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In re Commitment of B.S.

Decided: September 30, 1986.

IN THE MATTER OF THE COMMITMENT OF B.S.


On appeal from the Superior Court, Chancery Division, Family Part, Middlesex County.

Morton I. Greenberg, J. H. Coleman and Cohen. The opinion of the court was delivered by Cohen, J.A.D.

Cohen

B.S. has been a patient at Robert Wood Johnson University Hospital ("University Hospital") since July 1984. University Hospital applied for the involuntary commitment of B.S. pursuant to N.J.S.A. 30:4-25 et seq. and R. 4:74-7.*fn1 The Chancery Division held that even though B.S. suffered from mental illness, she was not shown to be dangerous to herself or others or property and therefore she was not a proper subject for commitment to a psychiatric hospital. University Hospital appealed in its own name,*fn2 and we now reverse.

Before she was admitted to University Hospital, B.S. had a lengthy history of mental illness. Since 1971, she had multiple admissions to psychiatric hospitals and periods of out-patient care. In 1982 she was diagnosed at Marlboro Psychiatric Hospital as a schizophrenic, with delusions and hallucinations.

B.S. now suffers from organic brain damage, resulting partly from early drug abuse, partly from a period of hypoxia occurring during a hospital procedure, and partly from acquired immune deficiency syndrome, or AIDS. It is uncertain if her schizophrenia continues, according to one witness, because she no longer communicates sufficiently to permit such a diagnosis. Another witness found no evidence of the hostility or suspicion

that he expected to find in a schizophrenic. B.S., according to Dr. Edward McGough, Professor at Rutgers Medical School and Chief of Psychiatric Services at University Hospital, is a serious management problem, whose behavior is restricted by a male guard, physical restraints, and "very high" doses of thorazine. Without the medication and restraints, Dr. McGough says, B.S. is hyperactive, "a bit of a menace" to patients and staff, and impossible to control. She is at times combative. There have been incidents of B.S.'s hitting and biting nurses, wandering the corridors and getting into bed with other patients. She cannot manage independently, and, according to Dr. McGough and a psychiatric resident who also testified, is dangerous to herself and others and needs to be put in a closed psychiatric unit. Her prognosis is unfavorable.

In addition to her mental problems, B.S. has had a series of physical disorders including AIDS and related endocarditis, tuberculosis, hepatitis, blood disorders and a bleeding skin condition. Beyond question, the AIDS-related problems heightened University Hospital's concern over B.S.'s presence and the dangers posed by her interaction with patients and staff.

For many months prior to the Chancery Division hearing, the Division of Mental Health, Department of Human Services, attempted to place B.S. in a nursing home or other facility capable of dealing with her mental and physical problems. Because the Division was working optimistically toward that end, University Hospital withheld its application for commitment. The Division's placement efforts failed, as did the continuing parallel efforts of the hospital's social service staff. Further, the psychiatric hospitals operated by the State are apparently not equipped to deal with a person presenting B.S.'s constellation of ills.

The Division opposed the application for commitment. It produced the testimony of Dr. Michael Rotov, the Division's Chief Psychiatrist. He found B.S. to be manageable under medication at University Hospital and becoming more so. He

believed she would be best placed in a nursing home equipped and willing to take her, but conceded that none had been found. He agreed with Dr. McGough that B.S. suffered from organic brain damage, but found no psychosis. He felt the constant restraints and lack of privacy caused B.S.'s behavioral problems, and recommended a reduction in the heavy administration of thorazine.

Dr. Rotov said that even though B.S. cannot take care of herself and requires "a structured setting," she is not a danger to herself or ...


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