Case Title: In re G.P.

Citation: 

Docket Number: SJC-11911

State: massachusetts

Court: Massachusetts Supreme Court

Date: 2015-11-05T00:00:00Z

Document:
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SJC-11911 
 
IN THE MATTER OF G.P. 
 
 
 
Suffolk.     September 10, 2015. - November 5, 2015. 
 
Present:  Gants, C.J., Spina, Cordy, Botsford, Duffly, Lenk, & 
Hines, JJ. 
 
 
Practice, Civil, Civil commitment, Standard of proof, Hearsay, 
Appeal, Moot case.  Uniform Trial Court Rules for Civil 
Commitment Proceedings.  Moot Question.  Words, "Likelihood 
of serious harm," "Very substantial risk." 
 
 
 
 
Civil action commenced in the Supreme Judicial Court for 
the county of Suffolk on June 1, 2015. 
 
 
The case was reported by Lenk, J. 
 
 
 
Ann Grant (Robert H. Weber with her) for the petitioner. 
 
Julia Kobick, Assistant Attorney General, for the 
respondent. 
 
Sandra J. Staub & Robert D. Fleischner, for Mental Health 
Legal Advisors & others, amici curiae, submitted a brief. 
 
 
 
BOTSFORD, J.  We consider here questions concerning 
proceedings under G. L. c. 123, § 35 (§ 35), a statute that 
authorizes the involuntary civil commitment of a person, for 
care and treatment, where there is a likelihood of serious harm 
2 
 
as a result of the person's alcoholism or substance abuse, or 
both.  In May, 2015, a District Court judge ordered G.P., the 
petitioner, committed pursuant to § 35 to the Women's Addiction 
Treatment Center (WATC), a facility operated by the Department 
of Public Health.  After an unsuccessful appeal of the 
commitment order to the Appellate Division of the District 
Court, G.P. filed a petition for relief in the county court 
pursuant to G. L. c. 211, § 3, to challenge and vacate the 
order.  A single justice reserved and reported the case. 
 
G.P. is no longer committed to the facility, rendering moot 
her challenge to the order of commitment.  See Acting Supt. of 
Bournewood Hosp. v. Baker, 431 Mass. 101, 103 (2000) (Baker).  
Nevertheless, we decide the case because it raises important 
issues concerning the operation of § 35 as well as the Uniform 
Trial Court Rules for Civil Commitment Proceedings for Alcohol 
and Substance Abuse (uniform § 35 rules) scheduled to go into 
effect on February 1, 2016, and these issues are likely to evade 
review on account of the relatively short duration of a 
commitment under § 35.  See, e.g., Baker, supra; Superintendent 
of Worcester State Hosp. v. Hagberg, 374 Mass. 271, 274 (1978) 
(Hagberg).1  See also Guardianship of V.V., 470 Mass. 590, 591-
592 (2015). 
                                                          
 
 
1 Furthermore, "[w]here . . . the single justice has, in 
[her] discretion, reserved and reported the case to the full 
3 
 
 
Background.  On May 4, 2015, G.P's mother petitioned the 
New Bedford Division of the District Court Department (New 
Bedford District Court) to have her daughter committed pursuant 
to § 35.  The petition alleged in relevant part that G.P.'s 
mother had observed G.P. abusing heroin and that G.P. was using 
about two grams per day; that G.P. had stated that she would 
kill herself with heroin if she could obtain enough to do so; 
that G.P. was refusing to eat because she stated she wanted to 
die; that G.P. had hit her mother "before" and "pushed" and 
"shoved" her many times; that G.P. had been abusing drugs for 
two years; and that she had had two "detox hospitalizations" in 
the past, the most recent having taken place eight to nine 
months previously. 
 
A District Court judge held a hearing on the petition the 
day it was filed.  Prior to the hearing, Dr. Ruth Saemann, a 
designated forensic psychologist, had examined G.P. and also had 
met with G.P.'s sister.  Dr. Saemann testified at the hearing 
that the family believed G.P. had been using heroin for the past 
two years; that G.P. was feeling "very despondent" and had 
stated she would kill herself if she could get enough heroin; 
that G.P. had threatened the family that they would never see 
                                                                                                                                                                                           
court, we grant full appellate review of the issues reported."  
Matter of a Grand Jury Investigation, 470 Mass. 399, 402 n.4 
(2015), quoting Martin v. Commonwealth, 451 Mass. 113, 119 
(2008). 
4 
 
G.P.'s child again if they did not give her enough money, and 
she had stolen items from the family in order to obtain money; 
that G.P. had tried detoxification on her own the previous week 
and had become very sick, followed by daily use of heroin since 
then; and that the family was concerned about G.P.'s three year 
old child, who had brought a syringe to the child's grandfather 
(G.P.'s father), although Dr. Saemann did not know when this 
incident had occurred.  According to Dr. Saemann, G.P.'s mother 
had stated that the previous week G.P. had pushed her, "[a]nd, 
that's not the first time that she's pushed her mother when she 
doesn't get her way."  Dr. Saemann also testified to what G.P. 
had told her, including that G.P. admitted having a heroin 
problem for the past two years; that she, G.P., recently had 
relapsed but had only used heroin twice in the previous week; 
that she denied her son had given a syringe to his grandfather; 
that she suffered from anxiety and depression but was not 
presently taking medication for those conditions, and also had 
hepatitis C; and that she was neither homicidal nor suicidal.  
Dr. Saemann examined G.P.'s arms and neck for needle marks and 
observed puncture marks that looked recent.  Dr. Saemann 
concluded her testimony by giving her opinion that G.P. met the 
requirements of § 35 for commitment, explaining, 
 
"I don't believe, given [G.P.'s] record and her 
history, that she is capable of stopping this on her own.  
I think she does need to, . . . that she has lost control 
5 
 
of the use of heroin and will need . . . a commitment.  I 
do find that she is a danger to herself by use of her 
heroin. . . .  I also think that . . . if indeed the child 
is finding syringes . . . and [G.P.]'s Hep[atitis] C 
positive, that is putting the child in serious harm's way." 
 
 
The judge credited as fact Dr. Saemann's testimony 
recounting what G.P.'s sister and G.P. had told her.  The judge 
further noted that G.P. had "pushed her mother the other day," 
and concluded that all he had heard "mitigates in favor . . . of 
a commitment.  I'm not saying [G.P.] didn't try. . . .  She 
failed.  She couldn't dry herself out.  She tried to detox.  
She's got recent track marks. . . .  [S]he can't do it on her 
own."  The judge ordered G.P. committed to WATC.2 
 
G.P. appealed the commitment order to the Appellate 
Division of the District Court,3 which denied relief and 
dismissed the appeal on May 21, 2015.  G.P. filed her petition 
for relief under G. L. c. 211, § 3, on June 1, 2015, naming the 
New Bedford District Court as the respondent.4  A single justice 
                                                          
 
 
2 The record does not indicate whether the judge specified 
the length of G.P.'s commitment in the order. 
 
 
3 Recognizing that G.P.'s commitment likely would end before 
her appeal could be heard in the normal course, the Appellate 
Division granted G.P.'s motion to expedite her appeal pursuant 
to rule 2 of the District/Municipal Court Rules for Appellate 
Division Appeals. 
 
 
4 Under S.J.C. Rule 2:22, 422 Mass. 1302 (1996), the 
District Court shall "be treated as a nominal party which may, 
but need not, appear and be heard" when named as a respondent in 
a petition for relief pursuant to G. L. c. 211, § 3. 
 
6 
 
reserved and reported the case to the full court without 
decision, and directed the parties to address the following 
questions: 
 
"1) The standard of proof required at a commitment 
hearing under G. L. c. 123, § 35; 
 
 
"2) whether the rules of evidence apply [in] a hearing 
on a petition for commitment pursuant to G. L. c. 123, 
§ 35; 
 
 
"3) [t]he route of appeal from a decision ordering 
civil commitment under G. L. c. 123, § 35; 
 
 
"4) the proximity in time of the 'evidence of, threats 
of, or attempts at, suicide or serious bodily harm' to the 
respondent, and the proximity in time of the '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' necessary to establish a 
'likelihood of serious harm,' G. L. c. 123, § 1,[5] to the 
respondent or others, for an order of commitment to issue; 
and 
 
 
"5) the quantum of risk necessary to establish '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.'  See G. L. c. 123, §§ 1, 35." 
 
 
Discussion.  We consider each of the reported questions 
infra, but first summarize § 35's provisions and the provisions 
of the trial court's uniform § 35 rules. 
 
1.  Commitment proceedings under § 35.  A petition for an 
order of commitment under § 35 of a person believed to be an 
                                                          
 
5 General Laws c. 123, § 1, provides definitions of a number 
of words and terms used in c. 123, and in particular, defines 
the term "[l]ikelihood of serious harm," which is used in G. L. 
c. 123, § 35 (§ 35).  We quote this definition in full, infra. 
 
7 
 
"alcoholic"6 or "substance abuser"7 may be filed by a police 
officer, physician, spouse, blood relative, guardian, or court 
official in any division of the District Court or the Juvenile 
Court.  G. L. c. 123, § 35, third par.  Once the petition is 
filed, the court must "immediately" schedule a hearing and cause 
a summons to be served on the person (respondent) or, if 
appropriate, issue a warrant of apprehension or of arrest.8  Id. 
The respondent has the right to counsel, and to have counsel 
appointed if indigent.  Id. 
                                                          
 
6 An "alcoholic" is defined as "a person who chronically or 
habitually consumes alcoholic beverages to the extent that (1) 
such use substantially injures his health or substantially 
interferes with his social or economic functioning, or (2) he 
has lost the power of self-control over the use of such 
beverages."  G. L. c. 123, § 35, first par. 
 
7 A "substance abuser" is defined as "a person who 
chronically or habitually consumes or ingests controlled 
substances or who intentionally inhales toxic vapors to the 
extent that:  (i) such use substantially injures his health or 
substantially interferes with his social or economic 
functioning; or (ii) he has lost the power of self-control over 
the use of such controlled substances or toxic vapors."  G. L. 
c. 123, § 35, second par. 
 
 
8 If the judge determines that there are "reasonable grounds 
to believe that [the respondent] will not appear and that any 
further delay in the proceedings would present an immediate 
danger to the physical well-being of the respondent," the judge 
may issue "a warrant for the apprehension and appearance of such 
person," but no arrest of the person may be made unless he or 
she may be presented immediately before a judge.  G. L. c. 123, 
§ 35, third par.  The statute also authorizes the judge to issue 
an arrest warrant if the respondent fails to appear when 
summoned.  Id. 
8 
 
When the respondent appears in court, a qualified 
physician, psychologist, or social worker must examine her.  Id.  
Counsel may remain present during the examination.  See R.B. 
Minehan & R.M. Kantrowitz, Mental Health Law § 13.11 (2007).  
The hearing on the petition follows the examination, and it must 
include competent medical testimony, but the petitioner may 
present additional evidence as well, G. L. c. 123, § 35, fourth 
par.; the respondent also may present evidence, including 
independent expert testimony, G. L. c. 123, § 35, third par.  If 
the judge finds, based on the evidence presented, that (1) the 
respondent is an "alcoholic" or a "substance abuser" as defined 
in § 35, and (2) there is a "likelihood of serious harm" as a 
result of the respondent's alcoholism or substance abuse (or 
both), the judge may order the respondent committed to a 
suitable facility operated by the Department of Public Health 
(department) under G. L. c. 111B for a period not to exceed 
ninety days, but case management services are to be available 
through the department for up to one year; if there is not such 
a suitable facility available, commitment may be ordered to a 
facility operated by the Department of Correction -- Bridgewater 
State Hospital, if the respondent is a man, or the Massachusetts 
Correctional Institution in Framingham, if a woman.  G. L. 
c. 123, § 35, fourth par.  Likelihood of serious harm may be 
established by a showing of (1) a substantial risk of serious 
9 
 
physical harm to the respondent; (2) a substantial risk of 
serious physical harm to other persons; or (3) a very 
substantial risk of physical "impairment or injury" to the 
respondent resulting from an inability to protect himself or 
herself in the community.  G. L. c. 123, § 1. 
 
Following a respondent's commitment, the superintendent of 
the public or private facility to which the commitment was 
ordered must review the necessity of the commitment on the 
thirtieth day and every fifteen days thereafter for as long as 
the commitment continues, up to the ninety-day limit.  G. L. 
c. 123, § 35, fourth par.  The superintendent may release the 
respondent before the end of the period of commitment originally 
ordered upon a written determination that release "will not 
result in a likelihood of serious harm."  Id. 
 
2.  Uniform § 35 rules.  In 2014, the Trial Court published 
for public comment a proposed set of uniform rules to govern 
proceedings under § 35.  Following a public comment period, a 
final version of the proposed uniform § 35 rules was submitted 
to this court for approval on June 1, 2015, and approved on 
July 22, 2015.  The rules will take effect February 1, 2016.9 
                                                          
 
 
9 This court's notice of approval of the Uniform Trial Court 
Rules for Civil Commitment Proceedings for Alcohol and Substance 
Abuse (uniform § 35 rules) referenced the present case and the 
fact that certain matters addressed by the rules were at issue 
in this case, and specifically noted that the court's decision 
might require revisions to the rules. 
10 
 
 
The uniform § 35 rules govern the conduct of commitment 
proceedings under § 35 in the District Court, Boston Municipal 
Court, and Juvenile Court Departments.  See rule 1(a) of the 
uniform § 35 rules.  The rules address, among other issues, the 
standard of proof that applies to § 35 proceedings, the types of 
evidence that may be considered, findings to be made by a judge, 
and the nature and contents of an order of commitment.  See 
rules 6(a), 7(a)-(c), 8(a)-(b).  In discussing the reported 
questions, we consider the particular rules that are pertinent 
to them. 
 
3.  Reported questions.  a.  Question 1:  standard of 
proof.  Section 35 does not specify the standard of proof 
applicable to § 35 commitment proceedings.  The uniform § 35 
rules mandate use of a "clear and convincing" standard of proof, 
i.e., that the judge must find proved by clear and convincing 
evidence the facts supporting determinations that the respondent 
is an alcoholic or substance abuser and that there is a 
likelihood of serious harm directly resulting from his or her 
alcoholism or substance abuse.  See rule 6(a).  G.P. argues that 
proof beyond a reasonable doubt is the required standard of 
proof for a commitment under § 35, pointing out that other types 
of civil commitments, see, e.g., G. L. c. 123, §§ 7, 8 (mentally 
ill person dangerous to self or others), have been interpreted 
to require proof beyond a reasonable doubt. 
11 
 
 
Proof beyond a reasonable doubt is a bedrock feature of due 
process in criminal trial proceedings.  See In re Winship, 397 
U.S. 358, 363 (1970).  As G.P. points out, we have recognized 
that a standard of proof beyond a reasonable doubt also may be 
constitutionally required in some types of civil commitment 
proceedings, see, e.g., Commonwealth v. Nassar, 380 Mass. 908, 
909, 916 (1980) (civil commitment under G. L. c. 123, § 16 [b]); 
Hagberg, 374 Mass. at 272 (civil commitment under G. L. c. 123, 
§§ 7, 8); Andrews, petitioner, 368 Mass. 468, 486 (1975) 
(commitment of sexually dangerous person under G. L. c. 123A), 
but that this standard is not constitutionally required for all 
civil commitment proceedings.  See Department of Youth Servs. v. 
A Juvenile, 384 Mass. 784, 791-792 (1981).  As a general matter, 
outside of criminal trial proceedings, the length of time that 
an involuntary commitment may last is key among the factors that 
may bear on the determination of what standard applies.  See 
Abbott A. v. Commonwealth, 458 Mass. 24, 40-41 (2010); Querubin 
v. Commonwealth, 440 Mass. 108, 120 n.9 (2003); Mendonza v. 
Commonwealth, 423 Mass. 771, 783 (1996).  Proof beyond a 
reasonable doubt of the likelihood of serious harm to oneself or 
others is required before a person is committed for mental 
illness under G. L. c. 123, §§ 7 and 8, for example, because a 
person can be subject to recommitment petitions and hearings 
12 
 
indefinitely.10  See Abbott A., supra.  In contrast, an 
individual committed under § 35 cannot be held for more than 
ninety days, and the statute does not allow for extensions.11  
Although a § 35 commitment is not a precursor to another type of 
commitment or proceeding, nonetheless, we view such a commitment 
as more akin to temporary commitments of mentally ill persons 
under G. L. c. 123, §§ 12 and 15 (b), or pretrial detentions of 
                                                          
 
 
10 The first order of commitment expires after six months, 
and all subsequent commitments expire after one year.  G. L. 
c. 123, § 8 (d). 
 
 
11 Other sections of G. L. c. 123 authorizing involuntary 
civil commitments on account of mental illness contain specific 
provisions for the extension or renewal of the initial order of 
commitment, or for seeking a new order of commitment.  See G. L. 
c. 123, §§ 7 (c), 8 (a), (d) (initial orders and renewal of 
orders of commitment of persons because of risk of serious harm 
by reason of mental illness); G. L. c. 123, § 12 (d) 
(authorizing application for commitment under G. L c. 123, §§ 7 
and 8, of person initially ordered committed for three-day 
period on emergency basis on account of risk of serious harm by 
reason of mental illness).  See also G. L. c. 123, §§ 15 (e), 16 
(b)-(c), 18 (a) (orders of commitment to hospital on account of 
mental illness of persons charged with or convicted of crimes or 
found not guilty by reason of lack of criminal responsibility).  
Section 35 contains no similar provisions.  Particularly in 
light of the liberty interests at stake, we interpret the 
absence of any provision for extension or renewal in § 35 to 
mean that an order of commitment under this section may extend 
no longer than provided in the order itself -- i.e., no longer 
than ninety days.  G. L. c. 123, § 35, fourth par.  See 
Fernandes v. Attleboro Hous. Auth., 470 Mass. 117, 129 (2014) 
("The omission of particular language from a statute is deemed 
deliberate where the Legislature included such omitted language 
in related or similar statutes").  A person may be committed 
more than once pursuant to § 35, but only as a result of a 
separate petition for commitment that is independently proved by 
clear and convincing evidence. 
 
13 
 
dangerous persons under G. L. c. 276, § 58A.12  In each of these 
proceedings, a clear and convincing standard of proof applies.  
See Mendonza, supra at 783 & n.5.  Given the limited and 
definite time frame involved in a § 35 commitment, we conclude 
that a clear and convincing standard is appropriate here as 
well.  It bears emphasis that the clear and convincing standard 
is not without teeth.  To meet it, there must be a showing that 
the facts establishing the "likelihood of serious harm," see 
G. L. c. 123, § 1, are "highly probably true" (citation 
omitted).  See Callahan v. Westinghouse Broadcasting Co., 372 
Mass. 582, 588 (1977).13 
                                                          
 
 
12 Pretrial detentions on the basis of dangerousness may be 
for 120 days, in the absence of good cause for an extension.  
G. L. c. 276, § 58A (3).  The pretrial detention under § 58A 
will end no later than the trial, or other disposition of the 
underlying charge.  See Mendonza v. Commonwealth, 423 Mass. 771, 
783 (1996). 
 
 
13 In Callahan v. Westinghouse Broadcasting Co., 372 Mass. 
588 (1977), this court explained the standard of proof by clear 
and convincing evidence by quoting with approval Dacey v. 
Connecticut Bar Ass'n, 170 Conn. 520, 537 n.5 (1976): 
 
 
"The burden of persuasion . . . in those cases 
requiring a showing of clear and convincing proof is 
sustained if evidence induces in the mind of the trier a 
reasonable belief that the facts asserted are highly 
probably true, that the probability that they are true or 
exist is substantially greater than the probability that 
they are false or do not exist." 
 
See Callahan, supra at 588 n.3, quoting McBaine, Burden of 
Proof:  Degrees of Belief, 32 Cal. L. Rev. 242, 263-264 (1944): 
 
14 
 
 
b.  Question 2:  rules of evidence.  Section 35 requires 
that a judge base his or her determination to order a respondent 
committed "upon competent testimony, which shall include, but 
not be limited to, medical testimony."  G. L. c. 123, § 35, 
fourth par.  The statute, however, is silent with respect both 
to whether the rules of evidence apply to § 35 commitment 
proceedings and to the issue of the admissibility of hearsay 
evidence.  Id.  Rule 7(a) of the uniform § 35 rules provides 
that the rules of evidence shall not apply to § 35 commitment 
proceedings, except for privileges14 and statutory 
disqualifications; this rule also states that hearsay evidence 
is admissible and may be relied upon if the judge finds it to be 
"substantially reliable."  G.P. asserts that there is no support 
                                                                                                                                                                                           
 
"The burden [of persuasion] is not a burden of 
convincing you that the facts which are asserted are 
certainly true or that they are almost certainly true, or 
are true beyond a reasonable doubt.  It is, however, 
greater than a burden of convincing you that the facts are 
more probably true than false.  The burden imposed is to 
convince you that the facts asserted are highly probably 
true, that the probability that they are true or exist is 
substantially greater than the probability that they are 
false or do not exist.  If then you believe upon 
consideration and comparison of all the evidence in the 
case that there is a high degree of probability that the 
facts are true you must find that the fact[s] have been 
proved." 
 
 
14 The commentary to rule 7 of the uniform § 35 rules 
indicates that the privileges at issue include constitutional, 
statutory, and common-law privileges.  Although not 
constitutionally required, rule 7(b) prohibits a judge in a § 35 
proceeding from drawing an adverse inference from a respondent's 
refusal to testify.  See rule 7(b) & commentary. 
15 
 
for "suspending" the rules of evidence; that the rules of 
evidence apply in other civil commitment proceedings such as 
those held under G. L. c. 123, § 8; and that where the 
Legislature has intended the rules of evidence not to apply, it 
has explicitly so provided, citing G. L. c. 276, § 58A (4), 
which expressly states that the rules concerning admissibility 
of evidence in criminal trials do not apply to pretrial 
detention hearings for allegedly dangerous persons. 
 
We disagree that strict adherence to the rules of evidence 
is required.  In certain types of proceedings, the court has 
recognized that formal rules of evidence may not apply, even 
where liberty interests are at stake and even where no specific 
statutory authority exists.  See Commonwealth v. Durling, 407 
Mass. 108, 117-118 (1990) (rules of evidence need not apply in 
probation revocation proceedings; probation revocation 
determination may be based on substantially reliable hearsay 
evidence).  See also Commonwealth v. Bukin, 467 Mass. 516, 519-
520 (2014); Abbott A., 458 Mass. at 34-35.  We have explained 
that, where a deprivation of liberty is involved, due process 
protections require "notice and opportunity for a hearing 
appropriate to the nature of the case" (emphasis in original).  
Myers v. Commonwealth, 363 Mass. 843, 854 (1973).  The uniform 
§ 35 rules afford the respondent -- who is entitled under § 35 
to be represented by counsel and to have counsel immediately 
16 
 
appointed if indigent -- the right to cross-examine witnesses, 
to call witnesses (and therefore to testify), and to present 
independent expert and other types of evidence.15  See rule 6(c).  
As for hearsay evidence, rule 7(a) specifies that it is 
admissible "only if the judge finds that it is substantially 
reliable."  See Commonwealth v. Patton, 458 Mass. 119, 132-133 
(2010) (discussing criteria relevant to determination of hearsay 
reliability). 
 
In Durling, 407 Mass. at 114-118, this court discussed in 
some detail the admissibility of hearsay in the context of 
probation revocation hearings.  We explained that reliable 
hearsay has always been allowed in probation revocation 
proceedings because of the "flexible" nature of the proceedings, 
                                                          
 
 
15 With respect to experts, § 35 states that the respondent 
may present independent expert testimony; rule 6(c) speaks more 
generally of the right to present independent expert evidence.  
The right to present expert testimony is likely to be difficult 
to actualize, given the emergency nature of § 35 proceedings and 
the reality that, in most cases, the hearing on the § 35 
petition is likely to be held on the same day the petition is 
filed.  See R.B. Minehan & R.M. Kantrowitz, Mental Health Law 
§ 13.12 (2007).  Nonetheless, in order to ensure that a 
respondent's right to present independent expert testimony is 
not chimerical, if a respondent seeks a continuance in order to 
present such evidence, a judge should give careful consideration 
to the request in light of the circumstances presented.  Even if 
the emergency nature of those circumstances would make a 
continuance inappropriate, it may make sense for the judge to 
deny the continuance request but invite a later motion for 
reconsideration of a commitment order supported by expert 
testimony.  Moreover, whether or not a respondent seeks or is 
able to present expert testimony, rule 6(c) entitles the 
respondent to present expert opinion evidence that might be 
contained in a medical or other type of record. 
17 
 
coupled with the need to consider "all reliable evidence."  Id. 
at 114.  Commitment hearings under § 35 are similar in that the 
most reliable and important information supporting or opposing 
commitment may only be available as hearsay, given the extremely 
short time frame in which the proceeding is to take place.  See 
G. L. c. 123, § 35, third par.  Moreover, as in this case, the 
petitioner may be a parent or other close family member of the 
respondent, and appearing without counsel.  The flexible nature 
of due process permits accommodation of these circumstances by 
not requiring strict adherence to the rules of evidence, so long 
as there is fairness in the proceeding.  Cf. Frizado v. Frizado, 
420 Mass. 592, 597-598 (1995) (proceedings under G. L. c. 209A).  
Allowing hearsay if it is credible preserves the "due process 
touchstone of an accurate and reliable determination," Durling, 
supra at 117-118, while accounting for practical considerations 
of § 35 hearings.  But precisely because hearsay evidence may 
well play an extremely significant role in these hearings, the 
judge's obligation to ensure that any hearsay on which he or she 
relies is "substantially reliable," as required by rule 7(a), is 
critical, particularly in light of the clear and convincing 
evidence standard of proof required by rule 6(a). 
 
c.  Question 3:  proper route of appeal of a commitment 
order.  The route of appeal of a § 35 commitment order is 
defined by applicable statutes and also by the uniform § 35 
18 
 
rules.  In the District Court and the Boston Municipal Court, 
the first stage of appeal is to the Appellate Division of the 
respective courts.  With respect to the District Court, see 
G. L. c. 123, § 9 (a) ("Matters of law arising in commitment 
hearings . . . in a district court may be reviewed by the 
appellate division of the district courts in the same manner as 
civil cases generally").  As for the Boston Municipal Court (as 
well as the District Court), see G. L. c. 231, § 108 ("Any party 
to a cause brought in the municipal court of the city of Boston, 
or in any other district court, aggrieved by any ruling on a 
matter of law by a trial court justice, may as of right, appeal 
the ruling for determination by the appellate division pursuant 
to the applicable rules of court").  Rule 11(a) of the uniform 
§ 35 rules essentially incorporates these provisions, but 
further specifies that, on request, the Appellate Division is to 
"expedite" consideration of any § 35 appeal."16,17 
 
A party aggrieved by a decision of the Appellate Division 
of the District Court or the Boston Municipal Court has a 
                                                          
 
 
16 Rule 11(a) of the uniform § 35 rules provides:  "Any 
person aggrieved by a decision of the District Court Department 
or the Boston Municipal Court Department may appeal to the 
Appellate Division of such Department within seven days.  Upon 
request, the Appellate Division shall expedite consideration of 
any appeal." 
 
 
17 The Juvenile Court does not have an appellate division.  
An aggrieved party is entitled to appeal a decision of a 
Juvenile Court judge in a § 35 proceeding to the Appeals Court.  
See rule 11(b) of the uniform § 35 rules. 
19 
 
statutory right of appeal to the Appeals Court.  See G. L. 
c. 231, § 109 ("An appeal to the appeals court shall lie from 
the final decision of the appellate division of any division of 
the district court department including appeals taken hereunder 
from the appellate division of the Boston municipal court 
department").  G.P. argues that the appellate remedy purportedly 
available under this statute is illusory, because the generally 
applicable procedural rules do not provide an avenue for relief 
in a timely manner, and, she claims, the statutory authority of 
the Appeals Court to provide relief under § 109 does not include 
the power to vacate an order of commitment.  As a result, G.P. 
asserts that the only appropriate avenue of appeal is a petition 
for extraordinary relief filed in this court pursuant to G. L. 
c. 211, § 3. 
 
G.P.'s argument fails.  Relief under c. 211, § 3, is a 
"truly extraordinary" remedy.  McMenimen v. Passatempo, 452 
Mass. 178, 184 (2008).  "Parties seeking review must demonstrate 
that they have no other legal remedy to pursue and, therefore, a 
petition under c. 211, § 3, is the only alternative."  
McGuinness v. Commonwealth, 420 Mass. 495, 497 (1995).  Here, 
there is another alternative under G. L. c. 231, § 109.  Under 
that statute, the Appeals Court is authorized to vacate an order 
of commitment.  Cf. Vrusho v. Vrusho, 258 Mass. 185, 188 (1927) 
(discussing power of Supreme Judicial Court, as sole appellate 
20 
 
court before creation of Appeals Court, to "enter any order 
which the Appellate Division ought to have made").  Cf. also 
Baker, 431 Mass. at 102, 107 (direct appellate review of 
commitment order entered in District Court, upheld by that 
court's Appellate Division; order of commitment vacated). 
 
With respect to expedition of the appeals, as this case 
demonstrates -- and as the uniform § 35 rules provide, see rule 
11(a) -- an appeal to the appropriate Appellate Division may be 
expedited on request.  Similarly, the Appeals Court has the 
authority to handle appeals on an expedited basis when 
expedition is called for, and there is no reason to believe that 
court will not do so.  See Kordis v. Appeals Court, 434 Mass. 
662, 669 n.13 (2001). 
 
d.  Question 4:  proximity in time of evidence necessary to 
establish a "likelihood of serious harm" to the respondent or 
others for an order of commitment to issue.  Section 35 provides 
that an order of commitment only may be entered if the judge 
finds, based on the evidence presented, both that the respondent 
is an "alcoholic" or "substance abuser" (as defined in § 35) and 
that there is "a likelihood of serious harm" as a result of that 
condition.  G. L. c. 123, § 35, fourth par.  This reported 
question concerns § 35's second required finding, and the 
specifics of the question are taken from the definition of 
"[l]ikelihood of serious harm" in G. L. c. 123, § 1: 
21 
 
 
"'Likelihood of serious harm', (1) a substantial risk 
of physical harm to the person himself 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." 
 
 
As its words and structure reflect, this definition has 
three prongs -- that is, it defines "likelihood of serious harm" 
in terms of three separate types of risk, any one of which, if 
found, independently qualifies as presenting a likelihood of 
serious harm.  The reported question addresses the definition's 
first two prongs, and focuses on the evidence of the 
respondent's past conduct that can be used as the basis for 
finding the requisite "substantial risk" that the respondent 
hereafter will inflict serious physical harm on himself or 
herself (first prong), or another person (second prong), as a 
result of the respondent's alcoholism or substance abuse.  More 
particularly, the question asks, in substance, how recent in 
time must the evidence of the respondent's past conduct have 
occurred for it to serve as a basis on which to find a 
substantial risk of physical harm to herself or to others.  In 
responding to the question, however, G.P. does not directly 
discuss past conduct, but focuses more on whether the 
22 
 
"substantial risk" of physical harm must be shown to be a risk 
of "imminent" harm.  We address the issue of imminence infra, 
but first consider the question's direct concern, namely, the 
proximity in time of the past conduct relied on to demonstrate a 
substantial risk of harm. 
 
i.  Evidence of past conduct.  The first prong of the 
definition of "likelihood of serious harm" requires "evidence 
of, threats of, or attempts at, suicide or serious bodily harm" 
to the respondent.18  G. L. c. 123, § 1.  This evidence is 
essential because it forms the basis on which the assessment of 
whether there is a "substantial risk" of harm to the respondent 
is to be made.  Id.  It is neither possible nor appropriate to 
try to establish a set of definite temporal boundaries for such 
evidence; the assessment of risk is a probabilistic one, and 
necessarily must be made on the basis of the specific facts and 
circumstances presented.  Cf. Commonwealth v. Boucher, 438 Mass. 
274, 276 (2002) (determination whether sex offender is "likely" 
                                                          
 
 
18 Contrary to the suggestion by the New Bedford Division of 
the District Court Department that "a finding of 'substantial 
risk' [of causing bodily injury] . . . may be based on any 
activity that evinces a genuine possibility of future harm" 
(emphasis in original), citing Commonwealth v. Rosenberg, 410 
Mass. 347, 362 (1991), quoting United States v. Sahhar, 917 F.2d 
1197, 1207 (9th Cir. 1990), the Legislature's use of the terms 
"threats" and "attempts," G. L. c. 123, § 1 -- terms often used 
in our criminal law and denoting actual conduct, see, e.g., 
Commonwealth v. Hamilton, 459 Mass. 422, 426-427 (2011) 
(threat); Commonwealth v. Marzilli, 457 Mass. 64, 66 (2010) 
(attempt) -- suggests that evidence of specific threats or 
attempts at serious self-harm is required. 
23 
 
to reoffend must be made "in the context of the particular facts 
and circumstances at hand").  But as a matter of experience and 
logic, the more recent the evidence of threats or attempts of 
suicide or infliction of serious bodily harm, the more weight 
that evidence should carry in supporting a determination that 
there is a significant risk of self-harm.  It would also seem to 
be the case that the more serious or the more numerous that 
previous attempts or threats of suicide or self-harm are shown 
by the evidence to be, the more significance they would carry in 
making a positive risk assessment about likelihood of harm.  It 
is important to keep in mind the context in which this risk 
assessment is being made.  An order of commitment under § 35 
results in a substantial curtailment of liberty for a period of 
time that, although limited, is hardly momentary.  The context 
underscores the need of the judge to weigh carefully the 
substantiality of the specific evidence of threats or attempts 
that is offered.19 
 
Our observations about the temporal relationship between 
the evidence of prior conduct and the necessary assessment of 
the risk of harm equally apply to the second prong of the 
                                                          
 
19 In the present case, there was no evidence of attempts at 
suicide by the respondent, and the evidence presented concerning 
the respondent's previous threats to harm herself did not 
include any indication as to when those threats were made.  The 
absence of a specific time reference significantly weakened the 
weight of this evidence. 
 
24 
 
definition of the "likelihood of serious harm," which requires 
evidence of past conduct to establish a substantial risk of 
serious physical harm to others going forward.  G. L. c. 123, 
§ 1.  To prove this prong, there must be "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."  Id.  In terms of the character of the evidence 
presented, the Legislature's use of the word "homicidal," and 
phrases such as "violent behavior" and "serious physical harm" 
signifies an intent that evidence of conduct reflecting a 
substantial level of force and intensity be presented.20 
 
ii.  Risk of harm.  We consider the point on which G.P. has 
focused, namely, whether, in order to meet the definition of 
"likelihood of serious harm" under the definition's first or 
second prong, it is necessary to show a substantial risk of 
imminent harm to self or others.  In Nassar, 380 Mass. at 908-
909, 912-917, this court considered the statutory definition of 
"likelihood of serious harm" in the context of determining 
whether the respondents, who had been found not guilty by reason 
of lack of criminal responsibility on charges of abandonment and 
manslaughter in connection with the death of their child, should 
                                                          
 
 
20 Again, in this case, evidence indicating that the 
respondent had pushed her mother on more than one occasion, with 
no further description of what the "push" entailed and no 
specific time frames, appears inadequate to satisfy the second 
definitional prong of "likelihood of serious harm." 
25 
 
be committed involuntarily pursuant to G. L. c. 123, § 16 (b).  
We concluded that proof of "likelihood of serious harm" 
necessary for a commitment order demanded proof that the danger 
or risk of harm at issue was "imminent."  Nassar, supra at 912-
913, 915-917.  G.P. argues that the Nassar decision controls 
here, and that the imminence of the anticipated harm is a 
required element of proof.  The District Court contends that 
imminence is a relevant and important factor to weigh in 
assessing the risk of harm, but only one of several, and that 
proof of imminent harm or imminent risk of harm is not required. 
 
It is true that the Legislature did not include the word 
"imminent" or specify any "immediacy" requirement in the 
definition of "likelihood of serious harm."  G. L. c. 123, § 1.  
But the general point in Nassar applies with equal force here:  
the reliability of an assessment of a substantial risk of harm 
diminishes the farther out one projects as to when the harm is 
likely to materialize.  See Nassar, 380 Mass. at 917 (proof of 
imminence of likely harm is required and "is linked to the 
requirement of an enhanced standard of proof in the sense that 
the forecast of events tends to diminish in reliability as the 
events are projected ahead in time").21  Accordingly, we conclude 
                                                          
 
 
21 Commonwealth v. Nassar, 380 Mass. 908, 909, 916 (1980), 
concerned a potentially indefinite commitment under G. L. 
c. 123, § 16 (b), and consequently proof beyond a reasonable 
doubt was the required standard.  See Commonwealth v. Querubin, 
26 
 
that to establish a likelihood of serious harm under the first 
or second definitional prong, a showing of imminence is required 
-- that is, the petitioner must demonstrate a substantial and 
imminent risk of serious injury to the respondent or to others 
on account of the respondent's alcohol or substance abuse, or 
both. 
 
The question remains as to what "imminent" means in this 
context.  In our view, "imminent" here does not mean "immediate" 
-- the petitioner need not establish a substantial risk that the 
anticipated harm will occur immediately.  Rather, what must be 
shown is a substantial risk that the harm will materialize in 
the reasonably short term -- in days or weeks rather than in 
months.  But again, the court's discussion of "imminence" in 
Nassar is pertinent.  See 380 Mass. at 917 ("We may accept, 
further, that in the degree that the anticipated physical harm 
is serious -- approaches death -- some lessening of a 
requirement of 'imminence' seems justified"). 
 
e.  Question 5:  quantum of risk necessary to satisfy "a 
very substantial risk."  The final reported question concerns 
                                                                                                                                                                                           
440 Mass. 108, 120 n.9 (2003).  Here, although we have concluded 
that proof by clear and convincing evidence is the appropriate 
standard of proof in a § 35 proceeding, it is itself a 
heightened one in relation to the usual preponderance of the 
evidence standard applicable in civil cases.  See Addington v. 
Texas, 441 U.S. 418, 423-424 (1979).  The heightened burden 
increases the need for greater reliability of the evidence.  See 
generally id. at 425-427. 
27 
 
the third prong of "likelihood of serious harm," which defines 
the term as "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."  G. L. c. 123, § 1.  The fifth 
question asks how much risk must be shown to make it "very 
substantial." 
 
Both parties agree that proof that the respondent is a 
chronic alcoholic or substance abuser, by itself, is 
insufficient to establish a "very substantial risk" of harm 
under the third prong.  G.P. argues that proof of the third 
prong is particularly stringent and more demanding than that of 
the first two prongs.  Citing Nassar, 380 Mass. at 913, she 
contends that there must be proof that an individual is unable 
to sustain himself or herself even marginally in society.22  We 
take a different view.  Clearly the degree of risk that the 
third prong requires to be proved is greater than that required 
by the first or second prong:  by definition, a "very 
substantial" risk is not the same as a "substantial" risk, and 
requires more certainty that the threatened harm will occur.  
                                                          
 
 
22 In Nassar, 380 Mass. at 913, the court agreed with the 
trial judge that no evidence had been presented establishing the 
third prong, stating that "it was enough to say evidence was 
lacking that the respondents were unable to protect themselves 
in the community; they had, after all, managed to sustain 
themselves, however marginally, over a period of years." 
28 
 
But under the third prong, the threatened harm is not, as G.P. 
contends, an inability to sustain oneself in the community.  The 
harm is, rather, "physical impairment or injury" to the 
respondent, and the "very substantial risk" of such harm is to 
be shown by evidence that (1) the respondent's judgment is so 
adversely affected by the abuse of alcohol or drugs that the 
respondent cannot protect himself or herself from physical harm, 
and (2) the respondent's community does not include any 
reasonably available external source of adequate protection.  
G. L. c. 123, § 1.  The focus of the evidence, then, must be on 
the respondent's degree of impaired judgment due to alcohol or 
drug abuse (or both); the degree of likelihood that, as a direct 
consequence, the respondent will sustain or inflict injury (for 
example, by failing to take care of an existing medical 
condition that is exacerbated by continued abuse of alcohol or 
drugs, or by lengthy exposure to extreme weather conditions); 
and the inability of any other person or persons in the 
respondent's community to provide protection against such risks.  
Finally, because a "very substantial" risk of harm must be shown 
in connection with this third prong, G. L. c. 123, § 1, the 
imminence of the risk becomes a factor that is even more 
important to consider than it is with respect to the other two 
prongs.23,24 
                                                          
 
23 A very substantial risk of overdosing, in and of itself, 
29 
 
 
4.  Order of commitment in this case.  G.P. is no longer 
committed to WATC pursuant to the order that was the subject of 
her petition for relief from the single justice, and therefore 
it is no longer necessary to review the validity of that order.  
We have discussed briefly some of the evidence presented in 
connection with our responses to the reported questions, see 
notes 19 and 20, supra, and add the following with the goal of 
offering some guidance for future cases.  As indicated at the 
outset of this opinion, the judge accepted as fact the testimony 
of the forensic psychologist who was a witness at the § 35 
commitment hearing and, based on those facts, issued the order 
of commitment, finding, at least implicitly, that G.P. was a 
substance abuser and that a likelihood of serious harm resulting 
from her substance abuse had been established.  It appears from 
his brief comments that the judge concluded that G.P. at least 
presented a substantial risk of serious harm to others, 
including specifically G.P.'s mother.  The evidence of such a 
                                                                                                                                                                                           
may qualify under this prong, but presumably any person who 
meets § 35's definition of an alcoholic or substance abuser 
presents a significant risk of overdosing.  Accordingly, there 
must be strong and specific evidence presented that the risk of 
the respondent's overdosing is indeed imminent, and that the 
degree of probability that he or she will do so is high. 
 
 
24 G.P. adds an argument that, as a matter of 
constitutionally required due process, before a judge may enter 
an order of commitment under § 35, the judge must find that 
there is no less restrictive alternative available.  The single 
justice did not report a question concerning this issue, and we 
decline to address it. 
30 
 
risk, however, was very weak.  There was no specific evidence of 
when G.P. allegedly "pushed" or "shoved" her mother or how often 
this had occurred, no evidence concerning the actual nature of 
the contact, and certainly no evidence that it was violent.25  
The essential basis of the judge's order appears to have been 
that G.P. was addicted to heroin and had not been able 
successfully to control the addiction.  As unfortunate as G.P.'s 
condition was, the evidence presented did not appear to satisfy 
the requirements of § 35 for an order of commitment. 
 
5.  Conclusion.  The petition for relief is dismissed as 
moot. 
 
 
 
 
 
 
 
So ordered. 
                                                          
 
 
25 It is not clear whether the judge also found that G.P. 
presented a likelihood of serious harm because she presented a 
substantial risk of physical harm to herself.  If the judge did 
make such a finding, again, the evidence presented was likely 
insufficient.  There was no time frame presented as to G.P.'s 
statements about wanting to die, and no evidence of actual 
attempts at suicide or self-harm. 
 
 
There is no suggestion in the record -- and the parties do 
not suggest -- that the judge found the third prong of 
likelihood of serious harm to have been established.