WPAS Wins
Stunning Victory in
Pierce County
v. State of Washington
by David Lord
October 18, 2005
Last month, the Washington Protection and
Advocacy System (WPAS) and Pierce County Regional Support Network (RSN) won a
stunning victory for Washington State mental health consumers in Pierce
County v. State of Washington. This lawsuit was originally brought by Pierce
County RSN and WPAS joined the court case as a plaintiff almost two years ago.
Ira Burnim, the legal director of the Bazelon Center for Mental Health Law, was
also an attorney on the case.
The case is not yet completed and a trial is
scheduled for November. However, the judge has already made two significant
rulings and a major part of the case settled. As a result, people who use
State mental health services have won three important victories:
- The State must provide appropriate
treatment for long-term hospital patients.
- Western State Hospital has a new
discharge policy that will be monitored by WPAS.
- The State can no longer automatically
take money away from community service providers when too many patients are
admitted to Western State Hospital.
Appropriate Treatment for Long Term
Hospital Patients
On September 9, 2005, Thurston County
Superior Court Judge Paula Casey ruled that the State is responsible for taking
“custody” of patients with 90 or 180 day civil commitments. This means
that the State can no longer refuse to treat these patients when Western State
Hospital (WSH) is full.
The State left many patients with 90-day and
180-day commitments at community hospitals, emergency rooms, and sometimes even
jails. As a result, these patients were stuck in “evaluation and
treatment” and other facilities. These facilities are not designed or
licensed to provide long-term psychiatric hospital care. Patients who have
longer commitments don’t receive adequate treatment in these short-term
facilities.
As a result of the Judge’s ruling, the State
must take “custody” and it seems likely that the State will have to open a new
ward at WSH. However, an increase in hospital beds should only be a short
term strategy to address the Judge’s ruling. In the long term, more effective
community supports should be put into place.
WPAS to Monitor Discharges from State
Hospitals
As a result of a partial settlement of the
lawsuit, Western State Hospital has a new discharge policy. The new policy
requires that patients be psychiatrically stable at the time they are
discharged, and they cannot be discharged to a place that is likely to cause
their mental illness to become worse. The implementation of this policy
will be monitored by WPAS. The State agreed to the policy after WPAS and the
Pierce County RSN showed that numerous hospital patients had been
inappropriately discharged from the State psychiatric hospital. Patients
were sent to the streets, homeless shelters and other unsafe situations.
WPAS began its investigation over two years
ago after receiving reports of people being discharged to the streets.
“The investigation was hard work – and you couldn’t do it from the office,”
explains Debbie Dorfman, WPAS Legal Director. “Legal team members
interviewed homeless people in shelters, streets, and jails. We found out
how bad the ‘patient dumping’ was at Western by talking to the people who
experienced it. For example, some people had to walk to shelters in
downtown Tacoma from WSH.” There was no discharge policy at Western State
Hospital.
The investigation took months to complete.
WPAS staff visited shelters, soup kitchens, boarding homes, clinics, and
community providers. Many people were interviewed and the records of many
patients were examined.
WPAS investigator Craig Awmiller was swamped
in paper. “The documents! There were thousands of them. We
pored over files for months. We reviewed records at Western, at community
agencies, and records from the State,” Awmiller said. “ Then, we had to get
examples of discharges to the experts. They determined whether or not the
discharges were up to professional standards.”
The WPAS team found many instances of poor
and unsafe discharges. An examination of Western State Hospital patient
discharge records by a national expert, Dr. Ivor Groves, found that 46 percent
of those discharges did not meet professional standards. Another expert,
Dr. John R. Elpers, UCLA Professor of Psychiatry, stated that “in regard to
discharge planning, [Western State Hospital] treatment teams are indeed doing
the same unsuccessful thing over and over again . . . that places their patients
at risk of suffering immediate and irreparable harm.”
Community Services Cannot be Punished when
Patients are Admitted to Western State Hospital
Judge Casey also ruled that the State can not charge the Pierce County
Regional Support Network “liquidated damages” for admissions to Western State
Hospital. These charges reduced the money the RSN has available to provide
community services by over $1 million per year.
For several years, the State has set a limit on how many patients can be
admitted to the state psychiatric hospitals from each Regional Support Network
(RSN). When there are more admissions than this limit, the State
automatically charges a penalty against the community providers. The
theory is that the community providers will do anything to avoid having their
clients admitted to the State hospital, because they will have to pay a huge
penalty if there are too many admissions.
WPAS supports the goal of serving people with psychiatric disabilities in the
community. However, as Awmiller puts it, “the State’s method for reducing
hospitalization makes no sense. They are actually taking away the money from
community providers when they don’t succeed in avoiding hospitalizations.
That’s backwards. Community providers need more resources, not less, to
keep their clients out of Western.”
Instead of punishing failure, the State should mandate that community
providers use services that have been shown to be effective in preventing
hospitalization. However, these services don’t come free. Siphoning
money out of the community through liquidated damages only makes the problems
worse.
The money taken away from the community as liquidated damages should be used
to pay for individualized, wrap-around services. Instead of requiring a
client in crisis to go to a community mental health center or other agency,
services and supports travel to the client. WPAS will advocate for the
development of these sorts of community services.
Potential Impact of
the Settlement and the Orders
The partial settlement and Judge Casey’s orders in this case have major
implications.
- First, the court’s requirement that the State take responsibility for
long-term patients will increase the size of Western State Hospital in the
short term – but patients will no longer be kept in community facilities,
including jails, that aren’t able to meet their needs.
- Second, WPAS will closely monitor the discharges from WSH and will
challenge the State when discharges don’t meet the policy’s standards.
- Finally, the end of liquidated damages could result in the restoration of
millions of dollars to community programs.
The Pierce lawsuit shows that reducing the size of the State hospitals is not
a worthy goal if the result is patients dumped onto the streets or denied
hospital care when they need it. Downsizing must be done appropriately and
safely. The lawsuit also affirms that well-funded, quality community
services are a solution for many of the serious problems of the State’s mental
health system.
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Full Participation in America
"We do not belong in segregated institutions,
sheltered workshops, special schools or nursing homes."
[www.allianceforfullparticipation.org]
by Phil Jordan
October 17, 2005
People with disabilities from all over the
country met in Washington D.C. last month. They had been invited to go to
a conference as guests of the newly formed Alliance for Full Participation.
Think about that a minute. They had been
asked to be guests, while others talked about how to include them.
The members of
Self Advocates Becoming Empowered (SABE)
were not satisfied to be onlookers, so they took matters into their own hands.
If people with disabilities are to achieve "full participation," then they
should not be guests, but organizers and participants in the conference.
Many of the other organizations were taken aback by the powerful advocacy of
SABE, but soon came to realize that if they were going to "talk the talk" of
full participation, they had also better "walk the walk!" It was at that
point that the Alliance for Full Participation could truly live up to its name.
Agenda for Full Participation in
America
In late September of this year, war raged in Iraq and people struggled to
rebuild their lives after being devastated by hurricanes. While all this
was going on, Americans who live with lifelong disabilities, their family
members, and the people who work alongside them, came together in partnership to
participate in a ground breaking event. Eleven national organizations
teamed up with people from every walk of life to create a single vision.
This is what they said:
We want dignity and respect for all. We want full
participation for all.
Self Advocates Becoming Empowered challenged us and
together we rose to their challenge.
People with developmental disabilities want our fellow
Americans to know that we have much to contribute and we want some things from
American society:
We are Americans too! We want to be included in all
communities in our great nation and to have all the rights and responsibilities
of full citizenship. We need to be safe and free at the same time.
We know how to do this. Few American communities are listening.
We belong in schools, neighborhoods, businesses,
government and churches, synagogues and mosques.
We do not belong in segregated institutions, sheltered
workshops, special schools or nursing homes. Those places must close, to
be replaced by houses, apartments and condos in regular neighborhoods, and
neighborhood schools that have the tools they need to include us. We can
all live, work and learn in the community. We invite our fellow citizens
to support the Community Imperative with us. It says that no one should
live in an institution because of disability.
[http://thechp.syr.edu/community_imperative.htm]
We can work in worthwhile jobs. We know how to help
each other do this. It is being done in some places, just not all places.
We hope to be welcomed to work for the American dream alongside other Americans.
Here is what the diverse group of American leaders believe
must happen to make this vision a reality:
For states that still fund public and private
institutions, we want to see a plan to close them over the next few years, and
people with lifelong disabilities helped to live in communities, in regular
houses and regular neighborhoods. Starting today we expect all states to
stop placing children in institutions and segregated residential schools.
People want real jobs with real pay, real businesses and
volunteer opportunities, not sheltered workshops and day programs. Just
because a person has a disability does not mean that person cannot contribute to
our communities.
Families with sons and daughters with lifelong
disabilities often need some support to have equal access to full and rich
family lives. Having a child (who may be an adult now) with a disability
must not force a family into poverty or constant, lifelong worry. While
some have support to lead decent lives, others have not and are isolated and
feel abandoned by America. Everyone who needs it must get the support they
need.
People with disabilities must be part of all planning,
governance, leadership and implementation of the programs that affect us.
As SABE has so aptly stated, "Nothing about us without us."
The term mental retardation has become hurtful. Stop
using it! Words hurt and labels limit human potential. It is
un-American. Try calling people by their name.
Public funds expended on behalf of people with
developmental disabilities must be under their control and direction and, for
children and others who need it, their families and trusted friends.
People who have chosen to work in this field directly with
people with developmental disabilities should be paid a decent wage with
benefits; they should not have to work two or three jobs just to support their
families. This is important work that must be respected.
Medicaid is the vital lifeline for people with
developmental disabilities. Medicaid reform must protect access to these
programs, promote inclusion for people in their communities and empower citizens
to control the funds spent on their behalf.
Inclusive communities are part of the solution.
Inclusive communities support all people, and make limited public funds go
farther, to help those in need.
America is changing and becoming more diverse. We
must understand and honor this diversity, and include all people in planning,
governing and participation in communities.
Poverty limits human potential. Jobs, opportunities
to start businesses, build assets and be a part of communities, help all
Americans.
People with intellectual and developmental disabilities
and their families are often pitted against people with other severe, chronic
and lifelong disabilities in American politics at all levels. We want to
work toward the same ends as other people with disabilities. Together.
We speak for ourselves and welcome positive coalitions with others.
Teams are working in each state to implement our vision
and goals. Citizens, governors, state legislators and policymakers must
help all of us reach this vision. If you want to join with us to create a
more inclusive America, we welcome you at:
www.AllianceForFullParticipation.org
The websites of the member organizations of the Alliance are listed below:
Self-Advocates Becoming Empowered
- www.sabeusa.org/
National Disability Rights Network
- www.ndrn.org/
Association of University Centers on
Disabilities - www.aucd.org
National Association of Councils on
Developmental Disabilities - www.nacdd.org
The Arc of United States -
www.thearc.org
United Cerebral Palsy -
www.ucp.org
The Council on Quality and Leadership
- www.thecouncil.org
American Network of Community Options
and Resources - www.ancor.org
National Alliance for Director
Support Professionals - www.nadsp.org
The National Association of State
Directors of Developmental Disabilities Services -
www.nasddds.org
American Association on Mental
Retardation (AAMR) - www.aamr.org
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Disability Advocates
Criticize FEMA's Slow Housing Response
By Dave Reynolds, Inclusion Daily Express
October 13, 2005
Reprinted with permission of Inclusion
Daily Express
International Disability Rights News Service
http://www.InclusionDaily.com
Your quick, once-a-day look at disability rights, self-determination
and the movement toward full community inclusion around the world.
BILOXI, MISSISSIPPI--Several Mississippi disability advocacy groups on
Wednesday criticized the federal government for its slow response in providing
adequate housing for people with disabilities.
Advocates representing the Mississippi Protection and Advocacy Systems, Inc.
(MPAS), the Arc of Mississippi, the University of Southern Mississippi and
Living Independence for Everyone gathered for a press conference to draw
attention for the need for accessible temporary housing.
Becky Floyd, executive director of MPAS, said that more than 20 people in
South Mississippi need trailers that are wheelchair-accessible, but that only
two have received them in the six weeks since Hurricane Katrina devastated the
area.
"They're so overwhelmed by all of it that they just lose our people with
disability," Floyd said of FEMA, the Federal Emergency Management Agency. "They
haven't been organized enough to have a certain group of people to handle the
special needs people."
Stan Cramer, FEMA's local public information officer, told the local
newspaper: "It's difficult to find travel trailers outfitted for the disabled."
"But all special needs people are on a priority list," Cramer said. "We're
certainly aware of special needs people needing housing, and we're doing
everything possible to find and deliver trailers to everyone who needs them."
Floyd told WLOX-TV: "It's difficult for everyone, but it's particularly
difficult for people with disabilities. It's very important for FEMA to
understand that people with disabilities need shelter. It's more difficult for
them to live in shelters, in tents or in other people's homes."
Related stories:
"Groups Blast FEMA For Failing The Disabled" (WLOX-TV)
http://www.wlox.com/global/story.asp?s=3972346&ClientType=Printable
"Disabled need handicapped-accessible trailers" (Sun Herald)
http://www.sunherald.com/mld/sunherald/news/local/12887678.htm
Other disability stories related to Hurricanes Katrina and Rita are available
on today's Below the Fold Page:
http://www.inclusiondaily.com/news/05/btf/10130556.htm#hurricanes
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Hurricane
Katrina's Impact on the
Disability Community:
Immediate Needs and Long Term Consequences
Resulting from Inadequate Government Policy
Compiled by
ADAPT
September 21, 2005
Hurricane Katrina aftermath: The immediate impact on survivors with disabilities;
While nursing homes and other institutional settings were an understandable
evacuation alternative as a first response, they are no more appropriate for the
long term than are the shelters like the Astrodome. Both need to be short
term so people can resume/rebuild lives in the community as quickly as possible.
In the evacuation process, people with disabilities were separated from their
wheelchairs and walkers, canes and service dogs, caretakers and family members.
As a result many people ended up being sent to nursing homes because they were
perceived to need more assistance than they typically do. It is imperative to
reunite people with family members and caregivers and service animals, and to
replace their assistive equipment so they can resume/rebuild their lives in the
community as quickly as possible.
People with disabilities have been grossly undercounted and unnoticed because
many bypassed shelters when they were immediately sent to nursing homes,
institutions and/or hospitals. These institutional settings, especially those
spread across the country, are not being served by the FEMA Super Service
Centers. It is imperative that an accurate accounting occur to identify all the
people with disabilities of all ages who were temporarily sent to nursing homes
in Louisiana and many other states, and that an inventory of their needs be
compiled.
Service coordination and brokering is essential to bridge the gap between the
persons with disabilities rendered homeless by Katrina and the accessible homes,
transportation, services and supports they need to resume/rebuild their lives in
the community as quickly as possible. Centers for Independent Living, local Arcs
and People First groups, and other community-based disability organizations are
experts on people with disabilities and their service and support needs. Funding
them to provide service coordination/brokering for Katrina survivors would be
cost effective, provide competent, knowledgeable assistance, and prevent the
need to "re-invent the wheel."
Longer term impact on entire national disability community;
The needs, services and supports of poor people with disabilities must not be
pitted against the needs, services and supports of the Katrina survivors. Policy
formulated to assist survivors of Katrina should not provide a stop-gap band-aid
solution to a gaping wound in the current disability service system. Reforming
the system to heal the wound for ALL Americans will prevent the need for similar
stop-gap initiatives in the future. People with disabilities and other poor
people have been waiting for as long as 10 years in some states for
affordable/accessible/HUD subsidized housing. Over and over, they have been told
"there is no housing."
In the aftermath of Katrina, great stocks of affordable/HUD subsidized
housing suddenly materialized. Like those who, thankfully, survived Katrina,
poor people with disabilities also need homes, and want to end their
homelessness. HUD, Congress and the President must find ways to help Katrina
survivors that don't decimate the already critical lack of resources available
to poor people with disabilities.
Legislation just proposed in the Senate provides that the Medicaid dollars
paying for disabled Katrina survivors in nursing homes and institutions would
follow them, assisting them to return to their former or new communities, and
not be forced to remain in the nursing homes and other institutions. This
enlightened common-sense solution should be available to ALL persons with
disabilities, being exactly what people with disabilities have been advocating
for the past 25 years. In addition, when this legislation passes, it should
assure that people with disabilities in the states, who have again been waiting
for years for funding that will allow them to return to or remain in their own
homes and communities, will not be pushed to the back of the line by the Katrina
survivors in need.
As hard and tirelessly as FEMA and the Red Cross worked in this unprecedented
national disaster, Katrina exposed the frightening lack of knowledge and
experience of both agencies when it comes to people with disabilities, the
systems that serve them, and the critical need for service
co-ordination/brokering in order to assure that people with disabilities are not
left behind to die, or left unserved when the crisis is over. Comprehensive and
long-term planning efforts must be adequately funded and need to meaningfully
involve people with disabilities so that the result will be an expert national
network that can mobilize immediately to see to the very particular and specific
needs of persons with disabilities in disaster situations. In order to assure
quality outcomes, the federal government must invest in a quality process.
# # #
54 million Americans have some level of disability, 26
million people have a severe disability. [Current Population Reports. U.S.
Department of Commerce - Census Bureau. Aug. 1997 p. 70-61]
This article was written and compiled by ADAPT.
Learn more about ADAPT at
http://www.adapt.org/
Learn more about housing issues at Steve Gold's website at
http://www.stevegoldada.com/
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WPAS Updates: What's Happening at
WPAS?
- by Phil Jordan and
Michael Smith
- October 17, 2005
WPAS Loses Long Time Advocate
Gillian
Maguire was at WPAS for a long, long time. For seventeen years she was an
advocate that just kept going and going and going . . .
It seems that everywhere you go in the state to talk with people
with disabilities, they always know Gillian. She was on the Governor's
Committee for Disability Issues and Employment, she was with Project PAS-Port
for Change from the very beginning, and she was the woman behind the scenes that
organized Independent Living Day each year in Olympia. Known for her sunny
smile and her dynamic personality, she is a friend to everyone she meets.
Gillian came to WPAS in the 1980s as an intern, and left in 2005
as the Director of Resource Advocacy. She was a dynamic force in our state
that created positive changes in the lives of people with disabilities.
Gillian, a native of Ireland, has moved back across the ocean
and now lives in France. She will be missed by the entire disability
rights community. Bon Voyage, Gillian!
WPAS Legal Team Scores Victory in Hearing
WPAS recently represented a client with multiple sclerosis in
need of a lift system in his home. The system would allow transfers from
bed to wheelchair to bathroom, and transfers in and out of a vehicle when out in
the community. The client had requested that his private insurance
purchase several lift systems, as recommended by his doctors. The insurer
originally denied the funding and approved instead a Hoyer lift. A Hoyer
lift is a brand of transfer device that could not be used in the client's home
and was not appropriate for the client's medical needs. WPAS attorney,
Michael Smith, represented the client at an appeal of the funding denial.
The panel was impressed by the presentation and approved payment for all of the
requested assistive technology, including a ceiling lift and portable lift, all
costs of installation, and engineering and construction costs.
WPAS Co-sponsors Conference, Gains New Allies
WPAS has spent a lot of time over the past few years calling
attention to the fact that people with disabilities are abused at an
astonishingly high rate. In September, WPAS co-sponsored a conference that
addressed that problem. "Making the Case for Justice" was a successful
conference that brought together the criminal justice community and advocates
for elders and people with disabilities to fight abuse and neglect against
vulnerable adults. One of the biggest benefits of the conference was the
beginning of a strong relationship between these two communities that have not
had a lot of experience with each other. Other conference organizers
included the Seattle Police Department, King County Sheriff's office, King
County Judicial Administration, and the Department of Social and Health
Services.
The King County Prosecutor's Office was one of the primary
sponsors along with the Washington State Developmental Disability Council, AARP
of Washington, Bellevue Police Department, and DSHS.
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P&A
Q&A - Answers to Questions People Ask WPAS
Voluntary
Mental Health Treatment for Minors
Law-In-Brief: Mental Health
#1
by Gordon Hom
September, 2005
Minors Twelve Years and Younger
Minors twelve years of age and younger must
have consent from the minor’s parent or legal guardian before obtaining
voluntary outpatient mental health treatment. See RCW 71.34.530.
Similarly, minors twelve years and younger must have parental or legal guardian
authorization for voluntary inpatient treatment. See RCW 71.34.042.
Rights of Minors Thirteen Years and Older
Minors thirteen years and older have a right
to obtain and receive outpatient mental health treatment without the consent of
their patents or legal guardian. See RCW 71.34.030. Similarly, minors
thirteen years and older have the right to admit themselves voluntarily for
inpatient mental health treatment without parental or legal guardian consent,
only if such admission is approved by a mental health professional. See
RCW 71.34.042. However, the parent or legal guardian must be notified
within twenty-four (24) hours of the minor’s admission and be given an
explanation of the medical necessity for the admission. See RCW
71.34.044.
A minor thirteen years or older who has been
voluntarily admitted to an evaluation and treatment facility may give written
notice of intent to leave at any time and must be discharged by the second day
following the facility’s receipt of this written notice. See RCW
71.34.046 (1) and (3).
A minor thirteen years or older who remains
voluntarily admitted at an evaluation and treatment facility must submit a
written renewal of consent every twelve (12) months. The need for continued
inpatient treatment must also be reviewed and documented no less than every one
hundred eighty (180) days. See RCW 71.34.042.
Any minor voluntarily admitted to inpatient
treatment under RCW 71.34.042 or RCW 71.34.052 shall be discharged immediately
upon written request of the parent. See RCW 71.34.054.
Parental Admission of Minors to Voluntary
Mental Health Treatment
Parents may admit their children to an
evaluation and treatment facility or a licensed inpatient mental health facility
without the child’s consent for examination and determination of whether the
child has a mental disorder and is in need of inpatient treatment. When a minor
is admitted voluntarily by a parent and without the minor’s consent, a
professional must complete an evaluation within twenty-four (24) hours, but no
more than seventy-two (72) hours, to determine if inpatient treatment is
medically necessary. Within twenty-four (24) hours of completing the
evaluation, the professional must notify the Department of Social and Health
Services if the minor will be held for treatment. See RCW 71.34.052.
A parent may similarly bring their minor
child to an outpatient mental health provider without the minor’s consent for
evaluation to determine whether the minor has a mental disorder and is in need
of outpatient treatment. RCW 71.34.054.
This publication is an information service of the
Washington Protection & Advocacy System (WPAS). It provides general information
as a public service only, and is not legal advice.
If you need
legal advice, you should contact an attorney. You do not have an
attorney-client relationship with WPAS.
If you would like more information about this topic, call (800) 562-2702 (voice)
or (800) 905-0209
(TTY).
To receive this publication in an alternative
format, such as large print or Braille, please call Washington Protection &
Advocacy System (WPAS) at 1-800-562-2702.
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Envoy Archives
Click here to browse
past issues of Envoy. If you are not reading this on the internet and
want to receive previous articles from WPAS, you can contact us by phone, letter
or e-mail at:
Washington Protection & Advocacy System
315 - Fifth Avenue South, Suite 850
Seattle, WA 98104
*Phone: (206) 324-1521 or in Washington State: (800) 562-2702
TTY: (206) 957-0728 or in Washington State: (800) 905-0209
Fax: (206) 957-0729
*Interpreters Available in over 200 languages via AT&T Language Line
E-mail: wpas@wpas-rights.org
URL: http://www.wpas-rights.org
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Envoy On-Line
Credits
Editor and Webmaster: Phil Jordan
Contributing Editors: Andrea Abrahamson, Betty Schwieterman, Gordon Hom,
David Lord, Jin Park, Michael Smith, Mark Stroh
Envoy On-Line is the newsletter of the Washington Protection and Advocacy
System (WPAS), a private, non-profit agency that has been protecting the rights
of people with disabilities since 1972. WPAS is a member of the National
Disability Rights Network. Eligibility for WPAS services is
determined by federal law. Contact WPAS
if you would like more information about our current priorities and available
services.
Envoy On-Line is not intended, nor should it be used, as a substitute for
specific legal advice since legal counsel may only be given in response to
inquiries regarding particular factual situations.
Envoy On-Line is available at no charge to interested persons in
Washington and is available in alternative formats upon request. To add your
name to the ENVOY mailing list, call or write:
Washington Protection and Advocacy System
315 - Fifth Avenue South, Suite 850
Seattle, WA 98104
Phone: (800) 562-2702 or (206) 324-1521
TTY: (800) 905-0209 or (206) 957-0728
Fax: (206) 957-0729
E-mail: webmaster@wpas-rights.org
Do you have feedback, questions or an opinion about one of the
stories in Envoy On-Line?
Email Us.
Interested in past issues of Envoy On-Line? You can find them in the
Envoy On-Line Archives.
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