University of Michigan Law School
Civil Rights Litigation Clearinghouse
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Case Name U.S. v. District of Columbia MH-DC-0002
Docket / Court 1:07-cv-00889-TFH ( D.D.C. )
State/Territory District of Columbia
Case Type(s) Mental Health (Facility)
Attorney Organization U.S. Dept. of Justice Civil Rights Division
Case Summary
On May 23, 2006, the U.S. Department of Justice's Civil Rights Division ("DOJ") sent its "findings letter" to the District of Columbia's mayor, advising him of the results of the June 2005, DOJ investigation of conditions and practices at the St. Elizabeth's Hospital ("St. E's"), a District ... read more >
On May 23, 2006, the U.S. Department of Justice's Civil Rights Division ("DOJ") sent its "findings letter" to the District of Columbia's mayor, advising him of the results of the June 2005, DOJ investigation of conditions and practices at the St. Elizabeth's Hospital ("St. E's"), a District facility having approximately fifteen buildings housing adults with acute, long-term mental health needs and forensic needs. The investigation occurred under the authority of the Civil Rights of Institutionalized Persons Act ("CRIPA"), 42 U.S.C. § 1997. According to the letter, DOJ and expert consultants visited the facility, reviewed a wide array of documents there, and conducted interviews with personnel and residents. The letter commended St. E'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 numerous deficiencies in patient care at St. E's.

DOJ concluded that these deficiencies at St. E's existed in four topic areas, including (1) protection from harm (e.g., assaults, elopements, suicides, over-reliance on seclusion, restraints, and psychotropic medications, inadequate risk management and quality assurance, environmental health and safety issues) (2) psychiatric and psychological care and treatment (e.g., inadequate treatment planning, assessments, diagnoses, and services), (3) medical and nursing care and treatment (e.g., poor symptom and medication documentation, inadequate infection control); and (4) discharge planning and placement in the most integrated setting. The letter provided details of deficiencies for all four of these categories.

The letter listed, at length, minimally-acceptable remedial measures for each of these categories. It invited continued collaboration toward resolving the deficiencies and alerted the District that, absent improvement, a CRIPA lawsuit would be filed to compel correction of the deficiencies and protection of St. E's patients' rights.

The DOJ letter eventually resulted in cooperative resolution of the hospital's cited problems, at least on paper. District officials and the DOJ reached an agreement that became the basis of a consent judgment filed contemporaneously with a CRIPA complaint against the District. Via DOJ Civil Rights Division lawyers, the United States, on May 11, 2007, filed in the U.S. District Court for the District of Columbia a CRIPA lawsuit against the District and its' officials responsible for operation of St. E's. Alleging violations of the Fifth Amendment's due process clause and of the Americans with Disabilities Act, 42 U.S.C § 12101, and implementing regulations, the complaint sought declaratory and injunctive relief to end the substantial departures from generally accepted professional standards of care at the hospital in the multiple aspects mentioned in the findings letter.

Simultaneously, a settlement agreement was filed which set out detailed remedial measures that the District agreed to implement at St. E's. The agreement also provided for the District to pay for a compliance officer to oversee and report (to the parties and hospital administration) on compliance with each of the agreement's provisions. Measured from the agreement's effective date, the agreement established 12, 18, 24, and 36 month time frames for compliance, depending on the provision at issue. The District also agreed to submit to the United States a corrective action plan every four months and a status report every six months during the agreed-upon five-year period of court jurisdiction over the matter.

In 2011, the U.S. filed a modified settlement agreement, approved by the court, that commended the hospital with continuing to cooperate with the earlier agreement. The revised settlement provides for continuing jurisdiction for another 12 months, to end in October 2012. Following the successful implementation of the remaining provisions of the agreement, the U.S. will no longer monitor compliance.

A separate case seeking similar injunctive and declaratory relief to improve conditions at St. E's had earlier been filed in the same federal court by a protective and advocacy organization, represented both by private counsel and by the organization's counsel. See University Legal Services, Inc. v. St. Elizabeth's Hospital, no. 1:05-cv-00585-TFH-JMF. Extensive discovery and motion practice in that case preceded the CRIPA case's settlement and continued even after the July 27, 2007 CRIPA settlement. This case is available at MH-DC-0004.

Elizabeth Daligga - 07/19/2012

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Issues and Causes of Action
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Integrated setting
Least restrictive environment
Disability (inc. reasonable accommodations)
Aggressive behavior
Classification / placement
Fire safety
Habilitation (training/treatment)
Incident/accident reporting & investigations
Individualized planning
Neglect by staff
Restraints : chemical
Restraints : physical
Sanitation / living conditions
Sex w/ staff; sexual harassment by staff
Staff (number, training, qualifications, wages)
Totality of conditions
Medical/Mental Health
Medication, administration of
Mental health care, general
Suicide prevention
Mental Disability
Mental Illness, Unspecified
Plaintiff Type
U.S. Dept of Justice plaintiff
Type of Facility
Causes of Action Civil Rights of Institutionalized Persons Act (CRIPA), 42 U.S.C. § 1997 et seq.
Defendant(s) Department of Health
District of Columbia
Plaintiff Description U.S. Department of Justice (on behalf of persons institutionalized at St. Elizabeth's Hospital)
Indexed Lawyer Organizations U.S. Dept. of Justice Civil Rights Division
Class action status granted 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 2007 - 2012
Case Ongoing Yes
Additional Resources
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Case Studies From Hospitals to Prisons: A New Explanation
By: Fredrick E. Vars & Shelby B. Calambokidis (Cornell Law Review)
[ Detail ] [ External Link ]

Links Jane Doe v. Hunter College
By: The Bazelon Center (The Bazelon Center)
[ Detail ] [ External Link ]

  Office of Protection and Advocacy v. State of Conneticut
By: The Bazelon Center (The Bazelon Center)
[ Detail ] [ External Link ]

1:07-cv-00889-TFH (D.D.C.)
MH-DC-0002-9001.pdf | Detail
Date: 10/26/2011
Source: PACER [Public Access to Court Electronic Records]
General Documents
Re: CRIPA Investigation of St. Elizabeths Hospital, Washington, D.C.
MH-DC-0002-0001.pdf | Detail
Date: 05/23/2006
MH-DC-0002-0002.pdf | Detail
Date: 05/11/2007
Settlement Agreement
MH-DC-0002-0003.pdf | Detail
Date: 05/11/2007
Modified Settlement Agreement [ECF# 9]
MH-DC-0002-0004.pdf | Detail
Date: 10/26/2011
Source: PACER [Public Access to Court Electronic Records]
Judges Hogan, Thomas Francis (FISC)
MH-DC-0002-0003 | MH-DC-0002-0004 | MH-DC-0002-9001
Plaintiff's Lawyers Brown Cutlar, Shanetta Y. (District of Columbia)
MH-DC-0002-0002 | MH-DC-0002-0003
Contreras, Rudolph (District of Columbia)
Jung, Je Yon (District of Columbia)
MH-DC-0002-0002 | MH-DC-0002-0003 | MH-DC-0002-9001
Kim, Wan J. (District of Columbia)
MH-DC-0002-0001 | MH-DC-0002-0002 | MH-DC-0002-0003 | MH-DC-0002-9001
Leung, Michelle (District of Columbia)
Preston, Judith C. (District of Columbia)
MH-DC-0002-0002 | MH-DC-0002-0003
Defendant's Lawyers Efros, Ellen A. (District of Columbia)
MH-DC-0002-0003 | MH-DC-0002-9001
Singer, Linda R. (District of Columbia)
Valentine, George C. (District of Columbia)

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