In re: J.C.N
Court of Appeals, Barbera, July 31, 2018,
Involuntary Commitment – An individual may be considered to pose a danger to herself where she maintains “the delusion that she could function normally without medication and followup treatment” necessary to avoid serious medical issues.
Facts:
In 2015, J.C.N. suffered a stroke and other medical issues. Her treatment included prescription steroids. However, four months later she began exhibiting symptoms of steroid-induced psychosis, “a serious mental illness characterized by defective or lost contact with reality and often accompanied by hallucinations or delusions.”
On November 17, 2015, a clinical social worker filed an Emergency Petition and Anne Arundel County PD transported her to the emergency department of the University of Maryland Baltimore Washington Medical Center.
J.C.N. was evaluated as needing medical treatment prior to evaluation. J.C.N. initially took the medication prescribed to treat her physical condition, but then refused.
On November 19, 2015, a psychiatrist evaluated J.C.N. and certified that she met criteria for involuntary admission.
On November 24, 2015, J.C.N. was transferred to the psychiatric unit for involuntary admission.
On December 1, 2015, J.C.N.’s involuntary admission hearing was held before an administrative judge.
After testifying about J.C.N.’s diagnoses, a psychiatrist testified that J.C.N. had “grandiose delusions,” believed that she personally knew President Obama, and had attempted to place phone calls to the White House. J.C.N. believed that she could drive, but this was not true given her medical conditions. Moreover, the psychiatrist testified that J.C.N. has a “serious thyroid condition… that can actually be very detrimental to her medical health.” Despite this, the psychiatrist testified that J.C.N. refused to take her medication.
The psychiatrist testified that, given her history, J.C.N., if released, would not take her prescribed medications and would not comply with follow-up psychiatric care. He further opined that J.C.N. would “quickly damage herself financially” if released. He added that J.C.N. needed institutional care because she presented a danger to her own life or safety or the lives or safety of others. He acknowledged that J.C.N. could “safely care for her own basic needs.” He ultimately concluded that J.C.N. was unable or unwilling to be voluntarily admitted, and there was no less restrictive form of intervention available consistent with her welfare and safety.
After deciding a preliminary issue relating to the timeliness of the hearing, the judge determined that involuntary admission was proper.
J.C.N. appealed, arguing that there was insufficient evidence that she was a danger to herself or others to support involuntary admission.
Held: The Court held that the administrative judge’s decision was not unreasonable given J.C.N.’s refusal to take medication necessary to avoid serious medical consequences.
Involuntary Commitment – Review standards- In order for a patient to be involuntarily committed after a hearing, it must be shown that the individual:
– Has a mental disorder
– Needs in–patient care or treatment
– Presents a danger to the life or safety of the individual or of others
– Is unable or unwilling to be voluntarily admitted to the facility
– There is no available less restrictive form of intervention that is consistent with the welfare and safety of the individual
– AND If the individual is 65 years old or older and is to be admitted to a State facility, the individual has been evaluated by a geriatric evaluation team and no less restrictive form of care or treatment was determined by the team to be appropriate.
From the Case: “Although some of J.C.N.’s delusions, taken alone or in combination with others, might not suggest that at the time of the hearing J.C.N. posed a danger to herself or others, at least one—the delusion that she could function normally without medication and followup
treatment—did pose a danger. The ALJ, evidently basing his decision on the credited testimony of Dr. Sidana, found that J.C.N.’s ‘lack of judgment, lack of insight, and these issues about finances as well,’ demonstrated that she did not have ‘sufficient judgment’ to ‘maintain herself’ outside of an institutional setting. Based on that ultimate finding, the ALJ decided that J.C.N. be involuntarily admitted. The record supports the ALJ’s decision.”
Commitment Hearing – “Initial confinement” refers to the period of the individual’s confinement in an inpatient mental treatment facility pending a hearing at which it is determined whether the individual is to be involuntarily admitted
Commitment Hearing – An emergency evaluee is not subject to “initial confinement” upon arrival in the emergency department, but rather if and when transferred to an “appropriate facility,” meaning an “inpatient institution that provides evaluation, care, or treatment for individuals who have mental disorders.”
From the Case: “J.C.N.’s involuntary admission hearing was timely, as it occurred on December 1, seven days after her admission to the Hospital’s psychiatric unit on November 24.”