In re D.K.
In re D.K.
Opinion of the Court
*95*1220This is an appeal from a decision and order of the Appellate Division of the District Court, affirming an order of involuntary civil commitment for mental illness issued by a District Court judge pursuant to G. L. c. 123, § 16 (b ). The question on appeal centers on whether the evidence was sufficient to establish a "likelihood of serious harm," as defined in G. L. c. 123, § 1. To answer this question, we apply principles regarding the temporal nature of evidence upon which this probabilistic assessment may rely.
In particular, the petitioner, Worcester Recovery Center and Hospital (WRCH), a Department of Mental Health (DMH) facility, presented evidence that the respondent, D.K., had required emergency hospitalization nearly two years earlier when she was found in a life-threatening condition, severely malnourished, and in a state of squalor, after failing to take medication to treat her mental illness, schizophrenia. We agree with D.K. that such evidence *96alone may be insufficiently proximate in time to make the requisite showing of imminence and risk under prong three of the statutory definition of "likelihood of serious harm." Here, however, WRCH also presented evidence that, at the time of the civil commitment hearing, D.K. was suffering from delusions of persecution, thought and perceptual disturbances, and as had occurred prior to the aforementioned emergency hospitalization, she was refusing psychiatric treatment and declining to bathe or change her clothing despite repeated offers of assistance by WRCH staff members. Together with the evidence of the extreme state in which she had presented in her prior hospitalization, this evidence was sufficient to support the legal conclusion required under prong three. Accordingly, we affirm.
Mootness. We note that the civil commitment order expired before the Appellate Division decided the appeal. "In the context of involuntary hospitalization, '[a]lthough an expired or terminated [commitment] order may no longer have operative effect, [an] appeal should not be dismissed without considering the merits of the underlying [commitment] order.' " Matter of M.C.,
Background.
WRCH filed the present petition pursuant to G. L. c. 123, § 16 (b ), seeking to commit D.K. for a period not to exceed six months. At the civil commitment hearing before a different District Court judge (hearing judge), WRCH presented evidence that D.K. suffered from schizophrenia,
Specifically, after her release in May 2013, from an approximately three-week-long hospitalization at Solomon Carter Fuller Center, another DMH facility,
More recently, after an approximately seven-month-long hospitalization at WRCH during which D.K. had achieved stabilization and was taking her medication,
According to Dr. Gilmore, D.K. lacked insight into her condition and did not "appear to have insight into her need to have treatment at all." Although D.K. earlier had spent approximately seven months at WRCH (from December 2013 to July 2014), she denied that she had previously been at the facility. D.K. also did not recognize Dr. Gilmore, although he had evaluated her in May *992014 during her prior hospitalization at WRCH.
D.K. testified on her own behalf. She stated that she had been eating "fine" under the supervision of WRCH, she did not intend to stop eating if transferred to jail, and she hoped to make bail and live with a friend. She stated that she did not "remember being on medications in the hospital, but outside in the community." She acknowledged stopping those medications. She did not recognize that she had schizophrenia and believed her prior medications were for depression.
The hearing judge issued an order committing D.K. for a period not to exceed six months. D.K. appealed to the Appellate Division. The Appellate Division affirmed the order and dismissed the appeal, and this appeal followed.
Discussion. WRCH filed the petition pursuant to G. L. c. 123, § 16 (b ), which in turn requires the judge to make findings required under G. L. c. 123, § 8 (a ). Section 8 (a ) permits civil commitment only if the judge finds beyond a reasonable doubt
"(1) a substantial risk of physical harm to the person himself as manifested by evidence of, threats of, or attempts at, suicide or serious bodily harm; (2) a *1223substantial risk of physical harm to other persons as manifested by evidence of homicidal or other violent behavior or evidence that others are placed in reasonable fear of violent behavior and serious physical harm to them; or (3) a very substantial risk of physical impairment or injury to the person himself as manifested by evidence that such person's judgment is so affected that he is unable to protect himself in the community and that *100reasonable provision for his protection is not available in the community."
At the hearing, Dr. Gilmore opined that neither prong one or two applied to D.K. WRCH proceeded on the theory that prong three was met. Thus, the question on appeal is whether the evidence supported the legal conclusion that there was an imminent and "very substantial risk of physical impairment or injury" to D.K. by virtue of her judgment being so adversely affected by her mental illness that she could not protect herself from physical harm. See Matter of G.P.,
1. Standard of review. We review the hearing judge's findings of fact for clear error. This is because the judge, having presided over the hearing, was in the best position to weigh the evidence and to assess witness credibility. See G.E.B. v. S.R.W.,
2. Evidence of an imminent and "a very substantial risk" under prong three. Viewed in isolation, D.K.'s prior hospitalizations -- the most recent of which occurred nearly two years prior to the hearing -- may not have been sufficiently proximate in time to sustain the showing of an imminent and very substantial risk of physical impairment or injury. As the court noted in Matter of G.P.,
The value of such remote evidence diminishes even more rapidly with regard to prong three, where "the imminence of the risk becomes a factor that is even more important to consider than it is with respect to the other two prongs." Matter of G.P.,
This does not mean, however, that evidence going back in time is irrelevant in making the assessment of risk required under prong three. As the court stated in Matter of G.P.,
Specifically, the evidence of D.K.'s prior condition placed in context the risk presented by her present condition, which included that she presently was experiencing thought and perceptual disturbances, believed she was being persecuted, was responding inappropriately to internal stimuli, and was unaware of her diagnosis and need for treatment. D.K. was refusing psychiatric treatment and was not bathing or changing her clothes, even though she was offered assistance at least ten times during the course of her two-month stay at WRCH prior to the hearing. These latter behaviors were significant not in isolation, but because they echoed some of the conduct D.K. had exhibited just *102prior to her emergency hospitalization almost two years earlier,
Decision and order of Appellate Division affirmed.
On appeal, D.K. does not dispute the evidence presented by WRCH at the civil commitment hearing; instead, her challenge centers on the legal conclusion regarding "likelihood of serious harm" that this evidence supports.
On appeal, D.K. does not dispute this diagnosis.
D.K. refused to allow Dr. Gilmore to examine her during the two months she was at WRCH, where she had resided since the trial judge had ordered the competency evaluation. However, Dr. Gilmore explained that his testimony regarding D.K. was based on his own observations of D.K., review of her medical records, and consultation with other professionals involved in her care.
D.K. had been hospitalized from April to May 2013.
D.K. was hospitalized at WRCH from December 2013 to July 2014. She was discharged in July 2014, following evaluation by Dr. Gilmore in May 2014 in which he opined that she had been stabilized due to her medications and was then-competent to stand trial.
During oral argument before the Appellate Division, counsel for WRCH indicated that D.K. had been hospitalized for two weeks in "January/February 2015" due to "dehydration and the potential life-threatening condition she was in." The record before the hearing judge, however, does not indicate any reference to this two-week hospitalization. Accordingly, we do not consider this statement in our analysis.
D.K. was also hospitalized at a private facility, Arbour-Fuller, but neither the details of her condition during this hospitalization nor the timing thereof is in the record.
At the time of the hearing, the only medicine prescribed was "PRN," indicating that D.K. was to take the medication as needed.
In May 2014, Dr. Gilmore opined that, D.K. had been stabilized due to her medications and was then competent to stand trial.
D.K. moved for a required finding at the close of WRCH's case, which was denied.
"A person is not to be committed under the statute unless the substantial risk is proved by the [petitioner] beyond a reasonable doubt." Commonwealth v. Nassar,
Because the evidence of D.K.'s present state, coupled with her hospitalization two years ago, support the legal conclusion required under prong three, we need not consider either the hospitalization in 2013 for a "hunger strike" or the February 2015 hospitalization for hearing voices with suicidal content. Notably, however, Dr. Gilmore testified that D.K. was not suicidal and that she was eating.
On appeal, D.K. contends for the first time that WRCH failed to show, beyond a reasonable doubt, that reasonable provision for her protection is not available in the community. The issue was not raised before the Appellate Division. Accordingly, D.K. has waived this argument. See Carey v. New England Organ Bank,
Case-law data current through December 31, 2025. Source: CourtListener bulk data.