Pembroke Hospital v. D.L.
Pembroke Hospital v. D.L.
Opinion
**347
"The right of an individual to be free from physical restraint is a paradigmatic fundamental right."
Matter of E.C
.,
Here, D.L. was held involuntarily at Pembroke Hospital (Pembroke) on a temporary basis due to mental illness. Upon the denial of Pembroke's petition to extend D.L.'s confinement, Pembroke allegedly "discharged" D.L., but simultaneously detained and transported him without his permission to a second hospital for another mental health evaluation. This second evaluation ultimately led to an order for involuntary confinement for a period of up to six months. In this appeal we are called upon to interpret the meaning of the word "discharge" as that term is used in G. L. c. 123 to determine whether an individual may be said to have been "discharged" from a facility if his or her liberty has not been restored. We conclude that the answer is no. 1
1.
Statutory framework for civil commitments
. General Laws c. 123, § 12, which provides for the temporary emergency involuntary restraint and commitment of persons with mental illness in certain circumstances, is the "primary route" for the involuntary civil commitment of an individual.
Guardianship of Doe
,
"[any mental health professional qualified under G. L. c. 112] who, after examining a person, has reason to believe that failure to hospitalize such person would create a likelihood of **348 serious harm by reason of mental illness may restrain or authorize the restraint of such person and apply for the hospitalization of such person for a [three]-day period at [an authorized facility]." 2
Once an individual is detained under § 12 (
a
), he or she may be admitted for care and treatment if a designated physician of the facility "determines that failure to hospitalize such person would create a likelihood of serious harm by reason of mental illness." G. L. c. 123, § 12 (
b
). Commitment pursuant to § 12 (
b
) may last only three business days. G. L. c. 123, § 12 (
a
) and (
d
) ; Mass. R. Civ. P. 6 (a),
An individual who has been admitted involuntarily to a hospital pursuant to § 12 (
b
) is entitled to legal representation and may request an emergency hearing in District Court if he or she has reason to believe that the admission is the result of an "abuse or misuse" of § 12. G. L. c. 123, § 12 (
b
). See
*1062
Newton-Wellesley Hosp
. v.
Magrini
,
A court order is required if a facility seeks to hold an individual involuntarily beyond the temporary emergency commitment allowed by § 12. The facility must file such a petition within the initial three-day period and must allege that "the failure to hospitalize would create a likelihood of serious harm by reason of mental illness." G. L. c. 123, § 7 (
a
). The court shall order the commitment of an individual only if it finds that the individual is mentally ill, that his or her discharge would create an imminent likelihood of serious harm, and there is no less restrictive alternative to continued involuntary hospitalization. G. L. c. 123, § 8 (
a
).
Commonwealth
v.
Nassar
,
Once the petition is filed, the court is to schedule a hearing within five days, with certain exceptions, G. L. c. 123, § 7 ( c ), after which the court ordinarily must render its decision on the petition within ten days, G. L. c. 123, § 8 ( c ). While the outcome of the petition is pending, the facility may continue the involuntary commitment. G. L. c. 123, § 12 ( d ). Periods of commitment under § 8 may last for periods of six to twelve months -- depending on the circumstances -- before additional judicial review is required. G. L. c. 123, § 8 ( d ). Under G. L. c. 123, § 9 ( b ), "[a]ny person" may also file a written application for a patient's discharge prior to the expiration of an order for commitment.
2. Background . The material facts are undisputed. On December 16, 2015, D.L. was committed involuntarily to Pembroke under § 12 ( b ) based on suicidal statements that he had made. Pembroke timely filed a petition for continued involuntary commitment pursuant to G. L. c. 123, §§ 7 - 8, alleging that D.L. had not been "eating or drinking for several days," and he would die in the following one to two weeks without intervention.
At the hearing, a Pembroke doctor testified that D.L. had been unresponsive, minimally cooperative with staff, and selectively mute during his stay. The doctor further testified that D.L. had been refusing food and medication, and that he was drinking no more than a minimal amount of fluids. The doctor expressed concern that "if this continues [D.L.] will completely stop eating, drinking, and die." Finally, the doctor testified that, in his opinion, there was no less restrictive setting appropriate and available for D.L. On cross-examination, however, the doctor agreed that progress notes indicated that D.L. had been eating and drinking "when hungry." After hearing the testimony and arguments, the District Court judge denied the petition, finding that Pembroke had not met its burden.
In the hours following the denial of the petition to continue D.L.'s involuntary commitment, staff at Pembroke were unable to locate a family member willing to house D.L. Thereafter, Pembroke determined that, because D.L. was psychotic and his family **350 would not take him in, D.L. needed "continued inpatient psychiatric care for his own safety in the context of worsening psychosis." Pembroke asserts that it then discharged D.L. 4 but, without *1063 allowing him to leave the hospital, Pembroke arranged to have D.L. transported without his permission to South Shore Hospital (South Shore) for a second evaluation pursuant to § 12 ( a ). 5 After being examined by a different doctor at South Shore, D.L. was returned to Pembroke in the early morning of December 31, 2015, this time pursuant to South Shore's § 12 ( a ) application. Once back at Pembroke, D.L. was rehospitalized involuntarily under § 12 ( b ).
Pembroke thereafter timely filed a second petition for D.L.'s continued commitment pursuant to G. L. c. 123, §§ 7 - 8. D.L. moved to dismiss the petition, claiming that the District Court lacked jurisdiction to rule on it because of the "abuse or misuse" of the § 12 procedure that occurred prior to the filing of the petition. The judge denied the motion to dismiss and, after a hearing, ordered D.L.'s commitment to Pembroke for a period of up to six months. 6 D.L. appealed from the denial of his motion to dismiss and from the District Court judge's order of commitment to the Appellate Division of the District Court Department, which affirmed the District Court judge's rulings and also found that there was no abuse of the involuntary commitment procedure under G. L. c. 123, § 12. We granted D.L.'s application for direct appellate review.
3.
Discussion
. Pembroke does not dispute that it had no authority to hold D.L. after its first petition to continue D.L.'s involuntary confinement was denied. See
Thompson
v.
Commonwealth
,
D.L. contends that Pembroke did not discharge him within the meaning of G. L. c. 123, and that the continued restraint was an "abuse or misuse" of § 12. Thus, he argues, that everything that took place subsequently, including the second petition for continued confinement, was tainted, and therefore, his motion to dismiss the petition was improperly denied. We review questions of statutory interpretation de novo. See
Meikle
v.
Nurse
,
a.
Mootness
. As an initial matter, Pembroke argues that because D.L. is no longer in the hospital's custody, this case is moot.
8
We disagree. Wrongfully committed patients have a surviving interest
*1064
in establishing, after discharge, that the orders by which they were committed were unlawful, "thereby, to a limited extent, removing a stigma from [their] name and record." See
Matter of F.C
.,
b. "
Discharge" within the context of G. L. c. 123
. The question whether Pembroke discharged D.L., as staff members of the facility claim to have done, depends on what the Legislature meant by the term "discharge" within the context of G. L. c. 123. The statute does not define "discharge"; however, the relevant dictionary definition is "to set at liberty: release from confinement, custody or care." Webster's Third New International Dictionary 644 (1993). See
**352
Commonwealth
v.
Campbell
,
"Our primary duty is to interpret a statute in accordance with the intent of the Legislature." See
Pyle
v.
School Comm. of S. Hadley
,
Reading the statute in light of the legislative intent to protect the patient's right to be "free from physical restraint" (citation omitted), see
Matter of E.C
., 479 Mass. at 119,
c. Application . Because we hold that "discharge" under c. 123 requires that an individual regain his liberty, we conclude that, contrary to Pembroke's assertion, D.L. was not discharged within the meaning of the statute after the initial petition **353 pursuant to §§ 7 and 8 was denied. Instead, Pembroke continued to confine D.L. following the denial of the petition until transferring him to South Shore in order to recommence the § 12 commitment process. Pembroke then admitted him for a second time as an involuntary patient under § 12, and filed a second petition seeking a further confinement pursuant to §§ 7 and 8.
As justification for its actions, Pembroke points to the fact that after the first petition had been denied and D.L. was supposed to be released, staff members were unable to secure housing for D.L. with family members. See 104 Code Mass. Regs. § 27.09(1)(a), (b) (2018).
In essence, Pembroke substituted its judgment for that of the judge in contravention of G. L. c. 123. This constituted an "abuse or misuse" of the authority afforded to facilities and health care **354 professionals under § 12. 12 As a result, the subsequent examinations by South Shore and *1066 Pembroke were improper, as was Pembroke's second petition under §§ 7 and 8. The fact that South Shore independently made a § 12 determination and admission is of no moment; nor is the fact that a different District Court judge came to a different conclusion regarding the second petition for continued confinement. Each of those events occurred as a direct result of Pembroke having failed to restore D.L.'s liberty. 13
4.
Conclusion
. Pembroke failed to discharge D.L. within the meaning of G. L. c. 123 after the denial of its petition to continue D.L.'s confinement; this was a violation of the statute. See G. L. c. 123, § 6 (
a
). In addition, Pembroke's § 12 (
a
) application to South Shore for evaluation and subsequent readmission and involuntary confinement of D.L. was an "abuse or misuse" of § 12. See G. L. c. 123, § 12 (
b
) ;
Magrini
,
So ordered .
We acknowledge the amicus briefs submitted by the Department of Mental Health, and by the Mental Health Legal Advisors Committee, the Disability Law Center, and the Center for Public Representation.
"Likelihood of serious harm" is defined as: "(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 substantial 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 reasonable provision for his protection is not available in the community." G. L. c. 123, § 1.
The burden of proof for civil commitment in Massachusetts is higher than the Federal standard, which requires at least "clear and convincing" evidence for civil commitment. See
Aime
v.
Commonwealth
,
The record does not contain information regarding the steps Pembroke took to "discharge" D.L.; however, as discussed infra , because D.L. did not regain his liberty he was not properly discharged.
In the § 12 ( a ) application, Pembroke alleged the same facts that had been alleged in the commitment petition that had been denied that same day.
The District Court judge found that there were "several intervening acts" between the denial of the first petition and the subsequent § 12 commitments; those intervening events included the new information that no one in D.L.'s family was willing to take him home from the hospital, and that an independent evaluation occurred at South Shore.
General Laws c. 123, § 6 ( a ), provides in relevant part: "No person shall be retained at a facility ... except under the provisions of [§§ 10( a ); 12 ( a )-( c ); 13; 16( e ); and 35] or except under a court order or except during the pendency of a petition for commitment or to the pendency of a request under [§ 14]."
D.L. was discharged from Pembroke prior to the argument before the Appellate Division.
In fact, the modern version of the statute reflects a fundamental shift in our law toward the destigmatization of mental illness and the "elevation of the dignity of [human beings]," which warrants constitutional protection against involuntary restraint. See Flaschner, The New Massachusetts Mental Health Code -- A Magna Carta or a Magna Maze, 56 Mass. L. Q. 49, 50 (1971).
This regulation, which requires "[a] facility [to] make every effort to avoid discharge to a shelter or the street" plainly should not be read to mean that a facility should go so far as to involuntarily commit an individual if accommodations cannot be secured upon discharge. See 104 Code Mass. Regs. § 27.09(1)(b). Instead, the facility is to "take steps to identify and offer alternative
options
to a patient and shall document such measures, including the
competent refusal of alternative options
by a patient, in the medical record" (emphases added). See
Had the judge found that discharging the patient would create a likelihood of serious harm, he would have gone on to determine whether a less restrictive alternative to involuntary confinement at the facility existed (such as releasing the patient to the care of his family). In such a case, if the patient's family members were not available to care for the patient, that fact would constitute a changed circumstance warranting judicial reconsideration of the petition.
As D.L. correctly points out, "[i]f not required to comply with a court ruling denying its commitment petition, a hospital is free to engage in serial involuntary admissions under § 12 by supplanting judicial determinations with medical opinion. This is fully at odds with the legal process our Legislature adopted in 1970 that only allows civil commitments based on proof of mental illness and likelihood of serious harm. G. L. c. 123, §§ 7 (
c
), 8 (
a
)." See
Sullivan
v.
Brookline
,
We note that requiring that an individual's liberty be restored prior to being restrained and readmitted pursuant to § 12 ( a ) imposes neither time nor distance prerequisites between admissions. However, an involuntary readmission pursuant to § 12 must be based on new information that was unavailable to the judge during the previous petition hearing. Here, as the judge denied the first petition -- finding D.L. not to be a danger to himself or others -- Pembroke needed new information pertaining to D.L.'s dangerousness in order to readmit him properly pursuant to § 12.
Reference
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