Submitted: January 27, 2009
Filed: February 6, 2009
Darrell V. McGraw Jennifer S. Wagner, Esq.
Attorney General Daniel F. Hedges, Esq.
Charlene A. Vaughan Mountain State Justice, Inc.
Deputy Attorney General Charleston, West Virginia
Charleston, West Virginia Attorneys for the Respondents
Attorneys for the Petitioner
The Opinion of the Court was delivered PER CURIAM.
As set forth below, we find that the circuit court's proposed order _ to conduct
an evidentiary hearing in this matter _ falls within the circuit court's power to ensure that a
state agency complies with legislative mandates. Specifically, the circuit court has the power
to ensure that patients are receiving treatment guaranteed to them under W.Va. Code, 27-5-9.
The circuit court also has the power to enforce a Consent Order it previously issued. For
these reasons, the Petitioner's Writ of Prohibition is denied.
To formulate a remedy to address these problems, the Court stated that the Legislature had already articulated guidelines for the operation of the State's mental health facilities:
By the passage of W.Va. Code, 27-5-9 in 1977, the West
Virginia Legislature acknowledged its concern for both humane
conditions of custody and effective therapeutic treatment.
Therefore, West Virginia has already articulated a legislative
position which is in conformity with the highest possible
standards of moral rectitude. Consequently, we are not asked to
impose a new constitutional standard upon a reluctant and
unwilling state; rather, we are asked only to order the executive
branch to fulfill its obligation under clear and unambiguous
statutory provisions.
168 W.Va. at 257, 284 S.E.2d at 237.
The Court went on to state that it was not an expert in medicine, mental health
or institutional management, nor was it a suitable forum for the development of an
appropriate plan for the entire reorganization of the mental health care delivery system in the
state. 168 W.Va. at 259, 284 S.E.2d 237-38. The Court therefore transferred the matter to
the Circuit Court of Kanawha County to monitor the case consistent with guidelines
announced in the opinion. These guidelines provide us with a means of assessing the current
action before this Court. The Matin I guidelines state:
This case exclusively concerns the rights of patients to
mandamus relief under our statute. Thus we arrive at the
following holdings: (1) W.Va. Code, 27-5-9 [1977] creates
specific enforceable rights in the entire inmate population of the
State's mental hospitals. (2) W.Va. Code, 27-5-9 [1977]
requires a system of custody and treatment which will reflect the
competent application of current, available scientific knowledge.
Where there is a good faith difference of opinion among equally
competent professional experts concerning appropriate methods
of treatment and custody, such differences should be resolved by
the director of the West Virginia Department of Health and not
by the courts. (3) It is the obligation of the state to provide the
resources necessary to accord inmates of mental institutions the
rights which the State has granted them under W.Va. Code, 27-
5-9 [1977].
168 W.Va. at 259-60, 284 S.E.2d at 238.
After a number of hearings in the circuit court, the parties agreed and the
circuit court accepted, in October 1983, what is termed the West Virginia Behavioral Health
System Plan. E.H. v. Matin, 189 W.Va. 102, 104, 428 S.E.2d 523, 525 (1993) (“Matin II”).
This plan was to be implemented by the DHHR with oversight by the court and a court
monitor. The plan was implemented and no significant problems with it were brought before
this Court until 1993. In 1993, in Matin II the DHHR appealed a ruling by the circuit court
halting the construction of a new hospital. (See footnote 4)
The Court in Matin II found that the circuit court exceeded its authority in ordering the halting of construction on the new hospital. Specifically, Syllabus Point 1 of Matin II held:
Where the legislature, through the budget process,
expressly provides for funding to build a new public facility,
absent some constitutional challenge or an express statutory
provision to the contrary, the courts are not authorized to
interfere with the legislative mandate.
The Court in Matin II was concerned about the level of the circuit court's
involvement in the decisions of the DHHR relating to the Behavioral Health System Plan.
The Court ordered the parties to file briefs on whether continued monitoring by the circuit
court was appropriate.
Four months later, in E.H. v. Matin, 189 W.Va. 445, 432 S.E.2d 207 (1993)
(“Matin III”), the Court held that the reasons for continued circuit court monitoring
outweighed the reasons in support of discontinuing it. The Court therefore decided to keep
the court monitor in place for eighteen more months, unless a sufficient showing could be
made to continue it for a longer period of time.
The circuit court monitoring continued until 2002. In an order dated March 27,
2002, the circuit court dissolved the office of the court monitor and removed the case from
its active docket. The circuit court stated that it would only consider major non-
implementation issues going forward, including the eight unresolved issues (See footnote 5) that were
identified in the order. The circuit court's order also notes that it would only consider these
issues after submission to an “ombudsman” process. While the case was removed from the
circuit court's active docket, the court continued to hold periodic hearings on the progress
the parties were making on these unresolved issues.
In 2002, the position of “Ombudsman for Behavioral Health” was developed
at the request of the then-Secretary of the DHHR, Paul Nussbaum. (See footnote 6) It was hoped that the
Ombudsman could provide an internal and informal means of resolving compliance issues
without resorting to litigation. Ideally, the Ombudsman would attempt to resolve individual
patient complaints by facilitating communication between agencies and through the use of
mediation. The Ombudsman compiles regular reports of grievances, monitors compliance
with various court orders issued in E.H. v. Matin, and is to meet regularly with DHHR
officials to resolve and avoid litigation.
The Ombudsman has issued regular reports to the circuit court and the DHHR from 2003 through 2008. The current dispute arises, first, out of two issues raised by the Ombudsman in his 2007-2008 Annual Report (See footnote 7) . These issues involve (1) generally, the provision and coordination of case management services; and (2) specifically, the treatment of traumatic brain injuries. The traumatic brain injury issue was initially resolved on July 3, 2007, when the parties entered into a “Consent Order on Services To Individuals With Traumatic Brain Injuries.” This Consent Order was entered into between the parties, with the assistance of a mediator. The circuit court did not participate in the making of the Consent Order, but adopted it after both parties agreed to it. The circuit court held a hearing on May 15, 2008, regarding the implementation of the traumatic brain injury delivery plan, as set forth in the Consent Order, and found that the DHHR had made insufficient progress and noted the possibility of reopening the matter for an evidentiary hearing.
Second, the current dispute arises out of another Ombudsman's report that was
issued on July 3, 2008, titled “A Review of Over-Bedding at Mildred Mitchell-Bateman
Hospital and Recommended Order.” This report, which builds upon the Ombudsman's
earlier report regarding the provision and coordination of case management services, was the
result of a number of grievances filed in April, May and June of 2008. As suggested by its
title, this report details a severe overcrowding problem at the hospital. This problem has
resulted in patients having diminished or virtually no privacy; patients not having access to
private bathrooms; patients not having access to shower facilities on a daily basis; male
patients not being able to shave on a daily basis; and patients sustaining injuries from tripping
over cots when there are three patients to one room. Another problem the hospital staff
reported to the Ombudsman was the mixing of patient populations, especially the nursing
home patients with dementia patients. (See footnote 8)
The report also details other staff related issues including a practice called “Freezing”, in which staff members are required to work an additional eight hour shift on top of the eight hour shift they have just finished. This “Freezing” process is mandatory and those that refuse to follow the practice are given written reprimands. The staff also stated that the “90 day temp” employee system does not work. These 90 day temporary workers are often, if not always, unqualified and inexperienced staff assigned to deal with violent and aggressive patients. One of these 90 day temporary employees was fired for drinking on the job and the regular staff generally does not feel comfortable working with them.
In general, the portrait that emerges from the Ombudsman's reports is that of a hospital that is overcrowded with patients, most of whom are frustrated by living on top of each other, being denied privacy and not having daily access to basic grooming needs. The regular staff suffers from extremely low morale due to forced overtime and working with unqualified temporary workers with questionable backgrounds. Specifically, the term 'Dickensian Squalor' that Justice Neely used to describe the hospital in 1981 is an apt description of the hospital that emerges from the Ombudsman's July 3, 2008 report.
The DHHR chose not to accept the Ombudsman's recommendations contained at the end of his reports. In an August 27, 2008, letter from the Deputy Attorney General, Charlene A. Vaughan, to the Ombudsman, she stated:
The DHHR remains grateful to you for your work in helping
identify the problems Bateman is experiencing in managing the
unusually high number of patients committed to it and
underscoring the urgency with which these problems need to be
addressed; however, (the DHHR) does not accept your
Recommended Order.
On August 28, 2008, the circuit court held a hearing on the issues identified
in the Ombudsman's Reports and on the continuing question of the DHHR's compliance with
the traumatic brain injury Consent Order agreed to by the parties in July 2007. The circuit
court found that the Ombudsman's reports raised significant issues of non-compliance with
the Consent Order and possible violations of W.Va. Code, 27-5-9, such that it determined that
an evidentiary hearing on these matters was warranted. The circuit court's order states:
After hearing on the issues related to progress in the
implementation of the Traumatic Brain Injury Services Delivery
Plan, and review of the progress by DHHR in the development
thereof, the Court finds that there has been insufficient progress
toward resolution of the issue. In additional [sic] after hearing
on the issue of overcrowding at the State psychiatric facilities
and the complexities contained within, the Court finds that the
consistent overcrowding (“overbedding”) is not disputed and
there is no remedy in sight; and thereupon,
It is hereby ORDERED that the proceedings in the
above-styled action be reopened in this matter for the purpose of
evidentiary hearings and relief upon these two issues.
On September 19, 2008, the DHHR filed the instant Petition seeking a writ of prohibition to halt enforcement of the circuit court's August 28, 2008 order.
In determining whether to entertain and issue the writ of
prohibition for cases not involving the absence of jurisdiction
but only where it is claimed that the lower tribunal exceeded its
legitimate powers, this Court will examine five factors: (1)
whether the party seeking the writ has no other adequate means,
such as direct appeal, to obtain the desired relief; (2) whether the
petitioner will be damaged or prejudiced in a way that is not
correctable on appeal; (3) whether the lower tribunal's order is
clearly erroneous as a matter of law; (4) whether the lower
tribunal's order is an oft repeated error or manifests persistent
disregard for either procedural or substantive law; and (5)
whether the lower tribunal's order raises new and important
problems or issues of law of first impression. These factors are
general guidelines that serve as a useful starting point for
determining whether a discretionary writ of prohibition should
issue. Although all five factors need not be satisfied, it is clear
that the third factor, the existence of clear error as a matter of
law, should be given substantial weight.
In accord, Syllabus Point 1, State ex. rel. Tucker Co. Solid Waste Authority v. W.Va. Div. of
Labor, 222 W.Va. 588, 668 S.E.2d 217 (2008).
The first argument by the DHHR is that the circuit court is exceeding its
authority previously granted to it by the Supreme Court in the three Matin decisions. The
DHHR argues that it has worked with the court monitor/Ombudsman for twenty-five years
and has met all of the challenges that have arisen during this time period. The DHHR states
that the conditions that led the Court in Matin I to order court supervision of the hospital
were far worse than the conditions that are present today. Citing to Board of Education of
Oklahoma City Public Schools v. Dowell, 498 U.S. 237 (1991), the DHHR argues that
termination of court oversight in an institutional reform case is appropriate when the local
authority can establish that (1) it has complied in good faith with the decree, (2) its
compliance has lasted for a reasonable period of time, and (3) the vestiges of past violations
have been eliminated to the extent practicable. 498 U.S. at 248-51.
While the Respondents attempt to factually distinguish Dowell from the present
case, the DHHR's argument is unconvincing even under the Dowell test. The DHHR's
attempt to differentiate the past violations described in Matin I from the current conditions
is simply not persuasive. The underlying issue in this case from the beginning was whether
the DHHR was in compliance with W.Va. Code, 27-5-9, which creates specific enforceable
rights for the entire inmate population of the State's mental hospitals. This Court's and the
circuit court's involvement in this case, the court monitors and the current Office of the
Ombudsman have all been attempts to ensure patients in the State's mental institutions are
being afforded the protections guaranteed to them in W.Va. Code, 27-5-9. After reading the
Ombudsman's July 3, 2008 report on the conditions at the hospital, the circuit court believed
that there were potentially a number of violations of W.Va. Code, 27-5-9 occurring at the
hospital, and scheduled an evidentiary hearing to develop a record on these issues.
Despite the DHHR's argument to the contrary, many of the same issues that
were present in 1981 at the time of the Matin I decision continue to be problems today,
according to the Ombudsman's report. These issues include the mixing of patient
populations, and the numerous staffing issues described above. With this in mind, even if
this Court were to accept the Dowell standard, the DHHR has not shown that it can meet the
third prong of the test, that is, that vestiges of past violations have ceased.
The DHHR next argues that the proposed circuit court order unconstitutionally encroaches on executive branch authority. The DHHR argues that it has evaluated the need for hospitalization and other behavioral health services, and has identified funding available to provide those services. The DHHR relies on Matin II to support its argument here, but ultimately fails to demonstrate how the circuit court's proposed evidentiary hearing encroaches on the executive branch. Matin II held that the circuit court exceeded its authority in ordering the halting of construction of a new hospital. The circuit court in this case is not ordering any project to be halted or trying to control some function that is normally reserved for the executive or legislative branch. Rather, the proposed evidentiary hearing has come about for the same reason that a court monitor was put in place at the beginning of this case in 1981, because of the possible violations of W.Va. Code, 27-5-9. The DHHR has not demonstrated how the circuit court's Order is encroaching on executive branch authority.
Finally, and in a similar vein to the second point, the DHHR argues that the circuit court is encroaching on legislative branch authority. Specifically, it is arguing that the legislative branch, not the judicial branch, of government controls the DHHR's budget, and the circuit court cannot order the DHHR to operate in a manner which would cause it to exceed its current budget. The DHHR again argues that the issues currently active in this case are separate and distinct from those that were present during Matin I, and that this Court should therefore not follow Matin I. However, the Court in Matin I anticipated that their decision would raise a separation of powers question. As the Court explained in a footnote, ensuring compliance with a statute passed by the legislature, is not an invasion of legislative authority:
Elsewhere a question has arisen concerning the financial
implications of the enforcement of the legal rights of mental
patients. The question has usually been phrased in terms of
separation of powers since orders according mental patients
decent treatment imply a reallocation of State budget, which
may deprive the Legislature of its right to establish priorities for
State funds. The definitive answer to this objection to Court
intrusion into the area of mental health has been provided by the
case of Wyatt v. Aderholt, 503 F.2d 1305, 1314-15 (5th Cir.
1974) where the court said:
It goes without saying that state legislatures are
ordinarily free to choose among various social
services competing for legislative attention and
state funds. But that does not mean that a state
legislature is free, for budgetary or any other
reasons, to provide a social service in a manner
which will result in the denial of individuals'
constitutional rights. And it is the essence of our
holding that the provision of treatment to those
the state has involuntarily confined in mental
hospitals is necessary to make the state's actions
in confining and continuing to confine those
individuals constitutional. That being the case,
the state may not fail to provide treatment for
budgetary reasons alone. . .”
168 W.Va. at 260 n. 2, 284 S.E.2d at 238 n. 2.
With this background in mind, the Court in Matin I stated:
In the case before us we are fortunate that we are not required to
impose a new duty upon the State Legislature through
constitutional interpretation. By enacting W.Va. Code, 27-5-9
[1977], the Legislature has already recognized its responsibility
to the inmate population of the mental hospitals, and
accordingly, it can be reasonably inferred that the Legislature
will cooperate with the West Virgina [sic] Department of Health
and the Circuit Court of Kanawha County in implementing an
appropriate plan to accord inmates their statutory rights.
168 W.Va. at 260, 284 S.E.2d at 238.
This reasoning applies to the present case. The circuit court is within its
authority to conduct an evidentiary hearing to determine whether violations of W.Va. Code,
27-5-9 are occurring. The DHHR has failed to demonstrate how a proposed evidentiary
hearing encroaches on legislative branch authority.
Finally, we must address the circuit court's decision to review the traumatic brain injury services issue. Both parties entered into a “Consent Order on Services To Individuals With Traumatic Brain Injuries” on July 3, 2007. The Department has allegedly failed to comply with the time line that it agreed to in the Consent Order. As we once said in Syllabus Point 1 of Seal v. Gwinn, 119 W.Va. 19, 191 S.E. 860 (1937);
A court may, under its inherent powers, reinstate a cause
which has been dismissed by consent of parties, and enter such
orders and decrees as may be necessary to enforce the decrees
entered before dismissal.
Accordingly, we believe that the circuit court is well within its authority to hold an
evidentiary hearing on the DHHR's failure to comply with this Consent Order.