Kern v. Direct Care and Treatment Executive Board and State of Minnesota

Background

In 2019, a Minnesota state court determined that Cody Kern was mentally ill and dangerous and civilly committed him to state custody and care. He became a patient in the Forensic Mental Health Program at the Minnesota Security Hospital. The program uses individualized treatment plans and a treatment team consisting largely of medical and mental-health professionals. The team assigns patients color-coded liberty levels that control the amount of individual freedom and permitted movement available to them. Those decisions are based on treatment progress, identified risks, legal status, clinical indicators, and the support a patient needs.

Kern has been diagnosed with schizoaffective disorder, bipolar type, and mild autism spectrum disorder. In 2022, his liberty level was reduced from yellow to orange and later from orange to gray. The parties disputed the events that led to the reductions. Kern argued that the treatment team punished behavior caused by his autism and did not properly account for that diagnosis.

Kern brought claims under Title II of the Americans with Disabilities Act (ADA) against both defendants and section 504 of the Rehabilitation Act (RA) against the Board. He sought declaratory and injunctive relief, reforms to the program, appointment of an independent monitor, damages, and fees. The court had previously dismissed his ADA and RA retaliation claims. After Kern returned to the blue liberty level, the court stated that the requested injunction requiring advancement to that level was moot.

Parties’ Arguments

The Board and the State moved for summary judgment. Summary judgment is appropriate when the evidence shows no genuine dispute over facts that could affect the result and the moving party is entitled to judgment under the law.

The defendants argued that Kern’s remaining claims were not legally cognizable because they challenged medical-treatment decisions. The ADA and RA generally do not provide a claim based on disagreement with medical treatment, although claims involving denial of services or other aspects of custodial life may be covered. The defendants characterized liberty-level decisions as medical treatment because medical providers made them based on patients’ clinical needs.

Kern argued that liberty-level decisions were not medical treatment because they were not made for a medical purpose or diagnosis. He maintained that the decisions were more like denials of services or other nonmedical treatment. At the hearing, his counsel described the requested accommodation as requiring the treatment team to account for his autism spectrum disorder when deciding his liberty levels.

Court’s Analysis

The court concluded that the liberty-level decisions were medical in nature. It relied on the undisputed evidence that the treatment team was composed mostly of medical professionals, that liberty levels were determined as part of each patient’s individualized treatment plan, and that the levels were tied to treatment progress, clinical success, and therapeutic purposes.

The court also concluded that Kern’s dispute was, in substance, a disagreement with those treatment decisions. The conduct at issue involved how Kern looked at certain staff members and the nature of certain comments he made. The treatment team treated that conduct as relevant to his clinical treatment and reduced his liberty levels. Kern challenged the significance assigned to that conduct and argued that the team should have considered his autism differently. The court viewed that requested accommodation as a request to change the treatment decisions themselves, rather than a legally cognizable disability accommodation claim.

The court emphasized that its decision did not mean every decision by a forensic mental-health treatment team falls outside the ADA and RA. It held only that these particular challenges were fundamentally disputes over medical treatment, which Eighth Circuit precedent does not allow under the ADA or RA.

Disposition

The court granted the defendants’ Motion for Summary Judgment. It dismissed Kern’s ADA and RA claims with prejudice and directed that judgment be entered.