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In re Hospitalization of B.

Decided: December 22, 1977.

IN THE MATTER OF THE HOSPITALIZATION OF B.


Callahan, J.d.c., Temporarily Assigned.

Callahan

The issue presented is whether this court shall order forced medication to an involuntarily committed patient.

B., a young adult, was arrested for atrocious assault and battery upon his three-year-old nephew, S.B. had been baby-sitting the child, who cried uncontrollably, concluded that the child had a devil, and struck him. While awaiting hearing on the charge in the county jail B. attempted suicide

and was involuntarily transferred to Trenton Psychiatric Hospital on January 14, 1977.

Subsequent civil commitment reviews found him to be a danger to himself and a continued course of treatment necessary for the patient. B. has remained in Trenton Psychiatric Hospital until the present time.

At a subsequent hearing on B.'s commitment, the treating physician sought the court's permission to administer a psychotropic drug. The trial judge, while ordering B.'s continued institutionalization, scheduled a separate hearing on the question of forced medication and invited a court-appointed psychiatrist to review the treatment program, interview the patient and report to the court on the medication issue.

The treating physician testified that the use of psychotropic drugs was required because B. had not responded to all conventional therapies. Psychotropics is the name given to a group of drugs utilized by professionals to reduce a patient's psychotic symptoms and allow the hospitalized patient's return to and maintenance in the community. The doctor's drug of choice was Prolixin because of its benefits, and since it is administered by injection only once every two weeks, it avoids a need for the patient to be disturbed more often. He indicated that the hospital had repeatedly sought B.'s voluntary cooperation in using such medication without success.

B.'s reluctance derives from his own experiences with Haldol, another psychotropic drug, and his observations of Trenton Hospital inmates who take Prolixin. When B. earlier received Haldol, he said he slept up to 20 hours a day. The medical literature describes excessive drowsiness as a relatively common side effect of Haldol and other psychotropic drugs. B. also testified that many patients who receive Prolixin at Trenton Hospital display disturbing side effects. Prolixin and Haldol are two of a group of major tranquilizers affecting the central nervous system which are used in the treatment of schizophrenia. In a significant percentage of

patients, psychotropic drugs are known to produce effects similar to the symptoms of Parkinson's Disease, such as loss of muscular control, involuntary grimaces and twitching, among other symptomatology. While such symptoms are temporary in most cases and are controlled by anti-Parkinsonian drugs, the effects are sometimes permanent and known as tardive dyskinesia, a neurologic disorder. American College of Neuropsychopharmacology -- FDA Task Force, "Neurologic Syndromes Associated with Anti-Psychotic Drug Use", 289 N. Eng. J. Med. 20 (1973). B.'s reservations are fully shared by some commentators. See, e.g. , Zander, "Prolixin Decanoate: A Review of the Research," 2 Mental Disability L.R. 37 (1977); DuBose, "Of the Parens Patriae Commitment Power and Drug Treatment of Schizophrenia: Do the Benefits to the Patient Justify Involuntary Treatment?," 60 Minn. L. Rev. 1149 (1976); Gardos et al., "Maintenance Antipsychotic Therapy: Is the Cure Worse than the Disease?" 133 Am. J. Psychiatry 32 (1976); Note, "Conditioning and Other Technologies Used to 'Treat?' 'Rehabilitate?' 'Demolish?' Prisoners and Mental Patients," 45 S. Cal. L. Rev. 616 (1972).

The court finds the patient's refusal to take Prolixin is not, however, based entirely on rational considerations, but reflects delusional thinking. B.'s condition has been diagnosed as paranoid schizophrenia. He apparently hears voices, which he believes to be God's and which he obeys. On one occasion those voices directed him to assault another inmate. The inmate was evidently not harmed, and he and B. are now said to be friends. According to Dr. Sadoff, the court-appointed expert with excellent qualification, B. feels he must remain alert and strong in order to ward off evil forces. Dr. Sadoff recommended the voluntary ingestion of a psychotropic, Mellaril, to be forced upon B. only as a final alternative.

At a subsequent hearing on November 11, 1977, B. was found by another county court judge to be competent to stand criminal trial on the ...


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