Supreme Court sides with Jane Doe in involuntary hospital admission case

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Open Source Photo/Michael Sauer

CONCORD, NH – The Supreme Court published its opinion Tuesday on a case that has significant ramifications on how the state handles its mental health patients. 

Jane Doe, a woman who was involuntarily admitted to a hospital emergency department in August, sued the state because she was kept there for 17 days before she was given a due process hearing.

The state law requires a patient receive a hearing within three days of being admitted, not including Sundays or holidays, but the former Attorney General Gordon MacDonald (who now sits on the Supreme Court) argued that admission begins when a patient is admitted into a designated receiving facility for mental health treatment. 

Doe maintained that admission begins with detainment. The Supreme Court agreed.

“The New Hampshire Supreme Court today unanimously affirmed that New Hampshire violated the legal right of a mental health patient held against her will in a hospital emergency room for seventeen days without being afforded judicial review of her detention,” Ken Norton of NAMI New Hampshire said in a statement Tuesday.

NAMI has been championing the cause of eliminating emergency room boarding of mental health patients since 2013. 

Both sides made oral arguments before the Supreme Court in March. NAMI filed an amicus brief with the court in support of Doe’s position and to provide background information.

In recent days, Norton said more than 80 mental health patients have been involuntarily detained in hospital emergency departments across the state, many of them children.

“Like Jane Doe, many are held for days and weeks,” Norton said.

He said the practice is dehumanizing, traumatizing, aggravates existing mental illness and is discriminatory against people with mental health issues.

In its opinion, the Supreme Court said the process is not working as the legislature intended. The plain meaning of the law, according to the court’s opinion, states a person is admitted to the “state mental health services system,” not a specific facility.

“These statutory provisions contemplate that a person’s admission to the state mental health services system and delivery to a receiving facility are to take place nearly simultaneously,” the court states. “Nothing in the statutory scheme allows a person to be held indefinitely pending delivery to a receiving facility.”

The practice of keeping patients in emergency departments grew ostensibly out of a shortage of receiving facility beds.

It’s still unclear how that problem will be resolved.

The Supreme Court said they do not opine on how the state should comply with its legal duties. 

Norton called on the Department of Health and Human Services, the Department of Justice, Gov. Chris Sununu, the legislature, hospitals and the courts to “work together to immediately comply with the court’s decision.”

If the legislature disagrees with the Supreme Court’s interpretation, it could rewrite the law to amend the statutory scheme, as long as it remains within constitutional bounds.

“We are pleased with today’s Supreme Court decision,” New Hampshire Hospital Association President Steve Ahnen said in a statement. “The Court clearly affirmed that when a patient is experiencing a mental health crisis, and receives an Involuntary Emergency Admission designation, then that patient should be immediately transferred to the appropriate setting to receive the specialized care and due process that they need and deserve. We will continue working with state leaders to ensure this ruling is carried out, and that we are meeting the needs of patients experiencing mental health crises, as well as their families.”

Norton said it is possible the hospitals may interpret it to mean they will be required to release patients after three days if a treatment center bed is unavailable. But he said NAMI doesn’t want to see anyone deemed to be a danger to themselves or others to be released prematurely.

The ultimate goal is to have sufficient mental health treatment capacity to serve everyone in need in a timely fashion.

“Hopefully it brings us back to finding solutions so people can get care immediately,” Norton said.