IN THE MATTER OF THE CIVIL COMMITMENT OF M.F. (SOCC-000001-06, SOMERSET COUNTY AND STATEWIDE) (RECORD IMPOUNDED)

RECORD IMPOUNDED
NOT FOR PUBLICATION WITHOUT THE
APPROVAL OF THE APPELLATE DIVISION
This opinion shall not "constitute precedent or be binding upon any court." Although it is posted on the
internet, this opinion is binding only on the parties in the case and its use in other cases is limited. R. 1:36-3.
SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
DOCKET NO. A-2737-19
IN THE MATTER OF THE
CIVIL COMMITMENT OF
M.F.
________________________
Submitted March 17, 2021 – Decided June 8, 2021
Before Judges Alvarez, Geiger and Mitterhoff.
On appeal from the Superior Court of New Jersey, Law
Division, Somerset County, Docket No. SOCC-
000001-06.
Joseph E. Krakora, Public Defender, attorney for
appellant M.F. (Thomas G. Hand, Assistant Deputy
Public Defender, on the briefs).
Serra Law Group, attorneys for respondent W.F.
(Anthony J. Serra, on the brief).
PER CURIAM
M.F.'s assigned counsel appeals from a January 8, 2020 order re-
committing M.F., a fifty-nine-year-old male with schizophrenia, to Greystone
Park Psychiatric Hospital (Greystone). We affirm.
We discern the following facts from the record. Since January 25, 2012,
M.F. has remained committed at Greystone due to a diagnosis of schizophrenia,
disorganized type. The parties do not dispute M.F.'s diagnosis. 1 M.F. has
suffered from schizophrenia, and remained institutionalized, for most of his
adult life.
After a commitment review hearing on June 12, 2019, the trial judge
determined that M.F. was no longer dangerous to himself or others and ordered
his continued institutionalization under conditional extension pending
placement (CEPP) status. See In re M.C., 385 N.J. Super. 151, 162 (App. Div.
2006); R. 4:74-7(h)(2). On December 26, 2019, unprovoked, M.F. punched his
roommate in the face, causing injury to both men. As a result, M.F. was
temporarily re-committed.
On January 8, 2020, almost two weeks after the incident, a commitment
review hearing was conducted. Dr. Svetlana Volskaya, the treating psychiatrist
at Greystone, opined that M.F.'s prognosis was "poor," and he was a "danger to
others since [he] had an incident of punching [a] peer in the face." She testified
that the peer was bleeding and had an abrasion on his nose, and that M.F.'s hand
1
Due to the severity of his mental illness, M.F. does not have the ability to
communicate his wishes or desires.
2 A-2737-19
had "significant swelling" as a result of the incident. Dr. Volskaya was
concerned, based on her past observations, about M.F.'s "aggressive behavior."
She indicated that, due to M.F.'s elevated creatinine levels, 2 she was forced to
reduce his lithium dosage. Dr. Volskaya opined that the December 26, 2019
incident was causally "related to the change" in the lithium dosage.
Dr. Volskaya testified that when M.F. initially arrived at Greystone, he
decompensated due to neuroleptic malignant syndrome. 3 Greystone staff
changed his medication, and he became "aggressive" and "unmanageable." Dr.
Volskaya concluded that M.F. remained a danger to himself and others and, if
discharged, would reasonably injure himself or others in the foreseeable future.
Following the hearing, the trial judge found that, although it had not
occurred since 2012, the neuroleptic malignant syndrome was "a matter of
concern in terms of management of" M.F because he continued "to be treated
with neuroleptics." The judge determined that the December 26, 2019 incident
2
Dr. Volskaya testified that psychiatrists must monitor creatinine levels when an
individual is on lithium to prevent kidney failure.
3
According to the National Institute of Neurological Disorders and Stroke,
neuroleptic malignant syndrome "is a life-threatening, neurological disorder most
often caused by an adverse reaction to neuroleptic or antipsychotic drugs."
Neuroleptic Malignant Syndrome Info. Page, Nat'l Inst. of Health,
https://www.ninds.nih.gov/Disorders/All-Disorders/Neuroleptic-Malignant-
Syndrome-Information-Page.
3 A-2737-19
was "significant," and that "a person was injured." The judge also found that
M.F. could not "be placed in a less restrictive setting presently because he would
not receive the type of medical scrutiny" necessary to control his condition. 4
The trial judge concluded that the State proved "by clear and convincing
evidence that [M.F.] remains a danger to himself with regard to his medical
condition and remains a danger to others because of the short period of time
since the last incident."
On appeal, M.F.'s assigned counsel raises the following arguments for our
consideration:
POINT I
THE TRIAL COURT ERRED AS A MATTER OF
LAW WHEN IT ORDERED THE COMMITMENT OF
M.F. BECAUSE THE STATE FAILED TO PROVE
THAT AN ISOLATED [PHYSICAL] INCIDENT
SATISFIED THE STATUTORY REQUIREMENTS
FOR INVOLUNTARY CIVIL COMMITMENT SET
FORTH IN N.J.S.A. 30:4-27.2.
POINT II
THE TRIAL COURT ERRED AS A MATTER OF
LAW WHEN IT ORDERED THE COMMITMENT OF
M.F. BECAUSE THE STATE FAILED TO PROVE
THAT M.F.'S MENTAL ILLNESS CAUSED HIM TO
4
In that regard, the judge indicated that a nursing home was not able "to provide
that kind of daily scrutiny of" M.F.'s creatinine levels which posed "a risk to him and
that in itself is a danger."
4 A-2737-19
BE A DANGER TO HIMSELF AS REQUIRED BY
N.J.S.A. 30:4-27.2.
POINT III
[THAT] M.F. WAS PREJUDICED BY THE
GUARDIAN’S PARTICIPATION BECAUSE IT LED
THE TRIAL COURT ASTRAY FROM THE PROPER
LEGAL STANDARD RATHER THAN THE BEST
INTEREST STANDARD ADVANCED BY THE
GUARDIAN AND TAINTED THE TRIAL
[COURT'S] CONSIDERATION OF THE EVIDENCE
IN CONNECTION WITH THE APPLICABLE
STATUTES THAT DEFINE THE STATE’S BURDEN
OF PROOF, N.J.S.A. 30:4-27.2. 5
POINT IV
THE TRIAL COURT'S ORDERS REGARDING
FUTURE REVIEW HEARINGS ARE THE SUBJECT
OF AN APPEAL PENDING IN A-3572-19 AND A
SUBSEQUENT STAY OF THOSE ORDERS, AND
ARE THUS MOOT IN REGARD TO THIS APPEAL.
"The scope of appellate review of a commitment determination is
extremely narrow." In re Civil Commitment of R.F., 217 N.J. 152, 174 (2014)
(quoting In re D.C., 146 N.J. 31, 58 (1996)). "The [trial] judge's determination
should be accorded 'utmost deference' and modified only where the record
reveals a clear abuse of discretion." In re J.P., 339 N.J. Super. 443, 459 (App.
5
The issue of M.F.'s best interests is more thoroughly addressed in M.F.'s separate
appeal pending under Docket No. A-3572-19.
5 A-2737-19
Div. 2001) (quoting State v. Fields, 77 N.J. 282, 311 (1978)). We owe a trial
judge's decision the utmost deference because "they have the 'opportunity to
hear and see the witnesses and to have the "feel" of the case, which a reviewing
court cannot enjoy.'" R.F., 217 N.J. at 174 (quoting State v. Johnson, 42 N.J.
146, 161 (1964)).
A court can enter an order of involuntary commitment if the State proves
by clear and convincing evidence that "mental illness causes the patient to be
dangerous to self or dangerous to others or property." R. 4:74-7(f)(1); see also
N.J.S.A. 30:4-27.2(m). One is "[d]angerous to others or property" when:
by reason of mental illness there is a substantial
likelihood that the person will inflict serious bodily
harm upon another person or cause serious property
damage within the reasonably foreseeable future. This
determination shall take into account a person's history,
recent behavior, and any recent act, threat, or serious
psychiatric deterioration.
[N.J.S.A. 30:4-27.2(i).]
One is "[d]angerous to self" when:
by reason of mental illness the person has threatened or
attempted suicide or serious bodily harm, or has
behaved in such a manner as to indicate that the person
is unable to satisfy his need for nourishment, essential
medical care or shelter, so that it is probable that
substantial bodily injury, serious physical harm, or
death will result within the reasonably foreseeable
future; however, no person shall be deemed to be
unable to satisfy his need for nourishment, essential
6 A-2737-19
medical care, or shelter if he is able to satisfy such
needs with the supervision and assistance of others who
are willing and available. This determination shall take
into account a person’s history, recent behavior, and
any recent act, threat, or serious psychiatric
deterioration.
[N.J.S.A. 30:4-27.2(h).]
The question of dangerousness calls "for a legal judgment guided by
medical expert testimony." In re Commitment of M.M., 384 N.J. Super. 313,
337 (App. Div. 2006) (citing D.C., 146 N.J. at 59; In re Commitment of D.M.,
313 N.J. Super. 449, 456 (App. Div. 1998)). The evidence must be "so clear,
direct and weighty and convincing as to enable [the factfinder] to come to a clear
conviction, without hesitancy, of the truth of the precise facts in issue." In re
Robert S., 263 N.J. Super. 307, 312 (App. Div. 1992) (alteration in original)
(quoting In re Jobes, 108 N.J. 394, 407 (1987)).
Having reviewed the record, and applying the deferential standard of
review, we conclude the trial judge did not clearly abuse his discretion in
ordering M.F.'s re-commitment. The undisputed testimony reveals that, just
thirteen days prior to the commitment review hearing, M.F. assaulted his
roommate at Greystone. As Dr. Volskaya indicated, this incident was likely the
result of the decrease in lithium, necessitated by his rising creatinine levels. We
are mindful that the "[d]etermination of dangerousness involves prediction of
7 A-2737-19
. . . future conduct," but "past conduct is important evidence as to his probable
future conduct." State v. Krol, 68 N.J. 236, 260-61 (1975); N.J.S.A. 30:4-
27.2(i). We are satisfied that M.F.'s assaultive behavior, which stemmed from
the difficulty in managing his medication regime, was sufficient to support the
conclusion he presented a danger to others. N.J.S.A. 30:4-27.2(i).
Furthermore, the uncontroverted medical expert testimony revealed that
M.F. required extensive medication, administered by hospital staff, to control
his schizophrenia. The evidence supported a finding that, absent this significant,
hospital-administered regimen, M.F. could again suffer from elevated creatine
levels or redevelop neuroleptic malignant syndrome, which would present a
danger to himself in the foreseeable future. 6 N.J.S.A. 30:4-27.2(h).
We therefore find no mistaken exercise of the trial judge's broad discretion
in this regard. We note that periodic reviews consider the circumstances at the
time of the review and that future reviews may lead the judge to a different
conclusion. On the record presented to the judge, we affirm M.F.'s continued
involuntary commitment.
6
The statutory definition of "[d]angerous to self" is discussed in greater detail in the
companion case.
8 A-2737-19
Affirmed.
9 A-2737-19