Olmstead v. L. C.

Summary

The two respondents, identified in the case as L. C. and E. W., were Georgia women with intellectual disabilities who also had psychiatric diagnoses, schizophrenia in one case and a personality disorder in the other. Both were voluntarily admitted to Georgia Regional Hospital in Atlanta. L. C.'s treatment team agreed by May 1993 that her needs could be met in a community-based program, yet she stayed in the hospital until February 1996; E. W.'s psychiatrist reached the same conclusion about her in 1996, and she remained until after the trial court ruled in 1997. In 1995 they sued the Commissioner of the Georgia Department of Human Resources, Tommy Olmstead, and other officials under Title II of the Americans with Disabilities Act of 1990, which forbids public entities to subject qualified individuals with disabilities to discrimination. The District Court and the Eleventh Circuit ruled for the women. The question was whether Title II can require a state to place people with mental disabilities in community settings rather than institutions. The women argued that Congress named isolation and segregation of people with disabilities as forms of discrimination, and that keeping them confined after their own clinicians recommended community care violated the statute. Georgia answered that discrimination means treating one group worse than another similarly situated group, that the women had not been denied anything because of their disabilities, and that a limited budget already stretched to serve others could not be redirected by court order. On 22 June 1999 the Court affirmed in part and vacated in part, six to three. Justice Ginsburg, writing for the Court in Parts I, II and III-A, held that unjustified isolation is properly regarded as discrimination based on disability, because it stigmatizes those kept apart and cuts them off from family, work and ordinary life. She added that states may rely on the reasonable assessments of their own professionals and that nothing in the law requires closing institutions for those who need them. In Part III-B, for a plurality of four, she held that the fundamental-alteration defense must allow the state to show its obligations to others with mental disabilities, as by maintaining a comprehensive, effectively working plan for community placement with a waiting list that moves at a reasonable pace. Justice Kennedy, concurring in the judgment, warned that states must not be pressed into placing patients in settings lacking necessary care. Justice Thomas, joined by the Chief Justice and Justice Scalia, dissented on the ground that discrimination ordinarily requires a comparison with a differently treated group and that the majority had imposed a standard of care. Justice Stevens's separate opinion is not part of the library text. The library text includes Ginsburg's opinion and parts of the Kennedy and Thomas opinions, without footnotes. Olmstead's integration principle became the basis of extensive federal enforcement and state planning for community-based services. L. C. was later publicly identified as Lois Curtis, who became known as an artist and advocate.

Plot or Argument

• The statute and the integration regulation

  Ginsburg sets out Congress's findings in the ADA, the text of Title II, the Attorney General's regulation requiring services in the most integrated setting appropriate, and the companion regulation excusing modifications that would fundamentally alter a program.

• Two women at Georgia Regional Hospital

  Part II recounts L. C.'s and E. W.'s admissions, their clinicians' recommendations for community placement, the delays that followed, and the lower courts' rulings, including the Eleventh Circuit's narrow view of the cost defense.

• Isolation as discrimination

  In Part III-A, for the Court, Ginsburg rejects Georgia's argument that discrimination requires unequal treatment of similarly situated groups, relying on the ADA's findings, earlier statutes and the Department of Justice's consistent view, and explains the two judgments behind treating unjustified institutional isolation as discrimination.

• Limits on the state's duty

  Ginsburg stresses that the law does not require closing institutions, that states may rely on their professionals' assessments, and that people who do not desire community placement need not accept it.

• The fundamental-alteration defense (plurality)

  Part III-B, for four justices, holds that courts must weigh the cost of a placement against the state's resources and its duty to others with disabilities, and suggests that an effectively working plan and a reasonably paced waiting list would satisfy the statute.

• Kennedy's concurrence (excerpt)

  Kennedy describes the history of deinstitutionalization, cautions against compliance on the cheap, and offers a narrower theory under which the women might show discrimination by comparison with other recipients of state medical services.

• Thomas's dissent (excerpt)

  Thomas surveys Title VII, the Rehabilitation Act and constitutional cases to show that discrimination has always meant differential treatment between groups, and warns of federalism costs when federal courts direct how states deliver public services.

Characters

• L. C. (Lois Curtis), respondent

  Georgia woman whose clinicians recommended community placement years before she received it.

• E. W., respondent

  Second plaintiff, who joined the suit and was also kept in the hospital after a community placement was recommended.

• Tommy Olmstead, petitioner

  Commissioner of the Georgia Department of Human Resources, sued with hospital and regional officials.

• Justice Ruth Bader Ginsburg, author of the opinion of the Court in part and plurality in part

  Held that unjustified isolation is discrimination based on disability.

• Justice Anthony M. Kennedy, concurring in the judgment

  Urged caution so that states would not move patients into settings without adequate care.

• Justice Clarence Thomas, dissenting

  Wrote for three justices that discrimination requires a comparison between groups.

Lessons

• What counts as discrimination?

  Georgia and Justice Thomas read discrimination in its traditional sense, as treating one group worse than another. The Court read the ADA's findings, which name isolation and segregation, as broadening the term to include keeping a person in an institution without justification.

  • How does Thomas define discrimination, and what cases does he rely on?
  • What congressional findings does Ginsburg use to support a broader meaning?
  • Should a statute's findings shape how courts read its operative words?

• Two harms of needless confinement

  Ginsburg gave two reasons for treating unjustified institutional isolation as discrimination: it reinforces assumptions that people kept apart cannot take part in community life, and it cuts them off from family, work, friends and education. Both reasons focus on the person's place in a community rather than on the quality of medical care alone.

  • What are the two evident judgments Ginsburg identifies?
  • Which everyday activities does she say confinement diminishes?
  • What does it mean to belong to a community, and what can take that away?

• Caution about deinstitutionalization

  Kennedy reminded readers that the movement of patients out of state hospitals after the 1950s, though often well meant, left many without care. His concurrence shows a justice agreeing with a result while warning about how it might be carried out.

  • What evidence does Kennedy cite about the effects of deinstitutionalization?
  • What does Kennedy mean by compliance on the cheap?
  • How should a state balance the freedom of patients with their need for close care?

• Limited resources and fair shares

  All the justices acknowledged that states have limited budgets and many people to serve. The plurality allowed states to defend themselves by showing a working plan and a reasonable waiting list, while the dissent thought the whole question belonged to state officials.

  • What would a state need to show under the plurality's reading of the fundamental-alteration defense?
  • Why does Thomas see federalism costs in the majority's approach?

Context

American public psychiatric hospitals held more than half a million patients in the mid-1950s. New medications, changes in federal funding and legal challenges led to a long decline in their populations, while community services developed unevenly. The Americans with Disabilities Act of 1990 declared that society had tended to isolate and segregate people with disabilities and set out a national mandate against discrimination.

Composition

L. C. filed suit in May 1995 and E. W. joined later; the District Court ruled in 1997 and the Eleventh Circuit in 1998. The case was argued on 21 April 1999 and decided on 22 June 1999. Georgia was supported by a number of states, while the United States and many disability and medical organizations, including the American Psychiatric Association, filed briefs supporting the women.

Reception

The decision became the foundation of federal efforts to expand community-based services, and many states adopted Olmstead plans for moving people from institutions into community settings. Advocates hailed it as a landmark for disability rights, while some states and commentators worried about costs and about patients who need intensive care; litigation over its application has continued since.

Comparisons

• youngberg-v-romeo

  Youngberg defined what the Constitution requires inside a state institution; Olmstead, resting on a statute rather than the Constitution, addressed when a person must be offered a place outside it.

• oconnor-v-donaldson

  The 1975 case barred confining a non-dangerous person who can live safely in freedom; Olmstead extended concern about needless confinement to voluntarily admitted patients under federal disability law.

• addington-v-texas

  Addington governs the proof needed to commit a person involuntarily, while L. C. and E. W. had entered the hospital voluntarily and sought to leave it.

• buck-v-bell

  Seventy-two years apart, the two cases show the Court addressing the place of people with intellectual disabilities in society under very different laws and assumptions.

Quotes

For Students

A reading companion for classical Christian high school students. See the student guide.

Reading Guide

Watch for

• The ADA findings that mention isolation, segregation and institutionalization.
• The integration regulation and the fundamental-alteration regulation.
• Ginsburg's two evident judgments about institutional isolation.
• The limits Ginsburg places on the state's duty.
• Thomas's survey of how the Court has read the word discrimination in other laws.

Key terms and names

Title II of the ADA

The part of the Americans with Disabilities Act that forbids discrimination by state and local governments in their services and programs.

Integration mandate

The regulatory requirement that public entities serve people with disabilities in the most integrated setting appropriate to their needs.

Fundamental alteration

A change so basic to a program that a public entity is not required to make it as a reasonable modification.

Plurality opinion

An opinion joined by more justices than any other but by fewer than a majority, so that it does not by itself set binding precedent.

Deinstitutionalization

The policy, from the 1950s onward, of moving patients out of large state hospitals and into community settings.

Ex rel.

Latin abbreviation meaning on the relation of, used when a person sues on behalf of another, as a guardian for L. C. did here.

Seminar Questions

1. Comprehension Why were L. C. and E. W. still in the hospital after their clinicians recommended community placement?
2. Comprehension Which parts of Ginsburg's opinion speak for the Court, and which only for a plurality?
3. Interpretation How do Ginsburg and Thomas each use earlier statutes and cases to support their readings of discrimination?
4. Interpretation Why does Kennedy agree with the judgment yet write at length about the dangers of deinstitutionalization?
5. Interpretation What does the plurality mean by a waiting list that moves at a reasonable pace?
6. Big Question What does a community owe to its members whose illnesses or disabilities make ordinary life difficult?

Faith Connections

• Mark 5:1-20 (Scripture)

  The Gerasene man who lived among the tombs is healed and sent home to his own people, an image of restoration to community.

• 1 Corinthians 12:22-26 (Scripture)

  Paul writes that the members of the body which seem more feeble are necessary, and that all suffer when one member suffers.

Logic and Rhetoric

Central argument: Ginsburg reasons that Congress's findings identify isolation and segregation as forms of disability discrimination, that unjustified institutional confinement both stigmatizes and impoverishes a person's life, and that a state must therefore offer community placement when its professionals recommend it and the cost is reasonable in light of its duties to others; Thomas replies that discrimination requires unequal treatment between groups and that the Court has imposed a standard of care.

Rhetorical device: definition. The case turns on competing definitions of a single word: Ginsburg's broader reading grounded in the ADA's findings (quote 0) against Thomas's traditional, comparative meaning (quote 4).

Debate: Resolved: that keeping a person in an institution after professionals recommend community care is a form of discrimination.

Memory Work

Unjustified isolation, we hold, is properly regarded as discrimination based on disability.

It must be remembered that for the person with severe mental illness who has no treatment the most dreaded of confinements can be the imprisonment inflicted by his own mind, which shuts reality out and subjects him to the torment of voices and images beyond our own powers to describe.

Writing Prompts

Essay: Evaluate whether the Court was right to treat unjustified institutional isolation as discrimination, weighing Ginsburg's reasons against Thomas's account of the word's ordinary meaning.

Comparison with Youngberg v. Romeo: Compare the role that professional judgment plays in Youngberg (1982) and in Olmstead (1999), and explain how each case uses it to define the state's obligations.

Medical Lens

Olmstead is the leading American case on the shift from institutional to community psychiatric care: it treats the clinical judgment of a patient's own treatment team as the trigger for a legal duty to offer community placement, and Kennedy's concurrence preserves a judicial record of the costs of deinstitutionalization, including the American Psychiatric Association's estimate of a 92 percent decline in public psychiatric hospital populations between 1955 and 1995.

• Opinion of the Court, Part II, paragraph beginning With the key legislative provisions in full view

  Recounts the two women's voluntary admissions to a psychiatric unit and the years between their clinicians' recommendations and their placement in community programs.

  Asylum Institution
• Opinion of Justice Kennedy, paragraph beginning Beginning in the 1950's, many victims of severe mental illness

  Summarizes the history and consequences of deinstitutionalization, relying on an American Psychiatric Association brief and a psychiatrist's critical assessment.

  Asylum Institution Madness Psychosis
• Opinion of the Court, Part III-A, paragraph beginning Consistent with these provisions, the State generally may rely

  Holds that states may rely on the reasonable assessments of their own professionals in deciding who is qualified for community-based care.

  Asylum Institution

Creative Prompts

• Classroom

  Hold a moot court for April 1999 in which counsel for Georgia and for L. C. and E. W. argue over the meaning of discrimination, and student justices write short opinions in the manner of Ginsburg, Kennedy and Thomas.

• Essay

  Write a short report, as a state planner after 1999, describing what a comprehensive, effectively working plan for community placement would need to include under the plurality's reasoning.

• Dialogue

  Write a conversation between a treating psychiatrist and a hospital administrator in 1994 about why a patient recommended for community placement is still on the ward.

Further Reading

• American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System, E. Fuller Torrey

  Psychiatrist's critical history of deinstitutionalization and federal mental-health policy.

• No Pity: People with Disabilities Forging a New Civil Rights Movement, Joseph P. Shapiro

  Journalist's account of the disability-rights movement that led to the Americans with Disabilities Act.