On December 3, 2024 the Maine Superior Court issued an order dismissing the 1989 class action lawsuit and subsequent 1990 injunction that is commonly known as the “AMHI Settlement Agreement or AMHI Consent Decree.” AMHI was a state inpatient psychiatric facility at the time (replaced by Riverview in 2004).
Below is a summary of the history of this lawsuit and the circumstances that led to its dismissal by the Superior Court.
In 1989, what is now Disability Rights Maine (DRM), and our partners, filed a class-action lawsuit in Kennebec Superior Court against the Superintendent of the Augusta Mental Health Institute (AMHI) and the Maine Commissioners of the Department of Health and Human Services (DHHS) and what is now the Office of Behavioral Health (OBH). Our lawsuit alleged that conditions at AMHI and the lack of community services for discharged patients violated constitutional rights.
Rather than proceed to trial, the parties reached a settlement agreement, which in 1990 was incorporated into a Consent Decree by the Court. The Consent Decree granted the Court judicial oversight of the settlement agreement until DHHS achieved substantial compliance with its terms.
The AMHI Settlement Agreement also required the appointment of a Court Master, an officer of the Court tasked with serving the interests of justice by monitoring and implementing the terms of the agreement. Since 2003, Daniel Wathen, a former Chief Justice of the Maine Supreme Judicial Court, has served as the Court Master.
While the Settlement Agreement aimed to address a number of issues, it had two significant limitations:
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- No Guaranteed State Funding. The Agreement only required DHHS to make “good faith efforts” to secure funding from the Legislature but didn’t guarantee any commitment from the Legislature to actually authorize the funding for those services.
- No Requirement for the State to Directly Provide Services. DHHS was not required to directly provide services but could delegate them to private agencies through contracts. The availability and quality of these services though, ultimately depend on the state’s effectiveness in enforcing the terms of its contracts with the providers.
Over the 34 years since its inception, the AMHI Settlement Agreement has undergone numerous legal challenges and adjustments. Although the Superior Court that was overseeing the Settlement Agreement maintained that compliance would require that individual class members were receiving the services promised under the terms of the Settlement Agreement, in 2004 the Maine Supreme Judicial Court overturned this interpretation and held that substantial compliance should be evaluated based on systemic rather than individual standards. The Court stated:
“To evaluate compliance with settlement agreement provisions by determining whether selected class member’s needs are being met sets the bar too high.” and that “the court is measuring substantial compliance not absolute compliance.”
Therefore, in 2006 a plan based on systemic standards was implemented but despite this plan, significant challenges remained. As outlined above, most community mental health services were provided through contracts with private mental health agencies, and the DHHS had limited ability to enforce these contracts. This lack of enforcement meant that individuals receiving services could not ensure providers fulfilled their contractual obligations.
In 2013, Riverview Psychiatric Center lost its certification from the U.S. Centers for Medicare and Medicaid (CMS) due to deficiencies such as excessive use of restraints and seclusion, medication errors, and poor record keeping. After making improvements, CMS recertified Riverview in 2019.
To address the contract issues in the community, a bill was introduced in 2019 entitled LD 1822, “An Act to Protect Access to Services for Adults with Serious and Persistent Mental Illness.” The law would have provided individuals the right to challenge the denial of access to mental health services by a provider in violation of its state contract. The first step was to be an informal process with DHHS and the provider. If the issue remained unresolved after this process, the individual would have been entitled to file a private action seeking injunctive relief. This legal remedy would have allowed the individual to enforce the provider’s contractual obligations with DHHS, compelling the delivery of the required services. However, the bill faced uniform opposition from mental health service providers and failed to progress out of committee.
Although Paragraph 277 of the Settlement Agreement required contracted mental health agencies to accept referrals unless specific conditions were met, DHHS lacked effective enforcement mechanisms to hold these providers accountable. In his 2019 report to the Court, Judge Wathen expressed support for the passage of LD 1822, highlighted the opposition to it from mental health providers, and concluded that DHHS was not in substantial compliance with this provision of the Settlement Agreement, stating:
“I continue to support its passage, but it faces opposition from the providers of mental health services…Clearly improved contract management and enforcement is required. Accordingly, based upon the foregoing account, which I find as fact, I conclude that the Department is not in compliance with Paragraph 277 of the Settlement Agreement.”
In 2021, under the guidance of Judge Wathen, an agreement was reached that modified the compliance standards by establishing 17 measurable standards focused on improving access to core mental health services, ensuring that Riverview maintained its CMS certification, and contract enforcement. The agreement allowed DHHS to petition the Court to terminate the Consent Decree once these standards were met.
As part of this process, DHHS adopted certain MaineCare rules to include “Protections for Adults with Serious and Persistent Mental Illness” that required providers to obtain DHHS authorization prior to either not accepting a referral for a new client or terminating the services of an existing client. DHHS also implemented new strategies to monitor this compliance, including working with DRM’s independent community-based advocates and adopting new data reporting processes.
As of 2024 DHHS had not met certain of these standards contained in the 2021 agreement. Judge Wathen proposed to the DHHS that they submit to him as Court Master a formal request under the terms of the AMHI Settlement Agreement to revise the compliance standards that they were not currently meeting so that they would now meet them, thus enabling them to achieve compliance with the provisions of the 2021 Agreement. He also directed DHHS to provide him with a report detailing the systemic improvements in Maine’s mental health system. The DHHS complied and on September 23, 2024, Judge Wathen issued an “Order Amending Compliance Standards” where he approved this DHHS request to change these standards and issued the following recommendation to DHHS:
“I recommend the Department recalculate the data contained in its previously issued quarterly reports and determine and report whether it has achieved compliance with the revised standards…”
DHHS then recalculated its data based upon these new standards and on October 24, 2024, Judge Wathen filed a progress report with the Court indicating that, based on these new calculations, substantial compliance had been met and he recommended that DHHS file a request with the Court to end the Consent Decree, stating:
“Accordingly, I recommend that the Department file a petition with the Court, pursuant to the original Consent Decree and the Agreement of the Parties dated January 20, 2021, seeking dissolution of the injunction entered by the Court on August 2, 1990.”
At my request, the Department has provided [a report] outlining system improvements and initiatives currently in place or underway. In my judgment, these efforts are designed to build upon and maintain the improvements achieved in the community mental health system and the State’s psychiatric hospitals since the advent of the Consent Decree.”
In accordance with Judge Wathen’s above recommendation, the DHHS filed a Notice of Substantial Compliance with the Superior Court on October 30, 2024, and requested that the Court end the Consent Decree.
Making an unnecessary but powerful point in its filing with the Court, DHHS highlighted changes in U.S. Supreme Court law regarding long-term class-action settlement agreements, referencing Horne v. Flores, which underscored the diminished necessity for prolonged court monitoring as follows:
“Much of the Department’s important work is not reflected in the existing metrics. Additional Court oversight would unnecessarily strain judicial resources and burden the parties with administrative work often disconnected from the Department’s task of making actual improvements on the ground… The reasons that existed in 1990 for additional Court monitoring of the compliance standards do not apply today.”
This change in the law was also cited in 2010 when the Maine federal court overseeing the Consumer Advisory Board v. Harvey Pineland class action case, which had been filed 35 years earlier in 1975, granted the State’s motion to terminate that consent decree, stating:
“Significant factual and legal changes have occurred since Plaintiff’s complaint was filed that make continued enforcement of the Community Consent Decree inequitable.”
DRM reviewed Judge Wathen’s orders and DHHS’s filings. As outlined above, the Court Master modified the compliance standards, as he is authorized to do under the terms of the AMHI Consent Decree, which then allowed DHHS to meet the adjusted criteria for substantial compliance. Additionally, his directive for DHHS to report on systemic changes beyond the existing metrics, and his subsequent citation of these reforms in his progress report to the Court, indicated his support for ending the Consent Decree both under the terms of the metrics of the 2021 agreement which he had just modified, and the reasoning in the 2009 U.S. Supreme Court and Pineland case.
DRM ultimately chose not to challenge the State’s filings, particularly in light of the changes in the law and the Court Master’s supporting its dismissal.
On December 3, 2024 Maine Superior Court Justice Bruce C. Mallonee granted the DHHS request and ordered that the AMHI case be dismissed, thus ending the 34-year-old AMHI Consent Decree. (A copy of this order can be found below)
Notwithstanding the Court’s dismissal, significant issues persist in Maine’s mental health system as 2025 approaches. The most critical shortcoming is the lack of enforceable individual rights for eligible recipients to receive services. The current system relies heavily on providers and state administrators, whose effectiveness is often influenced by whatever administration is in power at the time. The current leadership at OBH has made significant progress, such as no longer allowing providers to maintain internal waitlists, establishing Crisis Receiving Centers, and adopting the “Protections for Adults with Serious and Persistent Mental Illness” in MaineCare rules. However, without implementing a private right of action, as proposed in 2019, vulnerable individuals will have no recourse when the system fails.
Although the AMHI Consent Decree is no longer in effect, Maine must build on the progress of the past 34 years and address these systemic gaps to meet the mental health needs of its citizens, including shifting the power from the State of Maine and the service providers, to the people who receive the services. Otherwise, we will never realize equitable and effective mental health service delivery with long term quality outcomes.
Read the order.