Does I through III v. District of Columbia

232 F.R.D. 18, 2005 U.S. Dist. LEXIS 28796, 2005 WL 3110961
CourtDistrict Court, District of Columbia
DecidedNovember 21, 2005
DocketNo. CIV.A. 01-02398(HHK)
StatusPublished
Cited by14 cases

This text of 232 F.R.D. 18 (Does I through III v. District of Columbia) is published on Counsel Stack Legal Research, covering District Court, District of Columbia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Does I through III v. District of Columbia, 232 F.R.D. 18, 2005 U.S. Dist. LEXIS 28796, 2005 WL 3110961 (D.D.C. 2005).

Opinion

MEMORANDUM OPINION AND ORDER

KENNEDY, District Judge.

Plaintiffs are three mentally retarded adult women who receive habilitation services1 from the District of Columbia through the Mental Retardation and Developmental Disabilities Administration (“MRDDA”), a component of the Department of Human Services. Jane Doe I is an adult woman in her forties who has received such services from the District of Columbia since 1960. In 1984, allegedly without either consulting with Jane Doe I’s legal representative or obtaining substituted judgment from a court, District officials gave their consent to have Jane Doe I’s pregnancy aborted. Jane Doe II is an adult woman in her fifties. She was diagnosed in 1994 with exotropia, a condition where one eye deviates from the other. An elective surgical procedure was proposed and District officials gave their consent for the surgical procedure. Although she was active in Jane Doe II’s care, Jane Doe II’s mother and court-appointed advocate alleges that she was not consulted regarding the procedure. Jane Doe III became pregnant in 1978 and, according to plaintiffs, decided to carry the pregnancy to term. District officials, however, allegedly decided that she should have an abortion and gave them consent for the procedure without consulting with Jane Doe Ill’s legal representative and without obtaining substituted judgment from a court.

By their next friends, plaintiffs bring this action under 42 U.S.C. § 1983 asserting that their substantive and procedural due process rights secured by the Fifth and Fourteenth Amendments have been violated by the District’s unlawful practice of authorizing elective surgical procedures on retarded per[21]*21sons in its care2 without adequately attempting to ascertain their wishes or consult with family members. Plaintiffs assert these claims on their own behalf as well as for a putative class of all mentally retarded persons who have received, or will receive, habilitation services from the District of Columbia and for whom District officials have consented to elective surgical procedures.3 Presently before the court are plaintiffs’ amended motion for class certification4 [# 101] and plaintiffs’ motion for partial summary judgment [# 103]. Upon consideration of the motions, the oppositions thereto, and the record of the case, the court concludes that the motions should be granted.

I. BACKGROUND

A. History of the District’s Consent Policy

Although not the written policy of the District before April 1990, it was the “custom” of the superintendent of Forest Haven, a MRDDA facility that provides services to the mentally retarded, to sign consents for elective surgery without having been appointed guardian and without having consulted with the person having surgery. Pis.’ Ex. 6 at 335.5 Rather, the superintendent would approve elective surgical procedures based on the recommendations of a medical officer. This informal policy was in effect since at least 1978.

In April 1990, the longstanding policy of having the Forest Haven superintendent consent to elective surgery on mentally retarded citizens was set forth in writing in Policy H-18. Policy H-18 required that, for “treatment and non-invasive diagnostic procedures,” “[i]nformed consent must be given by the parent or Superintendent/Guardian.” Pis.’ Ex. 2 at 1. While the policy noted that “[f]amily contact is attempted,” Policy H-18, like its informal predecessor policy, essentially outlined a consent mechanism for the agency’s Superintendent alone, who, “on recommendation of the primary care physician, dental officer, or the Chief of Health Services signs the authorization form ... granting the necessary permission for treatment.” Id.

A revised policy, Policy H-6, dated January 15,1992, replaced Policy H-18. While the new policy incorporated Policy H-18’s language regarding obtaining consent for “treatment and non-invasive diagnostic procedures,” Policy H-6 stated that “[i]nformed consent must be given by the parent or Guardian,” eliminating the “Superintendent” as an independent provider of informed consent. Pis.’ Ex. 3 at 1. Unlike its predecessor, H-6 also included provisions for “elective surgery, dental treatment or invasive diagnostic procedures,” noting that for such pro[22]*22eedures the “MRDDA Administrator is responsible for signing the informed consent form ... which grants permission for the medical treatment.” Id. The Administrator “will sign” the consent form after being “adequately advised” of the medical need for the procedure, “alternative treatments, expected outcome ..., [and the] nature and degree of risks.” Id. at 2. Without establishing an order of priority for giving consent, or discussing the interrelation between the Administrator’s consent authority and the family’s, Policy H-6 also provided that “[i]nformed consent obtained from the family must have two staff signatures” on the consent form. Id.

Policy H-6 received considerable scrutiny from this court. In Boyd v. Howard Univ., Civil Action No. 97-2567, Mem. Op. (D.D.C. Dec. 23, 1999), a suit was brought on behalf of a mentally retarded woman under MRDDA’s care against the agency, alleging that in consenting on her behalf for elective surgical procedures, MRDDA violated her substantive and procedural due process rights. In granting summary judgment for the Boyd plaintiffs on their Section 1983 claim, the court held that, by failing to “incorporatef] any attempt to include [the patient’s] desires” when granting consent for surgical procedures, MRDDA “flatly violated” both the substantive and procedural due process rights of the persons under its care. Id. at 21-22.

In 1998, Policy H-6 was superseded by a policy entitled “Consent for Health Care Decisions” (“1998 Policy”). Pis.’ Ex. 4. The 1998 Policy required that MRDDA obtain information regarding: (1) “a customer’s incapacity to consent, pursuant to Sec. 21-2204 of the Health Care Decisions Act of 1988”; (2) the identities of known family members; (3) “the efforts to locate family members, even if the attempts were unsuccessful”; and (4) the physicians and medical procedures involved. Id. at 2. The 1998 Policy also directed MRDDA case managers to “search, identify and/or verify information on any available family member.” Id. Once such efforts are exhausted, the 1998 Policy provided different procedures for obtaining consent depending upon two factors: whether MRDDA can locate family members to provide consent, and whether the medical procedures for which consent is needed are “emergency” or “non-emergency.” Id. at 3-5. Whether the procedure is emergency or non-emergency, if MRDDA ease workers locate family members, the treating physician “will then be advised that he or she should contact the family member for the consent,” with MRDDA limiting its own role to “monitoring] the situation and [] obtaining] the necessary consents to allow MRDDA access to the medical records.” Id. at 3.

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Bluebook (online)
232 F.R.D. 18, 2005 U.S. Dist. LEXIS 28796, 2005 WL 3110961, Counsel Stack Legal Research, https://law.counselstack.com/opinion/does-i-through-iii-v-district-of-columbia-dcd-2005.