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Friday, April 4, 2008 News: Disabilities The Illinois Department of Public Aid must fully fund the full-time nursing care needed by a disabled individual in his home because it is an appropriate setting and because it will not cost the state more than it would have to pay to keep him hospitalized, a federal court ruled March 26 (Radaszewski v. Maram, N.D. Ill., No. 01-cv-9551, 3/26/08). The U.S. District Court for the Northern District of Illinois ruled that Eric Radaszewski and his mother, Donna, were entitled to judgment in their lawsuit brought under Section 504 of the Rehabilitation Act and Title II of the Americans with Disabilities Act. The court ordered the state to provide the full-time care required by Radaszewski's handicap, which the court said stemmed from brain cancer, a stroke, and subsequent medical treatment that left him with impaired physical and mental functions. The failure to accommodate Radaszewski's handicap violated the two laws because he was entitled to reside in an appropriate community-integrated setting and because accommodating his disability would not otherwise disrupt the provision of Medicaid services to other individuals, the court ruled. The court issued its decision on remand from a September 2004 appeals court decision that found the trial court had, in an earlier ruling, dismissed his claims prematurely. The U.S. Court of Appeals for the Seventh Circuit in that decision ruled that Eric was entitled to pursue claims challenging decisions by the Illinois Department of Public Aid, and its director, Barry S. Maram, not to pay for the full-time nursing care he alleged was necessary. The appeals court found dismissal was inappropriate because Eric might be able to demonstrate at trial that the cost of medical services he needed at home would be comparable to the costs of his receiving the high level of attention he would need in a skilled nursing facility or hospital (No. 176 HCDR 9/13/04 a0a9q5z5n7). At trial on remand, the plaintiffs made just such a claim. To support their claim, they presented evidence that accommodating his handicap by providing, in his home, the full-time nursing care he required would be less expensive for the state than if it was required to pay for full-time hospitalization. The court rejected the state's claim that he was entitled to only $4,593 per month, an amount that the court said would have paid for barely five hours per day of the nursing care he required. 'Fundamental Alteration' Defense Rejected The court found that Illinois was required to provide community-based treatment for disabled people like Eric as long as such treatment was appropriate, as long as Eric desired community placement, and as long as it did not require the state to "fundamentally alter" the nature of its program or services. The state did not contest that community-based treatment was appropriate. Although the state asserted a "fundamental alteration" defense, the court found it was unavailable under the circumstances. If Eric was placed in an institution, the state would be required to provide the necessary level of care with "constant monitoring and continuous skilled assistance in accomplishing basic bodily functions," the court said. "The services that Eric requires and presently receives at home are, in substance, the services that would be required in a hospital," it added. "The unrebutted evidence clearly shows that the cost of caring for Eric in the proper institutional setting--a hospital--would be substantially greater than the cost of allowing Eric to remain in the community and receive the same proper treatment and health care," it continued. Thus, it concluded, "Illinois has not demonstrated that providing the requested accommodation to Eric would impose an unreasonable burden on the state or fundamentally alter the nature of its programs and services." The court's decision is available.
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