# Appendix — Tennessee v. Lane > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/brief%3Amicro_IA40385014_0662%3A10 ## Record - **Collection:** Supreme Court brief - **Document type:** Appendix - **Published:** January 1, 2004 - **Citation:** 541 U.S. 509 ## Text | Supreme Court, US \ PILED NOV 1 2 2003 No. 02-1667 OFFICE OF THE CLERK In the Supreme Court of the Gnited States STATE OF TENNESSEE, PETITIONER Vv. GEORGE LANE, ET AL. = ON WRIT OF CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT APPENDIX TO THE BRIEF FOR THE UNITED STATES THEODORE B. OLSON Solicitor General R. ALEXANDER ACOSTA Assistant Attorney General PAUL D. CLEMENT Deputy Solicitor General PATRICIA A. MILLETT Assistant to the Solicitor General JESSICA DUNSAY SILVER SARAH E. HARRINGTON KEVIN RUSSELL Attorneys Department of Justice Washington, D.C. 20530-0001 (202) 514-2217 TABLE OF CONTENTS Appendix A (Cases Evidencing Unconstitutional Treatment of Individuals with Disabilities) ............ Appendix B (Disabilities Act Enforcement ID —ccinnictentiinmnsciemmcnimnmamemm Appendix C (Findings of Investigations Under the Civil Rights of Institutionalized Persons FD ccnnteeeremenemmenmennnemmenenemen Appendix D (Relevant Constitutional and I POTD ‘cccesecnnimmnnnmennens (I) le ld APPENDIX A Cases Evidencing Unconstitutional Treatment of Individuals with Disabilities: Foucha v. Louisiana, 504 U.S. 71 (1992) (Louisiana statute allowing continued confinement of the mentally ill, who were acquitted of crimes by reason of insanity, resulted in unconstitutional confinement, in violation of the Due Process Clause, where the hospital review committee had reported no evidence of mental illness and recommended conditional discharge); City of Cleburne v. Cleburne Living Ctr., 473 U.S. 432 (1985) (unconstitutional zoning discrimina- tion); Youngberg v. Romeo, 457 U.S. 307, 315, 322 (1982) (institutionalized persons have due process “right to ade- quate food, shelter, clothing, and medical care,” “safe condi- tions,” and freedom from unreasonable physical restraint, as well as to “such training as may be reasonable in light of [the resident’s] liberty interests in safety and freedom from unreasonable restraints”); O’Connor v. Donaldson, 422 U.S. 563 (1975) (unconstitutional confinement); Delano-Pyle v. Victoria County, 302 F.3d 567, 575-576 (5th Cir. 2002) (af- firming a jury verdict that included evidence of a police officer giving a sobriety test and Miranda warnings to a deaf plaintiff who could not understand him, and then arresting the plaintiff), cert. denied, No. 02-1223, 2003 WL 545392 (Oct. 6, 2003); Kiman v. New Hampshire Dep't of Corrs., 301 F.3d 13, 15-16 (1st Cir. 2002) (disabled inmate stated Eighth Amendment claims for denial of accommodations needed to protect his health and safety due to his degenerative nerve disease), aff’d by an equally divided court, 332 F.3d 29 (2003) (en banc); MX Group, Inc. v. City of Covington, 293 F.3d 326, 345 (6th Cir. 2002) (“blanket prohibition of all metha- (1) 2a done clinics from the entire city is discriminatory on its face”); Popovich v. Cuyahoga County Ct. of Common Pleas, 276 F.3d 808 (6th Cir.) (en banc) (deaf parent denied com- munication assistance in child custody proceeding), cert. denied, 537 U.S. 812 (2002); Armstrong v. Davis, 275 F.3d 849 (9th Cir. 2001) (failure to conduct parole and parole revocation proceedings in a manner that disabled inmates can understand and in which they can participate), cert. denied, 537 U.S. 812 (2002); Baird v. Rose, 192 F.3d 462 (4th Cir. 1999) (seventh-grader suffering from clinical depression prohibited from singing in school choir); Key v. Grayson, 179 F.3d 996 (6th Cir. 1999) (deaf inmate denied access to sex offender program required as precondition for parole), cert. denied, 528 U.S. 1120 (2000); Bradley v. Puckett, 157 F.3d 1022, 1025-1026 (5th Cir. 1998) (failure for several months to provide means for amputee inmate to bathe led to infection); Gorman v. Easley, 257 F.3d 738, 742 (8th Cir. 2001) (paraplegic arrested for trespass improperly restrained in non-wheelchair-accessible police van, causing his urine bag to burst, “soaking him with his own urine” and resulting in serious medical problems), judgment rev’d in part on grounds not relevant, 536 U.S. is] (2002); Layton v. Elder, 143 F.3d 469, 470-472 (8th Cir. 1998) (mobility-impaired veterans’ exclusion from a session of county quorum court and from courtroom due to their inability to access the second floor of the county courthouse); Innovative Health Sys., Inc. v. City of White Plains, 117 F.3d 37, 49 (2d Cir. 1997) (building permit denied for drug and alcohol treatment center “based on stereotypes and unsupported fears”); Love v. Westville Corr. Ctr., 103 F.3d 558, 558, 560-561 (7th Cir. 1996) (quadriplegic inmate “was unable to participate in sub- stance abuse, education, church, work, or transition pro- 3a grams available to members of the general inmate popula- tion” due to “intentional discrimination”); Koehl v. Dalsheim, 85 F.3d 86 (2d Cir. 1996) (Eighth Amendment violated when inmate with serious vision problem denied glasses and treatment); Weeks v. Chaboudy, 984 F.2d 185, 187 (6th Cir. 1993) (“squalor in which [prisoner] was forced to live as a result of being denied a wheelchair” violated the Eighth Amendment); Thomas S. v. Flaherty, 902 F.2d 250 (4th Cir.) (unconstitutional confinement when appropriate community placement available), cert. denied, 498 U.S. 951 (1990); Leach v. Shelby County Sheriff, 891 F.2d 1241, 1243-1244 (6th Cir. 1989) (finding a policy or custom of deliberate indifference to serious medical needs of paraplegic inmates; evidence showed that, “[dJespite his medical need for cleanliness, [an inmate] was not bathed for several days,” “was forced to remain for long periods of time in his own urine due to inadequate catheter supplies and was given inadequate aid _for his bowel training needs despite his repeated requests for help”), cert. denied, 495 U.S. 932 (1990); Chalk v. United States Dist. Ct. Cent. Dist. of Cal., 840 F.2d 701 (9th Cir. 1988) (certified teacher barred from teaching after diagnosis of AIDS); LaFaut v. Smith, 834 F.2d 389 (4th Cir. 1987) (Powell, J.) (failure to provide paraplegic inmate with an accessible toilet is cruel and unusual punishment); Parrish v. Johnson, 800 F.2d 600, 603, 605 (6th Cir. 1986) (prison guard repeatedly assaulted paraplegic inmates with a knife, forced them to sit in their own feces, and taunted them with remarks like “crippled bastard” and “[you] should be dead”); Clark v. Cohen, 794 F.2d 79 (3d Cir.) (unconstitutional con- finement), cert. denied, 479 U.S. 962 (1986); Miranda v. Munoz, 770 F.2d 255, 259 (1st Cir. 1985) (failure to provide medications for epilepsy, which caused prisoner’s death, 4a violated Eighth Amendment); Lynch v. Baxley, 744 F.2d 1452 (11th Cir. 1984) (State subjected individuals awaiting civil commitment proceedings to unconstitutional conditions of confinement in county jails); Pomerantz v. Los Angeles County, 674 F.2d 1288, 1289 (9th Cir. 1982) (“undisputed facts show that the Los Angeles County Jury Commissioner, and other employees directly involved in the jury selection process for the Superior Court for the County of Los Angeles had, prior to January 1, 1978, excluded all blind persons from jury service solely because they were blind”); Pushkin v. Regents of Univ. of Colo., 658 F.2d 1372 (10th Cir. 1981) (doctor with multiple sclerosis unconstitutionally denied residency out of concern about patients’ reactions); Ferrell v. Estelle, 568 F.2d 1128, 1133 (5th Cir.) (deaf habeas petitioner’s “rights were reduced below the constitutional minimum” because he could not understand his trial), with- drawn due to death of petitioner, 573 F.2d 867 (1978); Gurmankin v. Costanzo, 556 F.2d 184 (3d Cir. 1977) (holding unconstitutional an irrebuttable presumption that blind teacher cannot instruct sighted students); Wyatt v. Aderholt, 503 F.2d 1305 (5th Cir. 1974) (unconstitutional conditions of confinement for the mentally ill); Pathways Psychosocial v. Town of Leonardtown, 133 F. Supp.-2d 772, 791-792 (D. Md. 2001) (denying summary judgment for defendants on claim that town officials violated Equal Protection Clause through zoning decisions that excluded a home for individuals with mental retardation), after judgment, 223 F. Supp. 2d 699, 704-705 (2002) (jury found constitutional violation, and mo- tion for new trial was denied); McCray v. City of Dothan, 169 F. Supp. 2d 1260, 1279-1280 (M.D. Ala. 2001) (police offi- cer had “not articulated any specific facts upon which suspi- cion reasonably could be founded” other than “the com- 5a munication gap between a deaf man and herself”), aff’d in part & rev'd in part, No. 01-15756, 2003 WL 21067092 (11th Cir. Apr. 24, 2003) (Table); M.H. v. Bristol Bd. of Educ., 169 - F. Supp. 2d 21, 24-25 (D. Conn. 2001) (possible substantive due process violation where school employees spat water in disabled student’s face and restrained him so forcibly as to result in bruising); Doe v. Rowe, 156 F. Supp. 2d 35 (D. Me. 2001) (unconstitutional restriction on voting by those with mental disabilities); Project Life, Inc. v. Glendening, 139 F. Supp. 2d 703, 705 (D. Md. 2001) (unlawful rejection of permit for drug treatment facility based on “community preju- dices”), aff’d, No. 01-1754, 2002 WL 2012545 (4th Cir. Sept. 4, 2002); Salcido ex rel. Gilliland v. Woodbury County, 119 F. Supp. 2d 900, 931 (N.D. lowa 2000) (granting summary judg- ment for mentally ill plaintiff on claim that he was denied due process by State’s denial of an appropriate institutional placement without notice or hearing); New York v. County of Schoharie, 82 F. Supp. 2d 19 (N.D.N.Y. 2000) (inaccessible polling places); New York v. County of Delaware, 82 F. Supp. 2d 12 (N.D.N.Y. 2000) (inaccessible polling places); Schmidt v. Odell, 64 F. Supp. 2d 1014 (D. Kan. 1999) (amputee forced to crawl around jail, resulting in injury and infection, in violation of Eighth Amendment); Matthews v. Jefferson, 29 F. Supp. 2d 525 (W.D. Ark. 1998) (paraplegic litigant had to be carried up stairs to court room for all-day hearing at which he could not leave to get food or use the restroom to empty catheter, resulting in infection; eventually had to crawl down steps to get out after everyone left the court- house without him); Hanson v. Sangamon County Sheriff's Dep't, 991 F. Supp. 1059, 1061-1062 (C.D. Ill. 1998) (possible constitutional violation where deaf arrestee was denied the opportunity to post bond and make a telephone call because 6a the police department failed to provide, despite his requests, alternatives to the conventional telephone, and that denial resulted in much longer detention than other, similarly situated arrestees); Lewis v. Truitt, 960 F. Supp. 175 (S.D. Ind. 1997) (Fourth Amendment prohibits use of force against an individual, whom officers know to be deaf, for not comply- ing with officers’ spoken commands); Carty v. Farrelly, 957 F. Supp. 727, 739 (D.V.I. 1997) (“The abominable treatment of the mentally ill inmates shows overwhelmingly that defen- dants subject inmates to dehumanizing conditions punishable under the Eighth Amendment.”); Kaufman v. Carter, 952 F. Supp. 520 (W.D. Mich. 1996) (amputee hospitalized after fall in inaccessible jail shower); Bullock v. Gomez, 929 F. Supp. 1299, 1301, 1307 (C.D. Cal. 1996) (possible constitutional violation where California Department of Corrections’ family visiting program precluded HIV-positive inmates from having the same overnight visits with spouses afforded other inmates, even where spouse was also HIV positive and incapable of bearing children); Clarkson v. Coughlin, 898 F. Supp. 1019, 1049 (S.D.N.Y. 1995) (holding, inter alia, that state prison officials’ failure to provide interpreters or other assistive services to deaf and hearing impaired inmates during medical treatment violated the Eighth Amendment, as at least two such inmates experienced improper and possibly harmful treatment through provision of medical treatment in absence of qualified interpreters); Stillwell v. Kansas City, Mo. Bd. of Police Comm'rs, 872 F. Supp. 682, 688 (W.D. Mo. 1995) (holding that the Board of Police Com- missioners’ licensing scheme violates the Due Process Clause of the Fourteenth Amendment because it irrebuttably pre- sumes that an individual with only one hand is unqualified for the position of armed security guard); Harrelson v. 7a Elmore County, 859 F. Supp. 1465, 1466 (M.D. Ala. 1994) (paraplegic prisoner denied use of a wheelchair and forced to craw] around his cell); Eric L. v. Bird, 848 F. Supp. 303, 306, 308 (D.N.H. 1994) (possible constitutional violation where children with disabilities in foster care alleged that the State failed “to take the required measures to maintain the integ- rity of plaintiffs’ families where possible, to reunite removed children with their families as soon as possible, or to place them in secure, permanent homes within an appropriate time and in an appropriate manner,” as well as failed “to provide services necessary to protect children in the class from harm”); T.E.P. v. Leavitt, 840 F. Supp. 110 (D. Utah 1993) (statute prohibiting and voiding marriages between indivi- duals with AIDS); Noland v. Wheatley, 835 F. Supp. 476, 480-482 (N.D. Ind. 1993) (possible constitutional violation where semi-quadriplegic inmate confined to a wheelchair was confined to secluded padded cell for months, denied sufficient water to maintain kidney functioning or to permit sanitary handling of colostomy and urostomy bag, forcing him to “eat many meals with the human waste still on his hands,” and was unable to sleep in bed because his wheel- chair could not fit through the doorway, all resulting in adverse medical conditions); Casey v. Lewis, 834 F. Supp. 1569, 1582-1583 (D. Ariz. 1993) (holding that prison’s failure to provide accessible bathrooms, showers, and cells to mobility-impaired inmates, as well as a consistent pattern of delays in prisoner receipt of hearing aids, violated the - Eighth Amendment); Galloway v. Superior Court, 816 F. Supp. 12 (D.D.C. 1993) (blind individuals categorically ex- cluded from jury service); United States v. Borough of Audubon, 797 F. Supp. 353, 360 (D.N.J. 1991) (predominant motivation underlying city’s efforts to exclude group home 8a for the handicapped “was discriminatory animus”), aff'd, 968 F.2d 14 (3d Cir. 1992) (Table); Nolley v. County of Erie, 776 F. Supp. 715 (W.D.N.Y. 1991) (Constitution violated where inmate with HIV was housed in the part of a prison reserved for inmates who are mentally disturbed, suicidal, or a danger to themselves, and was denied access to prison library and religious services); Kroll v. St. Charles County, 766 F. Supp. 744, 744-751 (E.D. Mo. 1991) (courthouse and government buildings broadly inaccessible to individuals with mobility impairments); Bonner v. Arizona Dep’t of Corrs., 714 F. Supp. 420 (D. Az. 1989) (deaf, mute, and vision-impaired in- mate denied communication assistance, including during dis- ciplinary proceedings, counseling sessions, and medical treatment); DeLong v. Brumbaugh, 703 F. Supp. 399, 405 (W.D. Pa. 1989) (decision to exclude deaf individual from jury was “unreasonable, discriminatory and violative of Sec- tion 504 of the Rehabilitation Act”); Doe v. Dolton Elem. Sch. Dist., 694 F. Supp. 440 (N.D. Ill. 1988) (elementary student with AIDS excluded from attending regular classes or extracurricular activities); Robertson v. Granite City Comm. Unit Sch. Dist., 684 F. Supp. 1002 (S.D. Ill. 1988) (seven-year old student with AIDS confined to a modular classroom where he was the only student); Thomas v. Atascadero Unified Sch. Dist., 662 F. Supp. 376 (C.D. Cal. 1986) (kindergarten student with AIDS excluded from class and forced to take home tutoring); Thompson v. City of Portland, 620 F. Supp. 482, 485-487 (D. Me. 1985) (police violated the constitutional rights of a blind diabetic who was in insulin shock by arresting him, transporting him on floor of police cruiser, jailing him, and ignoring his explanation that he was in insulin shock, despite fact that he wore a Medic-Alert necklace and carried a white cane); Ass’n for ~ 9a Retarded Citizens of N.D. v. Olson, 561 F. Supp. 473, 491-492 (D.N.D. 1982) (finding violations of mentally retarded residents’ constitutional rights to privacy, private property, and free association, as (1) many of the mentally retarded residents “are left fully naked in front of each other and assistants and such residents are not provided places where they can be in private” and “are denied the opportunity to decide for themselves how to dress”; (2) the State did not “adequately provide for an accounting of [each] resident’s personal property and for a safe place of storage”; and (3) the State did not “provide residents who are capable of com- municating, reasonable opportunities to communicate with others both inside and outside the institution where they reside”), aff'd, 713 F.2d 1384 (8th Cir. 1983); Garrity v. Gallen, 522 F. Supp. 171, 214 (D.N.H. 1981) (“blanket discri- mination against the handicapped * * * is unfortunately firmly rooted in the history of our country”); New York State Ass’n for Retarded Children, Inc. v. Carey, 466 F. Supp. 487 (E.D.N.Y. 1979) (mentally retarded students excluded from public school system); Hairston v. Drosnick, 423 F. Supp. 180 (S.D. W. Va. 1976) (school refused to admit child with spina bifida without the daily presence of her mother, even though student was of normal mental competence and capa- ble of performing easily in a classroom situation); Smith v. Fletcher, 393 F. Supp. 1366, 1368 (S.D. Tex. 1975) (gov- ernment assigned paraplegic, who had a Master’s degree in physiology, to menial clerical tasks based on “arbitrary and unfounded decision as to her physical capabilities”), aff’d as modified, 559 F.2d 1014 (5th Cir. 1977); Mills v. Board of Educ., 348 F. Supp. 866 (D.D.C. 1972) (mentally retarded students excluded from public school system); Pennsylvania Ass’n for Retarded Children v. Commonwea'th, 334 F. Supp. 10a 1257 (E.D. Pa. 1971) (mentally retarded students excluded from public school system); Daly v. DelPonte, 624 A.2d 876, 880, 885 (Conn. 1993) (holding that the commissioner’s exer- cise of his “statutory authority to condition a motor vehicle operator’s license on the licensee’s reporting his or her medical status” violated the state constitution’s equal protec- tion provision because the record “contained no evidence that th[e] reporting requirement was narrowly tailored either to the plaintiff’s condition at the time of its issuance or to his probable future condition for the designated time period”); State v. Schaim, 600 N.E.2d 661, 672 (Ohio 1992) (under the Confrontation Clause, “[a] defendant who cannot hear is analogous to a defendant who cannot understand English, and a severely hearing-impaired defendant cannot be tried without adopting reasonable measures to accommo- date his or her disability”); Moye v. Moye, 627 P.2d 799, 801 (Idaho 1981) (holding that, while a parent’s physical condi- tion is a valid consideration in the “best interests” approach to determining the issue of a child’s custody, the trial court’s overemphasis on the mother’s epilepsy rendered the custody award to the father an abuse of discretion); State v. Staples, 437 A.2d 266, 268 (N.H. 1981) (ineffective assistance of counsel in failing to secure assistance for hearing-impaired defendant whose disability made him “unable to assist effec- tively in the preparation of his defense”); In re Marriage of Carney, 598 P.2d 36, 42 (Cal. 1979) (lower court “stereo- type[d] William as a person deemed forever unable to be a good parent simply because he is physically handicapped”); Connecticut Inst. for the Blind v. Connecticut Comm’n on Human Rights & Opps., 405 A.2d 618, 621 (Conn. 1978) (blanket exclusion from state jobs of persons with visual impairments); State v. Board of Educ., 172 N.W. 153, 153 lla (Wis. 1919) (excluding a boy with cerebral palsy from public school because he “produces a depressing and nauseating effect upon the teachers and school children”); State v. Barber, 617 So. 2d 974, 976 (La. Ct. App. 1993) (“{T]he Con- stitution requires that a defendant sufficiently understand the proceedings against him to be able to assist in his own defense. Clearly, a defendant who has a severe hearing impairment, without an interpreter, cannot understand the testimony of witnesses against him so as to be able to assist in his own defense.”); People v. Green, 561 N.Y.S.2d 130, 133 (County Ct. 1990) (holding that prosecutor’s peremptorily striking a juror solely because she was hearing impaired, and not because of any doubt of the juror’s ability to communi- cate, violated the juror’s right to equal protection); Stewart v. Stewart, 521 N.E.2d 956, 965-966 (Ind. Ct. App. 1988) (holding that father’s visitation rights were improperly ter- minated because of evidence that he was infected with the AIDS virus); Peeler v. State, 750 S.W.2d 687, 690-691 (Mo. Ct. App. 1988) (constitutionally ineffective assistance of counsel in failure to request an interpreter, where the hearing-impaired defendant was “probably unable to understand what was being said at trial”); District 27 Comm. Sch. Bd. v. Board of Educ., 502 N.Y.S.2d 325 (Sup. Ct. 1986) (two school boards sought to prevent attendance of any student with AIDS in any school in the city, unless all of the students at that school had AIDS); Bednarski v. Bednarski, 366 N.W.2d 69, 73 (Mich. Ct. App. 1985) (holding that a mother’s deafness was inappropriately weighed against her in a custody dispute over her two minor children); People v. Rivera, 480 N.Y.S.2d 426, 434 (Sup. Ct. 1984) (conviction was unconstitutionally obtained because the deaf defendant had no interpreter and did not understand his trial); Jn re 12a Marriage of Paula R., 102 Cal. App. 3d 981, 988-989 (Ct. App. 1980) (reversing the trial court’s award of permanent custody of child to father because mother was confined to a wheelchair, as the trial court did not use the proper standard in determining who should receive custody: “whether the handicapped parent’s condition will in fact have a substantial and lasting adverse effect on the best interests of the child”); Bevan v. New York State Teachers’ Retirement Sys., 345 N.Y.S.2d 921 (Sup. Ct. 1973) (statute allowing forced retire- ment of teacher who became blind), modified, 355 N.Y.S.2d 185 (App. Div. 1974); In re Adoption of Richardson, 251 Cal. App. 2d 222, 239 (1967) (trial court “stated, in effect, he will systematically strike any and all deaf-mute petitioners from any list of prospective adopting parents”); Commonwealth v. Smith, 119 A.2d 620, 622 (Pa. Super. Ct. 1956) (holding that the fact that a father suing for custody of his son suffers from epilepsy is a factor that should be considered in deter- mining whether to award custody). APPENDIX B The Justice Department publishes quarterly status reports, which include information from a sampling of the Department’s Disabilities Act enforcement efforts under 42 U.S.C. 12133. The status reports can be found at http:// www.ada.gov/enforce. htm. The 34 reports published to date list 110 matters concerning courthouse accessibility or effec- tive access to judicial proceedings. The following is a list of those matters. One case (against the State of Massachusetts alleging problems with physical accessibility) resulted in a lawsuit (that remains pending), which was reported in the January 2003 status report. The Table includes the juris- diction in which the courthouses are located, the type of problem reported by persons with disabilities, and the date of the status report in which the matter appears. There are 50 cases that resulted in formal settlement agreements, 51 cases that resulted in informal settlement agreements, and 8 cases that resulted in formal mediation. In cases resulting in informal settlements or mediation, the Justice Department does not identify the covered jurisdiction by name: Complaints Resulting In Formal Settlement Agree- ments: Jurisdiction “| Type of Problem | Status Report Lucas County, OH physical access Jan. - Mar. 2003 Guernsey County,OH | physical access Oct. - Dec. 202 Essex County, NJ physical access Oct. - Dec. 2002 Windsor County, VT lack of sign lan- Oct. - Dec. 2002 _guage interpreter Warren, OH physical access Apr. - June 2002 Ben Hill County, GA physical access Apr. - June 2001 Gulfport, MS lack of sign lan- Apr. - June 2000 guage interpreter (1b) 3b 2b Shelby County, TN lack of assistive Apr. - June 2000 listening devices Adair County, OK physical access Jan. - Mar. 2000 Houston, TX lack of assistive Jan. - Mar. 2000 listening devices Toledo, OH physical access and | July - Sep. 1999 lack of communica- tion assistance Lake County, IL lack of sign lan- July - Sep. 1999 guage interpreter Oklahoma County, OK physical access and | Apr. - June 1999 lack of communi- cation assistance Georgiana, AL physical access Apr. - June 1999 State of Hawaii lack of sign lan- Oct. - Dec. 1998 guage interpreter and assistive lis- tening devices McDowell County, WV_ | physical access July - Sep. 1998 Mendocino County,CA | physical access July - Sep. 1998 Johnson County, TN physical access July - Sep. 1998 Citrus County, FL physical access Apr. - June 1998 Chico County, AR physical access Jan. - Mar. 1998 Dickinson, ND physical access Jan. - Mar. 1998 Wetzel County, WV physical access Jan. - Mar. 1998 Twin Falls, ID lack of sign lan- Oct. - Dec. 1997 guage interpreter and communi- cation assistance Philadelphia, PA lack of procedures | Oct. - Dec. i997 for jurors to re- quest accommoda- tions Boone County, IN lack of assistive July - Sep. 1997 listening devices Grand Rapids, MI lack of assistive July - Sep. 1997 listening devices Outagamie County, WI | physical access and | Apr. - June 1997 lack of assistive listening devices Rome, NY physical access Jan. - Mar. 1997 Hancock County, MS assistive listening | Jan. - Mar. 1997 (deaf individual ex- cluded from jury service) Harrison County, MS assistive listening Jan. - Mar. 1997 (deaf individual ex- cluded from jury service) Roswell, NM lack of assistive Jan. - Mar. 1997 listening devices Santa Clara lack of assistive Oct. - Dec. 1996 County, CA listening devices Jones County, CA physical access Oct. - Dec. 1996 Town of Lloyd, NY lack of communi- July - Sep. 1996 cation assistance Tallahassee, FL lack of communi- Apr. - June 1996 cation assistance Pickens County, SC lack of assistive Oct. - Dec. 1994 listening devices Fulton, MO lack of communi- Apr. - June 1994 cation assistance Wadsworth, OH physical access Apr. - June 1994 4b Alexandria, LA lack of communica- | Apr. - June 1994 tion assistance and sign language in- terpreter Genesee County, MI physical access Apr. - June 1994 Hickman County, KY physical access April 1994 Van Buren County, AR | physical access April 1994 Harris County, TX physical access and | April 1994 lack of communi- cation assistance Scott County, AR physical access April 1994 Madison County, FL physical access April 1994 Pinellas County, FL lack of communi- April 1994 cation assistance Salt Lake City, UT lack of communi- April 1994 cation assistance (deaf individual excluded from jury) Paulding County, OH physical access April 1994 Complaints Resulting In Informal Settlement Agree- ments: Jurisdiction Type of Problem Status Report county in Ohio lack of sign lan- Jan. - Mar. 2003 _guage interpreter unnamed jurisdiction lack of assistive Jan. - Mar. 2003 listening devices county in Mississippi lack of sign lan- Jan. - Mar. 2003 interpreter county in Illinois lack of sign lan- Oct. - Dec. 2002 _guage interpreter county in Louisiana lack of sign lan- July - Sep. 2002 guage interpreter 5b county in Pennsylvania | lack of accessible | Apr. - June 2002 parking © county in Arizona physical access Apr. - June 2002 county in Nebraska physical access Jan. - Mar. 2002 New England state lack of sign lan- Jan. - Mar. 2002 court system guage interpreter and assistive listening devices county in Arizona lack of assistive Oct. - Dec. 2001 listening devices county in Texas lack of sign lan- July - Sep. 2001 guage interpreter county in California physical access July - Sep. 2001 Iowa court lack of sign lan- July - Sep. 2001 ‘guage interpreter county in Texas physical access Oct. - Dec. 1999 county in Oklahoma physical access Oct. - Dec. 1999 county in Pennsylvania | physical access Oct. - Dec. 1999 county in Texas lack of assistive | July - Sep. 1999 county in Colorado lack of accessible | July - Sep. 1999 parking Michigan court lack of communica- | July - Sep. 1999 tion assistance city in Pennsylvania physical access July - Sep. 1999 town in Ohio physical access Oct. - Dec. 1998 county in Michigan physical access Oct. - Dec. 1998 Louisiana parish physical access Apr. - June 1998 county in Michigan physical access Apr. - June 1998 county in Illinois lack of communica- | Jan. - Mar. 1998 tion assistance county in Michigan. lack of assistive lis- | Oct. - Dec. 1997 6b 7b county in Missouri physical access April 1994 “various cities and | physical access April 1994 towns in East and Mid- ; west” | county in Washington physical access April 1994 Michigan court lack of assistive lis- | April 1994 tening devices Pennsylvania county lack of accommoda- | April 1994 court tion for person with learning dis- ability | Complaints Resulting In Mediation: Jurisdiction Type of Problem Status Report county in Illinois physical access Oct. - Dec. 2002 county in Arkansas physical access Oct. - Dec. 2001 town in New York physical access Oct. - Dec. 2001 county in South lack of sign lan- July - Sep. 2001 Carolina guage interpreter cvunty in California physical access Apr. - June 2001 county in Tennessee _| physical access Jan. - Mar. 2000 county in Nebraska physical access Jan. - Mar. 2000 Michigan court lack of sign lan- July - Sep. 1997 . interpreter county in Arizona lack of communica- | Oct. - Dec. 1997 tion aids county in Florida physical access July - Sep. 1997 Tennessee circuit court | lack of communica- | July - Sep. 1997 tion aids county in California lack of assistive lis- | Apr. - June 1997 tening devices county in Michigan lack of auxiliary Jan. - Mar. 1997 aids supreme court of a | lack of auxiliary Jan. - Mar. 1997 “southern state” aids Colorado judicial lack of auxiliary Jan. - Mar. 1997 district aids county in Wyoming physical access Jan. - Mar. 1997 county in Michigan physical access Oct. - Dec. 1996 county in Virginia lack of auxiliary Oct. - Dec. 1996 aids , city in California lack of auxiliary July - Sep. 1996 aids county in West physical access July - Sep. 1996 Virginia county in Washington lack of visualcom- | Apr. - June 1996 munication assis- tance county in California lack of accessible | Apr. - June 1996 parking _ county in Pennsylvania _| physical access Jan. - Mar. 1995 “western state court” lack of assistive lis- | Oct. - Dec. 1994 tening devices Ohio court lack of communica- | Oct. - Dec. 1994 tion assistance county in Kentucky _ physical access July - Sep. 1994 county in Colorado physical access July - Sep. 1994 county in Colorado physical access Apr. - June 1994 In addition to the settlement agreements reported in the published status reports, there are several additional formal settlement agreements entered into between the Justice Department and various jurisdictions in cases dealing with courthouses. Although they are not reported in the status 8b reports, they are available on the website: http://www. ada.gov Jurisdiction Problem Date of Agreement Summers County, WV | physical access and | 5/11/00 lack of assistive lis-_ tening devices Craig County, VA physical access 1/30/02 Allendale County,SC | physical access 8/13/01 . Butte County, SD physical access F301 Boulder County, CO physical access 10/2/00 Warren County, IL physical access 9/6/01 Perry County, KY physical access 9/25/01 City of Cambridge, physical access 11/1/01 OH City of San Antonio, | physical access 1/30/02 TX City of Savannah,GA_ | physical access 1/30/02 City of Bismarck, ND | physical access 10/16/02 Columbia County, NY | physical access 5/19/03 Loudon County, TN physical access and | 7/25/03 lack of assistive lis- tening devices Madison County, MS physical access 7/25/03 Worcester County, physical access 7/28/03 MD APPENDIX C Findings of Investigations Under the Civil Rights Of Institutionalized Persons Act 42 U.S.C. 1997 et seq. Between 1980 and the enactment of Title II of the Americans with Disabilities Act in 1990, Department of Justice investigations under the Civil Rights of Institutionalized Persons Act, 42 U.S.C. 1997 et seq., found unconstitutional treatment of individuals with disabilities in institutions in more than ewenty-five States. From 1980 until the present, unconstitutional conditions have been found in more than 200 institutions in more than thirty States throughout the Country. The Tables below describe some of the findings issued by the Department of Justice pursuant to 42 U.S.C. 1997b(a) (1). Copies of the seuplete findings letters will be provided to the Court upon request, and have been served upon counsel for the petitioner and the private respondents. (le) 2c I. Investigations Prior to Enactment of the Americans with Disabilities Act and safety Name of Categories of Facility Constitutional Violations Rosewood MD 1982 | Failure to Many residents Center provide sustained injuries reasonable during “low staffing supervision periods” (p. 4). One resident left the facility unobserved and died of exposure. A profoundly retarded resident drowned when staff left him unattended in a bathtub. Another died after being pushed down a flight of stairs (pp. 4-5). On another occasion, “six severely handicapped female residents * * * were allegedly raped by an outside intruder. There was only one staff person on duty to supervise the 32 residents * * * and only one security officer on duty to cover the entire Rosewood facility. While the inability of the residents to communicate apparently prevented state officials from confirming the rapes * * * several of the residents had positive tests for gonorrhea of the throat right after the incident” (p. 4). Several male patients “show([ed) the presence of venereal disease” and “nonconsensual sexual contact occurred between one resident and at least one and possibly three residents” -(p. 4). Abuse of residents An employee sexually abused a resident (p. 4). Unsanitary conditions Facilities are deteriorating; the “stench of urine is prevalent ina number of buildings.” Plumbing problems left overflowing toilets unrepaired for days; heating problems subjected patients to “sub-freezing temperature in the buildings themselves” at times (p. 5). Inadequate training “Over 900 of the 1125 residents receive less than 50% of the services 4c 5c Name of State Year Categories of Constitutional Violations Details célled for in their program plans” (p. 2). Valley State Schools medical and mental health care East LA 1982 | Inadequate pp. 2-4 Louisiana medical and State mental health Hospital care Enid & Paul’s; 0K 1983 | Inadequate “Insufficient licensed physic an coverage has resulted in serious harms to residents,” contributing to patient deaths (p. 2-3). Inadequate training Lack of training “contributes to and manifests itself in residents’ aggressive and stereotypic behaviors * * * {such as] incessant disordered physical movements, headbanging, biting, hyperactivity, and assaultive behavior” (p. 5). Failure to provide reasonable supervision and safety “For example, a group of 21 naked residents were observed being led to @ shower area, where two staff sprayed the residents down with a large garden type hose” (p. 5). Name of Facility State Year Categories of Constitutional Violations Unreasonable use of physical and chemical restraints Details Abuse of residents Staff found “slapping, kicking, hitting, or spanking residents” while records also “reflect many instances of unexplained resident injuries” (p. 6). Unsanitary Lack of sanitation conditions practices contributed to parasitic and bacterial infections requiring quarantine of entire living areas (p. 6). Wheat Ridge CO | 1984 | Failure to “Due to lack of Regional provide staff, residents Center reasonable suffer neglect and supervision numerous accidents and safety and injuries. * * * [N]umerous residents have sustained injuries where the cause remains unknown. Resident on resident assaults are common; resi- dents engaging in self-abusive behav- iors are frequently unsupervised and unattended. Residents have been 6c 7c Facility State Year Categories of Constitutional Violations Details found with unexplained broken bones and burns to the body. For example, one resident was found with a femur segment protruding through the skin” (p. 2). During tour, staff came upon “approximately 20 adult women being cared for by one person amid great disorder and confusion. Many of these women were partially undressed, one was urinating on the floor of the living area and several were engaging in self- abusive behavior” (pm. 2). Inadequate medical and mental health care “A large number of Wheat Ridge residents suffer from severe contrac- tures of their limbs and other body deformities due to the absence of necessary physical and occupational therapy” (p. 3). “One troublesome secondary effect of these immobilizing contractures due to lack of physical State Year | Categories of Constitutional Violations Details therapy is the dysfunctioning of the digestive system,” which has apparently caused an “abnormally high percentage of Wheat Ridge residents to require pureed diets Or gastroatomies for tube feeding” (p. care 4). Logansport IN 1984 | Inadequate pp. 1-2 State medical and Hospital mental health Failure to provide reasonable supervision and safety “Patients are not being adequately monitored and supervised to prevent suicidal behavior or patient- on-patient violence, to notice and correctly diagnose symptoms of serious, physical or psychiatric dysfunctions, to monitor treatment responses and drug reactions, or to determine appropriate and reasonably safe modes of treatment for each patient” (pp. 2-3). &c Eglin Mental Health Centers Categories of Constitutional Violations Inadequate medical and mental health care; Inadequate training; Unreasonable use of physical restraints Lack of professional staff lead to “inappropriate uses of drugs and serious treatment errors which have resulted in physical danger to, or unnecessary physical or chemical restraint of, the involved patients” (p. 3). Patients are further “endangered by inadequate medical care relating to serious and sometimes debilitating or life-threatening drug side-effects” (p. 4). Sc infection, or disease” (pp. 4-5). Failure to provide reasonable supervision and safety “Units in the facilities are overcrowded to a point that makes it virtually imposcible for staff to maintain control without regular and extensive use of physical and chemical restraints” (p. 4). Unsanitary conditions “Sanitation and maintenance in portions of the facilities are so inadequate as tc resent serious risks to patients of poisoning, MI 1984 Failure to provide reasonable supervision and safety; Abuse of residents Large number of patient deaths under unusual circumstances, some associated with restraint practices (p. 3). A patient died after “a stranglehold was applied to him while he was being subdued. He reportedly lay on the seclusion room floor from 15-20 minutes before efforts were made to resuscitate him” (pp. 2-3). “Another patient also died due to strangulation, and his body showed signs of a beating” (p. 3). “A third patient \ allegedly died from injuries suffered in a beating. Still another patient, who had expressed her fear for her safety to her psychologist on a Friday, died over the weekend. Her body allegedly was bruised and battered” (p. 3). 10¢ Police found that another patient who had died ina seclusion cell “had contusions on his face and the back of his head” (p. 3). There have also been “numerous incidents of rape, assault and threat of assault, broken bones and bruises” (p. 3). A staff member was found to have had “sexual relations with three different patients in one night.” Other patients were beaten by staff, “including one who was stripped, placed in seclusion and severely beaten by several attendants” Unreasonable use of physical and chemical restraints “(R)estraints are used at Fairview in lieu of training and for the convenience of staff,” and were employed more than 2,000 times per month (p. 4). | (ip. 3). Inadequate Inadequate medical medical and care contributed to mental health several deaths and care preventable suicides (pp. 3-4). Fairview OR | 1985 | Inadequate Training “is Training training virtually non- Center existent” and “results ina serious level of self-injurious and aggressive behaviors” (ip. 3). Failure to provide reasonable supervision and safety Records showed “an alarmingly high number of injuries,” such as 197 incidents of injuries in one month resulting from self-abuse or aggression. In one two-month period, there were 27 incidents of sexual abuse (p. 3 n.1). “[Wle observed numerous residents with open wounds, gashes, abrasions, contusions, and fresh bite marks. Many other residents had deep scars and scabs from a long history of self- abuse or victimization” (p. 3). Due to inadequate supervision of residents with pica behavior (ingesting inedible objects), “[rlesidents have had to undergo Details Surgery, sometimes Oh &@ repeated basis, to remove foreign objects or to relieve bowel and other obstructions ceused by pica. Physicians at Fairview have indicated that some residents have had surgery so requently that any more operations resulting from pica would jeopardize their lives” ip. 8). Inadequate medical and mental health care Dangerous psychotropic medication practices (p. 7-8). “Seventy percent of residents institution-wide heave gum disease” (p. 8). Unsanitary conditions “Many of the cottages we toured smelled of urine and waste. Sewage backup in cottage basements, up to three feet high on the walls, is permitted to remain for days. * * * {Ajn August 1983 random sample of Fairview residents revealed l3c that 35% had pinworm infection, a parasite which is spread by fecal and oral routes in unclean environ- ments” (p. $). — Fort Stanton NM 1985, | Inadequate Facilities’ sole Bosepital «& medical and physician wrote Training mental health institution-wide Scheel care prescriptions for prescription medications and powerful Ppsychotropic medications, authorizing their use when nursing staff believes it necessary, in contravention of professional standards and creating substantial risk to patients (p. 2). jmental health care Unreasonable Psychotropic drugs use of being used to chemical restrain patients restraints without any oe physician assessment for the need for such measures (p. 2.) | Inadequate “Many residents are subjected to potentially dangerous” prescriptions of multiple psychotropic drugs- Name of State| Year | Categories of Details Facility Constitutional “without any medical justification” (p. 2) Southbury CT 1985 | Failure to Low staffing levels Training provide lead to inadequate School reasonable supervision, which supervision permitted one and safety —— resident to leave the facility and die of exposure; another was able to remove and hide a large knife (p. 10). In one cottage, staff compensate for low staffing level by placing “at least ome resident in restraints for up to 12 howms a day due to time staff’s inaba lity to monitor his activities” (p. 10). Use of psychotropic medications substantially departed from professional standards, creating substantial health risks for patients (pp. 3-6). — lnadequate medical and mental health care Investigation found “dangerous medication interactions and errors, and found that acute medical problems, such as fractures and infections, frequently do not receive critically necessary follow-up reatment” (p. 3). Inadequate Pacility’s failure training; to provide adequate Unreasonable training program use of resulted in “a physical and dangerous reliance chemical on the use of both restraints physical and chemical restraint” (p. 6). 1986 | Inadequate County Jail was medical and mental health care being used to house mentally ill persons awaiting civil commitment hearings or placement in a mental hospital for up to eleven days. At time of investigation, jail held 42 mentally-ill detainees (pp. 1-2). No mental health treatment was provided during period of confinement (p. 3). “Male mentally-ill detainees were confined * * * ina small cell designed to serve as the 16c Categories of Constitutional Violations ‘drunk tank.’ Some of the detainees were placed in hand and leg irons” (p. 3). lve Westboro State Hospital 1986 Unsanitary conditions “The smell and sight of urine and feces pervade not only the toilet areas, but ward floors and walls as well” (p. 3). “Bathrooms and showers were filthy. Living areas are infested with vermin. There are consistent shortages of clean bed sheets, face cloths, towels and underwear. Open commodes with human waste in them were often found in rooms to which many patients in unclean geri-chairs are confined all day, including meal times” (p. 3). “(Nlon-sterile techniques are used when changing patients’ dressings and feeding tubes” (p. 3). Name of Facility State Year Categories of Constitutional Violations Details problems, resulting in “increased dosages of potentially dangerous antipsychotic drugs” (p. 5). “Acutely life threatening illnesses * * * are also not detected appropriately or on a timely basis.* * * [I]nappropriate and inadequate medical care preceded many of the[] deaths” reviewed during the investigation (p. 5). “Patients also frequently do not receive prescribed medications because the ward or pharmacy lacks adequate supplies” (p. 4). Inadequate medical and mental health care Patients’ physical illnesses are often misdiagnosed as psychological Unreasonable use of physical and chemical restraints Facility used sedating drugs on elderly patients for no medically justifiable reason, but instead to control residents’ behavior “subjecting vulnerable geriatric patients to the dangerous effects of inappropriate drug usage and over- medication” (p. 7). Failure to provide reasonable supervision and safety; pp. 7-8 Inadequate training Kalamazoo MI 1986 | Inadequate Inadequate staffing Regional training; prevents the Psychiatric Unreasonable facility from Hospital use of providing treatment physical that could “reduce restraints or eliminate unreasonable risks to [patients’ ] personal safety and the undue use of bodily restraint” (p. 2). Inadequate Facility fails to medical and mental health care adequately monitor efficacy and side effects of potentially dangerous drugs, creating unjustifiable risk of “deleterious side effects, tardive dyskinesia, involuntary, abnormal muscle movements, akathisia, and parkinsonism” (p. 3). Napa State Hospital CA 1986 Failure to provide reasonable supervision and safety; Unreasonable use of physical and chemical restraints Severe staffing shortages “result in patient management, in lieu of treatment, through the inappropriate use of seclusion, chemical restraint, and physical restraint” (p. 2). Restraint practices “pose significant hazards to the personal safety of NSH patients” (p. 4). Inadequate medical and mental health care; Inadequate training Certain medication practices at facility “violated all known standards of medical practice” resulting in great danger to patient safety (p. 2). There was no monitoring of drug side effects and several patients exhibited an “antipsychotic drug- induced side effect, potentially irreversible, that may result in permanent physiological damage” (p. 3). 20c Categories of Constitutional Violations Facility failed to provide training programs adequate to protect patient safety and avoid need for restraint and seclusion (p. 5). Metropolitan Developmental Center 1986 Inadequate medical and mental health care “MDC employs antipsychotic medication primarily as a means of controlling behavior without proper [medical] justification.” As a result, “[n)umerous residents demonstrated serious neurological side effects from sustained exposure to high doses of antipsychotic drugs” (p. 2). Facility had no program to monitor for serious, potentially irreversible side effects of these medications (pp. 2- 3). Other residents “have been exposed to an extreme risk of drug-induced toxic poisoning by the absence of preliminary and periodic drug-level testing” (p. 3). 2lc Belle Chasse LA | 1986 | Inadequate Administration of State School medical and psychotropic drugs mental health substantially care departed from ~ professional Standards. There was no program to detect “Tardive Dyskinesia” which is “an antipsychotic drug induced side effect, potentially irreversible, that may result in permanent physiological damage” (p. 2). Broadview, OH 1987 | Inadequate In the absence of Cleveland é& training; adequate training Warrensville Unreasonable programs, “staff Developmental use of overuse psychotropic Centers chemical medication to restraints control the behavior of residents” (p. 1). Inadequate p. 2 mental health care Montgomery OH | 1987 | Inadequate pp. 2-3 Developmental medical and Center mental health care; Failure to provide reasonable supervision and safety 22c Name of Facility Los Lunas Hospital and Training School NM 1988 SS ey Categories of Constitutional Violations inadequate raining; Unreasonable use of chemical restraints “(S)traightjackets and ammonia inhalants are used as a consequence for antisocial behavior. Restrained individuals are in some cases isolated in a room with a closed door out of sight of staff. This practice, absent adequate surveillance, places severely handicapped residents at great risk of injury and is not professionally justifiable” (p. 2). “Los Lunas staff are using physical restraints, isolation and punishment * * * to control the behavior of residents in lieu of necessary training programs” (p. 2). Failure to Due to lack of medical and mental health care provide supervision, a woman reasonable was raped, developed supervision peritonitis, and and safety died (p. 3). Inadequate Facility provides almost no physical therapy to the large number of patients with body deformities who need therapy “to prevent muscular or skeletal breakdown” (ip. 3). IL 1989 Inadequate training; Unreasonable use of physical and chemical restraints “To control resident behavior, in lieu of professionally designed training programs, staff resort to chemical and physical — restraints” (p. 3). Inacequate medical and mental health care “Due to the lack of adequate medical supervision of patients, early signs of illness and disease go undetected and/or untreated” (p. 5). Failure to provide reasonable supervision and safety “”~ Patient was dead on the floor of her room for some time before staff discovered her, after staff failed to perform scheduled room checks. A patient strangled to death while left unsupervised in improperly-applied restraints. A resident who was left unsupervised ran out the front door and into traffic, where she was killed (pp. 6- 7). Failure to provide reasonable supervision and safety; Inadequate training Investigation found that inadequate supervision contributed to “an alarmingly high frequency of resident injuries” (p. 5). Inadequate training program “fails to reduce self-abusive, aggressive, and other maladaptive and inappropriate behaviors.” “As a result of these problems, rocking, pacing, and aimlessly wandering residents were seen throughout the institution. Instances of self- abuse were not an uncommon sight; observed attempts to intervene appropriately were rare. Many residents were observed to have cuts, bruises and scrapes. Clearly, many of the injuries may have been preventable with more effective programming and if more trained staff were available” (p. 3). 25c Unreasonable use of physical and chemical restraints “Staff resort to chemical and physical restraints to control residents’ behavior, in lieu of professionally designed training programs” (p. 3). Inadequate mental health care p. 4 Abuse of A number of staff residents had been disciplined or criminally charged for abusing patients (p. 5 n.1). Hawaii State HI 1990 | Inadequate Staff at facility Bospital food, clothing | confirmed that there and shelter was often insufficient food; “Staff reported that patients are often wrapped in blankets and sheets due to the absence of adequate clothing”; inadequate items for basic personal hygiene (p. 2). Unsanitary conditions “[Slanitation is grossly inadequate. During a tour of {one unit] our consultants had to walk around numerous puddles of urine. * * * * Kitchen facilities exhibited signs of serious cockroach 26c Categories of Constitutional Violations Details infestation and other unsanitary practices” ip. 3). Inadequate medical and mental health care “[D])rug practices at HSH are seriously deficient and represent significant departures from generally accepted medical standards” (p. 3). Unreasonable use of physical and chemical restraints; Inadequate training “In view of serious, chronic and facility-wide staffing shortages, HSH staff employ bodily restraints -- physical restraints, seclusion, and chemical restraints -- at an unjustifiably high level solely for their own convenience or in lieu of professionally designed treatment programs” ip. 5). Zic II. Investigations Subsequent To Enactment of the Americans with Disabilities Act Failure to “In many units, Developmental provide there was a4 Center reasonable pervasive smell of supervision urine. Residents in and safety; diapers were wet; unsanitary often their clothes conditions were soaked through with urine” (p. 3). Inadequate “[Wle observed young medical care children, some as young as two, whose limbs were severely contracted” from lack of physical therapy. “Many residents were left | unattended in cribs, with no efforts being made to move their limbs, position them, or to provide any real physical therapy services” (p. 3). “The penis of another resident, a paraplegic with an in-dwelling Foley catheter, was eroded throughout its entire length due to inadequate care and monitoring” (p. 3). 28c Inadequate medical care contributed to deaths of five residents in past Six months (p. 4). medical and mental health care Abuse of pp. 5-4 residents Inadequate pp. 8-9 training len Northern VA | 1991 | Inadequate In part because of Virginia training; inadequate training Training Unreasonable programs, use of Center use of restraints was physical and pervasive: chemical “restraint is used restraints so frequently that it appears to be the treatment of choice rather than a technique of last resort” (p. 4). Inadequate “Serious medical conditions and marked functional deterioration are not comprehensively evaluated or effectively treated” due to inadequate medical system (p. 5). Inadequate “Boswell’s staff are Retardation training; using restraints, Center Unreasonable isolation and use of punishment to physical and control the behavior chemical of residents in lieu restraints of necessary training programs” (p. 2). Inadequate pp. 3-4 mental health care Unsanitary p. conditions Embreeville PA | 1991 | Inadequate Delays in emergency Center medical and medical care mental health contributed to care patient death (p. 2). Abuse of Undercover agent residents observed repeated instances of abuse over nine-week period (p. 3). Inadequate p. 2 training programs Agnews CA | 1991 | Unsanitary “Clients and Developmental conditions residents smelled of Center urine and feces” (p. 2). Unreasonable Bodily restraint and use of medication used in physical and lieu of training chemical programs or adequate restraints staff supervision | (pp. 4-5). 30¢ 3le Name of Categories of Name of State/ Year | Categories of Details Facility Constitutional Facility Constitutional Violations Inadequate medical care Investigation found “resident after resident whose legs had lost all muscle tone and whose hip, knee and ankle joints had become permanently fixed or cemented in place in a deformed frog-leg or windswept position due to months and even years of inactivity” (p. 2).- “[I]nordinate delays in diagnosing and responding to serious resident illness” placed large population of medically fragile patients at substantial risk (pp. 5-6) TN 1992 Violations Inadequate medical and mental health care Deficiencies in the facility’s medical care system contributed to two recent deaths (pp. 5-6). Lack of psychiatrists leads to serious errors in diagnosis and medication prescription (pp. 7- 8). Abuse of residents Auministrators “confirmed to us that staff abuse of residents is a serious problem” (p. 2). Unreasonable use of physical and chemical restraints “Patients at MMHI are subjected to both an undue amount of bodily restraint and dangerous restraint practices” (p. 9). “[S]taff members are placing patients inappropriately in physical restraints simply because they are confused or disoriented.” Patients are also restrained while sedated, “a substantial departure from accepted standards of psychiatric care” (pp. 9-10). Fircrest Residential Habilitation “enter WA 1992 Failure to provide reasonable supervision and safety “([R)lesidents suffer needless serious injuries” due to lack of supervision, including an average of “410 incidents per month for some 32c 33c Categories of Constitutional Violations 440 residents” (p. 1). “Numerous residents were seen with fresh wounds and lacerations, including shaved spots on heads revealing stitches and healing injuries; red marks and significant bruises; multiple scabs and scars, and large bandages or casts” (pp. 1-2). “Our consultants observed residents engaged in self- injurious behavior, having seizures, masturbating in open view -- all without staff intervention of any kind” (p. 2). “[O]ne resident was found dead in the day room of a living unit; the resident had been dead for up to three hours before her body was discovered by staff” (p. 2). Dangerous positioning and feeding practices put residents’ lives at risk (p. 2). Name of Facility State sn dalla Year | Categories of Constitutional Violations Inadequate training Details “Due to a lack of human interaction and care, residents have developed significant stereotypic, maladaptive or anti- social behaviors” including “headbanging, eating foreign objects and pulling hair, to waving arms, flicking fingers and other self- stimulatory activities” (p. 1). “Much of the anti- social, maladaptive behavior, injuries and use of restraints is attributable, in significant part, to the lack of * * * training programs” (p. 5). Unreasonable use of physical and chemical restraints Physical restraints, including “staff incapacitating residents by holding them down involun- tarily on the floor or elsewhere for a period of ‘enforced relaxation’” were pervasively “used as punishment, for the convenience of staff and in lieu of training programs” (p. 4-5). 34c Forrest County Jail 1993 Categories of Constitutional Violations Inadequate mental health care “There are no mental health services available at the jail and the holding cells into which disturbed or mentally-ill * * * prisoners are placed pose a direct threat to their health and safety” (p. 2). “During the course of our tour of the jail, our consultants observed a severely mentally ill inmate, clad only in an undershirt, housed in the general population” where he had been waiting for several weeks for a transfer to a mental health facility. “He had allegedly eaten some glass and was prone to defecate on the floor of the cell” (pp. 2-3). 35c Name of Facility State Year Categories of Constitutional Violations Details a strap across the abdomen) and placed into a locked seclusion room” for convenience of staff. Leaving a restrained patient unsupervised creates “great risk of harm from choking and asphyxiation” (p. 2). Arizona State Hospital AZ 1993 Unreasonable use of physical and chemical restraints Patients “are routinely put into five-point restraints (a practice where a patient is restrained on a bed and bound by the ankles, by the wrists with the arms to the side, and by Jones County MS |1993 | Inadequate Mentally ill Jail medical and inmates, and mental health mentally ill persons care detained pending civil commitment proceedings, housed in five-by-six foot steel cage, sometimes for months (p. 4). Chicago-Read IL | 1993 | Inadequate pp. 1-2 Mental Health mental health Center care; Inadequate training Unreasonable p. 2-3 use of physical restraints Sonoma CA | 1994 | Failure to “As a result of Developmental provide inadequate Center reasonable supervision, supervision residents have been and safety subjected to numerous, serious, unnecessary injuries” (p. 2). 36c Name of Facility State Year Categories of Constitutional Violations Details In one incident, a resident drowned in a bathtub while unattended (p. 2). In another, one resident was attacked by another with a knife (p. 2). Inadequate training Training programs are inadequate and lead to harm from unaddressed behaviors and to the unnecessary and unreasonable use of physical and chemical restraints (pp. 4-6). Inadequate medical care Improper feeding practices for severely disabled residents “subject them to severe risk of choking, aspiration and aspiration pneumonia” (p. 3). “The lack of physical therapists and physical therapy services has led to the development of undue contractures, muscle atrophy, inappropriate body growth, and physical degeneration” (p. 3). 37c “The failure of staff to properly maintain [tracheostomy] tubes subjects residents to the risk of death from suffocation and presents other significant health risks, including infection” (p. 3). WI 1994 Failure to provide reasonable supervision and safety Inadequate supervision has led to serious resident injuries. For example, one elderly resident with a condition that - creates a great risk of falling was taken to the hospital for an injury caused by a fall, whereupon hospital staff noted that she had fallen 62 times that day (p. 10). Inadequate medical and mental health care While facility has over 300 residents with seizure disorders, management practices are dangerously deficient; some patients kept on medications with strong and dangerous side effects for years after they are no longer necessary; some are kept on potentially 38c dangerous drugs even though they are not helping. For example, one patient who had been seizure free for six years, was kept on medication even though lab results showed that dosage was too low to be having any effect and even though patient appeared to be suffering from dementia as a side effect of the drug (p. 3-4). Facility’s use of psychotropic medications substantially departs from professional standards, exposing patients to unnecesssr«y risks of dangerovs side effects (pp.7-9). Inadequate training; Unreasonable use of physical restraints pp. 10-13 39c and safety Eastern State 1994 | Inadequate pp. 1-6 Hospital and mental health Hancock care; Geriatric Inadequate Center raining; Unreasonable use of physical and chemical restraints Clover Bottom! IN 1995 | Failure to . Many injuries linked Developmental provide to lack of Center reasonable supervision; “in one supervision seven month period, a resident received injuries on twenty- six occasions,” half of which required stitches (pp. 3-4). Inadequate pp. 5-8 training programs Inadequate “Residents languish medical and mental health care in carts and ill- fitting wheelchairs, which exacerbate or allow physical deformities to progress -- in some cases to a point that the deformity may preclude a person from sitting upright in a wheelchair” (p.12). Name of Facility Nat T. Winston Developmental Center State/ Year TN | 1995 49c Categories of Constitutional Violations Inadequate training; Unreasonable use of physical and chemical restraints Details “NTWDC, because of the ineffectiveness of its behavioral programs, relies on physical and chemical restraints to control residents’ behavior” ip. 3). Leck of training programs and supervision contribute to high incidence of injuries, including “multiple bites, lacerations, broken bones, bruises and abrasions. One individual was injured 25 times * * * in an eight- month period. * * * Several residents were found attempting to cut themselves with knives or razorblades” (p. 4). Inadequate medical and mental health care pp. 4-5 Unsanitary conditions “Sanitary conditions were very poor at the food facility”; “Mold and mildew were prevalent throughout the refrigerators and coolers” because of plumbing leaks (pp. 5-6). TN 1995 Inadequate medical and mental health care “Due to an inadequate medical care delivery system * * * residents are subjected to needless fractures, recurrent aspiration, preventable weight loss, recurring seizures, avoidable injuries, and other direct threats to their health” (p. 2). Psychiatrists prescribing dangerous combinations of drugs “absent any rational justification in violation of medical standards” (p. 3). Failure to provide reasonable supervision and safety Due to lack of supervision, residents “are repeatedly ‘found with blood’ on them from injuries that occur outside of staff supervision. On other occasions, residents’ severe injuries are discovered only during bathing or at bedtime” (p. 5). Name of Facility State 42c Year Categories of Details Constitutional Violations “[Oj]ne eleven year old boy apparently lost the sight in one eye from repeated headslapping which resulted in a detached retina. Other residents were noted with swollen, disfigured features resulting from years of self-injury. Still others had permanent scars from continual self- mutilation of their faces and arms” (p. 6). Inadequate training Many residents’ “destructive behaviors remain unaddressed” by training programs. “For example, one resident had large scratches on her face that had been self-inflicted; our consultant psychologist was informed that there was no program to modify or eliminate this unsafe behavior.” The same was true for a patient who repeatedly reopened a face wound and one who had a history of pica for almost 20 years (p. 7). VA Year 1995 43c Categories of Constitutional Violations Inadequate medical and mental health care Details “[P]sychiatric care is grossly inadequate” and “poses direct threats to the health and safety of patients” (p. 3). “A county hospital is located only a few hundred yards [away], yet there have been a number of well-publicized deaths which are linked to substantial delays in providing adequate medical care” (p. 4). “[O]ne patient died partly because of a toxic buildup of antidepressants in her body. Another patient died from meningitis after a psychiatrist requested that she be seen by an internist who failed to appear to assess her life-threatening condition” (p. 4). Unreasonable use of physical and chemical restraints “Due to inadequate staffing, NVMHT is unable to provide one-on-one monitoring for many residents who are suicidal or are in restraints or 44c Name of Facility Categories of Constitutional Violations seclusion and require such close supervision. Patients have been injured while being restrained and are then left unattended by medical personnel” (p. 5). Failure to provide reasonable supervision and safety “(T]he lack of supervision and care is so grave that patients have been subjected to severe harm, including death” (p. 5). Landmark Learning Center FL 1996 Failure to provide reasonable supervision and safety pp. 3-4 Inadequate training and mental health care pp. 4-10 Harold Jordan Habilitation Center TN 1996 Inadequate training and mental health care pp. 3-4 45c Virginia Mental Health Institute State Year Categories of Constitutional Violations Failure to provide reasonable supervision and safety Details Problems with supervision persist: in the past year, there were 70 incidents of patients escaping from the facility, and an average of 27 incidents of patient self-injury and another 17 incidents of patient-on- patient violence each month (p. 7). Patients repeatedly injured themselves even when “supposedly under careful supervision.” “One patient committed approximately 12 such acts of self- injury while on ‘special observation’ status.” “One patient somehow managed to obtain a knife while in the seclusion room” (p. 7). Inadequate training “[S)taff have resorted to calling the police and having patients arrested rather than addressing the underlying psychological issues” (p. 8). 46c Central State Hospital VA 1997 Categories of Constitutional Violations Failure to provide reasonable supervision and safety Lack of staffing and failure to supervise patients leads to repeated incidents of preventable injury and suicide attempts (pp. 3-5). One patient Supposedly under 24- hour surveillance was found with 42 bruises over his body from unwitnessed incidents (p. 4). Inadequate medical and mental health care pp. 5-7, 9-11 Unreasonable use of physical and chemical restraints Facility’s use of restraints substantially departs from professional Standards (pp. 7-9). Patient died after being left in five- point restraint on bed as punishment; her psychiatrist had warned facility staff not to restrain her because of seizure risk. Nonetheless, the “patient had spent over 300 hours of the last two months of her life in restraints” (p. 8). 47c Los Angeles County Jail CA 1997 Inadequate mental health care Jail system housing approximately 1,700 mentally ill inmates provides virtually no treatment to most inmates other than medication (p. 8). Jail exacerbates many inmates’ illness by placing them in solitary confinement for 23 hours or more per day (p. 12). Failure to provide reasonable supervision and safety Jail places many mentally ill inmates in general population, but requires them to wear uniforms that designate them as mentally ill. Asa result, many inmates suffered from beatings and sexual assaults (pp. 14, 17). Centro de Reeducacion para Adultos PR 1997 Unsanitary conditions/ inadequate shelter “Many of the buildings are dilapidated, decaying, and lack adequate plumbing and lighting.” At one facility, “the showers do not work, the faucets do not work, and che toilets do not flush properly. In order to bathe the clients, staff dump 48c Categories of Constitutional Violations water from water tanks into large movable garbage cans from which the staff manually extract water using smaller buckets to pour it on the residents.” Lack of water means that staff cannot wash hands after changing some patients’ diapers (p. 3). Inadequate training and mental health care; Failure to provide reasonable supervision and safety Investigators found patient “sitting on the floor * * * moaning to himself. We noticed a stream of blood trickling down his helmet. * * * * When the nurse removed his helmet, we discovered that [the patient’s) head had been severely damaged due to years of self-abuse and head banging. [He) had butted and rammed his head into walls and post corners so often that he had pushed back completely his hair and skin on the front half of his head.” Nonetheless, “the Commonwealth has failed to provide [the patient] with 49c State Year Categories of Constitutional Violations Details professional psychological or behavioral services.” Investigation found many other such individuals not receiving adequate care (p. 6). Unreasonable use of physical and chemical restraints “Restraints are prevalent at many of the institutions * * * and are related lack of behavioral program- ming, training, and professional mental health intervention. * * * * [Sjtaff use a bed sheet to tie {a client’s] waist and torso to a bench and to one of the iron bars at the facility to keep her from walking around the building and engaging in aggressive, maladaptive behaviors such as biting and hitting other clients. Staff tie [another client) up in four- point restraints to her bed for the entire time she is menstruating” (p. 7) 50c Center for Integral Services Categories of Constitutional Violations Failure to provide reasonable supervision and safety “On our tour of CIS, we generally found a dangerous - environment for the clients. We noticed many CIS residents with fresh injuries, including lacerations and bruises, as well as historical remnants of past injuries suffered at CIS, such as disfiguring scars. Many clients had suffered facial injuries or severe injuries on the back of their heads with resulting deep scars and hair loss” (p. 3). Parents of clients showed pictures of “son with a very swollen, bulbous, purple and black eye. The father told us that his son has suffered a host of other injuries at CIS including a broken nose, a severe knee injury * * * and various head injuries, some requiring sutures.” Another picture showed a client with a black eye, “a bloody let eye socket, bloody swollen lips, and a face marked with fresh lacerations. The mother reported that her son has also suffered a fractured arm, numerous lacerations, bites, broken teeth” and “is now limited in the use of his hands to one index finger and thumb on each hand” (p. 4). Inadequate food, shelter and sanitation “[T)he facility runs out of food monthly” and “is in a state of disrepair.” “Residents have to sleep on beds with old, worn mattresses that are dirty and often wet.” Toilets do not flush. As a result, “virtually all of the toilets on the men’s side had urine and/or feces in them, producing a health hazard and an unpleasant, malodorous environment” (pp. 5- 6). “Staff admitted to us that they routinely bathe the male clients by lining them up naked and hosing them down in groups * * * with @ garden hose” (pp. o-7). Ab:.se of Facility res: tents administrator acknowledged problems with protecting clients from staff abuse and stated that “one CIS staff member had recently been convicted for sodomizing a client” (p. 3)™~ Unreasonable use of physical and chemical restraints “CIS frequently uses restraints as a substitute for meaningful activity during the day or for appropriate programs to address maladaptive behaviors * * * to control residents they routinely use mechanical restraints, such as leather cuff belts (which are tied to the heavy metal beds around the limbs of the clients), restraint vests and Straight jackets, and restraint nets” (ip. 8). 53c Inadequate medical and mental health care Facility “routinely runs out of certain critical drugs” such as anti-convulsant medications for epileptic patients, who suffered repeated untreated seizures as a result (pp. 5S, 10). “Most of the residents are put on psychotropic medication simply to control their behaviors without appropriate psychiatric assessments, diagnoses, treatment and monitoring” i(p. 9). lnadequate training programs pp. 7-9 1997 Failure to provide reasonable supervision and safety Client went for weeks with an undetected fractured shoulder, even though obviously in pain and bruised (p. 6). Abuse of residents Four staff members recently indicted for abusing residents, many other incidents of abuse documented by facility (pp. 4-5, 15-16). 54c Unreasonable use of physical and chemical restraints “A staff member left a client in full mechanical restraints unattended for hours in a room with a known aggressor” while staff watched television (p. 5). Failure to provide adequate training programs leads to some patients being in restraints virtually non-stop (p. 12). Failure to monitor clients in restraints led to injuries (p. 12-13). Inadequate training As a result of insufficient training programs, “residents’ aberrant behaviors continue unabated, often get worse, and lead frequently to other destructive behaviors” (p. 10). Staff in one unit withheld food from clients if they misbehaved (p. 10). Inadequate medical and mental health care pp. 13-15 Holly Center MD |1998 | Failure to Improper feeding provide techniques for reasonable severely disabled supervision residents and safety; contributed to a Inadequate constant rate of medical care hospitalization and several deaths from choking and severe respiratory problems (pp. 3-5). Systemic inadequacies in medical care contributed to the recent death of a severely handicapped and retarded resident (pp. 7-8). Inadequate pp. 8-13 training Davies County; KY /| 1998 | Inadequate No mental health Detention Center mental health care services provided. “During our tour, we observed several acutely mentally ill individuals at the main jail, obviously in need of psychiatric evaluation and treatment, being left for days at a time in ‘observation’ -- i.@., in a cell by themselves. One inmate was observed singing for hours on end, and eating his own feces” (p. 11). 56c As a result of inadequate mental health and suicide prevention system, a 15-year-old boy killed himself (p. 12). New Castle Developmental Center IN 1998 Failure to provide reasonable supervision and safety; Inadequate training “Injuries are pervasive throughout the campus. With a census of 164 individuals, New Castle averaged over 1,000 resident injuries/incidents on a monthly basis”; over a four-month period, “88 percent of New Castle residents sustained injuries; 82 percent of the residents were injured more than one time during this period” (pp. 2- 3). In a single month, one resident was assaulted 20 times and another was assaulted 19 times (p. 3). “Other injuries are unwitnessed by staff, including bone fractures, bloodied noses and body bruises” (p. 3). “(Wje witnessed instances in which residents engaged in aggressive and self- injurious behaviors (including head slapping, hand biting, eye gouging and table banging) without appropriate and timely staff intervention (p. 4). Inadequate medical and mental health care While half of residents have epilepsy, facility’s seizure management practices dangerously depart from accepted medical practices, increasing risk of liver and permanent brain damage (pp. 5- 6). Insufficient levels of nursing staff lead to failures to identify and treat serious medical problems (pp. 6-7). Georgia Juvenile Facilities GA 1998 Inadequate mental health care Inadequate mental health care provided throughout State’s juvenile detention facilities and training schools (pp. 9-11, 19-22). Many mentally ill youth “end up locked in security units where they spend 58c 59c Categories of Constitutional Violations large portions of their days isolated in small rooms with few activities. In these units, and elsewhere, they are often restrained, hit, shackled, put in restraint chairs for hours, and sprayed with [pepper spray] by staff who lack the training and resources to respond appropriately to the manifestations of mental illness” (p. 20). Inadequate medical care contributed to several recent deaths (p. 8). Unreasonable use of physical and chemical restraints Facility uses excessive and dangerous restraint techniques (p. 7). Western State Hospital VA 1999 Inadequate medical and mental health care Facility fails to identify and address mental health needs, leading to inadequate treatment and risk of harm. In one case, patient identified as suicidal was given no treatment to address suicidal urges and subsequently hanged himself in his room (pp. 3-4). Physicians are not permitted to prescribe some medically-indicated drugs for budget reasons (pp. 5-6). Failure to provide reasonable supervision and safety; Inadequate training Combination of inadequate staffing and training for patients results in high level of violence and injuries. Within one 90-day period, the facility of 370 patients “recorded 169 altercations, 81 instances of self- injurious behavior, and 128 falls” as well as 8 suicide attempts and 13 escapes. In the recent past, one patient committed suicide and was dead for an hour before being discovered (p. 9). WA 1999 Unreasonable use of physical and chemical restraints “In 1998, Rainier logged many thousands of hours of restraint use, without demonstrating that less restrictive | interventions were tried or that 60c Facility Categories of Constitutional Violations Details underlying behavioral support plans and services were adequate.” For example, the facility’s response to patients attempting to eat inedible objects (pica) or digging at their eyes or rectums was to place patients in nearly constant restraints: one patient with pica behavior spent 2,000 hours ina restraint suit over a six-month period; another averaged 600 hours per month for pica and rectal digging; another averaged 22 hours per day in the suit for rectal digging (pp. 2-3). Failure to provide reasonable supervision and safety; Inadequate training; Inadequate medical and mental health care “Without the necessary specialized treatment, * * * residents have suffered serious harm. Residents * * * have blinded themselves from chronic behaviors, such as eye poking and head banging, that the facilities have not addressed in accordance with ng era mS he ne > ihn apron ree accepted professional standards” (p. 7). Numerous incidents of unaddressed, dangerous behaviors, such as pica, head- banging, and eye- poking (pp. 7-8). In one facility, “approximately 20 percent of all Morgan residents were admitted to the emergency room or hospital, some on more than one occasion, for treatment of injuries” in a one- year period; during same year residents in another facility “suffered approximately 77 lacerations requiring sutures (32 involving the head), 37 bone fractures, 8 dislocated shoulders, and 2 incidents of finger amputation” (p. 10). Clark County Detention Center Tnadequate mental health care Jail failed adequately to identify mentally ill inmates and provide appropriate 62c Categories of Constitutional Violations treatment, resulting in serious harm and Suicides (pp. 5-6). Mercer County Geriatric Center NJ 2002 Failure to provide reasonable supervision and safety Steff fail to supervise geriatric patients. In one case “a family member used to visit at odd hours, only to find her unattended relative lying in urine, with parts of her naked body exposed” and with “unexplained skin bruises” (p. 3). More than a third of patients need assistance with eating and drinking, but poor nutrition and hydration practices result in substantial weight losses, hospitalization for dehydration, and even death. In one case, a resident with “an improperly positioned feeding tube” “slowly starved without adequate MCGC staff intervention.” In another case, “staff fed a resident so quickly, she aspirated and died” (p. 6). 63c Name of State/ Year | Categories of Details Facility Constitutional Violations Inadequate Staff “fail to medical and assess and treat mental health residents properly care for potentially serious medical and mental health problems,” including failure to prevent and treat “residents with deep, bleeding bedsores, infections, and other potentially life-threatening conditions” (p. 4). Unreasonable “Staff routinely use of restrain residents physical and while the staff chemical engage in various restraints tasks” (p. 5). Banks- GA |2002 | Failure to Staff failed to take Jackson- provide adequate measures to Commerce reasonable prevent serious Medical supervision falls, other than to Center and and safety, restrain patients to and unreasonable use of physical and chemical restraints chairs and beds (p.3). Other patients are injured by staff when transferred to and from bed, due to inadequate staff available or improper staff training (p. 4). Recently, one unsupervised resident wandered out of the facility in a wheelchair “crashed into a sidewalk curb, 64c Name of Facility Categories of Constitutional Violations overturned” and was seriously injured (p. 4). Inadequate medical and mental health care Facility fails to provide physical therapy that could “prevent contractures (i.e., permanent muscular contraction)” due to lack of adequate steff to implement physical therapy orders (p. 6). Failure to move and reposition patients led to development of pressure sores, some of which became infected and require hospitalization (pp. 6-7). “[T)here is insufficient psychiatric consultation and oversight of medication use” at the facility; a psychiatrist visits the facility only 4 times per year. As a result, many patients have been on inappropriate doses or types of powerful psychiatric medications for years (pp. 9-10). 65c “Approximately 60 residents at BJC have a diagnosis of depression, yet the facility fails to provide group or individual counseling, or other activities designed to treat depression” (p. 10). Inadequate food, clothing and shelter While facility provided ample food and drink, it frequently failed to assist patients who needed feeding and drinking assistance. As a result, “numerous residents were hospitalized for conditions related to lack of adequate hydration” (p. 9). KY 2002 Abuse of residents Numerous incidents of staff abuse, leading to arrests of staff, including one incident in which “an Oakwood staff member stomped on a resident’s head and rendered the resident unconscious” (p. 3). Failure to provide reasonable supervision and safety Very high incidence of harm to residents at facility. During one 3 month period, one patient “had 30 reported incidents of harm” (p. 4). Even though treating professionals rdered close supervision of resident with pica, lax supervision permitted resident to engage in “at least 70 more attempted and/or actual incidents of pica behavior involving paper, trash, toilet paper, shoestrings, a washcloth, an ink pen, a sock, and fecal material.” In another case, failure to supervise resulted in surgery to remove five plastic gloves staff had not observed the resident eating (p. 5). Unreasonable use of physical and chemical restraints Lack of adequate behavior management leads to “increased use of physical and chemical restraints even though all of the Oakwood psychologists interviewed stated Tata «+ 67c that restraints and other aversive or restrictive procedures such as helmets and mittens are unnecessary and unwarranted” (p. 7). Inadequate medical and mental health care More than half of the psychiatric diagnoses for patients are incorrect (p. 9). Many residents receive powerful psychotropic medications with potentially serious side effects “in place of adequate behavioral treatment plans” (p. 9). Facility does not adequately monitor those on psychotropic medications for serious, potentially irreversible side effects (p. 10). Although facility has more than 200 residents with seizure disorders, it provided neurology consultations for only 10-15 residents per month. As a result, many residents are simply 68c put on powerful anti-convulsant medications that might not be necessary, if treated properly, and which have serious side effects. One patient had been on such medications daily for 25 years, even though he had not had a seizure Since 1976 and there was no indication that he had been seen by a neurologist until 2001 (p. 14). Failure to provide adequate medical monitoring and care had contributed to preventable resident deaths (p. 11). On numerous occasions, nurses gave medication to wrong patient, and pills are found lying on floors of living areas (p. 16). 2002 Inadequate medical and mental health care Inadequate mental health care systems contributed to preventable suicides (pp. 4-6). 69c Facility provided no professional individualized treatment, other than medication, to seriously mentally ill residents (p. 7). Nevada Youth Training Center NV 2002 Inadequate medical and mental health care When mentally ill youth are receiving psychotropic medications at the time of entry into the facility, those “medications are automatically and permanently discontinued upon the youths’ arrival” without individualized review by a medical professional (p. 9). Santa Fe County Adult Detention Center NM 2003 Inadequate medical and mental health care Facility provides no qualified medical staff to treat inmates with serious mental illness, permitting counselors to make medical decisions about psychotropic medications (pp. 16- 17). Nim Henson Geriatric Center 2003 Inadequate medical and mental health care Facility medication practices substantially depart from professional Tle standards, placing patients at risk (pp. 3-6) Numerous patients put on feeding tubes unnecessarily, apparently for the convenience of staff (p. 11). Mentally ill patients “either are untreated or treated incorrectly” (p. 15). accepted practice and staff are inadequately trained (pp. 7-9). Unreasonable use of physical and chemical restraints Facility sedates elderly patients for convenience of staff (pp. 8-9). New Lisbon Developmental Center 2003 Failure to protect from physical harm Residents subjected to frequent physical harm by other residents as well as by facility’s staff (pp. 3-6). Inadequate medical and mental health care Inadequate medical care provided to residents with bowel obstructions and seizure disorders, placing residents at risk of serious complications (pp. 17-18). Program to deal with behavioral problems does not comport with generally Unreasonable Unnecessary use of use of mechanical physical and restraints (pp. 9- chemical 10). restraints Use of psychotropic drugs to control residents’ behavior does not comport with generally accepted practices (pp. 10-11). Los Angeles CA | 2003 | Inadequate Failure to treat an County medical and estimated 75% of Juvenile mental health juveniles in need of Rallis care mental health care (p. 7). Failure to comport with professional standards regarding psychological counseling (pp. 12- 14). Failure to administer psychotropic medications safely and effectively (pp. 14-16). Failure to effectively treat youths on suicide watch (pp. 17-18). 72e Name of State/| Year | Categories of Details Facility Constitutional Violations - Excessive use Unjustified use of of force Oleoresin Capsicum spray, including agéinst juveniles with respiratory problems (pp. 20- 22). Failure to Juveniles frequently protect from subjected to physical harm violence from other juveniles, resulting in “significant injury” (pp. 22-23). Garfield OK | 2003 | Inadequate Provision of medical County Jail 6 medical and services to inmates Garfield mental health “is seriously County Work care deficient and places Center inmates at risk of harm” (p. 10). Provision of mental health care inadequate, particularly in regard to suicide prevention (pp. 14- 15). Metropolitan CA | 2003 | Inadequate Psychiatric services State mental health “substantially Hospital care depart from generally accepted professional standards of care and expose the children and adolescents [in the facility] toa Significant risk of harm and to actual harm” (p. 3). 73c Name of Facility State Year Categories of Constitutional Violations Details Inappropriate use of psychotropic medications (pp. 9- 11). Unreasonable Use of physical and use of chemical restraints physical and “substantially chemical departs” from restraints standards of care and exposes children to “excessive and unnecessary restrictive interventions” (p. 25). Reginald P. MS 2003 | Inadequate “[I]nappropriate use White Nursing mental health of multiple Facility care medications” and “excessive reliance on psychotropic medications (chemical restraints)” (p. 8). Claudette Box; AL | 2003 | Inadequate Facility administers Nursing Home medical and “excessive or mental health unnecessary doses of care psychotropics” (p. 3). Oakley & MS |2003 | Unreasonable Use of physical Columbia use of restraints such as Training physical “[h]og-tying and Schools restraints [p] ole-shackling” despite lack of “penological justification or therapeutic or rehabilitative benefit” of such disciplinary methods (pp. 5-9). 74c Name of Facility State Year Categories of Constitutional Violations Details Excessive use of force Pacility staff “use excessive force with impunity” (pp. 9- 11). Inadequate mental health care “Many youth on psychiatric medications are not allowed to continue to receive those medications when they are admitted” ip. 15). Facilities “fail to employ adequate Suicide prevention measures” (p. 16). ee APPENDIX D CONSTITUTION OF THE UNITED STATES AMENDMENT XI The Judicial power of the United States shall no‘ be construed to extend to any suit in law or equity, commenced or prosecuted against one of the United States by Citizens of another State, or by Citizens or Subjects of any Foreign State. AMENDMENT XIV SECTION 1. All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws. * *x * * * SECTION 5. The Congress shall have power to enforce, by appropriate legislation, the provisions of this article. (1d) 2d SELECTED PROVISIONS OF THE AMERICANS WITH DISABILITIES ACT OF 1990, 42 U.S.C. 12101 et seq. § 12101. Findings and purpose (a) Findings The Congress finds that— (1) some 43,000,000 Americans have one or more physical or mental disabilities, and this number is increasing as the population as a whole is growing older; (2) historically, society has tended to isolate and segregate individuals with disabilities, and, despite some improvements, such forms of discrimination against indi- viduals with disabilities continue to be a serious and per- vasive social problem; (3) discrimination against individuals with disabilities persists in such critica] areas as employment, hoysing, public accommodations, education, transportation, communication, recreation, institutionalization, health services, voting, and access to public services; . (4) unlike individuals who have experienced discrimina- tion on the basis of race, color, sex, national origin, religion, or age, individuals who have experienced discrimination on the basis of disability have often had no legal recourse to redress such discrimination; (5) individuals with disabilities continually encounter various forms of discrimination, including outright inten- tional exclusion, the discriminatory effects of architectural, transportation, and communication barriers, overprotective rules and policies, failure to make modifications to existing facilities and practices, exclusionary qualification standards 3d and criteria, segregation, and relegation to lesser services, programs, activities, benefits, jobs, or other opportunities; (6) census data, national polls, and other studies have documented that people with disabilities, as a group, occupy an inferior status in our society, and are severely disadvan- taged socially, vocationally, economically, and educationally; (7) individuals with disabilities are a discrete and insular minority who have been faced with restrictions and limitations, subjected to a history of purposeful unequal treatment, and relegated to a position of political power- lessness in our society, based on characteristics that are beyond the control of such individuals and resulting from stereotypic assumptions not truly indicative of the individual ability of such individuals to participate in, and contribute to, society; (8) the Nation’s proper goals regarding individuals with disabilities are to assure equality of opportunity, full partici- pation, independent living, and economic self-sufficiency for such individuals; and (9) the continuing existence of unfair and unnecessary discrimination and prejudice denies people with disabilities the opportunity to compete on an equal basis and to pursue those opportunities for which our free society is justifiably famous, and costs the United States billions of dollars in unnecessary expenses resulting from dependency and nonproductivity. . (b) Purpose It is the purpose of this chapter— (1) to provide a clear and comprehensive national man- date for the elimination of discrimination against individuals with disabilities; 4d (2) to provide clear, strong, consistent, enforceable standards addressing discrimination against individuals with disabilities; (3) to ensure that the Federal Government plays a central role in enforcing the standards established in this chapter on behalf of individuals with disabilities; and (4) to invoke the sweep of congressional authority, including the power to enforce the fourteenth amendment and co regulate commerce, in order to address the major areas of discrimination faced day-to-day by people with disabilities. 5d Title II, Part A, of The Americans With Disabilities Act § 12131. Definitions As used in this subchapter: (1) Public entity The term “public entity” means— (A) any State or local government; (B) any department, agency, special purpose dis- trict, or other instrumentality of a State or States or local government; and (C) the National Railroad Passenger Corporation, and any commuter authority (as defined in section 2410(4) of title 49). (2) Qualified individual with a disability The term “qualified individual with a disability” means an individual with a disability who, with or without reasonable modifications to rules, policies, or practices, the removal of architectural, communication, or transportation barriers, or the provision of auxiliary aids and services, meets the essential eligibility requirements for the receipt of services or the participation in programs or activities provided by a public entity. § 12132. Discrimination Subject to the provisions of this subchapter, no qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity. § 12133. Enforcement The remedies, procedures, and rights set forth in section 794a of title 29 shall be the remedies, procedures, and rights this subchapter provides to any person alleging discrimina- tion on the basis of disability in violation of section 12132 of this title. § 12134. Regulations (a) In general Not later than 1 year after July 26, 1990, the Attorney General shal] promulgate regulations in an accessible format that implement this part. Such regulations shall not include any matter within the scope of the authority of the Secretary of Transportation under section 12143, 12149, or 12164 of this title. (b) Relationship to other regulations Except for “program accessibility, existing facilities”, and “communications”, regulations under subsection (a) of this section shall be consistent with this chapter and with the coordination regulations under part 41 of title 28, Code of Federal Regulations (as promulgated by the Department of Health, Education, and Welfare on January 13, 1978), ap- plicable to recipients of Federal financial assistance under section 794 of title 29. With respect to “program accessibil- ity, existing facilities”, and “communications”, such regula- tions shall be consistent with regulations and analysis as in part 39 of title 28 of the Code of Federal Regulations, ap- plicable to federally conducted activities under such section 794 of title 29. 7d (c) Standards Regulations under subsection (a) of this section shall include standards applicable to facilities and vehicles covered by this part, other than facilities, stations, rail passenger cars, and vehicles covered by part B of this subchapter. Such standards shall be consistent with the minimum guidelines and requirements issued by the Architectural and Transportation Barriers Compliance Board in accordance with section 12204(a) of this title. ~ * * ~ * 8d Title II, Part B, of The Americans With Disabilities Act § 12141. Definitions As used in this subpart: (1) Demand responsive system The term “demand responsive system” means any sys- tem of providing designated public transportation which is not a fixed route system. (2) Designated public transportation The term “designated public transportation” means transportation (other than public school transportation) by bus, rail, or any other conveyance (other than trans- portation by aircraft or intercity or commuter rail trans- portation (as defined in section 12161 of this title)) that provides the general public with general or special serv- ice (including charter service) on a regular and continu- ing basis. (3) Fixed route system The term “fixed route system” means a system of pro- viding designated public transportation on which a vehi- cle is operated along a prescribed route according to a fixed schedule. (4) Operates The term “operates”, as used with respect to a fixed route system or demand responsive system, includes op- eration of such system by a person under a contractual or other arrangement or relationship with a public entity. (5) Public school transportation The term “public school transportation” means trans- portation by schoolbus vehicles of schoolchildren, per- 9d sonnel, and equipment to and from a public elementary or secondary school and school-related activities. (6) Secretary The term “Secretary” means the Secretary of Trans- portation. § 12142. Public entities operating fixed route systems (a) Purchase and lease of new vehicles It shall be considered discrimination for purposes of sec- tion 12132 of this title and section 794 of Title 29 for a public entity which operates a fixed route system to purchase or lease a new bus, a new rapid rail vehicle, a new light rail ve- hicle, or any other new vehicle to be used on such system, if the solicitation for such purchase or lease is made after the 30th day following July 26, 1990, and if such bus, rail vehicle, or other vehicle is not readily accessible to and usable by in- dividuals with disabilities, including individuals who use wheelchairs. (b) Purchase and lease of used vehicles Subject to subsection (c)(1) of this section, it shall be con- sidered discrimination for purposes of section 12132 of this title and section 794 of Title 29 for a public entity which op- erates a fixed route system to purchase or lease, after the 30th day following July 26, 1990, a used vehicle for use on such system unless such entity makes demonstrated good faith efforts to purchase or lease a used vehicle for use on such system that is readily accessible to and usable by indi- viduals with disabilities, including individuals who use wheelchairs. 10d (c) Remanufactured vehicles (1) General rule Except as provided in paragraph (2), it shall be con- sidered discrimination for purposes of section 12132 of this title and section 794 of Title 29 for a public entity which operates a fixed route system— (A) to remanufacture a vehicle for use on such system so as to extend its usable life for 5 years or more, which remanufacture begins (or for which the solicitation is made) after the 30th day following July 26, 1990; or (B) to purchase or lease for use on such system a remanufactured vehicle which has_ been remanufactured so as to extend its usable life for 5 years or more, which purchase or lease occurs after such 30th day and during the period in which the us- able life is extended; unless, after remanufacture, the vehicle is, to the maxi- mum extent feasible, readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs. (2) Exception for historic vehicles (A) General rule If a public entity operates a fixed route system any segment of which is included on the National Register of Historic Places and if making a vehicle of historic character to be used solely on such segment readily accessible to and usable by individuals with disabilities would significantly alter the historic char- acter of such vehicle, the public entity only has to make (or to purchase or lease a remanufactured vehi- cle with) those modifications which are necessary to lld meet the requirements of paragraph (1) and which do not significantly alter the historic character of such vehicle. (B) Vehicles of historic character defined by regula- tions For purposes of this paragraph and section 12148(b) of this title, a vehicle of historic character shall be defined by the regulations issued by the Sec- retary to carry out this subsection. § 12143. Paratransit as a complement to fixed route service (a) General rule It shall be considered discrimination for purposes of sec- tion 12132 of this title and section 794 of Title 29 for a public entity which operates a fixed route system (other than a sys- tem which provides solely commuter bus service) to fail to provide with respect to the operations of its fixed route sys- tem, in accordance with this section, paratransit and other special transportation services to individuals with disabili- ties, including individuals who use wheelchairs, that are suf- ficient to provide to such individuals a level of service (1) which is comparable to the level of designated public trans- portation services provided to individuals without disabili- ties using such system; or (2) in the case of response time, which is comparable, to the extent practicable, to the level of designated public transportation services provided to indi- viduals without disabilities using such system. (b) Issuance of regulations Not later than 1 year after July 26, 1990, the Secretary shall issue final regulations to carry out this section. 12d (c) Required contents of regulations (1) Eligible recipients of service The regulations issued under this section shall require each public entity which operates a fixed route system to provide the paratransit and other special transportation services required under this section— (A)(i) to any individual with a disability who is unable, as a result of a physical or mental impairment (including a vision impairment) and without the assis- tance of another individual (except an operator of a wheelchair lift or other boarding assistance device), to board, ride, or disembark from any vehicle on the sys- tem which is readily accessible to and usable by indi- viduals with disabilities; (ii) | to any individual with a disability who needs the assistance of a wheelchair lift or other boarding as- sistance device (and is able with such assistance) to board, ride, and disembark from any vehicle which is readily accessible to and usable by individuals with dis- abilities if the individual wants to travel on a route on the system during the hours of operation of the system at a time (or within a reasonable period of such time) when such a vehicle is not being used to provide desig- nated public transportation on the route; and (ili) to any individual with a disability who has a specific impairment-related condition which prevents such individual from traveling to a boarding location or from a disembarking location on such system; (B) to one other individual accompanying the individual with the disability; and (C) to other individuals, in addition to the one individual described in subparagraph (B), accompanying 13d the individual with a disability provided that space for these additional individuals is available on the paratransit vehicle carrying the individual with a dis- ability and that the transportation of such additional individuals will not result in a denial of service to indi- viduals with disabilities. For purposes of clauses (i) and (ii) of subparagraph (A), boarding or disembarking from a vehicle does not include travel to the boarding location or from the disembarking location. (2) Service area The regulations issued under this section shall require the provision of paratransit and special transportation services required under this section in the service area of each public entity which operates a fixed route system, other than any portion of the service area in which the public entity solely provides commuter bus service. (3) Service criteria Subject to paragraphs (1) and (2), the regulations is- sued under this section shall establish minimum service criteria for determining the level of services to be re- quired under this section. (4) Undue financial burden limitation The regulations issued under this section shall provide that, if the public entity is able to demonstrate to the satisfaction of the Secretary that the provision of paratransit and other special transportation services otherwise required under this section would impose an undue financial burden on the public entity, the public en- tity, notwithstanding any other provision of this section (other than paragraph (5)), shall only be required to pro- 14d vide such services to the extent that providing such serv- ices would not impose such a burden. (5) Additional services The regulations issued under this section shall estab- lish circumstances under which the Secretary may require a public entity to provide, notwithstanding paragraph (4), paratransit and other special transportation services un- der this section beyond the level of paratransit and other special transportation services which would otherwise be required under paragraph (4). (6) Public participation The regulations issued under this section shall require that each public entity which operates a fixed route sys- tem hold a public hearing, provide an opportunity for public comment, and consult with individuals with dis- abilities in preparing its plan under paragraph (7). (7) Plans The regulations issued under this section shall require that each public entity which operates a fixed route sys- tem— (A) within 18 months after July 26, 1990, submit to the Secretary, and commence implementation of, a plan for providing paratransit and other special trans- portation services which meets the requirements of this section; and (B) on an annual basis thereafter, submit to the Secretary, and commence implementation of, a plan for providing such services. (8) Provision of services by others The regulations issued under this section shall— 15d (A) require that a public entity submitting a plan to the Secretary under this section identify in the plan any person or other public entity which is providing a paratransit or other special transportation service for individuals with disabilities in the service area to which the plan applies; and (B) provide that the public entity submitting the plan does not have to provide under the plan such serv- ice for individuals with disabilities. (9) Other provisions The regulations issued under this section shall include such other provisions and requirements as the Secretary determines are necessary to carry out the objectives of this section. (d) Review of plan (1) General rule The Secretary shall review a plan submitted under this section for the purpose of determining whether or not such plan meets the requirements of this section, includ- ing the regulations issued under this section. (2) Disapproval If the Secretary determines that a plan reviewed un- der this subsection fails to meet the requirements of this section, the Secretary shall disapprove the plan and notify the public entity which submitted the plan of such disap- proval and the reasons therefor. (3) Modification of disapproved plan Not later than 90 days after the date of disapproval of a plan under this subsection, the public entity which submitted the plan shall modify the plan to meet the re- quirements of this section and shall submit to the Secre- 16d tary, and commence implementation of, such modified plan. (e) “Discrimination” defined As used in subsection (a) of this section, the term “dis- crimination” includes— (1) a failure of a public entity to which the regula- tions issued under this section apply to submit, or com- mence implementation of, a plan in accordance with sub- sections (c)(6) and (c)(7) of this section; (2) a failure of such entity to submit, or commence implementation of, a modified plan in accordance with subsection (d)(3) of this section; (3) submission to the Secretary of a modified plan under subsection (d)(3) of this section which does not meet the requirements of this section; or (4) a failure of such entity to provide paratransit or other special transportation services in accordance with the plan or modified plan the public entity submitted to the Secretary under this section. (f) Statutory construction Nothing in this section shall be construed as preventing a public entity— (1) from providing paratransit or other special trans- portation services at a level which is greater than the level of such services which are required by this section, (2) from providing paratransit or other special trans- portation services in addition to those paratransit and special transportation services required by this section, or (3) from providing such services to individuals in ad- dition to those individuals to whom such services are re- quired to be provided by this section. 17d § 12144. Public entity operating a demand responsive system If a public entity operates a demand responsive system, it shall be considered discrimination, for purposes of section 12132 of this title and section 794 of Title 29, for such entity to purchase or lease a new vehicle for use on such system, for which a solicitation is made after the 30th day following July 26, 1990, that is not readily accessible to and usable by indi- viduals with disabilities, including individuals who use wheelchairs, unless such system, when viewed in its en- tirety, provides a level of service to such individuals equivalent to the level of service such system provides to individuals without disabilities. § 12145. Temporary relief where lifts are unavailable (a) Granting With respect to the purchase of new buses, a public entity may apply for, and the Secretary may temporarily relieve such public entity from the obligation under section 12142(a) or 12144 of this title to purchase new buses that are readily accessible to and usable by individuals with disabilities if such public entity demonstrates to the satisfaction of the Secretary— (1) that the initial solicitation for new buses made by the public entity specified that all new buses were to be lift-equipped and were to be otherwise accessible to and usable by individuals with disabilities; (2) the unavailability from any qualified manufac- turer of hydraulic, electromechanical, or other lifts for such new buses; - (3) that the public entity seeking temporary relief has made good faith efforts to locate a qualified manufac- 18d turer to supply the lifts to the manufacturer of such buses in sufficient time to comply with such solicitation; and (4) that any further delay in purchasing new buses necessary to obtain such lifts would significantly impair transportation services in the community served by the public entity. (b) Duration and notice to Congress Any relief granted under subsection (a) of this section shall be limited in duration by a specified date, and the ap- propriate committees of Congress shall be notified of any such relief granted. (c) Fraudulent application If, at any time, the Secretary has reasonable cause to be- lieve that any relief granted under subsection (a) of this sec- tion was fraudulently applied for, the Secretary shall— (1) cancel such relief if such relief is still in effect; and (2) take such other action as the Secretary considers appropriate. § 12146. New facilities For purposes of section 12132 of this title and section 794 of Title 29, it shall be considered discrimination for a public entity to construct a new facility to be used in the provision of designated public transportation services unless such fa- cility is readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs. § 12147. Alterations of existing facilities (a) General rule With respect to alterations of an existing facility or part thereof used in the provision of designated public transpor- tation services that affect or could affect the usability of the 19d facility or part thereof, it shall be considered discrimination, for purposes of section 12132 of this title and section 794 of Title 29, for a public entity to fail to make such alterations (or to ensure that the alterations are made) in such a manner that, to the maximum extent feasible, the altered portions of the facility are readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, upon the completion of such alterations. Where the public entity is undertaking an alteration that affects or could affect usability of or access to an area of the facility containing a primary function, the entity shall also make the alterations in such a manner that, to the maximum extent feasible, the path of travel to the altered area and the bathrooms, telephones, and drinking fountains serving the altered area, are readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs, upon completion of such alterations, where such alterations to the path of travel or the bathrooms, telephones, and drinking fountains serving the altered area are not disproportionate to the overall alterations in terms of cost and scope (as determined under criteria established by the Attorney General). (b) Special rule for stations (1) General rule For purposes of section 12132 of this title and section 794 of Title 29, it shall be considered discrimination for a public entity that provides designated public transporta- tion to fail, in accordance with the provisions of this sub- section, to make key stations (as determined under criteria established by the Secretary by regulation) in rapid rail and light rail systems readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs. 20d (2) Rapid rail and light rail key stations (A) Accessibility Except as otherwise provided in this paragraph, all key stations (as determined under criteria established by the Secretary by regulation) in rapid rail and light rail systems shall be made readily accessible to and usable by individuals with disabilities, including indi- viduals who use wheelchairs, as soon as practicable but in no event later than the last day of the 3-year period beginning on July 26, 1990. (B) Extension for extraordinarily expensive struc- tural changes The Secretary may extend the 3-year period under subparagraph (A) up to a 30-year period for key sta- tions in a rapid rail or light rail system which stations need extraordinarily expensive structural changes to, or replacement of, existing facilities; except that by the last day of the 20th year following July 26, 1990, at least 2/3 of such key stations must be readily accessible to and usable by individuals with disabilities. [Text truncated at 120,000 characters. The full text is on the page linked above.] --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/brief%3Amicro_IA40385014_0662%3A10. Public record. Not legal advice.