Supreme Court Rules on Olmstead Case

By Mary R. Anderlik
Health Law & Policy Institute

On June 22, the United States Supreme Court decided Olmstead v. L.C., 1999 WL 407380 (1999), one of a number of cases addressing aspects of the Americans with Disabilities Act of 1990 (ADA). The Court, by a 6-3 majority, ruled that the ADA requires states to place persons with mental disabilities in community settings rather than institutions if certain conditions are met.

The plaintiffs, L.C. and E.W., were two women with mental retardation and mental illness and histories of institutionalization. At the time the lawsuit was filed, both women were confined at the Georgia Regional Hospital awaiting placement in one of the State of Georgiaís community-based programs. In each case, the treatment team had concluded that treatment in a community setting would be appropriate. The plaintiffs charged that the Stateís failure to place them in community-based programs violated Title II of the ADA, which applies to public services. Title II regulations require that services be provided in "the most integrated setting appropriate to the needs of qualified individuals," unless the modifications required can be shown to "fundamentally alter" the nature of the service. The district court ruled in favor of the plaintiffs, and the Court of Appeals for the Eleventh Circuit affirmed.

The Supreme Court first addressed whether unnecessary institutionalization qualifies as discrimination by reason of disability under the ADA. The Department of Justice has taken this position, and the Court found its views were entitled to respect. In opposition, the State had argued that cost, rather than disability, motivated its denial (delay) of community placement, and that plaintiffs had to show that similarly situated individuals were given preferential treatment in order to establish discrimination. Justice Ginsburg, writing for the Court, responded that the ADA reflected a more comprehensive view of discrimination. In its introductory findings, Congress explicitly identified unjustified segregation as a form of discrimination, reflecting two "evident judgments:" (1) "institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life;" and (2) "confinement in an institution severely diminishes the everyday life activities of individuals." Further, persons with (serious) mental disabilities were being required to relinquish participation in community life in order to receive medical treatment, a sacrifice not required of persons without mental disabilities.

The Court emphasized that the ADA does not condone termination of institutional settings for people who need or want them, a central concern of a concurrence written by Justice Kennedy. A state "generally may rely on the reasonable assessments of its own professionals" in determining whether an individual is eligible for a particular service or program, and the ADA does not require community placement where it is opposed by the affected individual.

As to defenses, in a section of the opinion joined by Justices OíConnor, Souter, and Breyer only, Justice Ginsburg wrote that "[t]o maintain a range of facilities and to administer services with an even hand, the State must have more leeway than the courts below understood the fundamental-alteration defense to allow." The ADA permits a state to offer evidence concerning the effect of a requested modification on its ability to meet responsibilities to the diverse population of persons with mental disabilities, as well as the relation of the modificationís cost to the total mental health budget. Also, the opinion stated that in the context of a comprehensive, effectively working plan, a waiting list moving at a "reasonable pace" not controlled by endeavors to keep institutions full would satisfy the Stateís obligation to make reasonable modifications. The Court remanded the case for further proceedings consistent with its opinion.

In dissent, Justice Thomas, joined by Justices Rehnquist and Scalia, joined the State in asserting that discrimination requires proof that persons without disabilities were treated differently from persons without disabilities, i.e., a showing that the disabled and non-disabled needed the same services, and the disabled were denied the services while the non-disabled received them.

The Courtís decision accords weight to the interests of persons with mental disabilities seeking community placements and the interests of the states, and both sides are claiming victory. The case is of more general significance for at least two reasons:

The Olmstead opinion is available via the Internet at Lewis is available at The ADA and related regulations and guidance documents are available through the Americans with Disabilities Act Document Center at