Civil Commitment & Civil Competencies

Question 1

O’Connor v .Donaldson (1975) *

Answer 1

Mentally ill persons CANNOT be involuntarily hospitalized if they are not dangerous

Question 2

Rennie v. Klein (1981/1983) *

Answer 2

A involuntarily committed patient has the constitutional right to refuse psychiatric meds; however, such medication can be forcibly used when professional judgment has been exercised (NJ’s administrative review process provided adequate protection and satisfied due process).

Question 3

Jones v. U.S. (1983) *

Answer 3

NGRI acquittees CAN be subject to involuntary and indefinite commitment.

Question 4

U.S. v. Salerno (1987)

Answer 4

The Bail Reform Act DOES NOT violate the Fifth Amendment Due Process Clause (pre-trial detention doesn’t violate due process or excessive bail clauses)

Question 5

Foucha v. Louisiana (1992) *

Answer 5

An insanity acquittee MUST be BOTH mentally ill and dangerous for a state to justify continued hospitalization.

Question 6

Lake v. Cameron (1966)*

Answer 6

A civilly committed patient cannot be involuntarily held in a hospital if there are safe, less restrictive treatment alternatives.

1) Patients who are not dangerous “should not be confined if a less restrictive alternative is available.”
2) A mentally ill person is not required to carry the burden of showing availability of alternatives to an indeterminate confinement.

Question 7

Canterbury v. Spence (1972)*

Answer 7

A physician can be liable for malpractice if she fails to disclose severe, although rare, risks inherent in medical procedure (exception: if person unconscious/unable to consent, harm is imminent, & outweighs harm of tx, and if disclosure itself may do harm)

Question 8

U.S. v. Salerno (1987)

Answer 8

Bail Reform Act (of 1984 that permitted pretrial detention of defendants determined to be potentially dangerous) does not violate due process of the 5th Am. or the excessive bail clause of 8th Am.

Question 9

Estelle v. Gamble (1976)

Answer 9

Medical negligence is not enough to prove a constitutional violation of a prisoner’s right to tx

Question 10

Addington v. Texas (1979)*

Answer 10

The standard of proof in civil commitment proceedings is “clear and convincing” (75%)

Question 11

Lessard v. Schmidt (1972)*

Answer 11

Commitment proceedings must provide mentally ill person with the same protections as a criminal defendant i.e., right to counsel, right to remain silent, standard of proof beyond a reasonable doubt.

Also, commitment only permissible when “there is extreme likelihood” that if not confined, the person poses immediate harm to himself or others.

Question 12

Parham v. J.R. (1979)*

Answer 12

Parent/guardian can commit minor if staff physician certifies that minor should be commitment, even if minor opposes.

Commitment of minor by parent/guardian without an adversarial hearing is not a deprivation of liberty; informal commitment process OK

Question 13

Washington v. Harper (1990)*

Answer 13

If an inmate is dangerous and refusing meds, a judicial hearing re: involuntary meds is unnecessary and does not violate due process.

Question 14

Wyatt v. Stickney (1971)*

Answer 14

Sets the inpt care standards for persons with MI & ID

Constitutionally entitled to minimally adequate standards for treatment

Question 15

Baxstrom v. Herold (1966)

Answer 15

SCOTUS: Civil commit following a prison term doesn’t run afoul of double jeopardy.

Question 16

Caesar v. Mountanos (9th Cir. 1976)

Answer 16

Similar finding as In re Lifschutz where Dr. Caesar was found in contempt of court for refusing to release records. There needs to be a balance between privacy of patient-psychotherapist privilege v. compelling need to ascertain truth in court proceedings.

Question 17

Heller v. Doe (1993)

Answer 17

The Supreme Court held that Kentucky’s procedures for involuntarily committing mentally retarded persons did not violate the Equal Protection Clause. The Court reasoned that because retarded persons are not a suspect classification, Kentucky’s statute warranted only rational basis scrutiny – the Court’s lowest level of scrutiny. Consequently, the Court concluded that the state met its burden that its procedures were rationally related to a legitimate government purpose and were constitutional.

Question 18

Rogers v. Olkin (1980)

Answer 18

Throughout most of the 1970s, the legal assumption was that, once hospitalized, a patient had no role in treatment decisions. Hospitals could medicate and use other means of control or treatment without consultation with the patient or the patient’s family.[4]

This decision was one of the first that contributed to a growing body of case law recognizing that prisoners and competent mental patients have the right to refuse treatment. Rogers v. Okin set forth a procedure that would copied by many other states. This procedure requires a court hearing before a patient may be involuntarily medicated. The decision required that a court must hold a full evidentiary hearing, with counsel representing both sides and expert witness if needed, to make the decision whether an incompetent patient should be treated. This determination was to be made on the basis of “substituted judgment”, that is, on an estimation of what the patient would have desired, were he competent

Question 19

Youngberg v. Romeo (1982)

Answer 19

The Court held that the involuntarily committed do have liberty interests in safe confinement and freedom from bodily restraint under the Fourteenth Amendment. However, a historical right to adequate habilitation was less clear, made especially so by the facts of the case in question. Because no amount of habilitation would allow Romeo to live independently, the Court was unsure what would qualify as adequate habilitation. The Court held that Romeo’s liberty interests required Pennhurst to provide adequate habilitation, but only as it related to Romeo’s right to safe confinement and freedom from undue restraint. The Court declined to answer whether the Fourteenth Amendment includes a stand-alone right to adequate habilitation, or how to determine the level of habilitation required to protect other liberty interests under the Fourteenth Amendment. The Court emphasized the need to balance the legitimate interests of both parties involved to determine whether liberty interests were being adequately protected. In the involuntary commitment arena, deference to qualified professionals is necessary because of their specialized knowledge and the specific circumstances and risks inherent in a mental hospital. Therefore, such professionals and institutions can only be held liable for infringements on liberty interests when the decision by a professional is a substantial departure from accepted professional judgment.

Question 20

Zinermon v. Burch (1990)

Answer 20

In providing by law that a mental patient must give informed consent to hospitalization but then failing to make provision for the patient’s competence to be examined at admission, Florida predictably violated the patient’s rights. Florida’s established procedure for involuntary placement needs to be applied “to all patients who cannot be admitted voluntarily, both those who are unwilling and those who are unable to give consent.”