On July 9, 2002, the U.S. Department of Justice's Civil Rights Division ("DOJ") sent its "findings letter" to Iowa's governor, advising him of the results of the November 1999, and April-May 2001, DOJ investigations of conditions and practices at two state-operated centers for developmentally and mentally disabled persons: the Woodward State Hospital-School (subsequently renamed Woodward Resource Center) ("Woodward") in Woodward, Iowa, and the Glenwood State Hospital-School (subsequently renamed Glenwood Resource Center) ("Glenwood"), in Glenwood, Iowa. The investigations 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 twice, reviewed a wide array of documents there, and conducted interviews with personnel and residents. The letter commended Woodward and Glenwood staff for providing a high level of cooperation during the investigation, as well as the dedication many showed for resident well-being. Nevertheless, the investigation found deficiencies in resident care at both facilities, in that certain conditions and services at one or both substantially departed from generally accepted standards of care. Constitutional and federal statutory rights of residents at the facilities were violated in several respects, according to the DOJ.
DOJ concluded that deficiencies existed in conditions of resident care and treatment (1) at Woodward (and, to a lesser degree at Glenwood), regarding the use of restraints and restrictive procedures (e.g., over-use of restraints; use of electronic tracking devices at Woodward for staff convenience rather than resident care); (2) at Glenwood, regarding the substandard general medical care provided (e.g., lack of a medical director, a peer review quality assurance tool, a pharmacy and therapeutics committee, or policies and protocols to ensure consistent provision of care; insufficient provision of neurological resources) and, (3) at both centers, in their provision of deficient (a) psychiatric and psychological care (e.g., inadequate psychiatric and psychological assessments and diagnoses; unjustified use of psychotropic medications; poor monitoring of treatment outcomes; defective or non-existent pharmacy and therapeutics oversight; failure to obtain informed consent; inappropriate behavior plan development; non-integrated pharmacological and behavior plans), and (b) community placement programs (neither facility had established protocols ensuring adequate assessments to determine the most integrated setting appropriate for individuals' wants and needs). Nutrition management, physical and occupational therapy, and protection from harm deficiencies were described in the letter, depending on the facility, as ranging from non-existent to notable, with Woodward also described as lacking in appropriate habilitation services. Erroneous and incomplete record keeping plagued both facilities, according to the DOJ. The letter provided details of deficiencies for all of these categories.
Minimally-acceptable remedial measures for each of these categories were outlined in the letter, which concluded by inviting continued further collaboration in implementing the remediation. The letter provided notice that, absent a resolution of the federal concerns, the DOJ would file a CRIPA lawsuit to compel correction of the identified deficiencies at Woodward and Glenwood.
On November 18, 2004, in the U.S. District Court for the Southern District of Iowa, DOJ simultaneously filed a CRIPA complaint against Iowa and tendered a settlement agreement between the parties, the latter referencing an attached plan obligating the state to implement remedial measures (believed to be those set out in the findings letter; we do not have a copy of the "plan," so we infer this). The lawsuit, seeking declaratory and injunctive relief, set out that the state's practices at Woodward and Glenwood violated their patients' Fourteenth Amendment due process rights and their rights under the Americans with Disabilities Act ("ADA"), 42 U.S.C §§ 12101 et seq., and the ADA's implementing regulations, 28 C.F.R. Part 35.
The settlement obligated the state to ensure, and to periodically report upon its progress in ensuring, improvements that would bring the facilities up to generally accepted professional standards of care. The settlement also allowed for the United States to conduct regular compliance reviews, with facility inspections and interviews of staff and residents, and to fully access and review relevant documents.
The Court (Judge Ronald E. Longstaff) approved the settlement on November 24, 2004. On December 9, 2004, he issued an unpublished order which administratively closed the case, but retained jurisdiction to enforce his order of November 24th.
In April 2009, the DOJ filed a notice to update the court on the monitoring activities and changes at the two facilities, and extending the monitoring period another year. By May 13, 2010, the defendants filed a notice with the court that the consent decrees for both facilities had expired. There has been no further activity since that time. Elizabeth Daligga - 07/25/2012