The opinion of the court was delivered by: DOUGLAS EATON, Magistrate Judge
This case involves an involuntary commitment to Bellevue Hospital.
The case was assigned to me for all purposes on August 20, 2003. I
presided at the jury trial on November 3-6, 2003. The jury returned a
verdict of $1,000,001 in compensatory damages.
On December 19, defense counsel served a timely motion for judgment as
a matter of law, or a new trial on all issues, or at least a
On January 23, 2004, plaintiff's counsel served an opposing memorandum
and a declaration which annexed the trial transcript ("Tr.").
On February 14, 2004, defense counsel served a reply memorandum.
During the trial, it was undisputed that plaintiff had a serious mental
illness. The issue was whether he was dangerous. Plaintiff Robert Marion
was born in 1941 in North Carolina and has lived in New York City since
1970, mainly in the East Village. In 1985 a car hit his bicycle; while he
was recuperating from injuries to his head, neck and back, he "started
seeing the world, reality more and more, how the corporations were
fleecing the world." (Tr. 221.) Since then, he has had no regular
employment. He has been receiving Social Security disability payments
since about 1993. (Tr. 221-23; Exh. 1 p. 39; Exh. 2 p. 16.) In 1995 and
1996, he received prescriptions for two anti-psychotic medications,
Thorazine. (Tr. 189-92.) In June 1996, the Stuyvesant Polyclinic
discharged him from its outpatient mental health program.
. . .[This discharge was] due to the impression by
the doctors [at Stuyvesant] that he was no longer
benefitting from his [outpatient] treatment there. A
question was raised with regard to Mr. Marion's
treatment compliance, although his treating
psychiatrist did note that he was taking at least some
of the medication dosages. It appears that they
considered his preoccupation with political causes the
primary obstacle to successful treatment and
discharged him without recommending any other
(Tr. 193.) Plaintiff's expert psychiatrist, Dr. Peter Stastny, first
examined him in February 2001. Dr. Stastny reached a preliminary
diagnosis of schizo-typal personality disorder. In our case the crucial
date is December 23, 1998, when Marion was involuntarily committed to the
psychiatric ward of Bellevue Hospital. Although Dr. Stastny was not at
Bellevue, he reviewed Bellevue's records and testified:
For that particular day, I believe the most likely
diagnosis would have been adjustment disorder with
mixed emotional features. . . .
Marion's six-day stay in Bellevue is the only time he has ever been an
inpatient in a mental hospital. Except during those six days, there is no
evidence that anyone ever found him to be dangerous to himself or to
others, or that anyone ever complained that he had made any threats of
violence or committed any acts of violence. He has lived in New York City
for the past 33 of his 62 years. He is of medium height and weight.
During the month prior to December 23, 1998, Marion had visited
Bellevue's medical department four times as a diabetes patient who needed
some diabetes-related surgery. (Tr. 75.) He believed that December 23 was
the date for his surgery. That morning, when he came to Bellevue, the
reception staff either told him that he was mistaken, or told him that
Bellevue had postponed the surgery date. (Tr. 223-24.) In any event, he
became angry. Instead of escorting him to the sidewalk, the staff
escorted him within the building to the Psychiatric Emergency Room (also
known as CPEP, for Comprehensive Psychiatric
Emergency Program, Tr. 280, 288).
At trial, the parties submitted a written stipulation concerning the
legal requirements for an involuntary commitment, (Exh. 3, read by the
jurors at Tr. 262.) This stipulation included the following:
3. . . . New York Mental Hygiene Law § 9.39
authorizes [involuntary] admission only when the
mental illness . . . is likely to result in serious
harm to the person himself or to others.
4. Under New York Mental Hygiene Law § 9.39 "likely
to result in serious harm" means (1) a substantial
risk of physical harm to oneself as manifested by
threats of, or attempts at, suicide or serious bodily
harm or other conduct demonstrating that the person is
dangerous to himself or (2) a substantial threat of
physical harm to other persons as manifested by
homicidal or other violent behavior by which others
are placed in reasonable fear of serious physical
* * *
6. If a hospital admits a person [involuntarily], it
may not hold the person for more than forty-eight
hours unless the finding by the first physician that
the plaintiff met the criteria of the statute is
confirmed by another physician. . . .
The first finding was signed by defendant psychiatrist Robert T.
LaFargue at 12:45 p.m. on December 23. (Exh. 1, p. 79.) The confirming
finding was signed by defendant psychiatrist Robert Nadrich at 3:45 p.m.
on December 24. (Exh. 1, p. 80.) The jury had sufficient evidence to
find, as it did, that each of these men "acted in a manner that was
substantially below the standards generally accepted in the medical
community when he caused Mr. Marion to remain in Bellevue Hospital
against Mr. Marion's will." The intake records repeatedly recorded that
Marion showed no evidence of suicidal ideation or aggressive ideation.
Only Dr. Nadrich wrote anything about dangerousness, and what he wrote
was speculative and unimpressive. Dr. Stastny testified that both men
failed to ask questions designed to discern whether Marion had any
intention or likelihood for causing physical harm. (Tr. 109-20.)
At trial, the only witnesses were Dr. Stastny, Marion, Dr. LaFargue and
Dr. Nadrich. The jury heard excerpts from the deposition of psychiatric
nurse Jessie Emmanuel, who was the first person in the Psychiatric
Emergency Room to interview Marion. (Tr. 288.) She testified that "at the
time that I had seen him, he was not agitated. . . . not exhibiting
any aggression," although he was "pointing his fingers at staff telling
us we are all `slaves.'" (Tr. 267, 277, Exh. 1 p. 24.)
At 11:50 a.m. on December 23, Marion was interviewed by a medical
student named Danny Sperling. He wrote:
. . . The pt. repeatedly states that he needs
100 million dollars from the government so that he
could lead a better life. The pt. reports that the
government is involved in a plot of "povercide" to
kill all of the homeless by not giving them money.
The pt. states he believes he can solve all of
these world problems. The pt. currently denies
suicidal ideation and denies homicidal ideation as
well. Pt. believes that the police are evil and
involved in the government conspiracy to kill the
poor. The pt. currently has flight of ideas and
extremely pressured speech. ["Pressured speech" is
a rapid monologue that is hard to interrupt; Tr.
Pt. denies a past psychiatric hospitalization,
denies past suicidal attempts and denies any past
acts of violence.
The pt. reports suffering head trauma in a
bicycle-car accident 8 yrs. [ago].
(Exh. 1 p. 27.) Dr. LaFargue presumably read this a few minutes later. He
was the attending physician in the Psychiatric Emergency Room, and he was
in a central area with glass windows so that he was able to see all of
the patients in the Emergency Room. (Tr. 303.) At trial, he pointed to
Sperling's notes that Marion was complaining about "the government
conspiracy to kill the poor." Dr. LaFargue told the jury: "Whenever a
psychotic person is starting to say their thought content is about killing
and conspiracy, that raises more red flags and makes me more concerned
that this patient is indeed very dangerous." (Tr. 294.)
Dr. LaFargue testified: "I don't recall what happened as far as
how many minutes I spent with Mr. Marion. But any
patient who is agitated like i[t']s described that Mr. Marion is, we're
not going to take into a room and have and sit down with that patient.
Because that patient's inappropriate for that type of dialogue and can be
dangerous. . . . I don't recall the case at this point. But I'm sure [I]
observed Mr. Marion." (Tr. 302-03.) He acknowledged that Marion had not
hit anyone. (Tr. 304.) His attorney then asked:
Q: Can you explain for the jury how you still
came to the determination that he was dangerous?
A: When his behavior continues to escalate, when he
continued to escalate coming from the medical
emergency room to the psychiatric emergency room, and
it didn't didn't dissipate with verbal intervention
or even when he's put behind a locked door, he
continues to escalate, then that's dangerous.
Q: Doctor, if someone said [as Dr. Stastny did]
that it was a grave omission that you did not ask
the plaintiff if he intended to cause harm, what
would your response be?
A: . . .[T]he patient is exhibiting behavior that's
consistent with danger, and so, his body language is
telling me the answer to that question, which is he's
(Tr. 330.) The jury could rationally find that there was no clear
documentation or testimony about such "`body language," and that Marion,
albeit psychotic, was not dangerous. The jury could rationally choose to
agree with plaintiff's expert that finger-pointing was not a threat.
(Tr. 100.) Moreover, the jury could rationally find that Dr. LaFargue,
while sincerely convinced as to what would benefit Marion, did not follow
the stipulated legal requirement that there must be "a substantial threat
of physical harm to other persons as manifested by homicidal or other
violent behavior by which others are placed in reasonable fear of serious
physical harm." (Exh. 3, ¶ 4, emphasis added.) On cross examination, Dr.
Q: Would you agree that if[,] even if there is a
small risk of harm, you should hospitalize a person
because you cannot take
A: Yes. That's the Hippocratic oath.
(Tr. 344, emphasis added.)
Dr. LaFargue ordered that the staff medicate Marion with a combination
of Haldol and Ativan, to be injected intramuscularly ("IM") if he refused
to take it orally (per os, "PO"). (Tr. 322-24.) Nurse Emmanuel wrote:
12/23/98 12pm Pt. became increasingly anxious [with
positive] delusions, not following directions at this
time, talking rapidly, he is offered Ativan 3 mg PO
and Haldol 5mg PO, pt. refused He is given Haldol
5mg IM and Ativan 2 mg IM and placed on a stretcher
with waist support.
(Exh. 1 p. 32.) This medication quickly causes the patient to go to
sleep for a period of time. (Tr. 385.)
At about the same time, Sperling filled out a one-page form entitled
"Comprehensive Assessment Form, Initial Treatment Plan." (Exh. 1 p. 33.)
Where the form asked for "Rationale for Admission," Sperling wrote, ". .
. active mania, flight of ideas and pressured speech, with grandiose
ideas, with active psychosis." Where the form asked for "Discharge
Criteria," he wrote, "When pt's mania is resolved and mood is
stabilized." He and Dr. LaFargue both signed this form at 12:15 p.m.
Sperling also filled out the first page of the State of New York Office
of Mental Health form OMH 474 entitled "Emergency Admission Section 9.39
Mental Hygiene Law." (Exh. 1 p. 79.) The first page (which can result in
a involuntary commitment for up to 48 hours) does not specifically ask
for details to support a finding of dangerousness. It asks for
"Circumstances which led to the person being brought to this hospital,"
and Sperling wrote: "Pt. came to this hospital for a DM [diabetes
mellitus] checkup and was brought to CPEP for psychotic behavior. Pt. is
currently actively manic and agitated." In the last part of the first
page, the form states:
I HAVE EXAMINED THE ABOVE-NAMED PERSON PRIOR TO
ADMISSION AND FIND THERE IS REASONABLE CAUSE TO
BELIEVE THAT THE PERSON HAS A MENTAL ILLNESS FOR
WHICH IMMEDIATE OBSERVATION, CARE AND TREATMENT IN
A MENTAL HOSPITAL IS APPROPRIATE AND WHICH IS
LIKELY TO RESULT IN SERIOUS HARM TO HIMSELF OR
HERSELF OR OTHERS.
In the box under this statement, both Sperling and Dr. LaFargue placed
their signature at 12:45 p.m. Dr. LaFargue acknowledged that the initial
commitment was his responsibility, since Sperling ...