442 U.S. 584 (1979), 75-1690, Parham v. J.R.

Docket Nº:No. 75-1690
Citation:442 U.S. 584, 99 S.Ct. 2493, 61 L.Ed.2d 101
Party Name:Parham v. J.R.
Case Date:June 20, 1979
Court:United States Supreme Court

Page 584

442 U.S. 584 (1979)

99 S.Ct. 2493, 61 L.Ed.2d 101

Parham

v.

J.R.

No. 75-1690

United States Supreme Court

June 20, 1979

Argued December 6, 1977

Reargued October 10, 1978

APPEAL FROM THE UNITED STATES DISTRICT COURT

FOR THE MIDDLE DISTRICT OF GEORGIA

Syllabus

Appellees, children being treated in a Georgia state mental hospital, instituted in [99 S.Ct. 2495] Federal District Court a class action against Georgia mental health officials. Appellees sought a declaratory judgment that Georgia's procedures for voluntary commitment of children under the age of 18 to state mental hospitals violated the Due Process Clause of the Fourteenth Amendment, and requested an injunction against their future enforcement. Under the Georgia statute providing for the voluntary admission of children to state regional hospitals, admission begins with an application for hospitalization signed by a parent or guardian and, upon application, the superintendent of the hospital is authorized to admit temporarily any child for "observation and diagnosis." If, after observation, the superintendent finds "evidence of mental illness" and that the child is "suitable for treatment" in the hospital, the child may be admitted "for such period and under such conditions as may be authorized by law." Under Georgia's mental health statute, any child who has been hospitalized for more than five days may be discharged at the request of a parent or guardian, and the hospital superintendent, even without a request for discharge, has an affirmative duty to release any child

who has recovered from his mental illness or who has sufficiently improved that the superintendent determines that hospitalization of the patient is no longer desirable.

The District Court held that Georgia's statutory scheme was unconstitutional because it failed to protect adequately the appellees' due process rights and that the process due included at least the right after notice to an adversary-type hearing before an impartial tribunal.

Held: The District Court erred in holding unconstitutional the State's procedures for admitting a child for treatment to a state mental hospital, since, on the record in this case, Georgia's medical factfinding processes are consistent with constitutional guarantees. Pp. 598-621.

(a) Testing challenged state procedures under a due process claim requires a balancing of (i) the private interest that will be affected by

Page 585

the official action; (ii) the risk of an erroneous deprivation of such interest through the procedures used, and the probable value, if any, of additional or substitute procedural safeguards; and (iii) the state's interest, including the function involved and the fiscal and administrative burden that the additional or substitute procedural requirement would entail. Cf. Mathews v. Eldridge, 424 U.S. 319, 335; Smith v. Organization of Foster Families, 431 U.S. 816, 848-849. Pp. 599-600.

(b) Notwithstanding a child's liberty interest in not being confined unnecessarily for medical treatment, and assuming that a person has a protectible interest in not being erroneously labeled as mentally ill, parents -- who have traditional interests in and responsibility for the upbringing of their child -- retain a substantial, if not the dominant, role in the decision, absent a finding of neglect or abuse. However, the child's rights and the nature of the commitment decision are such that parents do not always have absolute discretion to institutionalize a child; they retain plenary authority to seek such care for their children, subject to an independent medical judgment. Cf. Pierce v. Society of Sisters, 268 U.S. 510; Wisconsin v. Yoder, 406 U.S. 205; Prince v. Massachusetts, 321 U.S. 158; Meyer v. Nebraska, 262 U.S. 390. Planned Parenthood of Central Missouri v. Danforth, 428 U.S. 52, distinguished. Pp. 600-604.

(c) The State has significant interests in confining the use of costly mental health facilities to cases of genuine need, in not imposing unnecessary procedural obstacles that may discourage the mentally ill or their families from seeking needed psychiatric assistance, and in allocating priority to the diagnosis and treatment of patients as soon as they are admitted to a hospital, rather than to time-consuming pre-admission procedures. Pp. 604-606.

(d) The risk of error inherent in the parental decision to have a child institutionalized for mental health care is sufficiently great that some kind of inquiry should be made by a "neutral factfinder" to determine whether the statutory requirements for admission are satisfied, see Goldberg v. Kelly, 397 U.S. 254, 271; Morrissey v. Brewer, 408 U.S. 471, 489, and to probe the child's background. The decisionmaker must have the authority to refuse to admit any child who does not satisfy the medical standards for admission. The need for continuing commitment must be reviewed periodically. Pp. 606-607.

(e) Due process does not require that the neutral factfinder be law-trained or a judicial or administrative officer; nor is it necessary that the admitting physician conduct a formal or quasi-formal adversary hearing or that the hearing be conducted by someone other than the admitting physician. While the medical decisionmaking process may

Page 586

not be error-free, nevertheless the independent medical decisionmaking process, which includes a thorough psychiatric investigation followed by additional periodic review of a child's condition, will identify children who should not be admitted; risks of error will not be significantly reduced by a more formal, judicial-type hearing. Pp. 607-613.

(f) Georgia's practices, as described in the record, comport with minimum due process requirements. The state statute envisions a careful diagnostic medical inquiry to be conducted by the admitting physician at each regional hospital. Georgia's procedures are not "arbitrary" in the sense that a single physician or other professional has the "unbridled discretion" to commit a child to a regional hospital. While Georgia's general administrative and statutory scheme for the voluntary commitment of children is not unconstitutional, the District Court, on remand, may consider any individual claims that the initial admissions of particular children did not meet due process standards, and may also consider whether the various hospitals' procedures for periodic review of their patients' need for institutional care are sufficient to justify continuing a voluntary commitment. Pp. 613-617.

(g) The differences between the situation where the child is a ward of the State of Georgia and the State requests his admission to a state mental hospital, and the situation where the child's natural parents request his admission, do not justify requiring different procedures at the time of the child's initial admission to the hospital. Pp. 617-620.

412 F.Supp. 112, reversed and remanded.

BURGER, C.J., delivered the opinion of the Court, in which WHITE BLACKMUN, POWELL, and REHNQUIST, JJ., joined. STEWART, J., filed an opinion concurring in the judgment, post, p. 621. BRENNAN, J., filed an opinion concurring in part and dissenting in part, in which MARSHALL and STEVENS, JJ., joined, post, p. 625.

Page 587

BURGER, J., lead opinion

MR. CHIEF JUSTICE BURGER delivered the opinion of the Court.

The question presented in this appeal is what process is constitutionally due a minor child whose parents or guardian seek state administered institutional mental health care for the child, and, specifically, whether an adversary proceeding is required prior to or after the commitment.

I

(a) Appellee1 J. R., a child being treated in a Georgia state mental hospital, was a plaintiff in this class action2 based on 42 U.S.C. § 1983, in the District Court for the [99 S.Ct. 2497] Middle District of Georgia. Appellants are the State's Commissioner

Page 588

of the Department of Human Resources, the Director of the Mental Health Division of the Department of Human Resources, and the Chief Medical Officer at the hospital where appellee was being treated. Appellee sought a declaratory judgment that Georgia's voluntary commitment procedures for children under the age of 18, Ga.Code §§ 88-503.1, 88-503.2 (1975),3 violated the Due Process Clause of the Fourteenth Amendment, and requested an injunction against their future enforcement.

A three-judge District Court was convened pursuant to 28 U.S.C. §§ 2281 (1970 ed.) and 2284. After considering expert and lay testimony and extensive exhibits, and after visiting two of the State's regional mental health hospitals, the District Court held that Georgia's statutory scheme was unconstitutional because it failed to protect adequately the appellees' due process rights. J. L. v. Parham, 412 F.Supp. 112, 139 (1976).

To remedy this violation, the court enjoined future commitments based on the procedures in the Georgia statute. It also commanded Georgia to appropriate and expend whatever amount was "reasonably necessary" to provide nonhospital facilities deemed by the appellant state officials to be the

Page 589

most appropriate for the treatment of those members of plaintiffs' class, n. 2, supra, who could be treated in a less drastic, nonhospital environment. 412 F.Supp. at 139.

Appellants challenged all aspects of the District Court's judgment. We noted probable jurisdiction, 431 U.S. 936, and heard argument during the 1977 Term. The case was then consolidated with Secretary of Public Welfare v. Institutionalized Juveniles, post, p. 640, and reargued this Term.

(b) J.L., a plaintiff before the District Court who is now deceased, was admitted in 1970 at the age of 6 years to Central State Regional Hospital in Milledgeville, Ga. Prior to his admission, J.L. had received outpatient treatment at the hospital for over two months. J.L.'s mother then requested the hospital to admit him indefinitely.

The admitting physician...

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982 practice notes
  • 807 F.2d 1243 (5th Cir. 1987), 85-2485, Lelsz v. Kavanagh
    • United States
    • Federal Cases United States Courts of Appeals Court of Appeals for the Fifth Circuit
    • January 21, 1987
    ...Youngberg, 644 F.2d 147 (3d Cir.1980) (en banc) (See also Rennie v. Klein, 720 F.2d 266, 268 (3d Cir.1983)). Another case, Parham v. J.R., 442 U.S. 584, 99 S.Ct. 2493, 61 L.Ed.2d 101 (1979), is cited by appellees for the proposition that the mentally ill have a right to be free from unneces......
  • 860 F.2d 1045 (11th Cir. 1988), 87-8635, S.H. v. Edwards
    • United States
    • Federal Cases United States Courts of Appeals Court of Appeals for the Eleventh Circuit
    • November 28, 1988
    ...stigmatized by hospitalization is a protectable interest under the Fourteenth Amendment due process clause, as well. Parham v. J.R., 442 U.S. 584, 99 S.Ct. 2493, 61 L.Ed.2d 101 (1979). This court agrees with the Magistrate's recommendation regarding the Fourteenth Amendment due process issu......
  • Garcia v. County of San Diego, 120518 CASDC, 15-CV-189 JLS (NLS)
    • United States
    • Federal Cases United States District Courts 9th Circuit Southern District of California
    • December 5, 2018
    ...children to have those decisions made by their parents rather than the state.” Wallis, 202 F.3d at 1141 (citing Parham v. J.R., 442 U.S. 584, 602 (1979) (holding that it is in the interest of both parents and children that parents have ultimate authority to make medical&......
  • 120 P.3d 210 (Ariz.App. Div. 1 2005), 1 CA-MH 05-0007, In re MH 2004-001987
    • United States
    • Arizona Court of Appeals of Arizona
    • September 22, 2005
    ...from the United States Supreme Court spell out the need for procedural due process in involuntary commitment hearings. Parham v. J.R., 442 U.S. 584, 627 (1979) (Brennan, J., concurring in part and dissenting in part); O'Connor v. Donaldson, 422 U.S. 563, 580 (1975) (Burger, C.J., concurring......
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854 cases
  • 807 F.2d 1243 (5th Cir. 1987), 85-2485, Lelsz v. Kavanagh
    • United States
    • Federal Cases United States Courts of Appeals Court of Appeals for the Fifth Circuit
    • January 21, 1987
    ...Youngberg, 644 F.2d 147 (3d Cir.1980) (en banc) (See also Rennie v. Klein, 720 F.2d 266, 268 (3d Cir.1983)). Another case, Parham v. J.R., 442 U.S. 584, 99 S.Ct. 2493, 61 L.Ed.2d 101 (1979), is cited by appellees for the proposition that the mentally ill have a right to be free from unneces......
  • 860 F.2d 1045 (11th Cir. 1988), 87-8635, S.H. v. Edwards
    • United States
    • Federal Cases United States Courts of Appeals Court of Appeals for the Eleventh Circuit
    • November 28, 1988
    ...stigmatized by hospitalization is a protectable interest under the Fourteenth Amendment due process clause, as well. Parham v. J.R., 442 U.S. 584, 99 S.Ct. 2493, 61 L.Ed.2d 101 (1979). This court agrees with the Magistrate's recommendation regarding the Fourteenth Amendment due process issu......
  • Garcia v. County of San Diego, 120518 CASDC, 15-CV-189 JLS (NLS)
    • United States
    • Federal Cases United States District Courts 9th Circuit Southern District of California
    • December 5, 2018
    ...children to have those decisions made by their parents rather than the state.” Wallis, 202 F.3d at 1141 (citing Parham v. J.R., 442 U.S. 584, 602 (1979) (holding that it is in the interest of both parents and children that parents have ultimate authority to make medical&......
  • 120 P.3d 210 (Ariz.App. Div. 1 2005), 1 CA-MH 05-0007, In re MH 2004-001987
    • United States
    • Arizona Court of Appeals of Arizona
    • September 22, 2005
    ...from the United States Supreme Court spell out the need for procedural due process in involuntary commitment hearings. Parham v. J.R., 442 U.S. 584, 627 (1979) (Brennan, J., concurring in part and dissenting in part); O'Connor v. Donaldson, 422 U.S. 563, 580 (1975) (Burger, C.J., concurring......
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118 books & journal articles
  • The fate of childhood: legal models of children and the parent-child relationship.
    • United States
    • Albany Law Review Vol. 61 Nbr. 2, December 1997
    • December 22, 1997
    ...relationship which sees the child as responsible for making decisions and suffering the consequences). (152) See, e.g., Parham v. J.R., 442 U.S. 584 (1979) (upholding Georgia's statute allowing parents to commit their children to a mental hospital). (153) See, e.g., Bellotti v. Baird, 443 U......
  • PARENS PATRIAE AND PARENTAL RIGHTS: WHEN SHOULD THE STATE OVERRIDE PARENTAL MEDICAL DECISIONS?
    • United States
    • Journal of Law and Health Vol. 33 Nbr. 1, September 2019
    • September 22, 2019
    ...school violated parents' constitutional right to direct their child's education). (85) Troxel, 530 U.S. at 66. (86) Parham v. J. R., 442 U.S. 584, 603 ("Most children, even in adolescence, simply are not able to make sound judgements concerning many decisions, including their need for ......
  • The Due Process Clauses of the 5th and 14th Amensments
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    • The Path of Constitutional Law Part IV: The Final Cause Of Constitutional Law Sub-Part Three: Civil War Amendments And Due Process Generally
    • January 1, 2007
    ...532, 540-43 (1985); id. at 561-63 (Rehnquist, J., dissenting). [356] 494 U.S. 113, 127 (1990). [357] 441 U.S. 418, 425-32 (1979). [358] 442 U.S. 584, 606-16 (1979); id. at 625-33 (Brennan, J., joined by Marshall & Stevens, JJ., concurring in part and dissenting in [359] 452 U.S. 18, 25-......
  • Between home and school.
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    • University of Pennsylvania Law Review Vol. 155 Nbr. 4, April 2007
    • April 1, 2007
    ...COLUM. L. REV. 337, 395-404 (2002) (including grandparents and "de facto" parents as parental surrogates) ; cf Parham v. J.R., 442 U.S. 584, 606-08 (1979) (holding that parents have the right to commit a child to a state mental institution against the child's wishes, so long as a ......
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3 provisions
  • Quarantine, inspection, and licensing: Communicable diseases control,
    • United States
    • Federal Register November 30, 2005
    • November 21, 2005
    ...that the level of process granted be commensurate with the degree of deprivation and the circumstances of the event. See Parham v. J.R., 442 U.S. 584, 608 (1979) (``What process is constitutionally due cannot be divorced from the nature of the ultimate decision that is being made.''). Furth......
  • Immigration: Continued detention of aliens subject to removal orders,
    • United States
    • Federal Register November 14, 2001
    • November 6, 2001
    ...issue of dangerousness without the recommendation of the physician who is a neutral and professional decisionmaker. Cf. Parham v. J.R., 442 U.S. 584, 607 (1979) (due process is satisfied where the neutral decisionmaker is a medical professional making a medical judgment); see also Youngberg......
  • Part II
    • United States
    • Federal Register November 30, 2005
    • November 21, 2005
    ...that the level of process granted be commensurate with the degree of deprivation and the circumstances of the event. See Parham v. J.R., 442 U.S. 584, 608 (1979) (``What process is constitutionally due cannot be divorced from the nature of the ultimate decision that is being made.''). Furth......