Background on Olmstead v. L.C.

L.C. and E.W. v. Olmstead case was brought in 1995 by the Atlanta Legal Aid Society on behalf of Lois Curtis and Elaine Wilson, women with mental retardation and psychiatric conditions who were patients in a state psychiatric hospital. The treating professionals in the hospital all agreed that they were appropriate for discharge into community programs, but slots were not made available. While the case worked its way through the courts, both women were placed in the community, where they have been doing very well. The case continued because the situation could arise again. Final settlement was reached on July 11, 2000.

The state of Georgia asked the Supreme Court to decide "[w]hether the public services portion of the federal Americans with Disabilities Act compels the state to provide treatment and habilitation for mentally disabled persons in a community placement, when appropriate treatment and habilitation can also be provided to them in a State mental institution."

The case turned on the meaning of a regulation that the U.S. Department of Justice adopted to enforce Title II of the ADA, stating that:

A public entity shall administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities. 28 C.F.R.§ 35.130(d).

The Department of Justice has interpreted this regulation as requiring the community placement of institutional residents when the state's own treating professionals have recommended such placement.

In allowing the women's right to community placement, the 11th Circuit set a very high standard for a holding of "fundamental alteration" while also giving substantial deference to the Justice Department's analysis. It held that "by definition, where, as here, the State confines an individual with a disability in an institutional setting when a community placement is appropriate, the State has violated the core principle underlying the ADA's integration mandate."

The circuit court made two arguments that, having been upheld, are useful to advocates. First, it specifically rejected the state's claim that the ADA was limited to discrimination between disabled and non-disabled people and that institutional services were provided only to disabled individuals. The court noted that the ADA specifically recognizes that discrimination existed in insitutionalization and that this finding would have been superfluous under the state's analysis. Second, it recognized that, during the course of litigation, there may be times when a person can be treated in the community and others when institutionalization is necessary. However, where the evidence shows that all experts agree that at a given time a patient could be served in the community, then the ADA mandates such a placement, unless it would be a fundamental alteration in the state's provision of services.

Finally, the circuit court remanded L.C.'s case for determination whether providing the community-based services would be a fundamental alteration in the state's services. The court set a very high standard, holding that "unless the State can prove that requiring it to make these additional expenditures would be so unreasonable given the demands of the State's mental health budget that it would fundamentally alter the service it provides, the ADA requires the state to make these additional expenditures." The court set forth three non-exhaustive factors for the district court to consider: 1) the reasonableness of the expenditures in light of the entire budget for mental health, 2) whether it would be unreasonable to require the state to expand its waiver program to minimize the financial burden, and 3) whether any difference in the cost of providing community-based services will lessen the state's burden. This was addressed in detail by the Supreme Court.

The Bazelon Center, which organized an amicus brief in the 11th Circuit written pro bono by the law firm of Howrey & Simon, mobilized organizations to file Supreme Court briefs as friends of the court, to assure the justices that states are already committed to providing services in the community instead of in institutional settings, and that they can comply with the integration mandate at a reasonable cost.

Twenty-two states filed a brief urging the Supreme Court to accept the case for review: AL, CA, CO, DE, FL, HI, LA, MD, MI, MS, MT, NE, NH, NV, PA, SC, SD, TN TX, UT, WY, WV. After the Court accepted the case, all of these and four additional states signed on to an amicus brief making the argument against federal court interference in states' operation of mental health and developmental disability systems. However, 15 of the original 22 states withdrew from the group, announcing that they would not oppose the 11th Circuit ruling. The 15 are: Alabama, California, Delaware, Florida (the organizer of the earlier brief), Louisiana, Maryland, Michigan, Mississippi, Nebraska, New Hampshire, Pennsylvania, South Carolina, South Dakota, Utah and West Virginia. And all four new states that had joined in support of Georgia's position—Indiana, Massachusetts, Minnesota and Washington—later wrote to the Court to withdraw.

• For an account of the final settment in L.C. & E.W. v. Olmstead, with an update on the plaintiffs' success in the community visit Atlanta Legal Aid's page.