Opinion ID: 3066667
Heading Depth: 3
Heading Rank: 2

Heading: Supreme Court and Eleventh Circuit Precedent

Text: So we are grateful to have two cases, one from the Supreme Court and one from a panel of this Court, which are especially instructive in helping us consider what process is constitutionally adequate after involuntary civil commitment: Parham v. J.R. (no relation) and Williams v. Wallis. In Parham, the Supreme Court considered constitutionally adequate process before and after the voluntary commitment of children to state hospitals by their parents. 442 U.S. at 587, 99 S. Ct. at 2496. A plaintiff class of committed children challenged Georgia’s scheme, arguing that they had a right to notice and a hearing before commitment. Id. at 587–88 & n.2, 99 S. Ct. at 2496–97 & n.2. Though the Supreme Court upheld Georgia’s practice, it wrote this: We conclude that the risk of error inherent in the parental decision to have a child institutionalized . . . is sufficiently great that some kind of inquiry should be made by a “neutral factfinder” to determine [if] the statutory requirements for admission are satisfied. . . . It is necessary that the decisionmaker have the authority to refuse to admit any child who does not satisfy the medical standards for admission. Finally, it 11 Case: 12-14212 Date Filed: 10/15/2015 Page: 12 of 22 is necessary that the child’s continuing need for commitment be reviewed periodically by a similarly independent procedure. Id. at 606–07, 99 S. Ct. at 2506 (emphasis added). Two things made the state scheme constitutionally adequate: review of an initial admission by a decisionmaker with authority to refuse admission, and, after admission, periodic review of the continuing need for commitment. 12 It is true that the plaintiffs in Parham focused on the initial deprivation of liberty caused by admitting children, rather than by keeping them committed, as here. But in its opinion the Supreme Court spoke several times about the requirements for continuing commitment. It explained that Georgia’s law “charged [hospital superintendents] with an affirmative statutory duty to discharge any child who is no longer . . . in need of therapy,” id. at 615, 99 S. Ct. at 2510, “[e]ven without a request for discharge,” id. at 591, 99 S. Ct. at 2498. And the Court linked that ongoing affirmative duty to its conclusion that the initial deprivation of liberty was constitutional: “We have held that the periodic reviews described in the record reduce the risk of error in the initial admission and thus they are necessary.” Id. at 617, 99 S. Ct. at 2511 (emphasis added); see also id. at 12 Parham did not require a judicial or even administrative hearing. Because the question—whether the child meets the commitment criteria—was a medical one, the Court held that review by a “physician will suffice, so long as he or she is free to evaluate independently the child’s mental and emotional condition and need for treatment.” Id. at 607, 99 S. Ct. at 2507. The Court explained that the State had an interest in ensuring that its doctors spent their time treating patients, not preparing for court. Id. at 605–06, 99 S. Ct. at 2506; see also id. at 606, 99 S. Ct. at 2506 (“Behavioral experts in courtrooms and hearings are of little help to patients.”). 12 Case: 12-14212 Date Filed: 10/15/2015 Page: 13 of 22 607, 99 S. Ct. at 2506 (“It is necessary that the child’s continuing need for commitment be reviewed periodically . . . .” (emphasis added)). After Parham, in Williams v. Wallis, this Court addressed what process a state must give to people who have been involuntarily committed on a continuing basis. The plaintiffs in Williams challenged “Alabama’s procedures for the release of patients committed to the State’s mental health system after being found not guilty of a criminal offense by reason of insanity.” 734 F.2d at 1436. Alabama assigned to each committed person a “treatment team” of medical professionals that would “devise[] an individualized treatment plan” with the stated goal of “transfer[ring] [the person] to a less restrictive environment and [securing his or her] eventual release.” Id. The treatment team reviewed the person’s progress every 60 to 90 days. Id. We described the process by which a committed person (an “acquittee”) would be released: The decision to release an acquittee is usually initiated by the treatment team. . . . After the team recommends release, an acquittee not classified as special can be released with the approval of the forensic unit director of the hospital to which he is committed. The proposed release of special patients[13] must be reviewed by the hospital’s superintendent or his designee. The reviewing authority may communicate the proposed release to the committing court, the district attorney, the acquittee’s family, and others, or may order further treatment for, or evaluation of, the acquittee. The hospital superintendent then makes the final decision whether to release the special patient. 13 “Special patients” were those who were “considered dangerous to themselves or others.” See Williams, 734 F.2d at 1436. 13 Case: 12-14212 Date Filed: 10/15/2015 Page: 14 of 22 Id. The plaintiffs claimed that this release process was unconstitutional because it did not require an adversary proceeding in which the State bore the burden of proof. Id. at 1437. But, looking to Parham, we held that due process does not demand an adversary proceeding. See id. at 1438–39. We explained: Hospitals and their medical professionals certainly have no bias against the patient or against release. Therefore, we can safely assume they are disinterested decision-makers. In fact, the mental health system’s institutional goal—i.e., transfer to a less restrictive environment and eventual release—favors release. Other factors also favor release, including a perennial lack of space and financial resources, which militates against any motivation to unnecessarily prolong hospitalization, and including the medical professional’s pride in his own treatment. The frequency of the evaluations also reduces the risk that the patient will be confined any longer than necessary. Id. at 1438 (emphasis added). We went on to explain that requiring an adversary proceeding “would have a natural tendency to undermine the beneficial institutional goal of finding the least restrictive environment including eventual release.” Id. at 1439 (emphasis added). Finally, we observed that Alabama provided a habeas corpus remedy as a “secondary or backup procedure, a safeguard” that existed to “rectify any error that might have occurred during the initial nonadversary review.” Id. at 1440. From this precedent we have synthesized several guiding principles. At the outset, as we have explained, it is clear that the State must conduct some form of periodic review of continuing involuntary commitments. See Parham, 442 U.S. at 14 Case: 12-14212 Date Filed: 10/15/2015 Page: 15 of 22 607, 99 S. Ct. at 2506 (“[I]t is necessary that the child’s continuing need for commitment be reviewed periodically by a[n] . . . independent procedure.”). Yet this still leaves the question we posed above: what type of periodic review is constitutionally adequate? It is clear that the review need not consist of an adversarial proceeding involving a judge or even an administrator. See Parham, 442 U.S. at 607–08, 99 S. Ct. at 2506–07; Williams, 734 F.2d at 1439; see also Austin, 848 F.2d at 1396 (holding that “due process requires that some periodic review take place” but not necessarily “a periodic judicial review”); Hickey, 722 F.2d at 549 (“Due process does not always require an adversarial hearing.”). But the cases impose two related restrictions on the form of review, at least where it is nonadversarial. First, the reviewer must be required to consider the propriety of ongoing commitment. See Parham, 442 U.S. at 615, 99 S. Ct. at 2510 (noting that the hospital superintendent “is charged with an affirmative statutory duty to discharge any child who is no longer mentally ill or in need of therapy”); Williams, 734 F.2d at 1439 (observing that periodic reviews seek to meet the “goal of finding the least restrictive environment including eventual release” (emphasis added)); see also Hickey, 722 F.2d at 549 (holding that adequate procedures included “regular review of [the plaintiff’s] continued confinement”); cf. Austin, 848 F.2d at 1395–96 (explaining that periodic review must include whether 15 Case: 12-14212 Date Filed: 10/15/2015 Page: 16 of 22 commitment should continue); Clark, 794 F.2d at 86 (describing that the periodic reviews considered whether to release the plaintiff). Second, the reviewer must be authorized to order release if the criteria for commitment are no longer met. See Parham, 442 U.S. at 607, 99 S. Ct. at 2506 (“It is necessary that the decisionmaker have the authority to refuse to admit any child who does not satisfy the medical standards for admission.”); Williams, 734 F.2d at 1440 (“[T]he release decision is first addressed in the nonadversary proceedings described above, and the final release decision can be, and most often is, made at this level by the hospital professionals.” (emphasis added)). 14 For instance, in Clark the Third Circuit considered a review scheme that violated this second restriction. There, medical professionals periodically reviewed the plaintiff’s continued confinement and had “consistently recommended that [she] be released” for something like eight years. Clark, 794 14 The APD argues that Williams does not stand for the proposition that the reviewer must be authorized to order release. It is true that in that case the “treatment team” was responsible for periodically reviewing continued involuntary commitment, but the treatment team could only “recommend[] release.” Williams, 734 F.2d at 1436; see also id. (“The decision to release an acquittee is usually initiated by the treatment team.” (emphasis added)). A hospital supervisor had to approve the treatment team’s release recommendation before the person could actually be released. See id. (explaining that the treatment team’s release recommendation for “special patients” was reviewed by “the hospital’s superintendent or his designee,” while the release recommendation for non-special patients was approved by “the forensic unit director of the hospital to which [the acquittee] [wa]s committed”). But it was the same group of medical professionals that reviewed the propriety of commitment and that, as a whole, had authority to order release. There was no requirement that the medical professionals petition a court to order release, or that some other entity without any say in the medical-review process approve release. The distance between the reviewer and the person with authority to release was vanishingly small in Williams: from medical professionals to their supervisors. Here the distance is vast: medical professionals must petition a state court to order release. 16 Case: 12-14212 Date Filed: 10/15/2015 Page: 17 of 22 F.2d at 86. But she was not released because “the reviewers lacked the authority to implement their recommendations.” Id. The Third Circuit found a violation of due process. Id. It explained that the review “required by the due process clause is not a moot court exercise. The [reviewers] must have the authority to afford relief.” Id.; see also id. (finding a violation of procedural due process because “[o]ver the course of more than twenty-eight years [the plaintiff] was never afforded a hearing before any decisionmaker with authority to resolve her dispute”). Finally, the cases suggest that habeas corpus may serve as a backup to periodic, nonadversarial review. See Williams, 734 F.2d at 1440; see also Hickey, 722 F.2d at 549 (explaining that periodic, nonadversarial review is constitutional because a committed person can “receive judicial review under the court’s discretionary power or may [petition for] habeas relief”). But no case has permitted habeas to be the primary review procedure. We assume this is because habeas is by its very nature not a periodic, state-initiated review, which, as we have just explained, is required. See Parham, 442 U.S. at 607, 99 S. Ct. at 2506.