In re J.P.
| Decision Date | 28 October 2020 |
| Docket Number | SJC-12872 |
| Citation | 155 N.E.3d 722,486 Mass. 117 |
| Parties | In the MATTER OF J.P. |
| Court | United States State Supreme Judicial Court of Massachusetts Supreme Court |
Lois M. Farmer, Hyannis, for J.P.
Richard F. Ready, Wellesley, (Heidi A. Kostin also present) for Southcoast Behavioral Health.
The following submitted briefs for amici curiae:
Ruth A. Bourquin, Matthew R. Segal, Jessica J. Lewis, Boston, & Jessie J. Rossman for American Civil Liberties Union Foundation of Massachusetts, Inc., & another.
Karen Owen Talley, Committee for Public Counsel Services, Kathryn Rucker, Coco Holbrook, Jennifer Honig, Boston, & Tatum A. Pritchard for Committee for Public Counsel Services & others.
Anna S. Richardson for Veterans Legal Services.
Lester D. Blumberg, Special Assistant Attorney General, for Department of Mental Health.
Present: Gants, C.J., Lenk, Gaziano, Lowy, Budd, Cypher, & Kafker, JJ.1
The long-term involuntary civil commitment of persons with mental illness is only permissible if a judge finds proof beyond a reasonable doubt that discharge would create a likelihood of serious harm. See G. L. c. 123, §§ 7, 8 ; Superintendent of Worcester State Hosp. v. Hagberg, 374 Mass. 271, 276, 372 N.E.2d 242 (1978). Here, after an evidentiary hearing, a District Court judge issued an order to civilly commit J.P. for a period not to exceed six months. J.P. appealed from the Appellate Division's affirmance of the decision to the Appeals Court, and we transferred the case to this court on our own motion. We are asked to determine whether sufficient admissible evidence was presented to warrant an order of civil commitment pursuant to G. L. c. 123, §§ 7, 8. We conclude that the answer is yes.2
Background. 1. Standard for long-term civil commitment. By petitioning the district court, the superintendent of a mental health facility may seek to commit involuntarily, for a period of between six and twelve months, an individual who has been admitted to the facility. G. L. c. 123, §§ 7 (a ), 8 (d ). For an order of commitment to be issued, the judge must find, after a hearing, that "(1) such person is mentally ill, and (2) the discharge of such person from a facility would create a likelihood of serious harm." G. L. c. 123, § 8 (a ). Further, the judge must find that there is no alternative that is less restrictive than hospitalization. Commonwealth v. Nassar, 380 Mass. 908, 917-918, 406 N.E.2d 1286 (1980).
The phrase "likelihood of serious harm" is statutorily defined as "(1) a substantial risk of physical harm to the person himself [or herself] as manifested by evidence of, threats of, or attempts at, suicide or serious bodily harm; (2) a substantial risk of physical harm to other persons as manifested by evidence of homicidal or other violent behavior or evidence that others are placed in reasonable fear of violent behavior and serious physical harm to them; or (3) a very substantial risk of physical impairment or injury to the person himself as manifested by evidence that such person's judgment is so affected that he is unable to protect himself in the community and that reasonable provision for his protection is not available in the community." G. L. c. 123, § 1. The harm must be shown to be imminent, that is, it will materialize "in days or weeks rather than in months." Matter of G.P., 473 Mass. 112, 128, 40 N.E.3d 989 (2015). Each of the statutory requirements must be demonstrated beyond a reasonable doubt.
Id. at 119, 40 N.E.3d 989. See Nassar, 380 Mass. at 913, 406 N.E.2d 1286.
2. J.P.'s civil commitment hearing. On February 12, 2018, J.P. was transferred from St. Luke's Hospital (St. Luke's) emergency room to Southcoast Behavioral Health (SBH). SBH filed a timely petition for J.P.'s involuntary commitment pursuant to G. L. c. 123, §§ 7, 8, after J.P. requested to be discharged. In the petition, SBH alleged that, as a result of mental illness, J.P. presented both a risk of harm to others and a very substantial risk of harm to himself in that he was unable to protect himself in the community.3 SBH further alleged that civil commitment was the least restrictive alternative in the circumstances.
At the commitment hearing, J.P.'s treating physician, Ronald Lee, testified that, once at SBH, J.P. was uncooperative in providing information regarding his psychiatric history, although he did indicate that he previously had been hospitalized at other mental health facilities.4 J.P. also refused to allow the facility either to release information to, or obtain information from, his mother or any other providers involved in his care.
Dr. Lee, who diagnosed J.P. with schizoaffective disorder–bipolar type
, found J.P. to be unengaged, uncooperative, and unwilling to participate in treatment. Lee testified that J.P. was one of the most paranoid patients he had ever met as a physician at SBH. J.P. refused medication and often walked out during meetings with the doctor. J.P. also was hostile and aggressive toward the doctor. J.P. referred to Dr. Lee as a "fucking punk" and a "fucking rat," and indicated that he could not work with the doctor because of the doctor's Asian ethnicity. Lee testified that, at one point during a meeting, as J.P. insisted to Lee that he did not have a psychiatric issue, J.P.'s jaw was clenched, his muscles were tensed, and he appeared to be bordering on lashing out. J.P. also warned the doctor that going forward with commitment proceedings would be a mistake. These interactions caused Lee to feel threatened at times.
According to the SBH medical records, J.P. told a different SBH doctor that he was able to "handle himself in a bar," stating, "I know what to do if anybody gets in my face." J.P. further revealed that he was trained in martial arts and "know[s] a few things." He also made threats to a nurse practitioner, telling her that if he did not get his (nonpsychiatric) medication, "something uncontrollable will happen and you won't like it."
Lee also reported that J.P. also had altercations with his peers during his stay. Two different patients reported to the doctor that J.P. had threatened their lives. In addition, J.P.'s roommate had to be moved out of the room for safety reasons.
The doctor also testified as to the content of the records from St. Luke's that accompanied J.P. when he transferred to SBH.5 According to those records, J.P. had threatened and exhibited paranoid behavior toward his mother. He accused his mother and neighbors of placing beer in his refrigerator. He also forced his mother to stay up at night to "keep a watch out" for him, telling her, "Don't you come back in the house."
J.P. presented his own expert witness, a doctor who examined J.P. the morning of the hearing. That doctor opined that J.P. suffered from a delusional disorder-paranoid
type or paranoid schizophrenia, but disagreed that that J.P. met the criteria for involuntary civil confinement.
At the conclusion of the hearing, the judge found that J.P. suffered from a major mental illness, that discharge from SBH would create a likelihood of serious harm, and that there was no less restrictive alternative to involuntary civil commitment. The judge subsequently ordered J.P. civilly committed for a period not to exceed six months.6
Discussion.7 Here, we review the sufficiency of the evidence presented that, if released, J.P. posed a likelihood of serious harm as defined by the statute.8 As discussed supra, a likelihood of serious harm can be proved in one of three ways. SBH presented evidence from which the judge concluded that the facility met the criteria of two of the definitions: J.P. posed a substantial risk of physical harm to others as well as a very substantial risk to his own safety.9
In our review of the sufficiency of the evidence, we accept the findings of fact made by the hearing judge unless clearly erroneous; however, we review without deference whether the legal standard for civil commitment was met. See Matter of a Minor, 484 Mass. 295, 302, 148 N.E.3d 1182 (2020).
1. Substantial risk of physical harm to others. To conclude that a person poses a substantial risk of physical harm to others, a judge must find either "[1] evidence of homicidal or other violent behavior or [2] evidence that others are placed in reasonable fear of violent behavior and serious physical harm to them." G. L. c. 123, § 1. With regard to this element, the judge focused on the second of the two alternative predicates, finding a risk of physical harm based on evidence from J.P.'s stay at SBH, and the statements that his mother made that others were placed in reasonable fear of physical harm from him. The judge also found that J.P.'s judgment was so affected by his paranoia, agitation, and contrariness as to affect substantially the safety of others in the community (as well as his own).
J.P. argues that the evidence of his mother's statements was inadmissible hearsay, and that, without them, there was insufficient evidence of a substantial risk of physical harm to others.
a. Hearsay evidence. Statements made by J.P.'s mother were contained in the emergency room records from St. Luke's, about which Lee, the treating physician from SBH, testified at the hearing. The records were not admitted in evidence. J.P. argues that the judge improperly considered this evidence because it was inadmissible hearsay.10 We agree.
The mother's statements were hearsay because they were made out of court during a conversation with a social worker and were offered for their truth. Moreover, the statements were reduced to writing and included in records from which Lee testified. Thus, Lee's testimony regarding the records containing the mother's statements comprised three levels of hearsay. In order for this testimony to have been admissible, each of the hearsay statements had to have fallen within one of the exceptions to the hearsay rule. Commonwealth v. DePina, 476 Mass. 614, 623, 73 N.E.3d 221 (2017).
SBH contends that the testimony regarding the mother's...
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In re P.R.
...available in the community." Id. The department must prove each of these elements beyond a reasonable doubt.7 See Matter of J.P., 486 Mass. 117, 119, 155 N.E.3d 722 (2020).On appeal, P.R. advances two distinct evidentiary arguments regarding the likelihood of serious harm that he posed. Fir......