Fall 1999						OCR UPdate - 3

OCR Assumes Active Role in Developing Department's Response to Olmstead v. L.C.

On June 22, 1999, the Supreme Court issued its ruling in Olmstead v. L.C. The Court held that unjustified institutionalization of people with disabilities violates the Americans with Disabilities Act (ADA). In its ruling, the Court said that institutionalizing a person with a disability who can benefit from and wants to live in the community constitutes discrimination because it severely diminishes the individual's ability to interact with family and friends, work and make a life for him or herself. While the decision acknowledges that states have limited resources, it also requires states to move at a reasonable pace to provide community-based alternatives for providing services to people with disabilities in more integrated settings.

The Court also set out a roadmap for complying with the "most integrated setting" requirement of the ADA. The Court indicated that states may demonstrate compliance with the ADA by showing that they have comprehensive and effective plans for placing qualified individuals with disabilities in less restrictive settings, and waiting lists that move at a reasonable pace.

Major components of HHS have come together to coordinate implementation of the principles established in the decision. Secretary Shalala has appointed OCR director Tom Perez, along with the director of the Health Care Financing Administration's Center for Medicaid and State Operations, as co-chairs of a Departmental working group that is coordinating the Department's immediate and long term response to the Olmstead decision. This group is developing a comprehensive technical assistance and outreach program on the "most integrated setting" requirement. In seeking to resolve the two dozen or so pending complaints raising Olmstead issues, OCR stands ready to provide technical assistance to bring all the stakeholders together to develop workable plans for eligible individuals to move to community settings. As Secretary Shalala told the National Conference of State Legislatures (NCSL) recently, "The Olmstead decision defines our mission: To build better systems of supports enabling people with disabilities to live life to the fullest." For a full text of Secretary Shalala's NCSL speech regarding Olmstead, see the OCR website (listed at the end of this Newsletter).

OCR Response To Racial And Ethnic Disparities In Health Care

Racial and ethnic disparities in health outcomes are well documented.

Photograph: Dr. Kevin A. Schulman (standing, right) discusses his recent study on "The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization" at the Spring Meeting of OCR Managers and Attorneys

There are many factors that contribute to these disparities, including economics, education, geography and genetics.

Unfortunately, racial discrimination also plays a role. Discrimination can infect the corporate board rooms, the classrooms and the courtrooms. It also can affect who gets to the operating room.

OCR's enforcement experience, coupled with compelling research documenting the prevalence of racial bias in physician decision-making, demonstrates that eliminating racial disparities in the provision of health care services is both a public health and civil rights challenge. Aggressive enforcement of civil rights laws must be an important component of our overall strategy to eliminate the racial disparities in health.

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