Heller v. Doe
Since the 1970s constitutionally mandated procedural safeguards have been available to all citizens detained in state psychiatric facilities. Several United States Supreme Court cases defined the contours of those protections against unwarranted confinement. O'Connor v. Donaldson (1) required both "mental illness" and "dangerousness" as standards that must be met before civil commitment of adults is justified. Addington v. Texas (2) established the need for at least "clear and convincing" evidence to prove those standards had been satisfied. Parham v. J.R. (3) recognized the interests of parents during their children's commitment process, and relaxed the procedural safeguards that are available to adults. At the same time, it judged minors' tights to liberty significant enough to demand a neutral, independent medical review prior to placement in a psychiatric hospital.
The rights of the adult mentally retarded or "persons with developmental disabilities" have been more difficult to define. The life-long deficits in comprehension or decision-making ability among this population confound the attempts of lawmakers to decide when the language of "voluntary" or "involuntary" choices should apply. An additional complexity arises because of the involvement of families in the lives of the mentally retarded. Legislators are hesitant to interfere with parents, guardians, or others who act as caretakers and representatives of people with mental disabilities.
Kentucky is just one of the states struggling to develop a process which acknowledges the role of families in planning for, monitoring, and assisting in their children's care. Despite its legislative efforts, according to the United States Court of Appeals for the Sixth Circuit, Kentucky has yet to find the balance between parental prerogatives and patient's tights. Kentucky's most recent legal difficulties resulted from the state's failure to provide residential placement choices to adults who were labeled "mentally retarded."
Samuel Doe, the pseudonymous plaintiff who initiated the suit that became Doe v. Austin (4), has been institutionalized since 1971. Until he filed suit in federal court, no independent review of the propriety his seventeen-year confinement had taken place. In 1986 a group of mentally retarded adults joined Doe to challenge Kentucky's administrative practices regulating admission to state residential care facilities. This class action resulted in several revisions to Kentucky law, and the abolition of facility admission practices that were declared unconstitutional.
Prior to 1986 a comprehensive statutory scheme guaranteed all procedural tights to the mentally retarded that applied prior to any involuntary commitment to a mental health facility. The law prescribed a judicial hearing where any person subject to commitment could employ a lawyer, testify, and call witnesses. Despite these legal protections, an alternative procedure for admission to Kentucky's residential treatment centers (RTC) for the mentally retarded was established by the state Cabinet for Human Resources. This process was administered by the Record Review Committee (RRC) and gave parents and guardians almost complete discretion over facility placement.
For example, an adult child committed via parent-initiated petition through the RRC was considered a "voluntary" patient even though he might wish to remain in the community. The four years this procedure was in effect (1982-1985), only one mentally retarded adult in the entire state of Kentucky was admitted through the "involuntary" process required by statute. A similar administrative policy governed the release of patients. It gave parents an absolute veto over any community placement suggested for their children. In effect, parents and guardians were in complete control of RTC admission and discharge, regardless of the apparent dictates of state law.
The Austin case raised serious questions about Kentucky's commitment policies for the mentally retarded. …