liibulletin: In re K.L.

In re K.L., 2004 N.Y. Int. 0014 (Feb. 17, 2004)

CONSTITUTIONAL LAW - MENTAL HYGIENE LAW § 9.60 - KENDRA’S LAW - ASSISTED OUTPATIENT TREATMENT - DUE PROCESS - EQUAL PROTECTION - SEARCH AND SEIZURE - FOURTH AMENDMENT

ISSUE & DISPOSITION

Issue(s)

1. Whether Mental Hygiene Law § 9.60 violates due process because the statute does not require a finding of incapacity before a psychiatric patient may be forced to comply with assisted outpatient treatment.

2. Whether Mental Hygiene Law § 9.60 infringes due process even though the statute does not require notice and a hearing before a noncompliant psychiatric patient can be temporarily removed to a hospital.

3. Whether Mental Hygiene Law § 9.60 violates equal protection because the statute does not require a finding of incapacity before a psychiatric patient can be subjected to assisted outpatient treatment.

4. Whether Mental Hygiene Law § 9.60 contravenes the Fourth Amendment’s prohibition against unreasonable searches and seizures in failing to require a physician to have probable cause or reasonable grounds before seeking an order that a psychiatric patient who is failing to comply with assisted outpatient treatment should be removed to a hospital involuntarily.

Disposition

1. No. Mental Hygiene Law § 9.60 is consistent with due process without a showing of incapacity because the statute does not permit forced medical treatment.

2. No. Mental Hygiene Law § 9.60 is consistent with due process without a notice and hearing requirement because a pre-removal hearing would not reduce the risk of erroneous deprivation and, under a Mathews v. Eldridge, 424 U.S. 319 (1976), balancing test, the government’s interest in reducing long periods of hospitalization outweighs the patient’s liberty interest at stake.

3. No. Mental Hygiene Law § 9.60 is consistent with equal protection because the statute does not authorize forcible medical treatment and therefore does not treat similarly situated persons differently.

4. No. Mental Hygiene Law § 9.60 does not violate the Fourth Amendment because the statute requires the physician to have a "clinical judgment" that the patient needs care and this judgment will be based on a physician’s reasonable belief that the patient does in fact require this care.

SUMMARY

Mental Hygiene Law § 9.60 provides for a system of assisted outpatient treatment (AOT) whereby psychiatric patients unlikely to survive safely in the community without supervision may avoid hospitalization by complying with court-ordered mental health treatment. Before a court can order AOT, they must hold a hearing at which a number of criteria must be established by clear and convincing evidence. In October 2000, a petition was filed seeking an order authorizing AOT for Respondent. Respondent opposed the petition and challenged the constitutionality of Mental Hygiene Law § 9.60 on a number of grounds. The Supreme Court rejected Respondent’s constitutional arguments, and the Appellate Division and the Court of Appeals both affirmed.

Respondent first argued that the statute violated due process and equal protection because it did not require a finding of incapacity before AOT could be ordered. The Court of Appeals held that, because the statute and AOT do not authorize forced medical treatment, a finding of incapacity was unnecessary to satisfy due process or equal protection. Moreover, the Court explained that a patient has a right to control their medical treatment but this right is not absolute. The Court said both the state’s police power to protect its citizens from potentially dangerous mentally ill persons and parens patriae power to provide care to its citizens who are unable to care for themselves allow the state to mandate treatment over the patient’s objections. The Court concluded that the statute’s requirements that the findings be made by clear and convincing evidence and that the AOT be the least restrictive alternative afford patients adequate due process.

Respondent also challenged the detention provision of the statute on due process grounds. Under Mental Hygiene Law § 9.60, if the patient does not comply with AOT, a physician who clinically judges that the patient may be in need of involuntary hospitalization can remove the outpatient to a hospital for up to seventy-two hours to determine whether hospitalization is in fact necessary. The Court found that, although involuntary detention for up to seventy-two hours is a substantial deprivation of liberty, a court hearing prior to the seventy-two-hour detainment is unnecessary. The Court used a Mathews v. Eldridge, 424 U.S. 319 (1976), balancing test and found that the risk of erroneous deprivation during the examination period is low, the state has a strong interest in immediately removing noncompliant patients, that doctors and not courts are better situated to assess the removal of a patient, and that the statute mandates a finding by clear and convincing evidence prior to the AOT order that the patient is unlikely to survive safely in the community without supervision. The Court found these factors outweighed the liberty interest.

Finally, the Court held there is no violation of the Fourth Amendment in the statute’s failure to specify that a physician has to have probable cause or reasonable grounds to believe that a noncompliant AOT patient is in need of involuntary hospitalization before a physician may seek the patient’s removal because that determination must be based on a physician’s reasonable belief that the patient needs care. The Court therefore affirmed the Appellate Division and held that Mental Hygiene Law § 9.60 is constitutional.

Prepared by the liibulletin-ny editorial board.