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Targeting two of Pennsylvania’s mental institutions where residents allegedly languish for years with no hope of community placement, lawyers from the Disabilities Law Projects in Philadelphia and Pittsburgh filed a pair of lawsuits in federal court last week. Norristown State Hospital is the target in Frederick L. v. Department of Public Welfare, filed in the Eastern District of Pennsylvania by attorneys Robert W. Meek and Ilene W. Shane. The suit says NSH currently has about 400 “non-forensic” residents, but that DPW has announced plans to move only about 60 to community settings by the end of fiscal year 2001-02. The other 340 residents are to be “institutionalized indefinitely at NSH,” the suit says, “even though they are appropriate for discharge to the community.” The second suit, Pennsylvania Protection and Advocacy Inc. v. DPW, was filed in the Middle District of Pennsylvania by Meek and fellow Philadelphia project attorney Robin Resnick, along with attorneys Mark J. Murphy and Carol A. Horowitz of the Disabilities Law Project in Pittsburgh. The suit challenges conditions at the South Mountain Restoration Center, a state-operated nursing facility located in rural Franklin County. “Conditions at SMRC are unacceptable,” the suit alleges. “On warm days, the temperature inside the non-air-conditioned facility hovers in the 80s. The smell of urine and feces permeates many rooms and wards. Excessive noise is a constant.” According to the suit, SMRC is where virtually all of Pennsylvania’s institutionalized mental patients who require nursing home care are placed even though it’s far from most of their friends and families. “For most SMRC residents, contact with any remaining family and friends is almost impossible since SMRC is far from their home counties and in a location that is isolated and impossible to access via mass transportation,” the suit says. Pennsylvania Protection and Advocacy Inc. is designated by the state as the agency with the responsibility under two federal laws — the Protection and Advocacy for Individuals with Mental Illness Act and the Developmental Disabilities Assistance and Bill of Rights Act — to advocate for and protect the rights of institutionalized individuals with mental illness and developmental disabilities. Both laws grant PP&A the right to pursue legal remedies, according to the suit. The 40-page complaint outlines the observations of PP&A members who visited SMRC in recent months, often by providing detailed anecdotes that describe how the 231 residents there are ignored or abused by staff. During one visit, the suit says, PP&A staff observed four areas of feces on the floor of a dayroom. An SMRC staff member cleaned the area only when it was pointed out to her, but did not use gloves and, after she was finished, returned to dispense medications to residents without first washing her hands. Residents’ privacy is almost never respected, the suit alleges, noting that men enter the women’s bathrooms unannounced, even when there are women using them. Some SMRC staff members “are verbally abusive to residents,” the suit says, and most residents receive a bath or a shower only once each week. Without any legal authority, the suit says, some SMRC residents’ charts have “do not resuscitate” or DNR orders that instruct staff that life-sustaining measures or treatments should not be provided. “At least some DNR orders were issued for SMRC residents who did not authorize them and who do not have terminal illnesses,” the suit alleges, including some that were “authorized by DPW staff and/or by family members who had not been appointed as the individuals’ guardians or who are not close relatives.” Until this year, the suit says, SMRC did not have a psychologist on staff for several years and relied on a retired state employee to provide psychiatric services on a part-time basis. “The only consistent form of mental health treatment provided to SMRC residents is the use of psychiatric medications,” the suit says. Many of SMRC’s residents could be placed in nursing homes nearer to their families since the Pennsylvania’s Medical Assistance Program provides funding to hundreds of nursing facilities throughout the state for services to Medical Assistance-eligible residents. Most SMRC residents are eligible for Medical Assistance, the suit says, and Pennsylvania is required under federal law to assure that individuals have “freedom of choice” of providers. The law also says that nursing facilities are required to provide mental-health and mental-retardation services to residents who need them and that DPW must arrange for such “specialized services.” But with few exceptions, residents from state psychiatric hospitals throughout Pennsylvania are automatically admitted to SMRC when they are deemed to need the care of a nursing facility. “Given the obligations of DPW and nursing facilities to provide specialized services to persons with mental illness and mental retardation, there should be many nursing facilities other than SMRC that could meet the needs of those residents who need the level of services provided in a nursing facility — including nursing facilities that are located in or near their counties of residence and their families and friends,” the suit says. But DPW never bars nursing facilities from the Medical Assistance program for refusing to accept persons with serious mental disabilities, the suit says.

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