Mclean Hosp. Corp. v. Town of Lincoln
| Decision Date | 23 September 2019 |
| Docket Number | SJC-12675 |
| Parties | The MCLEAN HOSPITAL CORPORATION v. TOWN OF LINCOLN & others. |
| Court | United States State Supreme Judicial Court of Massachusetts Supreme Court |
Diane C. Tillotson (M. Patrick Moore, Jr., also present), Boston, for the plaintiff.
Jason R. Talerman for town of Lincoln & others.
Michael C. Fee, Boston, for Arthur Anthony & others, was present but did not argue.
Benjamin Fierro, III, Boston, for Association for Behavioral Healthcare, Inc., & others, amici curiae, submitted a brief.
Felicia H. Ellsworth & Julia Prochazka, Boston, for Disability Law Center & another, amici curiae, submitted a brief.
Present: Gants, C.J., Lenk, Gaziano, Lowy, Budd, Cypher, & Kafker, JJ.
The question before us is whether the plaintiff's proposed residential program for adolescent males falls within the meaning of the Dover Amendment, G. L. c. 40A, § 3, second par. If so, it is exempt from certain zoning restrictions because the land and buildings would be used for "educational purposes." The plaintiff, The McLean Hospital Corporation (McLean), purchased 5.5 acres of land in the town of Lincoln (town), intending to develop a residential life skills program for fifteen to twenty-one year old males who exhibit extreme "emotional dysregulation." The program would allow these adolescents to develop the emotional and social skills necessary to return to their communities to lead useful, productive lives.
Before purchasing the property, McLean, a nonprofit institution, wrote to the town's building commissioner explaining the proposed use, and seeking a determination whether the project could proceed as of right, pursuant to the Dover Amendment, see G. L. c. 40A, § 3, second par., and its local analog, section 6.1(i) of the town's bylaw. The building commissioner replied in writing that the proposed use was educational, and that McLean could proceed under the Dover Amendment and the bylaw. After the purchase, however, a number of nearby residents challenged the decision before the town's zoning board of appeals (board). The board decided that the program was medical or therapeutic, as opposed to educational, and reversed the building commissioner's determination. McLean initiated an action in the Land Court challenging the board's decision. After a four-day trial, a Land Court judge determined that the proposed use was not primarily "for educational purposes," under a novel theory that attempted to distinguish between life skills that are "focused outward" and those that "look inward." McLean appealed, and we allowed McLean's petition for direct appellate review.
We conclude that, although not a conventional educational curriculum offered to high school or college students, the proposed facility and its skills-based curriculum fall well within the "broad and comprehensive" meaning of "educational purposes" under the Dover Amendment. See Regis College v. Weston, 462 Mass. 280, 286, 291, 968 N.E.2d 347 (2012). Accordingly, the decision of the Land Court judge must be vacated, and the matter remanded for entry of a judgment in favor of McLean.2
1. Background. We recite the essentially undisputed facts found by the trial judge, supplemented occasionally with uncontroverted facts in the record. See Vaiarella v. Hanover Ins. Co., 409 Mass. 523, 524, 567 N.E.2d 916 (1991). a. Other programs. The plaintiff currently operates a smaller version of the planned program, known as the "3East program," at its campus in Belmont, as well as a similar program for girls. McLean also operates a program for adults with emotional disorders, who are transitioning back into the community from a hospital setting, at another location in the town; that facility is a protected educational facility under the Dover Amendment, G. L. c. 40A, § 3, second par. McLean wants to move the 3East program from its already cramped quarters in Belmont to the newly purchased land in Lincoln so that it can increase the number of adolescents that the program serves, from six to twelve at any given time.
b. 3East program. The 3East program's curriculum is designed to instill fundamental life, social, and emotional skills in adolescent males who are deficient in these skills, who experience severe emotional dysregulation, and who have been unable to succeed in a traditional academic setting. Many of the residents have been diagnosed with borderline personality disorder ; all have varying degrees of emotional dysregulation. Some have a co-occurring condition such as attention deficit disorder, anxiety, or depression, and some have no official diagnosis.
Regardless of their diagnosis, all of the residents at McLean share difficulties in identifying and regulating their emotions, and therefore may react to ordinary, day-to-day events, which they perceive as stressful situations, with outbursts of fear, anger, or self-loathing. Overwhelmed by emotions they cannot identify or control, these individuals have difficulty concentrating in school, following directions, responding appropriately to others, and maintaining interpersonal relationships. They tend to view situations as juxtapositions of diametrically opposite positions (from "opposite sides of the Grand Canyon"), with no middle ground. Slight disappointments (i.e., "can we meet at 5:15 rather than 5:00?") may be viewed as negative statements about themselves, and can lead to increased feelings of abandonment, shame, "emptiness," anger, and resentment.
The 3East program uses a highly structured, nationally recognized, dialectical behavior therapy (DBT) approach to attempt to develop social and emotional skills in students with severe deficits in these skills. To do so, the program teaches students to notice and identify their emotions, to slow down and consider alternatives rather than simply reacting, and to interact constructively with other people. It teaches fundamental behavioral skills so that the students, whose difficulties in emotional regulation interfere with an ability to learn in a more traditional setting, may acquire skills to respond more productively to the challenges that confront them in their day-to-day lives. The goal of the program is to enable the students to return to their communities and their families, to succeed in traditional educational programs, and to become able to lead productive lives.
Entrance to the 3East program is selective. The admissions process screens out any individual who is unstable or requires hospitalization. Prospective residents also must demonstrate that they are ready and willing to devote themselves to learning these behavioral and cognitive skills, with the expectation that they will be able to function in their respective communities in the future. Once selected, participation in the immersive residential program generally lasts for sixty to 120 days; residents who complete the program successfully receive a graduation certificate.
During their time at the 3East program, residents receive approximately eleven hours per day of instruction and practice in social and emotional skills, focused in five well-established areas where prior research has shown that training can be very effective: mindfulness and ability to pay attention; emotional regulation; development and maintenance of interpersonal relationships; distress tolerance; and validation.
According to Alan Fruzzetti, the director of the program and the only individual explicitly credited by the judge, mindfulness "in DBT is defined as being able to pay attention on purpose in the present moment and without being judgmental." It is considered the "core skill in DBT," and involves emotional control and focus, which, the director pointed out, are essential "for learning anything." Emotional regulation teaches individuals how to identify the specific emotion "they are feeling, so as to enjoy positive emotions and ‘reduce their reactivity to a whole host of different stimuli in the world.’ " Distress tolerance is "a set of skills" that helps people "get[ ] through an apparent crisis" without making it "worse." Validation skills allow individuals to recognize and accept their own feelings and those of others without "judgments [that] tend to fuel negative emotion" toward oneself and others.
A typical day at the 3East program begins at 8:30 A.M. , with group mindfulness exercises, followed by classroom instruction from 9 A.M. until 4 P.M. 3 After classroom work is over, there are one and one-half hours for structured athletic time or family therapy, followed by dinner and a final group mindfulness exercise. After a forty-five minute period of skills practice and homework worksheets, the students have a period of free time until lights out at 10 P.M.
The curriculum is taught in an experiential manner by specialists in clinical education. Each day, the students learn multiple skills in forty-five minute classroom sessions, as well as how to apply them to the complex problems in life that they may encounter at home, school, or work. The process involves formal training sessions, demonstrations and examples by the instructors, group practice, and individualized practice sessions for each student, as well as daily worksheets and homework. Although a part-time registered nurse is available to treat any medical issues that arise for staff or students, no medical interventions are included as part of the program.
2. Discussion. The parties generally accept the judge's findings of fact; they dispute only her determination that the primary purpose of the proposed facility cannot be characterized as "educational" under G. L. c. 40A, § 3, second par. "The central issue in this case," then, "is one of law, not of fact."4 See Fitchburg Hous. Auth. v. Board of Zoning Appeals of Fitchburg, 380 Mass. 869, 872, 406 N.E.2d 1006 (1980). We must ascertain, based upon the facts found by the trial judge, to which we afford appropriate deference absent clear error, whether McLean's proposed use of the...
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