This case is here on certiorari. Presented for decision are questions concerning our procedures under Code Ann. § 27-1503 (Ga. L. 1977, pp. 1293,1295) for committing to mental hospitals persons who have been found not guilty of crimes by reason of insanity. (Such persons will be referred to hereinafter at times as "insanity acquittees.”) In
Skelton v. Slaton,
1.
State Law Concerning Insanity Acquittals.
In Georgia, there is a presumption of sanity. Code Ann. § 26-606 (Ga. L. 1968, pp.
1249, 1270);Durham v. State,
Code Ann. § 27-1503 (a) requires the trial judge to instruct the jury to specify in their verdict if the accused is being acquitted of a crime because of mental incompetency or 'insanity at the time of the commission of the act. The court is required to retain jurisdiction over the person so acquitted and immediately inquire into the insanity of the person at the time of acquittal, and "upon a showing of good cause by the prosecutor, [the court] may defer ruling upon the same and order such person to be confined in a State mental hospital, to be selected by the Department of Human Resources for a period of not less than 30 days.” Code Ann. § 27-1503(a) further states that such persons who have been committed to the Department of Human Resources shall not be released from confinement unless and until the court which committed them, after notice and hearing, shall find and determine that such persons do not meet the criteria for civil commitment under Code Ch. 88-5 or 88-25.
Subsection (b) of Code Ann. § 27-1503 allows an application for the release of a person who has been committed to the Department of Human Resources under subsection (a), upon the ground that he does not meet the civil commitment criteria under Code Ch. 88-5 or 88-25, to be made to the superior court of the county from which he was committed. However, no hearing upon such application is allowed until the person committed shall have been confined for a period of not less than 30 days
Under Code § 38-118, there is a presumption of the continued existence of a mental state once proved to exist. Accordingly, it has been held in
Pennewell v. State,
2. Course of the Litigation in this Case. The appellant in this case was tried for murder in December of 1977 and found by the jury to be not guilty by reason of insanity. Pursuant to Code Ann. § 27-1503(a), the trial court ordered that he be confined to a state mental hospital. In April of 1979, he filed with the trial court an application for his release under Code Ann. § 27-1503(b), arguing that he did not meet the criteria for civil commitment set forth in Code Chs. 88-5 and 88-25.
In the release proceeding, the appellant also filed a motion for an order declaring Code Ann. § 27-1503 to be unconstitutional, in that: (1) it denies him the full panoply of due process protections accorded a person in civil commitment proceedings, i.e., notice, hearing, right to counsel, appeal, periodic review, etc.; and (2) the release provisions of Code Ann. § 27-1503 are more stringent than those applicable to other persons who have been civilly committed. The appellant filed another motion for an order declaring that the state, being the party seeking treatment of the appellant, has the burden of proving by clear and convincing evidence that the appellant meets the statutory criteria for civil commitment.
The trial court ruled that the proceedings in this case are civil in nature, being analogous to habeas corpus
At the release hearing, the physician treating the appellant at the mental hospital testified that the appellant is afflicted with schizophrenia, but that he is in a state of remission. The physician testified that, in his opinion, the appellant presents no substantial risk of imminent harm to himself or others and that he is not a mentally ill person requiring involuntary treatment. See Division 4, infra. However, the physician did admit that the appellant could have a relapse at any time if he did not take medication which has been prescribed for him in order to control his psychotic behavior. On cross-examination, the physician admitted that persons suffering from the appellant’s condition experience reluctance to take prescribed medication when not under supervision. The only other witness to testify at the release hearing was the appellant’s mother, who testified that the appellant had improved and that she did not consider him to be dangerous.
The trial court found that the appellant had committed the killing for which the previous murder charge had been brought after he had quit taking his medication upon being released from a mental hospital. The petitioner testified, "that’s how I got in trouble.” (The "trouble” was killing his grandmother.) The trial court further found that, as recently as two weeks prior to the release hearing, the petitioner’s treating physician had gone on vacation and the petitioner had refused to take his medication. The court ruled that the petitioner continues to meet the criteria for civil commitment, and the application for release was denied. On appeal, the Court of Appeals affirmed, holding that the evidence supports the trial court’s ruling that the appellant continues to meet the standard for involuntary commitment. Citing
Pennewell v. State,
supra, the Court of Appeals held that there was a presumption of insanity existing at the commencement of the release hearing. Relying on this
The question we must decide is whether it is constitutionally permissible to commit to a mental hospital an individual acquitted of a crime by reason of insanity without requiring the state to bear the burden of proving that he presently meets the criteria for civil commitment. The determination of this question requires a consideration of various decisions of the United States Supreme Court, as well as the procedures in Georgia generally applicable in civil commitment proceedings.
3.
United States Supreme Court Decisions.
In Lynch v. Overholser,
However, four years later, in Baxstrom v. Herold,
One year later, the court decided Specht v. Patterson,
The court held that the latter finding was not an ingredient of the offense of "indecent liberties” and, therefore, due process of law required that this finding be made by the trial court after conducting a hearing at which the defendant was extended the full panoply of relevant due process protections, to wit: notice, right to be present with counsel, opportunity to be heard, right to confront and cross-examine witnesses, and right to offer evidence. See also Vitek v. Jones, — U.S. — (Docket No. 78-1155; decided March 25, 1980).
In Bolton v. Harris, 395 F2d 642 (D.C. Cir. 1968), the District of Columbia Circuit Court of Appeals was called upon to assess the impact of Baxstrom and Specht upon
However, as recognized in Bolton v. Harris, supra, the treatment of persons acquitted of crimes by reason of insanity in a manner different from other civil committees is justifiable under the equal protection clause "to the extent that there are relevant differences between these two groups.” Bolton v. Harris, supra, 395 F2d at 651, or, as stated in Powell v. Florida, supra, if the different procedures "relate to a legitimate State interest.” 579 F2d at 332. Thus, although one acquitted by reason of insanity must be given a hearing on present mental condition, summary commitment is permissible for a limited period of time necessary for evaluation and diagnosis of the insanity acquittee. Ragsdale v. Overholser, 281 F2d 943 (D.C. Cir. 1960); New Jersey v. Krol, supra; Lee v. Kolb, supra. And, because insanity acquittees have demonstrated their dangerous propensities by committing prior criminal acts, judicial approval can be required for their release even though such approval is not required for the release of other civil committees. United States v. Ecker, 543 F2d 178 (D.C. Cir.
In 1972, in Humphrey v. Cady,
Humphrey had been convicted of contributing to the delinquency of a minor, a misdemeanor punishable by a maximum sentence of one year in prison. In lieu of sentencing, he was committed to the "sex deviate facility” in state prison, under the Wisconsin Sex Crimes Act, which authorized commitment for a period equal to the maximum sentence authorized for the crime. At the end of that period, the state could petition for the renewal of commitment for five years.
Humphrey argued that the original and renewal commitment procedures were unconstitutional under Baxstrom and Specht. The Supreme Court held that this claim was substantial enough to require a hearing to determine what justification existed for denying persons committed under the Sex Crimes Act of the jury determination afforded to other persons in civil commitment proceedings.
The State of Wisconsin argued that the same procedural safeguards afforded in a civil commitment proceeding were not required under the Sex Crimes Act, because commitment thereunder was triggered by a criminal conviction, and was merely an alternative to penal sentencing. In response to this argument, the court noted, "That argument arguably has force with respect to an initial commitment under the Sex Crimes Act, which is imposed in lieu of sentence, and is limited in duration to the maximum permissible sentence. The argument can carry little weight, however, with respect to the subsequent renewal proceedings. . .” 405 U. S. at pp. 510, 511.
Also in 1972, the Supreme Court decided Jackson v. Indiana,
In Jackson, the court noted with approval that the Baxstrom principle had been extended to commitments following an insanity acquittal in Bolton v. Harris, supra, Cameron v. Mullen, 387 F2d 193 (D.C. Cir. 1967) and New York v. Lally,
In the recent decision of Addington v. Texas, supra, the court has held that when the state brings an involuntary civil commitment proceeding, the due process clause of the Fourteenth Amendment requires the state to justify confinement of the individual by proof more substantial than a mere preponderance of the evidence, although the reasonable doubt standard applicable in criminal cases is not constitutionally required. Addington had been committed to a mental institution based upon proof of his mental illness by clear and convincing evidence. The court held that this standard of proof satisfied due process.
4.
Georgia Civil Commitment Statutes.
Code Ch. 88-5 (Ga. L. 1978, p. 1789 et seq.) establishes hospi
Under Code § 88-501 (a), "mentally ill” means "having a disorder of thought or mood which significantly impairs judgment, behavior, capacity to recognize reality, or ability to cope with the ordinary demands of life.” Code Ann. § 88-501 (v) defines "mentally ill person requiring involuntary treatment” as "a person who is mentally ill and (1) who presents a substantial risk of imminent harm to himself or others as manifested by recent overt acts or recent expressed threats of violence which present a probability of physical injury to himself or to other persons, or (2) who is so unable to care for his own physical health and safety as to create an imminently life-endangering crisis.”
Code Ann. § 88-2502 (a) defines "mental retardation” as "a state of significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior which originates in the developmental period.” Code Ann. § 88-2502 (d) defines "mentally retarded person in need of community services” as "a mentally retarded person who, after comprehensive evaluation and hearing, is found to be in need of community services as defined in Section 99-3303 (c) of the Community Services Act for the Mentally Retarded.”
Code Ann. §§ 88-502.18 and 88-2503.18 require that "representatives” or guardians ad litem be appointed on behalf of persons alleged to be mentally ill requiring involuntary treatment or mentally retarded in need of community services. Persons alleged to be mentally ill or retarded cannot be detained in a mental hospital beyond a brief evaluation period unless voluntary hospitalization is sought or a team of medical experts makes a recommendation that they be involuntarily committed. See Code Ann. §§ 88-506.2 (a), 88-2504 (d). If such a recommendation is made, a "full and fair hearing” must be conducted for the purpose of determining whether the person meets the criteria for involuntary civil commitment. Code Ann. §§ 88-506.2 (a), 88-2504 (e). The person sought to be committed and his "representative” or
In the case of an individual who is 17 years of age or older, the hearing is in probate court; and in the case of an individual who is under the age of 17 years, the hearing is in juvenile court. Code Ann. §§ 88-501 (a), 88-501 (r), 88-2502 (n), 88-2502 (p). Code Ann. §§ 88-501 (a) and 88-2502 (p) enumerate the following procedural safeguards which must be observed at the "full and fair hearing”: The person who is the subject of the commitment proceeding is entitled to the effective assistance of counsel, and if he cannot afford counsel, the court is required to appoint counsel for him. The person also has the right to refuse in writing the appointment of counsel. The person has the right to confront and cross-examine witnesses and to offer evidence. The person has the right to subpoena witnesses and to require testimony in person or by deposition from any physician upon whose evaluation the decision may rest. In addition, the court shall apply the rules of evidence applicable in civil cases; the burden of proof shall be upon the party seeking treatment of the person; and the standard of proof shall be by clear and convincing evidence. 5
5.
Conclusions.
In order to put our rulings in this case in focus, it is helpful to briefly review the relevant provisions of Code Ann. § 27-1503: subsection (a) requires the jury to specify in their verdict whether the defendant is being acquitted of the crime by reason of mental incompetence or insanity at the time of the commission of
Although Code Ann. § 27-1503 (a) does not define "good cause,” we interpret it to mean a showing that there is reasonable cause to believe that the defendant presently meets the criteria for civil commitment. The summary commitment of the defendant for evaluation for a period not less than 30 days is constitutionally permissible. Ragsdale v. Overholser, supra; Bolton v. Harris, supra; New Jersey v. Krol, supra; Lee v. Kolb, supra.
The next question which arises is whether Code Ann. § 27-1503 is constitutionally deficient in that it does not require that a hearing be held after the 30-day evaluation period, even though it allows the defendant to invoke a hearing by filing an application for release.
We hold that all that due process requires is that the insanity acquittee be given a right to a hearing. This is a constitutional right, but, like other constitutional rights, it can be waived. The waiver is accomplished here if the insanity acquittee, or his appointed "representative” or guardian ad litem,
6
declines to file an application for release. Code Ch. 88-5 expressly gives the mentally retarded person the right to waive his commitment hearing. See Division 4, supra. Therefore, there is no equal protection violation. In addition, a hearing on the defendant’s application for release has been held in this case; therefore, any due process problem arising from § 27-1503’s failure to require a hearing has become moot.
This case resolves itself into essentially two other questions:
(1) What procedural safeguards that are observed at other civil commitment hearings must be observed when there is a hearing on the question of whether a person acquitted of a crime by reason of insanity meets the criteria for civil commitment?
(2) Where a person acquitted of a crime by reason of insanity is ordered committed to a mental hospital under § 27-1503 (a), and files an application for release under § 27-1503 (b), who bears the burden of proof on the question of whether such person presently meets the criteria for civil commitment?
When there is a hearing on the question of whether a person acquitted of a crime by reason of insanity meets the criteria for civil commitment, equal protection requires that the following rights, which are extended to other people in civil commitment proceedings, be extended to the insanity acquittee:
(1) Notice of the right to the hearing. Code Ann. §§ 88-506.2 (a) (1), 88-2504 (e). (Thus, after expiration of the 30-day period specified in § 27-1503 (a), the insanity acquittee and his "representatives” or guardian ad litem are entitled to notice of his right to obtain a hearing by filing an application for release.)
(2) Notice of the right to counsel and the right to have counsel appointed if the person cannot afford counsel. Code Ann. §§ 88-506.2 (a) (2), 88-2504 (e) (2).
(3) The right to confront and cross-examine witnesses and to offer evidence. Code Ann. §§ 88-501 (u), 88-2502 (p).
(4) The right to subpoena witnesses and to require testimony be given in person or by deposition from any physician upon whose evaluation the decision may rest. Id.
(5) Notice of the right to have established some sort of individualized plan specifically tailored to the person’s treatment needs. Code Ann. §§ 88-501 (w), 88-506.2 (a) (3), 88-2502 (i), 88-2504 (e) (3).
(6) Notice of the right to be examined by a physician of his own choosing at his own expense. Code Ann. §§
(7) The insanity acquittee also has a right to have "representatives” or guardian ad litem appointed in his behalf. When other persons are ordered committed to mental hospitals, Code Ann. §§ 88-502.18 and 88-2503.18 require that "representatives” or guardians ad litem be appointed in their behalf. In order that the insanity acquittee be treated equally, and in order that the previously enumerated rights of the insanity acquittee be safeguarded, "representatives” or guardians ad litem should be appointed in his behalf also.
It is, however, permissible to require judicial approval before the insanity acquittee can be released, even though other persons cannot be involuntarily committed unless a team of medical experts so recommends. See Code Ann. §§ 88-506.2 (a), 88-2504 (d).
The final question for decision concerns the allocation of the burden of proof in a release proceeding under § 27-1503 (b). In order to answer this question, we must first determine whether the insanity acquittal can be accurately viewed as an adjudication that the defendant met the criteria for civil commitment at the time the act was committed. If that question is answered in the affirmative, we must then determine whether the presumption of the continuation of a mental state once proved to exist can be constitutionally applied so as to relieve the state of the burden of proof at the release hearing.
In this case, the appellant’s acquittal of murder by reason of insanity necessarily constituted a finding by the jury that, at least at the time the act was committed, the appellant met the criteria for civil commitment under Code Ann. §§ 88-501 (a) and (v), defining "mentally ill person requiring involuntary treatment” as a person "having a disorder of thought or mood which significantly impairs judgment, behavior, capacity to recognize reality, or ability to cope with the ordinary demands of life... and (1) who presents a substantial risk of imminent harm to himself or others as manifested by either recent overt acts or recent expressed threats of violence which present a probability of physical injury to himself or to other persons ...”
However, in both original and renewal commitment proceedings, the burden of proof under Code Ann. §§ 88-501 (u) and 88-2502 (p) would be on the party seeking treatment of the patient. In this release proceeding, the burden of proof was cast on the appellant, because of the presumption of the continuation of a proven mental state and because the moving party generally bears the burden of proof in civil cases. See Code § 38-103. Code Ann. §§ 88-501 (u) and 88-2502 (p) do state that the court shall apply the rules of evidence applicable in civil cases.
Other courts have recognized the constitutional validity of requiring insanity acquittees to bear the burden of proving their fitness for release in order to obtain release from a mental hospital, where a similar burden of proof was placed on other civil committees seeking release. See Dorsey v. Solomon, 604 F2d 271 (4th Cir. 1979); New Hampshire v. Hesse,
The question we have to decide is whether the insanity acquittee is denied equal protection of the law, if he is required to bear the burden of proving his fitness for release while other civil committees are not. We hold that no equal protection violation occurs, because, as
Those courts which have forbidden insanity acquittees from being committed on the basis of a presumption of insanity arising from the jury verdict of not guilty by reason of insanity have noted that, under the law of the particular jurisdiction, the insanity acquittal raised only a reasonable doubt as to the defendant’s sanity at the time of the offense. Waite v. Jacobs, 475 F2d 392, supra, p. 396; Powell v. Florida, 579 F2d 324, supra, p. 330; Lee v. Kolb, 449 FSupp. 1368, supra, p. 1374; Allen v. Radack, 426 FSupp. 1052, supra, p. 1058. However, in Georgia, the defendant is required to establish his insanity by a preponderance of the evidence.
Durham v. State,
We are of the opinion that the appellant’s insanity acquittal clearly and convincingly established that he met the criteria for civil commitment at the time he
Nor are the other previously cited Supreme Court decisions violated, as long as the defendant is able to obtain a post-acquittal hearing at which (1) there is a judicial inquiry into his present mental condition, and (2) he is afforded substantially the same procedural safeguards that are extended in other civil commitment hearings. This was done in the present case. We find no error.
Judgment affirmed.
Notes
The general plea of insanity must be distinguished
As noted in Lynch, this statute was enacted by Congress for the District of Columbia, because it was anticipated that a high rate of insanity acquittals would follow in the wake of implementation of the "Durham rule.” Under the "Durham rule,” a person is held not to be criminally responsible for his acts if such person was suffering from mental illness and the crime is a product of that illness.
As the court stated in Baxstrom, "Classification of mentally ill persons as either insane or dangerously insane of course may be a reasonable distinction for purposes of determining the type of custodial or medical care to be given, but it has no relevance whatever in the context of the opportunity to show whether a person is mentally ill at all. For purposes of granting judicial review before a jury on the question whether a person is mentally ill and in need of institutionalization, there is no conceivable basis for distinguishing the commitment of a person who is nearing the end of a penal term from all other civil commitments.” 383 U. S. at pp. 111-112.
The United States Supreme Court employs a two-tiered analysis in determining equal protection claims. The state need only show a rational basis for treating people differently unless the differential treatment involves "invidious standards” or infringes upon "fundamental rights,” in which case a "compelling state interest” must be shown. In Baxstrom, Humphrey, and Jackson, supra, it is unclear whether the Supreme Court is applying the rational basis test or the strict scrutiny test. See New Jersey v. Krol, supra,
Code Ann. § 88-501 (u) provides: " 'Full and fair hearing or hearing’ shall mean a proceeding before a hearing examiner, under § 88-506.5, or before a court, as defined in subsection (r) of this section. The hearing may be held in a regular courtroom or in an informal setting, in the discretion of the hearing examiner or the court, but the hearing shall be electronically recorded or recorded by a qualified court reporter. The patient shall be provided with effective assistance of counsel. If the patient cannot afford counsel, the court shall appoint counsel for him or the hearing examiner shall have the superior court
The provisions of Code Ann. § 88-2502 (p) are comparable.
As held infra, the insanity acquittee has a right to have "representatives” appointed to guard his interests.
In Kovach, the Supreme Court dismissed for want of a substantial federal question a state court judgment requiring an insanity acquittee, who had been automatically committed, to bear the burden of proving his fitness for release in habeas corpus proceedings.
