HHS-OCR Complaints Re COVID-19 Medical Discrimination

States: Washington, Alabama, Tennessee, Utah, Oklahoma, Connecticut, North Carolina, Oregon, Nebraska, Arizona, DC, Texas

Date Filed: 2020

Agency: U.S. Department of Health and Human Services, Office for Civil Rights

Overview: These complaints concern illegal disability discrimination in medical care that is putting the lives of people with disabilities at imminent risk during the COVID-19 pandemic. The complaints challenge discriminatory crisis standard of care plans, no-visitor policies, and inaccessible testing that violate federal disability rights laws, including the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act (Section 504), and Section 1557 of the Affordable Care Act (ACA).

Crisis Standard of Care Complaints

Washington

Alabama

Tennessee

Utah

Oklahoma

North Carolina

Oregon

Arizona

North Texas

No-Visitor Complaints

Connecticut

MedStar Health (D.C.)

Texas

MHHS Texas

Other Complaints

Inaccessible Testing: Nebraska

HHS-OCR Documents

HHS-OCR Bulletin: Civil Rights, HIPAA, and COVID-19

HHS-OCR Resolution: Alabama

HHS-OCR Resolution: Connecticut

HHS-OCR Resolution: Tennessee

HHS-OCR Resolution: Utah

HHS-OCR Resolution: Texas and North Carolina

HHS-OCR Resolution: Medstar Health

HHS-OCR Resolution: Arizona

FAQs for Healthcare Providers during the COVID-19 Public Health Emergency: Federal Civil Rights Protections for Individuals with Disabilities under Section 504 and Section 1557

Additional Resources

Webinar: Disability Discrimination in the Rationing of Life Saving COVID Treatment: Who Gets Left Behind?

Applying HHS’s Guidance for States and Health Care Providers on Avoiding Disability-Based Discrimination in Treatment Rationing

Evaluation Framework for Crisis Standard of Care Plans 

Evaluation Framework for Hospital Visitor Policies

AADMD Statement on People with IDD and the Allocation of Ventilators During the COVID-19 Pandemic

50 State Crisis Standard of Care Plan Overview

Examining How Crisis Standards of Care May Lead to Intersectional Medical Discrimination Against COVID-19 Patients

Press Releases

Federal Civil Rights Resolution Makes Clear Hospital Visitor Policies Nationwide Must Accommodate Patients with Disabilities During COVID-19 Pandemic

State and National Groups File Federal Complaint Against Nebraska for Inaccessibility of COVID-19 Testing Program

Resolution of Federal Civil Rights Complaint Raises the Bar in Prohibiting Medical Discrimination Against People With Disabilities During COVID-19 Pandemic

COVID-19 Hotspots Arizona and Texas Crisis Standard of Care Plans Challenged by State and National Groups in Federal Complaints

Resolution of Federal Complaint Amidst Nationwide COVID-19 Surge Raises Bar in Prohibiting Blanket DNRs, Medical Discrimination Against People With Disabilities

Amidst Nationwide COVID-19 Surge, Health & Civil Rights Groups Secure Federal Approval of Revised Crisis Standards of Care Guidelines in Texas

NC Increases COVID-19 Medical Rationing Protections for Disabled Patients

Coalition of Civil Rights Groups and Legal Scholars Release Report on Intersectional Medical Discrimination During COVID-19

MedStar Health Agrees to End Discriminatory Treatment of Patients with Disabilities in Federal Resolution

Civil Rights Groups Secure Federal Approval of Revised Crisis Standards of Care in Arizona

Related Media

New York Times: Will Disabled People Be at a Disadvantage for Scarce Coronavirus Treatment?

U.S. News: Rights Groups: Coronavirus Treatment Plan Discriminates

Bloomberg Law: Virus Stokes Discrimination Concerns From Disability Groups (2)

NPR: Disability Groups File Federal Complaint About COVID-19 Care Rationing Plans

NPR: People With Disabilities Say Rationing Care Policies Violate Civil Rights

Seattle Times: People with disabilities would suffer if coronavirus care is rationed, advocates say in civil-rights complaint 

The Appeal: The Coronavirus Pandemic Has Brought Out Society’s Alarming Disregard for People With Disabilities

Bloomberg Law: Alabama’s Virus Ventilator Plan Latest to Draw Ire of Disabled

MyNorthwest: Advocacy group says people with disabilities could get denied COVID-19 treatment

AL.com: Alabama limit on ventilators discriminates against intellectually disabled, advocates claim

ProPublica: People With Intellectual Disabilities May Be Denied Lifesaving Care Under These Plans as Coronavirus Spreads

The Hill: Trump officials say people with disabilities must not be denied lifesaving coronavirus care

NPR: HHS Warns States Not To Put People With Disabilities At The Back Of The Line For Care

NBC News: Ventilators limited for the disabled? Rationing plans are slammed amid coronavirus crisis

New York Times: U.S. Civil Rights Office Rejects Rationing Medical Care Based on Disability, Age

WTVC-TV NewsChannel 9 News: TN disability rights advocates: State regulations discriminate by rationing critical care

New York Times: At the Top of the Covid-19 Curve, How Do Hospitals Decide Who Gets Treatment?

The Atlantic: Americans With Disabilities Are Terrified

Vox: “We’re being punished again”: How people with intellectual disabilities are experiencing the pandemic

Washington Post: Who gets a shot at life if hospitals run short of ventilators?

ABC: People with disabilities call for assurances of COVID-19 care

Daily Beast: In These States, the Disabled Could Go to the Back of the Ventilator Line

The Center for Public Integrity: State Policies May Send People With Disabilities to the Back of the Line for Ventilators

cheddar: Alabama Cuts Policy That Made it Harder for Disabled Coronavirus Patients to Get Ventilators

AL.com: Alabama disavows plan to limit ventilators for disabled during shortages

Alabama Political Reporter: Feds resolve complaint over “discriminatory” Alabama emergency ventilator policy

Bloomberg Law: Alabama Takes Down Allegedly Discriminatory Ventilator Guidance (1)

The Hill: Alabama removes controversial ventilator guidelines that denied coronavirus care to disabled

Nashville Post: Group files complaint against state triage guidance to HHS

Forbes: The Disability Community Fights Deadly Discrimination Amid The COVID-19 Pandemic

NPR: People With Disabilities Fear Pandemic Will Worsen Medical Biases

BMJ: US ventilator crisis brings patients and doctors face-to-face with life-or-death choices

CT News Junkie: Disability Rights Groups File Complaint With Office of Civil Rights

New York Times: Coronavirus Crisis Exacts Toll on People With Disabilities

Eyewitness News 3: Formal discrimination complaint filed on behalf of people with disabilities

Disability Scoop: Hospital No-Visitor Policies Endanger People With Disabilities, Advocates Say

CNN: How hospitals make tough ethical calls about which lives to save during a pandemic

Hartford Courant: Advocates want parents of people with intellectual disabilities to be excused from Connecticut’s no-visit rule at hospitals during the coronavirus crisis

NPR: Federal Government Asked To Tell Hospitals Modify Visit Bans

The CT Mirror: Hospital visitor bans fail disabled patients, complaint says

U.S. News: Hospitals Ordered to Allow Support for Disabled Patients

CT News Junkie: Connecticut Settles Disability Complaint Over Hospital Visitation

Hartford Business Journal: CT, Hartford HealthCare resolve civil rights complaint over visitor restrictions

Bloomberg Law: Disabled Allowed Support Visitors in Connecticut Hospitals (1)

Hartford Courant: State issues order allowing people with disabilities companions in hospital settings, settling civil rights complaint

New York Times: Connecticut Hospitals Ordered to Allow Visitors for Patients With Disabilities

Disability Scoop: Hospitals Told To Allow Visitors For Individuals With Disabilities

U.S. News: Coronavirus Crisis Exacts Toll on People With Disabilities

Lincoln Journal Star: Disability Rights Nebraska files complaint over Test Nebraska access

Bloomberg Law: Tennessee Updates Virus Plan After Disability Groups Protest

New York Times: Who Gets Lifesaving Care? Tennessee Changes Rules After Federal Complaint

AZ Central: Disability rights groups file federal complaint about ‘medical rationing’ in Arizona

KJZZ: Disability And Civil Rights Groups File Formal Complaint Vs. Arizona Over Crisis Standards Of Care Plan

Forbes: Disabled Discriminated Against By Crisis Health Plans, Groups Charge In Federal Complaints

NBC DFW: Pandemic Triage Guidelines Violate Federal Law, Discriminate: Complaint

New York Times: Should Youth Come First in Coronavirus Care?

Politico: Trump administration steps in as advocacy groups warn of Covid ‘death panels

AP News: Utah sets pandemic safeguards for people with disabilities

Salt Lake Tribune: Utah revises emergency plans to protect people with disabilities

The Hill: How an unexpected collaboration led Utah to amend its discriminatory triage plan

Open Minds: COVID, Rationing, & Consumers With Disabilities: Where Are We?

NPR: As Hospitals Fear Being Overwhelmed By COVID-19, Do The Disabled Get The Same Access?

CBS DFW: Revised Pandemic Rationing Plan Protects Disabled Texans From Being Sent To Back Of Line For Ventilators

The Federalist: Elderly And Disabled People Should Not Be Put At The Back Of The Line For COVID Care

Texas Standard: Revised Health Care Guidelines Protect Texans With Disabilities From Discrimination, If Rationing Occurs

NPR: HHS Civil Rights Office Tackles Health Care Discrimination Of People With Disabilities

CNN: Many doctors have negative perceptions of patients with disabilities — and that impacts quality of care, study finds

NPR: MedStar Health Changes COVID-19 Protocols Following Discrimination Complaint

Bloomberg Law: Arizona Amends Virus Care Standards to Protect Disabled Patients

AZ Central: Arizona revises its standards on pandemic ‘medical rationing’ after federal complaint

Associated Press: Arizona revises health standards around ‘medical rationing’

The Center for Public Integrity: Once Again, Some States are Choosing who Gets COVID-19 Care

Washington Post: MedStar Agrees to Deal in Federal Discrimination Case

Doe v. Trump

State: Oregon

Filed: February 6, 2020

Court: Ninth Circuit Court of Appeals

Overview: This brief supports the preliminary injunction of the Presidential Proclamation on the Suspension of Entry of Immigrants Who Will Financially Burden the United States Healthcare System as discriminatory against people with disabilities. The brief argues that the Proclamation attempts to replace the multi-factor public charge test provided by Congress with a single-factor test based exclusively on whether a visa applicant has “approved” health insurance to determine if they will be a “financial burden.”

Excerpt: “The Proclamation would re-impose these discriminatory barriers, requiring immigrants to provide proof of health insurance coverage through ‘approved’ plans that are not accessible for most people with disabilities due to medical underwriting, pre-existing condition exclusions, and other requirements. The purported goal of the Proclamation is to reduce the costs of uncompensated care, yet it excludes health insurance options available to individuals with disabilities that have been shown to reduce these costs, including subsidized Affordable Care Act (“ACA”) marketplace health plans and Medicaid. The Proclamation thus acts as a de facto bar to entry for immigrants with disabilities without any rational link to its alleged purpose.”

Case Documents

Amicus Brief

In the Matter of Marian T.

State: New York

Filed: December 31, 2019

Court: New York Court of Appeals

Overview: This brief argues that New York’s adoption statute requires the informed consent of adult adoptees. The lower court held that the consent of the adult adoptee is properly dispensed with where adoption would further the person’s best interests.

Excerpt: “In dispensing with Marian’s consent to her own adoption, the lower courts embraced the outdated-and discriminatory-view that adults with intellectual disability may be treated as perpetual children under the law. Despite changes in law, policy, and societal attitudes regarding the treatment of adults with intellectual disability, outmoded stereotypes of adults with intellectual disability as lacking personhood and the ability to exercise self-determination linger. The lower courts’ decisions reflect those outdated views and threaten a dangerous reversal of advances made by people with intellectual disability.”

Case Documents

Amicus Brief

Cropp v. Larimer County

State: Colorado

Filed: December 18, 2019

Court: Tenth Circuit Court of Appeals

Overview: The amicus brief supported Mr. Cropp’s petition for a rehearing en banc. Mr. Cropp is an individual with Alzheimer’s who was arrested after police found him wandering in his neighborhood and tackled him to the ground when he would not answer their questions. His wife came to visit him in jail and asked for an accommodation to be able to sit next to him and explain the release form he was required to fill out in order to leave the jail. Despite knowledge of Mr. Cropp’s disability, the County denied these accommodation requests without making an individualized inquiry or analysis of his communications needs. The district court granted the County’s motion for summary judgement and the Tenth Circuit affirmed.

Excerpt: “The majority’s decision undermines the requirements of Title II in two ways…First, Title II requires that public entities provide communication with disabled people that is “as effective as” communication with nondisabled people. In contrast, the majority would require disabled people to show that communication offered by a public entity was ‘wholly ineffective.’ Second, Title II requires that governmental entities give “primary consideration” to the requests of disabled people in determining the appropriate method of communication with them.”

Case Documents

Amicus Brief

Community for Permanent Supported Housing et al. v. Housing Authority of the City of Dallas

State: Texas

Filed: October 9, 2019

Court: U.S. Court of Appeals for the Fifth Circuit

Overview: The Arc filed an amicus brief in support of Plaintiffs’ appeal of the district court’s dismissal on ripeness grounds. The case, filed in federal district court in the Northern District of Texas in 2018, challenges the Housing Authority of the City of Dallas’s (DHA) refusal to use the U.S. Department of Housing and Urban Development’s (HUD) Project-Based Voucher (PBV) rent subsidy program to provide otherwise scarce affordable, independent housing opportunities for people with IDD in the community. DHA was poised to offer such PBVs—each of which would permit a single-family house to be rented at subsidized rates to several people with IDD who can live independently with appropriate supports—but then canceled its offering and has refused to offer any substitute, without any good reason. The lawsuit alleges that DHA’s actions violate the ADA, Section 504 of the Rehabilitation Act, the Fair Housing Act, and state law. The district court dismissed the case in April 2019 and Plaintiffs appealed to the Fifth Circuit. The amicus brief supports Plaintiffs’ request to reverse the district court’s dismissal order and let the case move forward and explains that DHA’s ongoing failure to provide access to its program (including through reasonable accommodations where necessary) deprives adults with IDD of a critical opportunity to live in the most integrated setting appropriate in the community and creates an acute risk of homelessness and institutionalization.

Excerpt: “Title II of the ADA requires public entities to administer programs in the ‘most integrated setting appropriate to the needs of qualified individuals with disabilities,’ and Olmstead is noteworthy for its broad recognition of the rights of people with disabilities to live and receive needed services and supports in the community—as opposed to institutional settings—which has become known as the ‘integration mandate’ of the ADA. But this mandate—which also protects those who are “at risk” of institutionalization—cannot be fully realized without affordable housing opportunities in the community that are accessible to people with IDD and enable them to live outside their family homes. For many adults with IDD currently living in their family homes, opportunities that allow them to live in the community separate from their families are often preferable because these opportunities provide greater independence and autonomy. Additionally, living in the community separate from their families can be critical for adults with IDD to avoid homelessness or institutionalization when a supporting family member inevitably ages and reaches a point where she or he can no longer provide shelter or support.”

Case Documents

Amicus Brief: Community for Permanent Supported Housing et al. v. Housing Authority of the City of Dallas

Related Media

Press Release: “The Arc and Partners File Amicus Brief Challenging Discriminatory Actions of Dallas Housing Authority
Relman Colfax: “Settlement Results in More Community-Based Housing for People with Disabilities in North Texas

Public Charge Amicus Briefs

States: California, Washington, New York, Illinois

Filed: 2019

Courts: Northern District of California, Southern District of New York, Eastern District of Washington, Northern District of Illinois

Overview: A coalition of national disability advocacy groups filed four amicus briefs in support of litigation to stop the U.S. Department of Homeland Security (DHS) from implementing its new “public charge” rule. Twenty-one states–led by California, Washington, and New York–as well as Cook County, Illinois, have filed cases against the Trump Administration to block the new rule. The advocacy groups – representing tens of thousands of people with disabilities and their families across the country – claim that the new public charge rule will prevent people with disabilities from entering this country or becoming legal residents in violation of federal disability law.

Case Documents

Briefs:
California v. U.S. Department of Homeland Security (District Court)
New York v. U.S. Department of Homeland Security (District Court) 
Washington v. U.S. Department of Homeland Security (District Court)
Cook County, Illinois v. U.S. Department of Homeland Security (District Court)
California v. U.S. Department of Homeland Security (Ninth Circuit)
New York v. U.S. Department of Homeland Security (Second Circuit)
Washington v. U.S. Department of Homeland Security (Ninth Circuit)
Cook County, Illinois v. U.S. Department of Homeland Security (Seventh Circuit)

Decisions:

California v. U.S. Department of Homeland Security

Cook County, IL v. U.S. Department of Homeland Security

New York v. U.S. Department of Homeland Security

Washington v. U.S. Department of Homeland Security

Related Media

Press Release: The Arc Applauds Federal Injunctions Against Public Charge Rule

Press Release: Disability Advocacy Groups File Amicus Brief Opposing the Administration’s Public Charge Rule as Illegal Disability Discrimination

Press Release: Supreme Court Lifts Stay on Public Charge Rule: Implementation Will Have Chilling Impact on People with Disabilities

The Hill: Disability rights groups join challenge to ‘public charge’ rule

Undisclosed Podcast: State v. Rocky Myers – Episode 4: Of Mice and Men

Through a review of Rocky Myers’ case in Alabama and a discussion with The Arc’s legal director, this episode explores the Supreme Court’s opinion in Atkins and later decisions holding that executing people with intellectual disability violates the constitution’s ban on cruel and unusual punishment.

Prisons as Institutions: An Overview of Challenges Facing Prisoners with IDD and Proposed Solutions Under the ADA and Other Disability Rights Laws (University of Minnesota Impact Magazine, 2017)

Individuals with IDD are dramatically over-represented in prisons and jails and face unique barriers. Powerful laws exist to protect them, but prisoners need accessible resources to assist them in advocating for their rights. This article explores recommendations to ensure equity for prisoners with IDD.

Using the ADA’s ‘Integration Mandate’ to Disrupt Mass Incarceration (Denver Law Review, 2019)

This document explores how advocates have used, and are beginning to use in new ways, the “integration mandate” of the Americans with Disabilities Act to advocate for the rights of individuals with disabilities to avoid unnecessary entanglement with the criminal justice system.

G.T. v. Board of Education of the County of Kanawha

State: West Virginia

Filed: 2020

Court: U.S. District Court for the Southern District of West Virginia

Plaintiffs: Parents of children with disabilities in Kanawha County Schools

Defendant: Kanawha County School District

Counsel: The Arc, Mountain State Justice, Bazelon Center for Mental Health Law, Disability Rights West Virginia, Latham & Watkins

Overview: In 2020, The Arc, along with other local and national disability advocacy organizations filed a class action complaint in federal court alleging that Kanawha County Schools (KCS) has failed to educate children with disabilities, including autism, intellectual or developmental disabilities, mental health concerns, and Attention Deficit Hyperactivity Disorder (ADHD). Specifically, the groups assert that KCS—the public school district serving the Charleston metro area—has failed to provide behavioral and academic supports to students with disabilities and is instead segregating them into separate schools and classrooms, or sending them home because KCS schools will not educate them. The advocates allege that KCS has violated federal laws protecting students with disabilities.

As described in the complaint, scores of children with disabilities enrolled in KCS have been separated unnecessarily from mainstream classrooms in their schools. Instead, the students are segregated for years in separate classrooms where they interact only with other students with disabilities, and receive an inferior education; placed on “homebound” status where they may only receive a few hours of tutoring each week; or suspended or even expelled from school for behaviors that are caused by their disabilities. The students are not receiving critical behavioral supports that can help them be successful in the general education classroom with their classmates without disabilities.

Specifically, the complaints allege that KCS is: 1) violating the Individuals with Disabilities Education Act (IDEA) by failing to provide children with disabilities with the special education they need to receive a “free appropriate public education” in the least restrictive environment; and 2) violating the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act (Section 504), and the West Virginia Human Rights Act by failing to educate children with disabilities in the most integrated setting appropriate to their needs, and denying them equal educational opportunity.

Case Documents

Due Process Complaint

Amended Federal Court Complaint

Order on Motion to Dismiss

Motion for Class Certification

Declaration of Judy Elliott

Declaration of Sara Boyd

Order Granting Class Certification

Fourth Circuit Brief

Fourth Circuit Amicus Brief on Behalf of Civil Law Professors

Fourth Circuit Amicus Brief on Behalf of Disability Rights Groups

Fourth Circuit Amicus Brief on Behalf of Educational Officials

Fourth Circuit Amicus Brief on Behalf of Civil Rights Groups

Plaintiffs’ Opposition to Defendant’s Motion to Dismiss

Fourth Circuit Decision on Class Certification

Press Releases

Class Action Complaint Filed in West Virginia Alleging Systemic Disability Discrimination in Kanawha County Schools

West Virginia, National Disability Advocacy Groups File Complaints Alleging Systemic Disability Discrimination in Kanawha County Schools

Court Rules that Federal Disability Rights Class Action Against Charleston, West Virginia School District Can Proceed

Judge Rules Kanawha County Special Education Lawsuit Can Proceed as Class Action

Related Media

Washington Post: ‘Warehousing at its worst’: Rights groups say W.Va. school system gives inferior education to special-needs students

West Virginia Record: Special needs student sues Kanawha County Schools for not properly providing for students

Charleston Gazette-Mail: Judge allows Kanawha students with disabilities case to become a class-action lawsuit