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In re Civil Commitment of J.G.

August 29, 2007


On appeal from the Superior Court of New Jersey, Law Division, Atlantic County, ATSC-76-06.

Per curiam.



Argued August 21, 2007

Before Judges Lisa and Holston, Jr.

Appellant, J.G., appeals the trial court's February 17, 2006, order continuing her involuntary civil commitment pursuant to N.J.S.A. 30:4-27.15 to the Behavioral Unit of the Atlantic City Medical Center (ACMC), with a review hearing in two weeks. We affirm.

J.G. is age forty-nine and has a long history of psychiatric hospitalizations. J.G. was involuntarily committed to the ACMC, on January 30, 2006, by a temporary order for involuntary commitment dated February 1, 2006, pursuant to N.J.S.A. 30:4-27.10. J.G. was recommitted after a review hearing to the ACMC pursuant to the February 17, 2006, order which is the subject of this appeal.

Subsequent to her recommitment, pursuant to the February 17, 2006, order, J.G. was transferred to Ancora Psychiatric Hospital (Ancora), where, after a review hearing on March 3, 2006, J.G. was placed on continued extension pending placement (CEPP) status, subject to a conditional discharge per N.J.S.A. 30:4-27.15(c)(1). Her CEPP status was renewed at several subsequent hearings, while placement was sought. J.G. was administratively discharged from Ancora on July 6, 2006. J.G.'s appeal of her February 17, 2006, recommitment was filed March 16, 2006.

At the beginning of the February 17, 2006 plenary hearing, J.G. expressed complaints about the adequacy of her treatment at ACMC, requested that the judge recuse himself because of his involvement in an earlier case involving her involuntary commitment, and sought to discharge the attorney appointed to represent her and represent herself. J.G. requested the discharge of counsel because counsel had an inadequate opportunity to meet with her and review the facts of her case and her previous commitment history prior to her hearing and, thus, was not prepared to properly represent her.

The judge declined to recuse himself stating that the existence of an appeal of his prior commitment order was insufficient grounds for recusal. The judge counseled J.G. against dismissing her assigned counsel because of her lack of legal training and counsel's knowledge of the law and trial procedures. The court ruled that J.G. would be allowed to conduct cross-examination on her own but directed her attorney to be available to advise her.

J.G. outlined a number of her complaints concerning her treatment at ACMC. They included the alleged stealing by hospital staff of her bank card, staff refusing her permission to order take-out food, the failure to provide her a vegetarian diet, and declining to provide her a medical evaluation and treatment.

Dr. Alexander S. Zwil, J.G.'s treating psychiatrist and medical director for inpatient psychiatry for ACMC, testified for the State. Dr. Zwil indicated J.G. refused to be formally examined. However, by observing J.G.'s affect and behavior and listening to her verbal output, as recently as the day of the hearing, he was able to make a psychiatric diagnosis to a reasonable degree of medical certainty.

Dr. Zwil made an Axis I diagnosis of schizophrenia, chronic paranoid type, consistent with previous diagnoses contained in records he had reviewed. Dr. Zwil noted that when J.G. was examined medically in the emergency room (ER) at the time of her admission to the ACMS she was found to have a low serum potassium level (LSP) which, based on her emaciated appearance, Dr. Zwil opined was probably due to low nutrition. The doctor stated that LSP is a potentially serious medical problem that can lead to cardiac arrhythmias. J.G. had refused potassium replacement, an electrocardiogram, and further laboratory testing since her admission to ACMC. Dr. Zwil indicated that J.G. had agreed to be treated with Risperdal for her psychiatric condition but refused Haloperidol.

Dr. Zwil opined that J.G.'s psychiatric and medical conditions placed her at great risk of exposure to malnutrition and victimization if she were released into the community on the date of the hearing, because the only available facility for her to be released to was the Atlantic City Rescue Mission. Dr. Zwil opined that because J.G. would not obtain adequate nutrition in those circumstances she was at risk to further the LSP and was apt to have additional malnutrition related metabolic disturbances which could put her at serious risk and disability or even death from medical causes.

Dr. Zwil, in support of his diagnosis of schizophrenia, paranoid type, stated that while admitted in the hospital, J.G. was preoccupied with delusional events in her verbalizations and writings, and was verbally aggressive and abusive with staff, including making anti-semetic remarks directed to staff she believed were Jewish. The doctor noted that J.G. had refused to provide ACMC staff permission to contact her family to confirm that she is able to return to her family's residence. He stated that J.G. was brought to the ER by her elderly mother who was unable to continue to care for her. Therefore, J.G. was unable to be discharged to her mother, leaving the Rescue Mission as the only alternative placement.

Dr. Zwil testified there had been no improvement in either J.G.'s psychiatric or medical conditions since her admission on January 30, 2006. Dr. Zwil stated that the anti-psychotic medication, Risperdal, can take as long as four to six weeks to work. The doctor recommended that J.G. continue with inpatient psychiatric treatment to insure her safe treatment, notwithstanding her lack of cooperation with treatment, so that after receiving her medication for a sufficient period of ...

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