Settlement could be near in Idaho mental health care case

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BOISE, Idaho (AP) — There are signs that a landmark lawsuit over juvenile mental health care in Idaho may be reaching a conclusion, resulting in a systemwide overhaul.

But the Jeff D. case has a long history of being reopened as federal judges repeatedly have found the state has done too little to care for children with developmental disabilities and behavioral health issues.

The class-action lawsuit first was filed in 1980. It was named for a boy who was confined at State Hospital South in Blackfoot. The boy, known only as Jeff D., regularly was given mind-numbing drugs. He sometimes was strapped down with leather restraints for an entire day. There was no school. There was no age-appropriate treatment regimen.

Jeff D. and other children shared the facility with mentally ill adult patients, including pedophiles.

After 35 years, however, resolution of the lawsuit — and a new approach to juvenile mental health care — finally could be at hand.

Gov. C.L. "Butch" Otter's recommended budget contains a $615,000 appropriation for legal fees associated with the case, indicating a settlement may be at hand.


A frightening place

Boise attorney Howard Belodoff initially investigated conditions at the hospital.

"In those days, State Hospital South did not have a separate unit for adolescents," Belodoff said. "So you had 10, 11, 12-year-old children who had been initially dropped off or committed or transferred from the juvenile justice system in the same housing as adults — mentally ill adults. And you don't get committed because you're acting a little strange. You get committed because you are a danger to yourself or others."

Behavioral health administrator Ross Edmunds told the Joint Finance and Appropriations Committee on Jan. 21 that conditions were unsafe in those days.

"There truly was some abuse that occurred," Edmunds said. "That was resolved. (They) created a new adolescent unit within a few years."

Things have improved substantially since those days, Belodoff agreed.

Today, State Hospital South has a separate ward for adolescents where schooling and age-appropriate treatment programs are offered. But federal judges determined that one part of the initial settlement agreement — starting a community-based mental health system for children to keep them from being institutionalized in the first place — never has been met.

But the question remains: Will another settlement mean that Idaho will bring its child mental health care system up to legal and constitutional standards?


'Years of inaction'

That hasn't been the case with prior settlement agreements that judges, again and again, have found the state has not lived up to. The sticking point has been a requirement that the state implement community-based mental health services.

The community-based services, Belodoff has argued, would involve a wide net of possible mental health interventions at schools, social services and local clinics. The aim is to provide treatment to youths with behavioral health problems in their communities, and to prevent youths from ever being institutionalized in all but the most extreme of circumstances.

Institutionalizing children severs them from their ties with the communities, with their families, with their schools and with all other components of their basic social support structure. Even if mentally ill youths do receive treatment while institutionalized, there are few options for continuing care after they are released, Belodoff said. All-in-all, children who have spent long periods in mental hospitals have a much harder time re-integrating into society and moving on to lead productive lives.

A battle has been waged for decades between Belodoff, who came to represent all Idaho children with mental health issues, and the state Attorney General's Office, which represents the Governor's Office, Department of Health and Welfare and other state government defendants.

Attorney General spokesman Todd Dvorak said the office does not comment on pending litigation.

Three years after the 1980 suit was filed, all sides agreed to a settlement that included "virtually all of the relief" Belodoff had sought, according to a 2011 finding by judges in the Ninth Circuit Court of Appeals.

"By the late 1980s, after years of inaction on the part of the state . plaintiffs filed a motion to enforce the decree," the appeals court ruling said. "The parties again negotiated a settlement."

In a 1990 supplemental settlement agreement, the two sides decided on a new plan of action to bring Idaho's child mental health system up to legal and constitutional requirements. But the state didn't follow up on the plan.

In 1998, Belodoff filed another motion to find the state in contempt. That action led to yet another settlement. At that point, it had been 18 years since the saga began, but progress continued at a snail's pace.

"The most significant aspect of the compliance agreement was the requirement that the (the state of Idaho) provide to the Plaintiffs an independently produced 'needs assessment' and compliance plan," Ninth Circuit judges wrote. "Two years later, after no more headway than a motion to dismiss, another motion for contempt, and an appeal, the district court 'determined that it must take a more active role in enforcing the decrees.'"

Having lost the court's trust, the state was required to file regular status reports detailing its non-compliance with deadlines and what steps it was taking to come into legal compliance.


Nearly thrown out

The state came close to ridding itself of the Jeff D. case in the late 2000s, when a circuit court judge ruled Belodoff hadn't produced convincing evidence that the state was continuing to violate prior court orders and settlement agreements.

But Belodoff appealed that decision to the Ninth Circuit Court of Appeals, which reversed much of the district court's ruling. The Ninth Circuit found the lower court had been in error: It was the state's burden to prove that it had complied with the order, not the plaintiffs' burden to prove the state had not complied.

That sent the case back to district court. Again, the two sides were ordered back to the bargaining table for a round of mediation that would last a year and a half. Today, Edmunds said, the two sides are "in the final stages of developing a settlement agreement."

Last month, the Department of Health and Welfare asked state legislators to appropriate about $615,000 in legal fees for the lawyers who sued the state. Edmunds did not have an estimate of the cost at the time of his testimony, but said he would keep legislators informed.


The last settlement?

Belodoff said the details of the settlement, which are being kept confidential, have been worked out and in the process of gaining approval of state officials.

"The purpose is directing government development and implementation of a sustainable, accessible, comprehensive and coordinated service delivery system for community-based mental health services for children," he said.

The new system will be put in place across all agencies that serve children.

"The ultimate goal is to prevent crises and prevent institutionalization," Belodoff said. "It's detrimental. It takes children away from their families, which really are their community support. . Services should be delivered in a community-based setting."

A plan to put the settlement agreement into effect will be developed over a nine-month period, Belodoff said, after which the state will have four years to put the plan into action.

Finally, the state will have to demonstrate over a three-year period that the system works. At that point, the lawsuit will be resolved. But a federal injunction will remain in place to keep the state from rolling back the new system.


Information from: Post Register,

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