Nov 20, 2024

Unstructured Clinical Judgments Barred from Civil Commitment Proceeding

by Maureen Rubin | Sep 12, 2023
An illustration depicting a medical professional beside a patient on a hospital bed, with a scale of justice symbolizing the intersection of healthcare and legal proceedings. Photo Source: Adobe Stock Image

A mentally disordered woman, sentenced to 17 years in state prison, then transferred to a state mental hospital, will not be recommitted because those who examined her failed to present sufficient evidence that showed she “currently represents a substantial danger of physical harm to others” beyond a reasonable doubt.

In 1999, defendant/appellant Rhonda Lynn Jenkins attacked her landlord with a hammer, causing three skull fractures. She also “imprisoned” him on her apartment floor for six hours. She was convicted of attempted murder and received additional time for using a deadly weapon on a person over 70 years old.

Jenkins was sentenced to 17 years in state prison, but after she served 15 years, she was transferred to a state mental hospital for treatment as a “mentally disordered offender.” Her commitment was extended five times, in civil, not criminal proceedings. Then, in 2022 another additional year was requested by the State because its experts believed she continued to suffer from a mental disorder that was not in remission and still presented a threat of “physical harm to others.” At her hearing, the State failed to present any live witnesses, relying instead on the written reports of three medical experts.

Both the State’s experts and those presented by Jenkins agreed that she continues to suffer from bipolar schizoaffective disorder. One of the State’s experts said Jenkins had “limited insight” into her condition and wanted to decrease her medications. Another noted that she was currently overweight and in a wheelchair. The third expert said Jenkins continues to “deny aspects of her symptoms” and has not “followed her treatment plan.” But none of them presented any evidence that she still poses a “substantial danger of physical harm to others.”

The expert witness for Jenkins, psychologist Dr. Kimberly Claggett, has been treating her for 11 months in “individual therapy sessions.” She said that Jenkins could be ready for conditional release within a year if she could be placed in a facility that still provides her with necessary support.

Defendant Jenkins then testified on her own behalf via Zoom. She acknowledged her mental illness and said she always takes her prescribed medications. She said she was “ready to be discharged” into a nursing home or other board and care facility.

On November 16, 2022, San Diego County Superior Court Judge Kenneth K. So ruled that Jenkins is still “suffering from a severe mental disorder,” is not in remission and continues to “represent a substantial danger of physical harm to others. In a 3-0 opinion authored by Justice Julia C. Kelety and joined by Presiding Justice Judith McConnell, Division One of California’s Fourth District Court of Appeal reversed So’s decision to extend Jenkins’ commitment.

In his concurring opinion, Justice Martin N. Buchanan went further, calling for an end to the type of “unstructured” predictions of future conduct that led So to extend Jenkins’ commitment. He said the State’s experts in civil commitment proceedings should not predict a candidate’s future conduct as they did to Jenkins, but should rely on approved risk assessment tools that more accurately evaluate the subject’s responses to questions, history, and likelihood of recidivism.

Jenkins’ commitment is governed by California’s Mentally Disordered Offender Act, which requires an expert evaluation of whether the offender continues to “pose a danger to society.” The Act allows the State’s Attorney General to petition annually for the continuation of “involuntary treatment.” A court will then consider whether there is sufficient evidence to warrant continued commitment. The court must review the “entire record” in the light most favorable to the judgment.

In Jenkins’ case, the district court considered several factors. Primarily the court was persuaded that except for her initial attack on her landlord, she had never been violent or dangerous since her initial commitment. There was also no physical aggression or violence the whole time against fellow inmates during the entire time she was committed. Additionally, her deteriorating health and age of 70 years also weighed against her posing a danger to society.

The opinion then reviewed relevant precedents, finding that although Jenkins “lacked insight” about her mental illness, “the record is devoid of sufficient evidence of additional violent conduct that would support a finding beyond a reasonable doubt that her mental illness presents a substantial danger of physical harm to others.” An order to vacate the trial court’s order was issued.

Buchanan’s seven-page concurrence makes a case for requiring that “standard violence risk assessment tools” rather than “unstructured clinical judgments” be used in all future civil commitment proceedings. He said these types of judgments are a “notoriously unreliable way of predicting future violence” and added, “In my view, the time has come for courts to banish this demonstrably unsound practice in civil commitment proceedings.” He also cited research that showed “poor accuracy” in predicting future violence.

In addition, he outlined the assessment tools that are now available and provide a “structured framework” for better analysis of the risk of physical violence and have been evaluated in peer-reviewed studies. He added that the California Legislature and Judicial Council endorsed their use and concluded, “Now that more reliable tools are available, I see no good reason to continue allowing the use of such a manifestly inferior method of predicting future violence—one that “brand as ‘dangerous’ many persons who are in reality totally harmless.”

With so much evidence about the superiority of “evidence-based” instruments, one must wonder why courts continue to find that “unstructured clinical judgments are a defensible way of predicting future violence in civil commitment proceedings,” as Buchanan persuasively wrote in his concurrence.

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Maureen Rubin
Maureen Rubin
Maureen is a graduate of Catholic University Law School and holds a Master's degree from USC. She is a licensed attorney in California and was an Emeritus Professor of Journalism at California State University, Northridge specializing in media law and writing. With a background in both the Carter White House and the U.S. Congress, Maureen enriches her scholarly work with an extensive foundation of real-world knowledge.

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