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In re Civil Commitment of J.E.

Superior Court of New Jersey, Appellate Division

June 7, 2013

IN THE MATTER OF THE CIVIL COMMITMENT OF J.E.

NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION

Argued December 12, 2012

On appeal from the Superior Court of New Jersey, Law Division, Essex County, Docket No. MH-87-2012.

Daniel F. O'Brien, Assistant Deputy Public Defender, argued the cause for appellant J.E. (Joseph E. Krakora, Public Defender, attorney; Mr. O'Brien, on the brief).

Thomas M. Bachman, Assistant Essex County Counsel, argued the cause for respondent, State of New Jersey/County of Essex (James R. Paganelli, Essex County Counsel, attorney; Mr. Bachman, on the brief).

Before Judges Nugent and Haas.

PER CURIAM

J.E. appeals from the March 13, 2012 Civil Commitment Order that continued his involuntary commitment pursuant to N.J.S.A. 30:4-27.15 to the Essex County Hospital Center (ECHC) and scheduled a review hearing for the following month. We affirm.

On January 13, 2012, after finding probable cause to believe then eighteen-year old J.E. was in need of involuntary commitment, a Law Division judge entered an order committing him to Newark Beth Israel Hospital, and scheduled an initial hearing for February 1, 2012. At the initial hearing, another judge continued J.E.'s involuntary commitment, authorized his transfer to ECHC, and ordered that a review hearing be scheduled in approximately thirty days. J.E. did not appeal either of those orders.

On March 8, 2012, five days before the review hearing, a psychiatrist examined J.E. According to the psychiatrist's report, J.E.'s mother died when he was two years old, and later two of his aunts died. In the year before J.E.'s admission, his father died, and J.E. became psychotic and depressed. He denied his own existence, his name, and his family. According to the psychiatrist, J.E. had taken three different medications since his admission, but he had not improved.

The psychiatrist reported that J.E. believed his parents were not dead, but in a spaceship on a permanent mission; that his aunt was an imposter; and that he, J.E., had a guardian called Yamaguchi Werewolf. Concluding her report, the psychiatrist stated that J.E. was unable to take care of himself medically or psychiatrically.[1]

The review hearing was conducted on March 13, 2012. The psychiatrist was the only witness. Consistent with her report, she testified that J.E.'s present diagnosis was "schizophrenic disorder mix, and a rule out schizophrenia chronic paranoid type but since he's so young we will not consider it schizophrenia." J.E.'s current medications were ineffective, so the psychiatrist had ordered blood tests to see if he could be started on a new medication.

The psychiatrist explained, as she had in her report, that J.E. was delusional. He did not believe that his name was his real name. He thought he had been born in Egypt or the Bahamas, and he thought his parents, both deceased, were in space on a space mission. Orphaned, J.E.'s only relatives were an aunt and cousin. He denied they were his relatives, believing his real cousin, named Werewolf, lived on the ECHC's third floor.

Based on J.E.'s delusional symptoms, the psychiatrist believed he was dangerous to himself, a condition warranting continuing involuntary commitment. Accordingly, she recommended that J.E.'s commitment status be reviewed in six weeks to give her time to review the blood tests and possibly start him on the new medication.

On cross-examination, the psychiatrist admitted that J.E. ate food provided to him, dressed himself, and cared for his personal needs. She also acknowledged that he had been compliant with his medications, had not been violent or threatening, and had not harmed himself or destroyed property.

On redirect examination, the psychiatrist explained that J.E.'s judgment was extremely poor and he did not know why he was in the hospital. He thought he had been brought to the hospital to have blood work done, and he wanted to leave, but he had no place to go. J.E. denied that his aunt and cousin were his family; he thought they were imposters. He also thought that he was someone else, gave the staff a different name each day, and could not take care of himself.

Following the hearing, the court determined that J.E.'s involuntary commitment should continue. Recounting some of J.E.'s serious delusions, including his belief that he was not himself, the court concluded: "I could [not] think of a more appropriate commitment than this one." The court entered a confirming order continuing J.E.'s commitment. That order is the subject of this appeal.

The court conducted another review hearing on April 24, 2012, after which it entered an order conditionally extending

J.E.'s placement pending his placement with his grandmother and aunt. J.E. was discharged on June 19, 2012.

In this appeal from the March 13, 2012 order continuing his commitment, J.E. makes the following arguments:

POINT I.
THE TESTIMONY OF DR. RAVELO AMOUNTED TO NET OPINION. NO FACTS WERE GIVEN IN SUPPORT OF THE CONCLUSION OF DANGEROUSNESS TO SELF. THIS TESTIMONY WAS INSUFFICIENT TO SUPPORT AN ORDER OF CONTINUED COMMITMENT
POINT II.
THE TRIAL COURTERRED BY CONTINUING THE INVOLUNTARY COMMITMENT OF J.E. THE STATE FAILED TO PROVE HE PRESENTED DANGER TO HIMSELF WITHIN THE REASONABLY FORSEEABLE FUTURE BY CLEAR AND CONVINCING EVIDENCE
POINT III.
J.E.'S APPEAL IS NOT MOOT

We are unpersuaded by J.E.'s arguments. The Legislature has declared "[t]he State is responsible for providing care, treatment and rehabilitation services to mentally ill persons who are disabled and cannot provide basic care for themselves or who are dangerous to themselves, others or property . . . ." N.J.S.A. 30:4-27.1a. The procedure for committing such individuals who are unwilling or unable to seek appropriate treatment is set forth in N.J.S.A. 30:4-27.1 to -27.23, Rule 4:74-7, and, in the case of minors, Rule 4:74-7A.

A "court may enter an order of temporary commitment to treatment authorizing the assignment of a person to . . . admission to or retention of custody by a facility pending final hearing if it finds probable cause . . . to believe that the person is in need of involuntary commitment to treatment." R. 4:74-7(c). A court may enter a final order involuntarily committing a person if the court finds "by clear and convincing evidence presented at the hearing that the patient is in need of continued involuntary commitment to treatment. . . ." R. 4:74-7(f)(1).

The phrase "in need of involuntary commitment to treatment" means

that an adult with mental illness, whose mental illness causes the person to be dangerous to self or dangerous to others or property and who is unwilling to accept appropriate treatment voluntarily after it has been offered, needs outpatient treatment or inpatient care at a short-term care, or psychiatric facility or special psychiatric hospital because other services are not appropriate or available to meet the person's mental health care needs.
[N.J.S.A. 30:4-27.2m.]
A person is "dangerous to self" if
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 harm 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. This determination shall take into account a person's history, recent behavior and any recent act, threat or serious psychiatric deterioration.
[N.J.S.A. 30:4-27.2h.]

The term "'[r]easonably foreseeable future' means a time frame that may be beyond the immediate or imminent, but not longer than a time frame as to which reasonably certain judgments about a person's likely behavior can be reached." N.J.S.A. 30:4-27.2kk.

A person who has been involuntarily committed is entitled to periodic reviews of the commitment. R. 4:74-7(f)(2). If a patient is entitled to discharge from an inpatient facility but has no appropriate place to go, "the court shall enter an order conditionally extending the patient's hospitalization and scheduling a placement review hearing within [60] days thereafter." R. 4:74-7(h)(2).

In order to continue a civil commitment, a court must find by clear and convincing evidence that the danger a committed person poses constitutes "a substantial risk of dangerous conduct within the reasonably foreseeable future." In re Commitment of T.J., 401 N.J.Super. 111, 119 (App. Div. 2008) (internal quotation marks and citations omitted). The mere potential for dangerous conduct, without more, is insufficient. In re Commitment of J.R., 390 N.J.Super. 523, 530 (App. Div. 2007).

Here, J.E. argues that respondent "State of New Jersey/County of Essex" (the State) did not clearly and convincingly establish that he presented an immediate risk of harm to himself. J.E. also argues that the psychiatrist's opinion was a "net opinion" entitled to no weight.

The State contends the case should be dismissed as moot. Alternatively, the State argues that the evidence clearly and convincingly demonstrated J.E.'s inability to care for himself.

At the outset, we reject the State's argument that the appeal is moot. Even if J.E. is possibly responsible for his hospital costs, as he alleges, and even if his confinement could affect his future status if he is recommitted, as he claims, "'we should nevertheless decide the issue because it implicates a committee's constitutional right to liberty, and by its nature, will continually become moot before judicial review.'" In re Commitment of B.L., 346 N.J.Super. 285, 292 (App. Div. 2002) (quoting In re G.G. 272 N.J.Super. 597, 600, n.1, (App. Div. 1994)).

We turn to J.E.'s argument that his commitment should not have been continued following the March 2012 hearing. When reviewing civil commitment decisions, "we afford deference to the trial court's supportable findings, " T.J., supra, 401 N.J.Super. at 119, and "reverse[] only when there is clear error or mistake[.]" In re Commitment of M.M., 384 N.J.Super. 313, 334 (App. Div. 2006). Nevertheless, we "must consider the adequacy of the evidence." Ibid. "[W]e have not hesitated to reverse involuntary commitments when the record failed to contain clear and convincing evidence of 'a substantial risk of dangerous conduct within the reasonably foreseeable future.'" T.J., supra , 401 N.J.Super. at 119 (quoting In re S.L., 94 N.J. 128, 138 (1983)).

Contrary to J.E.'s arguments, the State produced clear and convincing evidence that he posed a danger to himself. J.E. does not dispute the psychiatrist's opinion that he was severely delusional. After all, he disbelieved his own name, believed his parents were on a spaceship, and disbelieved that his only living relatives were in fact related to him. And though J.E. was capable of eating and caring for himself in a supervised institutional setting, he was incapable of caring for his psychiatric and medical needs. When the court continued J.E.'s commitment on March 13, 2012, there was no evidence that anyone outside of the hospital was willing and available to supervise and assist J.E.

Moreover, J.E.'s delusional behavior demonstrated that he was unable to satisfy his need for nourishment, essential medical care, and shelter, without assistance. He had suffered serious psychiatric deterioration following his father's death within the previous year. His current medications were not improving his condition.

J.E. argues that the psychiatrist gave a "net opinion" because she did not explain how his psychosis and consequent symptoms were likely to cause him to suffer harm within the reasonably foreseeable future. Significantly, J.E. challenged neither the psychiatric diagnosis nor the causal link between that condition and his severely delusional state. Considering the undisputed diagnosis and the undisputable degree of J.E.'s delusions, the trial court did not need an expert to spell out, explicitly, that J.E. was currently incapable of obtaining for himself food, shelter, and basic necessities, including medical needs, in light of his recent psychiatric deterioration. From that part of the psychiatrist's testimony J.E. did not dispute, a fact finder could readily conclude that a person who does not know his own name and believes he has no relatives is unable to care for himself. Further, the evidence supported the court's implicit conclusions that J.E.'s psychiatric condition would either not improve or continue to deteriorate if he were discharged; and, that left to his own devices, defendant would suffer serious harm within "a time frame as to which reasonably certain judgments about a person's likely behavior can be reached." N.J.S.A. 30:4-27.2kk.

We find no clear error or mistake in the court's decision warranting reversal.

Affirmed.


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