## Facts

- L.C. and E.W., two women with mental disabilities, were voluntarily admitted to a Georgia state psychiatric hospital and remained confined in a psychiatric unit.
- State treatment professionals determined that each could be appropriately served in a community-based program.
- Despite those determinations, the women remained institutionalized.
- The women sued state officials, alleging that continued institutionalization violated Title II of the Americans with Disabilities Act (ADA) and its implementing regulations requiring services in integrated settings.
- The district court granted partial summary judgment ordering community placement, reasoning that unnecessary segregation constituted discrimination not excused by funding limits.
- The Eleventh Circuit affirmed.

## Issues

1. Whether Title II of the ADA and implementing regulations require a state to provide community-based placement when state professionals find it appropriate.
2. Whether unjustified institutional isolation of persons with disabilities constitutes discrimination under Title II.
3. Whether a state may deny or delay community placement based on a “fundamental alteration” defense tied to resource allocation and system-wide obligations.

## Decision

- The Supreme Court held that unjustified institutional isolation of persons with disabilities can violate Title II of the ADA.
- The Court ruled that community placement is required when (1) state treatment professionals determine it is appropriate, (2) the individual does not oppose it, and (3) the placement can be reasonably accommodated.
- The Court rejected a per se rule requiring immediate community placement regardless of costs and accepted that states may assert a “fundamental alteration” defense.
- The Court affirmed in part, reversed in part, and remanded for consideration of whether the requested relief was a reasonable modification in light of the state’s available resources and obligations to others with disabilities.

## Legal Principles

- Title II’s anti-discrimination mandate, together with the integration regulation, can prohibit unjustified segregation of persons with disabilities in institutions.
- A public entity must provide services in the most integrated setting appropriate to the needs of qualified individuals with disabilities.
- A state must make reasonable modifications to avoid disability-based discrimination unless the modification would fundamentally alter the nature of the state’s services or programs.
- In assessing fundamental alteration, courts may consider the state’s responsibility to maintain a range of services for persons with diverse disabilities and the impact of reallocating limited resources.
- A state may demonstrate compliance through a comprehensive, effectively working plan for community placement and a waiting list that moves at a reasonable pace.

## Conclusion

The Court recognized that unnecessary institutionalization may constitute ADA discrimination and required community-based services when professionally appropriate and reasonably accommodated, while permitting states to resist immediate transfers if doing so would fundamentally alter their programs given system-wide resource constraints.


Olmstead v. L.C. ex rel. Zimring, 527 U.S. 581 (1999)