Opinion
DOCKET NO. A-5021-13T2
05-29-2015
IN THE MATTER OF THE CIVIL COMMITMENT OF R.M.
Lorraine H. Hoilien, Deputy Public Defender, argued the cause for appellant (Joseph E. Krakora, Public Defender, attorney; Ms. Hoilien and Stanley Shur, Assistant Deputy Public Defender, of counsel and on the brief). Melinda A. Harrigan argued the cause for respondent (Schroeder Law Group, attorneys; Ms. Harrigan, on the brief).
RECORD IMPOUNDED
NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION Before Judges Nugent and Manahan. On appeal from Superior Court of New Jersey, Law Division, Cumberland County, Docket No. CUCC-319-14. Lorraine H. Hoilien, Deputy Public Defender, argued the cause for appellant (Joseph E. Krakora, Public Defender, attorney; Ms. Hoilien and Stanley Shur, Assistant Deputy Public Defender, of counsel and on the brief). Melinda A. Harrigan argued the cause for respondent (Schroeder Law Group, attorneys; Ms. Harrigan, on the brief). PER CURIAM
Following the commencement of involuntary civil commitment proceedings as authorized by Rule 4:74-7 and N.J.S.A. 30:4-27.10(a), a court reviewed the clinical and screening certificates of two psychiatrists and temporarily committed R.M. to a treatment facility, finding him in need of involuntary commitment because he suffered from a mental illness causing him to be dangerous to himself, to others, or to property. N.J.S.A. 30:4-27.2(m); N.J.S.A. 30:4-27.10. Thirteen days later, a presiding judge of municipal court conducted a commitment hearing as required by N.J.S.A. 30:4-27.12 to determine whether there was a continued need for involuntary commitment. The municipal court judge determined there was such a need, entered a final order of involuntary commitment, and ordered a review hearing within two weeks. It is from this order that R.M. appeals.
Following the entry of the order, R.M. was transferred to Ancora Psychiatric Hospital and thereafter discharged subject to conditions not at issue on this appeal. Although the case is thus moot, our courts generally consider appeals challenging civil commitment, due to patients' liberty interests and the likelihood that issues will recur in other cases. See In re Commitment of N.N., 146 N.J. 112, 124 (1996).
Dr. Isiaka Bolarinwa, who had been treating R.M., was the only witness the State presented at the commitment hearing. Dr. Bolarinwa diagnosed R.M. as suffering from schizophrenia, chronic paranoid type. The doctor explained that while confined to the care facility, R.M. was complying with his medications "with support." The doctor testified R.M. had not fully stabilized since resuming his medications. Further, one of R.M.'s symptoms was auditory hallucinations of the "command type," which meant that R.M. heard voices telling him to do things.
In the doctor's opinion, within a reasonable degree of medical certainty, R.M. was absolutely a danger to himself or others or incapable of caring for himself. R.M. continued to hear voices, complained of tactile stimulation, and was still responding to his hallucinations.
During cross-examination, the doctor testified that R.M. was unable to care for himself due to his paranoid delusions. The doctor did not believe that R.M. could live in a supportive home environment because he was still very guarded and still paranoid. In the doctor's opinion, R.M., if discharged, would not take his medications, would not participate in any type of treatment, and would start to decompensate. Once that happened, R.M. would become dangerous. In short, the doctor explained that R.M. was still not psychiatrically stable, even though he was taking his prescribed medications.
R.M. testified. He told the judge that he wanted to be discharged and that he lived in a supportive environment consisting of his family and a girlfriend. He was cooperating with his doctors, who were adjusting his medications, and he agreed to take the medications if discharged. R.M. admitted, however, that before being admitted to the care facility he had not taken his medications for two or three days. In fact, he called the hospital to come get him because he was hearing voices "that were hurting people and everybody." R.M. also admitted that since being hospitalized he had heard the voices. He explained, however, that he always heard voices but his medications helped to lessen them and helped him control his response to them. In other words, when on medication, he would not do what the voices told him to do.
Based on the doctor's testimony and report as well as R.M.'s testimony, the municipal court judge determined that the State had clearly and convincingly proved that R.M. was in continued need of involuntary commitment.
R.M. contends on appeal the evidence presented at the initial commitment hearing did not clearly and convincingly establish that he was in need of involuntary commitment. We disagree.
A court is authorized to enter an order involuntarily committing a patient
if it finds, by clear and convincing evidence presented at the hearing that the patient is in need of continued involuntary commitment to treatment by reason of the fact that (1) the patient is mentally ill, (2) mental illness causes the patient to be dangerous to self or dangerous to others or property as defined in [N.J.S.A.] 30:4-27.2(h) and -.2(i), (3)] the patient is unwilling to be admitted to a facility for voluntary care or accept appropriate treatment voluntarily, and (4) the patient needs outpatient treatment as defined by [N. J.S.A. 30:4-27.2(hh)] or inpatient care
at a short-term care or psychiatric facility or special psychiatric hospital because other less restrictive alternative services are not appropriate or available to meet the patient's mental health care needs.
[R. 4:74-7(f)(1); see also N.J.S.A. 30:4-27.2(m).]
The term "mental illness" is defined as follows:
[A] current, substantial disturbance of thought, mood, perception or orientation which significantly impairs judgment, capacity to control behavior or capacity to recognize reality, but does not include simple alcohol intoxication, transitory reaction to drug ingestion, organic brain syndrome or developmental disability unless it results in the severity of impairment described herein. The term mental illness is not limited to "psychosis" or "active psychosis," but shall include all conditions that result in the severity of impairment described herein.
[N. J.S.A. 30:4-27.2(r).]
Additionally, an individual is deemed dangerous to himself or herself if
by reason of mental illness the person has threatened or attempted suicide or serious bodily harm, or has behaved in such a manner as to indicate that the person is unable to satisfy his need for nourishment, essential medical care or shelter, so that it is probable that substantial bodily injury, serious physical harm or death will result within the reasonably foreseeable future; however, no person shall be deemed to be unable to satisfy his need for nourishment, essential medical care or shelter if he is able to satisfy such needs with the supervision and assistance of others who are
willing and available. This determination shall take into account a person's history, recent behavior and any recent act, threat or serious psychiatric deterioration.
[N. J.S.A. 30:4-27.2(h).]
Furthermore, an individual is dangerous to self or others where
by reason of mental illness there is a substantial likelihood that the person will inflict serious bodily harm upon another person or cause serious property damage within the reasonably foreseeable future. This determination shall take into account a person's history, recent behavior and any recent act, threat or serious psychiatric deterioration.
[N. J.S.A. 30:4-27.2(i).]
Our review of a judge's decision concerning a patient's continued commitment "is extremely narrow and [the commitment determination] should be modified only if the record reveals a clear mistake." In re D.C., 146 N.J. 31, 58 (1996). Applying that standard to the facts of the case before us, we find no reason to disturb the judge's determination.
Here, R.M. does not dispute his diagnosis of schizophrenia, chronic paranoid type. Nor does he dispute that his condition is a mental illness as statutorily defined. Rather, he disputes that he is a danger to himself, to others, or to property. The hearing judge's conclusion that R.M. was unable to care for himself, according to R.M., lacks a substantial evidentiary basis. R.M. also contends the State failed to show that any danger R.M. posed to himself was "relatively immediate."
R.M. admitted that in the two or three days leading up to his involuntary commitment he had stopped taking his medications. He also admitted that he constantly heard voices and that his medication minimized the voices and helped him to resist their commands. Dr. Bolarinwa testified that because R.M. was hearing voices, complaining of tactile stimulation, and responding to his hallucinations, he was incapable of staying on his medication regimen without support. In other words, due to R.M.'s paranoid delusions, he was unable to care for himself. The doctor explained that if discharged, R.M. would not take his medications, would not participate in any type of treatment, and would start to decompensate, thereby becoming dangerous.
R.M.'s history and the doctor's testimony supported the judge's finding that clear and convincing evidence demonstrated R.M.'s need for continued commitment. The doctor's testimony concerning R.M.'s likely decompensation if he were discharged satisfied the requirement that the "risk of dangerousness . . . be relatively immediate[.]" In re Commitment of N.N., 146 N.J. 112, 130 (1996).
R.M. ardently argues before us, as he did before the hearing judge, that he was taking his medications and therefore the doctor's testimony that he would stop doing so was contrary to the evidence. That argument overlooks entirely the doctor's testimony that R.M. was maintaining his medication schedule with institutional support; had not psychiatrically stabilized; and was therefore incapable of maintaining the medication schedule without such institutional support.
R.M.'s remaining arguments are without sufficient merit to warrant further discussion in a written opinion. R. 2:11-3(e)(1)(E).
Affirmed. I hereby certify that the foregoing is a true copy of the original on file in my office.
CLERK OF THE APPELLATE DIVISION