Doe Ex Rel. Tarlow v. District of Columbia, 920 F. Supp. 2d 112

Jane Doe I, II, and III (represented by conservators/estates) sued the District of Columbia in 2001 alleging improper authorization of elective medical procedures for intellectually disabled patients, violating constitutional rights.
The plaintiffs sought damages and an injunction to stop substituted consent policies; Judge Kennedy initially granted an injunction based on the District’s failure to ascertain patients’ wishes under DC law.
The D.C. Circuit vacated the injunction, holding that when patients lacked capacity, decisions could be based on best interests if wishes were unknown or unobtainable, and that the then-current policy complied with due process.
On remand, the court granted summary judgment to the District on the District’s authority to consent to surgeries, while recognizing a factual issue regarding the District’s custom or policy to ignore or override family-warranted consent.
The plaintiffs amended to add a claim that abortions of Jane Does I and III were unauthorized because a court should govern consent for abortions of incompetent individuals; District moved to dismiss the new allegations.
The court declines to dismiss the remaining claims, including the rights to have children and related due process protections, and retains jurisdiction over state-law claims (e.g., under the Mentally Retarded Citizens Constitutional Rights and Dignity Act) with supplemental jurisdiction.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether abortions of I and III violated due process in consent procedures	District failed to protect bodily integrity and rights to have children.	Professional judgment under Youngberg sufficed with protective procedures.	Issues survive; dismissal denied
Whether Youngberg applies to voluntarily confined patients and the sufficiency of procedural protections	Youngberg rights do attach when there is not true voluntary consent and rights to bodily integrity were at stake.	Youngberg governs involuntary confinement; not applicable to voluntary patients.	Youngberg not dispositive; claims remain under broader due process framework
Whether federal due process standards override district procedures for competency determinations and consent to surgery	Federal procedures protect substantive liberty interests in having children; state law procedures may be insufficient.	State procedures may be adequate; federal law governs minimum due process requirements.	Procedures adequacy cannot be resolved at dismissal; claims survive

Doe ex rel. Tarlow v. District of Columbia, 489 F.3d 376 (D.C. Cir. 2007) (holds best-interests standard when patient wishes are unknown or unobtainable)
Doe v. District of Columbia, 593 F. Supp. 2d 115 (D.D.C. 2009) (law-of-the-case on authority to consent during earlier period)
Youngberg v. Romeo, 457 U.S. 307 (U.S. 1982) (distinguishes rights of involuntarily committed individuals and professional judgment standard)
DeShaney v. Winnebago County Social Services Dept., 489 U.S. 189 (U.S. 1989) (affirmative duty to protect arises from restraint of liberty; due process concerns)
Foucha v. Louisiana, 504 U.S. 71 (U.S. 1992) (substantive due process limits on detention and necessity of protections for liberty interests)