Opinion ID: 2275966
Heading Depth: 1
Heading Rank: 6

Heading: Commitment of the Mentally Disabled

Text: In this case, Santana contends that The Providence Center owed a duty to those who might come into contact with Kelly to ensure that he was supervised and/or restrained and/or monitored and/or medicated properly because it knew or should have known that he was an individual whose continued unsupervised presence in the community would create an imminent likelihood of serious harm by reason of mental disability, and because he was capable of committing acts of violence upon others. [11] The plaintiff's overarching argument is that defendant had a duty to exercise control over Kelly's conduct by seeking to have him committed. [12] It is undisputed that Rhode Island law provides statutory vehicles that allow a mental health professional to seek to have an individual committed to an appropriate facility in both emergency and non-emergency situations. See §§ 40.1-5-7, 40.1-5-8. But, the sections of the Mental Health Law providing for the initiation of certification proceedings are discretionary; they are not mandatory. See Ferreira v. City of East Providence, 568 F.Supp.2d 197, 214 (D.R.I.2008). Consistent with our state's public policy, the Mental Health Law makes the commitment of a mentally disabled individual a very difficult undertaking. For example, in an emergency situation, an examining physician or a qualified mental health professional who believes that an individual is in need of immediate care and treatment, and is one whose continued unsupervised presence in the community would create an imminent likelihood of serious harm by reason of mental disability, may apply for emergency certification to a facility. Section 40.1-5-7(a)(1). Significantly, the application must be based on the applicant's personal observations of the individual within the previous five days. Section 40.1-5-7(b). Within one hour of arriving at such a facility, the person must be seen by a physician, and within twenty-four hours a psychiatrist or physician must begin a preliminary evaluation and examination to be completed within seventy-two hours. Section 40.1-5-7(c). If, after the evaluation, the psychiatrist determines that emergency certification is improper, the person must be discharged. Id. Conversely, if the psychiatrist believes the person is a proper subject for emergency certification, then the application is confirmed, provided the facility is one which would impose the least restraint on the liberty of the person consistent with affording him or her the care and treatment necessary and appropriate to his or her condition and that no suitable alternatives to certification are available. Id. Significantly, a person must be discharged after ten days unless an application for a civil-court certification has been filed and set down for a hearing or unless the person remains as a voluntary patient. Section 40.1-5-7(g). In a nonemergent situation, [a] verified petition may be filed in the district court,    for the certification to a facility of any person who is alleged to be in need of care and treatment in a facility, and whose continued unsupervised presence in the community would create a likelihood of serious harm by reason of mental disability. Section 40.1-5-8(a). The petition may be filed by a number of individuals, including the director of any facility, or his or her designated agent whether or not the person shall have been admitted and is a patient at the time of the petition. Id. The petition must be based upon the personal observation of the petitioner within the last ten days; it must indicate what alternatives to certification are available, what alternatives have been investigated, and why they are not suitable. Section 40.1-5-8(b). The petition also must include the certificates of two physicians setting forth their opinion that the prospective patient is in need of care and treatment in a facility and would likely benefit therefrom, and is one whose continued unsupervised presence in the community would create a likelihood of serious harm by reason of mental disability, together with the reasons why. Section 40.1-5-8(c). A preliminary hearing is required within five business days from the date of the filing, and if the court finds that there is no probable cause to support certification, the petition must be dismissed and the patient discharged, unless he or she applies for voluntary admission. Section 40.1-5-8(d). However, if the court is satisfied that there is probable cause to support certification, a final hearing shall be scheduled, in which the person is given the opportunity to present evidence and cross-examine the witnesses against him or her, including any physician involved in certification. Section 40.1-5-8(d),(i). After the hearing, if the court finds by: [C]lear and convincing evidence that the subject of the hearing is in need of care and treatment in a facility, and is one whose continued unsupervised presence in the community would, by reason of mental disability, create a likelihood of serious harm, and that all alternatives to certification have been investigated and deemed unsuitable, it shall issue an order committing the person to the custody of the director for care and treatment or to an appropriate facility. Section 40.1-5-8(j). As in the emergency situation, to the extent practicable, the person must be cared for in a facility that imposes the least restraint upon his or her liberty, consistent with affording the care and treatment necessary and appropriate to his or her condition. Id. Importantly, the District Court must consider fully the alternatives to inpatient care. [13] Id. To support her argument that defendant owed her a duty, plaintiff directs us to Naidu v. Laird, 539 A.2d 1064 (Del.1988), a case involving a patient who suffered from severe and chronic paranoid schizophrenia. Id. at 1066-67. The patient had an extensive history of mental illness and he had been committed to various hospitals on nearly twenty occasions. Id. at 1067-68. In March 1977, the patient voluntarily committed himself after another psychotic episode, but he requested that he be discharged a few days later. Id. at 1069. Because the patient had been voluntarily committed, the hospital had five days under Delaware law to either release him or seek to commit him involuntarily. His doctors decided to release the patient. Id. Five and a half months later, in a psychotic state, the patient drove his vehicle into another car, killing the other driver. Id. The victim's wife filed suit against the doctors and the hospital that treated the patient, alleging that the defendants were grossly negligent in the care, treatment, and discharge of the patient and that such gross negligence was a proximate cause of her husband's death. Id. at 1066. In their defense, the doctors argued that because the patient did not pose a threat of harm to himself or others at the time he requested to be discharged, there was a statutory obligation to release him. Id. at 1071. In imposing a duty, the court said that the state's mental health statutes do not fully define all the duties of mental health professionals, nor do they eliminate the common law duty to use reasonable care in the treatment and discharge of mentally ill patients to protect against reasonably foreseeable events. Id. at 1072. The court held that [t]he special relationship which exists between mental health professionals and a patient provides the underlying basis for imposition of an affirmative duty owed by such professionals to persons other than the patient. Id. at 1075. That duty is to take whatever steps are reasonably necessary and available to protect an intended or potential victim(s) of the patient when the psychiatrist determines or should have determined, in keeping with the professional standards of the community, that the patient presents an unreasonable danger to that person(s) Id. It also has been held that a mental health provider's duty may include initiating involuntary commitment proceedings against an outpatient. See Lipari, 497 F.Supp. at 193-95. In Lipari, a mentally-ill patient was receiving psychiatric treatment from the Veterans Administration. Id. at 187. Against his doctor's advice, the patient, who, like Kelly, had directed no specific threats against any person, stopped attending therapy. Id. Shortly after he ceased treatment, the patient fired a shotgun into a crowded nightclub, killing a man, and seriously wounding his wife. Id. The plaintiffs argued that the hospital had a duty to detain the patient or to institute involuntarily commitment proceedings against him. Id. at 188. The court denied the defendant's motion to dismiss and refused to rule as a matter of law that there never is a duty to attempt to detain a patient by initiating commitment proceedings. [14] Id. at 193. Instead, the court held that when, in accordance with the standards of his profession, the therapist knows or should know that his patient's dangerous propensities present an unreasonable risk of harm to others, he has an affirmative duty to initiate whatever precautions are reasonably necessary to protect potential victims of his patient. [15] Id.