RECORD IMPOUNDED
NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION This opinion shall not "constitute precedent or be binding upon any court ." Although it is posted on the internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.
SUPERIOR COURT OF NEW JERSEY APPELLATE DIVISION DOCKET NO. A-1238-22
IN THE MATTER OF THE CIVIL COMMITMENT OF J.P.1
Argued February 14, 2024 – Decided May 8, 2024
Before Judges Currier and Firko.
On appeal from the Superior Court of New Jersey, Law Division, Mercer County, Docket No. MECC00094522.
Vanessa Fiore, Assistant Deputy Public Defender, argued the cause for appellant J.P. (Jennifer Nicole Sellitti, Public Defender, attorney; Vanessa Fiore and Cynthia Seda-Schreiber, Deputy Public Defender, on the briefs).
Michael Anthony Amantia, Assistant County Counsel, argued the cause for respondent State of New Jersey (Paul R. Adezio, Mercer County Counsel, attorney; Michael Anthony Amantia, on the brief).
PER CURIAM
1 We use initials pursuant to Rule 1:38-3(f)(2). Appellant J.P. appeals from the November 16, 2022 civil commitment
order that continued his involuntary commitment and denied his request to
convert to voluntary admission status. The court found J.P. did not have the
capacity to make an informed decision regarding a change to his status as
required under Rule 4:74-7(g)(1). We affirm.
J.P. was admitted to Capital Health Regional Medical Center on October
21, 2022 after attempting to commit suicide by jumping in front of an oncoming
train. The severe injuries required the amputation of both legs.
J.P. had prior diagnoses of bipolar mood disorder, multiple sclerosis,
cannabis use disorder, and chronic alcohol abuse. He had been hospitalized
multiple times between July 2022 and these events in October 2022. In July
2022, J.P. ingested anti-freeze and received inpatient psychiatric care for
approximately one month. In August, he was admitted to Capital Health for
inpatient psychiatric care after voicing suicidal thoughts about planning to jump
in front of a train. He was also treated at other facilities. J.P. was last admitted
to the hospital approximately a week before these events.
After the October 21, 2022 admission, J.P. was screened regarding his
mental health status and two psychiatrists completed certificates for his
involuntary commitment—Nayan Bhatia, M.D., and Mohammad M. Bari, M.D.
A-1238-22 2 During the screening, J.P. stated he had been living at the Rescue Mission,
and he went to the train station to take his life. He did not know if he was
intoxicated and "only remember[ed] waking up in the hospital with both legs
amputated."
Dr. Bhatia indicated in his certificate that J.P. expressed "[s]uicidal
ideation with no specific plan at this time," and his insight and judgment were
poor. Dr. Bhatia concluded that J.P. was dangerous to himself because of his
suicide attempt, his continued suicidal ideation, and his inability to satisfy his
essential medical care and shelter needs because he was "depressed" and "unable
to take care of [him]self due to decompensated psychiatric illness." Dr. Bhatia
recommended inpatient care.
Dr. Bari found that J.P. exhibited "unpredictable" and "impulsive
behavior." He also found J.P.'s insight and judgment were poor, and he would
be a danger to himself because of his suicide attempt and his inability to satisfy
his essential medical care and shelter needs. He recommended that J.P. receive
inpatient psychiatric care.
The court ordered J.P. be temporarily involuntarily committed to Capital
Health. During the initial hearing on November 16, 2022, J.P. requested his
A-1238-22 3 status be converted to a voluntary commitment. County Counsel opposed the
application.
At the hearing, Dr. Bhatia testified that J.P. understood he struggled with
depression, and acknowledged he did not complete outpatient treatment or take
his medication after being discharged from hospitalizations. Dr. Bhatia noted
the prescribed medications had not been effective and despite his
hospitalizations, J.P. had not improved. Dr. Bhatia considered J.P. a danger to
himself because of his suicidal ideations and attempts. J.P. did not have a family
support system and continued to voice suicidal thoughts. Dr. Bhatia thought
that J.P. understood the need for psychiatric treatment, but he did not understand
the consequences of not taking his medication.
On cross-examination, Dr. Bhatia acknowledged J.P. had been diagnosed
with bipolar mood disorder but said "[i]t hasn't been fully established that he has
bipolar [mood] disorder. . . . It's still a work in progress as to what exactly his
diagnosis is." Dr. Bhatia stated that J.P. wanted to try Electroconvulsive
Therapy (ECT), although the doctor was not sure how much J.P. knew about
ECT. According to the doctor, J.P. could not answer why he stopped taking his
medication after prior discharges, but he had expressed the desire to continue
treatment.
A-1238-22 4 During J.P.'s testimony, he stated he did not follow up with his treatment
or medications after being discharged, although he would seek treatment again.
J.P. stated his brother supported him "[i]n a way," but did not provide any
details. J.P. confirmed he wanted to try ECT.
On cross-examination, J.P. admitted he did not know where he would be
living in thirty or forty days. He conceded that even though he was able to fill
his prescriptions while he was living at the Rescue Mission, he did not continue
taking them. J.P. said he knew that if he did not take his medication, he "would
go back to square one"; however, he felt his condition had not improved with
the medicine. He stated he still felt depressed and had suicidal thoughts when
taking the medication and he did not think that stopping the prescriptions would
make a difference.
The court issued an oral decision, finding that J.P. satisfied the criteria for
involuntary commitment and was a danger to himself "based upon the recent
incidents and the prior suicide attempts." The court stated J.P. did not have "the
capacity to make the determination regarding his continued health treatment in
the hospital." The court noted J.P. had suicidal ideations, had attempted to
commit suicide which resulted in the amputation of his legs, and that he did not
A-1238-22 5 comprehend the consequences of not taking his medication. The court
memorialized its decision in a November 16, 2022 order.
On appeal, J.P. contends the court erred in denying his application for a
conversion to voluntary commitment as the State did not prove he lacked
capacity to make the determination regarding his commitment status.
Rule 4:74-7 governs the civil commitment of adults. "[A]ppellate review
of a commitment determination is extremely narrow and should be modified
only if the record reveals a clear mistake." In re D.C., 146 N.J. 31, 58 (1996).
We give the "utmost deference" to a trial court's decision and only modify it if
there was an abuse of discretion. In re Commitment of J.P., 339 N.J. Super. 443,
459 (App. Div. 2001) (quoting State v. Fields, 77 N.J. 282, 311 (1978)). As
long as the trial court made "supportable findings," its decision should be
affirmed. In re Commitment of T.J., 401 N.J. Super. 111, 119 (App. Div. 2008).
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RECORD IMPOUNDED
NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION This opinion shall not "constitute precedent or be binding upon any court ." Although it is posted on the internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.
SUPERIOR COURT OF NEW JERSEY APPELLATE DIVISION DOCKET NO. A-1238-22
IN THE MATTER OF THE CIVIL COMMITMENT OF J.P.1
Argued February 14, 2024 – Decided May 8, 2024
Before Judges Currier and Firko.
On appeal from the Superior Court of New Jersey, Law Division, Mercer County, Docket No. MECC00094522.
Vanessa Fiore, Assistant Deputy Public Defender, argued the cause for appellant J.P. (Jennifer Nicole Sellitti, Public Defender, attorney; Vanessa Fiore and Cynthia Seda-Schreiber, Deputy Public Defender, on the briefs).
Michael Anthony Amantia, Assistant County Counsel, argued the cause for respondent State of New Jersey (Paul R. Adezio, Mercer County Counsel, attorney; Michael Anthony Amantia, on the brief).
PER CURIAM
1 We use initials pursuant to Rule 1:38-3(f)(2). Appellant J.P. appeals from the November 16, 2022 civil commitment
order that continued his involuntary commitment and denied his request to
convert to voluntary admission status. The court found J.P. did not have the
capacity to make an informed decision regarding a change to his status as
required under Rule 4:74-7(g)(1). We affirm.
J.P. was admitted to Capital Health Regional Medical Center on October
21, 2022 after attempting to commit suicide by jumping in front of an oncoming
train. The severe injuries required the amputation of both legs.
J.P. had prior diagnoses of bipolar mood disorder, multiple sclerosis,
cannabis use disorder, and chronic alcohol abuse. He had been hospitalized
multiple times between July 2022 and these events in October 2022. In July
2022, J.P. ingested anti-freeze and received inpatient psychiatric care for
approximately one month. In August, he was admitted to Capital Health for
inpatient psychiatric care after voicing suicidal thoughts about planning to jump
in front of a train. He was also treated at other facilities. J.P. was last admitted
to the hospital approximately a week before these events.
After the October 21, 2022 admission, J.P. was screened regarding his
mental health status and two psychiatrists completed certificates for his
involuntary commitment—Nayan Bhatia, M.D., and Mohammad M. Bari, M.D.
A-1238-22 2 During the screening, J.P. stated he had been living at the Rescue Mission,
and he went to the train station to take his life. He did not know if he was
intoxicated and "only remember[ed] waking up in the hospital with both legs
amputated."
Dr. Bhatia indicated in his certificate that J.P. expressed "[s]uicidal
ideation with no specific plan at this time," and his insight and judgment were
poor. Dr. Bhatia concluded that J.P. was dangerous to himself because of his
suicide attempt, his continued suicidal ideation, and his inability to satisfy his
essential medical care and shelter needs because he was "depressed" and "unable
to take care of [him]self due to decompensated psychiatric illness." Dr. Bhatia
recommended inpatient care.
Dr. Bari found that J.P. exhibited "unpredictable" and "impulsive
behavior." He also found J.P.'s insight and judgment were poor, and he would
be a danger to himself because of his suicide attempt and his inability to satisfy
his essential medical care and shelter needs. He recommended that J.P. receive
inpatient psychiatric care.
The court ordered J.P. be temporarily involuntarily committed to Capital
Health. During the initial hearing on November 16, 2022, J.P. requested his
A-1238-22 3 status be converted to a voluntary commitment. County Counsel opposed the
application.
At the hearing, Dr. Bhatia testified that J.P. understood he struggled with
depression, and acknowledged he did not complete outpatient treatment or take
his medication after being discharged from hospitalizations. Dr. Bhatia noted
the prescribed medications had not been effective and despite his
hospitalizations, J.P. had not improved. Dr. Bhatia considered J.P. a danger to
himself because of his suicidal ideations and attempts. J.P. did not have a family
support system and continued to voice suicidal thoughts. Dr. Bhatia thought
that J.P. understood the need for psychiatric treatment, but he did not understand
the consequences of not taking his medication.
On cross-examination, Dr. Bhatia acknowledged J.P. had been diagnosed
with bipolar mood disorder but said "[i]t hasn't been fully established that he has
bipolar [mood] disorder. . . . It's still a work in progress as to what exactly his
diagnosis is." Dr. Bhatia stated that J.P. wanted to try Electroconvulsive
Therapy (ECT), although the doctor was not sure how much J.P. knew about
ECT. According to the doctor, J.P. could not answer why he stopped taking his
medication after prior discharges, but he had expressed the desire to continue
treatment.
A-1238-22 4 During J.P.'s testimony, he stated he did not follow up with his treatment
or medications after being discharged, although he would seek treatment again.
J.P. stated his brother supported him "[i]n a way," but did not provide any
details. J.P. confirmed he wanted to try ECT.
On cross-examination, J.P. admitted he did not know where he would be
living in thirty or forty days. He conceded that even though he was able to fill
his prescriptions while he was living at the Rescue Mission, he did not continue
taking them. J.P. said he knew that if he did not take his medication, he "would
go back to square one"; however, he felt his condition had not improved with
the medicine. He stated he still felt depressed and had suicidal thoughts when
taking the medication and he did not think that stopping the prescriptions would
make a difference.
The court issued an oral decision, finding that J.P. satisfied the criteria for
involuntary commitment and was a danger to himself "based upon the recent
incidents and the prior suicide attempts." The court stated J.P. did not have "the
capacity to make the determination regarding his continued health treatment in
the hospital." The court noted J.P. had suicidal ideations, had attempted to
commit suicide which resulted in the amputation of his legs, and that he did not
A-1238-22 5 comprehend the consequences of not taking his medication. The court
memorialized its decision in a November 16, 2022 order.
On appeal, J.P. contends the court erred in denying his application for a
conversion to voluntary commitment as the State did not prove he lacked
capacity to make the determination regarding his commitment status.
Rule 4:74-7 governs the civil commitment of adults. "[A]ppellate review
of a commitment determination is extremely narrow and should be modified
only if the record reveals a clear mistake." In re D.C., 146 N.J. 31, 58 (1996).
We give the "utmost deference" to a trial court's decision and only modify it if
there was an abuse of discretion. In re Commitment of J.P., 339 N.J. Super. 443,
459 (App. Div. 2001) (quoting State v. Fields, 77 N.J. 282, 311 (1978)). As
long as the trial court made "supportable findings," its decision should be
affirmed. In re Commitment of T.J., 401 N.J. Super. 111, 119 (App. Div. 2008).
However, "we have not hesitated to reverse involuntary commitments when the
record failed to contain clear and convincing evidence of '"a substantial risk of
dangerous conduct within the reasonably foreseeable future."'" Ibid. (quoting
In re Commitment of S.L., 94 N.J. 128, 138 (1983)).
To involuntarily commit an individual, the State must comply with
N.J.S.A. 30:4-27.2(m) and establish (1) the individual has a mental illness; (2)
A-1238-22 6 their mental illness must cause them to be dangerous to themselves, others, or
property; (3) they must be "unwilling to accept appropriate treatment voluntarily
after it has been offered"; and (4) they must need outpatient or inpatient care
because other services are not available or would not adequately meet their
needs. Rule 4:74-7(f)(1) tracks the statute in setting forth the same criteria.
In its oral decision, the court found that J.P. should be involuntarily
committed because he suffered from bipolar mood disorder and was a danger to
himself because of his suicide attempts. The court also found J.P. did not
understand the consequences of not taking his medication and stopped taking
his medicine each time he was discharged from inpatient treatment. Therefore,
although J.P. accepted treatment when hospitalized, he did not continue
treatment or medication after discharge. We are satisfied the State met its
burden to involuntarily commit J.P. and the court did not abuse its discretion in
ordering the commitment.
We turn to J.P.'s contention that he should be converted to voluntary
commitment status. Under N.J.S.A. 30:4-27.2(ee), a voluntary admission is
appropriate when an individual (1) has a mental illness; (2) their mental illness
causes them to be dangerous to themselves, others, or property; (3) they are
"willing to be admitted to a facility voluntarily for care"; and (4) they "need[]
A-1238-22 7 care at a short-term care or psychiatric facility because other facilities or
services are not appropriate or available to meet [their] mental health needs."
Under Rule 4:74-7(g)(1), an involuntarily committed individual can
request to be converted to voluntary status. A court must then "hold a hearing
within [twenty] days to determine whether the patient had the capacity to make
an informed decision to convert to voluntary status and whether the decision was
made knowingly and voluntarily." Ibid.
A voluntarily committed patient has the right to be discharged upon
request. N.J.S.A. 30:4-27.20. The discharge must take place within forty-eight
hours of their request unless the treatment team decides to initiate court
proceedings to involuntarily commit the individual. Ibid.
It is clear, under the applicable statutes, that a person cannot convert to
voluntary status unless they have the capacity to make a voluntary and knowing
decision and they are willing to receive voluntary care. N.J.S.A. 30:4-27.1(a)
and 27.2(m) establish "that a person should be involuntarily committed only
when the mentally ill person does not seek treatment of his own volition." In re
M.D., 251 N.J. Super. 19, 23 (Ch. Div. 1991). J.P. freely conceded he did not
seek treatment when he was not hospitalized and he did not take medication,
A-1238-22 8 even when he had filled prescriptions. J.P. was not willing to receive voluntary
care.
In addition, we cannot conclude the court abused its discretion in finding
J.P. did not have the capacity to make the knowing decision regarding his
commitment status. Dr. Bhatia stated J.P. did not understand the importance of
taking his medication because he stopped taking it when he left the hospital.
Not understanding the need for the medication establishes a basis for a lack of
capacity finding. In addition, the judge found J.P. was a danger to himself.
There was not just suicidal ideation—he had jumped into the path of an
oncoming train just days before.
We discern no basis to disturb the order of continued involuntary
commitment.
Affirmed.
A-1238-22 9