Lane v. Fiasconaro

1995 Mass. App. Div. 125
CourtMassachusetts District Court, Appellate Division
DecidedSeptember 27, 1995
StatusPublished

This text of 1995 Mass. App. Div. 125 (Lane v. Fiasconaro) is published on Counsel Stack Legal Research, covering Massachusetts District Court, Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lane v. Fiasconaro, 1995 Mass. App. Div. 125 (Mass. Ct. App. 1995).

Opinion

Greco, J.

This is an appeal from orders of the Lawrence Division of the District Court Department committing the appellant to a mental health facility pursuant to G.Lc. 123, §8, and authorizing the appellant’s treating physician to administer elec-troconvulsive therapy (“ECT”) and antipsychotic drugs pursuant to G.L.c. 123, §8B.

The trial judge made detailed findings of fact which indicated that the appellant was a thirty-two year old female with two children. Her husband was incarcerated. On January 4, 1995, a month before the hearing of the petitions in this case, the appellant was admitted to a hospital because of a drug overdose, and remained in the intensive care unit in a coma for eight days. This was her third hospitalization within a year as a result of suicide attempts. The appellant had psychiatric hospitalizations in 1989 and 1990. During these various hospitalizations, she was diagnosed as suffering from major depression and having a dependent personality disorder. After her second hospitalization in 1994 (immediately prior to the one which resulted in the present G.L.c. 123, §§7, 8 petitions), she was “on out-patient therapy with medication... without apparent success.”

Upon discharge from the intensive care unit on January 17,1995, the appellant agreed to a voluntary commitment pursuant to G.L.c. 123, §10. While so committed, she could not identify any stress factors in her life, denied any suicidal ide-ation, and was unhappy with her doctor. She would become “severely depressed” and “angry.” She did not find that her family was supportive. On January 24,1995, after the issue was broached by her treating psychiatrist, the appellant indicated that “she did not want ECT but... agreed that she needed a longer hospitalization because of her depression and was cooperative with staff.” The next day, she refused the proposed ECT treatment plan without giving a reason. On January 26, 1995, she recognized that she was getting worse and needed help. She agreed to [126]*126ECT the next day. However, her attorney insisted on obtaining a second opinion as to the need for ECT. The doctor consulted for that opinion agreed that ECT was “clearly indicated.” On the advice of her attorney, however, the appellant decided not to undergo ECT and to await the results of the G.L.c. 123, §8B hearing. During the same period, she was also “receiving pressure from her mother and brother not to accept ECT.”

The hearing was held on February 7,1995. While the matter was under advisement, the court allowed the appellant’s motion for an independent examination. After such examination, further evidence was presented to the court on February 28, 1995. Between these two hearing dates, the appellant was uncooperative with her treating psychiatrist (Dr. Dalby), verbalized “feelings of anxiety,” was “abusive,” “angry” and “unapproachable” to hospital staff, and was “continually ... somewhat depressed.”

Two doctors (Dr. Dalby and Dr. Rabinowitz) concluded that the appellant was mentally ill. Although Dr. Rabinowitz did not find her to be suicidal, the court concurred with Dr. Dalby’s assessment that the appellant’s discharge from the hospital would create “a substantial risk of harm to herself as manifested by evidence of threats of, or attempts at, suicide or serious bodily harm.” The court also found, based on Dr. Dalby’s opinion, that there was no less restrictive alternative to the hospitalization proposed for the appellant in view of the fact that when previously treated in a less restrictive setting, she “ended up in the hospital after serious attempts to cause serious physical harm to herself.”

On the G.L.c. 123, §8 issue of competence, the court’s ultimate finding stated:

The respondent does not have the present ability to make informed decisions regarding her psychiatric treatment, including but not limited to, ECT, as shown by the following facts:
a. The patient denies that she is presently ill,
b. The patient does not understand the nature of her illness,
c. The patient does not understand the risks of nontreatment,
d. The patient’s delusions and mental illness are persistent and impair her judgment.

The only additional subsidiary finding made by the court, however, was that Dr. Rabinowitz had found that the appellant was improving with the administration of the drug, prozac. Dr. Rabinowitz concluded that “she was not in any immediate danger to herself and was competent.”

The balance of the court’s subsidiary findings of fact dealt with the advisability of ECT over the use of antipsychotic drugs. While Dr. Rabinowitz was of the opinion that ECT was “over-kill,” the court accepted Dalby’s recommendation for ECT. The court found that Dalby was an expert in the administration of ECT, that outpatient psychotherapy and medication had been unsuccessful in the appellants case, and that ECT had been effective in cases like hers. Also considered was the conclusion of the doctor who had given a second opinion in January, 1995 that ECT was “clearly indicated.”

1. Appellant’s counsel informed this Division at oral argument that the appellant was no longer hospitalized and that ECT had, in fact, never been administered. We are unable to consider the appellee’s position on either the issue of mootness, or the substantive questions herein, as the appellee neither filed a brief, nor appeared at oral argument. In any event, we have elected to decide this appeal on its merits because the types of issues presented in this case are “capable of repetition, yet evading review.” Superintendent of Worcester State Hospital v. Hagberg, 374 Mass. 271, 272 (1978). See also, Guardianship of Weedon, 409 Mass. 196, 197 (1991); [127]*127Thompson v. Commonwealth, 386 Mass. 811, 813 n.2 (1982). Moreover, a prior commitment and finding of incompetence may be relevant in any future proceedings involving the appellant.

2. The trial court found beyond a reasonable doubt that the appellant was mentally ill, that her discharge from the hospital would create a likelihood of serious harm, and that there was no less restrictive alternative to the proposed commitment. It is clear from these findings that the court employed the appropriate standard in its G.L.c. 123, §8 decision. See Commonwealth v. Nassar, 380 Mass. 908, 912 (1980); Superintendent of Worcester State Hospital v. Hagberg, supra at 275-277. Moreover, the court’s findings were amply supported by incontrovertible evidence of the appellant’s mental illness; by her failure to have responded in the past to outpatient psychotherapy and medication; and by her repeated and serious suicide attempts which the court found “could not be dismissed as gestures.” The last of these attempts was “virtually fatal,” resulting in her hospitalization and comatose condition for eight days. The appellant admitted that on that occasion “she did in fact plan to kill herself.” There was no error, therefore, in the court’s G.L.c. 123, §8 order.

3. The court’s G.L.c. 123, §8 commitment order was not determinative of the second petition before the court for authorization to administer electroconvulsive therapy (“ECT’) §. G.L.c. 123, §8B. In such a proceeding, “a distinct adjudication of incapacity to make treatment decisions (incompetence) must precede any determination to override patients’ rights to make their own treatment decisions.” Rogers v. Commissioner of Dept. of Mental Health,

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Related

Commonwealth v. Nassar
406 N.E.2d 1286 (Massachusetts Supreme Judicial Court, 1980)
Superintendent of Worcester State Hospital v. Hagberg
372 N.E.2d 242 (Massachusetts Supreme Judicial Court, 1978)
Guardianship of Weedon
565 N.E.2d 432 (Massachusetts Supreme Judicial Court, 1991)
Thompson v. Commonwealth
438 N.E.2d 33 (Massachusetts Supreme Judicial Court, 1982)
Rogers v. Commissioner of the Department of Mental Health
458 N.E.2d 308 (Massachusetts Supreme Judicial Court, 1983)
Simon v. Weymouth Agricultural & Industrial Society
389 Mass. 146 (Massachusetts Supreme Judicial Court, 1983)

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Bluebook (online)
1995 Mass. App. Div. 125, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lane-v-fiasconaro-massdistctapp-1995.