3 N.E.3d 92
Mass. App. Ct.2014Background
- LH, a 57-year-old with MS, was subject to substituted judgment proceedings to determine treatment with Risperdal.
- LHCC petitioned for guardianship and a proposed antipsychotic treatment plan after supporting documentation and medical certificates were filed.
- At the August 30, 2010 hearing, Dr. Joseph and Dr. Rosmarin supported treatment; LH opposed antipsychotics and guardianship.
- The probate judge found LH could rationally consent to treatment with monitoring and authorized the treatment plan, appointing a guardian and Rogers monitor.
- The plan expired December 6, 2010; in 2011 LHCC moved to reinstate the Rogers order and to permit injectable Risperdal due to LH’s oral refusals.
- The judge reinstated and expanded the Rogers order with injectable administration; LH appealed both the guardianship/treatment orders and the reinstate/modify order.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the evidence supports treatment with antipsychotics under Rogers. | LH contends treatment is inappropriate and coercive. | Petitioners argue substantial evidence supports need for antipsychotics to manage agitation and paranoia. | Yes; evidence supports substituted judgment and treatment. |
| Whether LH's counsel provided effective assistance of counsel. | LH asserts counsel failed to advocate her preferences and cross-examine effectively. | Petitioners contend record insufficient to show prejudice; trial record underdeveloped for new trial claims. | No; record insufficient to prove prejudice on direct appeal. |
| Whether the petition for guardianship and treatment plan was properly warranted. | LH's opposition undermines necessity for guardianship and coercive treatment. | Record supports need for guardianship to administer treatment and improve quality of life. | Yes; filed petitions and medical certifications justify proceedings. |
| Whether the injection form of Risperdal was properly authorized. | LH refused oral Risperdal; injection was a permissible modification to treatment. | Injection ensures consistent treatment given LH's refusal to take oral medication. | Yes; Rogers order appropriately reinstated and expanded to include injectable administration. |
Key Cases Cited
- Rogers v. Commissioner of the Dept. of Mental Health, 390 Mass. 489 (Mass. 1983) (establishes substituted judgment framework for involuntary antipsychotic treatment)
- Guardianship of Erma, 459 Mass. 801 (Mass. 2011) (discusses substituted judgment in involuntary antipsychotic contexts)
- Commonwealth v. Patton, 458 Mass. 119 (Mass. 2010) (prejudice standard for ineffective assistance in civil cases involving fundamental liberty interests)
- Commonwealth v. Saferian, 366 Mass. 89 (Mass. 1974) (establishes prejudice standard in ineffective assistance claims; reversed in some contexts)
- Care & Protection of Georgette, 439 Mass. 28 (Mass. 2003) (civil case treating substituted judgment; notes on capacity and rights)
- Guardianship of Roe, 383 Mass. 415 (Mass. 1981) (right to refuse medical treatment in guardianship context)
- Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728 (Mass. 1977) (right to humane treatment and substituted judgment principles)