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.

Top 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.

• 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.

• 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.

• 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.

Verified Quotes

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.

• 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.

• 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.