Brandt v. Monte, Civil No. 06-0923 (RMB).

• Citation: 626 F.Supp.2d 469
• Decision Date: 29 January 2009
• Docket Number: Civil No. 06-0923 (RMB).
• Parties: John BRANDT, Plaintiff, v. Lyda MONTE, et al., Defendants.
• Court: United States District Courts. 3th Circuit. United States District Courts. 3th Circuit. District of New Jersey

626 F.Supp.2d 469

John BRANDT, Plaintiff, v. Lyda MONTE, et al., Defendants.

Civil No. 06-0923 (RMB).

United States District Court, D. New Jersey, Camden Vicinage.

January 29, 2009.

COPYRIGHT MATERIAL OMITTED

Andrea Janis Waye, Kira Feeny Spaman, Kit Applegate, Stephen M. Orlofsky, Blank Rome LLP, Cherry Hill, NJ, for Plaintiff.

Gerard Andrew Hughes, Office of the New Jersey Attorney General, Division of Law, Trenton, NJ, for Defendants.

OPINION

BUMB, District Judge.

John Brandt (the "Plaintiff"), who was an involuntarily committed patient at Ancora State Psychiatric Hospital ("Ancora") from September 2005 to September 2006,¹ brought this lawsuit alleging that state medical authorities violated his civil rights when they forcibly administered antipsychotic medication to him, first, pursuant to an emergency declaration and later, pursuant to a non-emergency procedure. He is now involuntarily committed at Ann Klein Forensic Center, another state hospital.

The treating physician at Ancora, psychiatrist Lyda Monte, and Ancora "treatment team" members Regina O'Connell, a psychologist, Doris Simmerman, a social worker, and John Coffee, a program coordinator, (collectively, the "Ancora Defendants") are all alleged to have had a personal role in the decision to medicate Plaintiff and are therefore sued in their individual capacities.² La Tayna Wood El, Ancora's chief executive officer, Kevin Martone, assistant commissioner for the New Jersey Division of Mental Health Services, Kevin Ryan, former commissioner of the New Jersey Department of Human Services, James Smith, former acting commissioner of the New Jersey Department of Human Services, and Anthony Haynes, the "Rennie Advocate" at Ancora, (collectively, the "State Defendants") are sued in their official capacities for injunctive relief.

Plaintiff now moves for partial summary judgment, contending that Defendants' undisputed conduct violated his constitutional rights as a matter of law. Defendants cross-move for summary judgment on the grounds, inter alia, that they are immune from suit pursuant to the doctrines of qualified and sovereign immunity. For the reasons stated herein, the Court denies Plaintiff's motion for partial summary judgment, and, in part, grants Defendants' cross-motion for summary judgment.

I. Statement of Facts

A. Background

Plaintiff has had a long history of psychological illness, which, at times, has manifested itself in violent and unlawful behavior. In 2003, Plaintiff was found not guilty by reason of insanity for criminal charges of burglary, criminal mischief, and criminal trespass as a result of breaking in to his exgirlfriend's college dormitory room and, in the midst of a dispute with her, destroying her property. He was thereafter involuntarily committed at Ancora, a psychiatric hospital.

This case arises from an incident at Ancora. In November 2005, Plaintiff was placed in Ancora's Medical Ward to receive treatment for an injury to his leg. His treating doctor, Cecilia Caringal, concluded that he should not be involuntarily committed because he suffered only from an impulse control disorder, an "Axis II" diagnosis, rather than the "Axis I" diagnosis that would normally justify involuntary commitment.³ In February 2006, on Caringal's recommendation, a state commitment court ordered that Plaintiff be transferred from the Medical Ward, that his "treatment team may begin a discharge plan if deemed appropriate," and that he "cooperate with his treatment team and take any medications prescribed by the treating psychiatrist. . . ." (Pl. Stat. Mat. Fcts. 4-5, ¶ 21.) Pursuant to the commitment court's order, the Medical Ward staff prepared paperwork recommending that Plaintiff be discharged and that his privileges be elevated. Before the recommendation could be acted upon, however, Plaintiff was transferred from the Medical Ward to Holly Hall C and placed under the care of the ward psychiatrist, Ancora Defendant Monte. The treatment team in Holly Hall C consisted of Ancora Defendants O'Connell, Simmerman, and Coffee, as well as nurse Deborah Berkebile.

The record is unclear as to whether the treatment team in Holly Hall C was aware of the Medical Ward's upgrade and discharge recommendations.⁴ The morning that Plaintiff was transferred, on February 9, he met with Monte and the treatment team for a routine intake interview, at which time Monte prescribed antipsychotic medication. Plaintiff, aware of the Medical Ward team's recommendation, believed he did not need antipsychotic medication and refused to consent to administration of the drugs. In the treatment team meeting, Plaintiff grew increasingly agitated. He raised his voice, and at one point left the room. After the meeting's abrupt conclusion, Monte completed a certificate that declared Plaintiff to be an "emergency" and ordered that he be medicated intravenously without his consent. She prescribed Topamax, Vistaril, Zyprexa, and Benadryl. On the "Emergency Certificate," she provided this basis for the emergency declaration:

HOSTILE, AGGRESSIVE, ANGRY, REFUSING TO TAKE MEDS, IMPULSIVE, LONG HX [HISTORY] OF AGGRESSIVE/ASSAULTIVE/CRIMINAL BEHAVIOR, EXTREMELY MANIPULATIVE—HAS COURT ORDER TO COMPLY WITH PRESCRIBED MEDICATION—VERY CONFRONTATIONAL WITH HIGH LEVEL OF AGITATION AND HOSTILITY—HX [HISTORY] OF 2 ESCAPES FROM GPPH [GREYSTONE PARK PSYCHIATRIC HOSPITAL]—KROL STATUS.

(Pl. Stat. Mat. Fcts. 8, ¶ 37.) In addition to the Emergency Certificate, Monte put Plaintiff on "one-to-one precautions," which requires a hospital staff member to be within an arm's length of the patient at all times and to keep a log noting the patient's behavior every fifteen minutes.

Medication was administered to Plaintiff pursuant to the Emergency Certificate only twice. At Ancora, drugs are routinely administered twice daily, at 8:00 a.m. and 8:00 p.m. Thus, Plaintiff's first emergency administration occurred at 8:00 p.m., almost nine hours after his encounter with the Ancora Defendants; the second emergency administration occurred at 8:00 a.m. the following morning.

That morning, Monte initiated the three-step Non-Emergency Procedure for medicating a patient involuntarily. By noon, this procedure had been completed. Thus, although Plaintiff continued to be medicated against his will, starting with the second day's evening administration, he was medicated pursuant to the Non-Emergency Procedure. The one-to-one precaution log, which documented Plaintiff's behavior for the entire 25-hour period of the Emergency Certificate, did not note any aggressive or otherwise abnormal behavior.

B. Administrative Bulletin 78-3 (Rules for Involuntary Administration of Medication)

Administrative Bulletin 78-3 sets out the procedures that New Jersey state hospitals must follow for forcibly medicating involuntarily committed patients. It deals with the administration of medication in both emergency and non-emergency situations. Indeed, Administrative Bulletin 78-3 was the subject of extensive litigation between 1977 and 1983, when the Third Circuit ultimately upheld its procedure for non-emergency forcible medication. That Third Circuit decision, Rennie v. Klein, discussed more fully below, held that the non-emergency procedure, which requires three levels of approval before patients may be forcibly medicated, struck a constitutionally appropriate balance by protecting the patient's liberty interest in refusing medication, while still allowing medical authorities to administer medication as needed. 720 F.2d 266, 269-270 (3d Cir. 1983).

Section IV(A) of Administrative Bulletin 78-3 provides that medical authorities may administer psychotropic medication only when patients have given voluntary, informed consent. The Bulletin outlines four exceptions to this consent requirement: (1) emergency administration of medication (the "Emergency Procedure"), (2) non-emergency refusal to give consent (the "Non-Emergency Procedure"), (3) patients incapable of giving informed consent, and (4) incompetent patients.⁵ (As there is no dispute that Plaintiff was competent and capable of giving informed consent, only the Emergency Procedure and the Non-Emergency Procedure are at issue in this case.)

In relevant part, the Emergency Procedure requires a treating physician to certify "that it is essential to administer psychotropic medication, because without medication there is a substantial likelihood that the patient will harm him/her self or others . . . in the reasonably foreseeable future. . . ." § IV(C)(1)(b). Once this "Emergency Certificate" is completed, medication may be administered for up to 72 hours. Id. The Emergency Procedure provides a mechanism for some type of review, but does not specify who the reviewing authority must be or whether review is even required. § IV(C)(1)(d)-(g).

The Non-Emergency Procedure (referred to in the parties' papers variously as "Refusing Status" and the "Three-Step Form"), outlines a three-step procedure for overriding a patient who refuses medication in the absence of an emergency. First, the treating physician must meet with the patient in an attempt to address his concerns. § IV(C)(2)(b)(1). If the patient persists in refusing medication and the physician believes that medication is a necessary part of the patient's treatment, then the matter is referred to a treatment team. § IV(C)(2)(b)(2). Second, the treatment team must review the physician's recommendation and the patient's objections, and then document its conclusions. § IV(C)(2)(c)(2). If the patient is present, the team must attempt to formulate a treatment plan acceptable to the patient and the team. § IV(C)(2)(c)(1). Third, if the patient still persists in refusing medication, then the Medical Director must conduct a personal examination of the patient. § IV(C)(2)(d)(1). If the Medical Director agrees with the treating physician, then the medication may be administered forcibly. § IV(C)(2)(d)(1)(B). Throughout this...