STATE INSTITUTIONS DOCUMENTS:
Welsch Case Documents

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The general category includes articles and speeches by institution staff, system-wide reports, and chronologically, other documents relating to the State Institutions in General. State Institutions: Future Planning includes individual proposals and reports and documents from joint planning efforts regarding future use of the state institutions. Welsch Documents includes orders in that action in the federal district court and related documents.

Summary of Welsch Decisions and Orders

Compilation and comments by Luther Granquist.

United States District Court Judge Earl R. Larson issued the first decision in the case after a trial held in September 1973.  He held that the Due Process Clause of the United States Constitution requires that civil commitment for reasons of mental retardation be accompanied by minimally adequate treatment designed to give each committed person "a realistic opportunity to be cured or to improve his or her mental condition."  373. F. Supp. at 499.  He wrote:

"The evidence in the instant case is overwhelming and convincing that a program of 'habilitation' can work to improve the lives of Cambridge’s residents.  Testimony of experts and documentary evidence indicate that everyone, no matter the degree or severity of retardation, is capable of growth and development if given adequate and suitable treatment."
373 F. Supp. at 495.

"It is the Court’s duty, under the Constitution, to assure that every resident of Cambridge receives at least minimally adequate care and treatment consonant with the full and true meaning of the due process clause."
373 F. Supp. at 498.

"The due process clause does no more than require that State officials charged with obligations for the care and custody of civilly committed persons make good faith attempts to place such persons in settings that will be suitable and appropriate to their mental and physical conditions while least restrictive of their liberties." 
373 F. Supp. at 502.

The Court deferred until after another hearing the question of what relief to provide.

After a hearing in May 1974, Judge Larson issued detailed findings of fact and conclusions of law (34 pages) and a ten-page order that included staffing ratios for direct care and other staff.  This Order was not appealed.

Judge Larson orders payment of $5,521.20 for the out-of-pocket cost of these two proceedings.

The United States Court of Appeals affirms the order for payment of costs.

At hearings in November and December 1975 the plaintiffs presented evidence regarding compliance at Cambridge State Hospital with previous orders and sought further relief. The defendants offered in evidence a study by the Minnesota Department of Public Welfare, "Study of Midwest Institutions for the Mentally Retarded" which purported to show authorized staff-resident ratios in 40 institutions for persons with mental retardation in eight Midwestern states. In this Order, Judge Larson granted the motion to strike these exhibits and related testimony.

Judge Larson makes detailed findings of fact on compliance with previous orders.  He also finds that there is a basis for further relief, particularly regarding staffing ratios and use of seclusion and psychotropic medication.

He concluded:

"But the officials who have the power to ensure compliance with this Order, including nonparties who more directly control the public purse, must understand that it is the considered judgment of this Court that the provisions of this Order, coupled with the Cambridge Order, require only the absolute minimum which must be implemented to secure the constitutional rights of the helpless fellow human beings who comprise the plaintiff class. This judgment is the product of considerable expert testimony as well as the experience of more than one year under the Cambridge Order. Nothing less than full compliance with all provisions of this Order is demanded if the constitutional rights of the mentally retarded are to be respected. More importantly, only full compliance can remove the public shame of years of neglect and inadequate care suffered by those of our children who have been involuntarily ordered to spend their days at Cambridge State Hospital."

The plaintiffs sought relief which would ensure that funding was available to allow compliance with the Court’s orders either by requiring the defendants to deposit Federal Medicaid reimbursement payments into a special account and to draw on it to fulfill those orders or by enjoining compliance with and enforcement by the Commissioners of Finance and Administration (who were named as defendants in a Supplemental Complaint) of state fiscal or complement control provisions which prohibited expenditure of unappropriated funds. Judge Larson ruled that he did not have to convene a three-judge federal court to rule on these questions, that the Eleventh Amendment to the United States Constitution barred the Medicaid financing order, and that he had the power to enjoin the fiscal or complement control provisions, but wanted further hearing on that issue.

Judge Larson issued an order enjoining the Commissioners of Finance and Administration from enforcing or attempting to enforce any provisions of state law which, if implemented, would cause the Commissioner of Public Welfare and the Administrator of Cambridge State Hospital to be unable to comply with the Court’s orders of October 1, 1974 and April 15, 1976. The March 30, 1976, April 15, 1976, and May 19, 1976 Orders had been appealed to the Eighth Circuit Court of Appeals.  Judge Larson stayed his injunction to allow an appeal, which was made.

The appeal of these four orders was heard by the Eighth Circuit Court of Appeals on January 13, 1977.  Friend of the Court briefs were filed on behalf of the Minnesota Senate and House of Representatives and several states challenging the orders. Shortly after the argument, Minnesota Governor Rudy Perpich wrote to the judges who heard the appeal expressing his intention to find a way to comply with the orders. The Court affirmed the March 30, April 15, and May 19, 1976 Orders. The Court vacated the July 28, 1976 Order, effectively eliminating that order but not reversing it. 

The Court stated:

"If Minnesota chooses to operate hospitals for the mentally retarded, the operation must meet minimal constitutional standards, and that obligation may not be permitted to yield to financial considerations..."

"...In any event, we desire to make it clear to the present Governor and the current Legislature that the requirements of the 1974 Order and the requirements of the April 15, 1976 Order that we uphold today are positive, constitutional requirements and cannot be ignored."  550 F.2d 1132.

The Court of Appeals noted that the question was one of what priority the Legislature would give to funding for the institutions and said the Legislature should have a chance to address that issue before the end of the current session.

In December 1977 the Court approved a settlement in the form of a detailed Consent Decree applicable to Cambridge State Hospital. This Decree replaced the orders issued by Judge Larson in October 1974 and April 1976. The Decree provided for appointment of a Monitor to review compliance with the Decrees and to hold hearings and make recommended findings of fact on matters relating to compliance. One reason this settlement could be reached was that Hastings State Hospital had been closed.

Judge Larson ordered that the defendants must pay plaintiffs' attorneys' fees and costs for trial preparation and settlement in late 1977.

Cambridge Consent Decree Monitor Frank Madden issued findings of fact and recommendations on compliance with staffing provisions of the Consent Decree.

In lieu of a hearing Mr. Madden approved a stipulation on staffing issues under the Cambridge Consent Decree.

The parties recorded their agreement on a statement of general principles to formulate a detailed Consent Decree. With this agreement, the trial that had been started involving Brainerd, Faribault, Fergus Falls, and Moose Lake State Hospitals was suspended.

Judge Larson approved a very detailed Consent Decree which covered all of the Minnesota state institutions for persons with mental retardation. Among other matters, this Consent Decree provided for increased funding for a court monitor.

Judge Larson issued an order incorporating agreed-upon procedures for the defendants to report to the Court Monitor and to counsel for the plaintiffs regarding compliance with the Consent Decree.

The Cambridge Consent Decree Monitor concluded that reductions in salary accounts at Cambridge State Hospital of $76,000 because the state faced a deficit violated the Cambridge Consent Decree. He also concluded that other reductions in salary accounts to meet the costs of attorney’s fees paid to counsel for the plaintiffs, that assignment of a central office staff person to the Cambridge salary accounts, and that reduction of salary accounts to pay for the Court Monitor and for technical assistance positions required by the September 1980 Consent Decree may not be violations of the Cambridge Consent Decree if the defendants could establish that sufficient funding was available to meet the obligations for full-time equivalent positions in the Cambridge Consent Decree.

The Court Monitor, Lyle Wray, adopted Findings of Fact and Recommendations made by Hearing Officer Frank Madden on three issues. He found that the system-wide reductions in salary accounts to meet a projected state budget deficit violated paragraphs 37 and 39 of the Consent Decree. He also found that the Commissioner had failed to submit legislative proposals required by paragraph 89(f) of the Consent Decree to eliminate the financial incentive for counties to place persons in state hospitals rather than in community-based services and to submit legislative proposals required by paragraph 89(b) of the Consent Decree to address the need for additional capacity in community-based residential facilities and developmental achievement centers.

This Court Monitor, Lyle Wray, adopted the Findings, Conclusions, and Recommendations made by Hearing Officer Frank Madden on staffing requirements of paragraphs 37 and 39 of the Consent Decree, including reductions made in salary accounts for the state institutions, the ramifications for the staffing requirements of the Consent Decree of the closure of Rochester State Hospital, and the use of state institution positions for DPW central office personnel. The Court Monitor found continuing noncompliance with the staffing provisions of the Consent Decree and recommended that the Court order the defendants, including the Commissioner of Finance, to assure that the salary account for the salary rosters covered by these provisions of the Consent Decree has an amount of money equal to not less than the sum required for total funding for salaries and fringe benefits for all positions.

The McKnight Foundation proposed to provide additional funding for the Court Monitor. Judge Larson ruled that such funding would be inconsistent with the Court Monitor provisions of the Consent Decree.

In this decision, Judge Larson considered the legislative proposal issues addressed by the Court Monitor as part of the May 21, 1981 Findings of Fact and Recommendations. He ordered the Commissioner of Public Welfare to submit a proposal to the 1982 Legislature to eliminate remaining financial incentives encouraging counties to place persons with mental retardation in state hospitals by equalizing the percentage of costs paid by counties for DAC services in state hospitals and in community-based facilities. He also ordered the Commissioner to submit to the 1982 Legislature a proposal for additional DAC capacity and to develop a method of effectively monitoring county expenditure of Community Social Services Act funds for DAC services.

In a lengthy decision, Judge Larson concluded that the defendants had failed to comply with the staffing requirements of paragraphs 37 and 39 of the Consent Decree. His detailed order enjoined the defendants from making any further reductions in the salary accounts during fiscal year 1982 except as permitted by the Court and required full funding of the salary accounts for fiscal year 1983. Judge Larson recognized the fiscal problems faced by the state, but emphasized that the Consent Decree was a binding legal obligation that must be honored. He added that "less there be any doubt, the Court will not hesitate to use its full power to ensure compliance should further relief become necessary because the defendants have again failed to live up to their commitment to the plaintiff class."

Court Monitor Lyle Wray adopted the decision of Hearing Officer Frank Madden that Paragraph 95 of the Consent Decree granted jurisdiction for the Court Monitor to determine whether a reduction in DAC services for a class member, Bruce L., from five days per week to three days per week violated paragraph 26 of the Consent Decree which mandated that all persons discharged from the state hospital were entitled to appropriate day program services. The Commissioner of Public Welfare contended that this issue should be presented to an appeals referee of the Department of Public Welfare. At that time, there were many such appeals from county agency cutbacks in DAC services. On the merits of the issue, the Court Monitor ruled that the reduction in funding for Bruce L., for whom Stearns County was the county of financial responsibility, from the amount of service specified in his Discharge Plan violated the Consent Decree unless the Commissioner could establish that individual need, not county funding issues, provided a basis for that reduction.

Judge Larson granted two motions by the Commissioner – to extend for 30 days the time to appeal the March 23, 1982 regarding staffing and to stay the effective date of certain provisions of that order. He considered the latter request fair because he was informed "that negotiations are or will be proceeding in an attempt to resolve some of the issues surrounding the March 23, 1982 Order: the Court urges the parties to pursue these negotiations and attempt to resolve these matters by consent."

The Commissioner provided no evidence to demonstrate that a reduction in DAC services for Bruce L. would provide "appropriate" services as required by paragraph 26 of the Consent Decree. Accordingly, the Court Monitor recommended that DAC services for him should remain at the five-day level until such time as his interdisciplinary team determined that a reduction was justified on the basis of individual need.

In the case involving class member Bruce L., Judge Larson ruled that paragraph 26 of the Consent Decree, which mandated appropriate day program services, was a key "anti-dumping" provision.  Judge Larson stated that the "Commissioner must proceed with vigor and diligence to do everything he can to assure the provision of appropriate day programming to discharged hospital residents." He ordered the Commissioner to take all actions necessary to assure that Bruce L. received full-day, full-week DAC services until such time as modification of that scheduled "is necessitated and justified to meet his individual need."

In a case similar to the Bruce L. case, the Court Monitor found that the Commissioner had failed to comply with paragraph 26 of the Consent Decree by acquiescing in reduction of funding by Ramsey County for DAC services for a class member attending the Sherburne County DAC.

Judge Larson ordered full-day, full-time services at the McLeod County DAC for three class members who resided at the Alice Haney Residence in Lester Prairie and for whom Ramsey County was the county of financial responsibility.

Court Monitor Richard Cohen found that the election not to fill one of the technical assistance positions required by paragraph 28 of the Consent Decree when that position became vacant but rather distribute the responsibilities of that position among eight regional services specialists hired by the Department was inconsistent with paragraph 28.

Judge Harry H. MacLaughlin ordered the Commissioner of Human Services either to seek modification of the Consent Decree or to fill the vacant technical assistance position within 90 days.

Court Monitor Richard Cohen issued a lengthy (203) page decision finding that the Commissioner and his subordinates failed to comply with paragraph 1 (actions required are the responsibility of the Commissioner) and paragraph 24 (all persons discharged should receive appropriate residential services) of the Consent Decree regarding placement of three class members at Hearthside Homes in St. Louis County. The Court Monitor recommended that the Commissioner develop more detailed placement standards and require state hospital and county agency personnel not to discharge class members to facilities which do not meet those standards.

Judge MacLauglin ruled that attorneys for the plaintiffs were entitled to an award of attorneys' fees in connection with a proceeding to enforce compliance with the requirements of the Consent Decree which resulted in a negotiated settlement. The issue was whether the Commissioner was obligated to assure that discharged class members placed in community facilities were cared for by staff persons trained to perform CPR.

Judge MacLauglin denied a motion to alter or amend his June 13, 1986 Order.

Judge MacLaughlin granted the motion of the Association of Minnesota Counties to intervene in proceedings before the Court relating to the Hearthside Homes compliance proceeding.

The Commissioner and her counsel and counsel for the plaintiff class reached an agreement to settle this case. Part of the agreement was that all pending matters, including the Hearthside Home compliance proceeding pending before the federal court, were to be dismissed. The Negotiated Settlement was subject to approval by the Court.

United States Magistrate Judge Janice Symchych denied a motion for the Minnesota Chapter, Congress of Advocates for the Retarded and parents of two state hospital residents to be permitted to intervene in the case.

On June 5, 1987, after notice had been given to class members and their representatives of the proposed Negotiated Settlement, Judge Doty conducted a hearing at which a large number of persons commented on the proposal. In an Opinion issued on July 31, 1987 and supplemented on August 26, 1987, Judge Doty approved the Negotiated Settlement.

The Court finds that the terms of the Negotiated Settlement have been met and dismisses the case.