NOT FOR PUBLICATION WITHOUT THE
APPROVAL OF THE APPELLATE DIVISION
OPINION CORRECTED 03/14/02
SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
A-0132-00T5
IN THE MATTER OF THE
COMMITMENT OF B.L.
A-1298-00T1
IN THE MATTER OF THE
COMMITMENT OF M.W.
Argued December 3, 2001 - Decided January 3, 2002
Before Judges Havey, Braithwaite and Weissbard.
On appeal from Superior Court of New Jersey,
Atlantic County, Law Division, Docket No. 290-
00 (A-0132-00T5).
On appeal from Superior Court of New Jersey,
Cape May County, Law Division, Docket No. 197-
99 (A-1298-00T1).
Lorraine Hunter Hoilien, Assistant Deputy
Public Defender, argued the cause for
appellant B.L. in A-0132-00T5 (Peter A.
Garcia, Acting Public Defender, attorney;
Ms. Hoilien and Theodore S. Novak, Deputy
Public Defender, on the brief).
Theodore S. Novak, Deputy Public Defender,
argued the cause for appellant M.W. in A-1298-
00T1 (Peter A. Garcia, Acting Public Defender,
attorney; Mr. Novak and Lorraine Hunter
Hoilien, Assistant Deputy Public Defender, on
the brief).
Carolyn B. Uliase argued the cause for
respondent Atlantic County in A-0132-00T5
(Hasbrouck & Uliase, attorneys).
Office of Cape May County Counsel, attorney
for respondent Cape May County in A-1298-00T1,
did not file a brief.
The opinion of the court was delivered by
BRAITHWAITE, J.A.D.
Appellants B.L. and M.W.See footnote 11, former patients at Ancora
Psychiatric Hospital ("Ancora"), appeal from orders revoking their
conditional release from Ancora and recommitting them to that
facility. They both contend that their involuntary
rehospitalization violated New Jersey's civil commitment statute
and their due process rights under the United States and New Jersey
Constitutions.
Because we agree with B.L. and M.W. that the procedures used
here violated the New Jersey civil commitment statute and their due
process rights, we reverse the orders involuntarily recommitting
them to Ancora. Furthermore, we set forth the procedures to be
followed for future cases by mental health service providers and
the trial court when a patient, who has been conditionally
released, violates his or her conditions.
Although both B.L. and M.W. are no longer involuntarily
committed, their appeals are not moot because they both remain
liable for the cost of their confinement. It is well settled in
New Jersey that an appeal in these types of cases is not moot, even
if the patient is no longer confined, when the patient remains
liable for his or her hospital bill, and a finding in the patient's
favor will entitle the patient to a credit for any period of
illegal commitment. In re R.B.,
158 N.J. Super. 542, 545 (App.
Div. 1978); accord In re W.H.,
324 N.J. Super. 519, 521 (App. Div.
1999); In re J.B.,
295 N.J. Super. 75, 80 (App. Div. 1996); In re
D.M.,
285 N.J. Super. 481, 485, n.1 (App. Div. 1995), certif.
denied,
144 N.J. 377 (1996); In re Raymond S.,
263 N.J. Super. 428,
431, n.1 (App. Div. 1993); In re A.A.,
252 N.J. Super. 170, 172,
n.1 (App. Div. 1991). In addition, even if appellants were not
responsible for their hospital costs, "we should nevertheless
decide the issue because it implicates a committee's constitutional
right to liberty, and by its nature, will continually become moot
before judicial review." In re G.G.,
272 N.J. Super. 597, 600, n.1
(App. Div. 1994).
I
We set forth the undisputed facts relevant to these appeals.
B.L. was involuntarily committed to Ancora on May 26, 2000,
pursuant to a temporary order. The doctor who examined B.L.
determined that he suffered from "schizo affective disorder -
bipolar type" and that he was a danger to himself or others.
See
N.J.S.A. 30:4-27.2b and -27.2m;
R. 4:74-7.
On June 30, 2000, Mary Lee, M.D., recommended to the court
that B.L. be conditionally released to return to his apartment.
Following the hearing, the court released B.L. under instructions
that he comply with certain conditions for ninety days.
See
N.J.S.A. 30:4-27.15c(2). The conditions required B.L. to: (1)
take his prescribed medication; (2) attend follow-up medication-
monitoring appointments; and (3) cooperate with clinical management
services.
On July 11, 2000, B.L. was involuntarily returned to Ancora
for a violation of his conditional release because he was not
taking his medication and could not maintain himself. The record
is devoid of any evidence that the "mental health agency staff
person" notified the trial court that B.L. failed to comply with a
condition or that he was rehospitalized.
N.J.S.A. 30:4-27.15c(3).
Further, there is no written explanation for his return to Ancora.
On July 28, 2000, the trial court conducted a post-reconfinement
hearing to review B.L.'s return from conditional release.
See ibid.
At the July 28 hearing, B.L. stated that he was returned to
Ancora because he arrived late for an appointment at the Hartford
Clinic and was put on the bottom of the list, leading B.L. to
"brush" away a piece of paper handed to him. B.L.'s treating
psychiatrist, V. Chheda, M.D., stated at the hearingSee footnote 22 that B.L. was
violent and swung at staff on July 11 and also attacked hospital
staff on July 14, requiring that he be restrained. Although
Dr. Chheda related these "violent" incidents to the court, she
acknowledged that B.L. was not committable. Dr. Chheda also said
that B.L. had violated his conditional release by not taking his
medication.
Dr. Chheda recommended that B.L. be kept on Conditional
Extension Pending Placement/Conditional Release ("CEPP/CR" or
"CEPP") status until he was stabilized, at which point he could be
discharged. B.L.'s counsel argued that it would be inappropriate
to continue to confine B.L. on CEPP/CR status because B.L. had an
apartment and a "place to go." Counsel further argued that since
B.L. was not dangerous and not committable, Ancora could not hold
him. There was no evidence presented that B.L. was a danger to
himself or others and Dr. Chheda only wanted him to remain for the
limited purpose of stabilizing him.
The trial court ordered B.L. to remain at Ancora on CEPP
status until he was "stabilized." The reason for that order was
B.L.'s violation of the conditions of his release. The court
directed Dr. Chheda to "stabilize him as quickly as possible [] and
get him out as quickly as [Dr. Chheda could]." The trial court
assumed that B.L.'s rehospitalization had been valid, stating that
"[h]aving been brought back here, I assume it was appropriate." On
August 7, 2000, B.L. was conditionally released to his apartment
with the same conditions imposed on June 30, 2000. B.L. filed a
timely notice of appeal to the order entered on July 28, 2000. He
also appeals his involuntary return to Ancora on July 11, 2000.See footnote 33
With respect to M.W., the following facts are relevant. In
October 1999, M.W. was involuntarily committed to Ancora. On
August 11, 2000, M.W. was conditionally released from Ancora and
placed on CEPP/CR status. The conditions required M.W. to: (1)
take her medication; (2) cooperate with case management; and (3) be
placed in a group home immediately when a bed became available.
The conditions were imposed for a period of ninety days.
See
N.J.S.A. 30:4-27.15c(2).
On September 1, 2000, M.W. was placed at the Goshen Home
("Goshen") in Cape May County. M.W., however, did not reside at
Goshen, but merely went there on several visits. She was
involuntarily returned to Ancora on September 16, 2000, for reasons
that are not adequately set forth in the record.
On September 22, 2000, M.W. was provided a hearing pursuant to
N.J.S.A. 30:4-27.15c(3). At the hearing, Dr. Villanueva, a
psychiatrist, told the court that no written documentation of
M.W.'s rehospitalization existed, but that her return was based on
"verbal" information that she had "decompensated."See footnote 44
Dr. Villanueva added that the factual basis for M.W.'s return
was her hallucinations and that she had become suicidal by
verbalizing the "voices of Chuck telling her to run in front of a
car." This information was included in a report written on
September 16, 2000, by M.W.'s admitting physician, Dr. Chang. That
report is not part of the record on appeal.
M.W., who was sworn, testified that on September 15, 2000, she
had decided not to take her medication because "the voices were
telling [her] not to take them," but she "composed" herself and
became "ready" to take the medication. She was then given her
medication, which she took. She testified that she took all of the
medication that she was given.
For the September 22 hearing, Ancora submitted a written
report, from Dr. Chheda, M.W.'s treating psychiatrist. The report
stated that Dr. Chheda had examined M.W. on September 20, 2000, and
that she was not a danger to herself or others. The report
included Dr. Chheda's note that M.W. was "awaiting stabilization."
At the September 22 hearing, Dr. Villaneuva stated that M.W.
was not dangerous, had been taking her medication, and had not been
involved in any "incidents of any kind." Dr. Villanueva added that
the institution "had to adjust her medication," but that the
institution did not want to commit her and wanted "to get her out
as soon as possible, as quickly as possible". According to Dr.
Villanueva, M.W. would be sent back to the group home that day if
the home would stabilize her (meaning, adjust her medication). The
doctor noted that "it's [the group home's] responsibility to
stabilize her," but added that at the home, "she's, you know,
barely being managed." The trial court was ready to conditionally
release M.W. back to the group home, but was informed by a hospital
social worker, Phyllis Federman, that there may not be a bed
available at the group home.
Consequently, the trial court ordered M.W. returned to CEPP
status. The conditions were that she: (1) take her medication;
(2) cooperate with clinical case management services; and (3) be
placed in a group home immediately when a bed became available. By
returning M.W. to CEPP/CR status, the court instituted a new
ninety-day period of conditional release. M.W. was released from
Ancora to Goshen on October 19, 2000. On November 6, 2000, M.W.
filed a notice of appeal from the order of September 22, 2000. She
also appeals her involuntary return to Ancora on September 16,
2000.See footnote 55
II
B.L. and M.W. argue that their involuntary recommitment,
without a precommitment hearing and any written documentation of
the reason for their recommitment, violates both New Jersey's civil
commitment law,
N.J.S.A. 30:4-27.1 to -27.23, and their due process
rights under both the federal and state constitutions. B.L. and
M.W. urge this court to enunciate clearly when a conditionally
discharged patient may be rehospitalized and what procedures are
required before an order of rehospitalization may be entered.
At the outset, a brief discussion of the purpose behind
certain changes to the civil commitment law is helpful to
understand the context in which conditional discharge,
recommitment, and the due process rights of mentally ill patients
should be reviewed. As discussed by our Supreme Court in
In re
D.C.,
146 N.J. 31 (1996), in 1987, the Legislature passed a
comprehensive civil commitment statute which sought to "create a
public health system that provides professional treatment and
services in a manner that 'protects individual liberty and provides
advocacy and due process for persons receiving treatment.'"
Id. at
42 (quoting
N.J.S.A. 30:4-27.1c).
Thus, the "findings and declarations" section of the law
specifically states:
Because involuntary commitment entails certain
deprivations of liberty, it is necessary that
State law balance the basic value of liberty
with the need for safety and treatment, a
balance that is difficult to effect because of
the limited ability to predict behavior; and
therefore, it is necessary that State law
provide clear standards and procedural
safeguards that ensure that only those persons
who are dangerous to themselves, to others or
to property, are involuntarily committed.
[
N.J.S.A. 30:4-27.1(b).]
The Court in
In re D.C. further noted that
R. 4:74-7 provides
additional guidance in these cases and was implemented to "'correct
a long standing history of procedural abuses in the civil
commitment process and to ensure that no person may be
involuntarily committed to a psychiatric institution without having
been afforded full procedural due process.'"
Id. at 43 (quoting
Pressler,
Current N.J. Court Rules, comment 1, on
R. 4:74-7
(1995)).
Thus, the above language and history indicates that the
protection of a person's due process rights was greatly important
to the Legislature when it passed the 1987 changes to the civil
commitment law. Against this backdrop, we turn first to a
discussion of the specific statutory section at issue,
N.J.S.A. 30:4-27.15(c), and second, to a discussion of whether due
process requires a precommitment hearing and written findings
detailing the reasons for the patient's rehospitalization.
New Jersey's Civil Commitment Law
N.J.S.A. 30:4-27.15c(1) addresses conditional release. It
states that a court may discharge a patient from involuntary
commitment, "subject to conditions, if the court finds that the
person does not need involuntary or continued involuntary
commitment and the court finds:"
(a) that the patient's history indicates a
high risk of rehospitalization because of the
patient's failure to comply with discharge
plans; or
(b) that there is substantial likelihood that
by reason of mental illness the patient will
be dangerous to himself, others or property if
the patient does not receive other appropriate
and available services that render involuntary
commitment unnecessary.
N.J.S.A. 30:4-27.15c(3) addresses the situation where a
patient discharged on conditional release fails to meet the imposed
conditions. It provides as follows:
The designated mental health agency staff
person shall notify the court if the patient
fails to meet the conditions of the discharge
plan, and the court shall issue an order
directing that the person be taken to a
screening service for an assessment. The
court shall determine, in conjunction with the
findings of a screening service, if the
patient needs to be rehospitalized and, if so,
the patient shall be returned to the facility.
The court shall hold a hearing within 20 days
of the day the patient was returned to the
facility to determine if the order of
conditional discharge should be vacated.
B.L. and M.W. argue that the respective mental health
facilities monitoring them violated
N.J.S.A. 30:4-27.15c(3) by
involuntarily returning them to Ancora without first notifying the
court, and in the case of M.W., recommitting her without evidence
of a violation of her conditional release.
Both appellants point out that the statute clearly provides
that if a mental health agency determines that a patient has
violated the conditions of his or her release, then the agency
"shall notify
the court," and "
the court shall issue an order
directing that the person be taken to a screening service for an
assessment."
N.J.S.A. 30:4-27.15c(3) (emphasis added). B.L. and
M.W. note that in their cases, the community mental health care
workers (in the case of B.L.) and Ancora (in the case of M.W.)
simply decided to rehospitalize them, without first notifying the
trial court. Only after B.L. and M.W. had been recommitted was the
court notified and a post-commitment hearing held within twenty
days, as required by
N.J.S.A. 30:4-27.15c(3).
They also point to Ancora's own policy manual which echoes
N.J.S.A. 30:4-27.15c(3), and places the decision of recommitment
with the court. In cases where a patient appears to be
noncompliant with the conditions of his or her discharge, the
manual states that the patient shall be evaluated at a designated
screening service, which shall notify the court of its findings.
The court shall then determine, in conjunction with the findings of
the screening service, if the patient needs to be rehospitalized.
Because the statute plainly vests the decision to
rehospitalize conditionally discharged patients in the trial court,
N.J.S.A. 30:4-27.15c(3) was violated when B.L. was involuntarily
rehospitalized on July 11, 2000, and when M.W. was involuntarily
rehospitalized on September 16, 2000. Therefore, the summary
involuntary rehospitalization of both B.L. and M.W. was improper
and must be reversed.See footnote 66
Moreover, we are satisfied that involuntary rehospitalization
of both B.L. and M.W. cannot be justified on these records because
neither patient was considered dangerous. "To enter an order of
involuntary commitment, the court must find by clear and convincing
evidence that the patient is mentally ill and that the illness
causes the patient to be dangerous to himself, others or property."
In W.H.,
supra, 342
N.J. Super. at 523. Neither psychiatrist
speaking at the hearings said that B.L. or M.W. met the standard
for involuntary commitment when they were returned to Ancora.
B.L. and M.W. also assert that their rights under
N.J.S.A.
30:4-27.15c(3) were violated when "[t]he designated mental health
agency staff person,"
ibid., failed to submit "written on the
record documentation when there [was] an allegation of non-
compliance with conditions of release." We disagree. The statute
only requires the "designated mental health agency staff person" to
notify the court if a patient has failed to comply. It does not
require that the notice be in writing. Moreover, in deciding
whether a patient should be rehospitalized, the statute does not
require the trial court to base its decision on a written report
from the screening service or mental health facility. Instead, the
statute only requires that the court shall make its determination
"in conjunction with the findings of a screening service."
Ibid.
There is no statutory requirement that these "findings" be in
writing.
As other provisions of the civil commitment law reveal, the
Legislature clearly determined when to require a writing.
N.J.S.A. 30:4-27.10a states that in order to involuntarily commit
a person, a hospital or facility must submit to the court a
clinical certificate completed by the patient's treatment team and
the screening certificate which authorized the admission of the
patient to the facility. Pursuant to
N.J.S.A. 30:4-27.10b, an
involuntary commitment may similarly be achieved if two clinical
certificates, at least one of which is prepared by a psychiatrist,
is submitted to the court.
N.J.S.A. 30:4-27.2 defines "clinical
certificate" to mean a form completed within three days of
examination of the patient by the psychiatrist or other examining
physician which states the specific facts upon which the examining
physician has based his or her conclusion.
The section dealing with rehospitalization of conditionally
discharged patients,
N.J.S.A. 30:4-27.15c(3), makes no mention of
clinical certificates, or any other writing. When "the Legislature
has carefully employed a term in one place and excluded it in
another, it should not be implied where excluded."
GE Solid State,
Inc. v. Director, Div. of Taxation,
132 N.J. 298, 308 (1993);
State
v. Dela Rosa,
327 N.J. Super. 295, 301 (App. Div.),
certif. denied,
164 N.J. 191 (2000).
In sum, we conclude that both B.L. and M.W. were improperly
rehospitalized because the applicable mental health facility failed
to notify the court prior to their involuntary rehospitalization
and the court did not order their rehospitalization. Therefore,
the involuntary rehospitalization of both B.L. and M.W. are
reversed. We do not conclude, however, that
N.J.S.A. 30:4-
27.15c(3) requires written documentation of the reasons for a
conditionally discharged patient's rehospitalization.
Notwithstanding the lack of such a statutory requirement, such
documentation may still be required as a matter of constitutional
due process. We discuss that next.
III
B.L. and M.W. argue that their involuntary return to Ancora
violated their due process rights. They contend that they were
entitled to a precommitment hearing before being rehospitalized
because their cases involved nonemergent violations which require
a hearing prior to any recommitment. In addition, they argue that
in any case involving the potential rehospitalization of
conditionally discharged patients, due process requires: (1) a
contemporaneous affidavit or written report from a person with
personal knowledge of the facts of the alleged violation of the
patient's condition, or at a minimum, the source of the information
must be submitted to the court, the patient and his or her counsel;
(2) a written court order with findings of fact and a determination
that those facts justify a compliance hearing or a return to the
hospital under the applicable legal standard; and (3) a plenary
hearing as soon as one can be held.
In making these claims, B.L. and M.W. rely heavily on
In re
B.H.,
212 N.J. Super. 145 (Law Div. 1986). In that case, decided
prior to the 1987 changes to the civil commitment law, the trial
court outlined the procedures that should be followed when a
conditionally discharged patient violates the conditions. The
court issued the guidelines in the absence of any statutory
authority, case law or court rules providing procedural guidelines.
Id. at 149. The court devised a two track system, distinguishing
between emergent situations, which would require only a
postcommitment hearing, and nonemergent situations, which would
require a precommitment hearing.
Appellants' reliance on
In re B.H. is misplaced. As noted, it
was decided prior to the changes to the civil commitment law.
Consequently, the Legislature was presumably aware of
In re B.H.
when it enacted comprehensive changes to the civil commitment law
in 1987. Not only did the Legislature have an opportunity to
include
In re B.H.'s procedures in 1987 and did not, but it also
declined to do so in 1994. In 1994,
N.J.S.A. 30:4-27.15c(3) was
amended to clarify that the court must issue the order directing
that a patient be taken to a screening service for an assessment.
Assembly Bill No.
A. 86 (Oct. 31, 1994).
Principles of statutory construction require "that a statute
must be interpreted in light of its common law antecedents."
Johnson Machinery Co., Inc. v. Manville Sales Corp.,
248 N.J.
Super. 285, 306 (App. Div. 1991). In addition, "'[a] legislative
body in this State is presumed to be familiar not only with the
statutory law of the State, but also with the common law.'"
Magierowski v. Buckley,
39 N.J. Super. 534, 554 (App. Div. 1956)
(quoting
Yanow v. Seven Oaks Park, Inc.,
11 N.J. 341, 350 (1953)).
The legislative history to the 1987 changes indicates that the
Legislature was aware of case law concerning involuntary
commitment.
See,
Senate Revenue, Finance and Appropriations
Committee,
Statement to A. 1813 (Feb. 5, 1987) (stating that this
bill "revises the statutes concerning involuntary civil commitment
to reflect clinical and programmatic advances and
to incorporate
language based on recent court decisions and rules") (emphasis
added);
Assembly Appropriations Committee,
Statement to A. 1813
(Dec. 11, 1986) (same);
Assembly Health and Human Resources
Committee,
Statement to A. 1813 (Oct. 9, 1986) (same). In light of
the legislative history indicating that the Legislature sought to
enact a civil commitment statute that would incorporate "recent
court decisions," we conclude that the Legislature consciously
rejected
In re B.H.'s two track system.
Although not set forth in appellants' briefs, their challenge
to lack of procedural due process is apparently based on both the
Fourteenth Amendment of the United States Constitution and Article
1, Paragraph 1 of the New Jersey Constitution. It is well settled
that because civil commitment impacts a patient's individual
liberty, the power of the State in this area is constitutionally
bounded by the principle of procedural due process.
In re S.L.,
94 N.J. 128, 136 (1983). Due process, however, is a flexible concept.
In re M.G.,
331 N.J. Super. 365, 374 (App. Div. 2000). Not all
situations that require procedural due process safeguards call for
identical procedures.
Morrissey v. Brewer,
408 U.S. 471, 481,
92 S. Ct. 2593, 2600,
33 L. Ed.2d 484, 494 (1972).
Here, the question is what level of due process is required
for a patient who has been conditionally discharged when his or her
liberty is affected by continuing to comply with the conditions of
discharge. Because a patient who violates his or her conditions is
subject to involuntary rehospitalization, depending on the court's
determination in conjunction with the findings of the screening
service,
N.J.S.A. 30:4-27.15c(3), the patient's liberty interest
mandates procedural due process greater than that provided in both
appellants' cases. Involuntary commitment to a psychiatric
facility is "'a massive curtailment of liberty.'"
Vitek v. Jones,
445 U.S. 480, 491,
100 S. Ct. 1254, 1263,
63 L. Ed.2d 552, 564
(1980) (quoting
Humphrey v. Cady,
405 U.S. 504, 509, 92
S. Ct.
1048, 1052,
31 L. Ed.2d 394, 402 (1972)). Involuntary civil
commitment "effects a great restraint on individual liberty."
In
re S.L.,
supra, 94
N.J. at 137.
We must consider and weigh three factors to determine what
procedural due process protections are constitutionally required.
Zinermon v. Burch,
494 U.S. 113, 127,
110 S. Ct. 975, 984,
108 L.
Ed.2d 100, 115 (1990). The factors are: (1) the private interest
affected by the governmental actions; (2) the risk of an erroneous
deprivation of these interests through the procedures used, as well
as the probable value, if any, of added procedural requirements;
and (3) the government's interest and the extent to which it will
be impeded by the use of additional safeguards.
Mathews v.
Eldridge,
424 U.S. 319, 334-35,
96 S. Ct. 893, 902-03,
47 L. Ed.2d 18, 33 (1976).
Clearly, B.L. and M.W.'s private liberty interests are
substantial, even if a hearing is provided within twenty days after
rehospitalization as provided by
N.J.S.A. 30:4-27.15c(3).
Vitek,
supra, 445
U.S. at 491, 100
S. Ct. at 1263, 63
L. Ed.
2d at 564.
Even though a conditionally discharged patient's liberty is
indeterminate, the patient is still free to enjoy "'many of the
core values of unqualified liberty.'"
In re True,
645 P.2d 891,
898-99 (Idaho 1982) (quoting
Morrisey,
supra, 408
U.S. at 482, 92
S. Ct. at 2600, 33
L. Ed.
2d at 495).
Under the second factor, the added requirements that B.L. and
M.W. seek (precommitment hearing, written findings) clearly would
reduce the risk of erroneously rehospitalizing a nondangerous,
mentally ill person and better ensure that recommitment would be
based on an accurate evaluation of the facts. That interest,
however, must be balanced against the third factor, the
governmental interest in expeditiously safeguarding the public from
persons formerly adjudged to be dangerous and in need of
commitment.
Balancing and weighing these factors leads us to conclude that
procedural due process does not require a precommitment hearing for
those patients that are involuntarily rehospitalized following the
violation of their conditional discharge. We emphasize, however,
that the recommitment must be based upon the standard for the
involuntary commitment of patients, that is, "the patient is
mentally ill and that illness causes the patient to be dangerous to
himself, others or property."
In re W.H.,
supra, 324
N.J. Super.
at 523. No other standard suffices. "[S]tablization" of a
patient, which was the standard used to rehospitalize B.L., is
insufficient.
Here, because
N.J.S.A. 30:4-27.15c(3) requires a hearing
"within twenty days of the day the patient was returned to the
facility," the hearing aspect of procedural due process is
satisfied for conditionally discharged patients. Returning a
patient involuntarily to a hospital after he or she violates a
condition of discharge means that the court has found by clear and
convincing evidence that the patient is a danger to himself, others
or property. "A post-deprivation hearing is appropriate and
constitutionally permissible in such cases because the 'threat of
harm to the [individual] or others is of such a nature that
confinement must take place immediately. When the choice is
between a loss of life or health and a loss of liberty for a brief
period of time, the preferable alternative is apparent.'"
In re
M.G.,
supra, 331
N.J. Super. at 377 (quoting
Coll v. Hyland,
411 F.
Supp. 905, 910 (D.N.J. 1976)).
Here,
N.J.S.A. 30:4-27.15c(3) does not require a precommitment
hearing, but does provide that rehospitalization can only occur if
there is a judicial determination which is based, in part, on the
findings of a screening service's assessment of the patient.
Therefore, the statute does offer some safeguards against erroneous
rehospitalizations by requiring a court to make the decision of
recommitment. Appellants implicitly acknowledge this safeguard,
noting that by requiring a clinical assessment and judicial
determination, the statute "recognizes that there will be cases in
which a person is not hospitalized and remains in the community."
Although we are satisfied that procedural due process does not
require a precommitment hearing for conditionally discharged
patients subject to the mandate of
N.J.S.A. 30:4-27.15c(3), it does
require other procedures that are not set forth in the statute. We
conclude that due process requires that the findings of the
screening service shall be in the form of a written certification.
The certification shall provide: (1) the name of the hospital that
conditionally released the patient; (2) the date of that release;
(3) the designated mental health agency and the designated contact
or staff person for the patient; (4) the violation of the condition
or conditions committed by the patient; (5) the name of the
screening service and the name of the person who performed the
screening; and (6) the results of the screening, setting forth
facts, observations and the basis for recommending that the patient
be rehospitalized. This certification provides a written, factual
basis for the court's resolution of the recommitment issue.
The certification shall be transmitted to the court so it can
determine whether the standard for rehospitalization has been met.
We recognize that in some instances it will be impractical to
transmit the writing to the court. On those occasions, the
screening service may communicate its findings to the court by
telephone and the court shall memorialize the information in
writing upon receipt. As soon as possible, the screening service
shall send the certification to the court.
Further, the court's determination, following the receipt of
the certification from the screening service, shall be in the form
of an order, accompanied by findings of fact and conclusions of law
as required by
Rule 1:7-4(a). The certification of the screening
service and the court's order shall be served on the patient and
his counsel at least ten days prior to any hearing required by
N.J.S.A. 30:4-27.15c(3). We conclude that the above procedure is
required because it is exceedingly arduous for a reviewing court,
let alone the trial court, to evaluate the merits of an application
to rehospitalize a patient without such a writing. It is also
quite difficult for the patient to fairly challenge a
rehospitalization determination at the subsequent hearing.
Clearly, in an initial involuntary commitment, clinical
certificates and a written order are required.
See N.J.S.A. 30:4-
27.10(a) - (d) and (h);
R. 4:74-7.
See also In re True,
supra, 645
P.
2d at 903 (stating that due process required written notice to
patient of reasons for and evidence relied on justifying
rehospitalization);
In re Richardson,
481 A.2d 473, 480 (D.C. 1984)
(stating that due process required submission of affidavit to court
within twenty-four hours of return, reciting recent actions of
patient and reasons for his or her return in sufficient detail).
We note that in appellants' cases, there is no documentation
of the reasons for their respective rehospitalizations, making
review of their cases difficult. No written record exists for
either B.L. and M.W. detailing why they were rehospitalized on
July 11, 2000 (for B.L.), and September 16, 2000 (for M.W.). The
lack of such a record is particularly troublesome in B.L.'s case,
since the trial court failed to review the merits of B.L.'s
rehospitalization and concluded peremptorily that "[h]aving been
brought back here, I assume it was appropriate."
Moreover, requiring such written documentation would take care
of the hearsay problem in B.L.'s case. B.L. argues that at his
July 28, 2000, hearing, Dr. Chheda relied on hearsay in support of
the reasons for his recommitment. Specifically, Dr. Chheda stated
that B.L. had stopped taking his medication and had taken a swing
at someone in the emergency room. Dr. Chheda, however, never
identified the source of this information, thereby precluding B.L.
from any opportunity to challenge the reasons for his recommitment
and preventing the trial court from evaluating the trustworthiness
of the information.
See In re J.B.,
supra, 295
N.J. Super. at 78-
79 (holding that insufficient medical evidence existed to support
commitment where testifying psychiatrist improperly based testimony
on hearsay screening documents, psychiatrist had no knowledge of
screener and testifying social worker relied on hearsay evidence
provided by a non-testifying case manager);
In re Raymond S.,
supra, 263
N.J. Super. at 433 (holding that insufficient evidence
existed to support commitment where most of the testifying doctor's
information came from conversations with "staff").
We also address another point required by procedural due
process and the civil commitment law that was not raised by
appellants. In both hearings, the record does not support that the
psychiatrist who spoke was placed under oath. Under the civil
commitment law, a hearing is an evidence-gathering proceeding.
See
N.J.S.A. 30:4-27.14. As such, witnesses must be sworn,
particularly the psychiatrists. Without swearing in the witnesses,
there are no proofs presented at the hearing. Due process requires
that a court must have proofs, "which lead to the decision[.]"
Callen v. Gill
7 N.J. 312, 319 (1951).
IV
Both appellants argue that the trial court improperly ordered
that they be placed on CEPP status, which continued their
involuntary stay at Ancora. We agree.
If a patient otherwise entitled to discharge
cannot be immediately discharged due to the
unavailability of an appropriate placement,
the court shall enter an order conditionally
extending the patient's hospitalization and
scheduling a placement review hearing within
60 days thereafter.
[
R. 4:74-7(h)(2).]
In In re G.G.,
272 N.J. Super. 597, 605 (App. Div. 1994), we
addressed situations similar to that here and held that orders of
CEPP were improper when the patients were otherwise entitled to
discharge and had living arrangements outside the hospital. There,
three patients committed at Trenton Psychiatric Hospital were
placed on CEPP status because the follow-up care portion of their
discharge plans had not been completed, even though they were
entitled to be discharged immediately. Id. at 602. We said:
CEPP is not intended as a means for extending
an involuntary commitment simply because the
hospital has not yet arranged for the periodic
follow-up care of a patient not found to be a
danger to self, others or property. Using
that erroneous approach here devalued
appellants' constitutional right to liberty.
[Id. at 605.]
Similarly, in these cases, the trial court improperly
conditionally extended B.L.'s and M.W.'s hospitalization, even
though they each had appropriate placements. The court ordered
B.L.'s continued hospitalization until he was stabilized. Since
B.L. had his own apartment, which constituted an appropriate
placement, his continued hospitalization was improper. Because
B.L. could not be rehospitalized for reasons of stabilization, B.L.
was entitled to an immediate discharge on July 28, 2000.
The trial court also conditionally extended M.W.'s
rehospitalization, subject to the condition that she be released to
Goshen as soon as a bed became available. M.W. did not return to
Goshen until four weeks later on October 22, 2000. A bed, however,
was immediately available for M.W. because Goshen was required by
regulation to maintain a bed for her while she was hospitalized.
See N.J.A.C. 10:37A-9.7(c). Thus, M.W. was entitled to an
immediate discharge.
V
We summarize the procedures that must be utilized when a
patient has violated the conditions of his or her release. The
designated mental health agency staff person must notify the court
when a patient has violated the conditions. This notification does
not have to be in writing. The court shall order the patient to be
screened. The screening service shall conduct an assessment, the
results of which shall be in a written certification. The
certification shall provide: (1) the name of the hospital that
conditionally released the patient; (2) the date of that release;
(3) the designated mental health agency and the designated contact
or staff person for the patient; (4) the violation of the condition
or conditions committed by the patient; (5) the name of the
screening service and the name of the person who performed the
screening; and (6) the results of the screening, setting forth
facts, observations and the basis for recommending that the patient
be rehospitalized. This certification provides a written, factual
basis for the court's resolution of the recommitment issue.
The certified screening document shall be transmitted to the
court. If it is not practical to transmit the writing to the
court, the finding of the assessment may be transmitted by
telephone and shall be memorialized in writing by the judge upon
receipt. As soon as possible, the written certification shall then
be sent to the court. The court shall determine, in connection
with the certified findings of the screening service, whether to
rehospitalize the patient. A patient can be rehospitalized only
when the standard for initial commitment is satisfied. The court
shall issue an order with its findings of fact and conclusion as
required by
R. 1:7-4(a).
VI
The orders under review are reversed.
Footnote: 1 1 We have combined these two cases for purposes of this
opinion because the same issues are implicated.
Footnote: 2 2 Dr. Chheda spoke at B.L.'s hearing but the record does not
indicate that she was sworn.
Footnote: 3 3 There was no court order entered returning B.L. to Ancora.
Footnote: 4 4 The record does not indicate that Dr. Villanueva was sworn.
Footnote: 5 5 There was no court order entered returning M.W. to Ancora.
Footnote: 6 6 Because the court was not notified that appellants were
returned to Ancora, no order recommitting them was ever entered.