Nicholas M. Berg
Nicholas M. Berg
Timothy R. Farrell
Timothy R. Farrell

Chicago lawyers helped secure reforms in treatment and discipline at a juvenile detention facility in Iowa.

Lawyers from Ropes & Gray LLP represented a class of minors alleging the Boys State Training School in Eldora, Iowa, violated due process and other rights by failing to provide adequate mental health care and by using solitary confinement and a physical restraint called “the wrap.”

U.S. District Court Judge Stephanie M. Rose in the Southern District of Iowa late last month ordered the facility to craft more detailed plans on how to treat the 40 to 60% of boys at the school who have a mental health diagnosis or who rely on psychotropics and ordered limits on using confinement and isolation.

Rose’s 116-page ruling granted injunctive relief to the plaintiffs, calling the school’s reliance on drugs and its shortage of psychotherapy a “disjointed, wholly inadequate design.”

”The culmination of the [s]chool’s many failures to treat students’ mental illnesses, taken together, create substantial risks of serious harm,” Rose wrote in the March 30 order. “Failure to treat mental illness increases the risks of deterioration of mental health, self-harm or suicide, more restrictive (and thus more harmful) placements, and criminal or delinquent recidivism.”

Rose also noted the school used solitary confinement when the teens’ behavior wasn’t necessarily threatening, and then it kept inmates there for detrimental lengths of time. Rose ruled the school should generally not keep children in isolation for more than one hour, consistent with standards disseminated by the American Correctional Association.

She also prohibited use of “the wrap,” a mattress on a metal bed frame with Velcro straps to immobilize different parts of the body, writing that United Nations conventions deem it torture. She ordered the parties to appoint a monitor to oversee the changes.

Rose presided over a nine-day bench trial in June 2019, featuring more than 28,000 pages of exhibits along with surveillance footage from the school.

The suit was filed in November 2017 by Children’s Rights, a national advocacy group, along with Des Moines-based Disability Rights Iowa and Ropes & Gray.

On behalf of boys at the school with some kind of significant mental illness, they alleged that the lack of care and use of restraints violated the Eighth Amendment prohibition on cruel and unusual punishment as well as the Americans with Disabilities Act and the Rehabilitation Act.

Eighth Amendment claims typically only apply after a formal finding of guilt in the criminal justice system, and since these cases involve juveniles who don’t go through that system, the Eighth Amendment wouldn’t usually apply, Rose wrote.

However, in cases involving claims of inadequate medical treatment, they arise under the Fourteenth Amendment and are analyzed using the Eighth Amendment’s “deliberate indifference” standard, requiring plaintiffs to show officials both knew of substantial medical need and health risks and disregarded them.

Rose found the situation at the school, where psychotherapy to back drug treatment is “practically non-existent,” created a constitutional violation.

“Based on the record in this case, the [c]ourt joins other courts that have found a facility does not meet its constitutional obligation to provide medical care to detainees when, in the case of mental illness, it fails to augment psychotropic medication with necessary psychotherapy,” she wrote.

She ruled the plaintiffs failed to carry their burden to establish violations of the federal ADA and Rehabilitation Act. But to remedy the due process violations, her order required the school to submit a plan by May explaining how students who need therapy will get it, how it will keep medical records confidential and how they can provide help to students at suicide risk.

Rose’s order also limits use of isolation rooms to when a student poses a risk to others. She banned use of “the wrap” and stated that if the school wants to use another type of restraint, it must show the court why such a tool would not pose mental-health risks, among other things.

Timothy R. Farrell and Nicholas M. Berg, partners at Ropes & Gray, represented plaintiffs in the case. Farrell said it was “an incredibly brave thing” for the boys to step forward.

“They should feel tremendous vindication and satisfaction knowing they were able to lead the charge in bringing about real change at an institution that was not doing right by them,” he said in an interview.

A spokesperson for the Iowa attorney general’s office, which represented the school and the defendant state officials, referred comment to the state’s department of human services. A spokesman for that agency could not be reached.

Farrell also said he thinks the ruling is an example for litigants against other institutions that are falling short.

"Having gone through this and looking to court opinions from similar cases and institutions across the country, I believe this opinion will be another really powerful pronouncement on what’s appropriate and what’s not appropriate,” he said. "And I hope that it will continue a trend and continue the momentum, in a way that sends a signal to other institutions that have practices like this that it’s not acceptable.”

The case in the U.S. District Court for the Southern District of Iowa is C.P.X., et al., v. Kelly Kennedy Garcia, No. 17 C 417.