OPINION
As appears from our opinion in Dixon v. Attorney General of Commonwealth of Pennsylvania,
The named plaintiffs and those situated like unto them, constituting the single class as described, were committed to Farview pursuant to Section 404 in the following manner: (a) The applications for these recommitments were not made by a relative or guardian or person standing in loco parentis to these people, (b) The applicant for recommitment was the Director of Social Services of Farview or another member of the Farview staff, (c) The applications were supported by certificates of two physicians who were members of the staff of Farview. (d) The applications were submitted to the Superintendent of Farview who “received” the persons named in the application, (e) The persons thus committed were not consulted coneerning their wishes about continued confinement or given notice of the filing of the applications by the Director of Social Services or others on the staff at Farview. (f) No relative, guardian or friend was consulted by the Director of Social Services or others on the staff at Farview concerning the continued confinement of these persons, (g) The persons thus committed were not represented by counsel in the proceedings leading to their recommitments, (h) These persons had no independent psychiatric diagnosis or psychological evaluation in connection with either the decision of the Director of Social Services to apply for commitment or the certifications by physicians that they were mentally disabled and in need of care, (i) No court made a finding that these recommitted persons required inpatient care, (j) There is no period fixed by the statute after which persons committed under Section 404 must be released.
*969 In respect to Farview itself the following facts appear. The hospital is situated near Waymart, Wayne County, Pennsylvania, and Wayne County is the extreme northeastern county of the Commonwealth of Pennsylvania. It is approximately 141 auto miles from Philadelphia and approximately 340 auto miles from Pittsburgh, the two cities named being the largest in the Commonwealth. Because of these distances from Farview it is difficult for many of the inmates to maintain contact with family and friends and also for Farview to attract psychiatrists to its staff. From the time of its establishment in 1912 up to and including the present time this institution had been the one mental health facility in Pennsylvania specifically designed and designated to provide maximum security care for the criminally insane and others. No mental institution in Pennsylvania other than Farview presently accepts, on any other than a temporary basis, persons who are under criminal sentence or individuals requiring confinement under conditions of maximum security because they are or are believed to be dangerous to themselves or others.
At the time the complaint was filed the medical staff at Farview consisted of the Superintendent, who is a psychiatrist, and five physicians, none of whom had had psychiatric experience before joining the Farview staff and none of whom have attained professional recognition as a psychiatrist. At the time the complaint was filed, the remainder of the Farview staff, housekeeping personnel excepted, consisted of two psychologists, two social workers with master’s degrees, and two case workers, one of whom held a bachelor’s degree, one recreational therapist, five registered nurses and twelve licensed practical nurses.
At the time the answer was filed there were at Farview approximately four hundred psychiatric security aides who functioned primarily as guards, and the regimen for inmates of Farview consisted almost entirely of custodial care, the prescribing and administering of drugs, a modicum of recreation and, for a small number of inmates, assignment to jobs at Farview which were in substance housekeeping positions.
We cannot avoid the conclusion that medical-psychiatric treatment of inmates at Farview was grossly inadequate not because of lack of willingness or competency of the Superintendent, Dr. John Shovlin, or of his staff, but because of the woeful inadequacy of the funds made available by the Commonwealth of Pennsylvania or its agencies to Farview for its maintenance and staffing. It is conceded that only three per cent of the inhabitants of Farview received any therapeutic-psychiatric treatment.
Some of the evidence given at the hearing of July 22-23, 1970, concerned “Operation Baxstrom” in New York, which entailed the transfer of all inmates of the two maximum security mental hospitals in New York having backgrounds essentially similar to those of the plaintiffs in this case. Almost one thousand inmates of the two New York hospitals referred to were transferred in 1966 to various non-maximum security state mental hospitals in New York. The so-called
“Baxstrom Operation”
was undertaken because of the decision of the United States Supreme Court in Baxstrom v. Herold,
The consensus among the psychiatrists testifying for the plaintiffs, who were well qualified in the opinion of the court as experts, was to the effect that it is unnecessary to have special maximum security facilities for civil patients; that confinement in a maximum security institution is adverse to rehabilitation; and that, at worst, a comparatively small proportion of criminally insane persons should be committed to maximum security institutions such as Farview.
*971 Dr. John Shovlin, the Superintendent at Farview, whom we find well qualified as an expert, testified however that during the past year, i. e., 1969-70, the Far-view staff had been augmented by eight college-level ward counselors through a federal grant running for two years. He pointed out there was a full time chaplain with pastoral training and three part time chaplains.
Shortly after the commencement of the suit at bar the Administration at Far-view began the transfer of patients to other institutions of lesser maximum security or placed some of the inmates at liberty in the community. On January 8, 1971, at the time of a post-trial hearing, 5 it was agreed that only fifteen persons of the class of the plaintiffs were then present at Farview, and that one of these insisted on staying at Farview and did not desire to be transferred to any other institution or to be set at large.
Further facts must be stated in order that the record in this case may be clear. Motions by the plaintiffs for summary judgment and for interim relief were heard on March 13, 1970. As appears in
The plaintiffs contend that Section 404 is unconstitutional on its face and also as applied to plaintiffs. We agree. As indicated earlier, see note 1,
supra,
the constitutional challenge to Section 404 is substantial.
7
Indeed, the defendant does not contend otherwise. There is no need for abstention here even under the strict standard of Younger v. Harris,
We entertain no doubt that Section 404 of the Pennsylvania Mental Health and Mental Retardation Act of 1966 (50 P.S., Section 4404) is unconstitutional on its face when viewed in the light of such decisions as Specht v. Patterson,
In the later case of
Gault
the defendant, fifteen years of age, was taken into custody because of lewd telephone calls. After hearings in a juvenile court, Gault, defined as a delinquent child under Ariz. Rev.Stat., Section 8-201-6 (d), was committed to a state industrial school in Arizona without: “1. Notice of the charges; 2. Right to counsel; 3. Right to confrontation and cross-examination; 4. Privilege against self-incrimination; 5. Right to a transcript of the proceedings ; and 6. Right to appellate review.”
We find Section 404 to be almost completely devoid of the due process of law required by the Fourteenth Amendment. That at least one high state tribunal takes the position that committing procedures and rules of commitment should be the same in a civil proceeding as in a criminal or quasi criminal one is demonstrated by the decision of the Court of Appeals of Kentucky in Denton v. Commonwealth,
The issue as to whether Section 404 has been unconstitutionally applied to the plaintiffs need not detain us long. An examination of the transcript of the *973 hearing of March 13,1970 shows that the process of “recommitment” concededly was by way of a “paper notation”, without any formal hearing or process whatsoever. Counsel for the defendant stated very candidly to the court in respect to the processing of individuals for “recommitment” under Section 404 the following:
“Mr. Work: When I used the word ‘paper notation’ Your Honor, I mean that the procedure as used, and as quite appropriately pointed out by plaintiffs in their brief and in their complaint, was a mere certification usually by two staff physicians of the facility.
“Judge Biggs: Well, was this a report by the physician or was it an oral report simply noted, or of that can’t you inform us?
“Mr. Work: It was written, Your Honor, on a specific form which the Department has for a certificate, a physician’s certificate.
“Judge Biggs: And that’s what you mean by a ‘paper notation’ ?
“Mr. Work: Yes, which was then merely attached to the so-called Superintendent’s Certificate of Acceptance and the individual was then deemed to be committed.” 11
We declare Section 404 to be unconstitutional on its face and in its application to the plaintiffs and others of their class.
The foregoing is deemed to constitute findings of fact and conclusions of law as required by Rule 52(a), Federal Rules of Civil Procedure, 28 U.S.C.
ORDER
And now, this 22nd day of April, 1971, the parties having consented through their attorneys to a finding by this Court that the commitments of all members of the class of plaintiffs are invalid under the United States Constitution, and the parties having further consented through their attorneys to the relief to be provided to the members of the class of plaintiffs by defendants through a Final Order of this Court, it is hereby ordered that the following provisions of the Consent Agreement between the parties providing for relief become the Final Order and Decree of this Court:
Terms: As used in this Order, the term “facility” means any state or county establishment, hospital, clinic, institution, or other organizational unit or part thereof, except Farview State Hospital, for treatment of the mentally ill.
I. Section 404 Of The Mental Health And Mental Retardation Act Of 1966
Defendants shall cease and desist from obtaining commitments under Section 404 of the Mental Health and Mental Retardation Act of 1966, and from accepting patients who have been committed under this provision. As of the date of this Court’s Order the class of plaintiffs will be closed.
II. Members Of The Class Of Plaintiffs At Facilities Or On Leave From Facilities
A. Each person will be discharged or newly committed within sixty (60) days of this Order except in cases where time extensions are authorized pursuant to .fifí II-D, IV-B, and IY-C. Discharge, where considered appropriate, shall take place at the earliest possible time.
B. Prior to any new commitment being sought, the receiving facility shall, for each of its patients who are members of the class of plaintiffs, if it has not already done so,
1) Evaluate such person using appropriate psychiatric, psychological and social work personnel;
2) Aid such person in contacting his nearest relative or relatives;
3) Develop a treatment program for such person, and discuss same with him and interested family.
C. No new involuntary commitment of a member of the class shall be sought without the receiving facility first exploring with the patient and interested *974 family whether a voluntary arrangement including the minimum restraint considered necessary by the facility is acceptable to the patient. This arrangement may include voluntary commitment to the facility or such informal relationships as are mutually agreeable.
D. Where no agreement can be reached between the facility and patient, and the facility determines that it will seek an involuntary commitment, the Guardian shall be informed of the treatment program developed for the patient and the minimum restraints believed necessary by the facility and reasons for this belief. Where the Guardian desires to communicate with the patient, the time limitation of f II-A may be extended up to 30 additional days.
III. Involuntary Commitments
The Secretary of Public Welfare, the Commissioner of Mental Health, and the Attorney General and their representatives and successors will assure that any new involuntary proceedings for members of the present class of plaintiffs will be in accordance with the following principles :
1) The subject thereof shall be informed of his right to counsel and an attorney shall be appointed to represent him unless he can afford to retain an attorney himself.
2) The subject thereof shall be entitled to independent expert examination and assistance in preparation for the hearing, through court appointment where the subject cannot afford to retain these services. Communications between the subject and the expert described herein shall be privileged.
3) The subject thereof shall be entitled to a full hearing at which he shall have the right to present evidence in his own behalf, to subpoena witnesses and documents, and to confront and cross-examine all witnesses against him.
4) The standard for commitment and the burden of proof shall be as follows: the evidence found to be reliable by the factfinder must establish clearly, unequivocally and convincingly that the subject of the hearing requires commitment because of manifest indications that the subject poses a present threat of serious physical harm to other persons or to himself. No commitment shall authorize confinement at Farview State Hospital absent a specific finding based on a preponderance of the evidence that placement at Farview State Hospital is necessary. To support such a finding the Commonwealth shall have the burden of proving that there is no facility or part of a facility where the subject of the hearing can be committed.
5) If the court orders commitment, it shall specify the maximum period of time for which its order authorizes commitment, which in no event shall exceed six months. The court order shall permit the facility having charge of the committed person to take whatever action toward greater liberty that appears to it to be in such person’s best interest without obtaining court approval, including placing such person on partial hospitalization, on outpatient care, on leave of absence, or discharging him.
6) There shall be a verbatim transcript and full record made of the commitment proceedings, and any member of the class committed pursuant to these proceedings shall have the right to state appellate court review, including provision for assistance of counsel and record and transcript without cost if he is unable to pay the cost thereof. Any person committed will be advised of his rights with respect to appeal by the court at the time of commitment.
IV. Members Of The Class Of Plaintiffs At Farview State Hospital
A. The Guardian shall be notified of any member of the class of plaintiffs who wishes to remain at Farview State Hospital. If the Guardian believes that this person understands the decision he is making the Guardian shall certify that he has no objection to such person’s remaining at Farview State Hospital. Such person shall be allowed to become a voluntary commitment.
*975 B. Apart from the preceding provision, and except as provided below, members of the class of plaintiffs still at Farview State Hospital shall be transferred within forty-five (45) days from Farview State Hospital to a facility. The receiving facility shall be selected on the bases of proximity to the patient’s closest family and of the patient’s county of residence at the time of commitment, unless another facility would be more appropriate for treatment or unless it appears that the patient can only be placed outside Farview State Hospital at another facility. Each member of the class transferred under this provision will come under the provisions of Section II of this Order, and the time limitations of that Section shall become effective as of the date of transfer.
C. In exceptional cases, where the Commissioner of Mental Health and Mental Retardation maintains that a member of the class of plaintiffs at Farview State Hospital cannot, for the purposes of diagnostic evaluation, be placed in any facility, the Commissioner shall report fully to the Guardian as to the reasons for this conclusion in each instance. If no agreement can be reached between the Commissioner and the Guardian, a hearing shall be held before one judge of this Court in which the Commissioner shall have the burden of proving to the Court that the particular member of the class cannot be placed in any facility for purposes of diagnostic evaluation. The record of the hearing held before this three-judge Court on July 22 and 23, 1970, may be incorporated in such a proceeding on the motion of either party, and defendants shall provide funds for the Guardian to retain counsel and in addition expert assistance of the Guardian’s choice to evaluate the patient as fully as possible and otherwise assist in preparation for the hearing. All costs, including fees for counsel and expert, shall be determined by the Judge before whom the hearing takes place at the conclusion of the hearing and charged to the Commonwealth. If the patient is transferred by order of the Court, he shall come within the provisions of Section II of this Order with a suitable extension of time if necessary. In the event that the Court orders that a member of the class of plaintiffs not be transferred from Farview State Hospital, or the Guardian agrees that a member not be transferred, and the patient does not agree to a voluntary commitment, involuntary commitment proceedings shall be in accordance with Section III of this Order and shall take place in the patient’s county of residence within forty-five (45) days of the Court’s order or Guardian’s agreement.
V. Transfer Back To Fairview
No member of the class of plaintiffs transferred from Farview State Hospital shall be returned to Farview State Hospital prior to a new commitment being obtained.
VI. Protection Of Guardian From Civil Liability
The Guardian shall not be subject to civil litigation or liability, in any form, for any action or inaction in the discharge of his duties or functions as Guardian, except that any party in interest may at any time petition to have the Guardian substituted, removed, or the Guardianship terminated.
VII. Reports On Disposition Of Members Of The Class Of Plaintiffs
The parties agree that they shall attempt to provide final relief for all members of the class of plaintiffs in accordance with this Order as expeditiously as possible. The Commissioner of Mental Health shall make a report on disposition of members of the class to the Court and Guardian ninety (90) days from the date of this Order, and shall make a final such report one hundred and fifty (150) days from the date of this Order.
Notes
. See
. Section 404 of the Pennsylvania Mental Health and Mental Retardation Act of 1966, 50 P.S., Section 4404, provides:
“Commitment on application by relative, etc.; physicians’ certificates; review (a) A written application for commitment to a facility may be made in the interest of any person who appears to be mentally disabled and in need of care. It may be made by a relative, guardian, friend, individual standing in loco parentis to the person to be committed, or by the executive officer or an authorized agent of a governmental or recognized nonprofit health or welfare organization or agency or any responsible person.
“(b) Such application shall be accompanied by the certificates of two physicians who have examined the person whose commitment is sought, within one week of the date of the certificates, and who have found that, in their opinion, such person is mentally disabled and in need of care. In the case of a mentally retarded person, the physicians’ certification shall be accompanied by the report of a psychologist. No person shall be committed hereunder if any certificate is dated more than thirty days prior to the date of commitment, except that if the mental disability consists of mental retardation, the certificates may be dated not more than three months prior to the date of commitment. The application, certificates and the report, if any, shall be signed and sworn to or affirmed.
“(e) The director may receive the person named in the application and detain him until discharge in accordance with the provisions of this act. When application is made by any person other than a relative or guardian, the director upon reception of the person named in the application shall notify the appropriate relative or guardian of such person of the commitment.
“(d) Every commitment made under this section except those to the Veterans Administration or other agency of the United States Government, shall be reviewed at least annually by a committee appointed by the director from the professional staff of the facility wherein the person is detained, to determine whether continued care and commitment is necessary. Said committee shall make written recommendations to the director which shall be filed at the facility, and be open to inspection and review by the department, and such other persons as the secretary, by regulation, may permit.”
. See also Requests for Findings of Fact and Conclusions of Law filed by the plaintiffs, in particular Paragraph “C”, “Commitment under Section 404,” p. 5. The defendants have indicated that they did not wish to file Requests and have not done so.
. In this case, decided February 23, 1966, Mr. Chief Justice Warren delivered the opinion of the Court and stated at 108,
The Supreme Court held the pertinent New York statutes unconstitutional in their application to Baxstrom on the ground that they denied him equal protection of the laws guaranteed by the Fourteenth Amendment. As will appear later, we do not rely on the Equal Protection Clause in the case at bar.
Following Baxstrom, a large number of inmates were transferred from Dannemora and from another state institution of maximum security, the Matteawan State Hospital, to institutions of lesser security. It has been testified to and we accept as correct the testimony that few of the persons thus transferred have had to be returned to Dannemora, Matteawan, or to any other institution of maximum security. See testimony of Doctors Hunt, Fox, Bappeport, and Bartlett; hearing of July 22-23, 1970, Tr. respectively, pages 24, 96, 222, 244. Cf. testimony of Dr. John Shovlin, Superintendent of Farview, Tr. p. 258.
. A court reporter was present at this informal hearing but her notes were not directed to be transcribed by court or by counsel.
. The reasons for the appointment of an
amicus curiae
and guardian
ad litem
are set out in Dixon,
supra,
. See again 313 F.Supp., note 3 cited to the text at 654. Cf. Ex parte Poresky,
. Colo.Rev.Stat.Ann., Section 40-2-32 (1963).
. Colo.Rev.Stat.Ann., Sections 39-19-1 to -10 (1963).
. Pa.Stat. Tit. 19, Sections 1166 and 1170 (1964).
. Transcript, Hearing 3/13/70, pp. 97-98.
