Disability Rights California v. County of Alameda

Background

Disability Rights California (DRC), California’s designated protection-and-advocacy system for people with disabilities, sued the County of Alameda, Alameda County Behavioral Health Care Services (ACBHCS), and Alameda Health System (AHS). DRC alleged that the defendants unnecessarily institutionalized, or placed at serious risk of institutionalization, Alameda County residents with serious mental-health disabilities because they did not provide sufficient intensive, community-based services.

DRC alleged that residents were detained at John George Psychiatric Hospital, held in inpatient units, transferred to Villa Fairmont Mental Health Rehabilitation Center, discharged to homelessness or jail, and repeatedly institutionalized. It also alleged that AHS failed to develop individualized treatment and discharge plans and failed to coordinate effectively with county and community providers. DRC sought relief under Title II of the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, and California Government Code sections 11135 and 11139.

Motions and Standing

AHS and the County Defendants separately moved to dismiss for lack of standing and for failure to state a claim. The court held that DRC had standing to sue both AHS and the County Defendants. DRC adequately alleged that its constituents had been unnecessarily institutionalized or faced an unnecessary risk of institutionalization, that the injuries were fairly traceable to the defendants’ conduct, and that the requested changes to the defendants’ practices and services could redress those injuries.

The court rejected arguments that DRC lacked standing because AHS could not provide all of the requested community-based services or because DRC had not identified individual constituents satisfying every standing requirement. The court treated those arguments as addressing the merits rather than standing.

Disability-Discrimination Claims

The court applied the integration requirement recognized in Olmstead v. L.C. Under that requirement, public entities generally must provide services in the most integrated setting appropriate when professionals determine that community treatment is appropriate, the affected individuals do not oppose it, and community placement can reasonably be accommodated. The court explained that this rule concerns the location of services, not simply whether a government should provide more or better services.

As to AHS, the court held that DRC had not plausibly alleged disability discrimination. DRC’s allegations that AHS failed to create individualized treatment and discharge plans, coordinate with providers, and improve mental-health outcomes concerned the quality or availability of services, rather than the provision of a specific service in an institutional setting that should instead be provided in the community. DRC also did not adequately allege that AHS’s retention decisions involved patients whom AHS’s treatment professionals had determined should receive community-based treatment.

As to the County Defendants, the court held that DRC’s allegations primarily sought expanded or strengthened community-based services to reduce institutionalization generally. The court concluded that Olmstead does not provide a remedy merely because a government could do more to prevent institutionalization. DRC had not identified with enough detail the specific services provided in institutions that could be provided in the community, or the specific services that residents risked receiving only in an institution. DRC also had not adequately alleged that community treatment for those specific services was appropriate, that the affected residents did not oppose it, and that community placement could reasonably be accommodated.

Because DRC might be able to correct these deficiencies, the court dismissed the claims against AHS and the County Defendants with leave to amend. The court did not decide the defendants’ arguments about reasonable modifications, a fundamental-alteration defense, political-question justiciability, or whether the County Defendants could be liable for AHS’s conduct.

Disposition

Judge Charles R. Breyer granted the defendants’ motions to dismiss with leave to amend. DRC had 30 days from the date of the order to file an amended complaint. The court denied AHS’s motion to strike allegations concerning racial disparities and the COVID-19 pandemic, and granted DRC’s motion to file a sur-reply. The opinion states that oral argument was unnecessary.