Entitlement Beneficiaries Must Be Able to Legally Redress Human Rights Abuses

Last November, the U.S. Supreme Court heard arguments in Health and Hospital Corporation of Marion County, Indiana v. Talevski, filed by the wife of a nursing home resident against the nursing home, alleging that her husband’s civil rights had been violated.

In response, the nursing home, owned by a corporation in a public-private partnership with the state of Indiana, argued that the resident and his family did not have any standing to sue. The question central to this case is whether those who receive public funds, including Medicaid, Supplementary Security Income (SSI), and assistance for food and housing, have the right to sue state agencies/facilities for civil rights violations, as they have had in the past.

Those who believe that beneficiaries of federal entitlements should not be allowed to file lawsuits argue that beneficiaries are third parties with no standing to file lawsuits regarding these entitlements because the contract is between the federal and state governments. Advocacy groups including AARP, the American Cancer Network, and the American Public Health Association point out that curtailing the ability of beneficiaries of federal entitlements to sue for violations of their civil rights will remove one of the most important mechanisms of oversight of state agencies.

Our nation has a troubling history of mistreating people with intellectual disabilities and psychiatric conditions. Patients in congregate settings, like institutions and asylums, have historically been subjected to gross violations of their human rights and punitive, rather than medically necessary, treatments. Patients in these settings were restrained for days, denied access to basic hygiene, and forcibly sterilized. Psychiatry patients are among the most vulnerable in society and are often the beneficiaries of federal entitlements. Losing the ability to sue for violation of their civil rights will disproportionately impact our patients and our profession. Lawsuits bringing attention to the loss of patients’ civil rights issues often help improve conditions of care and ensure that everyone—regardless of mental, physical, or cognitive state—is afforded basic protections and dignity.

It is important for us as psychiatrists to contact our state and federal legislators to make them aware of the implications of this case and ask them to codify additional protections and provisions into law. Additionally, we must talk with our patients and their families about this critical issue, so they are fully informed of their rights. ■

Nina Bihani, M.D., is a PGY-3 psychiatry resident at Wayne State University/Detroit Medical Center.

Mary Ann Schaepper, M.D., M.Ed., is a child psychiatrist in private practice in Redlands, Calif.