Case Title: In re J.P.

Citation: 

Docket Number: SJC-12872

State: massachusetts

Court: Massachusetts Supreme Court

Date: 2020-10-28T00:00:00Z

Document:
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SJC-12872 
 
IN THE MATTER OF J.P. 
 
 
 
Bristol.     April 6, 2020. - October 28, 2020. 
 
Present:  Gants, C.J., Lenk, Gaziano, Lowy, Budd, Cypher, 
& Kafker, JJ.1 
 
 
Mental Health.  Practice, Civil, Commitment of mentally ill 
person, Hearsay.  Evidence, Hearsay, Medical record. 
 
 
 
 
Petition for involuntary commitment filed in the New 
Bedford Division of the District Court Department on February 
16, 2018. 
 
 
The case was heard by Bernadette L. Sabra, J. 
 
 
The Supreme Judicial Court on its own initiative 
transferred the case from the Appeals Court. 
 
 
 
Lois M. Farmer for J.P. 
 
Richard F. Ready (Heidi A. Kostin also present) for 
Southcoast Behavioral Health. 
 
The following submitted briefs for amici curiae: 
 
Ruth A. Bourquin, Matthew R. Segal, Jessica J. Lewis, & 
Jessie J. Rossman for American Civil Liberties Union Foundation 
of Massachusetts, Inc., & another. 
 
Karen Owen Talley, Committee for Public Counsel Services, 
Kathryn Rucker, Coco Holbrook, Jennifer Honig, & Tatum A. 
Pritchard for Committee for Public Counsel Services & others. 
                                                 
 
1 Chief Justice Gants participated in the deliberation on 
this case prior to his death. 
2 
 
 
Anna S. Richardson for Veterans Legal Services. 
 
Lester D. Blumberg, Special Assistant Attorney General, for 
Department of Mental Health. 
 
 
 
BUDD, J.  The long-term involuntary civil commitment of 
persons with mental illness is only permissible if a judge finds 
proof beyond a reasonable doubt that discharge would create a 
likelihood of serious harm.  See G. L. c. 123, §§ 7, 8; 
Superintendent of Worcester State Hosp. v. Hagberg, 374 Mass. 
271, 276 (1978).  Here, after an evidentiary hearing, a District 
Court judge issued an order to civilly commit J.P. for a period 
not to exceed six months.  J.P. appealed from the Appellate 
Division's affirmance of the decision to the Appeals Court, and 
we transferred the case to this court on our own motion.  We are 
asked to determine whether sufficient admissible evidence was 
presented to warrant an order of civil commitment pursuant to 
G. L. c. 123, §§ 7, 8.  We conclude that the answer is yes.2 
Background.  1.  Standard for long-term civil commitment.  
By petitioning the district (or juvenile) court, the 
superintendent of a mental health facility may seek to commit 
involuntarily, for a period of between six and twelve months, an 
                                                 
2 We acknowledge the amicus briefs submitted by the American 
Civil Liberties Union Foundation of Massachusetts, Inc., and the 
Massachusetts Coalition for the Homeless; by the Committee for 
Public Counsel Services, Center for Public Representation, 
Mental Health Legal Advisors Committee, and Disability Law 
Center; by Veterans Legal Services; and by the Department of 
Mental Health. 
3 
 
individual who has been admitted to the facility.  G. L. c. 123, 
§§ 7 (a), 8 (d).  For an order of commitment to be issued, the 
judge must find, after a hearing, that "(1) such person is 
mentally ill, and (2) the discharge of such person from a 
facility would create a likelihood of serious harm."  G. L. 
c. 123, § 8 (a).  Further, the judge must find that there is no 
alternative that is less restrictive than hospitalization.  
Commonwealth v. Nassar, 380 Mass. 908, 917-918 (1980). 
The phrase "likelihood of serious harm" is statutorily 
defined as "(1) a substantial risk of physical harm to the 
person himself [or herself] as manifested by evidence of, 
threats of, or attempts at, suicide or serious bodily harm; (2) 
a substantial risk of physical harm to other persons as 
manifested by evidence of homicidal or other violent behavior or 
evidence that others are placed in reasonable fear of violent 
behavior and serious physical harm to them; or (3) a very 
substantial risk of physical impairment or injury to the person 
himself as manifested by evidence that such person's judgment is 
so affected that he is unable to protect himself in the 
community and that reasonable provision for his protection is 
not available in the community."  G. L. c. 123, § 1.  The harm 
must be shown to be imminent, that is, it will materialize "in 
days or weeks rather than in months."  Matter of G.P., 473 Mass. 
112, 128 (2015).  Each of the statutory requirements must be 
4 
 
demonstrated beyond a reasonable doubt.  Id. at 119.  See 
Nassar, 380 Mass. at 913. 
 
2.  J.P.'s civil commitment hearing.  On February 12, 2018, 
J.P. was transferred from St. Luke's Hospital (St. Luke's) 
emergency room to Southcoast Behavioral Health (SBH).  SBH filed 
a timely petition for J.P.'s involuntary commitment pursuant to 
G. L. c. 123, §§ 7, 8, after J.P. requested to be discharged.  
In the petition, SBH alleged that, as a result of mental 
illness, J.P. presented both a risk of harm to others and a very 
substantial risk of harm to himself in that he was unable to 
protect himself in the community.3  SBH further alleged that 
civil commitment was the least restrictive alternative in the 
circumstances. 
At the commitment hearing, J.P.'s treating physician, 
Ronald Lee, testified that, once at SBH, J.P. was uncooperative 
in providing information regarding his psychiatric history, 
although he did indicate that he previously had been 
hospitalized at other mental health facilities.4  J.P. also 
refused to allow the facility either to release information to, 
                                                 
3 Southcoast Behavioral Health (SBH) did not allege that 
J.P. was suicidal. 
 
 
4 J.P. indicated that he was originally admitted to St. 
Luke's Hospital (St. Luke's) as a result of a "209," which Dr. 
Lee interpreted to mean a 209A restraining order.  However, SBH 
could not confirm that such an order had been issued against 
J.P., and the judge did not make reference to it in her 
findings. 
5 
 
or obtain information from, his mother or any other providers 
involved in his care. 
Dr. Lee, who diagnosed J.P. with schizoaffective disorder–
bipolar type, found J.P. to be unengaged, uncooperative, and 
unwilling to participate in treatment.  Lee testified that J.P. 
was one of the most paranoid patients he had ever met as a 
physician at SBH.  J.P. refused medication and often walked out 
during meetings with the doctor.  J.P. also was hostile and 
aggressive toward the doctor.  J.P. referred to Dr. Lee as a 
"fucking punk" and a "fucking rat," and indicated that he could 
not work with the doctor because of the doctor's Asian 
ethnicity.  Lee testified that, at one point during a meeting, 
as J.P. insisted to Lee that he did not have a psychiatric 
issue, J.P.'s jaw was clenched, his muscles were tensed, and he 
appeared to be bordering on lashing out.  J.P. also warned the 
doctor that going forward with commitment proceedings would be a 
mistake.  These interactions caused Lee to feel threatened at 
times. 
According to the SBH medical records, J.P. told a different 
SBH doctor that he was able to "handle himself in a bar," 
stating, "I know what to do if anybody gets in my face."  J.P. 
further revealed that he was trained in martial arts and 
"know[s] a few things."  He also made threats to a nurse 
practitioner, telling her that if he did not get his 
6 
 
(nonpsychiatric) medication, "something uncontrollable will 
happen and you won't like it." 
Lee also reported that J.P. also had altercations with his 
peers during his stay.  Two different patients reported to the 
doctor that J.P. had threatened their lives.  In addition, 
J.P.'s roommate had to be moved out of the room for safety 
reasons. 
The doctor also testified as to the content of the records 
from St. Luke's that accompanied J.P. when he transferred to 
SBH.5  According to those records, J.P. had threatened and 
exhibited paranoid behavior toward his mother.  He accused his 
mother and neighbors of placing beer in his refrigerator.  He 
also forced his mother to stay up at night to "keep a watch out" 
for him, telling her, "Don't you come back in the house." 
J.P. presented his own expert witness, a doctor who 
examined J.P. the morning of the hearing.  That doctor opined 
that J.P. suffered from a delusional disorder-paranoid type or 
paranoid schizophrenia, but disagreed that that J.P. met the 
criteria for involuntary civil confinement. 
At the conclusion of the hearing, the judge found that J.P. 
suffered from a major mental illness, that discharge from SBH 
would create a likelihood of serious harm, and that there was no 
                                                 
5 The records themselves were not offered as evidence at the 
hearing. 
7 
 
less restrictive alternative to involuntary civil commitment.  
The judge subsequently ordered J.P. civilly committed for a 
period not to exceed six months.6 
Discussion.7  Here, we review the sufficiency of the 
evidence presented that, if released, J.P. posed a likelihood of 
serious harm as defined by the statute.8  As discussed supra, a 
likelihood of serious harm can be proved in one of three ways.  
SBH presented evidence from which the judge concluded that the 
facility met the criteria of two of the definitions:  J.P. posed 
a substantial risk of physical harm to others as well as a very 
substantial risk to his own safety.9 
In our review of the sufficiency of the evidence, we accept 
the findings of fact made by the hearing judge unless clearly 
erroneous; however, we review without deference whether the 
                                                 
 
6 J.P. was ordered committed on March 6, 2018.  Although the 
order of commitment expired on September 4, 2018, he was 
discharged from SBH on March 26, 2018. 
 
 
7 We note that, although J.P. is no longer involuntarily 
committed to SBH, the matter is not moot.  "[A]n individual has 
a personal stake in the outcome of litigating an appeal from an 
order of civil commitment, even after the individual is 
released."  Matter of a Minor, 484 Mass. 295, 300 (2020).  See 
Matter of F.C., 479 Mass. 1029, 1029-1030 (2018). 
 
8 J.P. does not contest the finding of mental illness, nor 
does he contest the finding that hospitalization was the least 
restrictive alternative available in the circumstances. 
 
9 SBH did not present evidence of the first prong, a 
likelihood of serious harm due to a substantial risk of suicide 
or other self-harm. 
8 
 
legal standard for civil commitment was met.  See Matter of a 
Minor, 484 Mass. 295, 302 (2020). 
1.  Substantial risk of physical harm to others.  To 
conclude that a person poses a substantial risk of physical harm 
to others, a judge must find either "[1] evidence of homicidal 
or other violent behavior or [2] evidence that others are placed 
in reasonable fear of violent behavior and serious physical harm 
to them."  G. L. c. 123, § 1.  With regard to this element, the 
judge focused on the second of the two alternative predicates, 
finding a risk of physical harm based on evidence from J.P.'s 
stay at SBH, and the statements that his mother made that others 
were placed in reasonable fear of physical harm from him.  The 
judge also found that J.P.'s judgment was so affected by his 
paranoia, agitation, and contrariness as to affect substantially 
the safety of others in the community (as well as his own). 
J.P. argues that the evidence of his mother's statements 
was inadmissible hearsay, and that, without them, there was 
insufficient evidence of a substantial risk of physical harm to 
others. 
a.  Hearsay evidence.  Statements made by J.P.'s mother 
were contained in the emergency room records from St. Luke's, 
about which Lee, the treating physician from SBH, testified at 
the hearing.  The records were not admitted in evidence.  J.P. 
9 
 
argues that the judge improperly considered this evidence 
because it was inadmissible hearsay.10  We agree. 
The mother's statements were hearsay because they were made 
out of court during a conversation with a social worker and were 
offered for their truth.  Moreover, the statements were reduced 
to writing and included in records from which Lee testified.  
Thus, Lee's testimony regarding the records containing the 
mother's statements comprised three levels of hearsay.  In order 
for this testimony to have been admissible, each of the hearsay 
statements had to have fallen within one of the exceptions to 
the hearsay rule.  Commonwealth v. DePina, 476 Mass. 614, 623 
(2017). 
SBH contends that the testimony regarding the mother's 
statements was admissible pursuant to G. L. c. 233, § 79, which 
permits the introduction of medical records as evidence of 
diagnosis, prognosis, and proximate cause of the condition 
diagnosed, among other things.  The purpose of the statute is to 
"admit presumptively reliable evidence without the necessity of 
calling numerous hospital personnel as witnesses."  Bouchie v. 
Murray, 376 Mass. 524, 528 (1978).  However, the emergency room 
records themselves were not admitted in evidence; thus, Lee's 
testimony regarding anything in those records, including the 
                                                 
10 J.P. raised a timely hearsay objection to the testimony 
regarding the mother's statements at the hearing. 
10 
 
mother's statements, was hearsay that is not admissible under an 
exception to the rule.11  As this portion of Lee's testimony was 
inadmissible, we need not go on to examine the admissibility of 
the mother's hearsay statements within the emergency room 
records. 
However, we conclude that J.P. suffered no prejudice from 
the admission of this evidence.  Although the judge indicated 
that she considered the mother's hearsay statements in 
concluding that J.P. posed a substantial risk of physical harm 
to other persons, she found that the mother was not the only one 
who reasonably feared physical harm from J.P.  Because, as 
discussed infra, the evidence presented was sufficient for a 
finding of a substantial risk of physical harm without the 
mother's statements, J.P. was not prejudiced by their admission.  
See Commonwealth v. Evans, 439 Mass. 184, 191, cert. denied, 540 
U.S. 923 and 540 U.S. 973 (2003) (admission of identification 
hearsay evidence not prejudicial where cumulative of other 
properly admitted evidence). 
                                                 
11 Even if Lee took the St. Luke's records into 
consideration when diagnosing J.P., an expert witness may not 
testify about evidence that formed the basis of their expert 
opinion but was not admitted in evidence.  Commonwealth v. 
Goddard, 476 Mass. 443, 448 (2017), quoting Commonwealth v. 
Barbosa, 457 Mass. 773, 785 (2010), cert. denied, 563 U.S. 990 
(2011) ("experts are prohibited 'during [their] direct 
examination[s] from informing the jury about the facts or data 
[they] considered that were not in evidence but that would be 
admissible with the right witness or proper foundation'"). 
11 
 
b.  Sufficiency of the evidence.  At the hearing, Lee 
testified to his personal experience with J.P. as J.P.'s 
treating physician, describing in some detail J.P's threats, 
menacing body language, and verbal abuse leading the doctor to 
feel threatened.  There also was evidence of J.P.'s intimidating 
behavior toward others at SBH, including threats to kill two 
patients.12 
J.P. contends that the evidence that others were placed in 
fear was "subjective, speculative or unspecified" and thus it 
amounted to subjective fear rather than the objective 
"reasonable fear" required by G. L. c. 123, § 1.  We disagree.  
A showing of "evidence that others are placed in reasonable fear 
of violent behavior and serious physical harm" means presenting 
evidence that, in the circumstances, a reasonable person would 
fear violent behavior and serious physical harm, and that 
someone actually did fear violent behavior and serious physical 
harm.  Unlike the first clause of the second prong, which 
requires a showing of "homicidal or other violent behavior" from 
the respondent, the second clause of the second prong requires a 
showing that those who interact with the respondent fear being 
subjected to "violent behavior and serious physical harm," and 
that such fear is reasonable.  G. L. c. 123, § 1. 
                                                 
12 We note that the testimony regarding the patients' 
statements to Lee was not objected to at the hearing. 
12 
 
Here, from an objective viewpoint, the evidence presented 
of J.P.'s behavior, including his verbal threats and demeanor, 
would cause a reasonable person to fear violent behavior and 
serious physical harm from J.P.  Further, there was testimony 
from Lee of his fear of such an outcome.  The judge further 
inferred that, given the descriptions of J.P.'s interactions 
with other medical providers and patients, others also feared 
violent behavior and serious physical harm.  Thus, we conclude 
that there was sufficient evidence (even without the mother's 
statements) demonstrating beyond a reasonable doubt that others 
were placed in reasonable fear of imminent violent behavior and 
serious physical harm to them.  See G. L. c. 123, § 1; Matter of 
G.P., 473 Mass. at 126. 
2.  Very substantial risk of harm to self in the community.  
The judge further concluded that there was sufficient evidence 
that without involuntary commitment, J.P. also posed a very 
substantial risk of harm to himself in the community because he 
would not be able to protect or care for himself.  See G. L. 
c. 123, § 1.  The evidence supporting this conclusion was not 
robust, and SBH did not press a sufficiency argument with regard 
to this prong.  Because we have concluded that the evidence 
presented was sufficient to demonstrate likelihood of serious 
harm under the second prong, we need not address the sufficiency 
of the evidence to prove the third prong, including J.P.'s claim 
13 
 
that SBH failed to prove that "reasonable provision for his 
protection [was] not available in the community."  G. L. c. 123, 
§ 1. 
However, we take this opportunity to address a footnote in 
the Appellate Division's decision in which the court expressed 
the view that "homelessness, in and of itself, presents a very 
substantial risk of harm to a person [himself]" due to the 
"risks of theft, abuse, and violence" that the homeless 
population faces.  It is true that homelessness can mean a lack 
of safety and stability, but that does not mean that 
homelessness, in and of itself, is sufficient to support a 
finding of a very substantial risk of harm to the person himself 
or herself.  If it is to be used at all as part of the 
involuntary civil commitment analysis, it must be done with 
extreme caution. 
Webster's Third New International Dictionary 1083 (1993) 
defines "homeless" as "having no home or permanent place of 
residence."  It is a broad term that may, but need not, be 
synonymous with living on the streets and being exposed to the 
attendant dangers that come with it.13  But even if a person does 
not have a place to stay and will be in a homeless shelter or on 
                                                 
 
13 Here, J.P. testified that although he could not return to 
live with his mother, he had other options, including staying in 
a hotel and staying with friends. 
14 
 
the street, that is not proof that he or she will pose a 
substantial danger to himself or herself. 
We further note that people become homeless for many 
reasons, including, but not limited to, being a domestic abuse 
survivor, being unemployed or underemployed, and falling on hard 
times.14  Mental illness may, or may not, be a factor.  None of 
these conditions, including mental illness, necessarily means 
that the person meets the criteria of the third prong, i.e., 
that there is, a "very substantial risk of physical impairment 
or injury to [that] person . . . as manifested by evidence that 
such person's judgment is so affected that he [or she] is unable 
to protect himself [or herself] in the community."  G. L. 
c. 123, § 1.  Thus, although homelessness may be part of the 
involuntary civil commitment analysis, it alone cannot suffice 
to demonstrate a likelihood of serious harm to the person 
himself or herself under G. L. c. 123. 
Conclusion.  The judgment of the District Court judge is 
affirmed. 
 
 
 
 
 
 
 
So ordered. 
                                                 
14 See National Law Center on Homelessness & Poverty, 
Homelessness in America:  Overview of Data and Causes, at 3 
(Jan. 2015) (listing unemployment and low wages as among top 
causes of homelessness).