Censured on mental health
Court rules Maine in non-compliance of AMHI consent decree
Copyright © 2003 Blethen Maine Newspapers Inc.
AUGUSTA — A superior court judge ruled Friday that the state has failed to comply with a wide array of requirements of a 12-year-old court order to improve services for patients at the Augusta Mental Health Institute.
In a 354-page decision, Superior Court Chief Justice Nancy D. Mills rebuked state officials who she said not only failed to meet the terms of the so-called AMHI consent decree but also should have admitted their inability to make that claim.
"This is not a failure of funding. The evidence made clear that until the recent budgetary problems, money for consent decree purposes was consistently provided by the Legislature. This is a failure of management to get the job done," Mills wrote in her ruling. "As of Jan. 25, 2002, the defendants were not in substantial compliance with the consent decree ... Because of this conclusion, the (class-action) members and the people of Maine require answers to the following:
"1. Why have the defendants been unable to comply in almost 12 years with the consent decree, which specified compliance by Sept. 1, 1995?
"2. Why didn't a representative of the defendants or the Office of the Attorney General have the knowledge, the foresight, the candor, and the courage to admit ... that the defendants were not in substantial compliance?
"3. What should be done now?"
Mills reasserted the court's control over large parts of the state mental health system, including AMHI, as part of her decision. But she did not answer her last question in Friday's decision, promising instead to soon issue another order outlining her plans to enforce her directives.
State officials signed the consent decree in 1990 to settle a class-action lawsuit filed the year before complaining of deteriorating and dangerous conditions at the state psychiatric hospital.
"After a seven-week trial ... the defendants proved that they were in compliance with 23 of the 197 paragraphs, leaving 174 promises to the class members (former AMHI patients) unkept," Mills wrote.
The consent decree contains 259 paragraphs, each identifying actions required of the state. Lawyers for the patients accepted the state's claim of compliance for 62 of the paragraphs, leaving the judge to decide on the state's claims of compliance on the remaining 197 requirements contained in the 1990 court order.
Lawyers in the case previously skirmished in court over the 12-year history of the consent decree. The state has been held in contempt of court twice by two different judges for missing deadlines to make improvements in the mental health system. But the trial that concluded in February was the first to adjudicate all the requirements of the consent decree. "This court has employed various approaches to supervise and encourage progress by the defendants toward substantial compliance with the consent decree: a finding of contempt, the threat of receivership, frequent meetings, and numerous requests for information," Mills wrote in her ruling. "In spite of these efforts, effective supervision has been difficult and information has not been forthcoming from (state officials) ... The defendants and their representatives have taken an obstructive stance toward the court."
The Attorney General's Office, which defended the state and officials of the state Department of Behavioral and Developmental Services, did not return repeated calls Friday afternoon and evening for comment.
Kathryn Monahan Ainsworth, a policy advisor to Gov. John Baldacci, said the ruling did not come as a surprise.
"We expected that would happen, to some extent," Ainsworth said.
Helen Bailey of the Disability Rights Center, a lawyer for the patients and one of the authors of the consent decree, said she was disappointed that disagreements between the two sides had to lead to the costly and difficult court battle. But she said she was pleased the judge agreed with most of positions put forward by her legal team.
"I did not believe the state was in substantial compliance," Bailey said. "There are several structural issues the defendants are having trouble with and lots of class members out there are not having their needs met. That's why we went to trial and (that position) has been upheld. It was pretty frustrating that this had to go to trial."
Bailey said Mills' decision on future action will be important. Lawyers for the patients asked the court during the trial to impose court-appointed officials to oversee key operations within the former Department of Mental Health to ensure future compliance with the terms of the consent decree.
Mills found problems in a number of services to the mentally ill. She said the state's development of a two-tiered mental health system with consent-decree class members moving ahead of other patients violates the terms of the consent decree itself. And she said patients in AMHI's unit for the criminally insane are warehoused without services they deserve.
"Patients who need hospitalization are denied admission at AMHI because it does not have the staff or the beds to accept the patients. Patients who are ready for discharge and whose discharge would make a bed available remain at AMHI because the resources they need to live successfully in the community are not available," Mills wrote. "People who live in the community require services and supports that are not provided because the defendants cannot identify or address those needs. People in crisis wait in emergency rooms for crisis workers who, with minimal education and training, are asked to do extraordinary tasks."
Mills gave no indication when the second part of her ruling may be released, that part detailing enforcement measures to ensure the state complies with terms of the decree.
Lawyers on both sides of the case have speculated an appeal of Mills' decision is likely.
Staff writer Susan M. Cover contributed to this report.
Gary Remal — 623-3811, Ext. 518
gremal@centralmaine.com