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In re Commitment of J.R.

January 3, 2007


On appeal from Superior Court of New Jersey, Law Division, Ocean County, Docket No. OCCC-127-06.

The opinion of the court was delivered by: Holston, Jr., J.A.D.




Argued December 5, 2006

Before Judges Skillman and Holston, Jr.

Appellant, J.R., appeals the Law Division's March 31, 2006 order continuing his involuntary civil commitment at Ancora Psychiatric Hospital (Ancora), pursuant to N.J.S.A. 30:4-27.15, with a review hearing in one week. We reverse.

On January 22, 2006, J.R. was initially admitted to Ancora. On February 3, 2006, J.R. was conditionally released and remained on conditional release (CR) until his readmission to Ancora on March 24, 2006.

At the re-commitment hearing held on March 31, 2006, the only witness called by the State was Dr. M. Rozmyslowicz, J.R.'s treating psychiatrist. Dr. Rozmyslowicz's report dated March 28, 2006 was also admitted into evidence by stipulation. The report states: "[J.R.] returned from CR [because he] did not take his medications [and] decompensated."

The doctor testified that she made an Axis 1 diagnosis of J.R. of "bi-polar disorder. Most recent episode mixed and for substance dependent." When Dr. Rozmyslowicz was asked her recommendation for further hospitalization and treatment, the doctor testified that "on Monday, I felt that it's too early to put [J.R.] on CEPP (Conditional Extension Pending Placement) status.*fn1 So I would like to ask the court to have more days." However, when asked if J.R. were released into the community, whether J.R. would "present a danger to himself or others," Dr. Rozmyslowicz replied: "The only danger that [J.R.] may present is that he may stop taking his medication as happened last time." (emphasis added). When asked the basis for her opinion that "[J.R.] might present a danger to others," the doctor stated: "Actually, Monday, when I examined that patient, I knew that over the weekend before, the patient was verbally assaultive to the staff and he presented with careless smoking."

In response to the judge's questioning as to what kind of conduct or symptoms [J.R.] exhibited as a result of his failure to take his medication, which precipitated J.R.'s readmission to Ancora, the doctor responded: "Patient's manic symptoms exacerbated. He was aggressive verbally." However, the doctor stated that she did not know of any incidents during J.R.'s release, between February 3 and March 24, 2006, where he assaulted anyone in the community.

The judge then conducted most of the remainder of the hearing. The judge directed the doctor to the screening documents that supported J.R.'s rehospitalization. The records had not been admitted into evidence and were never placed in evidence during the remainder of the hearing.*fn2 The judge referred the doctor to references in the documents that indicated J.R. "wasn't taking his medications, he decompensated and became aggressive." However, Dr. Rozmyslowicz testified that J.R. had not been aggressive toward anyone at the hospital in the last four days and that his condition had improved. He remained on level one observation because of his cigarette smoking and because of intrusive behavior. The doctor added: "But this behavior is drastically reduced right now."

On cross-examination, the doctor opined that if J.R. continued on his medications, he would be able to be satisfactorily discharged into the community. She reiterated that she had no indication that J.R. had acted to harm himself or others.

The judge then asked J.R. if there was anything he wanted to tell him. J.R. told the judge that he understood the need for him to take prescribed medications, but that he had run out of medication because he had only been given a month's supply. The judge challenged J.R.'s assertion by referencing the screening documents, which the judge suggested indicated J.R. told the screener that he did not feel he needed medication. J.R. explained to the judge that he now had the ability to maintain his medication regimen. J.R. stated: "The stuff they got me on now, I'm pretty stable and happy with it and I can continue with Ocean Mental Health 12 hours a week. You know, you sit, you eat dinner there, you've got groups, classes[.]"

J.R.'s counsel next called S.W., J.R.'s girlfriend, as a witness. S.W. testified that she had daily contact with J.R., was aware of his psychiatric needs, and that she and he had discovered, with the aid of his social worker, alternative sources for obtaining J.R.'s medication to enable him to maintain his supply. One of those sources was Ocean County Mental Health. She testified that J.R. had not acted out to harm himself or others. S.W. confirmed that she drove J.R. to his daily activities, which included going to see his probation officer, going to his programs in the evening, and going to church. S.W. testified that J.R. took his medications until they ran out, something she claimed both his probation officer and social worker also knew.

S.W. informed the judge that the symptoms J.R. displayed when he ran out of his medications were that he became tired and lazy, and did not want to shower. She also said that he becomes manic, "he just [concentrates] on [the] same thought over and over again. He's never harmful to society or ...

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