More than a year after it was filed, a civil lawsuit against the state of Minnesota, the Minnesota Extended Treatment Options (METO) program and METO staff continues to make its way through the U.S. District Court system. Former patients of the facility and their family members continue to push for an end to the use of restraints and seclusion as means of controlling patient behavior.

On Aug. 30, attorneys for the three families involved in the case will argue in U.S. District Court for a temporary injunction that would prohibit the use of various types of restraints and the use of seclusion at METO. The motion for the injunction was filed in mid-July and is just one of many actions taken in the case in recent weeks.

Court documents state that “Because Defendants have refused to stop the use of seclusion and restraints, Plaintiffs request this Court promptly issue a preliminary injunction immediately enjoining any further use of seclusion and restraints on residents of the METO program, or any successor program, including mechanical restraints, manual restraints, prone restraint, seclusion, individual isolation, electroconvulsive therapy and chemical restraints.”

The lawsuit seeks damages for violations of the federal civil and constitutional rights of people with developmental disabilities abused at METO, asks the court to enter an injunction against METO to prohibit its restraint and seclusion practices, and declare as unconstitutional the Department of Human Services’ position that restraint is permitted against people with developmental disabilities.

METO has long been a topic of scrutiny for the disability community. Its practices have been closely monitored by the Minnesota Disability Law Center, parents and family members of residents, and a number of disability rights, advocacy and service provider organizations.

Use of restraints and placement of patients in seclusion at METO are at the heart of the ongoing lawsuit, which was filed July 10, 2009 in U.S. Federal District Court in St. Paul. The lawsuit was filed on behalf of people with developmental disabilities and their families. Three of the plaintiffs were restrained at METO, a state mental health treatment facility in Cambridge.

METO is a program of the Minnesota Department of Human Services. Court documents state that staff there routinely restrained patients in a prone face-down position and placed them in metal handcuffs and leg hobbles at risk of injury, causing them to struggle, cry and yell once they were in the restraints. METO also placed patients in seclusion rooms for extended time periods, and deprived them of visits from family members.

The lawsuit also states that restraints and seclusion were used by METO as a practice of behavior modification, coercion, discipline, convenience and retaliation. METO staff allegedly restrained some patients hundreds of times, and used these tactics for conduct as benign as touching a pizza box, not staying within eyesight of staff, or even after patients were calmly eating a snack or watching television.

State officials have argued that restraint of patients at METO is necessary. But those who speak for the families say that their case is one about human dignity and respect for those with developmental disabilities.

Shamus O’Meara, a partner with the law firm of Johnson & Condon, P.A., represents the three families, the named plaintiffs in the lawsuit. “It’s ironic that we were filing motions in this case on July 26, the 20th anniversary of the Americans with Disabilities Act,” said O’Meara. “It shows that we still have a long way to go.”

The families involved are the Jensen, Brinker/Allen and Jacobs families. The Jensens were the initial plaintiffs. The Brinker/Allens and Jacobs families joined the case later. All allege abuse of their children at METO, through use of restraints as well as seclusion. They contend that incidents that promoted such treatment were minor and should have been handled differently. One young man had his arm broken and his family claims he was denied medical attention and proper treatment for a time.

Over the past several months various motions as well as a case settlement have been debated. At one point the state asked for more time to file an answer and to file a response to the complaint. But on June 29 Judge Franklin Noel denied that request, stating in court documents, “This case has been pending almost a year. Based upon repeated assurances that the parties were making progress in reaching a settlement, the Court postponed adopting a Pretrial Schedule until May 2010. In their current stipulation, filed only 5 days before the first due date in the Pretrial Schedule adopted on May 12, 2010, the parties again report significant progress in settlement negotiations. The only suggestion the parties make regarding the substance of their progress is that they were ‘discussing use of a mediator.’ At the scheduling conference in May, the Court had difficulty understanding the parties’ vastly different views of this case, in part because the Defendants have yet to answer the complaint. Although the parties contend in their stipulation that the filing of an answer will be ‘counter productive to the negotiations’, the Court cannot conceive of how the filing of an answer would in any way prejudice settlement negotiations. This case is almost a year old, and the Court doesn’t even know what the issues are, as Defendant has not yet answered the complaint.”

Noel continued, “If Defendant concedes that Plaintiffs’ complaint has merit, it should settle. If not, it must answer, so that issues in dispute can be joined. The parties request to extend the deadline for the Defendants to answer the Complaint is DENIED.”

DHS officials declined comment when contacted by Access Press.

METO has already been investigated by the state’s Ombudsman for Mental Health and Developmental Disabilities, which found a practice of abuse at the facility. Among its findings released in fall 2008, the ombudsman reported that documents in individual records revealed that people were being routinely restrained in a prone face-down position and placed in metal handcuffs and leg hobbles. In at least one case, a client that the metal handcuffs and leg hobbles were secured together behind the person, further immobilizing the arms and legs, reported it to the ombudsman staff. Some individuals were restrained with a waist belt restraint that cuffed their hands to their waist. An individual with an unsteady gait was routinely placed in this type of restraint, putting that person at risk of injury if they should fall.

METO policies stated that a person was not to be restrained for more than 50 minutes. But that practice was apparently not followed. Ombudsman office staff found numerous examples of documented incidents where after 50 minutes in a restraint, staff would continue the restraint but document it on a different restraint use form, sometimes with no indication that it was a continuation of the previous restraint. Documentation also revealed that in most cases where restraints were used the person was calm and cooperative about going into the restraint but began to struggle, cry and yell once they were restraints. In some cases, clients appeared conditioned to “assume the position” for application of restraints where they would lie on the floor and put their hands behind their back without resistance. The ombudsman also found METO failed to attempt any alternatives to avoid using restraints; the length of time some patients were restrained exceed even METO’s own guidelines; and the agencies that had protective obligations for METO patients or responsibility to serve as checks and balances over the actions of the program failed to protect the patients or turned a blind eye to the problem.