January 20, 2010
IN THE MATTER OF THE COMMITMENT OF S.C.
On appeal from Superior Court of New Jersey, Law Division, Camden County, Docket No. 1715-08.
NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION
Argued January 5, 2010
Before Judges Wefing, Grall and Messano.
S.C. appeals from an order of civil commitment entered on November 26, 2008. Because the evidence presented was not adequate to permit the judge "to come to a clear conviction" that S.C. was a person in need of involuntary commitment, we reverse. In re Commitment of G.G.N., 372 N.J. Super. 42, 59 (App. Div. 2004).*fn1
Upon a finding of probable cause that he was a person in need of involuntary commitment, S.C. was temporarily committed to Camden County Health Services Center-MHCD or another mental hospital through the "Kennedy Health System." N.J.S.A. 30:4-27.10g. The order of temporary commitment was entered on November 14, 2008. As required by statute and court rule, the judge scheduled a hearing on S.C.'s continued commitment within twenty days. N.J.S.A. 30:4-27.10h; N.J.S.A. 30:4-27.12a; R. 4:74-7(c)(1). Although the judge scheduled the hearing for December 2, 2008, it was held on an earlier date, November 26, 2008.*fn2
Dr. Anusuya Balasundaram testified at the hearing. The doctor treated S.C. at Hampton Hospital after he was stabilized at Kennedy Hospital and transferred to Hampton. Apparently based upon her review of S.C.'s records, the doctor explained that S.C. had one prior hospitalization in 2000 and was admitted to Kennedy Hospital because he indicated that he did not want to live, exhibited "psychotic symptoms" and appeared to be "catatonic."
By the time S.C. came under Dr. Balasundaram's care on November 18, 2008, he had been stabilized, was no longer catatonic and was speaking, but he had some "thought disorganization" - "thoughts [that] were not coherent." The doctor adjusted the dosage of his medications and was of the opinion that S.C. was improving. Nonetheless, the doctor "still fe[lt] that he would be unable to manage independently upon discharge at [that] time," because, as evidenced by his "repeatedly ask[ing] sort of the same questions over and over again," "his thought process [was] still not clear." By way of illustration, the doctor explained that S.C. had mistaken her for being a nurse although she had been seeing him as his psychiatrist, and he had repeatedly questioned her about his release and the nature of the upcoming hearing. On that ground, her "impression [was] that his thought process is still not clear enough for him to be able to make decisions and sort of manage independently at this time."
The doctor acknowledged that immediately prior to his admission to Kennedy Hospital, S.C. was living independently in an apartment he shared. She also knew that S.C. had been regularly attending an out-patient program and taking his prescribed medications prior to this hospitalization. In the doctor's opinion, suicide was no longer a concern and the only potential danger present was from S.C.'s lack of "ability to manage independently" attributable to his disorganized thought process. The doctor admitted, however, that there was no evidence that S.C. had failed to eat properly, attend his out-patient program or take his medication prior to this hospitalization. Moreover, she found no reason to believe that S.C. would deviate from his prior practice of complying with prescribed treatments.
S.C. also testified. He explained that he shared his apartment with his girlfriend and attended an out-patient program five days a week. His girlfriend prepared the meals he had at home, and lunch was provided by the facility in which he received out-patient treatment. He intended to continue his medication and his out-patient treatment upon his release.
The judge found that S.C. "continues to manifest some modest forms of confusion" that give rise to "concern as to his ability to appropriately manage himself in a surrounding less restrictive . . . than the hospital setting itself." The judge concluded that S.C.'s mental illness had improved but not "reached a maximum expectable degree of . . . stabilization and[,] therefore, that he continues to represent a danger to himself."
On review of orders of civil commitment, this court gives deference to the judge's determination and reverses "only when there is clear error or mistake." In re Commitment of M.M., 384 N.J. Super. 313, 334 (App. Div. 2006). Where the evidence is wholly inadequate to support the determination, the error must be corrected.
"[I]nvoluntary commitment . . . is a profound and dramatic curtailment of a person's liberty . . . ." In re Commitment of D.M., 285 N.J. Super. 481, 486 (App. Div. 1995) (internal quotations omitted), certif. denied, 144 N.J. 377 (1996); see Addington v. Texas, 441 U.S. 418, 426, 99 S.Ct. 1804, 1809, 60 L.Ed. 2d 323, 331 (1979). The curtailment is justified only when there is clear and convincing evidence that commitment is required because a patient unwilling to be hospitalized "is likely to pose a danger to self or others or property by reason of mental illness" if not committed. In re Commitment of S.L., 94 N.J. 128, 138 (1983); N.J.S.A. 30:4-27.12a; N.J.S.A. 30:4-27.2h, i, m, r. Because the patient's liberty is at stake, "'meticulous adherence to statutory and constitutional criteria'" for commitment is required. D.M., supra, 285 N.J. Super. at 486.
Under New Jersey law, the inquiry is cast in terms of whether an adult is "in need of involuntary commitment."
N.J.S.A. 30:4-27.12a; see R. 4:74-7(f)(1). Adults in need of involuntary commitment are those "whose mental illness causes [them] to be dangerous to self or dangerous to others or property and who [are] unwilling to be admitted to a facility voluntarily for care, and who need care at [a specialized facility] because other services are not appropriate or available to meet the[ir] mental health care needs." N.J.S.A. 30:4-27.2; see N.J.S.A. 30:4-27.2h, i, r (defining mental illness and dangerousness).
The most obvious failure of proof in this case is the absence of adequate evidence to support a finding of dangerousness. There was no evidence even suggesting that S.C. posed any danger to others or property. Thus, the State was required to establish by clear and convincing evidence that he was presently dangerous to self. The statute states what must be shown to establish danger to self sufficient to justify involuntary commitment.
"Dangerous to self" means that by reason of mental illness the person has threatened or attempted suicide or serious bodily harm, or has behaved in such a manner as to indicate that the person is unable to satisfy his need for nourishment, essential medical care or shelter, so that it is probable that substantial bodily injury, serious physical debilitation or death will result within the reasonably foreseeable future; however, no person shall be deemed to be unable to satisfy his need for nourishment, essential medical care or shelter if he is able to satisfy such needs with the supervision and assistance of others who are willing and available. [N.J.S.A. 30:4-27.2h.]
The evidence presented to the trial judge did not support a finding of dangerousness under this standard. While there was evidence that S.C. indicated that he did not wish to live at the time of his temporary commitment, Dr. Balasundaram testified that suicide was not a concern at the time of this hearing. There was absolutely no evidence that S.C. had ever engaged in behavior indicative of an inability to satisfy his need for nourishment, essential medical care or shelter. Moreover, nothing in the record suggested that probable substantial bodily injury, serious physical debilitation or death would result in the reasonably foreseeable future if his confinement were not continued. The only evidence introduced compelled the inference that S.C. would, as he had in the past, be able to satisfy his needs in the community with the assistance of his girlfriend and those who provided his mental health services five days a week.
Because the State failed to clearly and convincingly prove the dangerousness attributable to mental illness that was essential to justify continued restriction of S.C.'s liberty, we reverse the order of civil commitment entered on November 26, 2008.