As family law attorneys, we increasingly observe issues of mental health in family law cases. One area in which the law of domestic relations and issues of mental health intersect is that of guardianship and the involuntary commitment of individuals to a hospital or other institution. In a recent case, the Massachusetts Supreme Judicial Court addressed an important question: whether an individual counts as “discharged” from a facility if there wasn’t restoration of his or her liberty.
In the case, Pembroke Hospital involuntarily held the patient due to his mental illness. This was after he made suicidal statements; he was also unresponsive and minimally cooperative, including refusing food and medication. After holding him on a temporary basis, the hospital’s petition to extend confinement was denied. At that point, the hospital discharged the party. At the same time, however, it detained and transported him without his permission to South Shore Hospital for yet another mental health evaluation. That new evaluation ultimately resulted in an order for involuntary confinement for a period of up to six months. The party appealed, claiming that there was an abuse and misuse of the law by Pembroke Hospital. The state’s highest court decided to hear this appeal.
The applicable statute, Massachusetts General Laws chapter 123, section 12, allows a hospital to commit a person 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”. This commitment is meant to be used in cases of emergencies; it is also meant to be temporary. It may not exceed three business days; at this point the party must be discharged unless the facility files a petition for continued involuntary commitment or the party chooses to stay committed voluntarily.
What if the facility seeks to hold the person involuntarily beyond the temporary emergency commitment under the statute? In that case, the facility needs to seek a court order by filing a petition. The facility must prove that failure to hospitalize the person would create a likelihood of serious harm by reason of mental illness. If there is an imminent likelihood of serious harm, and the court finds that no less restrictive alternative exists to continued hospitalization, then the court will order commitment of the person. The stakes for meeting this standard are pretty high: it must be proven beyond a reasonable doubt.
What happened in this case?
The Massachusetts Supreme Judicial Court in this case had to address the issue of whether Pembroke Hospital “discharged” the subject from his commitment when it simultaneously transmitted him to the other hospital for evaluation. The high court held that this was not a “discharge” under the language of the applicable statute.
“Reading the statute in light of the legislative intent to protect the patient’s right to be “free from physical restraint”…it is clear that a facility “discharges” an individual under G. L. c. 123 only when that individual is set at liberty from involuntary restraint, and not when released from care as happened here,” the high court held. “Otherwise, the protections of the statute would be impermissibly weakened, if not rendered meaningless.”
In this case, the high court held, the hospital did not set the subject at liberty from involuntary restraint. In other words, his confinement continued even though Pembroke Hospital claimed it ended its care. At that time, Pembroke did not have the authority (by way of a court order) to continue confining the subject. The high court specifically noted that the trial judge found that the patient’s mental illness did not create a “likelihood of serious harm,” and the fact that he did not have a place to live upon his release was not a proper ground for Pembroke’s involuntarily restraint.
“In essence, Pembroke substituted its judgment for that of the judge in contravention of G. L. c. 123,” the Supreme Judicial Court held. “This constituted an ‘abuse or misuse’ of the authority afforded to facilities and health care professionals under § 12″. As a result, the high court vacated the order of civil commitment.
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