Title: Sidney Hirschfeld, Director, Mental Hygiene Legal Service v. Mitchell Teller

State: new-york

Issuer: New York Appellate Court

Document:

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This opinion is uncorrected and subject to revision before
publication in the New York Reports.
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No. 29  
Sidney Hirschfeld, Director, 
Mental Hygiene Legal Service, 
&c.,
            Appellant,
        v.
Mitchell Teller, &c., et al.,
            Respondents.
Lisa Volpe, for appellant.
Sarah C. Lichtenstein, for respondents.
PIGOTT, J.:
Beginning as early as 1996, defendants, certain nursing
homes in New York State, began accepting as residents patients
discharged from facilities licensed by the Office of Mental
Health (OMH).  The patients were primarily from New York State
psychiatric hospitals with diagnoses of mental illness.  All but
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one of defendant nursing homes placed the patients in discrete
units of the residence, referred to as "neurobiological units"
(NBUs), where the residents received psychiatric and psychosocial
rehabilitative services.  Defendant nursing homes operate under
licensing by the Department of Health but have never sought, nor
obtained, licenses from OMH.  
In October 2002, a series of related articles began
appearing in the New York Times focusing on the NBUs and claiming
that NBU residents were being deprived of legal protections
afforded to patients committed to psychiatric wards, including
the right to a lawyer.  Upon learning of the articles, Mental
Hygiene Legal Services (MHLS) conducted an investigation and
thereafter sought access to NBU residents and their records in
order to provide advocacy and legal representation to those who
might be in need of such services.  Defendant nursing homes
denied MHLS such access.
Thereafter, in June 2003, plaintiff Sidney Hirschfeld,
Director of MHLS (hereinafter MHLS), commenced this action
against defendant nursing homes alleging that because the nursing
homes are providing services for mentally disabled residents,
MHLS has a right of access to such residents.  MHLS sought
judgment declaring that it has the right of access at any and all
times to the residents and their records and also sought an
injunction enjoining defendant nursing homes from denying MHLS
such access.  
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No. 29
1  Defendant nursing homes maintain that the last date any
resident was accepted into an NBU was April 30, 2004, and the
date the last resident was discharged from the program by any one
of defendant nursing homes was August 16, 2004.
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Defendant nursing homes answered arguing, among other
things, that because MHLS has jurisdiction only over facilities
required to obtain operating certificates and OMH has determined
that the nursing homes are not required to have one, MHLS was
without authority to access the residents.
At some point during the litigation, defendant nursing
homes shut down the NBUs.1  Thus, defendant nursing homes no
longer maintain discrete units in which the NBU patients reside.
After motion practice not relevant here and significant
discovery, both parties moved for summary judgment.  Supreme
Court granted defendant nursing homes' motion and dismissed the
complaint.  The Appellate Division modified Supreme Court's order
by remitting the matter to Supreme Court for, among other things,
entry of a judgment declaring that MHLS does not have the right
of access to the mentally ill residents of NBUs of defendant
nursing homes (Hirschfeld v Teller, 50 AD3d 855).   
This Court granted MHLS leave to appeal.  We now
affirm.
MHLS is statutorily mandated to provide legal services
and assistance to individuals with mental disabilities.  Such
mandate is delineated in Mental Hygiene Law §47.01(a), which
provides, in relevant part:
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"There shall be a mental hygiene legal
service of the state in each judicial
department.  The service shall provide legal
assistance to patients or residents of a
facility as defined in section 1.03 of this
chapter, or any other place or facility which
is required to have an operating certificate
pursuant to article sixteen or thirty-one of
this chapter, and to persons alleged to be in
need of care and treatment in such facilities
or places, and to persons entitled to such
legal assistance as provided by article ten
of this chapter" (§ 47.01 [a]).  
Thus, by statute, MHLS's jurisdiction is limited to two
categories of facilities:  (1) facilities defined in Mental
Hygiene Law § 1.03 and (2) other places that are required to have
an OMH operating certificate.  MHLS claims that defendant nursing
homes fall within the designation "any other place or facility
which is required to have a operating certificate pursuant to . .
. [Article 31 of the MHL]."  Article 31 of the Mental Hygiene Law
vests OMH with the exclusive authority to issue operating
certificates to facilities providing services to the mentally
disabled.  But not every facility that treats the mentally
disabled requires an operating certificate from OMH.  14 NYCRR
part 70 "establish[es] an all inclusive set of categories, named
classes, to which all providers of services to the mentally
disabled subject to the requirement to obtain an operating
certificate" will be assigned (14 NYCRR 70.1[a]).  The
Commissioner determines if a provider is subject to OMH licensure
on the basis of three factors:  "characteristics of the persons
served; characteristics of the services provided; and the
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auspices of the provider of services" (14 NYCRR 70.1[b]).
In support of their motion to dismiss the complaint,
defendant nursing homes submit the deposition testimony of OMH's
Director of Inspection and Certification that OMH did not have
jurisdiction over defendant nursing homes and, as a result, OMH
did not exercise any licensing jurisdiction.  This decision was
based, in part, on a site report prepared by OMH's field office.
In opposition, MHLS does not challenge OMH's authority
to make a licensing determination, nor does it challenge OMH's
decision not to license defendant nursing homes.  MHLS claims
OMH's decision not to require an operating certificate is of no
import.  Rather, MHLS argues that the dispositive issue is
whether the facilities themselves are subject to licensing
because they provide residential services to the mentally
disabled.  
But precisely which facilities are, in fact, subject to
OMH licensure is a matter committed, in the first instance, to
the Commissioner's discretion and expertise.  Here, OMH decided
that licensure was not required.  Because only OMH is authorized
to determine whether a facility is required to have an operating
certificate and MHLS's jurisdiction is expressly limited to
licensed facilities, MHLS has failed to raise an issue of fact. 
Thus, defendant nursing homes are entitled to summary judgment
dismissing the complaint.
Finally, we express no opinion as to the correctness of
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OMH's decision underlying this case.  The proper way to challenge
any OMH licensure determination, however, is via a CPLR article
78 proceeding.  At that time, OMH would be a party to the
proceedings, allowing courts to review its determination on the
full administrative record.
Accordingly, the order of the Appellate Division should
be affirmed, without costs.
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Hirschfeld v Teller
No. 29 
LIPPMAN, Chief Judge (dissenting) :
In 1993, Mental Hygiene Law § 47.01 (a) was amended
with the express objective of extending the jurisdiction of the
Mental Hygiene Legal Service (MHLS), the state agency
legislatively assigned to act as counsel and advocate for the
mentally disabled.   That jurisdiction, formerly textually
limited to persons in "hospitals, schools or alcoholism
facilities," or alleged to be in need of care in such
institutions, was, pursuant to the amendment, significantly
expanded to embrace a range of other in- and out-patient
facilities, including community residences, group homes,
intermediate care homes and family homes.  It was the intent of
the legislation's sponsors that the amendment, passed by
unanimous vote of both houses of the Legislature, "would provide
MHLS with the means to represent individuals without first having
to establish jurisdiction because of their residence" (Senate
Introducer Mem in Support, Bill Jacket, L 1993, ch 330, at 5). 
The need for the amendment, introduced at the request of the
Administrative Board of the Courts, was explained at the time by
Counsel to the Office of Court Administration, whose comments in
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support of the amendment (Bill Jacket, L 1993, ch 330, at 11-12)
bear lengthy repetition here:
"Confusion arises . . . with respect to MHLS
services to persons in community residences,
group homes, intermediate care homes and
family care homes, all of which are places
where services are rendered to patients with
or without the benefit of a Mental Hygiene
Law legal admission status.  Currently there
are more than 29,000 such patients; and they
are in as much need of MHLS protective
services, advice and assistance as persons
who reside in hospitals and schools.
"In actual practice, MHLS has considerable
responsibilities towards these classes of
patients.  Without regard to type of facility
or a person's lack of legal admission status
therein, MHLS is involved in matters
including but not limited to: applications
for judicial authorization for medical
treatment; surrogate decision making for
medical treatment; transfers of patients;
discharge planning; confidentiality and
access to records; investigations of patient
abuse; proceedings for appointments of
conservators, committees and guardians;
recommitment of forensic patients; restraint
and seclusion; forced medication; assurance
of quality care and protection of patients'
rights in general; interstate transfer; and
objections to treatment . . .
"While most mental health professionals
recognize the value of the services provided
by MHLS to persons not having legal status, a
few dispute their authority to do so.  In
those instances MHLS must first do battle to
establish a jurisdictional foothold. 
Sometimes this may require litigation, which
may be protracted and which may yield
inconsistent results.  The effect is that
time will be lost and precious resources
diverted away from the real needs of a class
of persons who may truly require assistance."
This action seeking, among other relief, a declaration
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that MHLS is entitled to access to defendant nursing homes and
the residents of those homes admitted for and being treated for
psychiatric disorders was commenced by plaintiff Hirschfeld, the
Director of MHLS in the Second Judical Department, in June 2003.  
During the year prior, there appeared a Pulitzer Prize winning
series of investigative newspaper reports focusing on the
treatment of mentally disabled adults in state regulated
facilities.  One of the articles in this series, titled "Mentally
Ill, and Locked Away in Nursing Homes," detailed what had
evidently become a fairly widespread practice, if not a policy,
countenanced, if not actively promoted, by the State, of
discharging psychiatric patients from state psychiatric hospitals
to discrete nursing home units, referred to as "neurobiological
units" (NBUs), where they continued to receive psychiatric
treatment in highly restrictive settings.  The NBU placements
were, according to the article, tantamount to involuntary
psychiatric commitments without any provision for protection of
the committees' liberty interests and rights to due process;
whereas the legal rights of the affected individuals had been
protected while they remained institutionalized in OMH facilities
pursuant to statutes providing, inter alia, for judicial review
of involuntary commitments and for legal representation in
matters pertaining to patients' liberty interests, the NBUs into
which they had been discharged were not licensed by OMH and their
residents were shorn of the legal protections they had had as
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patients in OMH licensed facilities.   
After learning of the NBUs' existence in the public
press, MHLS, in a letter signed by each of its directors,
requested that defendant nursing homes afford its attorneys
access to the NBUs and their residents.  Counsel for the nursing
homes, however, responded denying access upon the ground that the
nursing homes were not OMH licensed facilities and did not fall
within MHLS's jurisdiction.
Now, seven years later, MHLS is still without access to
the mentally disabled residents of defendant nursing homes.  That
this should be so notwithstanding the 1993 enactment that was
supposed to have settled the issue and to have obviated the need
for the agency to engage in lengthy and costly litigation "to
establish a jurisdictional foothold" in such facilities, is a
most regrettable and unnecessary state of affairs, now justified
upon an interpretation of the agency's jurisdictional statute
(Mental Hygiene Law § 47.01 [a]), that is textually incorrect and
plainly at odds with the purposes informing its enactment; it is,
moreover, a reading that confuses judicial and administrative
prerogatives with potentially devastating consequences for the
representational rights and liberty interests of an acutely needy
client population.
Mental Hygiene Law § 47.01 (a) states, in part:
"The service shall provide legal assistance
to patients or residents of a facility as
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1Mental Hygiene Law § 1.03 (6), in turn, defines "facility,"
in relevant part, as:
"any place in which services for the mentally
disabled are provided and includes but is not
limited to a psychiatric center,
developmental center, institute, clinic,
ward, institution, or building, except that
in the case of a hospital as defined in
article twenty-eight of the public health law
it shall mean only a ward, wing, unit, or
part thereof which is operated for the
purpose of providing services for the
mentally disabled."
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defined in section 1.031 of this chapter, or
any other place or facility which is required
to have an operating certificate pursuant to
article ... thirty-one of this chapter, and
to persons alleged to be in need of care and
treatment in such facilities or places ..."
It is defendant's contention, now adopted by the
majority, that this provision expressly limits MHLS's
jurisdiction to facilities licensed by the Office of Mental
Health (OMH).  But the statute does not say that.  What it does
say is that the service shall provide assistance to patients or
residents of facilities "required to have an operating
certificate."  If the Legislature had intended to limit the
agency's jurisdiction to facilities that had been actually
certificated by OMH, it could have and, doubtless, would have
said so.  It did not.  There are compelling
reasons why such a limitation should not be implied.
MHLS is a watchdog agency necessarily independent of
OMH and, accordingly, situated in a separate branch of
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government, namely, the judicary.  Its legislatively assigned
mission is, at its core, to safeguard the basic liberty and due
process rights of those institutionalized by reason of mental
disability and those alleged to be in need of such institutional
care.  This mission routinely places the Service in an adversary
relation to OMH.  Whether in the context of representing
individuals contesting involuntary commitment or treatment
decisions by OMH personnel, or in advocating and sometimes
litigating over quality of care issues, such as overcrowding or
discharge planning, MHLS is regularly and unavoidably pitted
against OMH and other providers of mental health services.  It is
neither seemly nor consistent with the Service's basic
obligations to condition its jurisdiction upon administrative
edicts by its constant, indeed structurally designated adversary. 
Here, the record indicates that OMH has made a practice
of discharging patients carrying primary, axis I, psychiatric
diagnoses from its inpatient facilities to nursing homes, where,
according to the patients' OMH discharge plans they are to
continue to receive a range of treatments primarily for
psychiatric disorders.  Discovery in this action has disclosed
strong evidence that the treatment provided at defendant nursing
homes to OMH's former patients is modeled upon OMH inpatient
psychiatric care, and that the former OMH patients have been
confined to units they are not free to leave.  It has also
disclosed, at least at the one defendant nursing home actually
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2The OMH surveyor noted at the conclusion of what may be
fairly characterized as a scathing assessment:
"1. Issues raised by the advocacy groups to
the Office of Mental Health can be
substantiated.  These include the de facto 
placing of individuals with mental illness on
a locked unit.  There is a lack of
advocacy/legal representation available to
patients on these units.
"2. The majority of the patients in this
facility are individuals with mental illness
and therefor it appears that this constitutes
a facility for the mentally ill.
"3. The programming lacks any rehabilitative
or recovery oriented focus.
"4. Discharge planning did not reflect that
the planner was aware of the wide variety of
discharge options available.
"5. Restorative and rehabilitative services
that were prescribed are all available at
other more appropriate levels of care in the
community."
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surveyed by OMH, highly unsatisfactory institutional conditions
raising a host of properly legal issues.2  Nonetheless, OMH has
decided, evidently as a matter of agency policy, that it will not
require defendant nursing homes to obtain operating licenses.
It is the majority's understanding that this
administrative decision is presumptively conclusive of MHLS's
right of access to the nursing homes at issue.  It holds that
OMH, although complicit in the creation of this highly
problematic situation in which institutional psychiatric
confinement and treatment is apparently perpetuated without any
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legal process or access by residents to advocacy, may effectively
remove the situation and its likely victims from MHLS's
jurisdiction and scrutiny by declining to require a operating
license.   
To cast OMH as arbiter of plaintiff's jurisdiction is
inappropriate, not simply because OMH may well be -- and here
quite evidently is -- conflicted in deciding the issue, but
because it has no special expertise with respect to the essential
object of the inquiry.  There is no question that OMH is
empowered and possesses expertise relevant to decide, at least in
the first instance, whether a particular facility must obtain an
operating license.  But facility licensure is not the purpose of
the jurisdictional statute here at issue; MHLS's jurisdiction --
its right of access to facilities providing residential care and
treatment for the mentally disabled -- exists fundamentally,
although not exclusively, to assure that there will in the
context of commitment for mental disability be no infringement of
liberty interests without due process of law.  The inquiry, then,
to be answered in determining the statute's range of application
must in its most essential aspect be whether the facility or
place at issue is one in which there is ongoing treatment for
mental disability entailing on a regular basis the address of
forensic issues implicating a patient's or resident's right to
the assistance of counsel.  It is not the role of health care
administrators to determine when and where due process requires
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the presence and assistance of an attorney.  That judgment is
peculiarly within the competence and expertise of the judiciary. 
Thus, while it is undoubtedly highly and expressly relevant to
the jurisdictional inquiry whether a place or facility is
required to have an operating permit pursuant to article 31 of
the Mental Hygiene Law, that determination, for MHLS
jurisdictional purposes, is not OMH's to make.  It is in this
unique context, when disputed, properly made by the courts with
the jurisdictional statute's broad remedial purposes in mind.
OMH, of course, did not consider whether the residents
of defendant nursing homes would have adequate access to counsel
when it decided that it would not require the homes to obtain
operating certificates.  The Director of OMH's Bureau of
Inspection and Certification, testified that certification of
defendants was not required because it was OMH's policy not to
require skilled nursing facilities to obtain OMH operating
certificates; it was his understanding that those facilities fell
within the licensing jurisdiction of the Department of Health. 
Under OMH's regulations, this might be a rational ground for an
internal agency decision not to require an operating certificate
(see 14 NYCRR 70.1 [b]) -- OMH might reasonably wish to not 
burden providers with multiple, overlapping certification
requirements -- but this administrative rationale does not speak
to the jurisdictional issue framed by Mental Hygiene Law § 47.01
(a), which is not whether OMH has or has not required the nursing
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homes at issue to obtain operating certificates, but whether
those providers are "required to have an operating certificate
pursuant to article ... thirty-one of [the Mental Hygiene Law]"
(emphasis added). 
Mental Hygiene Law § 31.02 (a) (1) flatly requires an
OMH operating certificate for the "operation of a residential
facility or institution, including a community residence, for the
care, custody, or treatment of the mentally disabled."  Nursing
homes are "residential health care facilit[ies]" (Public Health
Law § 2801 [3]), and where a nursing home provides custodial
psychotherapeutic treatment of the mentally disabled there would
appear to be no ground to conclude that it is not subject to OMH
licensure, at least for purposes of determining the jurisdiction
of MHLS.  It may be that ordinarily nursing homes are licensed by
DOH.  But ordinarily nursing homes do not provide what amounts to
involuntary in-patient psychiatric care and treatment of patients
chronically afflicted with axis I psychiatric disorders. 
Moreover, there is absolutely no authority cited by defendants in
support of the proposition that the licensing authority of DOH is
exclusive of that of OMH.  It would, to the contrary, seem clear
that it was DOH's view that its licensees, to the extent that
they provided residential psychiatric services, could be subject
to OMH licensure and thus could be required to afford access to
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3DOH, it should be noted, supported MHLS's request for 
access to the NBUs, stating in a letter to the nursing
facilities:
"MHLS states, and this Department agrees,
that MHLS is an agency of the New York State
Court System, established by Mental Hygiene
Law (MHL), Article 47.  MHL § 47.03 (d)
provides that MHLS shall be granted access at
any and all times to any 'facility' or place
or part thereof.  For this purpose, MHL §
1.03 (6) defines 'facility' in the case of a
hospital as defined by Public Health Law,
Article, 28 to include a ward, wing, unit or
part thereof which is operated for the
purpose of providing services to the mentally
disabled.  A nursing home is a hospital
within the meaning of Article 28 of the
Public Health Law.  
"This Department agrees that the MHL provides
that MHLS is to have access to such
facilities [NBUs], including, to the extent
applicable, yours." 
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MHLS.3 
Quite apart from the fact that OMH's decision not to
require certification of defendant providers was not, and did not
purport to be, based upon the criteria relevant in determining
the reach of MHLS's jurisdiction, the treatment of its decision
as an administrative determination somehow binding upon MHLS and,
indeed, essentially preclusive of that agency's jurisdictional
claim is contrary to very basic principles of law and procedural
fair play.  
It is elementary that "[d]ue process . . . would not
permit a litigant to be bound by an adverse determination made in
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a prior proceeding to which he was not a party or in privity with
a party" (Gilberg v Barbieri, 53 NY2d 285, 291 [1981]) and,
accordingly, that a party may not be bound by an administrative
determination that it has not been afforded the opportunity to
oppose.  The OMH decision at issue, reached by means of a
cryptically described series of intra-agency conversations, was
not one that MHLS or anyone else was afforded any opportunity to
contest at the agency level.  Indeed, the decision was not the
product of any formal quasi-judicial or rule-making review
process discernible from the record.  Nor was it reduced to
writing or publicized;  it was apparently for internal purposes
only and, in fact, only came to light in the course of this
litigation's discovery phase.  
It would be offensive to due process to deem anyone
bound by a "determination" reached and publicized in such a
manner.  Here, however, the offense is compounded by the
circumstance that the party deemed bound is an independent state
agency whose jurisdiction has, in consequence of the
"determination"  been restricted in a manner incompatible with
its legislatively assigned mission and with the clear import and
intent of the governing jurisdictional statute.   This
"determination" does not command deference, and particularly not 
the extreme, practically talismanic deference it is now given.  I
would have thought it clear that courts could not upon such a
ground determine any rights, much less cede to bureaucrats the
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peculiarly judicial prerogative to determine when and where
counsel is required in defense of basic liberty interests.  It
should be self-evident that decisions as to the availability of
counsel for mentally disabled persons faced with critical
choices, and in some cases possible state compulsion in matters
respecting their liberty and personal integrity, should not be
made as a result of internal agency conversations by health care
administrators.  Those decisions are properly the function and
obligation of the judicial branch.  Obviously, the Legislature in
enacting the 1993 amendment expressly expanding MHLS jurisdiction
to include all facilities and places "required to have an
operating certificate pursuant to article ... thirty-one of [the
Mental Hygiene Law]" had not the slightest intention to commit
this essentially judicial task to the Commissioner of Mental
Health. 
*   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *
Order affirmed, without costs.  Opinion by Judge Pigott.  Judges
Graffeo, Read and Smith concur.  Chief Judge Lippman dissents in
an opinion in which Judges Ciparick and Jones concur.
Decided March 30, 2010