Case: DOJ CRIPA Investigation of North Carolina’s Public Mental Health Hospitals, Dorothea Dix Hospital in Raleigh, Broughton Hospital in Morganton, Cherry Hospital in Goldsboro, and John Umstead Hospital in Butner

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Case Summary

On March 17, 2004, the U.S. Department of Justice's Civil Rights Division ("DOJ") sent its "findings letter" to North Carolina's governor, advising him of the results of the spring and summer 2002, DOJ investigation of conditions and practices at the four North Carolina public mental health hospitals. Each facility served one of four regions in the state and provided services to a wide variety of patients, including adults with acute and long term care needs, children, adolescents, the elderly…

On March 17, 2004, the U.S. Department of Justice's Civil Rights Division ("DOJ") sent its "findings letter" to North Carolina's governor, advising him of the results of the spring and summer 2002, DOJ investigation of conditions and practices at the four North Carolina public mental health hospitals. Each facility served one of four regions in the state and provided services to a wide variety of patients, including adults with acute and long term care needs, children, adolescents, the elderly, and individuals with substance abuse problems.

The investigation occurred under the authority of the Civil Rights of Institutionalized Persons Act ("CRIPA"), 42 U.S.C. § 1997. DOJ and expert consultants visited the facilities, reviewed a wide array of documents there, and conducted interviews with personnel and residents. The letter commended the state's staff for providing a high level of cooperation during the investigation, as well as the dedication many showed for patient well-being. Nevertheless, the investigation found a number of constitutional and federal statutory violations deficiencies in conditions and patient care at the state's public mental health hospitals.

The DOJ investigation identified multiple substantial departures from generally accepted professional standards of care. The findings letter set out that these deficiencies in conditions of patient care and treatment existed at all four facilities in six topic areas, including (1) inadequate mental health treatment; (2) inappropriate use of restraints and seclusion; (3) inadequate nursing and medical care; (4) failure to ensure the reasonable safety of patients; (5) unsafe physical plant conditions; and (6) inadequate discharge planning, as evidenced by the failure to provide services to discharged patients in the most integrated setting. For all six of these categories, the letter provided examples of deficiencies that usually existed at each of the state's four facilities.

Minimally-acceptable remedial measures for each of these categories were outlined in the letter, which observed that improvements had already been made in some respects at the various facilities since the DOJ inspections occurred. The letter invited further collaborative steps toward remediation, but also notified the state that, absent prompt agreement to alleviate the DOJ's concerns, the federal government could seek to compel the state, via a CRIPA lawsuit, to correct the deficiencies and protect these four hospitals' patients' rights.

It appears the matter settled out of court, bcause according to the Department of Justice Annual Reports to Congress, compliance monitoring continued for several years. The last report listing such monitoring is for Fiscal Year 2009, see so apparently the matter was closed some time thereafter.

Summary Authors

Mike Fagan (5/23/2008)

People


Attorney for Plaintiff

Acosta, R. Alexander (District of Columbia)

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Documents in the Clearinghouse

Docket

Last updated Aug. 30, 2023, 2:30 p.m.

Docket sheet not available via the Clearinghouse.

Case Details

State / Territory: North Carolina

Case Type(s):

Mental Health (Facility)

Key Dates

Closing Date: 2009

Case Ongoing: No

Plaintiffs

Plaintiff Description:

U.S. Department of Justice, on behalf of people with mental illness confined to state public mental health facilities in North Carolina.

Plaintiff Type(s):

U.S. Dept of Justice plaintiff

Attorney Organizations:

U.S. Dept. of Justice Civil Rights Division

Public Interest Lawyer: Yes

Filed Pro Se: No

Class Action Sought: No

Class Action Outcome: Not sought

Defendants

Dorothea Dix Hospital (Raleigh), State

Broughton Hospital (Morganton), State

Cherry Hospital (Goldsboro), State

John Umstead Hospital (Butner), State

North Carolina Department of Health and Human Services, State

Defendant Type(s):

Jurisdiction-wide

Hospital/Health Department

Case Details

Causes of Action:

Civil Rights of Institutionalized Persons Act (CRIPA), 42 U.S.C. § 1997 et seq.

Constitutional Clause(s):

Due Process

Special Case Type(s):

Out-of-court

Available Documents:

None of the above

Outcome

Prevailing Party: Plaintiff

Nature of Relief:

Injunction / Injunctive-like Settlement

Source of Relief:

Settlement

Form of Settlement:

Private Settlement Agreement

Issues

General:

Fire safety

Individualized planning

Informed consent/involuntary medication

Restraints : chemical

Restraints : physical

Staff (number, training, qualifications, wages)

Jails, Prisons, Detention Centers, and Other Institutions:

Confinement/isolation

Disability and Disability Rights:

Integrated setting

Mental impairment

Mental Illness, Unspecified

Medical/Mental Health:

Intellectual disability/mental illness dual diagnosis

Medical care, general

Medication, administration of

Mental health care, general

Suicide prevention

Type of Facility:

Government-run