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New Jersey Can Forcibly Medicate Patients in Mental Institutions

By Casey C. Sullivan, Esq. on August 07, 2015 | Last updated on March 21, 2019

Congratulations are in order to the Nurse Ratcheds of the world. The Third Circuit ruled Tuesday that New Jersey can forcibly medicate institutionalized, mentally ill patients in state custody.

The appeal came after Disability Rights New Jersey challenged the forced-medication, arguing that it violated the Americans with Disabilities Act and the patients' due process rights. The Third Circuit disagreed, finding that the institutionalized were not discriminated against and had sufficient process available before being medicated.

Medication Time

The types of mental institutions featured in Ken Kesey's "One Flew Over the Cuckoo's Nest" are increasingly rare but still present. New Jersey operates four of them, psychiatric hospitals for civilly committed adults and those found not guilty by reason of insanity. In Kesey's book, such establishments are authoritarian institutions, trampling patients' physical and mental freedom, a theme animated in the form of the pill-pushing, domineering Nurse Ratched. We can't comment on quality of the New Jersey asylums, however.

The development of psychotropic drugs, along with shifts in public policy, has greatly reduced the amount of people institutionalized for mental illness. Those drugs are also "an almost essential component of treatment" for those who remain involuntarily committed, according to experts. Partly because of the drugs' negative side effects, however, many patients refuse to take them, according to the Third Circuit. Those patients are still medicated, just against their will.

The Rennie Process is Enough Process

The Supreme Court has never ruled on whether or not the forcible medication of institutionalized individuals, without a judicial proceeding, violates their due process rights. The Third, however, has. Through a series of lawsuits in the 70's, the court established what is known as the Rennie process. Under this process, an institutionalized patient refusing medication is entitled to an explanation of the treatment, a meeting with the patient's treatment team, and finally, an examination, review of their record and final decision by a medical doctor. That process was supplemented with slightly more stringent requirements while the case was being litigated.

Disability Rights New Jersey alleged that the Rennie process and current practice is little more than a rubber stamp. Disability Rights argues that forced medication should only be allowed when patients are ruled incompetent to make medical decisions through a judicial hearing with counsel and independent experts.

The Third Circuit was unwilling to grant Disability Rights relief. Forcible medication does not discriminate against the disabled in violation of the ADA, the court found, since non-disabled individuals are presumably entitled to the same process before being forcibly medicated. Further, the court ruled, New Jersey's procedures provide enough process before forced medication. The court analogized the institutionalized to prisoners and noted that the Supreme Court had approved "virtually identical" procedures in the context of inmate medication.

That means institutionalized patients who want to avoid medication won't be entitled to a day in court, though they will have access to medical review. Patients' rights advocates shouldn't be too upset by the ruling, however. As Nurse Ratched says, when faced with defeat, "the best thing we can do is go on with our daily routine."

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