Court Opinion

ID: 9845006
Source: CourtListenerOpinion
Date Created: 2023-09-24 03:13:46.502263+00
Date Added: 2024-06-11T09:15:50.187145
License: Public Domain

BISTLINE, Justice,
concurring specially.
b
I agree with the majority that conditionally released mental patients have a liberty interest which is entitled to protection under the due process clause of the United States Constitution. “Involuntary confinement for treatment of mental illness is a ‘massive curtailment of liberty.’ ” C. R. v. Adams, 649 F.2d 625, 627 (8th Cir. 1981). I also agree that the protections which the majority sets forth are a part of the process which is constitutionally required prior to deprivation of that liberty interest. I am concerned, however, that the majority has failed to specify several additional procedural safeguards which are, to my mind, also necessary to meet the minimum requirements of the due process clause. When the state sanctions the restriction of a liberty interest, such a restriction should intrude upon that interest to the smallest degree necessary for the purposes of the restriction. Shelton v. Tucker, 364 U.S. 479, 81 S.Ct. 247, 5 L.Ed.2d 231 (1960). The restrictions in this case go far beyond those necessary to achieve the medical and societal goals of the statutes governing the involuntary treatment of mental patients.
II.
Mathews v. Eldridge, 424 U.S. 319, 335, 96 S.Ct. 893, 902-03, 47 L.Ed.2d 18 (1976), held that, in considering what process is due, courts should take into account:
“First, the private interest that will be affected by the official action; second, the risk of an erroneous deprivation of such interest through the procedures used, and the probable value, if any, of additional or substitute procedural safeguard's; and finally, the Government’s interest, including the function involved *164and the fiscal and administrative burdens that the additional or substitute procedural requirements would entail.”
The private interest involved in an involuntary recommitment is of the first order— an individual’s liberty — and the harm which would result from an erroneous determination is correspondingly great. Diagnosis of mental disorders, and recognition of disorder symptoms, is at best imprecise, and there is therefore a great risk that an erroneous deprivation of liberty will in fact occur. With these two factors weighing heavily in favor of extensive procedural safeguards, I turn to the majority’s analysis regarding the interests of the state and the need for protection of the individual and of society.
Under the majority’s analysis, the determination of the degree of danger posed to the public and the immediacy of the risk to the patient is to be made by the director of the department of health and welfare or his designated representative, and the patient actually rehospitalized, prior to a hearing.1 This is clearly contrary to one of the basic precepts of procedural due process — that the process which stands between the state and the threatened individual must be completed prior to ultimately depriving the individual of the protected interest. If the state elects to hold only a post-deprivation hearing, a heavy burden is upon it to show that circumstances did not allow a pre-deprivation hearing.
It is an absolutely fundamental precept of the due process clause of the United States Constitution that, if possible, the proper procedures be accorded prior to deprivation of the protected interest.
“That the hearing required by due process is subject to waiver, and is not fixed in form does not affect its root requirement that an individual be given an opportunity for a hearing before he is deprived of any significant property interest, except for extraordinary situations where some valid governmental interest is at stake that justifies postponing the hearing until after the event.” Boddie v. Connecticut, 401 U.S. 371, 378-79, 91 S.Ct. 780, 786-87, 28 L.Ed.2d 113 (1971) (footnotes omitted) (emphasis original).
See Board of Regents v. Roth, 408 U.S. 564, 569-70, 92 S.Ct. 2701, 2705, 33 L.Ed.2d 548 (1972); Muscare v. Quinn, 520 F.2d 1212, 1215 (7th Cir. 1975); Wilderman v. Nelson, 467 F.2d 1173 (8th Cir. 1972).
“The fundamental mandate of the Fourteenth Amendment is that a person be afforded notice and an opportunity to be heard prior to deprivation of a significant liberty or property interest. (See Laing v. United States, 423 U.S. 161, 186, 96 S.Ct. 473 [486], 46 L.Ed.2d 416 (Brennan, J., concurring).) A narrow exception to this requirement has been fashioned as to property interests (Fuentes v. Shevin, 407 U.S. 67, 90-92, 92 S.Ct. 1983, 1999-2000, 32 L.Ed.2d 556) such that, in limited instances, ‘where only property rights are involved, mere postponement of the judicial enquiry is not a denial of due process, if the opportunity given for ultimate judicial determination of liability is adequate’ .... Given the ‘transcending value’ of a person’s interest in liberty . .., however, the prior hearing requirement cannot so readily be subverted with respect to liberty interests. As habeas corpus relief is an after the fact determination of the propriety of confinement, it cannot by any stretch of the imagination operate as a constitutional substitute for a prior (prerevocation) hearing. ... It is the state, in seeking deprivation of respondent’s conditional liberty, which must reliably establish *165facts justifying its proposed action. ... Moreover, review by way of a petition for habeas corpus is not mandatory ... and under the statutory language the patient’s petition will be denied if he is unable to marshal ‘facts sufficient to justify relief.’ Without being apprised of the reasons behind his recommitment, the patient can hardly be assured of the meaningful review to which he is constitutionally entitled.” In Re Anderson, 73 Cal.3d 98, 140 Cal.Rptr. 546, 551-52 (1977) (citations omitted).
The majority’s rule favors post-deprivation hearings by placing discretion in the hands of the director or his designated representative to recommit a patient without a hearing based solely upon the reports of totally untrained lay-people. The majority’s analysis assumes that most reported relapses are either accurately diagnosed or involve immediate danger to the public or the patient. No factual basis for this assumption appears in the record. In fact, literature on the subject suggests that the opposite is true. For example, a recent law review article, after an exhaustive review of available literature, concludes:
“(a) there is no evidence warranting the assumption that psychiatrists can accurately determine who is ‘dangerous’; (b) there is little or no evidence that psychiatrists are more ‘expert’ in making the predictions relevant to civil commitment than laymen; (c) ‘expert’ judgments made by psychiatrists are not sufficiently reliable and valid to justify non judicial hospitalization based on such judgments; (d) the constitutional rights of individuals are seriously prejudiced by the admissibility of psychiatric terminology, diagnoses, and predictions, especially those of ‘dangerous’ behavior; and therefore (e) courts should limit testimony by psychiatrists to descriptive statements and should exclude psychiatric diagnoses, judgments, and predictions.” Ennis & Litwack, Psychiatry and the Presumption of Expertise: Flipping Coins in the Courtroom, 62 Cal. L.Rev. 693, 696 (1974).
It would be wrong, and in many cases tragic, to assume that all reports of “relapses” are either accurate or necessarily justify immediate rehospitalization. As the court noted in C. R. v. Adams, supra, “[i]f the patient is refusing treatment, which usually means missing appointments, the treating psychologist informs the mental health referee, who has the authority to issue an order for the patient’s return to the hospital.” 649 F.2d at 629 (emphasis added). The fact that a patient misses an appointment during out-patient treatment does not necessarily indicate a danger to the community or to the individual. On the other hand, the harm suffered by unnecessary reinstitutionalization cannot be cured by a post-deprivation hearing.2 The possibility of simple error in the factual basis for a reported relapse gives rise to the spectre of the conditionally released patient being plucked by the state from his or her home or place of work, with no prior notice, and returned to an institution, even in those instances in which the patient has indeed in all respects followed the conditions of the release program. This cannot be tolerated.
Ennis & Litwack conclude that “psychiatric judgments are not only unreliable with respect to the ultimate diagnoses, but lack consistency even in the perception of the presence, nature, and severity of symptoms.” 62 Cal.L.Rev. at 706 (emphasis added). The Supreme Court has recognized that the very nature of the medical, as *166opposed to factual, determination that a person must be committed, requires procedural safeguards.
“We recognize that the inquiry involved in determining whether or not to transfer an inmate to a mental hospital for treatment involves a question that is essentially medical. The question whether an individual is mentally ill and cannot be treated in prison ‘turns on the meaning of the facts which must be interpreted by expert psychiatrists and psychologists.’ Addington v. Texas, 441 U.S., at 429, 99 S.Ct., at 1811. The medical nature of the inquiry, however, does not justify dispensing with due process requirements. It is precisely ‘the subtleties and nuances of psychiatric diagnoses’ that justify the requirement of adversary hearings. Addington v. Texas, 441 U.S., at 430, 99 S.Ct., at 1811.” Vitek v. Jones, 445 U.S. 480, 100 S.Ct. 1254, 1265, 63 L.Ed.2d 552 (1980).
A 1969 study concluded that:
“[Psychiatrists are rather inaccurate predictors — inaccurate in an absolute sense— and even less accurate when compared with other professionals, such as psychologists, social workers and correctional officials and when compared to actuarial devices, such as prediction or experience tables. Even more significant for legal purposes, it seems that psychiatrists are particularly prone to one type of error— overprediction. They tend to predict antisocial conduct in many instances where it would not, in fact, occur. Indeed, our research suggests that for every correct psychiatric prediction of violence, there are numerous erroneous predictions. That is, among every group of inmates presently confined on the basis of psychiatric predictions of violence, there are only a few who would, and many more who would not, actually engage in such conduct if released.” Dershowitz, The Psychiatrist’s Power in Civil Commitment: A Knife That Cuts Both Ways, Psychology Today, Feb. 1969 at 47.
In 1966 the Supreme Court held, in Baxstrom v. Herold, 383 U.S. 107, 86 S.Ct. 760, 15 L.Ed.2d 620 (1966), that felons detained in department of corrections mental hospitals after their prison terms had expired must be released or civilly committed. A study of 969 patients in New York State who were affected by the decision found that one year after the patients were transferred to civil hospitals, 147 were discharged to the community and 702 were found to present no special problem to the hospital staff. Only seven were so dangerous as to require recommitment to a prison hospital. See Hunt & Wiley, Operation Baxstrom After One Year, 124 Am.J.Psychiat. 974 (1968). Another study found that a team of five mental health professionals was able to accurately predict dangerousness only one third of the time in advising whether patients should be released. This means that two thirds of the patients which this team recommended not be released because of dangerousness, but who were nevertheless released, were not in fact dangerous. See Kozol, Boucher & Garofalo, The Diagnosis and Treatment of Dangerousness, 18 Crime & Delinquency 371 (1972).
If professionally trained people, in a clinical setting, cannot agree among themselves as to the problems of mental patients, the risk of unnecessarily depriving conditionally released patients of their liberty based upon the unprofessional3 observations of untrained observors in a non-clinical setting is extremely high. Particularly pertinent to the choice between a pre-deprivation, in-community hearing and a post-deprivation hearing in an institutional setting is the fact that “psychiatric judgments are strongly influenced by the context of the examination .... Prospective patients are likely to respond quite differently to the *167question if they are permitted to answer them in the familiarity of their own homes, rather than in a strange and possibly frightening hospital environment.” Ennis & Litwack, supra, 62 Cal.L.Rev. at 748.
It is alarming to see the rather casual attitude of the other members of this Court towards distinction between a pre-deprivation hearing and a post-deprivation hearing. See, e.g., Simmons v. Board of Trustees, 102 Idaho 552, 633 P.2d 1130 (1981). The majority’s statement that “the ... need for immediate rehospitalization of a conditionally released mental health patient suspected of remission is such that the general rule that an individual be given a hearing before he is deprived of a protectible interest is inapplicable” improperly places the burden upon the person being deprived of their liberty to show why a pre-deprivation hearing is required under the facts of the particular case. As I have attempted to demonstrate, the need for most hearings to be held only following recommitment is extremely small, the degree of curtailment of liberty and possible harm to the detainee is great, and the possibility of an erroneous diagnosis, leading to a loss of civil liberty, is greater in a clinical setting. The majority’s statement that “[t]he situation present when a decision is made to revoke the conditional release status of the patient is extraordinary: the patient because of a suspected remission in his mental condition possibly poses a danger to others and/or to himself” is pure speculation. The reason for a hearing in the first instance is to determine whether the facts which the department asserts are in fact true. A rule allowing prehearing determinations by individuals acting on behalf of the state to provide the only safeguard against erroneously taking a person into custody cannot suffice to protect the civil liberties of the people affected — if it could, prior hearings would simply not be a part of due process. As I explain post at note 6, an emergency situation may very well justify a prehearing deprivation. Short of that, however, the scales must be tipped in favor of a pre-deprivation hearing. In this regard, it need only be noted that original commitment hearings, which require showings of need for commitment which are identical to those required for recommitment must, under I.C. § 66-329 and the Idaho and United States constitutions, be preceded by a hearing. Unless the majority is willing to take the position that original commitment proceedings need not be preceded by a hearing, so long as a designated individual makes certain factual findings, then its concern for the public and the health of the patient rings hollow.
The factual determination of whether a parole violation has occurred will ordinarily be much less complex than the determination of whether a conditionally released patient has suffered a relapse requiring re-commitment. Consequently, the possibility of error in recommitting a patient is higher, and the majority simply draws the wrong conclusions from its comparison with parole revocation proceedings. While the majority’s requirement of a hearing is much closer to the requirements of the due process clause than the procedures mandated by I.C. § 66-339 (1974), it still falls short of meeting the minimum necessary to insulate individuals from abuses of state power.
In this regard, the evils of I.C. § 66-339 (1974) are apparent. I.C. § 66-339 provided at the time of True’s rehospitalization:
“Rehospitalization required of patient conditionally released from state hospital. —In the event it is reported to the director of the department of health and welfare or his designated representative by any two (2) persons who are either licensed physicians, health officers, designated examiners or peace officers, the prosecuting attorney or a judge of a court, that any patient who is under commitment to the custody of the director of the department of health and welfare and who has been conditionally released from a facility, has relapsed and is again in need of hospitalization, the director of the department of health and welfare or his designee may order said patient to be rehospitalized or otherwise detained immediately. Such order, made in writing or by telephone, until it can be put in *168writing and indorsed [sic] by a judge of any court of competent jurisdiction of the county in which said patient is then residing; shall authorize any peace officer or health officer to take the patient into protective custody and transport him back to the hospital or other place of detention, or restrain him until the director can send transportation for him, which detention or restraint may not exceed a period of forty-eight (48) hours unless said detention is in a facility.” (Emphasis added.)
Even if one were to assume that “relapse” and “in need of hospitalization” were terms which automatically demonstrated a danger to the public sufficient to justify an immediate loss of liberty without a prior hearing,4 one must still inquire into the nature of the “report” which, under the statute, is not required to be in writing, and empowers the director to issue an ex parte, verbal order to recommit the patient.
To my mind, in order to satisfy the due process clause, the “report” upon which a director’s order may issue (1) must be either in writing or recorded, so that the person subject to the order may review, understand, and rebut the information upon which the order is based, and (2) must set forth the reasons justifying immediate detention and/or reinstitutionalization. Affidavits are ordinarily required in other situations in which ex parte orders are allowed, see e.g., I.R.C.P. 6(c)(2); Dietrich v. Brooks, 27 Or.App. 821, 558 P.2d 357, 359 (1976) (written complaint statutorily required pri- or to termination of trial visit status), and they should certainly be required when an individual’s liberty is so drastically affected. Additionally, I would hold that, except in emergency situations, the director’s order itself must be in writing so that it may be reviewed and rebutted.
I am also concerned that some patients might be unable or unwilling to take advantage of the procedural safeguards which due process requires, due to either a lack of understanding of their rights or institutional barriers to exercising those rights. Under I.C. §§ 66-340 and -347, recommitted patients may challenge their recommitment by way of either an appeal to district court from the order of recommitment or a writ of habeas corpus. Both proceedings must be in district court, yet no provisions are made for the assistance of counsel. The majority correctly holds that the right to counsel attaches at the (presumably) administrative hearing on a patient’s recommitment order. I would also hold that the provisions for counsel set forth in I.C. § 66-329(e) (1974)5 as to the original commitment proceedings are required by due *169process to be extended to recommitted patients who wish to challenge the validity of their order of recommitment under I.C. §§ 66-340 and -347 or who wish to challenge the reports of persons seeking recommitment before recommitment has actually been ordered. The need for and right to such counsel is present regardless of whether there is a hearing prior to or immediately after deprivation of the patient’s liberty. Thus, when a patient is detained outside a “facility” under I.C. § 66-339, the legal assistance should be made available forthwith and certainly within 48 hours, to insure that such patient is not detained longer than the maximum amount of time allowed by the statute.
I.C. § 66-329(d) (1974) provided:
“Upon receipt of such application and designated examiners’ reports the court shall appoint a time and place for hearing which may be held immediately but in any event such hearing must be held not more than five (5) days from the receipt of such designated examiners’ reports and thereupon give written notice of such time and place of such hearing to the petitioner, to the proposed patient, to his legal guardian, if any, or to his spouse, parents, or nearest known other relative, if any, or friend.” (Emphasis added.)
This notice is required by due process in recommitment proceedings as well, to insure that if the mental condition or physical capabilities of the patient are such that he or she cannot understand or exercise the right to contest recommitment, someone who can understand that right and, if necessary, exercise it, has notice of the attempt to recommit.
To summarize, I would hold that the due process clauses of the United States and Idaho constitutions require that conditionally released mental patients, except in emergency situations,6 receive the following procedural safeguards prior to reinstitutionalization: (1) written notice to the patient and at least one other person as set forth in I.C. § 66-329(d); (2) an in-community hearing to determine whether recommitment is necessary — before either a neutral hearings examiner with a background in mental health or a district judge; (3) an opportunity at the hearing to present evidence and testimony and to cross-examine witnesses against the patient; and (4) legal counsel, at the state’s expense if the patient is indigent.
This Court has not previously waivered in its protection of liberty interests from unwarranted and arbitrary intrusions by the state. See State v. Wolfe, 99 Idaho 382, 582 P.2d 728 (1978). The Court should more fully respond to the obligation to protect the liberty of all citizens of our state, and particularly the disadvantaged, by insuring that the state only restrict such liberty when it is necessary to do so, and never otherwise.

. I am concerned by the “as soon as reasonably possible” time limit set by the majority for post-deprivation hearing. This leaves tremendous discretion as to timing in the hands of the institution. I would require that the hearing be held within 48 hours of the time that the person is taken into custody, unless the patient requests additional time to conduct discovery and prepare his or her case. See I.C. § 66-339 (may not detain conditionally released patient outside of institute for more than 48 hours); I.C. § 66-329A (person may be taken into custody as emergency patient without court order only if evidence supporting seizure is presented to court within 24 hours).

. For a fictionalized but thought-provoking account of the harm that may befall those committed to a mental institution, and particularly those who do not belong there, see K. Kesey, One Flew Over the Cuckoo’s Nest. As the Supreme Court stated in Vitek v. Jones, 445 U.S. 480, 100 S.Ct. 1254, 1265, 63 L.Ed.2d 552 (1980):
“Because prisoners facing involuntary transfer to a mental hospital are threatened with immediate deprivation of liberty interests they are currently enjoying and because of the inherent risk of a mistaken transfer, the District Court properly determined that procedures similar to those required by the court in Morrissey v. Brewer, supra, were appropriate in the circumstances present here.” (Emphasis added.)

. I.C. § 66-339 allows a recommitment order to issue upon reports from “any two (2) persons who are either licensed physicians, health officers, designated examiners or peace officers, the prosecuting attorney or a judge of a court .... ” The majority retains the aspect of the statute, even where no prior hearing is allowed. There is no requirement that any of the persons allowed to report be trained in detecting or diagnosing “relapses” or mental problems in general.

. Although the majority reads the factual predicate necessary for original commitment into I.C. § 66-339 (1974), a reading with which I agree, this does not obviate the need for, or the feasibility of, a prior hearing. See I.C. § 66-329 (original commitment proceedings must include prior hearing).

. I.C. § 66-329(e) (1974) provided:
“An opportunity to be represented by counsel shall be afforded to every proposed patient, and if neither he nor others provide counsel, the court shall appoint a counsel at the time the application is received by the court and authorize a proper fee to be paid such counsel from the county funds. The court may order the department of health and welfare in the county wherein the proposed patient resides to make an investigation of the ability of said proposed patient and his relatives legally liable as specified in section 66-354, Idaho Code, to pay for said counsel, and to forward a report of the findings to the court. If the findings so warrant, the court may order the prosecuting attorney or other proper official to initiate suit in the name of the county to collect any fees paid by the county for said proposed patient’s counsel.”
I.C. § 66-329(g) now provides that “[a]n opportunity to be represented by counsel shall be afforded to every proposed patient, and if neither. the proposed patient nor others provide counsel, the court shall appoint counsel in accordance with chapter 8, title 19, Idaho Code I.C. § 19-852(b)(l) requires that the state provide counsel for needy persons “at all stages of the matter beginning with the earliest time when a person providing his own counsel would be entitled to be represented by an attorney and including revocation of probation." (Emphasis added.) Certainly the loss of liberty involved in recommitment to a mental institution is no less than that lost through revocation of probation. In some instances the deprivation is substantially greater. See, e.g., Kesey, supra note 2.

. By “emergency situations,” I mean those situations in which there is an immediate and patently evident risk of harm to the patient and/or the public. While such a situation would in most instances justify an arrest, and thereby moot the question of whether a prior hearing is required, a procedure for immediately placing such a patently dangerous patient in the hands of those qualified to attend to the patient’s mental/physical problems is certainly preferable to placing such a person in a county jail.