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, 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. Elizabeth'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. Elizabeth's.

DOJ concluded that these deficiencies at St. Elizabeth'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. Elizabeth'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, on May 11, 2007, the United States 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. Elizabeth's. The complaint alleged violations of the Fifth Amendment's due process clause and the Americans with Disabilities Act, 42 U.S.C § 12101, and implementing regulations. Plaintiffs 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. Elizabeth'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.

On October 26, 2011, the U.S. filed a modified settlement agreement, approved by the court, that commended the hospital for continuing to cooperate with the earlier agreement. The revised settlement provided for continuing jurisdiction. Following the successful implementation of the remaining provisions of the agreement, the case was dismissed in September 2014. However, the parties' joint motion to dismiss gave notice to the court that monitoring between St. Elizabeth's Hospital and University Legal Services would continue.

A separate case seeking similar injunctive and declaratory relief to improve conditions at St. Elizabeth's had been filed earlier 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. In that case, extensive discovery and motion practice preceded the CRIPA case's settlement and continued even after the July 27, 2007 CRIPA settlement.

Elizabeth Daligga - 07/19/2012
Lauren Latterell Powell - 11/08/2017


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