Thomas S. By Brooks v. Flaherty, C-C-82-418-M.

Decision Date21 November 1988
Docket NumberNo. C-C-82-418-M.,C-C-82-418-M.
Citation699 F. Supp. 1178
CourtU.S. District Court — Western District of North Carolina
PartiesTHOMAS S., by his guardian ad litem, Joyce M. BROOKS, Jeanette H., Todd C., Phillip B. and Margaret R., by her guardian ad litem, Cornelius Manly, on behalf of themselves and all others similarly situated, Plaintiffs, v. David T. FLAHERTY, Secretary, North Carolina Department of Human Resources, and Allen Childress, in his official capacity as guardian for plaintiff Thomas S., Defendants.

COPYRIGHT MATERIAL OMITTED

Edward G. Connette, Gillespie, Lesesne & Connette, Charlotte, N.C., Roger Manus and Deborah Greenblatt, Carolina Legal Assistance, Raleigh, N.C., for plaintiffs.

Wilson Hayman and Doris J. Holton, Asst. Attys. Gen., North Carolina Dept. of Justice, Raleigh, N.C., for defendant Secretary of Human Resources.

FINDINGS OF FACT AND CONCLUSIONS OF LAW

McMILLAN, District Judge.

                                                TABLE OF CONTENTS
                                                                                          Page
                 I. HISTORY OF PROCEEDINGS                                                1181
                II. FINDINGS OF FACT                                                      1183
                    A. Plaintiff-Intervenors                                              1183
                        1. Jeanette H.                                                    1183
                        2. Todd C.                                                        1184
                        3. Phillip B.                                                     1184
                        4. Margaret R.                                                    1184
                    B. Plaintiff Class                                                    1184
                        1. Description of the Class and General Findings                  1184
                        2. Aggression, Self-Abuse and Other Physical Injury               1186
                        3. Drugs                                                          1186
                            i. Adverse Effects                                            1187
                           ii. Standards for Avoiding, Minimizing and Treating Adverse    1187
                                 Effects
                          iii. Behavior Control                                           1188
                           iv. Chemical Restraint                                         1188
                            v. Excessive Dosages                                          1188
                           vi. Polypharmacy                                               1188
                        4. Seclusion and Mechanical Restraint                             1188
                        5. Unnecessary Confinement                                        1190
                            i. Locked Wards                                               1190
                           ii. Institutional Confinement                                  1190
                        6. Association/Access to Community                                1192
                        7. Habilitation                                                   1192
                            i. Individual Evaluations and Treatment                       1192
                           ii. Trained Staff                                              1192
                          iii. Inhumane Living Conditions                                 1193
                           iv. Abnormal Environment                                       1193
                
                              v. Unavailable Services                                     1193
                             vi. Behavior Problems                                        1194
                            vii. Deterioration and Loss of Self-Care Skills               1194
                         8. Lack of Adequate Community Services                           1195
                         9. Professional Judgment                                         1196
                        10. Certification — Accreditation                           1197
                III. CONCLUSIONS OF LAW                                                   1199
                     A. Substantive Due Process Rights Under Youngberg v. Romeo           1199
                         1. Safety                                                        1200
                         2. Freedom from Undue Bodily Restraint                           1200
                         3. Minimally Adequate Habilitation                               1200
                     B. State Created Liberty Interest Related to Purpose of Confinement  1202
                     C. State-Created Liberty Interests Based on State Regulations        1202
                     D. Freedom of Association                                            1203
                 IV. RELIEF                                                               1204
                
I. HISTORY OF PROCEEDINGS

Paul Caldwell, next friend of plaintiff Thomas S., filed this suit on July 7, 1982, seeking declaratory and injunctive relief under federal and state law. Also on July 7, 1982, Mr. Caldwell was appointed guardian ad litem for Thomas S. On July 10, 1984, Joyce M. Brooks was substituted as guardian ad litem for Thomas S.

Thomas S., a nineteen-year-old Gaston County resident when this action was filed, had been diagnosed as suffering from, inter alia, schizophrenia and borderline mental retardation, and was incapable of either living independently or managing his own affairs. Given up for adoption at birth, Thomas spent his first eighteen years in approximately forty different foster homes and institutions while in the custody of the Gaston County Department of Social Services ("DSS"). DSS shuffled Thomas through so many placements during his youth because there were no appropriate community-based treatment facilities available in Gaston County during this period.

Soon after Thomas' eighteenth birthday, DSS succeeded in having Thomas declared legally incompetent. In February, 1982, defendant Allen Childress, regional adult mental health specialist with the North Carolina Department of Human Resources, was appointed Thomas' guardian. Because Childress considered Thomas' then-current placement, a rest home for the elderly, inappropriate, Childress caused Thomas to be admitted to the "R" (mental retardation) unit at Broughton Hospital on March 15, 1982.

Four months after Thomas was institutionalized at Broughton, his next friend brought this suit against Sarah Morrow, then Secretary of the North Carolina Department of Human Resources ("Secretary"); Allen Childress, in his official capacity as Thomas' guardian ("guardian"); and the directors of two local agencies, DSS and the Gaston-Lincoln area mental health program. The Gaston County Commissioners later were joined as additional defendants.

The complaint alleged that the defendants had denied Thomas substantive due process accorded by the Fourteenth Amendment. It protested the defendants' failure to provide minimally adequate treatment, alleging that Thomas' hospitalization imposed a degree of restraint on his liberty inconsistent with professional judgment regarding his treatment. The complaint charged that the defendants had deprived Thomas of liberty interests created by state law, a procedural due process claim under the Fourteenth Amendment. The complaint also asserted various pendent state law claims. Thomas requested an injunction ordering the defendants to place him in an appropriate group home and to provide other treatment recommended by professionals who had examined and worked with him.

On May 26, 1983, the court entered a consent judgment permitting the two local agency defendants to contract with an independent nonprofit organization for foster care and treatment from the date of Thomas' discharge from Broughton until March 1, 1984. Because of the consent order, the court deferred all parties' motions for summary judgment and declared the case inactive until February 1, 1984.

On March 22, 1984, four individuals, Jeanette H., Todd C., Phillip B. and Margaret R., moved to intervene as plaintiffs. The court appointed Cornelius Manly as guardian ad litem for Ms. R. on May 4, 1984. Also on March 22, 1984, these individuals joined Thomas S. in a motion to certify a statewide class of similarly situated individuals pursuant to Fed.R.Civ.P. 23. The class is defined as:

adults who are mentally retarded or who have been treated as mentally retarded and who are or will be inappropriately kept in public psychiatric institutions in North Carolina in conditions violative of their constitutional rights.

After reactivating the case, the court found that Thomas had been shifted to at least three additional placements since the consent judgment was filed. On August 15, 1984, the court heard arguments on all pending motions. The court ruled on the cross motions for summary judgment on September 18, 1984. Thomas S. v. Morrow, 601 F.Supp. 1055 (W.D.N.C.1984). All pendent state law claims against state officials were dismissed, in accordance with Pennhurst State School & Hospital v. Halderman, 465 U.S. 89, 104 S.Ct. 900, 79 L.Ed.2d 67 (1984). The claims against the local officials also were dismissed without prejudice. Relying on Youngberg v. Romeo, 457 U.S. 307, 102 S.Ct. 2452, 73 L.Ed. 2d 28 (1982), the court granted summary judgment against the Secretary and the guardian on Thomas' substantive due process claim without reaching the procedural due process claim.

On December 7, 1984, the court entered a judgment requiring the Secretary and the guardian to develop a treatment plan and appoint a case manager for Thomas. The judgment directed them to furnish Thomas the treatment recommended by qualified professionals who had evaluated his needs. In accordance with the recommendations, the order specified that Thomas should be placed in a "stable suitable supervised community residential placement such as: (1) a non-institutionalized specialized adult foster care situation ... or (2) a group home with adults of average intelligence." Adhering to the recommendations, the court also directed that Thomas should be provided non-residential services such as mental health counseling, adult basic education and vocational training, and "opportunities for community interaction." The Secretary and the guardian appealed.

Also on December 7, 1984, the court permitted the intervention of the four additional plaintiffs and certified the...

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