Title: In re M.L.

State: vermont

Issuer: Vermont Supreme Court

Document:

In re M.L.  (96-040); 167 Vt. 53; 702 A.2d 92

[Filed 08-Aug-1997]

       NOTICE:  This opinion is subject to motions for reargument under
  V.R.A.P. 40 as well as formal revision before publication in the Vermont
  Reports.  Readers are requested to notify the Reporter of Decisions,
  Vermont Supreme Court, 109 State Street, Montpelier, Vermont 05609-0801 of
  any errors in order that corrections may be made before this opinion goes
  to press.

                            No. 96-040

In re M.L.                                   Supreme Court

                                             On Appeal from
                                             Washington Family Court

                                             November Term, 1996

Mary Miles Teachout, J.

       Wendy Beinner and Michael K. Benvenuto, and Charles Tetreault and
  Bessie Weiss, Law Clerks (On the Brief), Vermont Legal Aid, Waterbury, for
  appellant

       Jeffrey L. Amestoy, Attorney General, Montpelier, and Janet Bull and
  Marybeth McCaffrey, Assistant Attorneys General, Waterbury, for appellee

PRESENT:  Allen, C.J., Gibson, Dooley, Morse and Johnson, JJ.

       JOHNSON, J.   In this case we address an issue of first impression
  under Vermont's mental health statutes: whether the family court may issue
  an order of nonhospitalization that authorizes the State to rehospitalize
  the patient without a prior hearing if the patient violates certain
  treatment conditions.  Petitioner M.L. appeals from an order of
  nonhospitalization that includes a summary rehospitalization provision.  We
  agree that the provision violates the statutes governing orders of
  nonhospitalization, see 18 V.S.A. §§ 7618, 7621, and accordingly reverse.

                                     I.

       M.L. is a single man in his late thirties who has been diagnosed with
  chronic schizophrenia for many years.  As a result of his illness, M.L. has
  for several years been obsessed with A.K., a married woman in her sixties
  who works as a clerk dispatcher at the Shaftsbury state police barracks. 
  Prior to his most recent admission to the Vermont State Hospital (VSH),
  M.L. frequently contacted and harassed A.K.  M.L. first met A.K. when he
  went to the barracks to lodge a complaint against the organization that
  provided him with mental

 

  health services.  He later attempted to contact A.K. countless times, both
  at work and at home. He called her on the emergency lines at the barracks,
  and called back repeatedly after he was told of the danger to the public of
  tying up those lines.  Twice, he told A.K., "If you hang up on me again, I
  will kill you."  A number of times M.L appeared at the window of the police
  barracks and watched A.K. at work.  This sometimes occurred during the
  evening shift hours when A.K. was alone at the barracks.  He wrote A.K. at
  least thirty times, telling her that spirits were directing him to make
  contact with her.  He also called A.K. at home several times a day and
  sometimes during the early morning hours, saying that he had to talk to
  her.

       M.L. persisted in his attempts to contact A.K. despite several court
  orders, criminal complaints, and the sustained efforts of the state police
  to protect A.K.  On May 31, 1994, M.L. appeared on foot at A.K.'s home and
  stood in her front yard.  He led her husband on a chase into the woods and
  then reappeared on A.K.'s deck and approached her, until he was secured by
  her husband and two state police officers.

       Less than a month after this incident, in June 1994, the Bennington
  District Court committed M.L. to VSH for a ninety-day period.  See 13
  V.S.A. § 4822.  This was M.L.'s fifth admission to VSH.  When the State
  sought to extend the period of hospitalization, see 18 V.S.A. § 7620, the
  parties stipulated that M.L. would remain hospitalized until December 1994,
  and that if he were still hospitalized at that time, the State would then
  seek judicial review of the hospitalization order.  The State filed a
  request for judicial review on December 15, 1994.

       The court held two days of hearings in March 1995.  The State sought
  either an order of hospitalization or an order of nonhospitalization to be
  stayed for several months while the Department of Mental Health established
  a placement in the community with appropriate treatment and supervision. 
  The court issued an order of hospitalization, but stated that M.L. could
  request a further hearing in four months if a suitable community placement
  had not been arranged.

 

       During his stay at VSH, M.L. took his medication regularly, complied
  with hospital rules, and earned privileges to spend unsupervised time on
  the hospital grounds and in the town of Waterbury.  He did not attempt to
  contact A.K.  Nonetheless, although M.L. complied with his treatment
  program, he did not accept that he was mentally ill, that he needed
  treatment for his illness, or that his illness impaired his judgment.  In
  particular, according to his treating psychiatrist, M.L. continued to be
  obsessed with A.K. and angry with the state police.

       In April 1995, the State moved to modify the order of hospitalization
  to an order of nonhospitalization because an appropriate community
  placement was available.  The court granted the motion, subject to a number
  of restrictive conditions designed to ensure both proper treatment for M.L.
  and protection for A.K.  Specifically, the order of nonhospitalization
  stated that: (1) M.L. would receive twenty-four-hour-a-day supervision
  while living in the community; (2) if M.L. eloped from his treatment
  program, he could be arrested and returned to the program pursuant to 18
  V.S.A. § 7105; and (3) if M.L. eloped twice within one week, visited A.K.
  or her relatives, or traveled to the towns where A.K. lives and works, he
  could be immediately returned to VSH and held there for up to seventy-two
  hours prior to the State seeking judicial review.  This third condition
  authorizing M.L.'s summary rehospitalization is the subject of the present
  appeal.

                                     II.

       M.L. argues that the summary rehospitalization provision violates the
  statutes governing orders of nonhospitalization, which authorize a court to
  modify an order of nonhospitalization or issue an order of hospitalization
  "after proper hearing."  18 V.S.A. §§ 7618(b), 7621(d).(FN1) The State urges
  us to accept the family court's reasoning that summary rehospitalization is
  a

 

  form of treatment authorized by the statute.  See 18 V.S.A. § 7618(a) (if
  court finds that treatment program other than hospitalization is adequate
  to meet person's treatment needs, court shall order person "to receive
  whatever treatment other than hospitalization is appropriate"). On this
  view, the court's broad discretion in crafting an order of
  nonhospitalization includes the authority to require summary
  rehospitalization under certain circumstances.

       We are not persuaded by the State's attempts to reconcile summary
  rehospitalization of persons on orders of nonhospitalization with the
  statutory requirement that such orders be modified only after a proper
  hearing.  The State first argues that the statute requires only that a
  hearing be held before an order of nonhospitalization is modified, not
  before a person is rehospitalized.  This argument escalates form over
  substance.  The statutory scheme plainly envisions that a person on an
  order of nonhospitalization is, in fact, not hospitalized.  A court must
  issue an order of nonhospitalization if it finds that "a treatment program
  other than hospitalization" is adequate for a given person.  18 V.S.A. §
  7618(a) (emphasis added).  A court that makes such a finding "shall order
  the person to receive whatever treatment other than hospitalization is
  appropriate."  Id.  Although the order of nonhospitalization will not be
  judicially modified until a hearing is held, the order is effectively
  revoked when M.L. is removed from the community and returned to VSH.

       Nor do we read § 7618(a) as granting the family court discretion to
  override the hearing requirement and authorize summary rehospitalization
  under certain circumstances.  The court does have broad discretion to craft
  an appropriate order of nonhospitalization.  But, as we have already
  discussed, the statute draws a clear distinction between hospitalization
  and treatment other than hospitalization.  By its plain language, the
  statute limits orders of nonhospitalization to requiring "treatment other
  than hospitalization."  Id.  Thus, although the court may consider a wide
  range of options for treatment, summary rehospitalization is not one of
  those options. See Burlington Elec. Dep't v. Vermont Dep't of Taxes, 154
  Vt. 332, 335-36, 576 A.2d 450,

 

  452 (1990) (where meaning of statute is plain on its face, Court will
  enforce statute according to its terms).(FN2)

       Ultimately, the argument for summary rehospitalization turns not on
  statutory interpretation but on a practical problem: How can people such as
  M.L., who pose a risk of danger to the public or to specific individuals,
  be released from the state hospital and treated in the community? 
  According to the family court, M.L. "can be treated in the community
  consistent with public safety . . . only if highly structured conditions
  with immediate rehospitalization consequences are in place."  The State
  agrees, and maintains that the statutory hearing requirement should not be
  an obstacle that prevents M.L.'s release from VSH.

       Unfortunately for the State's argument, § 7618 plainly and explicitly
  requires a predeprivation hearing before a patient on an order of
  nonhospitalization may be rehospitalized. If this requirement appears to
  prevent M.L.'s release from the hospital, it is only because the State is
  seeking an order of nonhospitalization for a patient that is admittedly
  dangerous.  In effect, the State wants to release a patient from VSH but
  nonetheless avoid the risk that judicial procedures or an adverse judicial
  determination could in any way delay or prevent rehospitalizing M.L. should
  that be warranted.  The statutory scheme does not permit the State to
  retain this type of control over patients on orders of nonhospitalization,
  because those patients by statute gain a liberty interest that cannot be
  terminated without a prior hearing.  Cf. G.T. v. Stone, 159 Vt. 607, 611,
  622 A.2d 491, 493 (1992) (patient committed to VSH and

 

  conditionally released has liberty status that cannot be terminated without
  due process of law).

       If a patient is so dangerous that such control is necessary to ensure
  public safety, then the patient is not an appropriate candidate for an
  order of nonhospitalization.  Indeed, M.L.'s order of nonhospitalization,
  which requires constant supervision and authorizes summary
  rehospitalization, is so restrictive that it is better characterized as a
  plan for hospital treatment in a community setting.(FN3)  The trend toward
  deinstitutionalization may require the State to seek more restrictive and
  secure community placements for patients who are too dangerous to live
  unsupervised in the community.  Unless the relevant statutes are amended,
  however, the court may not authorize summary rehospitalization of patients
  on orders of nonhospitalization.

       The dissent claims that our decision "upsets the careful legislative
  balance between patients' rights and public safety."  Post, at 1.  To the
  contrary, our decision follows the Legislature's intent as expressed in the
  language of the governing statutes.  The dissent notes that, based on the
  trial court's findings, an order of nonhospitalization would not be prudent
  without a summary rehospitalization provision.  But, as we have already
  discussed, the statute requires a hearing before an order of
  nonhospitalization may be changed to an order of hospitalization.  Simply
  put, based on the trial court's findings, M.L. is too dangerous to be
  placed on an order of nonhospitalization unless that order eviscerates the
  statutory hearing requirement.  Although the courts have broad discretion
  to fashion appropriate orders of nonhospitalization, we are not free to
  override statutory procedures to find some way for a dangerous patient to
  live in the community.

       The dissent may be correct that our decision will not help M.L., who
  as a result of our holding is more likely to remain hospitalized.  The
  Legislature, however, has the option to revisit the mental health statutes
  and adapt the statutory requirements to respond to the increasing pressures
  for deinstitutionalization.  As long as it acts within constitutional
  bounds, designing

 

  procedures that protect both mentally ill patients and the public is the
  province of the Legislature.

       In light of our decision, we remand this case to the family court for
  reconsideration of its order.  We express no opinion as to whether M.L.
  should continue on an order of nonhospitalization or whether, as the court
  originally concluded, M.L. is too dangerous to be released without a
  provision for summary rehospitalization.  M.L. argues that statutory
  emergency procedures, such as the emergency examination, 18 V.S.A. § 7504,
  and the warrant for immediate examination, id. § 7505, combined with the
  other restrictive conditions in the order, are sufficient to prevent harm
  to A.K., and that summary rehospitalization provides no additional
  protection.  Rather than address this issue now, we prefer to remand for
  the family court's reconsideration in light of our holding that summary
  rehospitalization provisions may not be included in orders of
  nonhospitalization.  A substantial period of time has elapsed since the
  court issued its order, and M.L.'s current situation may be quite
  different.  The family court is better situated to make this determination.

       Reversed and remanded.

                              FOR THE COURT:

                              _______________________________________
                              Associate Justice

  ------------------------------------------------------------------------------
                                  Footnotes

FN1.  M.L. also argues that the court's order violates his due process
  rights by depriving him of his liberty without a hearing.  Cf. G.T. v.
  Stone, 159 Vt. 607, 613-14, 622 A.2d 491, 494-95 (1992) (federal and
  Vermont constitutions require hearing before patient's conditional
  discharge may be revoked, unless patient poses imminent danger of harm to
  self or others).  As we conclude that the summary rehospitalization
  provision violates the relevant statutory provisions, we do not address the
  constitutional claim.

FN2.  The dissent's reliance on In re A.C., 144 Vt. 37,