At one time accused of abusing and neglecting hundreds of mentally disabled people by not providing food, medication, adequate housing, therapy or mental health care by U.S. federal officials, Puerto Rico, has reached an agreement with the U.S. ending a 12-year legal battle to improve the island's health system for the mentally disabled.

Puerto Rico has since agreed to make dozens of changes, including opening new treatment centers and hiring more employees, as a result of the more than 1,300 court orders issued during the lengthy litigation, Justice Secretary Guillermo Somoza said.

"This is the oldest case in the history of Puerto Rico," he said.

The island shuttered four of its six residential treatment centers and is seeking to relocate the last 18 patients from those centers to new community homes, Health Secretary Lorenzo Gonzalez said.

"There is still work to be done," he said.

Previously, Puerto Rico operated six treatment centers at which Gonzalez said patients were kept locked in rooms and forced to eat with their hands, among other violations.

The litigation that ended in October began in 1997 when the parent of a mentally disabled child submitted a complaint with the U.S. Department of Justice, which filed a civil rights lawsuit in April 1999 following a two-year investigation.

At the time, the island's health department had a $3 million budget with 300 employees.

Subsequently, the health department built 52 new community homes and now has a $40 million budget and more than 500 employees. The system serves more than 700 mentally disabled people.

In the next three years, a local judge will ensure that the remaining corrective actions will be taken, Somoza said.

"This is definitely a significant achievement," Gonzalez said. "It will improve the quality of life of a population that desperately needs it."

Gonzalez, however, lamented that the department has found only 64 of the 200 people who were on the waiting list for treatment.

"People left. They got tired," he said.

The announcement received cautious praise from Esther Caro, director of the Mayaguez Association of People with Impediments, one of the island's few private organizations that caters to the mentally disabled.

Her organization has worked with mentally disabled adults who have been enrolled in government programs, which cater mostly to parents who are unwilling or unable to care for their mentally disabled children.

"We are witnesses that the service being provided is poor, minimal and deficient," Caro said.

Neither Somoza nor Gonzalez answered repeated questions about whether any action had been taken against government employees accused of abuse and neglect.

Based on reporting by the Associated Press.

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