U.S. Departments of Health & Human Services and Justice Issue Letter of Findings to State of Rhode Island Over Improper Over-Hospitalizations of Children with Disabilities

An investigation by the United States Department of Health and Human Services Office for Civil Rights (HHS OCR) and the United States Attorney’s Office for the District of Rhode Island and has found that the State of Rhode Island violated federal civil rights laws by routinely and unnecessarily segregating children with mental health and/or developmental disabilities at Bradley Hospital, an acute-care psychiatric hospital. HHS OCR Regional Manager Susan Rhodes and United States Attorney Zachary A. Cunha made the announcement today in Rhode Island, issuing a joint Letter of Findings, which was transmitted to the Governor of Rhode Island and the Director of Rhode Island Department of Children, Youth, and Families (DCYF).

The federal government’s comprehensive, multi-year investigation resulted in a finding – PDF that the State left children in DCYF care hospitalized at Bradley for far longer than necessary. While Bradley Hospital inpatient admissions are designed for acute care lasting one to two weeks, the federal investigators concluded that children with mental health and/or developmental disabilities in DCYF’s care often stayed in the hospital for weeks, months, and, in some cases, for more than a year. According to the investigation, in these cases, children stayed at Bradley even though they were ready for discharge and would have been better served in less restrictive, community-based care settings. The investigation also marks the first Olmstead case out of OCR’s new HHS Olmstead Initiative.

“Today’s finding follows on the heels of the Office for Civil Rights’ efforts to strengthen access to care for people with disabilities like these children in Rhode Island,” said HHS OCR Director Melanie Fontes Rainer. “We must do better by our children and the communities we serve, and States and others must follow federal civil rights laws to ensure every child can access care free from discrimination. As we approach the 25th anniversary of the Olmstead decision, today’s action also emphasizes our commitment to continue to protect the critical right of individuals to live in their own homes and communities.”

“Children with disabilities should be able to come home to the love and support of their families and not be confined to an institution for months on end,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division. “We will continue our vigorous enforcement of the ADA to ensure that children with disabilities can receive the community-based services they need to live with their families and participate in their communities.”

“It is nothing short of appalling that the state has chosen to warehouse children in a psychiatric institution, rather than stepping up to provide the community care, support, and services that these kids need, and that the law requires,” remarked U.S. Attorney Zachary A. Cunha. “I am hopeful that the findings we announce today will spur swift action by the state to meet its obligations under federal law, and far more importantly, to ensure that the civil rights of these children are upheld.”

Title II of the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act of 1973 (Section 504), and the Supreme Court’s ruling in Olmstead v. L.C. require state and local governments to make services available to people with disabilities in the most integrated setting appropriate to their needs. Enforcement of Title II of the ADA, Section 504, and the integration mandate of the Olmstead decision is a priority of the Department of Justice and Department of Health and Human Services. The federal investigation found that by failing to ensure that children with disabilities were able to access the care they needed in the most integrated setting appropriate, DCYF violated Title II of the ADA and Section 504.

As detailed in the government’s Letter of Findings, from January 1, 2017, through September 30, 2022, 527 children either in DCYF care and custody, or receiving services voluntarily through DCYF, were admitted to Bradley Hospital. Despite the fact that Bradley Hospital’s short-term services are designed only to stabilize a child in crisis, of the 527 children admitted to Bradley during the relevant period, 116 were hospitalized in a single admission for more than 100 consecutive days; 42 were hospitalized for more than 180 days; and seven children were hospitalized for more than one year. The investigation found that extended hospitalization often traumatizes the children as well as their families, compounding the effects of noncompliance with federal civil rights laws.

Additional information about the ADA can be found at www.ada.gov, or by calling the Department of Justice’s toll-free ADA information line at 800-514-0301 or 800-514-0383 (TDD). For more information on Section 504 of the Rehabilitation Act and how it protects individuals with disabilities, visit: https://www.hhs.gov/civil-rights/for-individuals/disability/index.html.

Individuals who believe their civil rights have been violated can file a complaint with the HHS Office for Civil Rights at: www.hhs.gov/civil-rights/filing-a-complaint/index.html. Anyone in Rhode Island may also report civil rights violations directly to the U.S. Attorney’s Office for the District of Rhode Island at https://www.justice.gov/usao-ri/civil-rights-enforcement or 401-709-5000.