Opinion ID: 317697
Heading Depth: 2
Heading Rank: 1

Heading: The defendants unjustifiably withheld from Donaldson specific forms of treatment.

Text: 16 The evidence establishes that there were at least three forms of treatment the defendants withheld from Donaldson. 17 First, he was denied grounds privileges. Since the purpose of hospitalization is to restore the capacity for independent community living, one of the most basic modes of treatment is giving a patient an increasing degree of independence and personal responsibility. One of the plaintiff's expert witnesses was Dr. Walter Fox, Director of the Arizona Mental Health Department and former president of the Association of Medical Superintendents of Mental Hospitals. He had interviewed Donaldson and examined his hospital record. Fox testified that confining Donaldson to a locked building, with no opportunity for grounds privileges was not 'consistent' with a treatment plan for a patient with Donaldson's history. 18 Gumanis denied Donaldson a privilege card, even after Donaldson had asked him for one. Fox testified that it would have been 'standard psychiatric practice' to extend grounds privileges to a patient of Donaldson's background, condition, and history. Gumanis, in his testimony at trial, could not give a convincing explanation for his refusal of grounds privileges to Donaldson. 6 At one point he sought to shift the responsibility for the refusal to O'Connor's shoulders, saying that he recalled having denied privileges after consultation with O'Connor. Later, he testified that at the time in question Donaldson had appeared to him to be 'really upset', and that he had 'probably' made the decision to deny Donaldson a privilege card on his own. Donaldson testified that soon after his transfer to Department C, Dr. Hanenson, the physician in charge of that department, gave him a privilege card. 19 The second form of treatment denied Donaldson was occupational therapy. Donaldson testified that Gumanis consistently refused to allow him to enter occupational therapy. This testimony was borne out by a progress note entered in Donaldson's hospital record January 17, 1964. Again, Fox testified that given what he called Donaldson's 'social history', Donaldson would have been ideally suited to benefit from occupational therapy. According to Donaldson. Gumanis did not want him to go into occupational therapy, because Gumanis feared that he would learn touch-typing and would use this skill, in Donaldson's words, to 'write writs', that is, to prepare habeas corpus petitions. Gumanis gave no reason why he denied Donaldson occupational therapy, although in the course of his testimony he did allude to the fact that he had done so. Not until Donaldson was transferred to Dr. Hanenson's care was he allowed to enter occupational therapy. 20 Third, the simplest and most routine form of psychiatric treatment is to have a patient talk with a psychiatrist. Donaldson testified that in the eighteen months O'Connor was in direct charge of his case, he spoke with O'Connor 'not more than six times', and that the total time he spent talking to O'Connor did not consume more than one hour. He testified that in the eight and one-half years he spent under Gumanis' care, he did not speak with Gumanis more than a total of two hours-- an average of about fourteen minutes a year. He testified that neither Gumanis nor O'Connor ever heeded his requests to discuss his case. On one occasion Gumanis said that he 'talked only to patients that he wanted to'. Gumanis did not recall that conversation. Once again, there was evidence to show that the situation improved when Donaldson was transferred to Dr. Hanenson's care. Donaldson testified that Hanenson managed to speak with him once a week, even though, according to Donaldson, patients were more numerous, psychiatrists fewer, and conditions worse in Hanenson's Department C than they had been in Gumanis's Department A. 21 B. The defendants recklessly failed to attend to and treat Donaldson at precisely those junctures when treatment could have most helped Donaldson recover and therefore be released. 22 The jury could have concluded that Donaldson should have been marked, at his entrance to the hospital, as a prime candidate for an early release, and that the defendants acted recklessly in failing to treat or attend to him during the early stage of his confinement. Fox testified that, given Donaldson's history, 7 he should have been 'pegged' for an 'early discharge'. Moreover, a progress note entered by Gumanis after his first diagnostic interview with Donaldson, March 25, 1957, recorded that Donaldson 'appeared' to be 'in remission'. Gumanis defined 'remission' for the jury as a state 'when the patient does not express delusions or paranoid ideas', and told the jury that it was hospital practice to release patients who were in remission. He testified that Donaldson was not released because he wanted to 'observe (Donaldson) further'. But after that interview the first progress note entered in Donaldson's hospital record is dated four months later; and the next report five months after that. Asked about this, Gumanis first replied, 'When you have 900 patients you do that'; later, he insisted that he had seen Donaldson frequently, but had not recorded progress notes after each observation. The jury, however, could have discounted this testimony and concluded that Gumanis acted wantonly in giving a patient who had appeared to be 'in remission' the same treatment he gave his 900 other patients. 23 C. The defendants wantonly, maliciously, or oppressively blocked efforts by responsible and interested friends and organizations to have Donaldson released to their custody. 24 At issue here are two efforts made to secure Donaldson's release, one by Helping Hands, Inc., a Minneapolis organization which runs halfway houses for mental patients and John H. Lembcke, a college friend of Donaldson. 25
26 Helping Hands made an inquiry to the hospital concerning the possibility of releasing Donaldson to its custody by a letter dated June 6, 1963: 27 We are interested in the possibility of signing out your patient, Kenneth Donaldson, and taking him as a resident at our halfway house at 3800 Columbus Avenue, Minneapolis. A maximum of six people live here, including our house mother, and myself, as president. At this time we have a room for Kenneth, who has interested us very much through his letters. Enclosed with the letter was a brochure describing Helping Hands and a letter from the Minneapolis Clinic of Psychiatry and Neurology, stating that 'it would be impossible in any of our State Hospitals for a patient to receive the type of attention and care' provided at Helping Hands. The author of this letter pointed out that the woman identified by the letterhead as the founder and director of Helping Hands had 'rehabilitated well over a thousand over the years'. The letter requested information concerning Donaldson's age, health, and 'qualifications for work'. 28 The hospital responded June 17, 1963, in a letter signed by O'Connor, then Clinical Director of the hospital. It gave Donaldson's age, and answered inquiries concerning his health and qualifications for work with the bare statement that Donaldson was 'mentally incompetent at the present time'. The crisp consluding paragraph read: 29 Should he (Donaldson) be released from this Hospital, he will require very strict supervision, which he would not tolerate. Such a release would be to the parents. We see no prospects of his release to any third party at any time in the near future. 30 The jury could have decided that Gumanis and O'Connor acted wantonly and maliciously in issuing this response, and that this conduct foreclosed an opportunity for Donaldson to win back at least a part of his freedom, and to gain access to a level of psychiatric treatment unavailable to him at the Florida Hospital. Each of the defendants sought to shift the responsibility for sending this curt reply to the other's shoulders. They discussed the question in terms of whether hospital rules, in general, fixed responsibility for deciding whether a patient could be furloughed by the attending physician, or the Superintendent or Clinical Director; they did not discuss it in terms of their recollections of the particular event. The jury would have been justified in finding the two jointly responsible for the incident. 31
32 John H. Lembcke, a certified public accountant in Binghamton, New York, who is married and has three children, had been a classmate of Donaldson's at Syracuse University in the 1920's. On four occasions, Lembcke sought to have Donaldson released to his custody. The first was on July 3, 1964, when Lembcke informed the hospital that Donaldson was a friend of his, and inquired whether there were 'any conditions under which he would be released so that I could bring him back to New York State'. The same day the hospital received the letter, O'Connor penciled a note to Gumanis that is attached to the letter in Donaldson's hospital record. The note said: 33 This man must not be well himself to want to get involved with someone like this patient, who even the recent visiting psychologist considered dangerous-- Recommend turn it down. 34 Rich, the new Clinical Director, wrote Lembcke saying that Donaldson had 'shown no particular changes mentally', and that if released he would 'require complete supervision.' 35 The second inquiry came by letter of November 27, 1964. Again O'Connor appended a note to Gumanis that is in the hospital records. This note gave three reasons for denying Lembcke's request to have Donaldson released to him: parental consent would be required; the patient 'would not stay with party mentioned'; and 'we don't know anything about party'. Gumanis prepared a letter, dated November 27 and again signed by Dr. Rich, 'advis(ing)' Lembcke that Donaldson would 'require further hospitalization'. The reply did not mention the three reasons for the denial set out in O'Connor's note, and did not request any further information from Lembcke, even though Lembcke in his November 23 letter had offered to provide any information the hospital should request. 36 The third attempt by Lembcke began with another letter to the hospital, dated December 21, 1965. According to Lembcke's testimony, the hospital responded by saying Donaldson could be released on two conditions: (1) that Lembcke would give Donaldson 'adequate supervision' so that the release would not be detrimental to his mental health; and (2) that Lembcke would secure parental permission for Donaldson to go to New York with Lembcke. In May 1966, Lembcke went to Florida, and met with Gumanis and O'Connor. While in Florida he saw Donaldson and obtained from Donaldson's parents a letter dated May 14, 1966, giving their consent to Donaldson's being released to him. Nothing happened. In his testimony Lembcke did not explain how or why he came to abandon this 1966 effort to secure his friend's release. 37 Lembcke's final and most important effort to secure Donaldson's release began in March 1968. On March 21, the General Staff, at a meeting attended by Gumanis and Hanenson but not by O'Connor, recommended Donaldson's release on a trial visit or out-of-state discharge. On March 24, Lembcke wrote the hospital renewing his offer to take Donaldson. On March 28, the hospital responded, imposing three conditions on Donaldson's release: (1) that Lembcke be willing to come for Donaldson; (2) that he be willing to supervise Donaldson; and (3) that he be willing to take Donaldson to a psychiatrist if Donaldson needed treatment. By letter of March 31, Lembcke acceded to these conditions. On April 4, the hospital replied with a letter imposing two additional conditions: (1) a detailed statement concerning the home supervision Donaldson would be given; and (2) written authorization for the release from Donaldson's parents. Lembcke wrote back giving the hospital the information about home supervision it had requested. The hospital replied by again saying it would be necessary to obtain the written consent of Donaldson's parents. 38 On September 18, 1968, Lembcke wrote the hospital, enclosing a photocopy of the notarized written permission Donaldson's parents had signed May 14, 1966. The hospital responded in a letter dated September 24, signed by Dr. Rich. The letter informed Lembcke that Donaldson had been mentally ill for many years, that he 'still express(ed) delusional thinking' and that 'it would not be fair to you or to him to release him from the hospital at this time without adequate planning'. The letter added, in its final paragraph, that it would be necessary for the hospital to have more recent authorization from Donaldson's nearest relative than the one Lembcke had proffered. At that point, Lembcke gave up; whenever he met the conditions imposed by the hospital officials, new conditions were imposed. As he put it, 'after requirements were met, requirements were increased'. 39 One other facet of Lembcke's last attempt to secure Donaldson's release bears mention. As noted, O'connor did not attend the Staff Conference which had recommended Donaldson's release March 21. O'Connor first learned of the hospital's recommendation in June, when Donaldson wrote to the Division Director of the hospital concerning the effort being made to release him. The division director forwarded the letter to O'Connor, who in turn forwarded it to Hanenson, asking for information concerning the proposed release. Hanenson responded with a memorandum dated June 17. Across the bottom of this memborandum, O'Connor pencilled in the remark, 'the record will show, I believe, we have been through this before and decided Mr. Lembcke would not properly supervise the patient'. It was not clear when O'Connor supposed this 'decision' to have been made, and in his deposition O'Connor was unable to locate any record of it in the hospital record. Moreover, there were suggestions in the record that Dr. O'Connor's conduct, in this and other respects, was influenced by his knowledge of Donaldson's history of writing letters to the press and to outside officials. From all of this evidence, the jury would have been justified in concluding that the frustration of Lembcke's effort to secure Donaldson's release in 1968 was entirely or primarily the result of O'Connor's bad faith intervention or, at the least, that the intervention was in reckless disregard of Donaldson's rights. 40 D. The defendants continued to confine Donaldson knowing he was not dangerous, or with reckless disregard for whether he was dangerous. 41 Three of the plaintiff's expert witnessess-- Fox, Raymond D. Fowler, Jr., Chairman of the Psychology Department at the University of Alabama and former President of both the Alabama and Southern Psychological Associations, and Julian Davis, Director of the Psychology Department at the Florida State Hospital-- testified that they did not believe Donaldson was dangerous. Fox's and Fowler's opinions were based upon the hospital records, Donaldson's pyschological reports, Donaldson's past history, and raw data from his physchological examinations. Lembcke testified that in his half century of having known Donaldson, he had never known Donaldson to be 'violent', 'aggressive', or 'belligerent'; that, on the contrary, he knew Donaldson to be a 'gentle' man. Dr. Walls testified that he did not believe Donaldson was physically dangerous; Gumanis himself conceded that he did not think Donaldson dangerous while Donaldson was in the hospital, although he said he could not predict what Donaldson would be like outside the hospital. There was no evidence in the record of Donaldson's ever having been violent in any way. 42 On the basis of this testimony the jury would have been justified in finding that Donaldson was non-dangerous, and in inferring that the defendants knew him to be so. 43 E. The defendants did not do the best they could with available resources. 44 As they did in the district court, the defendants on appeal pitch their defense in substantial part on their contention that they did the best they could with limited resources available to the state psychiatric hospital. Donaldson rebuts this contention, first, by pointing out the contrast between the treatment he received from the defendants and that he received from Hanenson. Hanenson allowed him grounds privileges and occupational therapy, spoke with him frequently, and within a year of taking charge of his case arranged a staff conference that recommended his release. Second, he relies on the testimony of Fox and the other experts to the effect that Gumanis and O'Connor failed to take steps that would have been open to them to take, even given the admittedly stark limitations on the resources available to them. We agree that these two considerations were a sufficient basis for the jury to reject the defendants' defense that they did the best they could with available resources. 45 We turn now to the novel and important question whether civilly committed mental patients have a constitutional right to treatment.