an adverse conclusion about the facility from the state's non-cooperation. It also considered information from regulatory and standards agencies that had surveyed NSH and information from interviews of NSH staff, advocates, family members of patients, and patients. Not only did DOJ find "significant and wide-ranging" deficiencies in NSH patient care, it concluded these deficiencies were "widespread and systemic." NSH deficiencies had been the subject of a prior CRIPA investigation, which led to a 1990 consent decree that was dismissed in 1995. Nevertheless, the DOJ found that significant problems at NSH had recurred. These problems included: (1) failure to protect patients from harm from assaults and suicide (and from staff sales of illegal drugs to patients); (2) inappropriate use of seclusion, restraint and PRN ("pro re nata" or "as-needed") psychotropic medications; and (3) inadequate medical, nursing and psychiatric care. In addition to the recurring problems, the DOJ received information showing (4) deficient mental health treatment planning, programming, and nutritional management; (5) unsanitary conditions; and (6) failure to place patients in the most integrated setting, as required by law. For each of these categories, the findings letter included several specific examples of malfeasance or misfeasance, often describing instances of neglectful or cruel conduct by state personnel. The DOJ noted that it could obtain remedial measures by filing a CRIPA lawsuit against the state, although the letter invited the state to avoid litigation and work cooperatively with DOJ to resolve the identified deficiencies.

The DOJ letters eventually resulted in cooperative resolution of these hospitals' many problems, at least on paper. California's officials and the DOJ reached an agreement that became the basis of a consent judgment filed contemporaneously with this lawsuit. The consent judgment contained an explicit "Enhancement Plan" nearly eighty pages long. The plan set out details of standards for comprehensive improvements in care and conditions at MSH and NSH. The consent judgment named an expert independent monitor, Mohamed El-Sabaawi, M.D., to oversee the process of implementing these standards. Dr. El-Sabaawi would have full access to the facilities, patients, and staff, and his periodic reports would go to the court, the parties, and hospital administrators.All terms of the plan were to be implemented within three years, except for the immediate implementation of suicide prevention components of the plan. By its terms, the consent judgment would terminate after five years, with earlier termination possible if the state complied earlier. While the consent judgment remained in effect, the court retained jurisdiction to enforce the terms of the order. District Judge George P. Schiavelli promptly accepted the settlement and entered the consent judgment.

Also on May 2, the DOJ sent California findings letters based on its CRIPA investigations of conditions and practices at two more state mental health facilities: Patton State Hospital and Atascadero State Hospital. DOJ officials and expert consultants had visited the facilities, reviewed a wide array of documents and conducted interviews with personnel and residents. The investigations found significant deficiencies in patient care at both Patton and Atascadero Hospitals, specifically with respect to psychiatric and pharmaceutical services, medical care, protection from harm, use of restraints, seclusion, and medications. The findings were broadly similar to those of the MSH and NSH investigations.

On February 27, 2007, the parties filed an amended consent judgment. Its terms and duration remained the same, but it added as defendants the officials operating Patton State Hospital and Atascadero State Hospital. Thus, all four hospitals were subject to the consent judgment's enhancement plan. Judge Schiavelli again entered judgment in accordance with the parties' agreement.

On December 12, 2007, a detainee in Coalinga State Hospital filed a petition for a writ of mandamus to compel the defendants to comply with the amended consent judgment. The plaintiff argued that the judgment applied to the Coalinga State Hospital, where he was being detained. On August 19, 2008, the court denied the petition, finding that the judgment did not apply to residents of the Coalinga State Hospital.

A pro se group of residents at Atascadero moved to intervene in the suit on June 21, 2011. The United States and the defendants both opposed the motion to intervene, and the district court denied the motion on October 31, 2011. The residents appealed, but the Ninth Circuit (Judges Michael D. Hawkins, Sidney R. Thomas, and M. Margaret McKeown) upheld the district court's decision. In a decision filed on August 13, 2013, the panel found that the residents' motion to intervene had been filed too late. 538 F. App'x 759.

Back in November 2011, the court found Atascadero and Patton State Hospitals had sufficiently complied with the consent judgment and no longer were subject to the court's jurisdiction. MSH was later released from the consent agreement in October 2012.

In October 2012, the court released NSH from the consent judgment except regarding sections pertaining to placing residents in prone restraints. A recent restraint death at the hospital prompted the court to continue the restraint-related sections of the consent judgment for one more year. Napa State Hospital was eventually released from the consent judgment in October 2013. The case is now closed.

Kristen Sagar - 10/06/2008
Mike Fagan - 05/22/2008
Elise Coletta - 04/12/2019


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Issues and Causes of Action
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Issues
Benefit Source
Medicaid
Content of Injunction
Discrimination Prohibition
Monitor/Master
Monitoring
Reasonable Accommodation
Reporting
Defendant-type
Hospital/Health Department
Disability
disability, unspecified
Integrated setting
Least restrictive environment
Mental impairment
Discrimination-basis
Disability (inc. reasonable accommodations)
General
Access to lawyers or judicial system
Aggressive behavior
Classification / placement
Confidentiality
Confinement/isolation
Education
Food service / nutrition / hydration
Habilitation (training/treatment)
Individualized planning
Neglect by staff
Record-keeping
Restraints : chemical
Restraints : physical
Sanitation / living conditions
Sex w/ staff; sexual harassment by staff
Sexual abuse by residents/inmates
Special education
Staff (number, training, qualifications, wages)
Suicide prevention
Medical/Mental Health
Dental care
Intellectual disability/mental illness dual diagnosis
Intellectual/Developmental Disability
Medical care, general
Medication, administration of
Mental health care, general
Self-injurious behaviors
Suicide prevention
Vision care
Mental Disability
Autism
Brain injury
Depression
Intellectual/developmental disability, unspecified
Learning disability
Plaintiff Type
U.S. Dept of Justice plaintiff
Type of Facility
Government-run
Causes of Action Americans with Disabilities Act (ADA), 42 U.S.C. §§ 12111 et seq.
Civil Rights of Institutionalized Persons Act (CRIPA), 42 U.S.C. § 1997 et seq.
Defendant(s) Atascadero State Hospital
Metropolitan State Hospital
Napa State Hospital
Patton State Hospital
State of California
Plaintiff Description U.S. Department of Justice (Civil Rights Division)
Indexed Lawyer Organizations U.S. Dept. of Justice Civil Rights Division
Class action status sought No
Class action status granted No
Filed Pro Se No
Prevailing Party Plaintiff
Public Int. Lawyer Yes
Nature of Relief Injunction / Injunctive-like Settlement
Source of Relief Settlement
Form of Settlement Court Approved Settlement or Consent Decree
Order Duration 2006 - 2013
Filing Year 2006
Case Closing Year 2013
Case Ongoing No
Case Listing MH-CA-0002 : DOJ CRIPA Investigation of Atascadero State Hospital, Atascadero, California (C.D. Cal.)
MH-CA-0005 : DOJ CRIPA Investigation of Patton State Hospital (C.D. Cal.)
ID-CA-0005 : U.S. v. California (N.D. Cal.)
Additional Resources
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  An Analysis of CRIPA Findings Letters Issued to Jails for Constitutional Violations by the Department of Justice
Date: Apr. 15, 2016
By: Jeff Mellow, Bryce E. Peterson & Mijin Kim (John Jay College of Criminal Justice Faculty)
Citation: Am. J. Crim. Just. (April 2016)
[ Detail ] [ External Link ]

Docket(s)
2:06-cv-02667-GPS-E (C.D. Cal.)
MH-CA-0004-9000.pdf | Detail
Date: 04/28/2016
Source: PACER [Public Access to Court Electronic Records]
General Documents
RE: Investigation of Metropolitan State Hospital, Norwalk, California
MH-CA-0004-0004.pdf | Detail
Date: 05/13/2003
Re: Metropolitan State Hospital, Norwalk, California
MH-CA-0004-0005.pdf | Detail
Date: 02/19/2004
Re: Napa State Hospital, Napa, California
MH-CA-0004-0001.pdf | Detail
Date: 06/27/2005
Complaint
MH-CA-0004-0002.pdf | Detail
Date: 05/02/2006
Consent Judgment
MH-CA-0004-0003.pdf | Detail
Date: 05/02/2006
Re: Atascadero State Hospital, Atascadero, California
MH-CA-0004-0007.pdf | Detail
Date: 05/02/2006
Re: Patton State Hospital, Patton, California
MH-CA-0004-0010.pdf | Detail
Date: 05/02/2006
Amended Consent Judgment [ECF# 9]
MH-CA-0004-0006.pdf | Detail
Date: 02/27/2007
Source: PACER [Public Access to Court Electronic Records]
Order [ECF# 297-1] (C.D. Cal.)
MH-CA-0004-0008.pdf | Detail
Date: 10/03/2012
Source: PACER [Public Access to Court Electronic Records]
show all people docs
Judges Collins, Audrey B. (C.D. Cal.) show/hide docs
MH-CA-0004-0008
Eick, Charles F. (C.D. Cal.) [Magistrate] show/hide docs
MH-CA-0004-9000
Schiavelli, George P. (C.D. Cal.) show/hide docs
MH-CA-0004-0003 | MH-CA-0004-0006 | MH-CA-0004-9000
Plaintiff's Lawyers Acosta, R. Alexander (District of Columbia) show/hide docs
MH-CA-0004-0005
Birotte, Andre Jr. (California) show/hide docs
MH-CA-0004-0008
Bohan, Mary (District of Columbia) show/hide docs
MH-CA-0004-0003 | MH-CA-0004-0006
Boyd, Ralph F. Jr. (District of Columbia) show/hide docs
MH-CA-0004-0004
Brown Cutlar, Shanetta Y. (District of Columbia) show/hide docs
MH-CA-0004-0002 | MH-CA-0004-0003 | MH-CA-0004-0006
Cuncannan, Jacqueline (District of Columbia) show/hide docs
MH-CA-0004-0003 | MH-CA-0004-0006 | MH-CA-0004-9000
Daniels, Howard F. (California) show/hide docs
MH-CA-0004-0006 | MH-CA-0004-9000
Donnelly, Matthew J. (District of Columbia) show/hide docs
MH-CA-0004-0003 | MH-CA-0004-0006 | MH-CA-0004-0008 | MH-CA-0004-9000
Gonzales, Alberto (District of Columbia) show/hide docs
MH-CA-0004-0002
Jones, Terrence M (California) show/hide docs
MH-CA-0004-0008 | MH-CA-0004-9000
Kim, Wan J. (District of Columbia) show/hide docs
MH-CA-0004-0002 | MH-CA-0004-0003 | MH-CA-0004-0006 | MH-CA-0004-0007 | MH-CA-0004-0010
Maddox, William G. (District of Columbia) show/hide docs
MH-CA-0004-0003 | MH-CA-0004-0006
Perez, Thomas E. (District of Columbia) show/hide docs
MH-CA-0004-0008
Plessman, Gary L. (California) show/hide docs
MH-CA-0004-0006
Schlozman, Bradley (District of Columbia) show/hide docs
MH-CA-0004-0001
Seltman, Lee (District of Columbia) show/hide docs
MH-CA-0004-0003 | MH-CA-0004-0006
Snyder, Anita C. (District of Columbia) show/hide docs
MH-CA-0004-0003 | MH-CA-0004-9000
Tayloe, Benjamin O. (District of Columbia) show/hide docs
MH-CA-0004-0002 | MH-CA-0004-0003 | MH-CA-0004-0006 | MH-CA-0004-0008 | MH-CA-0004-9000
Weidman, Leon W. (California) show/hide docs
MH-CA-0004-0006
Yang, Deborah W. (California) show/hide docs
MH-CA-0004-0003 | MH-CA-0004-0006 | MH-CA-0004-9000
Defendant's Lawyers Angelopoulos, Tracey L. (California) show/hide docs
MH-CA-0004-9000
Burns, Janet E (California) show/hide docs
MH-CA-0004-9000
Furtek, Frank S. (California) show/hide docs
MH-CA-0004-0003 | MH-CA-0004-0006
Kim, Jennifer M. (California) show/hide docs
MH-CA-0004-9000
Prince, George D. (California) show/hide docs
MH-CA-0004-9000
Rodriguez, Cynthia (California) show/hide docs
MH-CA-0004-0003 | MH-CA-0004-0006

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