Secretary of Public Welfare of Pennsylvania v. Institutionalized Juveniles

• Decision Date: 20 June 1979
• Docket Number: No. 77-1715,77-1715
• Citation: 99 S.Ct. 2523,442 U.S. 640,61 L.Ed.2d 142
• Parties: SECRETARY OF PUBLIC WELFARE OF PENNSYLVANIA et al., Appellants, v. INSTITUTIONALIZED JUVENILES et al
• Court: U.S. Supreme Court

442 U.S. 640

99 S.Ct. 2523

61 L.Ed.2d 142

SECRETARY OF PUBLIC WELFARE OF PENNSYLVANIA et al., Appellants,

v INSTITUTIONALIZED JUVENILES et al.

No. 77-1715.

Argued Oct. 10, 1978.

Decided June 20, 1979.

Syllabus

Appellees filed a class action in Federal District Court against the Pennsylvania Secretary of Public Welfare and the directors of three state mental health facilities, seeking declaratory and injunctive relief and contending that Pennsylvania's procedures for the voluntary admission of mentally ill and mentally retarded children to a state hospital violated the Due Process Clause of the Fourteenth Amendment. Holding that the State's procedures were insufficient to satisfy the Due Process Clause and that only a formal adversary hearing could suffice to protect children in appellees' class from being needlessly confined in mental hospitals, the District Court concluded that specified procedures were required before any child could be admitted voluntarily to a mental hospital.

Held:

1. 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. That inquiry must carefully probe the child's background and must also include an interview with the child. It is also necessary that the decisionmaker have the authority to refuse to admit any child who does not satisfy the medical standards for admission. Finally, the child's continuing need for commitment must be reviewed periodically. Parham v. J. R., 442 U.S. 584, 99 S.Ct. 2493, 61 L.Ed.2d 101, controlling. P. 646.

2. Pennsylvania's procedures comply with these due process requirements. No child is admitted without at least one and often more psychiatric examinations by an independent team of mental health professionals whose sole concern is whether the child needs and can benefit from institutional care. The treatment team interviews the child and parents and compiles a full background history. If the treatment team concludes that institutional care is not in the child's best interest, it must refuse the child's admission; every child's condition is reviewed at least every 30 days. Pp. 646-650.

459 F.Supp. 30, reversed and remanded.

Norman J. Watkins, Harrisburg, Pa., for appellants.

David Ferleger, Philadelphia, Pa., for appellees.

Mr. Chief Justice BURGER delivered the opinion of the Court.

This appeal raises issues similar to those decided in Parham v. J. R., 442 U.S. 584, 99 S.Ct. 2493, 61 L.Ed.2d 101, as to what process is due when the parents or guardian of a child seek state institutional mental health care.

I

This is the second time we have reviewed a District Court's judgment that Pennsylvania's procedures for the voluntary admission of mentally ill and mentally retarded children to a state hospital are unconstitutional. In the earlier suit, five children who were between the ages of 15 and 18 challenged the 1966 statute pursuant to which they had been admitted to Haverford State Hospital. Pa.Stat.Ann., Tit. 50, §§ 4402, 4403 (Purdon 1969). After a three-judge District Court, with one judge dissenting, declared the statute unconstitutional, Bartley v. Kremens, 402 F.Supp. 1039 (ED Pa. 1975), the Pennsylvania Legislature amended its mental health code with regard to the mentally ill. The amendments placed adolescents over the age of 14 in essentially the same position as adults for purposes of a voluntary admission. Mental Health Procedures Act of 1976, § 201, Pa.Stat.Ann., Tit. 50, § 7201 (Purdon Supp.1978). Under the new statute, the named plaintiffs could obtain their requested releases from the state hospitals independently of the constitutionality of the 1966 statute, and we therefore held that the claims of the named plaintiffs were moot. Kremens v. Bartley, 431 U.S. 119, 129, 97 S.Ct. 1709, 52 L.Ed.2d 184 (1977). We then remanded the case to the District Court for "reconsideration of the class definition, exclusion of those whose claims are moot, and substitution of class representatives with live claims." Id., at 135, 97 S.Ct. at 1718.

On remand, 12 new plaintiffs, appellees here, were named to represent classes of mentally ill and mentally retarded children. Nine of the children were younger than 14 and constituted all of those who had been admitted to the State's hospitals for the mentally ill in accordance with the 1976 Act at the time the suit was brought; three other children represented a class of patients who were 18 and younger and who had been or would be admitted to a state hospital for the mentally retarded under the 1966 Act and 1973 regulations implementing that Act. All 12 children had been admitted on the application of parents or someone standing in loco parentis with state approval after an independent medical examination.

The suit was filed against several named defendants, the Pennsylvania Secretary of Public Welfare and the directors of three state owned and operated facilities. The District Court, however, certified a defendant class that consisted of " 'directors of all mental health and mental retardation facilities in Pennsylvania which are subject to regulation by the defendant Secretary of Public Welfare.' " 459 F.Supp. 30, 40 n. 37 (ED Pa. 1978).¹

Representatives of the nine mentally ill children sought a declaration that the admission procedures embodied in § 201 ² of the Pennsylvania Mental Health Procedures Act of 1976, Pa.Stat.Ann., Tit. 50, § 7201 (Purdon Supp.1978), which subsequently have been expanded by regulations promulgated by the Secretary of Public Welfare, 8 Pa.Bull. 2432 et seq. (1978), violated their procedural due process rights and requested the court to issue an injunction against the statute's future enforcement. The three mentally retarded children presented the same claims as to §§ 402 ³ and 403 ⁴ of the Mental Health and Mental Retardation Act of 1966, Pa.Stat.Ann., Tit. 50, §§ 4402 and 4403 (Purdon 1969), and the regulations promulgated thereunder.⁵

The District Court certified two subclasses of plaintiffs ⁶ under Fed.Rule Civ.Proc. 23 and held that the statutes challenged by each subclass were unconstitutional. It held that the State's procedures were insufficient to satisfy the Due Process Clause of the Fourteenth Amendment.

The District Court's analysis in this case was similar to that used by the District Court in J. L. v. Parham, 412 F.Supp. 112 (MD Ga. 1976), reversed and remanded sub nom. Parham v. J. R., 442 U.S. 584, 99 S.Ct. 2493, 61 L.Ed.2d 101. The court in this case concluded that these children had a constitutionally protected liberty interest that could not be "waived" by their parents. This conclusion, coupled with the perceived fallibility of psychiatric diagnosis, led the court to hold that only a formal adversary hearing could suffice to protect the children in appellees' class from being needlessly confined in mental hospitals.

To further protect the children's interests, the court concluded that the following procedures were required before any child could be admitted voluntarily to a mental hospital:

1) 48-hour notice prior to any hearing;

2) legal counsel "during all significant stages of the commitment process";

3) the child's presence at all commitment hearings;

4) a finding by an impartial tribunal based on clear and convincing evidence that the child required institutional treatment;

5) a probable-cause determination within 72 hours after admission to a hospital;

6) a full hearing, including the right to confront and cross-examine witnesses, within two weeks from the date of the initial admission. App. 1097a-1098a.⁷

Appellants, all of the defendants before the District Court, appealed the judgment. We noted probable jurisdiction, and consolidated the case with Parham v. J. R., 442 U.S. 584, 99 S.Ct. 2493, 61 L.Ed.2d 101. 437 U.S. 902, 98 S.Ct. 3087, 57 L.Ed.2d 1132.

II

(a) Much of what we said in Parham v. J. R. applies with equal force to this case. The liberty rights and interests of the appellee children, the prerogatives, responsibilities, and interests of the parents, and the obligations and interests of the State are the same. Our holding as to what process is due in Parham controls here, particularly:

"We conclude that 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. . . . That inquiry must carefully probe the child's background using all available sources, including, but not limited to, parents, schools, and other social agencies. Of course, the review must also include an interview with the child. It is necessary that the decisionmaker have the authority to refuse to admit any child who does not satisfy the medical standards for admission. Finally, it is necessary that the child's continuing need for commitment be reviewed periodically by a similarly independent procedure." Parham v. J. R., supra, at 606-607, 99 S.Ct., at 2506.

The only issue is whether Pennsylvania's procedures for the voluntary commitment of children comply with these requirements.

(b) Unlike in Parham v. J. R., where the statute being challenged was general and thus the procedures for admission were evaluated hospital by hospital, the statute and regulations in Pennsylvania are specific. Our focus here is on the codified procedures declared unconstitutional by the District Court.

The Mental Health Procedures Act of 1976 and regulations promulgated by the Secretary describe the procedures for the voluntary admission for inpatient treatment of mentally ill children. Section 201 of the Act provides that "[a] parent, guardian, or person standing in loco parentis to a child less than 14 years of age" may apply for a voluntary...