Full opinion text
JOSEPH H. YOUNG, District Judge. I. INTRODUCTION This class action was instituted on behalf of 76 children confined in mental hospitals under the jurisdiction of the Maryland Juvenile Court. In their amended complaint, plaintiffs brought this action pursuant to 42 U.S.C. § 1983 in an effort to obtain rights which they claim are due them under the Fourteenth Amendment of the U.S. Constitution, section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794, and the Maryland Juvenile Causes Act, § 3-801 et seq., of the Courts and Judicial Proceedings Article of the Maryland Annotated Code. The amended complaint names as defendants the following State officials in their official and representative capacities: Neil Solomon, Secretary of Health and Mental Hygiene; Stanley Platman, Assistant Secretary for Mental Hygiene and Addictions; Gary Nyman, Director of Mental Hygiene; Rex Smith, Director of the Juvenile Services Administration (“JSA”); Richard A. Batterton, Secretary of Human Resources; Richard W. Bateman, Director of the Maryland Social Services Administration (“SSA”); and Robert L. Karwacki, an Associate-Judge of the Circuit Court of Baltimore City. Plaintiffs allege that monetary damages are inadequate, and they seek declaratory and injunctive relief pursuant to 28 U.S.C. §§ 2201 and 2202, and 42 U.S.C. § 1983. Jurisdiction is founded upon 28 U.S.C. §§ 1331, 1343, 2201, and 2202. In essence, plaintiffs seek relief in connection with four claims relating to various procedures and standards utilized in connection with the involuntary civil commitment of juveniles to mental institutions. First, plaintiffs allege that class members are committed to mental hospitals through constitutionally vague and inadequate standards. They argue that such commitments are unlawful under Md.Ann.Code art. 59, §§ 11 and 12. Second, once confined to these institutions, class members are denied periodic review as to whether continued hospitalization is necessary. Third, plaintiff class members do not always receive representation by legal counsel during all stages of the commitment process. Finally, once committed to mental facilities, plaintiff class members contend that they are denied appropriate medical, psychiatric, and rehabilitative treatment, and that the treatment they do receive is not within the scope of the least restrictive alternatives available. In their pre-trial brief, plaintiffs have requested the Court to grant the following relief: to declare that the actions and omissions complained of in connection with the civil commitment of juveniles violate the Sixth, Eighth, and Fourteenth Amendments to the U.S. Constitution, as well as 42 U.S.C. § 1983, the Juvenile Causes Act, Md.Cts. & Jud.Proc.Code Ann. § 3-801 et seq., and section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794; to issue an Order enjoining defendants from discriminating against plaintiff class members by denying them the same residential placements and other community-based health, welfare, and social services as afforded non-handicapped persons; to enjoin defendants from committing plaintiff class members to state mental institutions without appropriate hearing and dispositional procedures which embody constitutionally adequate commitability standards; to issue an Order requiring mandatory hearing procedures for the periodic review of commitment; to enjoin defendants from committing plaintiff class members without appropriate independent evaluations to define their present needs in light of the least restrictive appropriate placement; to enjoin further commitments until defendants present a plan for the creation or provision of sufficient appropriate less restrictive alternatives to hospital confinement; to appoint a Special Master and Expert Panel to assist in formulating and implementing the appropriate Decree; to order retroactive relief as to all rights requested; and, finally, to award plaintiffs and their class court costs and reasonable attorneys fees. Defendants, on the other hand, maintain that the declaratory and injunctive relief requested by plaintiffs is unwarranted in light of actions already undertaken by the State to remedy the commitment inadequacies complained of by plaintiff class members. They further contend that the Court is precluded by Younger v. Harris, 401 U.S. 37, 91 S.Ct. 746, 27 L.Ed.2d 669 (1971), from granting the relief sought as to legal representation. Finally, since defendants characterize plaintiffs' requests as constituting essentially habeas corpus relief challenging the fact or duration of physical confinement rather than the conditions of such confinement, defendants maintain that relief may not be obtained in this action under 42 U.S.C. § 1983. This case began on December 13, 1976, and after almost two years of discovery, which included extensive deposition testimony, the case went to trial on December 15,1978 and was concluded on December 28, 1978. The documentation amassed in this case demonstrates the thoroughness with which counsel for both sides prepared for trial. There were, for example, over 230 pages of Admissions of Fact totaling more than 600 individual admissions. Obviously, in a case of this complexity, the findings upon which the Court bases its conclusions cannot be exhaustive. In dealing with each of plaintiffs’ four principal claims, the Court will present briefly those salient factual premises upon which its ultimate conclusions and legal remedies are based. II. CONSTITUTIONALITY OF COMMITMENT STANDARDS Plaintiffs argue that the standard for commitment of juveniles by the Juvenile Court to State mental hospitals is unconstitutional in that it is void for vagueness and violative of equal protection under the Fourteenth Amendment. An additional argument advanced is that the State may not legitimately confine mentally ill juveniles without a finding that they are dangerous to themselves or others. Maryland law provides two statutory bases for the civil commitment of juveniles to mental facilities. Article 59, § 11(g) of the Md.Ann.Code provides the following standard for the voluntary commitment of persons under eighteen years of age: (g) Persons under 18 years of age. —With the exception of those facilities established under Article 59, § 31(a), any facility licensed by or under the jurisdiction of the Department may admit for the purposes of care or treatment, or both, any person under the age of 18 years who has any mental disorder which is susceptible of care or treatment and whose admission to such facility has been requested by at least one parent or his legal guardian. The person requesting such admission must, as a prerequisite to the admission, be able to understand the nature of the request. The admission request must be formal, written and assented to by an admitting physician at the facility. No person admitted pursuant to this subsection may be retained for more than three days, after the person who requested his admission requests his release, unless his admission status is changed pursuant to § 12 of this subtitle. No person admitted pursuant to this subsection may be retained by a facility for any period in excess of one year unless his admission status has been changed after initial admission or unless at the expiration of each one-year period of inpatient residence a new request is executed by a parent or the legal guardian of the patient. At those facilities established under Article 59, § 31(a), the admission of any person under 18 years of age shall be treated as an involuntary admission and shall be subject to the provisions of § 12 of this article, except that a minor who has attained the age of 16 years may consent to admission for the purpose of diagnosis and consultation pursuant to Article 43, § 135A. Additionally, the admission of a minor by a parent to a child or adolescent unit for the purpose of diagnosis and consultation which is assented to by two physicians may be treated as a voluntary admission for a period not to exceed 20 days. The standard for involuntary commitment of adults to mental facilities is located in Md.Ann.Code, art. 59, § 12, and requires at a minimum that prior to admission a person must be found affirmatively to possess a mental disorder, requires commitment for the protection of himself or others, needs inpatient medical care or treatment, and is unwilling or unable to be admitted voluntarily. Civil commitments can also be made pursuant to section 3-820 of the Juvenile Causes Act which allows the Juvenile Court to commit a child to a mental hospital without having made findings such as those required by art. 59, § 12, supra. According to plaintiffs, section 3-820 violates the Fourteenth Amendment’s equal protection clause since there is no rational basis justifying the difference between the two commitment standards. Under section 3-820, commitments can be made so long as the JCA’s dispositional objectives are satisfied: The overriding consideration in making a disposition is a program of treatment, training, and rehabilitation best suited to the physical, mental, and moral welfare of the child consistent with the public interest. JCA § 3-820(b). Before applying the dispositional provision, however, the Juvenile Court must make a jurisdictional determination that a child is “delinquent, in need of supervision, or in need of assistance.” JCA § 3-804. See also JCA § 3-802 which outlines the purposes of the Act. Citing Papachristou v. City of Jacksonville, 405 U.S. 156, 165-70, 92 S.Ct. 839, 31 L.Ed. 2d 110 (1970), plaintiffs argue that the JCA commitment standard is unconstitutional and should be invalidated since it lacks appropriate standards restricting the discretion of those officials applying the law. They rely principally on two cases, Stamus v. Leonhardt, 414 F.Supp. 439 (S.D.Iowa 1976) (“best interest” standard invalidated), and Goldy v. Beal, 429 F.Supp. 640 (M.D.Pa.1976) (“need of care” standard invalidated), where district courts found unconstitutional commitment statutes that were too vague in allowing civil commitments on the basis of subjective, ad hoc determinations. Since “involuntary civil commitment to a mental hospital, like involuntary confinement of an individual for any reason, is a deprivation of liberty which the State cannot accomplish without due process of law,” O’Connor v. Donaldson, 422 U.S. 563, 580, 95 S.Ct. 2486, 2496, 45 L.Ed.2d 396 (1975) (Burger, C. J., concurring), the due process issue raised by plaintiffs necessarily implicates the degree of specificity required in making such determinations. As the Goldy court explained, the “in need of care” standard was impermissibly vague because it lacked the degree of specificity mandated by due process considerations in light of the serious nature of the child’s loss of liberty: Such lack of specificity in a statute that authorizes an interference with the constitutionally protected right of physical liberty places insufficient limits on the discretion of officials who are responsible for its implementation, with the result that there is nothing in the statute to prevent it from being enforced arbitrarily. Such a result amounts to vagueness that violates due process. See Kendall v. True, 391 F.Supp. 413, 418 (W.D.Ky.1975), and Bell v. Wayne County General Hospital, 384 F.Supp. 1085, 1096 (E.D.Mich.1974). 429 F.Supp. at 648. Plaintiffs likewise challenge the JCA commitment provisions on equal protection grounds, claiming that there is no possible rational basis for the different standards employed in JCA § 3-820 and art. 59, § 12. In Reed v. Reed, 404 U.S. 71, 92 S.Ct. 251, 30 L.Ed.2d 225 (1971), the Supreme Court wrote that: A classification “must be reasonable, not arbitrary, and must rest upon some ground of difference having a fair and substantial relation to the object of the legislation, so that all persons similarly circumstanced shall be treated alike.” Royster Guano Company v. Virginia, 253 U.S. 412, 415, 40 S.Ct. 560, 64 L.Ed. 989 (1920). 404 U.S. at 76, 92 S.Ct. at 254. To bolster their contention that similar standards should apply for commitment of both adults and juveniles, plaintiffs point to the recommendations offered by the Final Report of the Maryland Commission on Juvenile Justice (hereinafter referred to as the “Karwacki Report”), Plaintiffs’ Exhibit No. 6, which proposed that certain redefinitions in the direction of greater specificity be made as to commitment and treatment criteria. For example, with reference to proposed legislation affecting children in need of support (“CINS”) and children in need of assistance (“CINA”), the Karwacki Report made the following proposal: The broad-scoped, ill defined “best interests of the child” formula is abandoned as the criteria for court intervention, and, substituted in its stead, is a more particularized inquiry as to whether it is necessary for the Court to protect the child from a specific harm. Thus the general law is replaced by more explicit terms enabling a more even-handed application of the law in all jurisdictions of Maryland. The Commission is convinced that intervening in the life of a child and his family should only occur when benefits to them are likely to be realized. Karwacki Report at 27. In its proposed legislation which would render commitment standards more precise, the Karwacki Commission recommended the following standard: (c) A child in need of assistance may be placed in an institution for the mentally ill or mentally retarded if: (1) The child is mentally ill or retarded; (2) The child is in need of institutional in-patient treatment; and (3) The child presents a danger to his own life or safety of others. Karwacki Report, Appendix C.4, at 14. Since the equal protection clause has been held applicable to involuntary civil commitment proceedings, Dorsey v. Solomon, 435 F.Supp. 725 (D.Md.1977), plaintiffs submit that specific findings reflecting the need for commitment should be made prior to a Juvenile Court’s ordering such commitment as is now done with adults. Plaintiffs contend that while not all Juvenile Court judges apply the JCA dispositional provision, section 3-820, it is undisputed that the judges do not apply the art. 59, § 12 involuntary commitment standards which require specific findings prior to ordering commitment. See Defendants Solomon, et al. Answer to Complaint ¶24. The “best interests of the child” standard, they claim, is so vague as to permit an “unwritten standard providpng] no basis for review.” Plaintiffs’ Pre-trial Brief at 5 n. 1. In their final challenge to the JCA’s commitment standards, plaintiffs suggest that due process considerations require that a state may not deprive someone of his liberty on grounds of his being mentally ill unless that person presents a serious danger to himself or to others. Suzuki v. Quisenberry, 411 F.Supp. 1113 (D.Hawaii 1976). The JCA dispositional standard requires no such finding of dangerousness. Since involuntary commitment entails a “massive curtailment of liberty,” Humphrey v. Cady, 405 U.S. 504, 92 S.Ct. 1048, 31 L.Ed.2d 394 (1972), plaintiffs argue that their liberty interests prevent them from being institutionalized without due process of law. This requirement is even more important in cases where juveniles are committed pursuant to the State’s parens patriae powers: It matters not whether the proceedings are labeled “civil” or “criminal” or whether the subject matter be mental instability or juvenile delinquency. It is the likelihood of involuntary incarceration— whether for punishment as an adult for a crime, rehabilitation as a juvenile for delinquency, or treatment and training as a feeble-minded or mental incompetent— which commands observance of the constitutional safeguards of due process. Where, as in both proceedings for juveniles and mentally deficient persons, the state undertakes to act in parens patriae, it has the inescapable duty to vouchsafe due process, and this necessarily includes the duty to see that a subject of an involuntary commitment proceedings [sic] is afforded the opportunity to the guiding hand of legal counsel at every step of the proceedings, unless effectively waived by one authorized to act in his behalf. Heryford v. Parker, 396 F.2d 393, 396 (10th Cir. 1968). Dangerousness to others results in commitment under the State’s police powers, whereas dangerousness to oneself provides the rationale for commitment by the State’s parens patriae powers. The view that a state’s exercise of its parens patriae power in the context of civil commitment of juveniles must bear some relationship to actual need or realistic goals is but a modern recognition of a long-recognized maxim that “[t]he restraint can continue [only] as long as the necessity continues.” Matter of Oakes, 8 L.Rep. 123 (Sup.Jud.Ct.Mass.1945). More recently, the Supreme Court affirmed this view when it concluded: “At the least, due process requires that the nature and duration of commitment bear some reasonable relation to the purpose for which the individual is committed.” Jackson v. Indiana, 406 U.S. 715, 738, 92 S.Ct. 1845, 1858, 32 L.Ed.2d 435 (1972). See also Bell v. Wayne County General Hospital at Eloise, 384 F.Supp. 1085, 1096 (E.D.Mich.1974). Plaintiffs’ challenge to the JCA commitment standards really represents a logical argument beginning with the need to make a specific finding of dangerousness. Since the parens patriae rationale requires that dangerousness be present, plaintiffs, in effect, argue that such a determination must be made initially before the commitment can be justified. Also, in order to make this determination, the authorities need more precise guidelines than those currently embodied in the JCA commitment standards. Without articulation and application of appropriate standards, subsequent commitments under the parens patriae doctrine lack the necessary “reasonable relation” between commitment and purpose. Jackson v. Indiana, supra, 406 U.S. at 738, 92 S.Ct. 1845. As the court in French v. Blackburn, 428 F.Supp. 1351, 1360 (M.D.N.C.1977), recognized, “the involuntary commitment proceedings do not have as their sole purpose the deprivation of liberty, but also have as a significant and valid goal the treatment and aid of a person alleged to be mentally ill or inebriate and who is imminently dangerous to himself or others.” Unless the state commitment standards embody an approach more specific than the “best interests of the child,” there is no guarantee that involuntary commitment will bear any rational relationship to the underlying parens patriae principle justifying the juvenile’s loss of liberty. The State, of course, submits that the JCA standards are not vague or otherwise violative of constitutional due process and equal protection guarantees. In their post-trial Memorandum, defendants Solomon, et al. suggest that: [t]he State has a legitimate interest in deciding that children who have been adjudicated to be in need of supervision, in need of assistance, or delinquent, but who are not dangerous to themselves or others, can benefit from the treatment provided in a mental hospital Since parents are limited by Article 59, Section 11 with respect to the placements they can make, the juvenile court may be the only avenue for placement of certain children who, while not “dangerous,” could benefit from treatment provided in a mental hospital. The “legitimate state interest” standard of [Planned Parenthood of Missouri v.J Danforth, [428 U.S. 52, 96 S.Ct. 2831, 49 L.Ed.2d 788 (1976)] is satisfied. Post-Trial Memorandum of Defendants Solomon, et al. at 18-19. The problem with this argument, however, is that in the specific context of involuntary commitment to a mental hospital where the deprivation of liberty is great and the possibility of stigmatization is very real, the mere possibility of benefit is not enough to justify such official paternalism: . [T]he mere presence of mental illness does not disqualify a person from preferring his home to the comforts of an institution. * * * * * * In short, a State cannot constitutionally confine without more a nondangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends. O’Connor v. Donaldson, 422 U.S. 563, 575-76, 95 S.Ct. 2486, 2493-94, 45 L.Ed.2d 396 (1975). In Lessard v. Schmidt, 349 F.Supp. 1078, 1093 (E.D.Wis.1972), the court reiter- ated the fact that the restrictions placed upon liberty in such cases must depend on there being sufficient capacity to harm. As was properly explained in Suzuki v. Quisenberry, 411 F.Supp. 1113, 1124 (D.Hawaii1976), citing Lynch v. Baxley, 386 F.Supp. 378, 389-92 (M.D.Ala.1974), A finding of dangerousness indicates the likelihood that the person to be committed will inflict serious harm on himself or on others. In the case of dangerousness to others, this threat of harm comprehends the positive infliction of injury — ordinarily physical injury, but possibly emotional injury as well. In the case of dangerousness to self, both the threat of physical injury and discernible physical neglect may warrant a finding of dangerousness. Although he does not threaten actual violence to himself, a person may be properly committable under the dangerousness standard if it can be shown that he is mentally ill, that his mental illness manifests itself in neglect or refusal to care for himself, that such neglect or refusal poses a real and present threat of substantial harm to his well-being, and that he is incompetent to determine for himself whether treatment for his mental illness would be desirable. See also Bell v. Wayne County General Hospital at Eloise, 384 F.Supp. 1085 (E.D.Mich.1974). At trial, plaintiffs presented testimony from several experts who concluded that the present JCA commitment standards were too vague and resulted in numerous inappropriate placements in mental institutions. Plaintiffs also point to the fact that defendants have even admitted the fact that some juveniles are inappropriately admitted to mental' hospitals. According to Dr. Stanley Platman, Assistant Secretary for Mental Health and Addictions, inappropriate placements by the Juvenile Court result in some cases because the mental hospitals lack the control over these admissions which they exercise over civil commitments under article 59. This lack of control may be attributed, no doubt, to the lack of specific standards in the JCA. Of particular interest is the Department of Health and Mental Hygiene’s admission itself that inappropriate placements occur because of ignorance or insensitivity, both of which may be encouraged by inadequately articulated commitment standards: a child who could be treated in a community mental health center should not be placed in an institutional setting for treatment. Too often because of lack of parental ability, lack of juvenile court appreciation of mental health programs and lack of foster care placement facilities, children who do not need to be institutionalized in hospitals find their way into our regional hospital centers. Inappropriate placements are costly to the individual, the mental health system and society. State of Maryland, Department of Health and Mental Hygiene, Plan for Fiscal Years 1979-1983 at V-561 (Plaintiffs’ Exhibit No. 7). While issues relating to appropriateness of placement may ■ further implicate the range of placement alternatives available and the claim that the least restrictive alternative should always be employed, the first hurdle is the placement decision itself which must be based upon standards subject to meaningful subsequent review, both as to the initial determination as well as to continued commitment and treatment. Consequently, the Court holds that the present JCA commitment standards are unconstitutional for the reasons expressed above and directs that standards be adopted which satisfy constitutional prerequisites. III. MANDATORY PERIODIC REVIEW The next challenge plaintiffs bring against Maryland’s juvenile commitment procedure is a due process and equal protection challenge to the absence of any mandatory periodic review provisions in the JCA or the State’s Mental Hygiene Law. JCA section 3-826 states that “[i]f a child is committed to an individual or to a public or private agency or institution, the court may require the custodian to file periodic written progress reports, with recommendations for further supervision, treatment, or rehabilitation.” (Emphasis added.) Although providing for some progress reports, this section does not mandate periodic review since a court “may” but need not require filing of such written reports. Basing their claims upon due process grounds, plaintiffs rely on Jackson v. Indiana, 406 U.S. 715, 738, 92 S.Ct. 1845, 1858, 32 L.Ed.2d 435 (1972), where the Supreme Court held that “[a]t the least, due process requires that the nature and duration of commitment bear some reasonable relation to the purpose for which the individual is committed.” See also McNeil v. Director, Patuxent Institution, 407 U.S. 245, 250, 92 S.Ct. 2083, 32 L.Ed.2d 719 (1972). Similarly, the Court has concluded that even if an involuntary commitment was initially permissible on parens patriae grounds, “it could not constitutionally continue after that basis no longer existed.” O’Connor v. Donaldson, 422 U.S. 563, 575, 95 S.Ct. 2486, 2493, 45 L.Ed.2d 396 (1975). Plaintiffs want a “mandatory” periodic review, meaning a review that is automatically initiated by the Court at the appropriate time period rather than having to wait for the committed person, his guardian, or relative to initiate such review. Plaintiffs contend that “patient-initiated review” such as habeas corpus would be ineffective given the possibility that mental patients will be unable in many instances to utilize this avenue successfully: The failure of patients to request a hearing may be attributable to their incompetence, their lack of knowledge of the relevant procedures, the effort necessary to utilize the procedures, the cost of pursuing review, the disorienting effects of drugs or other treatments, or institutional pressures to rely on staff judgments rather than to invoke legal remedies. Thus the requirements of periodic recommitment cannot be satisfied by the mere existence of patient-initiated review procedures. Note, Developments in the Law — Civil Commitment of the Mentally Ill, 87 Harv.L. Rev. 1190, 1398 (1974). Furthermore, mandatory periodic review would not only extend to the fact of commitment but would also present an occasion to review whether treatment should be continued, albeit in a less restrictive alternative. As plaintiffs amply demonstrate, not only has the Karwacki Commission endorsed mandatory periodic review but several national organizations have done so as well. The Proposed Standards for Juvenile Justice prepared by the Juvenile Justice Standards Project of the Institute of Judicial Administration and the American Bar Association would require such review of the status of all children under court supervision “at least once every six months following the initial dispositional hearing.” Defendants respond that such review is not constitutionally required since the provisions of Rule 916 of the Maryland Rules of Procedure which allows for modification or vacation of an order by any party, person, institution, or agency is all that is needed to prevent overlong or unnecessary commitments. The evidence presented at trial, however, demonstrates that reliance on Rule 916 alone will not guarantee that children remain committed only so long as is medically necessary. Mandatory periodic review does rest upon a constitutional foundation because the deprivation of liberty attendant upon a commitment can only be justified as long as that commitment is actually necessary. Without some formal, automatic review procedure, the risk is too great that children will be institutionalized far longer than required or actually become lost in a slow-moving, self-perpetuating bureaucracy. Regular review will serve as a failsafe check to make certain that no one remains committed longer than necessary and that no one remains committed to a more restrictive treatment program when a less restrictive alternative would be more therapeutic. Plaintiffs amply demonstrated that overlong hospitalization resulted from the lack of periodic review. One of defendants’ experts, Dr. Alp Karahasan, testified that juveniles committed pursuant to the JCA remained hospitalized far longer than children committed pursuant to Article 59 standards. The Admissions of Fact revealed that fifteen class members committed for at least six months had no progress reports submitted to the Juvenile Court and received no placement review hearing during their hospitalization. These class members were hospitalized from periods ranging from six to twenty-two months. Twenty-three class members had progress reports submitted to the Juvenile Court but received no placement review hearing. Ten of the twenty-three in this group did not have progress reports submitted every six months. In sixteen out of the twenty-three cases where reports were submitted to the Juvenile Court by hospital personnel, recommendations of discharge and/or a more appropriate alternative placement were made. Finally, only seventeen class members ever received placement review hearings by the Juvenile Court, and such hearings were not held every six months for the five class members who had been hospitalized for one year or longer. This record is a spotty one at best and indicates the need for a more systematic periodic review. There has been no showing that the expense of such review in terms of time or money will be great; however, overlong hospitalization, has been shown to be antitherapeutic and likely to create institutionally dependent children. One class member, William B., entered Spring Grove Hospital Center on June 29, 1976 and was recommended for release on September 29, 1976 by his treating psychiatrist in a letter to the Department of Social Services. Four similar letters were also written making the same recommendation; however, there is no evidence that the Juvenile Court received this information. William B. was finally discharged on December 21, 1977. Since commitments must now be made in terms of constitutionally adequate standards, mandatory periodic review is a necessary complement to this overall approach. Mandatory periodic review will ensure that a redetermination as to both suitability of commitment and the nature of that commitment will be based upon the standards employed during the original commitment hearing. The Supreme Court has recently noted the importance of periodic review in Parham v. J. L., 442 U.S. 584, 99 S.Ct. 2493, 61 L.Ed.2d 101 (1979), where Chief Justice Burger commented, “[w]e assume that a child has a protectible interest not only in being free of unnecessary bodily restraints but also in not being labeled erroneously by some because of an improper decision by the state hospital superintendent.” 442 U.S. at-, 99 S.Ct. at 2504. The Court expressly affirmed the “child’s continuing need” for periodic commitment review as a means of guarding against possible arbitrariness in the initial admission decision, 442 U.S. at 607 n. 15, 99 S.Ct. 2493, which raises the next logical question of who should conduct such review. IV. THE RIGHT TO MANDATORY APPOINTED COUNSEL Defendants have admitted that counsel are not always provided to juveniles in commitment hearings, and plaintiffs invoke JCA § 3-821 and Rule 906 of the Maryland Rules of Procedure to establish such a right at all stages of juvenile commitment proceedings. Rule 906 relates to the Right to Counsel in Juvenile Causes and states, in pertinent part: a. In All Proceedings — Appearance of Out-of-State Attorney. The respondent is entitled to be represented in all proceedings under this Chapter by counsel retained by him, his parent, or appointed pursuant to the provisions of subsection b 2 and 3 of this Rule. An out-of-state attorney may enter his appearance and participate in a cause only after having been admitted in accordance with Rule 20 of the Rules Governing Admission to the Bar of Maryland (Special Admission for Out-of-State Attorneys). Once so admitted, his appearanee and participation is limited by the restrictions of that Rule, b. Waiver of Representation — Indigent Cases. 2. Representation of Indigents. (a) Unless knowingly and intelligently waived, and unless counsel is otherwise provided, an indigent party, or an indigent child whose parents are either indigent or unwilling to employ counsel, shall be entitled to be represented by the Office of the Public Defender at any stage in a waiver, adjudicatory or disposition hearing, or hearing under Rule 916 (Modification or Vacation of Order). (b) Upon request or upon the court’s own motion, the Office of the Public Defender shall appoint separate counsel to represent any indigent party other than the child if the interests of the child and those of the party appear to conflict, and if such counsel is necessary to meet the requirements of a fair hearing. (Amended Nov. 5, 1976, effective Jan. 1, 1977.) Section 3-821 of the JCA provides that “A party is entitled to the assistance of counsel at every stage of any proceeding under this subtitle.” According to plaintiffs, then, “Rule 906 . . . implements this right in specifying the state agency responsible for providing counsel and implicitly charges the juvenile judges with the obligation to assure representation of all parties in juvenile proceedings over which they preside.” Plaintiffs’ Pretrial Brief at 34. Plaintiffs argue that effective assistance of counsel is required as part of due process in all criminal proceedings, Powell v. Alabama, 287 U.S. 45, 71, 53 S.Ct. 55, 77 L.Ed. 158 (1932); Gideon v. Wainwright, 372 U.S. 335, 83 S.Ct. 792, 9 L.Ed.2d 799 (1963); Argersinger v. Hamlin, 407 U.S. 25, 37, 92 S.Ct. 2006, 32 L.Ed.2d 530 (1972), and that the same right was extended to juvenile delinquency proceedings by In re Gault, 387 U.S. 1, 87 S.Ct. 1428, 18 L.Ed.2d 527 (1967), where the Supreme Court noted that a delinquency adjudication “subjected [the juvenile] to the loss of his liberty for years [and was] comparable in seriousness to a felony prosecution.” 387 U.S. at 36, 87 S.Ct. at 1448. Since counsel was necessary to help fathom the law as well as ascertain relevant facts and guarantee regularity of proceedings, id., the Court held that the Due Process Clause of the Fourteenth Amendment requires that in respect of proceedings to determine delinquency which may result in commitment to an institution in which the juvenile’s freedom is curtailed, the child and his parents must be notified of the child’s right to be represented by counsel retained by them, or if they are unable to afford counsel, that counsel will be appointed to represent the child. 387 U.S. at 41, 87 S.Ct. at 1451. In Briggs v. Mandel, Civil No. 54644 (Circuit Court of Baltimore City, 2/28/75), the court established the right of appointed counsel in involuntary civil commitment hearings in Maryland. Since the circumstances of the present case involve that “massive curtailment of liberty” found in Humphrey v. Cady, 405 U.S. 504, 509, 92 S.Ct. 1048, 1052, 31 L.Ed.2d 394 (1972), as well as a restriction of liberty similar to that in In re Gault, supra, defendants have shown no reasons as to why the facts of the present case necessitate an outcome different from Briggs, Humphrey or Gault. In the present case, the reasoning of Gault applies a fortiori because the problem is not so much the inability of the child to afford counsel as it is the inability of the child facing civil commitment to understand the nature of the commitment process. Clearly this situation is one contemplated by the Supreme Court in Argersinger where “The right to be heard would be, in many cases, of little avail if it did not comprehend the right to be heard by counsel.” 407 U.S. at 31, 92 S.Ct. at 2009, citing Powell v. Alabama, 287 U.S. 45, 68-69, 53 S.Ct. 55, 63-64, 77 L.Ed. 158 (1932). The right to counsel is similarly warranted on equal protection grounds since counsel is already required for juvenile commitments pursuant to Article 59, §§ 11(g) and 12, and is expressly contemplated by Rule 906 and JCA § 3-821. Today there can be “little doubt that a person detained on grounds of mental illness has a right to counsel, and to appointed counsel if the individual is indigent.” Lessard v. Schmidt, 349 F.Supp. 1078, 1097 (E.D.Wis.1972), vacated and remanded on other grounds, 414 U.S. 473, 94 S.Ct. 713, 38 L.Ed.2d 661 (1974). See also In re Barnard, 147 U.S.App.D.C. 302, 310, 455 F.2d 1370, 1378 (D.C.Cir.1971);. Heryford v. Parker, 296 F.2d 383 (10th Cir. 1968); Suzuki v. Quisenberry, 411 F.Supp. 1113 (D.Hawaii 1976); Bell v. Wayne County General Hospital at Eloise, 384 F.Supp. 1085 (E.D.Mich.1974); Lynch v. Baxley, 386 F.Supp. 378, 389 (M.D.Ala.1974). This right was specifically recognized by Judge Harvey of this bench in the context of insanity acquittees, Dorsey v. Solomon, 435 F.Supp. 725, 733 (D.Md.1977), and the reasoning therein is equally applicable to the instant case. Plaintiffs have also pointed to the extensive commentary in legal periodicals supporting the right to counsel in civil commitment cases. Defendants respond that there is no basis for the requested declaratory relief and that such relief is unnecessary in light of the Memorandum issued on March 17, 1978 by Chief Judge Robert C. Murphy to all Maryland trial judges. That Memorandum, however, mentioned the right to counsel, and in particular the need to implement a program assuring notification of counsel, in terms which did not emphasize that counsel had to be required in all instances: To assure that the right to counsel in these cases is properly secured, a procedure must be established to assure that the local Public Defender (or in those counties where representation is provided through Legal Aid, Judicare, or other agencies) is notified whenever a juvenile petition is filed if it is ascertained that the child’s parents are unable or unwilling to provide counsel. Efforts to establish such a procedure with the cooperation of the Juvenile Services Administration, the Department of Social Services and the Public Defender’s Office are now under way. While this procedure should protect the child’s right to counsel in every case, it is incumbent upon all juvenile judges to make certain such representation is in fact made available. If, pending implementation of the procedure, or after its implementation, there is no counsel present for the child and such counsel is not waived in accordance with Rule 906 b 1, juvenile judges should make provision for counsel before beginning the proceedings. This is of particular importance in any juvenile proceeding which might result in the child’s placement in a mental health facility or other placement outside of his home. Defendants’ Exhibit No. 1. Although Chief Judge Murphy speaks in advisory terms only, defendants note that “Most of plaintiffs’ evidence as to failure to provide counsel deals with commitments which predated Judge Murphy’s Memorandum and the institution of the new procedure.” Defendants’ Solomon, et al. Post-Trial Memorandum at 12. Plaintiffs have, however, submitted evidence as to juvenile representation in Baltimore and Anne Arundel Counties indicating that even after the letter of March 17,1978, there were two class members who were not represented by counsel in connection with their placement in a mental hospital — a juvenile in Anne Arundel County who was committed to Crownsville Hospital Center (Plaintiffs’ Exhibit No. 18) and one in Baltimore County who was detained at Spring Grove Hospital Center pending placement (Plaintiffs’ Exhibit No. 119). While this opinion was in the drafting stage, the Supreme Court decided Parham v. J. L., 442 U.S. 584, 99 S.Ct. 2493, 61 L.Ed.2d 101 (1979), in which the right to counsel in the voluntary civil commitment context was discussed at length by the Chief Justice. In Parham, the Court held that “the risk of error inherent in the parental decision to have a child institutionalized for mental health care is sufficiently great that some kind of inquiry should be made by a ‘neutral factfinder’ to determine whether the statutory requirements for admission are satisfied.” 442 U.S. 606, 99 S.Ct. at 2506. Yet the Court went further to explain that due process requirements did not require that the neutral factfinder had to be “law-trained or a judicial or administrative officer.” Id. Recognizing that “[t]he mode and procedure of medical diagnostic procedures is not the business of judges,” id., the Court determined that an adequate independent review could be performed by a “staff physician ... so long as he or she is free to evaluate independently the child’s mental and emotional condition and need for treatment.” Id. In holding that the reviewing mental factfinder did not have to be law-trained or a judicial or administrative officer, Chief Justice Burger explicitly premised his conclusions upon the belief that adversary confrontation between parent and child would pose the danger of “significant intrusion” into the parent-child relationship. “Pitting the parents and child as adversaries often will be at odds with the presumption that parents act in the best interests of their child.” 442 U.S. at 610, 99 S.Ct. at 2508. Referring to “those pages of human experience that teach that parents generally do act in the child’s best interests,” the Court concluded that “[t]he statist notion that governmental power should supersede parental authority in all cases because some parents abuse and neglect children is repugnant to American tradition.” Id. at 603, 99 S.Ct. at 2504. Finally, counsel was not required to conduct the review since there was no reason to conclude that lawyers would be more skilled evaluators than professional physicians and psychiatrists. Id. at 611, 99 S.Ct. 2493. As the Supreme Court has noted, however, “due process is flexible and calls for such procedural protections as the particular situation demands.” 442 U.S. at 608, 99 S.Ct. at 2507, citing Morrissey v. Brewer, 408 U.S. 471, 481, 92 S.Ct. 2593, 33 L.Ed.2d 484 (1972). In the present case, a flexible due process approach mandates a different conclusion from that arrived at by the Supreme Court in the voluntary commitment context. The issue before this Court is the scope and character of periodic review of involuntary commitments. Here we have no assumed paternalism between parent and child and no possible intrusion of the adversary system into the sensitive psychology of the parent-child relationship. The “statist notion” discussed above which was described as repugnant to the American tradition in the case where governmental power sought to supersede parental power is simply irrelevant here. When it is the State which, in effect, has become the child’s family, a more independent, adversary-type review of commitment is required. Requiring legal counsel in such instances does not reflect the belief that the State will abuse or neglect such children, but rather demonstrates the need to hold the State accountable whenever its actions are premised upon the “best interests” of a mentally disturbed child. As Chief Justice Burger indicated, the risks are higher when a child is alone and at the State’s mercy: “For a child without natural parents, we must acknowledge the risk of being ‘lost in the shuffle.’ ” Parham, supra, 442 U.S. at 619, 99 S.Ct. at 2513. Consequently, the risk of error both initially and over the long run when the state commits a child is sufficiently great to warrant mandatory periodic review by a neutral factfinder skilled in the complexity of adversary contests. Although the State may have assumed the position of surrogate father and mother, one cannot assume the same sort of care and concern to be forthcoming in the absence of the loving concern of natural parents. The evidence in this case has revealed not so much an insensitive bureaucracy, so much as a ponderously slow one. The record is replete with instances of overlong and unnecessary involuntary commitments. Although adversarial input will never substitute for the love and affection of a child’s natural parents, it may nonetheless serve to relieve some degree of suffering by helping ■ to prevent unnecessary and overlong involuntary commitments. The right to counsel for involuntarily committed juveniles is too important a guarantee to leave to the vagaries of haphazard application. Having found that such a right exists as a matter of due process and that Maryland law even contemplates such a right, it is necessary to grant injunctive relief providing that no juvenile shall hereafter be involuntarily committed to a Maryland mental hospital unless counsel has been provided. Furthermore, counsel must also be present at the time of any redetermination, such as the mandatory six-month review discussed in the preceding section. As the court in Tucker v. City of Montgomery Board of Commissioners, 410 F.Supp. 494, 508 n. 19 (M.D.Ala.1976), said, Where the claim of ineffective representation stems not from the nature of representation but rather from the fact of either no representation or delayed provision of counsel while defendant suffers loss of liberty, equitable relief can be fashioned which guarantees protection of the right to counsel. Voluntary civil commitments will, of course, be governed by the Supreme Court’s ruling in Parham, supra, and the statutory provisions of the Annotated Code of Maryland and Rule 906. Following the approach of the Tucker court, this Court directs the defendants within thirty days to file a plan with the Court outlining the means through which the right to counsel will be implemented. Defendants have raised several objections to the Court’s ability to grant the relief sought by plaintiffs as to mandatory counsel. Contending that the Court is barred from acting by Younger v. Harris, 401 U.S. 37, 91 S.Ct. 746, 27 L.Ed.2d 669 (1971), which would require a federal court to avoid intervention in an ongoing state civil proceeding such as the commitment of juveniles, see Huffman v. Pursue, Ltd., 420 U.S. 592, 95 S.Ct. 1200, 43 L.Ed.2d 482 (1975), reh. denied, 421 U.S. 971, 95 S.Ct. 1969, 44 L.Ed.2d 463 (1976); O’Shea v. Littleton, 414 U.S. 488, 94 S.Ct. 669, 38 L.Ed.2d 674 (1974); Lynch v. Snepp, 472 F.2d 769 (4th Cir. 1973), cert. denied, 415 U.S. 983, 94 S.Ct. 1576, 39 L.Ed.2d 880 (1974), defendants maintain that there are no exceptional grounds such as bad faith or harassment which would warrant raising the lack of counsel question in any collateral federal proceeding other than through a habeas corpus petition. Defendants would therefore bring the facts of this case within the rationale of Preiser v. Rodriguez, 411 U.S. 475, 500, 93 S.Ct. 1827, 36 L.Ed.2d 439 (1973), which dealt with a challenge to improper confinement rather than the conditions of that confinement. Consequently,' section 1983 relief would be inappropriate in this case, and plaintiffs must then be required to satisfy the pertinent habeas corpus exhaustion provisions of 28 U.S.C. § 2254(b) and (c). As a further and final basis for precluding the relief sought in this case from a federal court, defendants point to the inappropriateness of injunctive relief on the basis of general principles of comity. Rizzo v. Goode, 423 U.S. 362, 377-81, 96 S.Ct. 598, 46 L.Ed.2d 561 (1976). The evidence, argue defendants, does not justify broad injunctive relief, especially in light of Chief Judge Robert C. Murphy’s March 17, 1978 Memorandum to all Trial Judges in Maryland recommending that “juvenile judges should make provision for counsel before beginning the proceedings.” Defendants’ Exhibit No. 1. (Emphasis added). Plaintiffs respond to defendants’ Younger argument by noting the absence of any pending state court proceeding. They did not bring the present action to enjoin any ongoing Juvenile Court proceeding or as a means of proceeding in lieu of appealing a state court ruling on the claims presented herein. Several cases cited by plaintiffs in their Reply to Defendants Solomon et al. Post-Trial Memorandum support their argument that abstention under Younger and Huffman is unwarranted in the instant case. See, e. g., French v. Blackburn, 428 F.Supp. 1351 (M.D.N.C.1977); Coll v. Hyland, 411 F.Supp. 905 (D.N.J.1976); Goldy v. Beal, 429 F.Supp. 640 (M.D.Pa.1976); Kidd v. Schmidt, 399 F.Supp. 301 (E.D.Wis.1975). In French, the court declined to abstain in a case challenging North Carolina’s statutory involuntary commitment procedures since there was no commitment proceeding pending as to the plaintiff. 428 F.Supp. at 1354 n. 5. The court in Coll reached a similar conclusion by way of distinguishing Schmidt v. Lessard, 421 U.S. 957, 95 S.Ct. 1943, 44 L.Ed.2d 445 (1975): Defendants also claim that abstention is proper. They contend that under the teachings of Younger v. Harris, 401 U.S. 37, 91 S.Ct. 746, 27 L.Ed.2d 669 (1971), and its progeny, this suit is not appropriate for injunctive relief because of the interference with state activities. They rely primarily on Huffman v. Pursue, Ltd., 420 U.S. 592, 95 S.Ct. 1200, 43 L.Ed.2d 482 (1975), and Schmidt v. Lessard, 421 U.S. 957, 95 S.Ct. 1943, 44 L.Ed.2d 445 (1975). However, these cases are readily distinguishable. In Huffman, the federal action was filed immediately after the state trial court had entered its judgment but during the period for appeal in the state system. In Schmidt v. Lessard, supra, a three-judge court declared the Wisconsin civil commitment procedures constitutionally defective, but the Supreme Court vacated that judgment and remanded for further consideration in light of Huffman v. Pursue, Ltd., supra. Examination of the lower court opinions reveals that the federal intervention occurred immediately after the patient had been committed but before a hearing had been set in the state court. 411 F.Supp. at 908. Goldy, which presented a challenge to Pennsylvania’s mental health statute, also involved a claim by defendants that the federal court should abstain from deciding the merits in light of the reasoning of Younger, supra, and Railroad Commission v. Pullman Company, 312 U.S. 496, 61 S.Ct. 643, 85 L.Ed. 971 (1941). In rejecting defendants’ arguments, the court stated: The abstention issues require little comment. Defendants maintain that this Court should abstain under the Pullman rationale in order to afford the Pennsylvania state courts the opportunity to construe section 406 in a manner that would avoid the constitutional problems of vagueness and overbreadth. The short answer to this contention is that the Pennsylvania Supreme Court recently declined an opportunity to rule on the constitutionality of section 406, in Commonwealth ex rel. Finken v. Roop, 234 Pa.Super. 155, 339 A.2d 764 (1975), petition for allocatur denied, October 17, 1975. In Finken, a habeas corpus action challenging a commitment pursuant to section 406, the Pennsylvania Superior Court, in a 4-3 opinion, ordered the petitioner discharged for failure to comply with the procedural requirements of the Act itself. Three of the judges also reached the constitutional issues raised by the petitioner, and held, inter alia, that the commitment standards of section 406 were void for vagueness. Id. at 179-184, 339 A.2d 764. The Pennsylvania Supreme Court’s denial of allocatur in Finken means that there is no prospect of a Pennsylvania Supreme Court decision regarding the constitutionality of section 406 in the near future. Because a federal court may not abstain “ ‘simply because the rights asserted may be adjudicated in some other forum,’ ” Zwickler v. Koota, 389 U.S. 241, 248, 88 S.Ct. 391, 395, 19 L.Ed.2d 444 (1967), citing Stapleton v. Mitchell, 6 F.Supp. 51, 55 (D.Kan.1945), this Court declines defendants’ invitation to abstain in this case. Defendants’ Younger v. Harris argument is equally without merit. The Younger v. Harris doctrine only applies when a federal court is asked to enjoin or interrupt an on-going state court proceeding in which the federal plaintiffs will have an opportunity to have their claims adjudicated. See Hicks v. Miranda, 422 U.S. 332, 95 S.Ct. 2281, 45 L.Ed.2d 223 (1975). There presently exists no state court proceeding whatsoever involving these plaintiffs, and no such proceeding is imminent. Younger v. Harris, therefore, simply does not apply to this case. 429 F.Supp. at 644-45. The court further addressed defendants’ argument that under the rationale of Preiser v. Rodriguez, 411 U.S. 475, 93 S.Ct. 1827, 36 L.Ed.2d 439 (1973), a section 1983 action was improper where habeas corpus relief under 28 U.S.C. § 2254 was the appropriate avenue: Several cases decided since Preiser would appear to support plaintiffs’ proposed distinction from that case. In Gerstein v. Pugh, 420 U.S. 103, 95 S.Ct. 854, 43 L.Ed.2d 54 (1975), plaintiffs were pretrial detainees who were being held for trial under a prosecutor’s information and who had not had any judicial determination of probable caúse. They brought a section 1983 action in the district court, claiming a constitutional right to a judicial hearing on the issue of probable cause and requesting an order that the state authorities afford them a probable cause determination. The Court held that “[bjecause release was neither asked nor ordered, the lawsuit did not come within the class of cases for which habeas corpus is the exclusive remedy.” Id. at 107 n. 6, 95 S.Ct. at 859. See also Gomez v. Miller, 341 F.Supp. 323 (S.D.N.Y.1973) (3-judge court), which was decided prior to the decision in Preiser, but was affirmed summarily following Preiser in Miller v. Gomez, 412 U.S. 914, 93 S.Ct. 2728, 37 L.Ed.2d 141 (1973). Because plaintiffs in this case do not request release from custody, they are not required to proceed by habeas corpus. Accord, Bradford v. Weinstein, 519 F.2d 728, 730 (4th Cir. 1974), vacated and remanded as moot, 423 U.S. 147, 96 S.Ct. 347, 46 L.Ed.2d 350 (1975); and Pope v. Chew, 521 F.2d 400, 406 n. 8 (4th Cir. 1975). 429 F.Supp. at 645-46 (footnote omitted). This Court finds the reasoning in Goldy to be entirely apposite to the present case. Consequently, plaintiff class members will not be barred from pursuing their claims under 42 U.S.C. § 1983. Finally, Kidd also found Younger-Huffman abstention inappropriate in a situation where the state children’s court exercised continuing jurisdiction over the juvenile for matters concerning questions of dependency and neglect but not commitment. Since there were no pending state commitment proceedings, abstention was held to be inappropriate. 399 F.Supp. at 303. See also Santiago v. City of Philadelphia, 435 F.Supp. 136, 144-46 (E.D.Pa.1977); Kamke v. Silverman, 418 F.Supp. 1003, 1005 (E.D.Wis.1976). Defendants reason that there is no basis for injunctive relief as to the provision of counsel on the grounds that there has been no showing of their “direct responsibility” for any constitutional violations and that there is insufficient evidence pointing to the need for an “extraordinary remedy.” Rizzo v. Goode, 423 U.S. at 373-77, 96 S.Ct. 598. The Fourth Circuit, however, has noted that “[wjhile Rizzo states that the principles of federalism militate against injunctive relief under 42 U.S.C. § 1983 against the executive branch of state or local governments, Rizzo does not preclude recourse to broad injunctions when a clear pattern of unconstitutional conduct has been established.” Bolding v. Holshouser, 575 F.2d 461, 466 (4th Cir. 1978), cert. denied, 434 U.S. 837, 99 S.Ct. 121, 58 L.Ed.2d 133 (1979). See also Tucker v. City of Montgomery Board of Commissioners, 410 F.Supp. 494, 509 (M.D.Ala.1976); Cicero v. Olgiati, 410 F.Supp. 1080, 1091 (S.D.N.Y.1976). As already explained, plaintiffs’ evidence amply demonstrates that counsel has not been provided even after Chief Judge Murphy’s letter and extending through the date of the trial. In noting that the provision of counsel as contained in the statute and court rule is often disregarded in juvenile proceedings, plaintiffs endeavor to distinguish the ruling in Kelly v. Wyman, supra, 294 F.Supp. 893 (S.D.N.Y.1968), aff’d, 397 U.S. 254, 90 S.Ct. 1011, 25 L.Ed.2d 287 (1970). In Kelly, welfare recipients challenged under the Civil Rights Act, 42 U.S.C. § 1983, procedures utilized in terminating their welfare benefits which ended their assistance prior to a hearing. While the three-judge court mandated that certain procedures, including a pretermination hearing, were constitutionally required, the court refused relief with regard to the allegation that the regulations were frequently disregarded. 294 F.Supp. at 907. Plaintiff class members successfully distinguish Kelly on two grounds. First, Kelly involved administrative matters only and did not codify any constitutional right which this Court has found to be applicable. Second, the regulations in Kelly had been recently promulgated, whereas JCA § 3-821 was first enacted in 1969 and Rule 906 of the Maryland Rules of Procedure was enacted in 1975. Accordingly, defendants’ arguments that injunctive relief is not warranted are without merit, and they should comply with this Court’s Order to file a plan within thirty days which will implement the right to counsel. V. THE RIGHT TO TREATMENT, CARE, AND HABILITATION IN THE LEAST RESTRICTIVE SETTING More than any other aspect of plaintiffs’ case, the alleged right to treatment, care, and habilitation in the least restrictive setting will require an evaluation of the technical medical issues often raised in psychiatric treatment and also a consideration of whether additional revenues should be forthcoming from the State to satisfy minimum constitutional standards. When law, medicine, therapy, and the public purse all become intertwined in a single problem, we have all of those ingredients calling for a “special delicacy of the adjustment to be preserved between federal equitable power and State administration of its own law.” Rizzo v. Goode, 423 U.S. 362, 378, 96 S.Ct. 598, 607, 46 L.Ed.2d 561 (1976), citing O’Shea v. Littleton, 414 U.S. 488, 500, 94 S.Ct. 669, 38 L.Ed.2d 674 (1974). This Court takes cognizance of Judge Van Graafeiland’s observation that “[a] Federal judge rearranging a State’s penal or education system is like a man feeding candy to his grandchild. He derives a great deal of personal satisfaction from it and has no responsibility for the results.” McRedmond v. Wilson, 533 F.2d 757, 766 (2d Cir. 1976) (Van Graafeiland, J., dissenting). At the same time, a federal court has an obligation to announce and apply constitutional standards as well as to monitor their implementation. To find otherwise would, in effect, be to write the Supremacy Clause out of the Constitution altogether. Although there are obvious practical limits on the extent to which a federal court can command expenditures from the state treasury, the fact that guaranteeing a constitutional right may call for additional state funding is not a valid defense to a constitutional requirement. Doe v. Lally, 467 F.Supp. 1339, 1351 (D.Md.1979); Palmigiano v. Garrahy, 443 F.Supp. 956, 978-79 (D.R.I.1977). A. Sources of the Right Plaintiffs rely on both statutory and constitutional sources to support their argument for the right to appropriate treatment, care, and habilitation. As statutory authority for their view, plaintiffs direct the Court’s attention to the dispositional sectional of the JCA, section 3-820, supra, and the general purposes section which provides for a “liberal” construction of the JCA’s overall objectives: §