475 F.Supp. 908 (W.D.Mo. 1979), 75 CV 87, Eckerhart v. Hensley

Docket Nº:75 CV 87 C.
Citation:475 F.Supp. 908
Party Name:Thomas ECKERHART et al., Plaintiffs, v. C. Duane HENSLEY et al., Defendants.
Case Date:August 11, 1979
Court:United States District Courts, 8th Circuit, Western District of Missouri

Page 908

475 F.Supp. 908 (W.D.Mo. 1979)

Thomas ECKERHART et al., Plaintiffs,


C. Duane HENSLEY et al., Defendants.

No. 75 CV 87 C.

United States District Court, W.D. Missouri, Central Division.

Aug. 11, 1979

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Stuart R. Berkowitz, Michael U. Bastian, Legal Aid Society of St. Louis, Ronald L. Carlson, St. Louis, Mo., for plaintiffs.

Wm. F. Arnet, Michael Boicourt, Asst. Attys. Gen., Jefferson City, Mo., for defendants.


ELMO B. HUNTER, District Judge.

This is an action in which plaintiffs seek declaratory and injunctive relief regarding treatment and conditions at Fulton State Hospital, Fulton, Missouri. This case was certified as a class action under F.R.Civ.P. 23(b)(2) on September 16, 1977. Plaintiffs represent "all patients involuntarily confined to the Forensic Unit, Fulton State Hospital, on such date as any judgment may be rendered herein disposing of all allegations raised by the plaintiffs, or any portion thereof." 1

Defendants are public officials responsible for the supervision and operation of the Forensic Unit and members of the Missouri Mental Health Commission. Named defendants include Dr. C. Duane Hensley, past Director of the Missouri Department of Mental Health and Dr. James K. Ritterbusch, Superintendent of Fulton State Hospital. 2

The Forensic Unit consists of two residential units, one known as the Marion O. Biggs Building for the Criminally Insane ("Biggs Building") and the other known as the Rehabilitation Unit. The Biggs Building houses patients who, in addition to being mentally ill or mentally disabled, have been deemed to be dangerous to themselves or others to an extent which requires that their care and treatment be conducted under conditions which provide maximum security. The Biggs Building is the only unit of the Missouri Department of Mental Health housing solely maximum security patients. The Rehabilitation Unit also houses patients who have been determined to represent a danger to themselves or others. As a general matter, the conditions of confinement in the Rehabilitation Unit are less restrictive than those prevailing in the Biggs Building. As patients are judged to no longer require confinement in a maximum security setting, they are usually transferred from the Biggs Building to the Rehabilitation Unit where they reside in progressively less restrictive wards until they are transferred to another institution or are discharged.

The patients confined in the Forensic Unit were committed under a variety of statutory provisions. The following describes the types of commitments and approximate

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percentages of the patient population as of March 30, 1979:

Type of commitment Percentage
------------------ ----------
Involuntary civil commitment by
Probate Court [FN3] 15
Not guilty by reason of mental disease
or defect [FN4] 50
Pretrial psychiatric observation and
evaluation [FN5] 12
Criminal sexual psychopath [FN6] 10
Transfers from the Missouri
Department of Corrections [FN7] 2
Incompetent to proceed with trial [FN8] 7
Commitment by Juvenile Court [FN9] 1
Voluntary commitment [FN10] 3

Plaintiffs contend that defendants are in violation of the eighth and fourteenth amendments to the United States Constitution by their failure to provide an adequate program of care and treatment for patients confined in the Forensic Unit. Plaintiffs also claim that certain of defendants' policies and practices regarding visitation, telephone, mail, and the use of seclusion and restraints, violate patients' constitutional rights. This Court has jurisdiction under 28 U.S.C. s 1343(3). I. CONSTITUTIONAL RIGHT TO TREATMENT In Welsch v. Likins, 550 F.2d 1122, 1125, 1126 n.6 (8th Cir. 1977), the Eighth Circuit recognized that noncriminal mentally ill or retarded patients committed to state institutions without their consent have a federal constitutional right to treatment. This recognition was premised upon the district court's holding that the due process clause of the fourteenth amendment requires that mentally retarded persons who have been civilly committed to state mental institutions be afforded at least minimally adequate treatment. Welsch v. Likens, 373 F.Supp. 487, 491-97 (D.Minn.1974). A constitutional right to treatment for mental patients has been recognized in several other circuits. Bowring v. Godwin, 551 F.2d 44, 48 n.3 (4th Cir. 1977) (dicta); Scott v. Plante, 532 F.2d 939, 947 (3d Cir. 1976) (states a claim); Wyatt v. Aderholt, 503 F.2d 1305 (5th Cir. 1974); Rouse v. Cameron, 125 U.S.App.D.C. 366, 373 F.2d 451 (1966) (dicta). Defendants argue that the constitutional right to treatment of civilly committed mental patients is not well established in the law. Rouse v. Cameron, supra, the seminal case in the field, was decided on statutory grounds. "(W)e need not resolve the serious constitutional questions that Congress avoided by prescribing this right." Id. 125 U.S.App.D.C. at 370, 373 F.2d at 455. Adequate treatment was first held to be the Constitutional right of civilly committed mental patients in Wyatt v. Stickney, 325 F.Supp. 781 (M.D.Ala.1971), Aff'd sub nom. Wyatt v. Aderholt, supra. Wyatt involved patients who were generally

involuntarily committed through noncriminal procedures and without the constitutional protections that are afforded defendants in criminal proceedings. When patients are so committed for treatment purposes they unquestionably have a constitutional right to receive such individual treatment as will give each of them a realistic opportunity to be cured

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or to improve his or her mental condition. Rouse v. Cameron, 125 U.S.App.D.C. 366, 373 F.2d 451; Covington v. Harris, 136 U.S.App.D.C. 35, 419 F.2d 617.

Id. at 784. Defendants point out that Judge Johnson's holding in Wyatt relies on cases from the District of Columbia Circuit interpreting statutory rights under the District of Columbia Code. Wyatt v. Stickney was affirmed by the Fifth Circuit, Wyatt v. Aderholt, 503 F.2d 1305 (5th Cir. 1974), on the basis of its earlier decision in Donaldson v. O'Connor, 493 F.2d 507 (5th Cir. 1974). In Donaldson v. O'Connor, plaintiff was involuntarily committed to a state mental hospital for fourteen and one- half years. After his release, he sought to recover damages under 42 U.S.C. s 1983 from hospital and state mental health officials for their failure to provide him with psychiatric care in violation of his claimed constitutional right to treatment. The Fifth Circuit affirmed a judgment for plaintiff and held that the only constitutionally permissible justification for civil commitment of a nondangerous person to a state mental hospital is to provide treatment and that such persons have a constitutional due process right to such treatment. 11 The Supreme Court vacated the judgment of the Fifth Circuit in O'Connor v. Donaldson, 422 U.S. 563, 95 S.Ct. 2486, 45 L.Ed.2d 396 (1975). Defendants contend that the vacation of the Fifth Circuit's opinion in Donaldson, specifically depriving that opinion of precedential effect, 12 brings into question the validity of the entire theory of a constitutional due process right to treatment. The Eighth Circuit has not read O'Connor v. Donaldson in that way 13] Page 914 Defendants further argue that any constitutional right to treatment does not apply to the class of plaintiffs in this case. The great majority of the patients confined in the Forensic Unit came to be there by reason of their involvement in the criminal justice system. Prior to their commitment, these individuals were accused of serious crimes, including acts of violence. 14Many of those patients who were not accused of violent criminal acts prior to their commitment are transfers from other state mental health facilities, in which they could not safely reside due to violent or aggressive behavior. Defendants maintain that the dangerous character of the type of patient in the Forensic Unit provides a constitutionally acceptable basis for confinement Other than for the provision of treatment. Therefore, say defendants, the State may confine such persons, in the exercise of its police power, for their own protection as well as for the protection of others, without being constitutionally required to provide treatment. 15 Defendants also point out that the Wyatt right to treatment cases did not involve a maximum security facility or patients committed because of their danger to themselves or others. Federal courts have previously recognized a constitutional right to treatment in patients similar to those included in the plaintiff class. Scott v. Plante, 532 F.2d 939 (3d Cir. 1976) (incompetent to stand trial); Rouse v. Cameron, 125 U.S.App.D.C. 366, 373 F.2d 451 (1966) (not guilty by reason of insanity); United States v. Pardue, 354 F.Supp. 1377 (D.Conn.1973) (incompetent to stand trial); Davy v. Sullivan, 354 F.Supp. 1320 (M.D.Ala.1973) (three judge court) (criminal sexual psychopath); Stachulak v. Coughlin, 364 F.Supp. 686 (N.D.Ill.1973) ("sexually dangerous person"). In Davis v. Watkins, 384 F.Supp. 1196 (N.D.Ohio 1974), and Davis v. Balson, 461 F.Supp. 842 (N.D.Ohio 1978), the court held that the patients at Lima State Hospital, "a maximum security (hospital) for the criminally insane" operated by the Ohio Department of Mental Health and Mental Retardation, have a constitutional right to treatment. The holding in Davis, which was based on Wyatt v. Stickney, supra, concerned a patient population in many respects identical to that of the Forensic Unit. Davis v. Balson, 431 F.Supp. at 849-50. This Court has no quarrel with defendants' contention that the state may confine the dangerous mental patient against his will in order to protect both society and the patient from his violent behavior. However, that well-settled justification for involuntary confinement does not dispose of the...

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