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State in Interest of R.G.W.

October 20, 1976

STATE OF NEW JERSEY IN THE INTEREST OF R.G.W.


Nitto, J.c.c., Temporarily Assigned.

Nitto

Petitioner seeks a court order implementing his constitutional and statutory right to effective medical and psychiatric treatment or, in the alternative, directing his immediate release.

Petitioner was originally institutionalized at Greystone Park Psychiatric Hospital, Morristown, New Jersey, by order of the Passaic County Juvenile and Domestic Relations Court, dated February 25, 1974, upon a finding by this court that he suffered from a mental condition rendering him incompetent to stand trial upon a complaint alleging murder in the first degree. The date of the offense charged was August 24, 1973, some three days before petitioner's sixteenth birthday.

Institutionalization of petitioner upon this finding and subsequent orders of the court has continued to date, uninterrupted, for a period in excess of 2 1/2 years.

Notwithstanding the findings of the court, reflected in its order of February 25, 1974, Greystone Park Psychiatric Hospital authorities failed to treat the condition found to exist by the court, asserting that such mental condition, in fact, did not exist. The determination of the hospital authorities was made known to the court by letter, dated April 3, 1974.

This assertion precipitated a rehearing on the question of petitioner's competence by the court on May 10, 1974.

Following testimony by the State, defense, and the hospital authorities, the court, by order of May 10, 1974, affirmed its original conclusions -- finding that the contention of the Greystone Park authorities, to the effect that petitioner required no further treatment and that no psychosis existed, to be totally without merit -- and remanded petitioner to Greystone Park where he remained, ostensibly untreated for the condition found to exist by the court, until June 25, 1976.

On June 25, 1976, following plenary hearing on the complaint as directed by the New Jersey Supreme Court in State in the Interest of R.G.W. , 70 N.J. 185 (1976), the court determined, among other things, that petitioner remained incapable of comprehending his position, consulting with counsel or cooperating in his defense, and therefore was not competent to stand trial. The court further determined that petitioner, at the time and place alleged in the complaint was psychotic and laboring under such defect of reason as to be incapable of distinguishing right from wrong or comprehending the nature and quality of his acts, and that such condition persisted at the time of the June 25, 1976 hearing, with the result that petitioner was rendered a danger to himself and to the community.

By order dated June 29, 1976 the court entered a judgment of acquittal on the complaint alleging murder in favor of petitioner by reason of his insanity at the time of the offense alleged, and ordered his continued institutionalization at Greystone Park Psychiatric Hospital until further order of the court.

During the June 25, 1976 hearing the court permitted expert testimony assessing implementation of petitioner's right to treatment for the condition found to exist by the court on February 25, 1974, May 10, 1974 and June 25, 1976.

Testimony in this respect was furnished by psychiatrists Dr. J. Lloyd Morrow, and Dr. Samuel I. Kesselman, who, testifying for petitioner and the State on the three occasions to which reference has been made, furnished the medical and psychiatric evidence upon which the court based its judgments.

Both psychiatrists concurred that petitioner had received no meaningful treatment for his condition at the Greystone Park facility from the time of his original commitment, February 25, 1974, principally for the reason that the medical authorities there refused to recognize the existence of the mental infirmity diagnosed by them and found to exist by the court.

The psychiatrists further concurred that, assuming recognition of petitioner's mental infirmity, appropriate treatment for his condition was not available at any state institution or any private institution within the State of New Jersey. With due consideration for the security aspects necessarily attendant to petitioner's institutionalization, the Menninger Clinic, Topeka, Kansas, was recommended as a suitable place of treatment.

Petitioner requested a court order implementing his right to treatment following the testimony of Dr. Morrow and Dr. Kesselman. The court adjourned hearing on the application pending the joining in the action of the New Jersey Commissioner of Institutions and Agencies and the Passaic County Board of Chosen Freeholders, in addition to the Passaic County Prosecutor.

On October 8, 1976, the necessary parties having been joined as directed by the court, plenary hearing on petitioner's application was held.

Dr. Morrow, testifying in behalf of petitioner, confirmed his previous diagnoses of petitioner's condition, noting that the underlying psychosis which rendered petitioner dangerous to himself and to others had not abated since his original commitment in February 1974. He equated the Greystone Park Psychiatric Hospital facility to a "warehouse" for the mentally infirm and asserted that, for all the validity of the mode of treatment being furnished petitioner, he would be equally well-served by confinement at a penal institution. He added that petitioner's condition would likely "harden" and become exceedingly difficult to treat in the near future if definitive psychiatric treatment were not immediately undertaken.

Dr. Morrow restated his position -- first expressed at the hearing of June 25, 1976 -- that, at the very least, treatment appropriate to petitioner's condition required that he have a personal relationship, on a one-to-one basis, with a psychiatrist or qualified psychotherapist; a meaningful program of social developmental activity, and a meaningful program of education consistent with his intellectual ability.

Dr. Kesselman, testifying in behalf of the State of New Jersey at the request of the Passaic County Prosecutor, also confirmed his previous diagnoses of petitioner's condition, noting no material change in the underlying psychosis. He characterized petitioner as a severe assaultive risk at the present time, with potential for dangerousness to himself in circumstances where the assaultive tendencies were frustrated. He concurred in Dr. Morrow's view that, absent implementation of one-to-one psychotherapy in connection with other rehabilitative treatment, petitioner's condition would "harden" and resist any means of neutralization.

Dr. Kesselman testified that "one to one" psychotherapy was not a realistic expectation at Greystone Park Psychiatric Hospital, notwithstanding its indispensability to a particular case, for the reason that patient population substantially overbears staff resources to accomplish such treatment.

The indispensability of one-to-one psychotherapy in the treatment of psychosis such as that suffered by petitioner was the consequence, it was noted, of the fact that the rapport developed between patient and therapist formed the basis of the patient's motivation to participate in supplemental treatment such as group therapy and vocational or educational training. Dr. Kesselman asserted that without such motivation on the part of the patient, his psychosis would never be abated by other than medical accident. He cited an example from his professional experience in which the mode of treatment for petitioner recommended by Dr. Morrow, and in which he concurred, precipitated impressive, affirmative results.

Review by the court of petitioner's clinical history at Greystone Park Psychiatric Hospital did not disclose his ever having been provided purposeful psychotherapy. There is no evidence of record which indicates that petitioner was ever afforded educational training of consequence during his long confinement at that facility. The record does reflect that attempts in this connection were undertaken. Reasonable

justification for their abandonment far short of accomplishment of specific goals is not apparent.

Dr. Kesselman observed that group therapy in which petitioner is presently involved is producing insight, evidencing the present amenability of his condition to treatment, though it remains, in its latent state, substantially unneutralized.

He noted, however, in his formal report on petitioner's condition -- admitted into evidence before this court without objection, the following: "The therapy he is receiving is standardized, but lacking in quality and intensity. * * * Prognosis for improvement to the extent where he will be ready for release without presenting a threat to society is unfavorable at present."

Dr. Kesselman indicated that the motivation which now impels petitioner to participate in group therapy may well be the result of his merely having grown older and matured, rather than the product of medical design. The court's study of ...


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