In re Joseph SCHMIDT, Respondent. Appeal of COUNTY OF ALLEGHENY.
Supreme Court of Pennsylvania.
Decided Feb. 4, 1981.
Reargument Denied May 28, 1981.
429 A.2d 631
Argued Sept. 24, 1979. Reargued Sept. 30, 1980.
Marlene W. Jackson, Asst. Atty. Gen., for Dept. of Public Welfare.
Thomas E. Coval, Willow Grove, Timothy E. Finnerty, Pittsburgh, for Joseph Schmidt.
Before O‘BRIEN, C. J., ROBERTS, NIX, LARSEN, FLAHERTY and KAUFFMAN, JJ.
OPINION
NIX, Justice.
Appellant, County of Allegheny, petitioned the Court of Common Pleas for the involuntary commitment of respondent, Joseph Schmidt, to an appropriate facility. Appellee, Commonwealth of Pennsylvania, intervened as a party-respondent and presented testimony to establish that the state-operated facility known as Western Center would not be an appropriate facility as required by the Mental Health and Mental Retardation Act of 1966 (hereinafter referred to as the Act). Act of October 20, 1966, Special Sess. No. 3, P.L. 96, § 406,
Respondent is an adult male who at the age of eight was placed by the Court of Common Pleas, upon the petition of respondent‘s family, in a privately operated residential school for mentally retarded children. Respondent resided and received treatment for the following fourteen years at this school which was under contract with the county to provide such care. He is able to walk, although he frequently moves around on his hands and knees. He can use a scoop dish to feed himself but still requires much assistance. He is unable to discriminate between edible and inedible objects and, although not toilet trained, he is toilet regulated. The school found that as respondent grew into a husky, muscular young man, it was unable to channel his physical energy and curiosity and was unable to provide the constant supervision respondent required. The county attempted unsuccessfully to find other suitable placement for respondent. It was at this point, after fourteen years of assuming the responsibility, that appellant county petitioned for respondent‘s commitment to an appropriate state facility.
Evidence established that Western Center was not an appropriate facility for respondent since its staff-patient ratio was 1:14. Respondent‘s previous school found that it could not adequately treat respondent in a 1:7 staff-patient
Neither is there any real dispute between the county and the state that (1) the county does not presently have a program that will meet respondent‘s needs; and (2) Western Center does not presently have a program to meet respondent‘s needs. The actual controversy between the county and the state is which of them is lеgally obligated to assume the responsibility for providing the proper care for respondent. The county argues that the trial court should have placed upon the state the responsibility of providing appropriate care. The state, on the other hand, argues that the trial court‘s order should be affirmed because it is the county‘s responsibility to provide the proper care for respondent.
We start the inquiry with the realization that the mentally retarded are in no way responsible for their dependency, and that society‘s concern for their welfare should not be grudgingly or reluctantly given. We also recognize that this is not a question of which governmental unit will ultimately bear the financial cost of the services required.1 The basic issue is which governmental unit has the responsibility to assume the initiative in locating and developing the appropriate placement. The court below determined that it was the county‘s responsibility; for the reasons that follow, we сannot agree.
We are not here concerned with the legitimacy of the deprivation of the liberty of an individual that may be occasioned by residential placement. See, e. g., Haldeman v. Pennhurst State School & Hospital, 446 F.Supp. 1295 (E.D. Pa.1977); Goldy v. Beal, 429 F.Supp. 640 (M.D.Pa.1976); New York Association for Retarded Children v. Rockefeller,
Our question here is somewhat different. Here there is no question that residential care will be required for the long-term care of Josеph Schmidt, even under the most favorable prognosis. This is not an instance where there is a possibility of a less structured placement than those made available by existing state facilities. To the contrary, the available state facility is inadequately structured for respondent‘s present needs and the anticipated objective of the court below is to provide him with the skills to cope with life in a setting such as Western Center. The question to be
The responsibilities and duties of the state are set forth in Art. II of the Act. Specifically, § 201(1) of the Act,
In counter distinction to the obligation and responsibilities of the state the Act describes in Art. III the obligations and responsibilities of the counties. Specifically, § 301(d) of the Act,
... it shall be the duty of local authorities in cooperation with the department to insure that the following mental health and mental retardation services are available:
(1) Short term inpatient services other than those provided by the State.
(2) Outpatient services.
(3) Partial hospitalization services.
(4) Emergency services twenty-four hours per day which shall be provided by, or available within at least one of the types of services specified heretofore in this paragraph.
(5) Consultation and education services to professional personnel and community agencies.
(6) Aftercare services for persons released from State and County facilities.
(7) Specialized rehabilitative and training services including sheltered workshops.
(8) Interim care of mentally retarded persons who have been removed from their homes and who having been accepted, are awaiting admission to a State operated facility.
(9) Unified procedures for intake for all county services and a central place providing referral services and information.
Paragraph (e) of section 301 of the Act,
It is evident that the dichotomy sought to be achieved under the Act was intended to separate and yet coordinate state-county responsibilities to insure the availability of adequate mental rеtardation services for all of the residents of the states in need of such services. The state, through the department, was given the responsibility for the overall supervision and control of the program. Read together, § 201(1), (4) of the Act,
In comparison, the duties assigned to counties are not аll encompassing. The counties have been charged under § 301(d) of the Act,
The doctrine of least restriсtive alternative was first articulated by Chief Judge Bazelon in Lake v. Cameron, 364 F.2d 657 (D.C.Cir.1966) and subsequently adopted as a constitutional requirement in a series of commitment and treatment related cases. Lessard v. Schmidt, 349 F.Supp. 1078 (E.D. Wis.1972) vacated and remanded on other grounds, 94 S.Ct. 713 (1974); Lynch v. Baxley, 386 F.Supp. 378 (M.D.Ala.1974). Wyatt v. Aderholt, 503 F.2d 1305 (5th Cir.1974); Horacek v. Exon, 357 F.Supp. 71 (D.Neb.1973); Dixon v. Weinberger, 405 F.Supp. 974 (D.D.C.1975); Davis v. Watkins, 384 F.Supp. 1196 (N.D.Ohio 1974); Halderman v. Pennhurst State School and Hospital, 446 F.Supp. 1295 (1977).
This approach to the problems related to mental retardation was reflected in the regulations promulgated by the secretary pursuant to § 301 of the Act,
The County Program is the means by which minimum services as described in the act shall be readily available to promote the social, personal, physical and economical habilitation or rehabilitation of mentally retarded person with all due respect for the full human, social and legal rights of each person. This means that the health, social, educational, vocational, environmental and legal resources that serve the general population shall be marshalled and
coordinated by the County Program to meet the personal development goals of mentally retarded persons, in accordance with the principle of normalization.... In keeping with this principle of normalization, the County is responsible to utilize county program funds for the mentally retarded to accomplish the following objectives:
4. shaping and maintaining an environment most productive of basic human personality qualities involving parent-child and sibling relationships, environmental adaptation, self-awareness and learning motivation and ability;
5. specific training and learning situations designed and implemented to develop all potential;
6. community development and restructuring to achieve the maximum normalization for the mentally retarded person wherever he is.
I. Responsibility for Planning, Direction and Coordinated Delivery of Services—The Base Service Unit:
The County Administrator shall be responsible to providе for the establishment of an organizational unit consisting of multidisciplinary professional and nonprofessional services for persons who are mentally retarded and in need of service from the County Program.... The Base Service Unit shall be responsible to perform the following functions in such a way as to carry out the objectives of the County Program as stated above.
D. Provide for comprehensive diagnosis and evaluation services to:
3. Develop a practical life-management plan for the individual and his family and provide the necessary counseling and following-along services;
These regulations make it clear that the legislative grant of power to the counties under § 301(e)(3) of the Act,
While we agree with the rejection by the court below of the narrow role urged by the county for its participation and obligations in the area of mental retardation, we cannot agree that the county is responsible in this instance for the care of Joseph Schmidt. In this case the need for institutionalization can neithеr be prevented or minimized. Joseph Schmidt will unquestionably require long term residential placement. There is no less restrictive alternative available for the county to provide. To the contrary, the available state facility is inadequate because it does not provide a sufficiently structured environment for Joseph. The concept of normalization is not a consideration in the placement of Joseph.
It is the state‘s responsibility to find a placement for Joseрh with a staff-patient ratio suitable to his needs. The state will not be allowed to ignore that responsibility and that obligation by stating that an appropriate facility is not immediately available. Section 201(1) of the Act,
LARSEN and FLAHERTY, JJ., filed concurring opinions.
ROBERTS, J., concurred in the result.
LARSEN, J., concurring.
This is solely a matter of statutory construction—is the county or the state responsible, under the Mental Health and Mental Retardation Act of 1966,
Article II defines the rеsponsibilities of the state. Section 4201 of Article II provides:
The department shall have power, and its duty shall be:
(1) To assure within the State the availability and equitable provision of adequate mental health and mental retardation services for all persons who need them....
Section 4201(4) further provides the department has the power and duty:
To adopt State-wide plans for the operation of all State operated facilities under the jurisdiction of the department and to assign to each facility or portion thereof, such duties for the care of the mentally disabled, as the secretary shall prescribe.
While § 4201(1) and (4) standing alone might not be sufficient to clearly dispel the Commonwealth‘s notion that the state has only supervisory powers, § 4202 does so in no uncertain terms. Section 4202 provides:
(a) The department shall operate all State facilities and shall assign such functions to each as the secretary shall prescribe. (b) The department is hereby authorized to establish, extend, operate and maintain additional facilities and provide mental health and mental rеtardation services therein. (emphasis added)
Conversely, the counties have been given no corresponding general grant of authority and duty in Article III, which delineates the powers and duties of counties. Section 4301 provides, in relevant part:
(d) ... it shall be the duty of local authorities in cooperation with the department to insure that the following mental health and mental retardation services are available:
(1) Short term inpatient services other than those provided by the State.
(2) Outpatient services.
(3) Partial hospitalization services.
(4) Emergency services twenty-four hours per day which shall be provided by, or available within at least one of the types of services specified heretofore in this paragraph.
(5) Consultation and education servicеs to professional personnel and community agencies.
(6) Aftercare services for persons released from State and County facilities.
(7) Specialized rehabilitative and training services including sheltered workshops.
(8) Interim care of mentally retarded persons who have been removed from their homes and who having been accepted, are waiting admission to a State operated facility.
(9) Unified procedures for intake for all county services and a central place providing referral services and information. (emphasis added)
(e) Such local authorities shall also have the power to establish the following additional services or programs for the mentally disabled:
(1) Training of personnel.
(2) Research.
(3) Any other service or program designed to prevent mental disability or the necessity of admitting or committing the mentally disabled to a facility. (emphasis added)
Neither subsection (d) nor (e) generally grants authority to establish the type of long-range care needed for respondent. While subsection (d) does not purport to be exclusive, the whole tenor of that subsection contemplates interim, temporary or periodic mental health and mental retardation services. The nine services specifically enumerated strongly suggest a legislative scheme allocating short-term and periodic care only to the counties. Moreover, § 4301(d)(8) specifies the county shall provide interim care for mentally retarded persons who have been removed from their homes and are awaiting admission to a state operated facility. Thus, the legislation clearly envisions state operation of permanent care facilities for the mentally retarded.
It is unfortunate that the Act is not more explicit regarding long-term care of those mentally disabled or retarded persons needing continuous supervision. Since it is not, our task is to give the Act its most reasonable interpretation to effectuate the legislature‘s intent. Given the limited grant of authority to the counties to provide services of an interim, temporary or periodic nature, and given the broad grant to the state to provide adequate mental health and mental retardation services for all persons who need them, it seems clear to me that the legislative scheme allocated the responsibility for long-term care of the mentally infirm to the state.
As Joseph Schmidt undoubtedly requires long-term residential placement, the majority‘s discussion of the “least restrictive alternative” and the “rejection by the court below of the narrow role urged by the county” is unnecessary. I therefore express no opinion on the merits of this discussion.
I join all of the majority opinion except that portion which cites a rеgulation promulgated by the executive branch of government as evidence of the intent of the legislative branch of government. The flaw in this reasoning is self-evident.