Judge Reeves said final ruling coming soon in state’s mental health lawsuit

JACKSON, Miss. (WLBT) - U.S. District Judge Carlton Reeves said the state could expect a ruling soon in a case involving its mental health care system.

Thursday, Reeves held a special meeting to discuss the duties of a court-appointed monitor put in place to oversee the state’s system and ensure the state was working to bring the system into compliance with federal law.

Attorneys for the federal government submitted their recommendations for the monitor’s role in August.

The state, meanwhile, objects to having a monitor but says if one is in place, it should be bound by the remedial plan adopted by the court previously.

Both the state and the feds agreed that the monitor should be Dr. Michael Hogan, who previously was appointed by the court as a special master to assess the state’s mental health program and draw up recommendations to improve it.

“One thing we do agree on is that Dr. Michael Hogan will be the monitor, and he will get paid and he will work,” Reeves said during the call.

At the heart of the matter is Mississippi’s adult mental health care system. In 2016, the U.S. Department of Justice filed suit against the state, citing numerous violations of the Americans with Disabilities Act. Three years later, in 2019, the judge ruled the state had violated the law by unnecessarily confining patients and by confining them at institutions, rather than in community health settings.

“On paper, Mississippi has a mental health system with an array of appropriate community-based services. In practice, however, the mental health system is hospital-centered and has major gaps in its community care,” Reeves wrote in his September 2019 ruling. “The result is a system that excludes adults with (serious mental illness) from full integration into the communities in which they live and work.”

Reeves said the trial also uncovered that there was a “disconnect between the services Mississippi promises to patients and the services it actually delivers.” Among them, he said:

PACT is unavailable and under-enrolled
Mobile Crisis Services are illusory
Crisis Stabilization Units are not available
Peer Support Services are not billed
CHOICE [housing program] is far too small

PACT is the Program of Assertive Community Treatment, which according to the state’s website, is a program geared at providing rehabilitation and recovery for people in the community who “have not benefited from traditional outpatient services.”

According to the MSDH’s website, individuals in need of the service can now call a 24-hour, 7-days-a-week hotline for PACT services.

Reeves said the case was “well-suited for a special master” who could help bring the state into compliance. In February 2020, after receiving recommendations from the state and feds, Reeves appointed Dr. Michael Hogan as a special master to oversee compliance efforts.

July of this year, the court adopted a 62-point remedial plan drawn up by Hogan and ruled that a monitor would be appointed to ensure the state was implementing that plan. Before appointing the monitor, though, Reeves asked attorneys for both sides to recommend how the monitor should proceed.

In light of that plan, the judge praised attorneys for the U.S. for presenting “a detailed list of things of what the monitor should do, how he should do it, what the court ought to be doing, how the monitor should be compensated... a very thoughtful plan.”

Attorneys for the state, meanwhile, submitted a response saying they did not consent to have a monitor and that the lawsuit should be thrown out.

Counsel for the state further argued that the monitor should have a very limited role “verifying what Mississippi has already demonstrated by sworn declaration - that Mississippi has met the capacity and funding obligations recommended in the special master’s report, which the court has adopted in full.”

Reeves called Thursday’s meeting to more details from the United States on its proposal and to give Mississippi “the opportunity to tell the court why the proposal of the United States should not be adopted.”

During the roughly two-hour discussion, numerous aspects of what the monitor’s role should be were discussed, including whether the monitor could hire or maintain staff, who should pay the monitor, who the monitor could speak to, how long the monitor would be in place, and the like.

The state wants the monitor to wrap up work in 2022 and be reassessed each year on whether he should continue working. The feds, meanwhile, want the monitor to be in place for three years.

Additionally, attorneys for the federal government recommend that the monitor should be responsible for reviewing and validating data and information submitted by the Department of Mental Health, speaking with state officials, speaking with individuals receiving services, and participating in the annual clinical review required by the remedial plan.

The monitor also would be responsible for providing regular written reports to the court, testifying in matters connected with the enforcement of the order, and hiring staff to assist in those responsibilities.

DOJ attorneys also maintain that costs associated with the monitor should be footed by the state and that the state should “deposit $100,000 into the Registry of the Court as interim payment of costs incurred.”

Previously, costs incurred by the special master had been split evenly by the state and the U.S.

James Shelson, an attorney for the state, said that arrangement should continue.

However, Deena Fox, a representative for the DOJ, said the state should be responsible since the court has found the state in violation.

Reeves intimated that he agreed with Fox that the state about who should incur costs, but said that the court should not be responsible for handling the money.

“I do think the costs ought to be borne by the state at this juncture,” he said. “But I’m likely not going to have a clerk of the court responsible for paying and holding money. That’s my forecast.”

Parties also disagreed on who the monitor could speak to. The feds recommend that the monitor and his staff “have full access to persons, employees, residences, facilities, buildings, programs, services, documents, records (including medical and other records in unredacted form), and any other materials necessary to assess the state’s compliance with this order.”

Hogan’s remediation plan, which was adopted in full by the court, includes a clinical review process, which includes a review of between 100 and 200 patients a year. According to court documents, Hogan “testified that this kind of evaluation should provide a meaningful cross-check of the state’s own data.”

In its July 14 ruling, the court noted that Hogan had been “hamstrung by the state’s objection to him communicating with anyone on the ground - the non-party stakeholders in Mississippi’s mental health system.”

The state, though, objects to the monitor speaking to stakeholders and said Thursday that the department should have legal representation when monitors want to interview state employees and visit state facilities.

The judge agreed with that point but said the monitor should be able to speak to individuals receiving mental health service without state officials present.

Parties even had disagreements over certain wording, including “non-compliance,” “partial compliance,” and “substantial compliance.” Shelson said the state was unclear about the meaning of phrases, like partial compliance.

Fox, though, told the court the words were self-explanatory. “Non-compliance is the opposite of substantial compliance.”

A copy of the special master’s recommendations is shown below.