947 N.E.2d 1073
Mass.2011Background
- Erma, a ~50-year-old mentally ill woman under guardianship, has a history of refusing antipsychotic meds and numerous hospitalizations since 1991.
- Her husband has served as permanent guardian since 2003 under G. L. c. 201, § 6.
- In 2009 the Probate Court issued a substituted judgment treatment order authorizing injectable antipsychotics, expiring April 17, 2010, after a February 13, 2009 hearing.
- Prior substituted judgment orders and treatment plans existed from 2003–2006, with a 2006 order followed by hospitalization and transfer to a state hospital in 2007.
- In early 2009 the Department of Mental Health moved to intervene and reinstate/update the order; clinician’s affidavit and medical certificate were prepared by a nurse practitioner treating Erma since 2008.
- Erma appealed the 2009 substituted judgment order, but the court later held the appeal moot due to expiration and subsequent UPC changes, while noting a public-importance issue on notice requirements.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Is the appeal moot? | Order expired; UPC changes render appeal moot. | Two other related proceedings and current orders show ongoing interest; mootness not fatal. | Appeal dismissed as moot. |
| Did notice requirements satisfy due process for motions for substituted judgment orders? | Department failed to serve affidavits and medical certificate seven days before hearing. | Rule 6(c) requires seven-day notice, including for affidavits; failure violated notice requirements. | Notice requirements violated; failure to serve documents seven days prior was prejudicial. |
| Can a substituted judgment determination be based exclusively on affidavits and documentary evidence? | Due process requires live testimony; exclusive reliance on affidavit is improper. | Court did not necessarily base exclusive findings on affidavits; mootness precludes full resolution. | No definitive ruling due to mootness; issue not reached. |
| What governs the need for a separate order for substituted judgment to authorize antipsychotic treatment? | Statutory framework requires substituted judgment to authorize treatment separate from guardianship. | Guardianship-plus-secondary order is required; statutory context supports separation. | Court reiterates framework requiring a distinct substituted judgment order for treatment. |
Key Cases Cited
- Rogers v. Commissioner of the Dep’t of Mental Health, 390 Mass. 489 (1983) (substituted judgment and due process framework for antipsychotic treatment orders)
- Smith v. McDonald, 458 Mass. 540 (2010) (notice and due process considerations in substituted judgments; public importance noted)
- Wellesley College v. Attorney Gen., 313 Mass. 722 (1943) (principles of due process in administrative proceedings)