Hundreds of institutionalized mental health patients will be released to community-based programs throughout Pennsylvania over the next few years under a settlement approved Friday by a federal judge.
Even as he sanctioned it, U.S. Middle District Judge John E. Jones III urged caution in implementing the deal, which ends a 2-year-old class-action suit against the state Department of Public Welfare.
The situation is delicate, the release program will be costly, and the emotions surrounding the issue are high, Jones said.
Yet he said creation of a release option is mandatory to protect the constitutional rights of the more than 1,200 people in the state's intermediate care facilities for the mentally disabled.
"No remedy in a world such as this, where family members must make wrenching decisions regarding loved ones who are in many cases profoundly impaired, will be perfect," Jones said.
According to filings in the case, it is estimated that at least 300 people will seek community placements under the terms of the settlement negotiated by DPW and the nonprofit Disability Rights Network.
Setting up an integration system and community programs to support it is expected to cost the state as yet untold millions of dollars, according to those involved in the case.
The rights network filed suit on behalf of five institutionalized people in 2009. One plaintiff in the case has been in a state-run facility in Ebensburg for more than 45 years.
Settlement talks began in January after Jones ruled that DPW was violating the Americans With Disabilities Act by not having a functioning system for integrating institutionalized mental health patients into the community.
He noted that no such patients have been integrated into community programs in Pennsylvania for at least 10 years, even though some were on waiting lists to leave the facilities.
The accord backed by Jones calls for DPW to develop a list of patients who want to leave institutions or have no preference for going or staying. Those people will be evaluated, with the help of family members or guardians, to determine their suitability for release.
A committee will be formed to educate patients and their families about the community option.
At least 50 people will have to be placed in community programs by June, while at least 75 will have to be released in 2012-13; 100 each year in 2013-14 and 2014-15 and 75 per year after that.
Jones said one institutionalized person filed a written opposition to the settlement, as did the families and guardians of 101 other patients. Several state lawmakers also voiced opposition, he said.
The judge said most objections focused on two issues: That some patients will be wrongly placed in community programs and that an exodus of patients will result in closure of the care facilities.
A typical letter of concern the court received after the then-tentative settlement became public in June came from the younger brother of a woman who has been in a center at Selinsgrove since the 1980s.
"She does not speak and no one knows how much she is able to understand," the brother wrote. "I agree that higher functioning individuals should have the option to go to community care, but in her situation I fear it would be detrimental to her well-being."
Some opponents of the settlement wrote on behalf of patients who are in their 80s and have been institutionalized for decades. Many praised the care their loved ones receive at the state centers.
One man wrote that his severely disabled sister has been in a center since 1949 and that a release would be "devastating" for her.
In approving the settlement, Jones counseled against any possible "unintended bias" toward releasing patients who aren't ready.
He said the long-term fate of the state's intermediate care facilities "is not before us today, nor is it a facet of the settlement," but is an issue for the state Legislature.
The judge said DPW is "subject to significant budgetary constraints," but said implementing the settlement might eventually lessen the cost of serving such clients.
Court filings show that when the suit was filed it was costing $240,000 per client per year to serve patients in the state-run facilities.
Another facet of the settlement sanctioned by Jones requires DPW to pay $432,500 of the Disability Rights Network's legal fees in the case.
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