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($()* A<< c<6X9`(Courier New\  `$Times NewRoman%2A`Arial1, 2, 3,Level 1Level 2Level 3Level 4Level 5m-c((3$ !      0  (#$  0  2'N0Footer  .  (#A7X` hp x (#A . (O$0  2 e  a  .3  0` (#(#4#32Quick 1.0  .0 0<:Page Number <l:Footnote TexXXX<:Footnote Ref(2C$ !  ݃ Level 1 Level 2 Level 3 Level 4 Level 5($(2C$ !  ;=)< C<< c64Heading 1  SH\  `&Times New RomanS          SH\  `&Times New RomanS      =#7Xd#  * `CG Times _    1  .EXXThepartieshaveconsentedtothefilingofthisbrief.Amicistatethat  counselforapartydidnotauthorthisbriefinwholeorinpartandthatnooneotherthanamiciortheircounselmadeamonetarycontributiontothepreparationor ( submissionofthisbrief.8ܖE  8  #X#LXܖ4# (_    2  .EXXFullbiographiesofthefourteenformeradministratorsonwhosebehalfthis  briefisfiledareattachedinanAppendixtothebrief. #X#LXE5#  * `CG Times G & :C)  ! "(#X! >IQA=x h  p @XE` (#(#ܖXX#X#LXܖ#\  `&Times New Roman # =C"  ! "(#X!ܖXX4..' (#"(#'  4[  7    ii  7    S CEKQW]cioAutoList1A.A.A.A.A.A.A.A.3#37=CIQYag1.a.i.(1)(a)(i)1)a)(;3$2#  0  .3  0   }CEKQW]cioAutoList2A.1.A.A.A.A.A.A. & :C)  ! "(#X! >TQA=x h  p @XE` (#(#ܖXX#X#LXܖ# # =C"  ! "(#X!ܖXX4..' (#"(#'  4[  7    ii  7     d+ +dX Xd _  3.EXXThis#X#LXE #EXX#LԀbridgeloanwasconsideredsoundenoughpolicytobefundedina  yearinwhichtheoverallDepartmentofMentalHealthbudgetwascutby$12.8millionandthenumberofstateemployeesworkingfortheagencyhasdecreasedbyovertenpercent.Thisisbecauserelativelysmallincreasesinfundingfortheshorttermwillcapturelongtermsavings.#X#LXEf# _  4.EXXPublicentitiesunderTitleIIaresubjecttoatleastthesamerequirementsas  privateemployerswithregardtotheobligationtoseekavailablefundstomakereasonableaccommodations.TheregulationstoTitleImakeclearthatanemployercannotassertafundamentalalterationorundueburdendefensetoarequestedaccommodationifithasnotpursuedavailablefundingfortheaccommodationfromothersources:0  Ifanemployerorothercoveredentitycanshowthatthecostofaccommodationwouldimposeanunduehardship,itwouldstillberequiredtoprovidetheaccommodationifthefundingisavailablefromanothersource,e.g.,aStatevocationalrehabilitationagency,orifFederal,State,orlocaltaxdeductionsortaxcreditsareavailabletooffsetthecostoftheaccommodation. (#(# 29C.F.R.Pt.1630,App.1630.2(p)(2001).  #X#LXE # P_  5.EXXTheCourtwasfamiliarwiththesetransitioncoststoachievingintegration  inpubliceducationandlongendorsedpublicexpendituresnecessarytoremedysegregation.Millikenv.Bradley(II),433US267(1977).#X#LXE # NorristownEasleyEasleyi<6X9`("Courier 10cpiXx6X@8;X@* `(CG TimesScalableXXw P7XP !  _XX___EM@3 _@  INTHEUNITEDSTATESCOURTOFAPPEALS  @$$ FORTHETHIRDCIRCUIT򀀀 0 @tt%NO.023721 򀀀򀀀 ( x  󀀀 @    @@FREDERICKL.;NINAS.;KEVINC.;STEVENF.,ONBEHALFOFTHEMSELVESANDALLPERSONS@@!SIMILARLYSITUATED,   `     h      p   Appellants,@)v.  DEPARTMENTOFPUBLICWELFAREOFTHECOMMONWEALTHOFPENNSYLVANIA;FEATHERO.HOUSTOUN,INHEROFFICIALCAPACITYASSECRETARYOFPUBLICWELFAREFORTHECOMMONWEALTHOFPENNSYLVANIA,   `     h      p   Appellees. 򀀀򀀀  H @AppealfromtheMemorandumandOrderoftheUnitedStates@D D DistrictCourtfortheEasternDistrictofPennsylvania@nnenteredSeptember5,2002inCivilActionNo.00CV4510  򀀀  ЀBRIEFFOR14FORMERSTATEMENTALHEALTHAGENCYADMINISTRATORS,AMICICURIAE,#EM#EMINSUPPORTOFTHE  X APPELLANTS 򀀀 8"  󀀀 P# SusanStefan0 0 (# (#0h(#(#0h(#h(#0(#(#IraBurnimh$(#(# RobertD.Fleischner0  0h(#(#0h(#h(#0(#(#JenniferMathis% (#(# StevenJ.Schwartz0  0h(#(#0h(#h(#0(#(#JudgeDavidL.BazelonCenterfor0@ #h(#h(#0@ #x(#x(##EM2#EM&!(#(# CenterforPublicRepresentation0  0(#(#MentalHealthLaw#EM+ #EM'# (#(# 22GreenSt.0 0 (# (#0h(#(#0h(#h(#0(#(#110115thStreetNWSuite1212#EM #EM($!(#(# Northampton,MA010600 h 0h(#h(#0(#(#Washington,D.C.200055002#EM #EM)0%"(#(# 41358762650 0 (# (#0h(#(#0h(#h(#0(#(#2024675730#EM #EM*H&#(#(#    `     h       COUNSELFORAMICI @.)& @3  @8#LXXdd8 @  #EEi#EiE   `    TABLEOFCONTENTS   F9  99  TABLEOFAUTHORITIESh"h"H(#iii H INTERESTOFAJ_ԢMICI_ԀCURIAE""J(#1@(#(#K(#EX XEiԈ ( x #Ei XEX,#SUMMARYOFARGUMENT""J(#2 0  ARGUMENT""J(#4 `  I.0  THECOURTERREDINITSINTERPRETATIONOFTHE   FUNDAMENTALALTERATIONDEFENSE""J(#(#(#4     A.#EEi#EiEԀ0 ` ModerateandTemporaryCostsAssociatedwithDesegregation(` (#` (#    ` DoNotFundamentallyAlteraMentalHealthSystem.""J(#4 @ #EEi#EiE63     ` 6301  .0   TransferringInstitutionalResourcestotheCommunity,63G0ی p (# (# Ќ     `  OverTime,IstheAcceptedStrategyforPromoting   `  Integration.""J(#5 P 63     ` 6302  .0   UtilizingResourcesfromMultipleStateandFederal630ی (# (# Ќ     `  SourcesIstheAcceptedStrategyforFunding.   `  CommunityIntegration.""J(#7  63     ` 6303  .0   DevelopingAdministrativeMechanismsandStructures630ی0 (# (# Ќ  0  0` (#(#0 ` (#` (#ToFacilitatetheTransferofResourcesandPeoplewithDisabilitiesIsNecessarytoPromoteIntegrationandCommunityPlacement.@"@"I(# (# (#11 (#x     B.0 ` TheDistrictCourtErredinHoldingThatanAccommodationX% ` (#` (#    ` ThatDoesNotResultinImmediateCostSavingsisa   ` FundamentalAlteration.@"@"I(#12 '"     ` 1.0 TheDistrictCourt,CourtofAppealsandSupreme)%" (# (#    `  CourtinOlmsteadRejectedtheArgumentthatLack * &#    `  ofFundsJustifiedInstitutionalSegregation.@"@"I(#13 +8'$  -P(%  FJ FG JFSG J     ` 2.0 TheSupremeCourtandThisCircuitHaveUnderscored (# (#    `  thatDefensesinADACasesMustBeConstrued   `  NarrowlytoAccomplishthePurposeoftheADA.@"@"I(#17 0 #EEi#0  C.0` (#(#RecentDistrictCourtFormulationsofFundamentalAlteration `` (#` (#    ` intheContextofOlmsteadClaims.@"@"I(#20 $ t 0  D.0` (#(#TheProperFormulationofaFundamentalAlterationDefenseL ` (#` (#    ` inThisCase.@"@"I(#22 `  L P} #MLӀ t  II.0  THEDISTRICTCOURTERREDBYENTERINGJUDGMENT (#(# 0  AGAINSTPLAINTIFFSONTHEIRADMINISTRATIVEMETHODSCLAIM.@"@"I(#(#(#24   ЀCONCLUSION@"@"I(#30 $ APPENDIX0 ` X#LXEEX XXX#LԀ#Ei XEX"#31L` (#` (# CERTIFICATIONS38  D S#EEi"#  @LL  TABLEOFAUTHORITIES  Cases  ( Alexanderv._ԢChoate_,469U.S.287(1985) E(#10,27  P EasleybyEasleyv.Snider,36F.3d297(3rdCir.1994)@"@"I(#17 ( x FrederickL.v.DepartmentofPublicWelfare,157F.Supp.2d509 P  (E.D.Pa2001)@"@"I(#2?28?2@29@2 d  FrederickL.v.DepartmentofPublicWelfare,217F.Supp.2d.581   (E.D.Pa.2002)B(#9,25,28   HenriettaD.v._ԢGuiliani_,119F.Supp.2d181(_ԢE.D.N.Y._Ԁ2000)@"@"I(#24  _ԢIndep_.LivingRes.Ctr.v.CityofWichita,2000U.S.Dist.LEXIS6324 @ (_ԢD.Kansas_ԀMarch15,2002)@"@"I(#24 T KathleenS.v.Dept.ofPublicWelfare,10F.Supp.2d460 ,| (_ԢE.D.Pa_.1998)@"@"I(#26 @ L.C.by_ԢZimring_Ԁv.Olmstead,138F.3d893(11thCir.1998)@"@"I(#1A23A2B24B2 h Martinv._ԢP.G.A._ԀTour,532U.S.661(2001)@"@"I(#18  Martinv.Taft,222F.Supp.2d940(_ԢD.Ohio_Ԁ2002)@"@"I(#21   Messierv._ԢSouthbury_ԀTrainingSchool,1999U.S.Dist.LEXIS1479 "0 Ѐ(_ԢD.Conn_.1999)@"@"I(#17 #D _ԢMilliken_Ԁv.Bradley(II),433U.S.267(1977)@"@"I(#15 &l! Olmsteadv.L.C.,527U.S.581(1999) E(#passim D(#! SalveReginaCollegev.Russell,499U.S.225(1991)@"@"I(#25 l*%# Williamsv.Wasserman,164F.Supp.2d591(_ԢD.Md_.2001) E(#20,21 ,'% Ї Statutes   AmericanswithDisabilitiesAct,42U.S.C.1213112134 E(#passim ( Section504_ԢRehabilition_ԀAct,29U.S.C.794 E(#17,19  P 42U.S.C.1396d(a)(13) E(#17,19 ( x H.R.101485,PartI,101stCongress,2ndSession,(May14,1990)@"@"I(#18 d  H.R.101485,PartIII,101stCongress,2ndSession,(May15,1990)@"@"I(#19    RegulationsandRules   28C.F.R.35.130(b)(3)(i)""J(#9 @ 29C.F.R.pt.1630,App.1630.2(p)(2001)@"@"I(#10 h Fed.R.Civ.P.52(a)@"@"I(#25 @  Articles  h Elias,Navon,TheMassachusettsExperiencewithManaged  MentalHealthCareandMedicaid,14HealthAffairs46(1995)""J(#9  Oliver,Montgomery,ANetworkApproachtoOutpatientService ! DeliverySystems:ResourcesFlowandSystemInfluence,30Health "0 ServicesResearch(1996)@"@"I(#2C26C2D27D2 #D Talbot,TheFateofthePublicPsychiatricSystem,36Hospital &l! andCommunityPsychiatry(1985)@"@"I(#26EiEEX XEiԈ 0'"  #X#LX XEX3##EXX#L13#EiEEX XEi  D(#! М#Ei XEX3##EEi3#k  INTERESTOFAMICICURIAE9  949  C 3#  1        {4B.` hp x (#XB    Thiscaseraisesissuesofgreatimportancetothementalhealthanddisabilitycommunities.Asformerstatecommissioners,directors,oradministratorsofmentalhealthagencies,amiciareuniquelypositionedtospeaktothepolicyandlegalissues ( x presentedbythiscase,includinghowpublicsystemsofcaremayoperateinamannerthatbestaddressestheneedsandrightsofpeoplewithdisabilities,thatremediestheirlonghistoryofsegregation,andthatiscosteffectivefortheStates.Asaresultoftheirconsiderableexperienceinmanagingstatesystemsofcare,amici  haveabreadthofunderstandingaboutthemechanismsStatesusetoaccomplishcommunityplacementandthewayinwhichlegalrulesaffectstatepractices.  Amiciwerestatecommissioners,directors,oradministratorsineleven @ States.9  999  D 3#  2      ׀TheyhavebeeninvolvedwitheveryaspectoftheirStatesservicesystems, h frommakingbudgetarydecisionstooverseeingthephasingdownofinstitutionsandthedevelopmentofnewcommunitycarealternatives.Amicistronglysupport   communityservicesinintegratedsettingsasthebestmethodoftreatingthemajority "0 ofpeoplewithdisabilities.  AmiciarguethattheDistrictCourtfundamentallymisunderstoodthe ( financingandoperationofcommunitymentalhealthserviceswhenitruledthatunlesscommunityplacementsfromfacilitiesresultedinimmediatecostneutralityorsavingstheywouldfundamentallyalterthestatementalhealthprogram.ThiserrorwasaggravatedbytheCourtslimitationof availablefinancialresourcestotheStatesmentalhealthbudget,andbyitsdismissal,withoutanalysis,oftheplaintiffs administrativemethodsclaim.Asformeradministrators,amiciconcludethatthe  accommodationrequestedbyplaintiffsisreasonable,workable,andiswhatadministratorsintheirpositiondoonaregularbasis.5   SUMMARYOFARGUMENT  @ >4  TheDistrictCourtsconclusionsoflawreflectamisunderstandingofboththeSupremeCourtsmandateinOlmsteadv.L.C.,527U.S.581(1999) , andofhow  Statesaccomplishinstitutionaldesegregation.TheCourthadtwogoalsinformulatingthefundamentalalterationdefensetoanOlmsteadclaim:toprevent "8 claimsfromintentionallyoreffectivelyeliminatinginstitutionsasatreatmentoption,andtoprotectStateswithacomprehensivecommunityplacementplanandawaitinglistmovingatareasonablepacefromtheinterferenceanddisruptionofpiecemeallitigation.(Infra,pp.1216.)TheDistrictCourtsformulationofthedefenseisfar +&$ broaderthanthatcontemplatedbytheSupremeCourt.   NeitherCongressnortheSupremeCourtenvisionedthatpublicentitiescould ( successfullyassertafundamentalalterationdefenseagainstanOlmsteadclaim  X simplybyshowingthatceasingdiscriminatorysegregationwouldnotbeentirelyorimmediatelycostfree.NordoStateprogramsmakeplansfordesegregationoftheirinstitutionsonthepremisethatimmediatecostsavingswillresult.Infact,Stateswhichhavemadesubstantialprogressinimplementingthismandatehavedemonstratedthatintegrationandtheprovisionofintegratedservicesmaycostmoney,butoftenthesecostsareminimizedorcompletelyoffsetbythetransferofinstitutionalresourcesandtheabilitytoutilizeotherfundingsources.Thereallocationandcombinationofresourcesandtheimplementationofadministrativemechanismstofacilitateintegration,donotfundamentallyaltermentalhealthprograms.(Infra,pp.420.)    TheCourtalsoerroneouslylimiteditsanalysistotheresourcesavailabletothedefendantinitsmentalhealthbudget.(Infra,pp.2021.)Indecidingthe "8 contoursofthefundamentalalterationdefense,thisCourtshouldtakeintoconsiderationtherealitiesofinstitutionaldesegregation.Stateshavebeenundertakingthetransferoflargeinstitutionalpopulationstothecommunityformorethantwentyfiveyears,andtherearecertainstandardmethodologiesusedto +&$ accomplishthisgoal.ThedecisionoftheCourtbelowignorestheserealitiesandcreateslegalrulesatoddswiththem.(Infra,pp.2124.) (   Stateswishingtoendunnecessarysegregationmustaffirmativelyadoptanadministrativeframeworkthatenablesthemtodoso.Thisframeworkincludescomprehensive,multiyearplanning,accessinganarrayofavailableresourcesincludingfederalandmultiagencystatefunding,andoccasionallyusinglimitedfundstoshiftinstitutionalservicestothecommunity.(Infra,pp.2628.)D2 D2TheCourt   shouldnothavedeniedplaintiffsadministrativemethodsclaimwithoutanydiscussionorlegalanalysis.Inamicisexperience,administrativemethodsare @ crucialtoaStatessuccessinaccomplishinginstitutionaldesegregation.YettheCourtbelowmadenoefforttoapplythelawtoplaintiffsspecificallegations.(Infra,pp.2429.)  h 1?  ARGUMENT  I.0  THECOURTERREDINITSINTERPRETATIONOFTHE   FUNDAMENTALALTERATIONDEFENSE .!(#(#   A.0 ` ModerateandTemporaryCostsAssociatedwithDesegregationdonot #H FundamentallyAlteraMentalHealthSystem. ` (#` (# L  Establishingservicestofacilitateintegrationnecessarilycostsmoney,which, ,'|"  withtherightadministrativemechanisms,canusuallyberecoupedinarelativelyshorttime.Thismoneyisnotinevitablytakenfromservicestootherclients.The |+&$ merefactthattherearesomeimmediatecostsassociatedwithcommunityintegrationisnotsufficient,astheDistrictCourtheld,toconstituteafundamentalalterationofthementalhealthsystem.Mentalhealthsystemsregularlyanticipateshorttermmoderatecostsassociatedwithintegrationandhavedevelopedmechanismstominimizethem.TheDistrictCourtsconclusionsoflawwouldserveasadisincentiveforStatestopursuetheseprovenandsuccessfulintegrationstrategies.     0 ` 1.0 ` (#` (#TransferringInstitutionalResourcestotheCommunityOver  TimeIsanAcceptedStrategyforPromotingIntegration., (# (# FQ  Oneofthemostsuccessfulstrategiesforpromotingintegrationofinstitutionalizedpersonsistotransfertheresourcesalongwithindividualsfromtheinstitutiontothecommunity.Commonlyknownasreallocation,Stateshavelongusedthismethodtofinancenewcommunityprogramsinacosteffectivemanner.Becauseintegratedcommunitysupportservicesgenerallycostless,oratmostthesame,astreatmentinasegregatedinstitution,transferringfundsfrominstitutionstothecommunitygenerallyresultsinsavingstotheState.Communityplacementisatleastcostneutral,asisthecaseinPennsylvaniawithrespecttothemostneedyplaintiffsatNorristownStateHospital.Ineithersituation,compliancewiththeADAneitherfundamentallyalterstheStatesmentalhealthprogramnorrequiresadditionalresources,atleastwhenviewedovertime. ,'%   Theonlyrealcosttocommunityplacementisatemporarycostattendanttothetransferprocess,whenstaffandenvironmentalexpensesarestillincurredattheinstitutionwhileindividualsareinthemidstofthetransition.ItisthistransitioncostwhichwastheentirefocusoftheCourtbelow,andwhichitfoundtobea fundamentalalteration.  Inamicisexperience,itiscommon,evenexpected,thatsometransitional x  costsoccurwhenimplementinganOlmsteadplan.Thisishardlya fundamental   alterationoftheStatesprogramsinceitisminor,temporaryandanticipated.Ultimately,institutionalcostscanbetransferredthroughreallocationtothecommunity.Whatvaries,dependingoncircumstances,isthetimeittakestoachieveeitherbudgetneutralityoroverallsavings.Thesesavingsmaybeachievedinthesamefiscalyear;insomecircumstancesitmaytakelongerthanayear.  Thereareanumberofwellestablishedmethodsforaccomplishingthetransitionofpersonswithdisabilitiesfrominstitutionstothecommunity,usinginterimfundingstrategies.Forexample,theMassachusettsOlmsteadplancallsfor "0 theclosingofastatehospitalandplacementofmorethan100personsintocommunityprogramsinthecurrentfiscalyear.Inordertoassistintheimplementationofthisgoal,theDepartmentofMentalHealthconceived,proposed,andsuccessfullylobbiedforasocalled bridgeloanaccountfor$3.6million.The +&$ accountisforoneyearonlyandthefundswillnotannualize.Fundswillbeusedtocloseastatementalhospitalandtomovemanyofitsresidentstocommunityprograms.Inthenextyear,thecostoftheprogramswillbecoveredbythesavingscreatedbyclosingofthefacilityandthelessexpensivecommunitytreatment.Thisandsimilarapproachesusedbymanyoftheagencieswhichamicidirected, P  recognizesthatalthoughtherearesomeoverlappingcostsinoneyearasthefacilityisphaseddown,sufficientsavingswillaccrueoverthecourseofseveralyearstomakeaonetimeexpenditurefinanciallymanageableandclinicallyappropriate.Z 3#  3      ׀  TheDistrictCourtignoredthisbasicrealityininsistingthatsavingshadtobeimmediate. `   h    ` 2.0 UtilizingResourcesfromMultipleStateandFederalSourcesIs @ theAcceptedStrategyforFundingCommunityIntegration.T (# (#   Asecond,wellestablishedstrategyforfundingcommunityprogramsistoutilizeresourcesnotavailabletopayforinstitutionalservices,includingvariousfederalprograms.ThemostsignificantoftheseprogramsisMedicaid,whichincludesabroadrangeofStatePlan,waiver,optional,andpilotprogramsdesignedspecificallytofacilitatetheintegrationofpersonswithdisabilities.Usingand &l! combiningthesefundswithotherstateresourceshasprovidedbroadflexibilityandsubstantialopportunitiesforStatestotransferinstitutionalizedpersonstothecommunity,withoutcompromisingexistingprogramsordeprivingotherpersonswithdisabilitiesofbasicsupports.  Fromtheirexperience,amiciknowthatfewifanyStatesrelyontheirmental P  healthbudgetsalonetoaccomplishsuccessfullongtermintegrationofpersonsneedingmentalhealthservicesintothecommunity.Rather,StatescananddomakeuseofanarrayofMedicaidfundingoptionssuchasrehabilitationandcasemanagement,federalhousingprogramssuchasSection8,andprogramsadministeredbytheDepartmentofLaborsuchastheTickettoWorkprogramtosuccessfullyintegrateitsclientsintothecommunity.Amiciknowthattheuseof @ variousfundingsourcesisthemosteffectivemethodtoaccomplishtheADAsintegrationmandate.  TheSupremeCourtinOlmsteadappreciatedthis,rejectingGeorgias   argumentthattheMedicaidprogramevincedaCongressionalpreferenceforinstitutionaltreatment,D2D2527U.S.at601,andpointedlynotingthatGeorgiahadused %X  only700ofits2109communitybasedwaiverslots.Id.Whilethewaiversreferred 0'"  toinOlmsteadarenotavailableforpersonsages2265inthementalhealthsystem, X)$" theyareavailableforyouthandtheelderly.Manyothermentalhealthservicescan +&$ bepaidforthroughMedicaidoptionswhichStatesarefreetoadopt. x     AlthoughPennsylvaniahasadoptedamandatorymanagedcarebehavioralhealthprogram,FrederickL.,217F.Supp.2d581,589,otherStateshaveused  P Medicaidfundinginadditiontothebenefitsofmanagedcaretomovepeopletomoreintegratedsettings.See,EileenElias,Marc_ԢNavon_,TheMassachusetts P  ExperiencewithManagedMentalHealthCareandMedicaid,14HealthAffairs46, x  48(1995)(savingsfromthemanagedcareprogramreinvestedtoexpandcommunitybasedcontinuingcareservices).  Forexample,SouthCarolina,RhodeIsland,NewHampshire,andMassachusettshaveusedMedicaidssocalled RehabilitationOption,42U.S.C.Ϣ1396d(a)(13),anonmandatorybenefitwhichisnotincorporatedintoitsbehavioralhealthmanagedcareprogram,tofundqualifyingrehabilitationservicesprovidedindividualswholiveincommunityprograms.TheMedicaidreimbursementreducestheoveralldirectcosttothestateofprovidingtheresidentialprogramandvastlyincreasesthenumberofindividualswhocanbeservedinthecommunity.Likewise,manyStates,includingVermont,SouthCarolina,NewHampshire,andMassachusetts,utilizeothernonmanagedcareMedicaidreimbursementstoaugmenttheirmanagedcareprogramandtheStateappropriationforservicestopeopledischargedtothecommunity.Thereareanumberofotherfederalvocational, +&$ educational,andsocialserviceprogramswhichprovidefundstoassisttheStateinintegratinginappropriatelyinstitutionalizedpeopleintothecommunity.  TheADAforbidstheStatefromclaimingthatcommunityplacementisnotareasonableaccommodationiftheStatecouldaffordtoplacepeopleinthecommunity,butsimplychoosesnottoseekorspendfundsthatarereadilyavailableandwouldbeeffectiveinprovidingtheaccommodation.\ 3#  4      ׀Thisisthekindof x   thoughtlessnessandindifferencewhichtheCourthasmadeclearconstitutesdiscriminationagainstpeoplewithdisabilities.Alexanderv._ԢChoate_,469U.S.287,  295(1985).  Inthiscase,thelowerCourterredasamatteroflawinconsideringonlyfundingavailableinthestatementalhealthbudget,ratherthanincludingotherDPW @ Мandfederalfundstargetedtopeoplewithmentaldisabilities,includinghousing,socialservice,vocationalrehabilitation,incomesupport,andeducationalsupport.Thesefundingstreams,theonesactuallyusedbymentalhealthagenciestocreateandsustaintreatmentinthecommunity,shouldbetheonesincludedinassessmentsofavailableresourcestoassistinfundingthecostsoftherequestedreasonableaccommodations.   ` 3.0 DevelopingAdministrativeMechanismsandStructuresto   FacilitatetheTransferofResourcesandPeoplewithDisabilitiesIsNecessarytoPromoteIntegrationandCommunityPlacement. (# (#     ManyoftheduplicatecostswhichconcernedtheDistrictCourtcanbeminimizedthroughsimpleadministrativemechanisms.Amicihaveimplemented h thesemechanismssuccessfullywithoutalteringprograms.Thosepartsofahospitalpreviouslyusedtohousepatientscanbeusedforofficespace,forstorage,andforprogramming.Valuablelandcanbesoldforhousingandindustrialdevelopment,oftenprovidingmorejobstothecommunitythanwereavailableatthehospital.Mostimportant,costs,staffandthetreatmentservices,canbetransferred,liketheresidents,tothecommunity.  %X    TheDistrictCourtsfailuretoconsiderwhetherPennsylvaniahadestablishedanyadministrativemechanismstofacilitatetheintegrationoftheresidentsofNorristown,aswellasitsartificialandunjustifiedfocusonimmediatecostsavings +&$ andstatementalhealthfunding,providedthefactualfoundationforitslegalerrorinendorsingtheStatesfundamentalalterationdefense.  B. 0 ` TheDistrictCourtErredinHoldingThatanAccommodationThat  P DoesNotResultinImmediateCostSavingsisaFundamentalAlteration. ` (#` (# Ѐ 8  Mz  TheCourtsholdingthatanyaccommodationthatdoesnotresultinimmediatecostsavingsisafundamentalalterationfliesinthefaceoftheSupreme p  CourtsinterpretationoffundamentalalterationinOlmsteadandamicisexperience   ofhowinstitutionaldesegregationisaccomplished. First,theargumentthatany  immediatecostsassociatedwithinstitutionaldesegregationcreateafundamentalalterationwouldunacceptablycircumventOlmsteadsholdingthatlackoffunding h doesnotexcuseorlegalizeunnecessarysegregation.Second,bothCongressandtheSupremeCourthavealwayscontemplatedthatreasonableaccommodationsandintegrationwillcomeatsomecost,aslongasthatcostdoesnotconstituteanundueburden.Finally,therequirementofimmediatesavings!ratherthansavingsrealizedoverseveralyears!simplydoesnotmirrorcommonpracticesinthisarea,norreflecttheanalysisofanycourtthathasconsideredcommunityintegrationundertheADA. `  0'"     ` 1.0 TheDistrictCourt,CourtofAppealsandSupremeCourtin  OlmsteadRejectedtheArgumentthatLackofFundsJustified  InstitutionalSegregation.( (# (#   ToappreciatethelegalerrorandpracticalproblemswiththefundamentalalterationstandardcreatedbytheCourtbelow,itisimportanttoreviewthefactsandargumentsinOlmstead.GeorgiaconcededthatplaintiffsL.C.and_E.W._Ԁwere P  appropriateforplacementinthecommunity,asdidDPWwithregardtotheplaintiffsinthiscase.LikeDPW,Georgiaassertedthatitsimplydidnothavethefundstomaketheplacements.Georgiarepeatedly arguedthatfailuretoplace  unnecessarilysegregatedindividualsinthecommunitybecauseoflackoffundswasnotdiscriminationoraviolationoftheADA.  EachCourttoconsiderthisargumentrejectedit. TheDistrictCourt,the H EleventhCircuitCourtofAppeals,andtheSupremeCourteachheld thatStates x couldnotuselackoffundsasareasontoholdpeopleunnecessarilyininstitutionalsettings.TheOlmsteadDistrictCourt rejectedtheStatesargumentthatinadequate   funding,notdiscriminationagainstL.C.and_E.W._Ԁ`byreasonoftheirdisabilities,accountedfortheirretentionat[thehospital],findingthat unnecessaryinstitutionalsegregationofthedisabledconstitutesdiscriminationpersewhichcannotbejustifiedbyalackoffunding,Olmstead,527U.S.at594(quoting p)$" DistrictCourtdecision).TheEleventhCircuitagreedthatlackoffundsdidnot +&$ excuseGeorgiafromdiscriminationcharges, _Ԣreject[ing_]theStatessuggestionthatL.C.and_ԢE.W._sclaimsmustfailbecausethedenialofcommunitybasedplacementswasbasedonlackoffunds.L.C.by_ԢZimring_Ԁv.Olmstead,138F.3d  P 893,902(11thCir.1998).TheSupremeCourtaffirmedtheEleventhCircuitandthe ( x DistrictCourtholdings,firmlyrejectingtheStatespersistentcostbasedargument.Olmstead,527U.S.at597.Rather,theSupremeCourtheldthatthefailureto x  integratewillingindividualswhodidnotneedtobeinaninstitutionwasdiscriminatoryundertheADA.Id.at600601.    AlthoughthepluralityinOlmsteadbroadenedthefundamentalalteration @ defenseprescribedbytheEleventhCircuit,itdidnotequateanyadditional  h  expenditurewithfundamentalalteration.TheCourtspositionwithregardto @ institutionsandcostswasclear.Itwantedtomaintaininstitutionalalternativesforthosethatneededthem.527U.S.at601602,604605.Integrationcoststhat  threatenedtheexistenceofinstitutionsasanalternativewouldfundamentallyalterthementalhealthsystem,becauseinstitutionalalternativesareanessentialfeatureofsuchsystems.Id.at604605. %X    However,theCourtwasequallyconcernedthataStatenotdelaycommunityplacementofunnecessarilysegregatedpeoplesimplybecauseoftherisingper X)$" capitacostofmaintainingtheStatesinstitutions.Thus,theCourtdidnotallowthe +&$ defendantstoavoidliabilitysimplybypointingtotheexistenceofawaitinglist,oreventoawaitinglistmovingatareasonablepace,butrequiredthatthelistbemovingatareasonablepace notcontrolledbytheStatesendeavorstokeepitsinstitutionsfullypopulated.Id.at605606. ( x   TheCourtwasawarethatStatesmightdelayplacementbasedonfiscalratherthanclinicalconsiderations.Itsexplicitrejectionofthisrationaleasapermissiblefactorinthepaceofplacementevidencesitsunderstandingthatmakingplacementsresultsinsomecosts.AlthoughitwishedtoprotectStateswhenthosecostsrosetothelevelofafundamentalalteration!threateningtheStatesabilitytomaintaininstitutionsasatreatmentoption!itsimultaneouslywantedtoguaranteethevindicationofrightsundertheADA . NothingintheOlmsteaddecisionsuggests @ thatanytransitionalcostsassociatedwithcommunityintegration,nomatterhow p small,couldconstituteafundamentalalterationofthementalhealthsystem.] 3#  5      ף    TheCourtsotherconcernwasnotspecificallycostrelated.IfaStatewas   doingagoodjobsystemicallyatplacingallofitsunnecessarilysegregatedclientsinthecommunity,andnotkeepingpeopleininstitutionsforyearsforfinancialreasons,theCourtdidnotwantindividualstojumptheplacementlinesimplybyfilinga 8'"  lawsuit.527U.S.at606.TheOlmsteadpluralityconsideredthattheEleventh  Circuitsformulationoffundamentalalterationwould,asapracticalmatter,meanthatStates!eventhosewhichalreadyhadacomprehensiveplanforcommunityplacementandbrisklymovingwaitinglistscouldneverwinanintegrationcase. ( x Id.at603(unlikelythataStaterelyingontheEleventhCircuitsformulationof P  fundamentalalteration couldeverprevail).TheCourtsoughttoinsulateStatesalreadyeffectivelycarryingoutthedesegregationmandateonastatewidescalefromcourtinterferenceonbehalfofasmallgroupofpeople.  Bycontrast,therulingoftheDistrictCourtheremeans,asapracticalmatter,thatStateswhicharethefarthestfromcompliancewiththeintegrationmandatecanneverloseanOlmsteadcase.Themorelimitedtheplanningfordesegregationthata @ Statehasundertaken,themoreitwillcosttoimplementanydesegregationplan.ThemorethataStatereliesoninstitutionalization,especiallyunnecessaryϢinstitutionalization,themoreitwillrequireafundamentalalterationofitsspendingschemeandbudgetplanstoaccommodateplaintiffs.Ontheotherhand,themorethataStatehascommittedtocommunityplanningandplacement,thelessitwillcosttocomplywiththeADAsintegrationmandate,andthelessofanalterationoftheStatesbudgetandplanningprocesswillberequired.ThelowerCourtsruleisaperverseinterpretationofOlmsteadthatrunsexactlycountertotheSupreme +&$ CourtsintentiontoinsulatetheStatesalreadydoingthejobofdesegregation,whileleavingvulnerabletoliabilityStatesthathadnoplans,waitinglists,oreffectiveprocessesforpromotingdesegregation.   ` 2.0 CongressandTheSupremeCourtHaveUnderscoredthat ( x DefensesinADACasesMustbeConstruedNarrowlytoAccomplishthePurposeoftheADA.P  (# (#   Congressintendedthatthefundamentalalterationdefensebeconstruedextremelynarrowly,protectingprogramsfromaccommodationsonlyifthemodificationswouldjeopardizeeithertheiridentityortheirexistence.ThisisthewaythatfundamentalalterationhadbeeninterpretedunderSection504oftheRehabilitationAct,E229U.S.C.794E2includingcasesthatCongressspecificallycitedtointhelegislativehistoryoftheADA.  Thisunderstandingcomportswithcasesdecidedinthiscircuitandothersconcerningthemeaningofthefundamentalalterationdefense.WhenthisCourtrejectedaproposedmodificationofthehomeattendantprograminEasleybyEasley   v.Snider,36F.3d297(3rdCir.1994),itwasbased,inpart,onmaintainingthecore "0 purposeoftheprogram,regardlessofcost,andpartlyonthefactthattheproposedexpansionoftheprogramwassogreatitwouldresultin possiblyjeopardizingthewholeprogram.36F.3dat305.SeealsoMessierv._ԢSouthbury_ԀTrainingSchool, X)$" 1999U.S.Dist.LEXIS1479(_ԢD.Conn_.1999)at*3637( whereplaintiffsrequested +&$ reliefwouldbesounreasonablegiventhedemandsofthestatementalhealthbudgetandresourcesthatitwouldaltertheessentialnatureofitsservices,defendantsmayavoidmakinganaccommodation).  TheSupremeCourtexplicitlydifferentiatesbetweenpermissiblemodificationsthatconstitute alterationsofdefendantsprograms,whicharepermissibleandevenrequiredbytheADA,andthosechangeswhichrisetothelevelofa fundamentalalteration.InMartinv._ԢP.G.A._ԀTour,532U.S.661(2001),   themajorityrejectedareadingofthestatute,thatwouldhavepermittedthePGAtodeterminewhichruleswereessentialtothegameofgolf. JusticeScaliasreadingofthestatuterenderstheword`fundamentallargelysuperfluous,becauseittreatsthealterationofanyrulegoverninganeventatapublicaccommodationlikeafundamentalalteration,532U.S.at689,n.51.  Similarly,theDistrictCourtbelowconcludedthatanyexpenditureofmoney  wouldbeafundamentalalteration.ThisisnotatenableinterpretationofCongressintent. CongressunderstoodthatcompliancewiththeADAwouldcostmoney.The "0 CongressionalBudgetOfficereportedthatenactment wouldresultinsubstantialcostsforstateandlocalgovernments,H.R.101485,PartI,101stCongress,2nd 8'"  Session(May14,1990)atp.47.Theissueofcostdominatedfloordebatesandsurfacesfrequentlyincommitteereportsandtestimony.Noone,including +&$ Мopponentsofthelegislation,everenvisionedthatacoveredentitycouldbeexemptedfromcompliancebyassertingthatcompliancewouldnot resultinimmediatecostsavingsastheDistrictCourtheldhere.  TheexpendituresenvisionedbyCongressweresubstantialbecauseofthesweepingreachoftheADA.ThepurposeofTitleIIwasunderstoodtobetheaccomplishmentofenormoussocialchange,andCongressexplicitlyacknowledgedthatitwouldcostasubstantialamountofmoney:0  ThepurposeofTitleIIistocontinuetobreakdownbarrierstotheintegratedparticipationofpeoplewithdisabilitiesinallaspectsofcommunitylife...Whiletheintegrationofpeoplewithdisabilitieswillsometimesinvolve @ substantialshorttermburdens,bothfinancialandadministrative,thelong P rangeeffectsofintegrationwillbenefitsocietyasawhole. (#(# H.R.101485,PartIII,101stCongress,2ndSess.(May15,1990)at49(emphasis < added)(footnotesexcluded).Congressexpectedtherewouldbecostsspecificallyassociatedwithcommunityintegration,andnotedthatimpositionofthesecostswasnotnewtotheADA,buthadalsobeenafeatureofSection504oftheRehabilitationActoverthepastdecade.Inafootnotetothepassagequotedabove,theCommitteereiteratedthat [_c]ases_ԀwhichhaveenforcedtherightsofpersonswithdisabilitiestoaccessiblepublicserviceshaverecognizedthatSection504mayplacesubstantialburdensonstateandlocalagenciesinordertoaccomplishthegoalsofnondiscriminationandintegration.Id.n.50.   |+&$    ThishardlycomportswiththeDistrictCourtsconclusionthatanycost,no  matterhowsmall,isafundamentalalteration . TheCourtsstandardrendersthe ( word fundamentallargelysuperfluous.Infact,undertheDistrictCourtsframework,anyexpenditurenotpartofdefendantsexistingbudgetarrangementsisafundamentalalteration.ThisleavesunnecessarilysegregatedpeopleexactlywheretheywerebeforeOlmstead!entirelydependentonthewhimandinstitutional   modelsofthestatementalhealthagencyfortheirliberty.)L L( PL  C.0 ` RecentDistrictCourtFormulationsofFundamentalAlterationinthe   ContextofOlmsteadClaims.4` (#` (#   Recently,twoDistrictCourtshavespecificallyexaminedtheconceptoffundamentalalterationinanattempttofurtherelaboratetheSupremeCourtsinstructionsinOlmstead.ThefirstcasewasWilliamsv.Wasserman,164 X ТF.Supp.2d591(_ԢD.Md_.2001)inwhichMarylandprevailed.TheCourttherenotedthatMaryland,unlikePennsylvania,had awaitinglist,awaitinglistequityfund,andprioritizedcategoriesofcrisisresolutionforprovidingservices.Id.at633. !  Becausetrialexpertshadagreedthatawindowof35yearswasnecessarybeforesignificantcostsavingscouldbereapedfromdownsizinginstitutions,theCourtadopteda35yeartimeframeinitsanalysis,idF2.F2at638,ratherthanrequiring H(#! immediatecostneutrality.Significantly,ratherthanconsideringcommunityplacementsan addonor extratothestatebudget,Marylandhadplanned ,'% Мcommunityintegrationoveramultiyearperiod,andtheCourtfoundthat whenbudgetproblemshavecausedreductionsinstatehospitalfacilities,Marylandhastriedto`holdharmlessitscommunityprograms,whichareseenasa`higherprioritythantheinstitutionalprograms.Id.at634.InPennsylvania,budget ( x difficultiesresultineliminationofplansfornewcommunitybeds.  IncontrasttotheholdingoftheCourtbelow,anotherCourthasconcludedthatthefundamentalalterationdefensewouldrequiretheCourttolookat theresourcesavailabletotheState.Martinv.Taft,222F.Supp.2d940,986(D.Ohio  2002).Thecase,whichinvolvespeoplewithdevelopmentaldisabilities,containedextensivediscussionoftheMedicaidprogram,waiveroptions,andfederalfundingasaresourceforfundingcommunityplacements.See,e.g.,id.at95357,96669, @ 97475.  InallthecasesthathavebeenlitigatedabouttherequirementstheADAplacesonpublicentities,includingWilliamsandTaft,notasingledefendanthas   argued,andnotasingleCourthasheld,thatifcompliancewiththeADAdoesnotresultinimmediatecostsavingsforthedefendant,thereisafundamentalalterationofthedefendantsprogram.ThelowerCourtsadoptionofthisnoveltestislegallyerroneousandpracticallyunattainableinmostinstances.ItisinconsistentwithCongresssintent,theSupremeCourtscommand,andtherealitiesofintegrating +&$ institutionalizedpersonswithdisabilities.  D.0 ` TheProperFormulationofaFundamentalAlterationDefenseinThis ( Case.<` (#` (#   ThefundamentalalterationdefensemustbeconsistentwithSupremeCourtprecedent.Thus,reliefcannotberequestedwhichwouldresultindeprivingState 8  clientsofneededinstitutionalalternatives,norwhichwouldinterferewithexistingcomprehensiveandeffectiveplanstoplaceallpersonsstatewideneedingcommunityplacement.Neitheroftheseconcernsisatissuehereatall.  AproperapplicationofthefundamentalalterationdefensewillprotectStateswhichhavedonemosttoestablishaneffectiveplanforstatewidecommunityintegration.ThemoreseriouslyaStatehascommitteditsresources,structureditsadministrativemethods,undertakenlongtermplanningtoassurethatitsclientsreceivetreatmentinthemostintegratedsettingcommensuratewiththeirneeds,andthemoreeffectivelyitisaccomplishingthisgoalstatewide,thelessitshouldhavetoworrythatOlmsteadliabilitywillforceadhocexceptionsandinequitable ! reallocationofplacementresources.Amiciproposefourfactorswhichmustbe #@ evaluatedindeterminingwhetheranintegrationremedywouldconstituteafundamentalalterationofanagencysprogram:0  1)whethertheStatehasaStatewidecomprehensivecommunityplacementplanforidentifyingpersonswhoareunnecessarilyinstitutionalizedandcreatingthecommunityresourcesnecessarytoprovidethemwithintegrated ,'% services,andawaitinglistmovingatareasonablepacenotdictatedbyStateendeavorstokeepinstitutionalbedsfullypopulated; (#(# Ѐ0  2)whethertheStateiseffectivelyutilizingallresourcesavailabletoittoaccomplishintegration; (#(# 0  3)costsoftheplacementsoverthetimeperiodinvolvedinplanningandimplementingcommunityplacementsfortheplaintiffs;and (#(# 0  4)thedegreetowhichdefendantshavedevelopedandutilizedadministrativemethodssupportingthetreatmentofclientsinthemostintegratedsetting. (#(# e  AstheSupremeCourtnoted,defendantswithastatewidecomprehensiveplanandawaitinglistmovingatareasonablepacenotcontrolledbyadesiretokeepitshospitalbedsfilled(i.e.,fiscalconsiderations)shouldgenerallybeabletosucceedinassertingthefundamentalalterationdefense.TheCourtbelowfoundthatdefendantsdidnotmeetthisstandard.  TheemphasisonacomprehensiveplanindicatesthattheSupremeCourtintendedtoshieldStatesthathadfocusedonandplannedfortheneedtoplacepeopleintothecommunityonastatewidebasis,priortoandapartfromthelitigationbeforetheCourt.Acomprehensiveplanismorethananannualinquiryintowhetherthereareextrafundsleftoverinthebudgettofundcreationofcommunitybeds.ItislongtermandcentraltotheStatesmentalhealthpolicy,notan addonor extrafundingitemsubjecttoeliminationatthefirstchillofbudgetdifficulties.Pennsylvaniassystemoffundingcommunityplacements,thatdependsfromyearto +&$ yearonavailableextramoney,isunpredictableandprecludeslongtermplanning.Itistheantithesisofacomprehensivestatewideplan,anditunderscoresthesignificanceofplaintiffsadministrativemethodsclaims,whichtheCourtbelowsummarily!anderroneously!denied.4                          defF2F2    defF2F2    defF2F2    defF2F2                defF2F2    defF2F2  defF2F2    defF2F2  defF2F2    defF2F2  defF2F2    defF2F2                defF2F2    defF2F2                       II.0  THEDISTRICTCOURTERREDBYENTERINGJUDGMENT P  AGAINSTPLAINTIFFSONTHEIRADMINISTRATIVEMETHODSCLAIMS. (#(#    Twoofthefiveclaimsassertedbyplaintiffsintheircomplaintassertedthat   defendantshadusedcriteriaormethodsofadministrationthathadtheeffectofsubjectingthemtodiscriminationonthebasisofdisabilityinviolationoftheADA,28C.F.R.35.130(b)(3)(i).  Publicentitiesactandfailtoactlargelyasaresultoftheiradministrativestructure.TheTitleIIadministrativemethodsclaimhasbeenusedtosuccessfullyremedyadministrativemethodologiesandstructuresthatresultedindisabilitydiscrimination,fromthemethodsusedbyacitytoenforceitshandicappedparkingordinance,_Indep_.LivingRes.Ctrv.CityofWichita,2002U.S.Dist.LEXIS6324 "0 (_D.Kansas_ԀMarch15,2002),tothemethodsusedtoadministeracityssocialwelfareprograms.HenriettaD.v.Giuliani,119F.Supp.2d181(_E.D.N.Y._Ԁ2000). 0'"    Inthiscase,plaintiffsidentifiedanumberofspecificadministrativepracticeswhichtheyasserteddirectlyresultinunnecessarysegregation,fromthefailuretouse +&$ appropriatemethodstoassesswhetherresidentsatNorristownStateHospitalcouldliveinthecommunitytodefendantsfailuretoasktheLegislatureforthenecessaryfundstoaccomplishadequatecommunityintegration.Inaddition,plaintiffschallengedanadministrativepracticewhich,fromamicisperspective,isthe ( x paradigmofanadministrativepracticethatclearlyandpredictablyleadstounnecessarysegregation:thechoicetofinancecreationofnewcommunityresourcessolelythroughaprogram(_CHIPP_/_SIPP_),whichisfundedby extrafundingleftoveraftertheregularagencybudgethasbeenfunded.̀  TheCourtbelowdidnotԀundertakeanalysisofanyoftheplaintiffs @ administrativemethodsclaimsorstateconclusionsoflawregardingtheseclaims.Rather,itsimplygrantedjudgmenttodefendantsinaonesentencefootnote, forreasonsdiscussedinconnectionwiththeintegrationmandateclaims.FrederickL., h 217F.Supp.at591,n.11.  Thisisinsufficientasamatteroflaw.TheFederalRulesofCivilProcedurerequireatrialcourtto findthefactsspeciallyandstateseparatelyitsconclusionsoflawthereon,Fed.R.Civ.P.52(a).TheSupremeCourthassaidthatappellatecourtsshould,throughtheirapplicationofdenovoreview, encourageadistrictCourttoexplicatewithcarethebasisforitsconclusionsoflaw.SalveReginaCollegev. X)$" Russell,499U.S.225,233(1991). +&$   ThelowerCourtsfailureisespeciallytroublinginlightofthedirectnexusbetweenanagencysadministrativemethodsandthelikelihoodthatitwillcontinuetounnecessarilysegregateitsclients.Inaddition,DPWsmethodsofadministrationrelatingtocommunityplacementhadalreadybeenheldtoviolatetheADAinKathleenS.v.DepartmentofPublicWelfare,10F.Supp.2d460,473(_E.D.Pa_.1998), P  andthereisnoevidencethatthesepracticeshavechanged.ThecourtinKathleenS. x  heldthatDPWhadviolatedtheADAwithrespecttotwoofthethreeplaintiffsubclassesbyutilizing methodsofadministrationwhichhaveresultedindiscriminationagainstclassmembersthroughitsfailuretoinitiateplanssufficientlyinadvancetoensurethenecessaryplacementsinthecommunitywithinareasonabletime.Id.Althoughplaintiffsmadeanidenticalclaimbelow,theCourtfailedto @ considertheclaimatall.  Theunderstandingthatsuccessfultransitionofanagencysclientsfrominstitutionbasedtocommunitybasedtreatmentmustrelyona rangeoffinancialandadministrativemechanismsisatleasttwentyyearsold.See,X#LXEԀ#EXX#Lo#JohnA._Talbott_, "0 TheFateofthePublicPsychiatricSystem,36HospitalandCommunityPsychiatry %X  46(1985).ԀAdministrativemethodsarecrucialtotheaccomplishmentoftheADAsmandatethattreatmentmustbeprovidedinthemostintegratedsettingappropriatetotheneedsoftheclient.Whileinstitutionalservicesareprovidedinoneplace,and +&$ paidforinlargepartbytheStatethroughonebudgetline,communityservicesinvolvemultipleservicesprovidedbymultipleagenciesworkingthroughanumberoffederalstategovernmentprograms.See,_ԢAmalya_ԀL.OliverandKathleen  P Montgomery,ANetworkApproachtoOutpatientServiceDeliverySystems:ResourcesFlowandSystemInfluence,30HealthServicesResearch771(1996).Ԁl P  Thesesystemsdonotcoordinateautomatically.ԀWithoutsoundadministrativemechanismsandefficientmethodsoffunding,peoplewilleitherremainunnecessarilyinstitutionalized,or,likeoneoftheplaintiffsinOlmstead,besubjectto  dischargetohomelesssheltersorthestreets.  Unnecessarysegregationisoftennotachoicebutafailuretomakechoices,aninertiathatretainsoldadministrativemethodsbuiltuponaninstitutionalmodel which @ virtuallyguaranteesthatpersonswillremainneedlesslyinstitutionalized.See p Alexanderv._ԢChoate_,469U.S.287,295(1985)(benignneglectasourceof  discrimination).TheCourtsfindingthatPennsylvaniahasnotrespondedtotheSupremeCourtsdirectiveinOlmsteadbycreatingacomprehensiveplanfor "8 communityintegrationsuggestsinertia,asdoesPennsylvaniasapparentfailuretomakeanychangestoitsinstitutionallybasedmethodsofadministrationthathavealreadybeenheldtoviolatetheADA.  TheCourterredinrulingfordefendantsontheseclaims,particularlyinlightof +&$ itsrelianceonthefundamentalalterationdefense.Thefailuretoutilizeavailableadministrativemechanismstomaximizeintegrationhastheresultofperpetuatingsegregationwhen,withoutfundamentallyalteringtheirprograms,agenciescouldreducesegregation.AStateshouldnotprevailonafundamentalalterationdefenseifitcouldincreaseintegrationthroughcommonlyutilizedadministrativemechanismsorreadilyavailableresourcesandfunding.ThisispreciselythemeaningoftheADAsrequirementthatpublicentitiesreasonablymodifytheirpoliciesandpracticestoavoiddiscriminationonthebasisofdisability.  Asallegedinthecomplaintandsupportedbyevidenceattrial,DPWhasnotestablishedmethodsofadministeringitsmentalhealthsystemthatfosterintegration.WhileitjԀhassomemechanismstoassistinplacingunnecessarilysegregatedindividualsinthecommunity,ithaschosennottousethem.Forexample,withinthementalhealthbudget,DPWmaytransferfundingfrominstitutionstothecommunity,withthepermissionofthegovernor.FrederickL.,217F.Supp.2dat587,n.10.Yetit   hasmadenoattempttodosoat NorristownStateHospital,whereonethirdofthe "0 residentsarestipulatedtobeunnecessarilysegregated.  Infact,DPWseffortstofacilitate desegregationarealmostwholly 8'"  accomplishedthroughfundingthatisexplicitly extraoran addontotheprincipalbudget!the_ԢCHIPP_Ԁand_ԢSIPP_Ԁprograms.SeeFrederickL.G2G2,217F.Supp.at +&$ 588( DPWhasnotallocatedfundstothecountiesfortheirexpansionproposalsexceptthrough_ԢCHIPP_/_ԢSIPP_)andFrederickL.v.DepartmentofPublicWelfare, ( 157F.Supp.2d509,513(_ԢE.D.Pa_.2001)( theCommonwealthhasintermittently  P providedfundingtothecountiesthroughtheCommunityHospitalIntegratedProjectProgram)(emphasisadded).HavingnewcommunityservicesdependexclusivelyonnewfundingratherthanembeddingitwithinDPWs basebudget willpredictably x  subjectclientsofitsmentalhealthsystemtounnecessarysegregation asithasat   NorristownStateHospital!andprolongunnecessarysegregationinviolationofthe ( ADA.  Amicimadethesystematicplanningandfunding ofcommunityplacementa (x central,integratedfeatureoftheirbudgetsandadministrativeoperations,ratherthanrelyingonthevagariesofwhateverextrafundingmightbeavailableeachyeartocreateanunpredictablenumberofcommunityplacements.6ԀEveninverydifficultfiscaltimes,likethosebeingfacednowbynearlyeverystate,creativeadministratorsworkingwithlimitedbudgetscanfulfilltheirOlmsteadresponsibilitieswithinsmaller "H budgetsandwithoutwithdrawingintegratedservicesfromonegroupofpersonswithdisabilitiesinordertoserveanother.  H'"    p)$" М  CONCLUSION       Forthereasonstatedabove,thisCourtshouldreversethedecisionoftheDistrictCourt.     m     u Respectfullysubmitted,     m     u AmiciCuriae, P       m     u Bytheirattorneys, `       m     u 򀀀        m     u SusanStefan       m     u RobertD.Fleischner     m     u StevenJ.Schwartz     m     u CenterforPublicRepresentation     m     u 22GreenStreet     m     u Northampton,MA01060     m     u 4135876265     m     u Ira_Burnim_     m     u Jennifer_Mathis_     m     u JudgeDavidL.BazelonCenterfor     m     u MentalHealthLaw     m     u 110115thStreetNW        m     u Washington,D.C.200055002     m     u 2024675730  &h!  HEE  APPENDIX     IdentificationofAmiciFormerStateMentalHealthCommissioners,Directors ( andAdministrators  #EHE #PatrickBabcock   Formorethanfiveyears,PatrickBabcockservedastheDirectorforthe P  MichiganDepartmentofMentalHealthbeforebecomingtheDirectoroftheDepartmentofSocialServices.Asthestateofficialresponsibleforthedeliveryofmentalhealthservices,Babcockoversawcommunitymentalhealthservicesthatincluded55communitymentalhealthboardsservingall83Michigancounties.Healsowasresponsibleforcommunityresidentialservicesforformerresidentsofstatefacilitiesforpersonswithmentalillnessanddevelopmentaldisabilities.BabcockistheDirectorofPublicPolicyforthe_W.K._ԀKelloggFoundation,wherehisdutiesincludeservingasProjectDirectorofahealthreformprojectinthreeMichigancountiesandanationalinitiativetomonitortheimpactofdevolutionoffederalpoliciestostategovernments. MarilynBerner,M.S.W.,J.D.   MarilynE.Berner,JD,_LICSW_,isbothanattorneyandasocialworker, h presentlyworkingasaconsultantinFlorida.Shehaspracticedinthepublicandprivatesectorsasanattorneyandasamentalhealthprofessional.ShedirectedtheHomelessEvaluationProgramattheMassachusettsMentalHealthCenterandwasemployedasanAreaDirectorofAdultServicesfortheDepartmentofMentalHealth.SheheldanappointmentasaLecturerinPsychiatryatHarvardMedicalSchool.  Mostrecently,shewasChiefofStafffortheMassachusettsDepartmentofMentalHealth,wheresheadvisedtheCommissioneronpolicymattersinvolvingthementalhealthauthorityoftheCommonwealth,managedanumberofspecialprojects,maintainedliaisonwithotherstateagencies,managedthefunctionsofseveraloperationalarmsoftheDepartment,anddirectedtheimplementationofpolicy.  ,'% JosephJ._Bevilacqua_,Ph.D.   Joseph_Bevilacqua_ԀhastwentyoneyearsexperienceasStateCommissionerof ( MentalHealthServicesinRhodeIsland,Virginia,andSouthCarolina.HealsoservedasAssistantCommissionerforCommunityServicesforfouryearsinVirginia.Priortostateservices,_Bevilacqua_ԀservedintheUnitedStatesArmyasasocialworkofficerworkinginpsychiatrichospitalsandMentalHealthClinicsbothinthestatesandoverseas.Throughout_Bevilacqua_scareerhehasbeenactivelyaffiliatedwithanumberofacademicinstitutions,includingappointmentsattheUniversityofVirginia,BrownUniversity,MedicalCollegeofVirginia,UniversityofSouthCarolina,andMedicalUniversityofSouthCarolina.Heusedhisstateroletoencouragecollaborationbetweentheuniversitiesanddepartmentsofmentalhealth.Thiscollaborationincludedresearchprojects,studentplacementsinstateprogramsandfacultyconsultationinmajorstateinitiativessuchascommunitydevelopmentandhospitaldownsizing.Hehasalsowrittenanumberofpublicationsinthefieldofmentalhealth.  Apriorityof_Bevilacqua_scommissionershipshasbeenactiveandstrongsupportofconsumersofmentalhealthservices._Bevilacqua_ԀservedtwotermsasPresidentoftheNationalAssociationofStateMentalHealthProgramDirectorsandcurrentlyservesontheBoardofDirectorsoftheHumanServicesResearchInstitute,Boston;theCenterforHealthResources,Lincoln,RhodeIsland;TheGreenDoor,a_psychosocial_ԀrehabilitationprograminWashington,DC;andtheNationalAlliancefortheMentallyIllRhodeIsland. RodneyCopeland,Ph.D.  ?+ 4 <DL!X?RodneyCopelandhasbeenanadministratorofrehabilitation,socialservice, ! mentalhealthandhealthprogramsfortheStateofVermontsince1978.From1995to2000,hewasCommissioneroftheDepartmentofDevelopmentalandMentalHealthServiceswherehewasresponsiblefortheadministrationoftheStatesprogramsforadultswithseriousmentalillness;childrenandadolescentswithasevereemotionaldisturbance;andprogramsforpersonswithmentalretardation.Inthatcapacityheusedavarietyoffundingstrategies,includingmaximizingMedicaidbenefits,bridgefunding,andprivatefoundationsupporttotransitionpeoplefromtheStatesmentalhospitaltothecommunity,byreducingtheinstitutionalbudget,sothatwhentheprocesswascomplete,therewerenoincreasedcoststotheState.Dr.Copelandhastaughtatanumberofuniversitiesincluding?+ 4 <DL!X?theUniversityof ,'% California,SantaBarbara,_Washburn_ԀUniversity,theUniversityofSanDiego,_Adelphi_-Vermont,SchoolofSocialWork,JohnsonStateCollege,UniversityofVermont,UniversityofKansasandSouthwesternMissouriStateCollege.HeisnowtheDirectorof dtheHIV/AIDSProgramfortheVermontDepartmentofHealth.  < KingDavis   KingDavisservedasCommissioneroftheVirginiaDepartmentofMental    Health,MentalRetardationandSubstanceAbuseServicesfrom1990through1994.Duringthatperiod,apriorityofthedepartmentwastheplacementofindividualswithdisabilitiesinthecommunity.Anumberofinitiativesweredevelopedtoincreasethesuccessofcommunityplacements.TheCommonwealthofVirginiascommitmenttocommunityplacementsextendsasfarbackas1968withthedevelopmentoftheCommunityServicesAct.Additionally,inresponsetoeffortsbytheU.S.JusticeDepartmenttoensurecompliancewiththeCivilRightsofInstitutionalizedPersonsAct,theGovernor,AttorneysGeneral,andthelegislaturesupportedtheDepartmentofMentalHealthseffortstodecreaseitsrelianceoninstitutionsinfavorofcommunitybasedstrategiesofcare.ThisstrategyincludedspecificplacementinlocalcommunitiesofafixednumberofinstitutionalizedresidentswithmentalretardationattheNorthernVirginiaTrainingCenter.ThiscommunitybasedstrategybecametheacceptedpolicydirectionoftheCommonwealthofVirginia.DavisistheWilliam&CamilleHanksCosbyProfessoratHowardUniversity.KingcurrentlyoccupiestheRobertLeeSutherlandChairinMentalHealthandSocialPolicyattheUniversityofTexasatAustin. MaryJaneEngland,M.D.   AsthefirstcommissioneroftheMassachusettsDepartmentofSocialService "0 ( DSS)from1979to1983,MaryJaneEnglandhelpedestablishandadministeranewstateagencyforchildrenandtheirfamilies.BeforeherappointmentatDSS,sheservedastheAssociateCommissioneroftheMassachusettsDepartmentofMentalHealthandMentalRetardation.  In1995,Dr.EnglandservedaspresidentoftheAmericanPsychiatricAssociation,andsheisapastpresidentoftheAmericanMedicalWomensAssociation.SheservesastheVicePresidentoftheNationalAcademyofPublicAdministration,theAmericanCollegeofPsychiatry,theAmericanCollegeofMentalHealthAdministration,andtheGroupfortheAdvancementofPsychiatry. -n()   Dr.EnglandalsoservedontheBoardofOverseersfortheU.S.DepartmentofCommerce,MalcolmBaldrigeNationalQualityAward.ShecurrentlyservesontheU.S.DepartmentofHealthandHumanServicesSubstanceAbuseandMentalHealthServicesAdministrationNationalAdvisoryCouncil;theNationalInstituteofMentalHealthAdvisoryCouncil;andthePresidentsQualityForumPlanningCommittee.  Dr.EnglandwasalsoassociatedeananddirectoroftheLuciusN._Littauer_MasterinPublicAdministrationProgramattheJohnF.KennedySchoolofGovernment,HarvardUniversity.SheisthechairoftheBoardofVisitorsofBostonUniversitySchoolofPublicHealthandamemberoftheBoardofVisitorsofBostonUniversitySchoolofMedicine.Dr.EnglandwaspresidentoftheWashingtonBusinessGrouponHealth,anonprofitnationalhealthpolicyandresearchorganizationwhosemembershipincludesmanyofthenationsmajoremployers.SheisnowPresidentofRegisCollegeinMassachusetts.  *z  PaulG.Gorman,Ed.D.  PaulG.Gorman,istheDirectoroftheWestInstituteattheNewHampshire T DartmouthPsychiatricResearchCenter.TheWestInstituteisdedicatedtodevelopingandevaluatingimplementationstrategiesforevidencedbasedpracticesforpeoplewithseverementalillness.Hiscareerspansthirtyyearsofinvolvementinmanagementofmentalhealthsystemsinboththepublicandprivatesector.Dr.GormanwastheDirectorofMentalHealth,SubstanceAbuseandDevelopmentalServicesforthestateofNewHampshire,andservedastheSuperintendentofNewHampshireHospital(_NHH_),thesinglepublicpsychiatrichospitalinNewHampshire.HewasthechiefoperatingofficerofWestCentralBehavioralHealth,thecommunitymentalhealthcenterassociatedwiththeDartmouthHitchcockMedicalCenter.HealsowastheDirectorofOutPatientServicesfortheHumanResourceInstitute,aprivatepsychiatrichospitalinBoston,Massachusetts.Dr.Gormanhasservedonanumberofboards,includingtheboardoftheNationalAssociationofStateMentalHealthProgramDirectors'ResearchInstitute.  %X   Kenneth_Heinlein_,Ph.D.  D(#$   KenHeinleinisaformerDirectoroftheWyomingDepartmentofHealthanditspredecessortheDepartmentofHealthandSocialServices,bothofwhichincludedmentalhealthservices.HeispresentlytheAssociateDirectoroftheWyomingInstituteforDisabilities(WIND),oneofanationalnetworkofuniversity -n() centersondisabilities.HeisalsotheDirectorofResearchandProgramEvaluationWINDatwhichheconductsresearchinpost-institutionalplacements,includingresearchintothecostandqualityofcommunity-basedsupportsandservicesforpersonswithdevelopmentaldisabilitiesandcommunityconsensusforimplementingmentalhealthservices.Hehasmorethan20yearsexperienceinthefieldsofmentalhealthanddevelopmentaldisabilities,includingdirectservicestoadultswithdevelopmentaldisabilitiesincommunity-basedvocationalandresidentialsettings,developmentaldisabilitiesprogramsservinginfants,toddlers,andpreschoolagedchildrenwithdevelopmentaldelaysandbehaviorchallenged,andadultswithdisabilities.  d  PamelaS.Hyde,J.D.  PamelaHydewasappointedbyGovernorRichardF.CelesteastheDirector , oftheOhioDepartmentofMentalHealth,andlatertheOhioDepartmentofHumanServices,thestatesMedicaidandchildwelfareagency.SheservedastheDirectoroftheSeattleDepartmentofHousingandHumanServices,andthenwasrecruitedasPresidentandChiefExecutiveOfficerof_ComCare_,aPhoenixbasedbehavioralhealthmanagedcarecompany.Shecurrentlyconsultswithstateandlocalgovernments,foundations,federalagencies,andnonprofitorganizationsnationwideonavarietyofhumanservicesandorganizationalissues.Hydeistrainedasanattorneyandalsospentseveralyearsasanadvocateandexecutivedirectorofastatewideprotectionandadvocacyagency.   DennisR.Jones,M.S.W.,M.B.A.   DennisJoneswasCommissionerofMentalHealthinIndianafrom1981until j#  1988.HewasthenCommissionerfortheTexasDepartmentofMentalHealthandMentalRetardationforsixyears.Bothofthesepositionsincludedinstitutionalandcommunityresponsibilityformentalretardationaswellasmentalhealth. _Danna_Ԁ_Mauch_,Ph.D.  DannaMauchservedasDirectorofMentalHealthfortheStateofRhode +&) Island,asAssistantCommissionerofMentalHealthforMassachusetts,and ,'* ExecutiveDirectorofanambulatoryandlongtermcareprovider.IntheCommonwealthofMassachusetts,shedirectedtheDivisionsofForensicMedicine,MentalHealthandSubstanceAbuse.Untilrecently,sheservedastheSpecialMasterfortheUnitedStatesDistrictCourtfortheDistrictofColumbia,evaluatingtheimplementationofreformstothepubliclyfinancedmentalhealthsysteminthenationscapital.Inhergovernmentroles,Dr.Maucheffectedmajorsystemschangesintheprovisionofpsychiatriccare.Asaresult,RhodeIslandsMentalHealthSystemwasratednumberoneinthenationbythePublicCitizenHealthResearchGroup.  Dr.MauchservedasmemberoftheNationalAdvisoryBoardoftheU.S.CenterforMentalHealthServicesandcochairedahealthcarereformtaskforceonbehavioralhealthfortheLaborandHumanResourcesCommitteeoftheU.S.Senate.ShewasalsoPrincipalInvestigatoronanumberoffederalandfoundationfundedresearchanddemonstrationprojectsinthementalhealthandlongtermcarefields.Shehaspublishedseveralkeyarticlesandbookchaptersonthemanagementofcareandpublicprivatepartnershipsinservicesdeliveryandsystemsmanagementforthebehavioralhealthcareindustry.Dr.MauchrecentlyservedastheChiefExecutiveOfficerofMagellanPublicSolutions,Inc.,ahealthcareorganizationwiththecapacitytodeliverspecialtycaremanagementsolutionstothepublicsector. NeilMeisler,MSW   NeilMeislerisDirectorofResidentialandDevelopmentalPsychotherapeutic | ServicesinChestertown,MarylandandisanAssistantProfessorofPsychiatryattheMedicalUniversityofSouthCarolina.InhislongcareerasanadministratorofstatementalhealthserviceshehasservedasDirectoroftheDivisionofMentalHealthintheRhodeIslandDepartmentofMentalHealth,MentalRetardationandHospitals,asExecutiveDeputyCommissioneroftheSouthCarolinaDepartmentofMentalHealth,andDirectoroftheDivisionofAlcohol,DrugAbuse,andMentalHealthoftheDelawareDepartmentofHealthandHumanServices. JohnA.Morris D(#$    JohnMorrisservedaninterimappointmentasDirectorofMentalHealthfor )2%& SouthCarolinafrom1995to1997;healsoservedasDeputyStateDirector.Before1990,heheldnumerousclinicalandadministrativepositionsintheDepartmentofMentalHealth,havingbegunhiscareerasawardattendantattheSouthCarolina -n() StateHospitalin1969.MorrisbecameaprogramdirectorfortheMissouriDepartmentofMentalHealthinthemid1970s.?+ 4 <DL!X?  HeisProfessorofClinicalNeuropsychiatryandBehavioralSciencesattheUniversityofSouthCarolinaSchoolofMedicineandthefoundingDirectoroftheSCCenterforInnovationinPublicMentalHealth,apartnershipbetweentheSchoolofMedicineandtheSCDepartmentofMentalHealth.Inaddition,MorrisisVisitingProfessorofMentalHealthPolicyattheGeorgeWarrenBrownSchoolofSocialWorkatWashingtonUniversityinSt.Louis,wherehewasnamedaDistinguishedAlumnusin1996.Heiscurrentlyprincipalinvestigatoronafederalgranttoreplicateasupportedemploymentmodelforpersonswithseriousmentalillnesses,andhasbeenPIontwograntstoreplicateruralassertivecasemanagementmodels.MorrisisimmediatepastpresidentoftheAmericanCollegeofMentalHealthAdministration,andservesontheBoardofDirectorsfortheTechnicalAssistanceCollaborative,Inc.,aswellasfortheNationalAdvisoryCounciltotheGeorgetownTechnicalAssistanceCenterforChildrensMentalHealthandtheKentuckyCenterforMentalHealthStudies.HeisservingathreeyeartermontheStandingReviewCommitteeonKnowledgeApplicationfortheCenterforMentalHealthServices,andhasjustbeeninvitedtoserveaoneyeartermonthePublicPolicyCommitteeoftheNationalMentalHealthAssociation. ThomasD.Romeo   ThomasRomeowasDirectorofRhodeIslandsstatewideagencyformental | healthfor12years.WiththesupportoffourGovernors,theRhodeIslandStateLegislature,andmanycitizens,heestablishedasystemofservicesbaseduponindividualneedsandwiththeultimategoalbeingreturntooneshomecommunity.InRhodeIsland,institutionalsettingscontinuetobeconsidereda lastresort. 1̛  %X !   CERTIFICATIONOFBARMEMBERSHIPN   I,StevenJ.Schwartz,herebycertifythatIamamemberingoodstandingof < theBarofthisCourt.     m     u _________________________________     m     u StevenJ.Schwartz     AiE@@( ( & #EAijP#CERTIFICATIONOFCOMPLIANCE       PursuanttoFed.R.App.P.32(a)(7)(C),I,RobertD.Fleischner,herebycertifythattheBriefofAmicicomplieswiththeFederalRuleofAppellateProcedure32(a)(7)(B)(i)concerningthelengthofbriefs.TheBriefcontains64H234H2I242I2words,excludingtheTableofContents,TableofCitations,Appendixandcertificationsofcounsel.  ThisbriefcomplieswiththetypefacerequirementsofFed.R.App.P.32(a)(5)andthetypestylerequirementsofFed.R.App.P.32(a)(6)becauseithasbeenpreparedinaproportionallyspacedtypefaceusingWordPerfect7.0/8.0inTimesNewRomanStyle,14pointfont.     m     u   ______________________________     m     u   RobertD.Fleischner   М@ G2 G2@@  CERTIFICATEOFSERVICE     I,RobertD.Fleischner,herebycertifythattwocopiesoftheBrieffor14FormerStateMentalHealthAdministrators,AmiciCuriae,wereservedbyFederalExpressonDecember13,2002onthefollowing:0  ClaudiaM._Tesoro_,Esquire,SeniorDeputyAttorneyGeneral,OfficeofAttorneyGeneral,21South12thStreet3rdFloor,Philadelphia,PA19107 d  3603 (#(# 0  RobertW.Meek,EsquireandRobin_Resnick_,Esquire,DisabilitiesLawProject1315WalnutStreet,Suite400,Philadelphia,PA191074798 (#(# 0  MarkJ.Murphy,Esquire,DisabilitiesLawProject,1901LawandFinanceBuilding,429FourthAve.,Pittsburgh,PA152191505.Q (#(#      m         m     u   _______________________________     m     u   RobertD.Fleischner         m     u    %  }    -  N