Rogers v. Okin

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738 F.2d 1
Rubie ROGERS, et al., Plaintiffs, Appellees,
v.
Robert OKIN, M.D., etc., et al., Defendants, Appellants.
Rubie ROGERS, et al., Plaintiffs, Appellants,
v.
Robert OKIN, M.D., etc., et al., Defendants, Appellees.
Nos. 79-1648, 79-1649.
United States Court of Appeals, First Circuit.

Heard April 4, 1984.
Decided June 14, 1984.

William L. Pardee, Asst. Atty. Gen., Government Bureau, Boston, Mass., with whom Francis X. Bellotti, Atty. Gen., and Carl Valvo, Asst. Atty. Gen., Government Bureau, Boston, Mass., were on brief, for Robert Okin, M.D., etc., et al.

Joseph H. Rodriguez, Laura M. LeWinn and Penelope A. Boyd, Trenton, N.J., on brief for N.J. Dept. of Public Advocate, Div. of Mental Health Advocacy, amicus curiae.

Richard Cole, Boston, Mass., with whom Robert Burdick, Boston, Mass., was on brief, for Rubie Rogers, et al.

Before CAMPBELL, Chief Judge, DAVIS* and COFFIN, Circuit Judges.

COFFIN, Circuit Judge.

This case concerns the rights of involuntarily committed mentally ill patients in Massachusetts to refuse antipsychotic drugs. It has involved all court levels in the federal system and the highest court of Massachusetts.

On April 27, 1975, Rubie Rogers and six other plaintiffs, all present or former mental patients in the May and Austin Units of the Boston State Hospital, filed suit against various officials and staff members of the hospital. The plaintiffs sought injunctive and monetary relief from the defendants’ practices concerning the forcible medication and seclusion of patients in non-emergencies. Following certification of the plaintiff class and a lengthy trial, the district court granted plaintiffs injunctive relief on both their medication and seclusion claims, but denied plaintiffs’ claims for damages under federal and state law. Rogers v. Okin, 478 F.Supp. 1342 (D.Mass.1979).

Defendants appealed only from the district court’s order enjoining the forcible use of antipsychotic medication. Defendants did not appeal from the district court’s order enjoining the seclusion of patients against their will. See Rogers v. Okin, 634 F.2d 650, 662 n. 12 (1st Cir.1980). Plaintiffs cross-appealed from the denial of their damages claims. We affirmed in part and reversed in part the district court’s injunctive order; we affirmed the district court’s denial of damages.1

On April 20, 1981, the Supreme Court granted certiorari to decide whether an involuntarily committed mental patient has a constitutional right to refuse treatment with antipsychotic drugs. 451 U.S. 906, 101 S.Ct. 1972, 68 L.Ed.2d 293 (1981); see Mills v. Rogers, 457 U.S. 291, 293, 298-99, 102 S.Ct. 2442, 2445, 2448-49, 73 L.Ed.2d 16 (1982). Defendants did not seek review of the seclusion injunction, and plaintiffs, as respondents, did not cross-petition from the denial of relief on their damages claims. Id. at 294 n. 2, 102 S.Ct. at 2445 n. 2.

With certiorari pending in the Supreme Court, on April 23, 1981, the Massachusetts Supreme Judicial Court issued its opinion in In re Guardianship of Roe, 383 Mass. 415, 421 N.E.2d 40 (1981). Roe involved the right of a noninstitutionalized, mentally incompetent person to refuse antipsychotic drugs. The Massachusetts court held that, absent emergency, a judge (rather than a guardian or a doctor) would have to determine whether a noninstitutionalized, incompetent ward could be forcibly medicated. The court, grounding its result in common law and federal constitutional law, found that the ward had a protected liberty interest in refusing treatment with antipsychotic drugs. If incompetent, the ward was entitled to a judicial determination of “substituted judgment”, that is, a judgment that approximated the ward’s subjective perspective. The court identified six “relevant” but “not exclusive” factors that should guide the decisions of judges making the substituted judgment determination. At — – —, 421 N.E.2d at 56-59.

In light of Roe and under the United States Supreme Court’s “settled policy to avoid unnecessary decisions of constitutional issues”, 457 U.S. at 305, 102 S.Ct. at 2451, the Court vacated our judgment and remanded for determination of whether the rights and duties of the parties could be determined entirely under state law. 457 U.S. at 305-06, 102 S.Ct. at 2451-52. The Court stated that an involuntarily committed patient’s right to refuse medication has both substantive and procedural aspects, and that state law may go further than the federal Constitution both in recognizing substantive liberty interests and in creating procedural protections for those interests. 457 U.S. at 299-300, 102 S.Ct. at 2448-49.

After briefing and oral argument as to a proper course on remand, we certified nine questions of state law to the Massachusetts Supreme Judicial Court. On November 29, 1983, the Massachusetts court issued detailed answers that clarified the nature and extent of a patient’s substantive and procedural rights under Massachusetts statutory, regulatory, and common law. Rogers v. Commissioner, 390 Mass. 489, 458 N.E.2d 308 (1983). These rights will be discussed in greater detail below.

Before we acted on the Supreme Judicial Court’s answers, the United States Supreme Court decided Pennhurst State School & Hospital v. Halderman, — U.S. —-, 104 S.Ct. 900, 79 L.Ed.2d 67 (1984), in which the Court held that the Eleventh Amendment bars federal courts from awarding injunctive relief that orders state officials to comply with state law. The Pennhurst holding places new limits on the role of the federal courts in this long-lived litigation. With regard to the forcible medication of involuntarily committed mental patients, Massachusetts recognizes substantive and procedural rights that extend above the floor set by the due process clause of the Fourteenth Amendment. Such rights emanating from state law are no longer directly enforceable by federal courts in injunctive actions against state officials. The federal courts retain the power and, in the circumstances presented by this suit, the obligation to decide the patients’ federal constitutional claims.

We pause to note the irony that results from rereading the Supreme Court’s Mills v. Rogers opinion in light of Pennhurst. In 1982, the Supreme Court avoided decision of a difficult federal constitutional question by remanding to this court, urging us to dispose of the case on state law grounds. 457 U.S. at 306, 102 S.Ct. at 2452.2 With Pennhurst, the Court removed our power to do so. Now, two years after the Supreme Court returned this case to us in furtherance the Court’s “settled policy” of avoiding unnecessary constitutional questions, Pennhurst requires us to face those questions. Fortunately, as will be indicated below, the Massachusetts Supreme Judicial Court’s answers to our certified questions of state law have simplified our current task by changing the variables in the constitutional equation.

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