A Fairer Approach in Addressing the Opioid Epidemic: Recent Changes to the Law Regarding Involuntary Commitments for Alcohol and Substance Use Disorders under M.G.L. c. 123, § 35

Lyons_Crystalby Crystal Lyons

Heads Up

The opioid epidemic, in Massachusetts and nationwide, is a public health crisis demanding the attention and resources of all facets of government. One tool that has seen substantially increased usage is M.G.L. c. 123, § 35 (“Section 35”), which permits involuntary commitment of persons with alcohol or substance use disorder for treatment of up to 90 days if a court finds that they present a likelihood of doing serious harm to themselves or others. A petition under this section often accompanies an arraignment on criminal charges related to substance use, although not every individual subject to a Section 35 petition also faces criminal charges. The increase in usage has also spurred increased attention to the standards and processes that should apply to proceedings under Section 35. The involuntary commitment of women without any criminal charges to a correctional facility (MCI-Framingham) for treatment has been the focus of the most criticism and concern, including in articles in this Journal.

In response to the scrutiny, the Legislature and courts alike have recently updated and clarified the law. First, in July 2015, the Trial Court promulgated Uniform Trial Court Rules (“Uniform § 35 Rules”) to govern Section 35 commitment proceedings, which Rules went into effect February 1, 2016. Second, this past November, the Supreme Judicial Court issued its decision in In the Matter of G.P., “concerning the operation of § 35 as well as the … uniform § 35 rules.” 473 Mass. 112, 113 (2015). Third, in January 2016, the Legislature passed House Bill 3956, signed into law as Chapter 8 of the Acts of 2016 and effective April 24, 2016, which specifically amended Section 35 to bar sending women without criminal involvement to state prison for treatment. Finally, House Bill 4056 (“Opioid Bill”), passed and signed into law in March 2016, made one additional small change, extending the warrants for arrest under Section 35 for up to 5 business days. Once these changes are fully implemented, many of the previous concerns relating to Section 35—including the inherent limitations of the court system as a mechanism to access treatment services; the increasing number of individuals, in particular women, who are civilly committed to state prisons for treatment; and need for greater uniformity in commitment hearings—should be allayed. This article addresses the primary changes and clarifications made as a result of this recent court and legislative action.

First, as the title of this article suggests, the definitions in Section 35 were updated. In order to reflect the current, clinical understanding of the underlying disorder, the terms “alcoholic,” “substance abuser,” and “addict” were replaced with “a person with an alcohol disorder, substance use disorder, or both.”

Second, and most celebrated, under amended Section 35, women without criminal convictions may no longer be sent to MCI-Framingham for treatment when no beds at other facilities are available. To implement this reform, a total of forty-three new beds have been designated for women at Taunton State Hospital and Lemuel Shattuck Hospital to cover the estimated additional need. Under a new provision, however, a judge may evaluate the need to commit an individual to a secure facility “as the only appropriate setting for treatment” (often based on risk of violence)—men to MCI-Bridgewater and women to an as yet to be designated facility approved by the Department of Mental Health or the Department of Public Health.

Third, to standardize and expedite hearings, the new Uniform § 35 Rules clarify several procedural points. When a petition is first filed, the court must make an initial assessment to determine: 1) whether a proper party under the statute has made the filing and there exists a reasonable basis to believe the standard can be met; and 2) whether the respondent, i.e., the individual subject to the petition, is present and, if not, whether that particular court is the best venue to hear the petition.

Notwithstanding that individuals are increasingly looking to “section” themselves to access treatment when other treatment resources are unavailable or inadequate, under Section 35, an individual may not file a petition on his own behalf. Nevertheless, if the court determines that there is a strong basis for a petition, the court may ask a police officer or court official (often a probation officer) to step in as the statutorily qualified petitioner. Once the court finds both a reasonable basis for the petition and a proper petitioner, the petition may not be withdrawn or dismissed without leave of the court. This restriction against voluntary termination recognizes the public health and safety concerns underlying Section 35 proceedings and may help address the problem that occurs when family members or other petitioners develop cold feet as a result of pushback they may receive from a reticent respondent.

Under the second inquiry, if the respondent is present in court, the hearing must go forward without delay in that court (and bail should be set if the respondent is also arraigned on criminal charges). There are no venue restrictions for Section 35 petitions based on residency or otherwise, and adult hearings may proceed in juvenile court and vice versa. This frees petitioners to go to the court nearest to where they are able to locate the respondent, the court where criminal charges are pending, or the court nearest to where the petitioner may live or work (particularly where the petitioner is a treating physician or police officer).

When the respondent is not present at the time the petition is filed, the court may evaluate whether it is the most appropriate court to maintain the petition, and may issue a summons or, more frequently, a warrant for the respondent’s apprehension and return to that court during court hours only. The new Opioid Bill extended the time that the warrant may be returned from three to five business days. When a respondent is located far enough away from the originating court such that travel there during court hours is not practicable, officers may instead take the respondent to the nearest court, which can seek to have the petition transferred to that court. The Uniform § 35 Rules also clarify that the petitioner need not be present for the hearing to go forward (or she may appear remotely). This is helpful where a petition must be transferred to another court but the petitioner is unable to timely travel to the new court, as well as in those cases where the petitioner may be an on-duty treating physician who cannot leave the hospital.

Finally, in light of the respondent’s liberty interests at stake, in In the Matter of G.P., the Supreme Judicial Court clarified the standards for involuntary, civil commitment under the statute. The two primary rulings in the case establish that the appropriate standard of proof is clear and convincing evidence and that substantially reliable hearsay is admissible. This holding make Section 35 hearings analogous to probation violation hearings—a familiar standard for those in the criminal justice system.

The Court also addressed the type of evidence necessary to sustain a finding of clear and convincing evidence of likelihood of serious harm directly resulting from alcohol and/or substance use. Such risk can be established by demonstrating a substantial risk of physical self-harm, harm to others, or by showing that the respondent’s judgment is impaired to such a degree that there is a very substantial risk of physical impairment or injury. Each of the three methods also requires a showing of imminence of harm, which for purposes of Section 35 means not that the risk of harm must be immediate, but rather that it must materialize in the reasonably short term—meaning days or weeks rather than months. The Court elaborated on the types of evidence which would credibly support such an imminent risk: specific threats, proximate in time or numerous in nature, with the seriousness of the threats or past harm carefully weighed. Where a risk of harm to others is alleged, it must be of a substantial level of force and intensity to be categorized as “violent behavior” or “serious physical harm” under the statute. A simple pushing of another out of the way, for example, is not sufficient.

Under the third method (impaired judgment), the Court explained that the type of harm that may suffice was akin to an inability of the respondent to treat an injury or medical condition (e.g., failure to take prescribed medication or obtain regular dialysis) or a risk due to extreme weather conditions, and an inability of the respondent’s “community” to adequately address the risk. The ability of the respondent’s community to provide protection would likely be lower where an individual is homeless or living only with elderly parents or small children. A risk of overdosing may be sufficient under this prong, but only where “strong and specific evidence [is] presented that the risk of overdosing is indeed imminent and the degree of probability she will do so is high.” In the Matter of G.P., 473 Mass. at 129 n.23. A recent nonfatal overdose would likely satisfy this prong.

Both In the Matter of G.P. and the Uniform § 35 Rules address and protect a respondent’s right to present independent medical evidence and to appeal any commitment, allowing for both motions to reconsider and expedited review on appeal.

These recent changes bring consistency, transparency, and increased fairness to Section 35 proceedings. And with the additional dedicated Section 35 treatment beds allocated for women, increased fairness also means access to meaningful treatment and rehabilitation resources.

Crystal L. Lyons is an Assistant District Attorney in the Appeals & Training Bureau of the Middlesex District Attorney’s Office, and a member of the BBJ Board of Editors. She previously practiced business litigation, clerked for the Ninth Circuit Court of Appeals, and graduated Order of the Coif from UCLA School of Law. This article represents the opinions and legal conclusions of its author and not necessarily those of the Middlesex District Attorney’s Office.

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