Appendix — Secretary of Public Welfare of Pa. v. Institutionalized Juveniles

Supreme Court brief1979

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VOLUME I—Pages 1a-434a

APPENDIX

in the Supreme Court of the

Unjted States

October Term, 1978

No. 77-1715

SECRETARY OF PUBLIC WELFARE, Common-

wealth of Pennsylvania, ALDO COLAUTTI;

JOHN FONG, Director of Haverford State Hospi-

tal; NICHOLAS D’ALUISIO, Director of Polk

State School and Hospital; C. DUANE YOUNG-

BERG, Director of Pennhurst State School and

Hospital, sued as representative of all others

similarly situated,

Appellants

INSTITUTIONALIZED JUVENILES in Pennsyl-

vania Institutions for the mentally ill and mentally

retarded, namely, KEVIN S.; RICHARD S-.;

JAMES PAUL M.; EDWARD B.; R.1YMOND C.;

WILLIAM B.; FRANCIS B.; MARIA L.; THOM-

AS W.; NANCY LOUISE D.; GINA S.; and

GEORGE §., by their next friend and guardian ad

litem, David Ferleger, individually and on behalf

of all others similarly situated,

Appellees

Appeal From the Judgment of the United States

District Court for the Eastern District of

Pennsylvania

————————————————————

APPEAL DOCKETED MAY 31, 1978

JURISDICTION NOTED JUNE 19, 1978

——_—

TABLE OF CONTENTS

PAGE

Volume I

mmmevemt Docket Batries ......ccccccccccsccss la

Complaint—November 16, 1972 .............. 8a

I ee i li 24a

First Set of Interrogatories to Defendants ....... 25a

ee ee ec luneekeswans 29a

ee Ses BGs Ok, GEG x cvcvckccrsecesiéces 3la

Motion for Sealing of Affidavits and Protection of

DD cnvdsweaeiecens<seaanuesnenoes 32a

EERE SEIS I, eI AERA De RL ony et 34a

Pre-Trial Oral Examination of Dr. Barbara Arm-

strong: .

See TI «ww cc cccccccceses 42a

eT ee 108a

Redirect Examination ............... i21la

Pee 130a

Exhibit A—Class Action Suit ............. 133a

Exhibit B—Individual Patient Summaries ... 135a

Exhibit C—Individual Patients Summaries ... 166a

SS er ee eee 18la

Incarcerated Juveniles—Why? The Mental Institu-

tionalization of Juveniles in Pennsylvania .... 210a

Argument on Plaintiffs’ Motion for a Class Action

Determination and on Defendants’ Motion To

ee: SE Gd, GD ~c ob. 0 6s kd eeuuO Ons 232a

Order Dated April 29, 1974 ...............445. 269a Dr. Michael A. Ingall:

SEE. cee secret ncsnocceccresecesecceseses 271la Direct Examination ............ __ 586a

Se SU GED” sccuncccvvcucseccans 274a Cees... 597a

Summaries of Selected Patients ............... 317a Dr. Eli Charles Messinger:

Pre-Trial Oral Examination of Dr. Max Sugar: epreet Tmmminatiem occ ccccccccccs 614a

Direct Examination ................. 365a Cross-Examination ................-. 633a

Cross-Examination ................-- 383a Examined by the Court .............. 636a

Redirect Examination ............... 432a DEFENDANTS’ EVIDENCE:

Dr. Levon Donald Tashijian:

Volume II Disect Exemimation ........ccccccces 643a

se uceuwe 659a

Evidentiary Hearing, Second Day:

Redirect Examination (cont’d.) .............. 435a

Recross-Examination ................ 442a DEFENDANTS’ EVIDENCE:

Deposition of Dr. Joel S. Feiner, M.D.: Dr. Levon Donald Tashjian:

Direct-Examination ................-. 465a COUPES cw ccc cc cccwses 662a

Cross-Examination ...........e.eeee- 484a Redirect PE FE 671a

Order Dated August 21, 1974 ................ 521a Examined by = Court ........+-.-+. 672a

The Evidence: Dr. seats Harry mest

Evidentiary Hearing, First Day ............ 525a rato na sca Sent er cre te

PLANTIFFS’ EVIDENCE: Dr. James F. Masterson:

Dr. Henry O. Kandler: ED on oc oc ue easaneesus 717a

’ — Pe ere 729a

CroeSxemiaation 0200s lsccsccs $40 Redirect Examination 20. 7400

Direct Examination ................. 541la Evidentiary Hearing, Third Day .............. 743a

rs ss ee eben e 548a Defendants’ Exhibit No. 1—Questionnaire ...... 772a

Redirect Examination ............... 580a Defendants’ Exhibit No. 4—Admission Note of D.D. 774a

Recross-Examination ................ 81a Defendants’ Exhibit No. 5—Admission Note of

Examined by the Court .............. 382a BG wie bg dubuee cakedts bakes aes 780a

i ii

Opinion of the United States District Court for the

Eastern District of Pennsylvania .......... 783a

ee BG, BED ov cc cic ebaiisevctecvioes 813a

Dissenting Opinion, District Court ............ 814a

Court’s Proposed Order—September 16, 1975 .... 824a

Defendants’ Exceptions to Court’s Proposed

Order—October 17, 1975 ..........2000.- 833a

Final Order—November 17, 1975 ............. 843a

Notice of Appeal to the Supreme Court of the

nc bao aves oheeee keeeka 853a

I He OTD 6c ccc kc ccccstecesecese 856a

TD. ID on cites nic'eencscoceess 864a

ee es ok ae eK on wen deme ie 865a

Volume III

errors 867a

Amended and Supplemental Complaint—November

DL oda benku ese oeusneeeieseadeen 875a

pa a 5 es 916a

Diotion For Class Actiom ....cccccccccccccces 926a

Plaintiffs’ Interrogatories to Defendants ........ 930a

Defendants’ Answer to Plaintiffs’ Interrogatories .. 932a

Defendants’ Supplemental Answer to Plaintiffs’ In-

i cnn ss kb hus oat p6e0 6 b060ens ¥-< 936a

Response to Motion For Class Action .......... 941a

rr ss est ecbptapececisces 943a

Order—Findings of Fact and Conclusions of Law

a Cr Vdeoscdsueeenwnsaweess 955a

Memorandum and Order—Defendant Class—

Gk Se re ar 956a

Plaintiffs’ Offer of Proof and Request For Evi-

eee 960a

Defendants’ Supplemental Memorandum and Af-

I ert lee rane ra, ae 962a

Deposition of Linda L. Glenn—April 13, 1978 ... 972a

Opinion and Order—May 25, 1978 ........... 105la

os a ian oe uden ened 1101la

Docket Entries la

IN THE UNITED STATES DISTRICT COURT FOR

THE EASTERN DISTRICT OF PENNSYLVANIA

Civil Action No. 72-2272

Kevin Bartley; Steve Gentile; Lesile Levine; Vicki

Mathews; Mark Weand, minors, through their next friend,

individually and on behalf of all others similarly situated,

Plaintiffs

Jack B. Kremens, individually and as Hospital Director

of Haverford State Hospital; Helene Wohlgemuth, individ-

ually and as Secretary of Public Welfare of the Common-

wealth of Pennsylvania; William B. Beach, Jr., individually

and as Deputy Secretary for Mental Health and Mental

Retardation of the Department of Public Welfare of the

Commonwealth of Pennsylvania,

Defendants

RELEVANT DOCKET ENTRIES

1972

Nov. 16, Complaint filed.

Nov. 16, Plaintiffs’ Memorandum of Law in support of

Motion for Class Action and Convening of a Three-

Judge Court filed.

Dec. [Illegible,] Defendants’ motion to dismiss filed.

2a Docket Entries

1973

Jan. 2, Plaintiffs’ first set of interrogatories to Defendants

filed.

March 13, Plaintiffs’ Motion for class action filed.

June 8, Transcript of 5/10/73 filed.

; in- Support of

Aug. 2, Defendants’ Memoranda of Law in

‘ Defendants’ Motion To Dismiss and Defendants

Motion To Oppose Plaintiffs’ Motion for a Class

Action filed.

Oct. 4, Youth Law Center of San Francisco, California's

request for leave to file brief amicus curiae and brief

amicus curiae in support of plaintiffs on behalf of

Youth Law Center filed.

Dec. 20, Second set of interrogatories to defendants filed.

1974

jan. 25, Defendants’ answers to second set of interroga-

tories filed.

April 2, ORDER [dated 4-1-74] that argument shall take

place before a three-judge Court on 4-16-74 at 10:00

a.m. re: plaintiffs’ motion for a class action deter-

mination and on defendants’ motion to dismiss; briefs

of the moving party shall be filed within 8 days from

date of this Order, and reply briefs 5 days thereafter,

etc. filed. 4-3-74 Entered and copies mailed.

April 16, Argued sur defendants’ motions to dismiss, and

for class action; Court stated that case may proceed

as a single class action. [3-Judge]

Docket Entries 3a

April 19, ORDER that hearing and argument shall take

place before the three-judge court at such time and

place as the court shall designate following the filing

of the final pre-hearing Order, by 5-1-74 for plain-

tiffs’ final proposed order, and the holding of the

final pre-hearing conference, scheduled for 5-28-74

at 11:00 a.m. in Room 3006, etc. filed. 4-22-74

Entered and copies mailed.

April 29, ORDER that Haverford State Hospital is dropped

as a party defendant, and that complaint shall stand

amended by said elimination; that this action shall

be maintained as a class action under Rule 23 (b) (1)

and (2) of FRCP on behalf of the class comprised

of all persons 18 years of age or younger who have

been, are or may be admitted to mental health fa-

cilitics in Pa. pursuant to 50 P.S. §§4402 and 4403,

etc.; that David Ferleger, Esq. is appointed guardian

ad litem for the plaintiffs and their class pursuant to

FRCP Rule 17(c), etc. filed. 4-30-74 Entered and

copies mailed.

April 30, ORDER that the Court Order of 4-19-74 [Paper

#47] is amended filed. 5-1-74 Entered and copies

mailed.

June 6, Answer filed.

July 29, Final Pre-lfcaring Order, certificate of service

filed.

July 30, Transcript of 4-16-74 re: argument on plaintiffs’

motion for a class action determination and on de-

fendants’ motion to dismiss filed.

Aug. 21, ORDER granting petition of American Civil

Libertics Foundation permitting same to participate

4a Docket Entries

as amicus curiae in this cause filed. 8-23-74 Entered

and copies mailed.

Aug. 21, ORDER that final hearing and argument shall

take place on 9-9-74 at 10:00 a.m., and on 9-11-74

from 9:30 a.m.-1:00 p.m.; that pre-trial briefs are

not required, but may be submitted by 9-3-74; that

final pre-hearing Order is fully approved, etc. filed.

8-23-74 Entered and copies mailed.

Aug. 23, ORDER [dated 8-22-74] that Pennsylvania

Association for Retarded Citizens [PARC], Inc. and

National Center for Law and the Handicapped, Inc.

are granted leave to participate as amici curiae herein

filed. 8-26-74 Entered and copies mailed.

Sept. 3, Defendants’ Brief, with exhibits in support there-

of filed.

Sept. 6, Brief of Amici Curiae, Penna. Association for

Retarded Citizens, Inc. and National Center for Law

and the Handicapped, Inc. filed.

Sept. 16, Copy of Brief of Amici Curiae, Penna. Associa-

tion for Retarded Citizens, Inc. and National Center

for Law and the Handicapped, Inc. filed.

Sept. 16, Brief of American Civil Liberties Foundation of

Pennsylvania, Inc., Amicus Curiae filed.

Sept. 30, Deposition of Dr. Joel S. Feiner, M.D. of 8-21-74

filed.

Oct. 2, Plaintiffs’ Trial Brief, with certificate of service

filed.

Oct. 7, Brief of Amicus Curiae United States of America,

with certificate of service filed.

_ =) ae ie note, aD

Rt ete Me Ae J

Docket Entries 5a

Oct. 7, Transcript of testimony of Evidentiary hearing of

9-9-74 filed.

7, Transcript of testimony of Evidentiary hearing of

9-11-74 filed.

7, Deposition of Dr. Barbara Armstrong of 3-2-73

filed. [Exhibit P-7]

8, Order that Plaintiffs’ proposed Findings of Fact

and Conclusions of Law be filed on 10-21-74; De-

fendants’ reply be filed within 10 days of receipt of

plaintiffs’ Proposed Findings of Fact and Conclusions

of Law filed. 10-9-74 entered and copies mailed.

Oct.

Oct. 18, Plaintiffs’ proposed findings of fact and con-

clusions of law, certificate of service filed.

Oct. 30, Transcript of testimony of Evidentiary Hearing

of 10-7-74, Third Day filed.

Nov. 1, Defendants’ proposed findings of fact and con-

clusions of law, certificate of service filed.

Nov. 8, ARGUED SUR: Final merits of the case...

C.A.V.

Nov. 8, ORDER that plaintiffs’ request for admission of

Exhibits 2 and 3 is DENIED filed. 11-11-74 En-

tered and copies mailed.

1975

June 25, Order denying plaintiffs’ motion for temporary

restraining order, etc. filed. 6/26/75 entered and

copies mailed.

July 24, Opinion, Huyett, J., Gibbons, J. and Broderick, J.

finding §§402 and 403 unconstitutional, etc. filed.

6a Docket Entries

july 24, Order that judgment is entered in favor of

plaintiffs and against defendants: Counsel for the

partics shall confer and submit an appropriate form

order consistent with Opinion within 20 days filed.

7/25/75 entered and copies mailed.

Aug. 7, DISSENTING OPINION, Broderick, J., to the

opinion of the court of 7/24/75 filed. 8/7/75

entered and copies mailed.

Aug. 22, Defendants’ notice of appeal filed. (Certificate

of service) (75-2121)

Oct. 17, Defendants’ exceptions to proposed order, etc.

and certificate of service filed.

Oct. 31, Certified copy of Order from USCA wherein

appellants’ motion for Jeave to stay all proceedings

until 30 days after the Supreme Court of the

U. S. acts in this maiter is GRANTED; motion by

plaintiffs-appellees to dismiss appeal with memoran-

dum of law in support of motion to dismiss appeal,

etc. is DENIED without prejudice, etc. filed.

Nov. 17, ORDER that this action is properly maintained

as a class action and that certain sections of the Penn-

sylvania Mental Health and Mental Retardation Act

are declared invalid, etc. filed. 11-18-75 entered and

copies mailed.

Nov. 25, Defendants’ motion for a stay and certificate of

service filed.

Nov. 26, Defendants’ notice of appeal to the Supreme

Court (Final Order) and certificate of service filed.

(75-1064) :

Dec. 1, ORDER that defendants’ motion to stay is DE-

NIED filed. 12-2-75 entered and copies mailed.

ee ee ee

Docket Entries 7a

1976

Feb. 4, Certified copy received from the Supreme Court

of the U. S. re file of petition for a writ of certiorari

on 1-27-76 as #75-1064, etc. filed.

8a Complaint

COMPLAINT—NOVEMBER 16, 1972

IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF

PENNSYLVANIA

Kevin Bartley; Steve Gentile; Leslie Levine; Vicki

Mathews; Mark Weand, minors, through their next

friend, individually and on behalf of all others simi-

larly situated,

Plaintiffs

Vv.

Haverford State Hospital; Jack B. Kremens, individu-

ally and as Hospital Director of Haverford State Hos-

pital; Helene Wohlgemuth, individually and as Secre-

tary of Public Welfare of the Commonwealth of Penn-

sylvania; William B. Beach, Jr., individually and as

Deputy Secretary for Mental Health and Mental Re-

tardation of the Department of Public Welfare of the

Commonwealth of Pennsylvania,

Defendants

COMPLAINT—-CLASS ACTION

PRELIMINARY STATEMENT

1. Plaintiffs, individually and on behalf of all others

similarly situated, seck declaratory and injunctive relief,

oh Oe ee hws he Re

DA Naveen EN 4 of . :

Complaint 9a

and damages, for violations of their civil rights resulting

from the operation of certain parts of the Pennsylvania

Mental Health and Mental Retardation Act of 1966 which

permit the involuntary commitment of persons eighteen

years of age or under to mental health facilities on a dif-

ferent basis than other persons and without notice, hearing,

right to counsel and other procedural safeguards. The con-

vening of a three judge court is also sought. The statutes

are challenged on the grounds that they conflict with the

Due Process and Equal Protection Clauses of the Four-

teenth Amendment to the United States Constitution.

Il.

JURISDICTION

2. Jurisdiction is conferred upon this court by 28

U.S.C. § 1331 which provides for original federal question

jurisdiction. The amount in controversy, exclusive of in-

terest and costs, is greater than $10,000.

3. Jurisdiction is conferred upon this court by 28

U.S.C. § 1343(3) which provides for original jurisdiction

in all suits authorized by 42 U.S.C. § 1983 to redress the

deprivation under color of state law of any right, privilege

or immunity secured by the Constitution of the United

States and by federal law. Defendants here act under color

of law.

4. Plaintiffs’ action for declaratory and injunctive

relief, and for damages, is authorized by:

a. 28 U.S.C. 2201, 2202, 2281 and 2284, and

by Rules 57 and 65 of the Federal Rules of Civil Pro-

10a Complaint

cedure, which relate to declaratory judgments, injunc-

tions and three judge courts.

b. 42 U.S.C. §§ 1983 and 1988, which relate

to civil rights actions.

III.

THREE-JUDGE COURT

5. This is a proper case for determination by a three-

judge court pursuant to 28 U.S.C. §§ 2281 and 2284 since

Plaintiffs seek an injunction to restrain Defendants, a state

institution and state officers, from the enforcement, exe-

cution and operation of portions of state statutes (50 P.S.

§§ 4402(a) (1), 4402(a) (2), 4402(c), 4403 (a) (1),

4403 (a) (2) and 4403(c)) of state-wide applicability on

the ground that said statutes are contrary to the United

States Constitution.

IV.

CLASS ACTION

6. The named Plaintiffs bring this action on their

own behalf and, pursuant to Rule 23 (a) , 23(b) (2) of the

Federal Rules of Civil Procedure, on behalf of all others

similarly situated.

7. The members of the class of Plaintiffs similarly

situated are all persons under eighteen years of age who

have been, are, or may be admitted or committed to Haver-

Complaint lla

ford State Hospital and all other state mental health fa-

cilities under the challenged provisions of the state statute.

8. The requirements of Rule 23 are met in that: the

class is so numerous that joinder of all members is imprac-

tical (and the total membership of the class is indeter-

minate) ; there are questions of law and fact common to

the class; the claims of the representative parties are typi-

cal of the claims of the class; the representative parties

will fairly and adequately protect the interests of the class;

and the parties opposing the class have acted on grounds

generally applicable to the class, thereby making appro-

priate final injunctive and declaratory relief with respect

to the class as a whole.

9. Defendant Jack B. Kremens, Hospital Director of

Defendant Haverford State Hospital, is sued as representa-

tive of the directors of all mental health facilities in Penn-

sylvania, all of which are under the authority and super-

sion and regulation of Defendants Wohlgemuth and

Beach. All the allegations in Paragraph 8 above (with

the exception of the last clause) are applicable here and

are incorporated by reference.

10. The questions of law and fact involved are:

a. Are the representative parties, and their

class, admitted or committed involuntarily to De-

fendant Haverford State Hospital and other mental

health facilities pursuant to the challenged Statutory

provisions?

b. Do Defendants operate, execute and enforce

the challenged statutes?

c. Are the challenged statutes contrary to the

Due Process and Equal Protection Clauses of the

Fourteenth Amendment to the United States Consti-

tution?

12a Complaint

PLAINTIFFS

11. Plaintiff Kevin Bartley is a citizen of Pennsyl-

vania, age 16, having been born November 4, 1956.

12. Plaintiff Steve Gentile is a citizen of Pennsyl-

vania, age 18, having been born March 20, 1954.

13. Plaintiff Leslie Levine is a citizen of Pennsyl-

vania, age 15, having been born October 8, 1957.

14. Plaintiff Vicki Mathews is a citizen of Pennsyl-

vania, age 15, having been born September 10, 1957.

15. Plaintiff Mark Weand is a citizen of Pennsyl-

vania, age 15, having been born June 13, 1957.

16. All named Plaintiffs are being held at Defend-

ant Haverford State Hospital against their will having

been admitted or committed by Defendants or under their

direction pursuant to the challenged sections of the Penn-

sylvania Mental Health and Mental Retardation Act of

1966. Such admissions and commitments were accom-

plished without notice, hearing, right to counsel or order

of court.

VI.

DEFENDANTS

17. Defendant Haverford State Hospital is a men-

tal health “facility” under Section 102 of the Pennsylva-

nia Mental Health and Mental Retardation Act of 1966.

ee ee) ee ee Ee ea

ws a ee

Complaint i3a

It receives admissions and commitments of persons, in-

cluding Plaintiffs and their class, under said act.

18. Defendant Jack B. Kremens is Hospital Direc-

tor of Defendant Haverford State Hospital and is charged

with supervision and administration of the facility. See

Sections 102 and 203 of the Pennsylvania Mental Health

and Mental Retardation Act of 1966 (hereafter the “Act”).

It is to Kremens or his delegate that applications for ad-

mission, commitment and release must be made. See Sec-

tions 402 (b) , 403(b) and 403(c) of the Act.

19. Defendant Helene Wohlgemuth is the Secretary

of Public Welfare of the Commonwealth of Pennsylvania

which department has the power and duty to enforce the

Act and all regulations necessary and appropriate to the

proper accomplishment of the Act and to operate and as-

sign functions to all state facilities. See Sections 201 (2)

and 202 (a) of the Act.

20. Defendant William B. Beach, Jr. is the Deputy

Secretary for Mental Health and Mental Retardation of the

Department of Public Welfare of the Commonwealth of

Pennsylvania. He has general authority to supervise and

regulate mental health facilities within Pennsylvania.

Vil.

FACTUAL ALLEGATIONS

Kevin Bartley

21. Plaintiff Kevin Bartley was committed to Haver-

ford State Hospital on November 30, 1971 under Section

403 (a) (2) of the Act.

14a Complaint

22. He was committed by his mother although =

did not wish to enter the hospital then = cone “0

i is critical of m

remain now. Kevin Bartley is cri me

he believes are the hospital’s overeat hiya? sma

i ’s playing favorites with pa .

regulations, the staff’s p ype fc vag

a unishments for minor ru '

ane i ee wards as punishment for mere allega

tions of wrongdoing, without hearing or proof.

23. Bartley believes that nothing worthwhile is -

curring to him inside the hospital and that his time is we

ly being wasted. This is true. When he —_ re ’

he plans to go to school and learn a usable trade.

Steve Gentile

24. Plaintiff Steve Gentile was aes ae

ford State Hospital on August 24, 1971 by his father u

der Section 403 (a) (2) of the Act.

i ital involuntarily, is

25. Gentile entered the hospita .

being detained there involuntarily and wishes to leave but

is restrained from doing so by Defendants and the opera-

tion of the challenged portions of the Act.

Leslie Levine none

inti i ine’ her committe

26. Plaintiff Leslie Levine's mot

to Haverford State Hospital on October 11, 1972 under

Section 403 (a) (2) of the Act. |

27. Levine does not wish to remain at the hospital

but is restrained from leaving by Defendants and by the

operation of the challenged portions of the Act.

28. Levine was committed to the hospital because

she does not get along with her mother and sister. Her

Complaint 15a

parents are divorced; her father is remarried and living in

Florida. Leslie Levine would like to be with her father;

they get along well and, every time she spends some time

with him, her behavior is excellent. However, because she

is with her mother and sister and does not get along with

them, Levine is an involuntary mental hospital patient.

Vicki Mathews

29. Plaintiff Vicki Mathews was committed to

Haverford State Hospital on August 9, 1972 by her par-

ents under Section 403 (a) (2) of the Act.

30. She entered the hospital involuntarily.

31. Mathews does not get along well with her par-

ents and has in the past run away from home. If she

were considered a “delinquent,” and dealt with through

the juvenile court process, she could not be institution-

alized against her will except after a full hearing, upon

order of a court. In fact, as the mental health commitment

laws permit, her parents had the choice of avoiding the

due process protections afforded juveniles in other contexts

and of dealing with her in their own way, thus depriving

Mathews of any hearing and committing her to a mental

hospital.

32. Because her parents had the financial means, on

information and belief, they applicd for her discharge from

the hospital under Section 403(c) so that she could be

shipped, against her will, to a boarding school in Texas.

Mark Weand

33. Plaintiff Mark Weand was admitted to Haver-

ford State Hospital on June 23, 1972 by his mother under

Section 402 (a) (2) of the Act.

16a Complaint

34. After another hospital would not admit him be-

cause of his age, Weand first entered Haverford for _

cal reasons because of excess use of drugs. Once at the

hospital, his mother was convinced by agents and em-

ployees of Defendants to have Weand admitted for psy-

chiatric reasons. Weand did not wish to become a men-

tal patient and repeatedly has informed gag

agents and employees of his desire to leave. They have

not permitted him to do so.

35. At the hospital, Weand has not been involved

with any therapeutic drug programs because he has not

been addicted to any drugs.

36. His mother is concerned about him but will not

apply for his release except upon the approval . the we

pital physicians, employees and agents of Defen “wir :

Weand were a voluntary patient under Section 402 of the

Act and were over eighteen, he would be permitted to

leave the hospital “at any time’ regardless of the physi-

cians’ approval or opinion.

37. The major reason Weand has been se 0p

for the past five months is that the hospital s agents an

employees have considered his attitude hostile and —

sive. The basis for this “hostile” and aggressive _ e

is Weand’s belief that he doesn’t belong in the mental oa

pital and Weand’s questioning and criticism of the hospita

regimen and his treatment there.

The Statutory Scheme a ies

j ia Mental Healt

38. Section 402 of the Pennsylvania

and Mental Retardation Act of 1966 (50 P.S. § 4402)

provides as follows: (Those parts which are challenged

" Ait tro mtins > ne edamame

~~ i

pen

Se tae a Mpa ines Teeter aie ee

ee ed

Complaint 17a

as unconstitutional by this Complaint are emphasized by

underlining [italics ])

Section 402. Voluntary Admission: Applica-

tion, Examination and Acceptance; Duration of Ad-

mission.

(a) Application for voluntary admission to a

facility for examination, treatment and care may be

made by:

(1) Any person over eighteen years of age.

(2) A parent, guardian or individual standing

in loco parentis to the person to be admitted, if such

person is eighteen years of age or younger.

(b) When an application is made, the director

of the facility shall cause an examination to be made.

If it is determined that the person named in the ap-

plication is in need of care or observation, he may be

admitted.

has been made under the provisions of Section 402 (a)

(2) and the person admitted is still eighteen years of

age or younger, any person voluntarily admitted shall

be free to withdraw at any time. Where application

has been made under the provisions of Section 402

(a) (2), only the applicant or his successor shall be

free to withdraw the admitted person so long as the

admitted person is eighteen years of age or younger.

(d) Omitted here.

39. Section 403 of the Act (50 PS. § 4403) pro-

vides as follows. (Those parts which are challenged as

unconstitutional by this Complaint are emphasized by un-

derlining [italics ])

18a

Complaint

Section 403. Voluntary Commitment; Applica-

tion, Examination and Acceptance; Duration of Com-

mitment.

(a) Application for voluntary commitment to

a facility for examination, treatment and care may be

made by:

(1) Any person over eighteen years of age.

(2) <A parent, guardian or individual standing

in loco parentis to the person to be admitted, if such

person is eighteen years of age or younger.

(b) The application shall be in writing, signed

by the applicant in the presence of at least one wit-

ness. When an application is made, the director of

the facility shall cause an examination to be made.

If it is determined that the person named in the ap-

plication is in need of care or observation, he shall

be committed for a period not to exceed thirty days.

Successive applications for continued voluntary com-

mitment may be made for successive periods not to

exceed thirty days each, so long as care or observa-

tion is necessary.

detained for more than ten days after he has given

written notice to the director of his intention or de-

sire to leave the facility, or after the applicant or his

successor has given notice of intention or desire to

remove the detained person.

(d) Omitted here.

40. The only other provisions for civil commitment

to a mental health facility provided by the Act are:

Mit tinss tt asain, clits A MO Ns eel Stee end Ste RAS el Anat Aa Ce eat oni oct a

er es _

Complaint 19a

a. Section 404 which permitted commitment of

persons upon application of third parties (including

parents, guardians, individuals standing in loco paren-

tis, etc.) upon application with certificates of two

physicians. Because of its denial of Constitutional

Due Process rights, this section has been declared un-

constitutional. See Section 404 and Dixon vy. Attor-

ney General of the Commonwealth of Pennsylvania,

325 F. Supp. 966 (M.D. Pa. 1971).

b. Section 405 permits involuntary detention

of persons, regardless of age, under emergency con-

ditions for no longer than ten days.

c. Section 406 permits involuntary commitment

of persons, regardless of age, upon petition to the

State court of common pleas, and after hearing and

examination. The respondent to such petition has the

right to notice of the hearing, the right to counsel and

the opportunity and right to present testimony and

evidence in his or her behalf and to confront his or

her accusers. The court may order outpatient or par-

tial hospitalization instead of in-hospital commitment.

VII.

FIRST CAUSE OF ACTION

For a First Cause of Action, Plaintiffs reallege Para-

graphs 1 through 40 above, which are incorporated here-

in by reference, and further allege:

41. Voluntary patients over eighteen years of age en-

ter facilities under the Act on their own application and

20a Complaint

volition under Section 402 or 403 and may leave and dis-

charge themselves either at any time (Section 402) or up-

on proper written notice (Section 403). Plaintiffs and

their class are denied such entrance and separation from

the facility by the challenged portions of these sections of

the Act.

42. The statute thus creates two classes of potential

and actual “voluntary” admittees, distinguishable only on

the basis of age. There is no adequate state justification

for this arbitrary clessification.

43. A person over eighteen years of age who does

not wish to enter a facility may be placed there involun-

tarily only upon the order of a court pursuant to the

procedures, including a petition, notice and hearing, man-

dated by Section 406 of the Act. A person under eighteen

years of age who does not wish to enter a facility may be

placed there involuntarily simply upon the application of a

parent, guardian or individual standing in loco parentis; no

notice or petition is required nor is any sort of hearing or

court order provided for.

44. The statute thus creates two classes of potential

and actual involuntary admittees and committces, distin-

guishable only on the basis of age. There is no adequate

state justification for this arbitrary classification.

45. The challenged portions of the Act and Defend-

ants’ actions in operating, enforcing and executing the

same, deny Plaintiffs and their class the equal protection

of the laws in violation of the Fourteenth Amendment to

the United States Constitution.

Complaint 21a

IX.

SECOND CAUSE OF ACTION

For a Second Cause of Action, Plaintiffs reallege

Paragraphs 1 through 40 above, which are incorporated

herein by reference and further allege:

46. By operation of the challenged portions of the

Act, Plaintiffs and their class are detained and incarcerat-

ed involuntarily in mental hospitals and other facilities

without:

a. the right to notice;

b. the right to a hearing;

c. the right to counsel and, if indigent, appoint-

ment of counsel;

d. the right to present evidence and testimony

on their own behalf;

e. the right to subpoena witnesses and docu-

ments;

f. the right to confront and cross-examine wit-

nesses against them and those who wish them to enter

a facility;

g. the right to independent expert examination

and assistance;

h. the right to be involuntarily detained only

upon decision of a disinterested and impaitial deci-

sion-maker;

i. the right to be involuntarily detained only

upon a decision that they are in need of care, treat-

ment or observation, such decision being based on

clear and convincing evidence;

22a Complaint

j. the right to appeal and review, including pro-

vision for assistance of counsel and record and tran-

script without cost if appellant is unable to pay the

cost thereof;

k. other procedural safeguards.

47. By operation of the challenged portions of the

Act, and by Defendants’ actions in operating, enforcing

and executing the same, Plaintiffs and their class are de-

prived of their life, liberty and property without due pro-

cess of Jaw in violation of the Fourteenth Amendment to

the United States Constitution.

PRAYER FOR RELIEF

WHEREFORE, Plaintiffs respectfully pray, on behalf

of themselves and all others similarly situated, that this

Honorable Court:

1. Assume jurisdiction of this cause, convene a three-

judge court pursuant to 28 U.S.C. §§ 2281 and 2284 to

determine this controversy, and set this case promptly for

an expedited hearing;

2. Determine by Order, pursuant to Rule 23(c) (1)

of the Federal Rules of Civil Procedure, that this action

be maintained as a class action;

3. Enter a final judgment, pursuant to 28 U.S.C.

§§ 2201 and 2202 and Rule 57 of the Federal Rules of

Civil Procedure declaring that the challenged portions of

the Pennsylvania Mental Health and Mental Retardation

Act of 1966, that is 50 P.S. §§ 4402 (a) (1), 4402 (a) (2),

nines tienen tine ll

Complaint 23a

4402 (c), 4403 (a) (1), 4403 (a) (2), and 4403 (c) (see

paragraphs 38 and 39 above), are invalid, void and of no

effect on the grounds that they violate the Due Process and

Equal Protection Clauses of the Fourteenth Amendment to

the United States Constitution;

- 4. Enter preliminary and permanent injunctions en-

joining Defendants from enforcing and executing such

statutory provisions;

5. Award damages to each of the named Plaintiffs

in the amount of $15,000 each for unconstitutional depri-

vation of their rights;

6. Allow Plaintiffs their costs herein and reasonable

attorney’s fees;

7. Grant such additional and alternative relief as

may be deemed by this Court appropriate, just, proper and

equitable. |

Respectfully submitted,

(s) David Ferleger

David Ferleger

Attorney and Next Friend for

Plaintiffs

Mental Patient Civil Liberties

Project

121 South 18th Street

Philadelphia, Pa. 19103

(215) 561-4715

On the Brief:

Ronald Soskin

Stan Abramson

Dated November 16, 1972

24 Motion To Dismiss Interrogatories to Defendants 25a

IN THE UNITED STATES DISTRICT COURT FOR

THE EASTERN DISTRICT OF PENNSYLVANIA

MOTION TO DISMISS

eo aleed

IN THE UNITED STATES DISTRICT COURT FOR

THE EASTERN DISTRICT OF sponte states

Ped ain 6%

[Caption Omitted]

FIRST SET OF INTERROGATORIES TO

DEFENDANTS

Civil Action No. 72-2272

Definitions

, —_ As used in the interrogatories below, the following

d rinting. ,

[Title commen 5p B-1 words shall be taken to have the following meanings:

a. “Juvenile (s)”—Persons eighteen years of

MOTION TO DISMISS age or younger.

b. “Facility (ies)”—‘‘Any mental health estab-

Defendants move that this Honorable Court dismiss lishment, hospital, clinic, institution, center, day care

the above captioned action on the basis that Plaintiffs have center or other organizational unit, or part thereof,

failed to plead an action upon which relief may be granted. which is devoted primarily to the diagnosis, treatment,

care, rehabilitation or detention of mentally disabled

ar wong von — persons.”” (As defined in the Mental Health and

ssis

Mental Retardation Act of 1966).

c. ‘‘Act’—The Pennsylvania Mental Health

and Mental Retardation Act of 1966.

d. “Director(s)”—‘The administrative head

of a facility and includes superintendents.” (As de-

fined in the Act).

e. “Department’”—The Department of .Public

Welfare.

f. “Adult \s)”"—Persons over eighteen years of

age.

December 12, 1972

26a Interrogatories to Defendants

g. “Civil Commitment”—Commitment to a

facility under Section 406 of the Act.

h. “Voluntary Admission” —Admission or

commitment to a facility under Section 402 or

Section 403 of the Act.

i. “State’—Pennsylvania, often with reference

to the state government.

Interrogatories

1. Name all the state facilities, that is, those owned

and operated by the state. Also, their addresses.

2. What are the names of all the facilities in Penn-

sylvania which are privately owned, regulated hy the state

and the Department, and which admit or commit any

persons under the Act? Also, their addresses?

3. What are the policies of the Department with

regard to criteria for admission or commitment of juveniles

to facilities, that is, what criteria are used?

4. What are the policies of the Department with

regard to criteria for admission and commitment of adults

to facilities, that is, what criteria are used?

5. What are the policies of Directors with regard to

acting upon applications for voluntary admissions of juve-

niles to facilities, that is, what criteria are used?

6. What are the policies of Directors with regard

to acting upon applications for voluntary admissions of

adults to facilities, that is, what criteria are used?

7. Identify and describe the nature, custody and

location of all memoranda, directives, orders, policies, reg-

— re ——-, . % Naw

Interrogatories to Defendants 27a

ulations and other or similar documents issued by the De-

partment or other state authorities or known to Defendants

which pertain to the voluntary admission or civil commit-

ment of juveniles to facilities.

8. Identify and describe the nature, custody and

location of all memoranda, directives, orders, policies,

regulations and other or similar documents issued by

the Department or other state authorities or known to

Defendants which pertain to voluntary admission or civil

commitment of adults to facilities.

9. Name all juveniles presently in all facilities as

voluntary admissions and provide the name of the facility

each is in.

10. Name all juveniles presently in all facilities as

civil commitments and provide the name of the facility

each is in.

11. For each juvenile in a facility as a voluntary

admission, what is or are the major behaviors or activities

upon which such admission was based?

12. For each juvenile in a facility as a civil commit-

ment, what is or are the major behaviors or activities upon

which such commitment was based?

13. For each juvenile in a facility as a voluntary

admission, what is the name and address of the applicant

for admission and identify the relationship of the applicant

to the juvenile (e.g., parent, guardian or person in loco

Parentis) ?

14. For each juvenile in a facility as a result of a

civil commitment, what is the name and address of the

28a Interrogatories to Defendants

Petitioner and identify the relationship of the Petitioner to

the juvenile?

(s) David Ferleger

David Ferleger

Mental Patient Civil Liberties

Project

121 S. 18th Street

Philadelphia, Pa. 19103

Attorney for Plaintiffs

December 22, 1972

Please answer, in accordance with Rule 33, within

thirty days.

Motion for Class Action 29a

IN THE UNITED STATES DISTRICT COURT FOR

THE EASTERN DISTRICT OF PENNSYLVANIA

Civil Action No. 72-2272

[Title omitted in printing. ]

MOTION FOR CLASS ACTION

Plaintiffs, by their attorney and next friend, David

Ferleger, Esquire, respectfully move this Honorable Court

to order that this action be maintained as a class action.

Rule 23(c) provides:

As soon as practicable after the commencement

of an action brought as a class action, the court shall

determine by order whether it is to be so maintained.

An order under this subdivision may be conditional,

and may be altered or amended before the decision

on the merits.

In their Memorandum of Law in Support of Motion

for Class Action and Three-Judge Court, filed with the

Complaint, Plaintiffs detailed the argument on which they

here rely at pages 1 through 3 of that memorandum. No

30a Motion for Class Action

i iled i ition by

memorandum or motion has been filed in Opposi

Defendants, except a motion to dismiss under Rule 12 (b)

(6).

Respectfully submitted,

(s) David Ferleger

David Ferleger, Esquire

Mental Patient Civil Liberties

Project

121 South 18th Street

Philadelphia, Pa. 19103

Attorney and Next Friend

to Plaintiffs

March 13, 1973

[Certificate of Service omitted. ]

Order Dated April 25, 1973 3la

ORDER

[Caption Omitted]

AND NOW, this 25 day of April, 1973, it is hereby

ordered and decreed that:

1. Th two affidavits of juveniles at Haverford

State Hospital submitted by Plaintiffs on April 12, 1973

to this Court be sealed and impounded until further order

of this Court;

2. The parties and their attorneys shall not disclose

to others the names of the affiants except with the permis-

sion of the Court. The contents, without identifying data,

may be disclosed;

3. Defendants, their agents and employees, are en-

joined from interfering with the First Amendment rights of

affiants and from punishing, disciplining, interrogating or

otherwise imposing sanctions on affiants by reason of their

affidavits herein.

For the Court:

(s) Thomas A. [Illegible]

32a Motion for Sealing Affidavits

[Caption Omitted ]

MOTION FOR SEALING OF AFFIDAVITS AND

PROTECTION OF AFFIANTS

David Ferleger, attorney for Plaintiffs, respectfully

represents that:

1. Attached are two affidavits of juveniles now at

Haverford State Hospital pursuant to the chalienged por-

tions of the state mental health act. Their parents and

various mental health professionals, including the Defend-

ants and their agents, caused their commitment.

2. The affiants would be embarassed and their (and

their families’) reputation affected adversely by public dis-

closure of their names and their affidavits.

3. The affiants fear that the Defendants and their

employees will take disciplinary or other action against

them for their criticisms of their confinement as expressed

in these affidavits.

Wherefore, it is respectfully prayed that: 1) these affi-

davits be sealed and impounded until further order of the

Court; 2) the parties and their attorneys be ordered not

to disclose the names of the affiants to the public except

with the permission of the Court; and 3) the Defendants,

their agents and employees be enjoined from interfering

with the First Amendment rights of affiants and from pun-

Motion for Sealing Affidavits 33a

ishing, disciplining, interrogating or otherwise imposing

sanctions on affiants by reason of their affidavits herein.

Respectfully submitted,

(s) David Ferleger

David Ferleger, Esquire

Mental Patient Civil Liberties

Project

121 S. 18th Street

Philadelphia, Pa. 19103

This is to certify that on da i

; y of April, 1973,

mailed a copy of the foregoing to Marx Leopold, Esq. ~

Barry Roth, Esq., Office of Le

; a gal Counsel, De

Public Welfare, Harrisburg, Pa. areapuoniee

David Ferleger

[Caption Omitted]

AFFIDAVIT

My nameisA...M... I was transferred to Haver-

ford from the University of Pennsylvania Hospital. My

parents brought me here, but I didn’t want to come. It

was too late, I couldn’t do anything about it. I said I

didn’t want to stay here. The doctor got Me to admit that

I needed help but I told him that I still didn’t want to

stay. Like | know some girl that was here a couple of

weeks ago, Debbie Geiger, her parents told her they were

going to see a doctor—that’s how she got here. But if

you’re under 18, well you know.

When I first got here they pushed me into a room

and told me to take off my clothes and put on pajamas.

Then they took me up to the fifth floor. I wasn’t expecting

to be locked up. It really drives you crazy, They didn't

explain anything to me—they put you up there and that’s

it. My mother says if she knew that she woujdn’t have put

me in here. I was up there 3 or 4 days before I was sent

to Building 9.

They threaten you here—that’s the really bad part.

You do what we say or you go up the hill or something—

restrictions. Like me and D...D.. —we'll probably

get sent up the hill again cause we didn’t go to our half

hour of art therapy. D . . . got sent up for five days because

he wouldn’t take his restrictions. They don’t care—they

don’t care about anything. The evening and late night

staff stinks. The only staff that really cares is the day

staff.

Affidavit 35a

I got transferred to Building 4 one night. I cut my-

self on purpose. My hands were bleeding and they said I

was going for a tetanus shot. They didn’t explain what

they were doing or tell you they were taking you up. They

should at least have told my parents. I would still be

ihege but my doctor, Dr. Kratsa, got me back the next day.

If you get sent up on a Friday and your doctor is only here

Tuesday, Wednesday and Thursday, you'll be there till

next Tuesday at least. Do you think you can do anything

about the restrictions and us getting sent up the hill?

I am presently 1 patient at Haverford State Hospital.

Since a notary pubiic is not available at the hospital and °

since I am not able to secure release for the purpose of

signing before a notary public, I am forced to sign without

notarization. I swear that the above statements are true

and correct to the best of my knowledge, information and

belief and I sign below under pain of perjury.

££ hA ae

Signed on this 9th day of April, 1973.

[Caption Omitted]

AFFIDAVIT

My nameisD...D... I am 14 years old and live

with my parents at 2624 Sunset Boulevard in Broomall,

Pennsylvania.

Before I got here I was on probation for truancy. |

broke probation because I was truant again. My parents

told me they wanted to have a meeting with me down at

Haverford State. My mom said a psychiatrist and a social

36a Affidavit

worker would be there. This woman at the Media Court

House recommended to my parents that they bring me

here. They wanted me to come that day but I said no,

I wanted to say goodbye to my friends that night. I came

the next morning at 7 a.m. I didn’t even get to see my

probation officer. When I got to the hospital the doctor,

Dr. Kratsa, wanted me to go to reform school. My parents

kept saying no. They made it sound like if I didn’t come

here I’d be going to reform school. So I figured it would

be a lot better here than reform school. So I said yes.

That’s how they tricked me.

About the only big complaint I have is the restrictions.

That’s the only thing that’s a matter with this hospital.

I was supposed to sit in my alcove for two nights because

I didn’t do clean-up. I got sent up the hill to the locked

building because | wouldn’t take my restrictions. I think

that’s pretty stupid. Why should we be sent up there?

We don’t belong there with those people. They ought to

have a better way of punishing you. I was there for 5

days—I’ve never been locked up for a length of time like

that before. There are people there that bothered me and

wanted me to let them do stuff to me, but I don’t want

to get them in trouble—that’s just part of their problem.

One guy used to wake me up and pounce on top of me

and hit me.

The fourth floor of Building 4 is worse than the fifth

floor where I got sent the first time. I had a bad day in

Building 9 and I was mixed up and I didn’t want to stay

there that night, but they wouldn’t let me go to Building 4

just for the night. So I broke a window to get sent there.

They found phenobarbitol tablets in my room after I broke

the window. I got them here at the hospital—a lot of

kids in the building did. That’s why a lot of us got sent

Affidavit 37a

up here. I had a bowl of grass too that I had from home.

My friends used to bring up stuff too. The fourth floor is

worse than the fifth. I’ve been here over a week now.

Most of them on this floor want to try stuff with me but

I won't let them. One guy gave me all sorts of presents

and then he told me what he wanted me to let him do just

like the others, but I told him no. I want to get off this

floor. I’ll never bring any dope in anymore. I like the

stuff they’re giving me here though—I’m flying. Don’t

let them change it. I’d rather be on the fifth floor again or

in Building 9. I want to be able to go home on the week-

ends. I’ll write a commitment saying I won’t do dope any-

more. I'd like you to try and help me. I want you to

talk to my doctor, Dr. Kratsa, about all of this.

I am presently a patient at Haverford State Hospital.

Since a notary public is not available at the hospital and

since I am not able to secure release for the purpose of

signing before a notary public, I am forced to sign without

notarization. 1 swear that the above statements are true

and correct to the best of my knowledge, information and

belief and I sign below under pain of perjury.

_ fr Paw

Signed on this 9th day of April, 1973.

38a Appearances

IN THE UNITED STATES DISTRICT COURT FOR

THE EASTERN DISTRICT OF PENNSYLVANIA

Civil Action No. 72-2272

Kevin Bartley, Steve Gentile, Leslie Levine, Vicki

Mathews, Mark Weand, minors, through their next

friend, individually, and on behalf of all others

similarly situated

vs.

Haverford State Hospital, Jack B. Kremens, et al.

Oral examination before trial by Dr. Barbara Arm-

strong, at the law office of Mental Patient Civil Liberties

Project, David Ferleger, Esquire, 121 South 18th Street,

Philadelphia, Pennsylvania, on Friday, March 2, 1973, at

10:00 a.m., before Patricia M. Kosmalski, Approved Re-

porter.

Present:

David Ferleger, Esq., and Stan Abramson, Esq., Coun-

sel for the Plaintiffs.

Barry A. Roth, Esq., Assistant Attorney General,

Counsel for the Defendants.

(2) (it is stipulated and agreed by and between

counsel that sealing, filing, and certification of the

DR.

Colloquy 39a

examination before trial be waived, and that all ob-

jections, except as to the form of the questions, be re-

served to the trial of the cause.)

BARBARA ARMSTRONG, Director of Adolescent

Services, Haverford State Hospital, Haverford, Penn-

sylvania, sworn.

MR. FERLEGER: Dr. Armstrong, do you un-

derstand the purpose of this deposition?

THE WITNESS: No.

MR. FERLEGER: The purpose of a deposition,

under the Federal Rules of Civil Procedure, under

the rules of lawsuits conducted, each side is afforded

the opportunity for discovery to find out what poten-

tial witnesses may have to say, and to record testi-

mony in case it is needed in the future for court. The

deposition can be used in court to contradict or im-

peach what you say. It can be used in court if it hap-

pens that at the time of trial or hearing, you happen

to (3) be more than a hundred miles away.

For example, you can’t come if you should die

before the court hearing. This deposition can be

used as your testimony in that case, and under other

exceptions and circumstances, it can also be used.

Because it can be used in court and because of

the seriousness of the discovery process, you were

sworn at the time this deposition was taken. So, you

are obliged to tell the truth, as this is a serious kind

of thing we are about to begin here today.

THE WITNESS: Yes. I understand.

Colloquy

MR. FERLEGER: Have you read the com-

plaint and memorandum in the Bartley suit?

Mr. Roth, I would appreciate it if you don’t

shake your head and answer for her.

MR. ROTH: I am not answering.

THE WITNESS: I am not sure. I remember

I read the deposition, I guess, in this case, of Dr.

Kremens.

MR. FERLEGER: Have you read this paper

captioned, “Complaint in Class, More Than In Law,

of Class Action’”’?

(4) MR. ROTH: Do you mind showing me

copies? Do you want to state your purpose of this

deposition—I imagine, your objective, instead of go-

ing into needless impressions or embarrassment?

MR. FERLEGER: My objective is to determine

what information Dr. Armstrong might have that

would lead to discovery of other relevant material in

this lawsuit. Since she is the doctor of a number of

named plaintiffs and other members of this class ac-

tion, I want to talk to her about problems involved.

I don’t know where you got the idea I have the de-

sire to embarrass or press her.

MR. ROTH: Iam concerned that this is going

to be a fishing deposition, and I am going to make a

motion to discontinue the deposition.

MR. FERLEGER: As to what questions I ask,

if you want to object, you can object.

MR. ROTH: I am well aware of the rules of

federal court.

Colloquy ' 4la

I want you to know that I will make the appro-

priate motion now to terminate this deposition.

MR. FERLEGER: Any motion you wish to (5)

make is up to you.

MR. ROTH: Let’s proceed. Let’s get on to the

deposition proper.

THE WITNESS: Mr. Ferleger, what is the

proper procedure? If you don’t mind, may I ask you

a question?

MR. FERLEGER: No, I will be glad to answer

any questions you have, if I can.

THE WITNESS: Is it necessary that I have

read the memorandum, which I did not see? I have

no idea of its contents.

MR. FERLEGER: It is necessary. I was going

to try to find out as to whether you were familiar—

THE WITNESS: My capacity is, in addition to

being an administrator, as well as a director, a direc-

tor of a specific specialty service named, “Adolescent

Services,” at Haverford State Hospital. I am not just

one of the hospital’s doctors involved in certain cases.

Therefore, I must represent my staff.

Secondly, I would like to request that any cor-

respondence or memorandums that were sent to or

by Dr. Kremens in regard to this suit, I (6) be al-

lowed to see.

MR. FERLEGER: Certainly. I think the ap-

propriate thing for you to do is to ask your counsel

to share with you the legal papers that were filed

with the court.

42a Dr. Barbara Armstrong—Direct

MR. ABRAMSON: I want to mention that at

any time if you don’t understand or realize what it

is we are asking you, or you are not quite clear on

it, feel free to ask a question. Don’t hesitate because

you don’t understand what you are being asked. Then

again, please do not answer any question until you do

understand it.

MR. FERLEGER: In reference to what you

just said, doctor, we have asked you to come to this

deposition, and what you say here the law requires

it be your opinion and your feelings, not the feelings

of your staff or Dr. Kremens.

If we had wanted the hospital’s position—or per-

sonnel—at Haverford State Hospital, we would have

asked them to send, under federal rules, a representa-

tive of the hospital.

We ask you, Dr. Barbara Armstrong, because you

took an oath, to say what your answers are (7) to

these questions.

THE WITNESS: That I understand, but there

is a condition, in that you ask for, also, at least, a

licensed representative presently in the hospital. In

that regard, I have to convey information I haven’t

gathered myself.

Direct Examination

BY MR. FERLEGER:

Q. Can you give us your background, education, and

professional experience?

MR. ROTH: If we can dispense with that, or

do you plan to attack her credibility as a psychiatrist

Dr. Barbara Armstrong—Direct 43a

or as a licensed psychiatrist who practices at Haver-

ford State Hospital? It would save time.

MR. FERLEGER: She might have more quali-

fications.

MR. ROTH: Can you indicate the purpose of

it?

MR. FERLEGER: Her experience and educa-

tional background is certainly relevant in court and—

MR. ROTH: The only way it is relevant (8)

is if you are going to attack her credibility as a prac-

ticing psychiatrist.

MR. FERLEGER: If I want to qualify her as

an expert witness, it is relevant.

MR. ROTH: But the question is whether we

can agree she is an expert witness. Do you want her

to perform as an expert witness?

MR. FERLEGER: This is discovery.

MR. ROTH: You are fishing.

MR. FERLEGER: I am not fishing.

BY MR. FERLEGER:

Q. (Continued) Where did you go to school?

A. To Temple undergraduate school and Hahne-

mann Medical College, and the University of Pennsylvania

Hospital for Psychiatric Residence, with a specialty in psy-

chiatry.

Q. Did you go from the University of Pennsylvania

Hospital to Haverford?

A. No, I was at Devereux for a year, and for three

years | was chairman of the Department of Psychiatry for

44a Dr. Barbara Armstrong—Direct

a U.S. Army hospital in Badcreusnach, Germany, and up-

on returning to the United States, I took a position at

Haverford State, with the purpose of setting up and di-

recting an adolescent service.

(9) Q. Did your work involve adults and adoles-

cents?

A. Child guidance clinic and in an adolescent clinic.

So my work did involve both adults and children as chair-

man of that department.

Q. How long have you been at Haverford?

A. Four years.

Q. How long have you been the Director of Adoles-

cent Services?

A. The entire time.

Q. During these past four years, have you had ex-

perience with the court commitments of juveniles, as well

as voluntary commitments?

A. Yes, I have.

Q. Have you testified in court hearings?

A. Yes.

Q. For juveniles?

A. Yes.

Q. Have you also been involved in procedures for

admission of juveniles, pursuant to application by their

parents under the Act?

A. Yes.

Q. Can you tell me, please, what the procedure is

at Haverford when parents call up or present themselves

or their children at the hospital, saying they want the (10)

child to be admitted as a voluntary patient?

A. The hospital has no specific admission policy.

It follows the Mental Health and Retardation Act of 1966.

You are familiar with the Act?

Dr. Barbara Armstrong—Direct 45a

Q. I didn’t mean the criteria. I am just interested

in what happens—

MR. ROTH: I object. I think Dr. Armstrong

answered that question. You asked her what proce-

dure occurs at Haverford, and she stated it is in com-

pliance with the Mental Health and Retardation Act.

BY MR. FERLEGER:

Q. The Act says the director makes a finding, but

jack Kremens doesn’t do that.

MR. ROTH: I object to this questioning. You

asked her what the procedure is and she has informed

you.

MR. FERLEGER: Your objection is noted. She

can now answer.

MR. ABRAMSON: What we are interested in

is not what the Act calls for specifically, but how it

is applied at the hospital. In other words, if, for in-

stance, a parent or guardian (11) feels that they

would like to have their child, or the person who they

are responsible for, enter the hospital, w! at are your

actual mechanics: who do they see; what actually

goes on or takes place before the child is or is not

admitted, in a very practical sense?

MR. ROTH: I appreciate this elaboration, Mr.

Abramson.

We are confining this to 402 and 403 of the

Act?

MR. ABRAMSON: Yes.

46a Dr. Barbara Armstrong—Direct

THE WITNESS: Also, persons 18 years of age —

and under?

MR. ABRAMSON: Yes.

A. Practically speaking, my understanding of the

Mental Health and Retardation Act is such that the direc-

tor may designate a professional on his staff to make an

examination. Subsequently, what happens, this prevents

a person, the applicant who is either a parent or guardian,

from acting in loco parentis.

The child who is 402, is then brought in for examina-

tion. On a 402, it is a prescheduled general admission,

therefore, they are examined by one of the members of

the Adolescent Services, at which time, a (12) determina-

tion is made whether the child needs, in fact, care in the

hospital, or what facilities. If it is not indicated, the child

is not admitted. If it is indicated, a rch admitted ~

the a iate facility. As part of our services,

the child scat dnaieetend of the Adolescent Services, then

he is admitted to the hospital at large. A social worker,

in fact, who is designated as part of the Adolescent Ser-

vices, then contacts the parent for further personal history

or further studies.

Q. Is that initial examination by one of your staff?

A. Generally.

Q. Does that take one day or half a day?

MR. ROTH: I object to that question.

BY MR. FERLEGER:

Q. (Continued) How long?

MR. ROTH: I object to that question.

MR. FERLEGER: She can answer now.

Dr. Barbara Armstrong—Direct } 47a

MR. ROTH: | am familiar. I want you to know

I don’t want you jumping at her.

MR. FERLEGER: I want her to realize that

Mr. Roth is objecting for the record as permitted,

and you are required to answer.

We don’t have a Judge here to rule.

(13) MR. ROTH: But you are permitted to

elaborate.

BY MR. FERLEGER:

Q. (Continued) The initial examination after the

application—the one you referred to usually by a member

of your staff—what is the usual length of time for that ex-

amination?

A. We should qualify it and say the examination is

by a psychiatrist, not any other discipline, and the length

of time is variable. It depends on the individual psychia-

trist and whether the child is interviewed alone or with a

family member present—anywhere from an hour to three

quarters of an hour. On occasion, if it is not done by other

staff, it may be the same period of time or shorter.

Q. Ina court commitment under Section 406 of the

Act, as you probably know, the first part of the procedure

involves, usually—the person is not then hospitalized—

it involves just lay testimony, is that right, somebody pre-

sents a petition?

MR. ROTH: I object to that as being argu-

mentative, and calls for a conclusion of law as to what

a 406 commitment is.

(14) BY MR. FERLEGER:

Q. (Continued) I will ask it this way.

48a Dr. Barbara Armstrong—Direct

When a juvenile is committed under court commit-

ment, you testified that those persons are referred to you,

haven’t you?

A. Yes, I have.

Q. After you testified—in your experience, very

often the court commits the juvenile for a period of 10

days for evaluation and observation; isn’t that correct?

A. 10, 30, 60, or an indefinite period.

MR. ROTH: I object to your line of question-

ing, based on—

BY MR. FERLEGER:

Q. What I mean is this. There have been occasions,

haven’t there, when the first time you saw 4 juvenile, the

subject of a 406 petition, is when the court Committed him

to Haverford State Hospital, and directs the hospital to

evaluate and observe that person, and after doing this

evaluation and observation, you then go back to Harris-

burg and report your findings?

A. That happens on occasion, yes.

Q. And that period of time that you have the juve-

nile for that observation and evaluation is 19 days?

(15) MR. ROTH: ro t6 this line of

questioning, again, based upon the fact the question

is argumentative. Also, by asking that question, you

are trying to mislead the witness.

BY MR. FERLEGER:

Q. (Continued) Those occasions when you have

gotten the juvenile from the court, when you first see the

court—when you get the court papers and records, and

are told that this is a court commitment to evaluate and

observe—those occasions have happened, hayen’t they?

A. Yes.

Dr. Barbara Armstrong—Direct 49a

Q. In that case, at some future point, you have gone

back to the court and told the court or Master your recom-

mendations and evaluation?

A. Correct.

Q. That takes how long, from the time a person

comes in under Section 406 and the time recommenda-

tions are made to the—

MR. ROTH: I object to this questioning, again,

based upon the fact, number one, the specific ques-

tion is misleading. The issue is commitment under

402 and 403. Counsel is trying to mislead and draw

a parallel between 406 and (16) 402 and 403. Fur-

thermore, if I understand correctly, juveniles 18 and

under, 406 applies to everyone.

BY MR. FERLEGER:

Q. (Continued) Answer the question.

A. Your question is: how long does it take? I have

to answer you: it takes as long as the court specified. It

may be 10. It may be 30. It may take 60. It is specified

on the commitment by the court.

MR. ROTH: May I cross-examine at this

point, or do I have to wait until the end?

MR. FERLEGER: I think we should wait.

MR. ROTH: Fine.

BY MR. FERLEGER:

Q. Of the juveniles now in your care at Haverford

State Hospital, can you tell me how many are committed

under Section 402, how many under 403, and how many

under 406?

A. You'll have to allow me a moment to count.

Q. Do! have a copy of the document in your hand?

50a Dr. Barbara Armstrong—Direct

A. You have a copy.

MR.ROTH: That question has already been an-

swered, to which you commented on and we replied

to. It is a matter of record. You (17) can find your

answer there, too. Furthermore, the current status,

as I understand your question—

A. (Continued) I can’t answer you currently, as

I am answering as advised by your staff, to take the word

“currently” to apply to the date we received notification

of your deposition.

Q. Whatever you have on your list and what is the

date?

MR. ROTH: As long as the date is reflected,

and you can answer that approximately.

BY MR. FERLEGER:

Q. (Continued) Do you have a list with you to-

day of the juveniles at Haveriord, their ages and commit-

ment sections?

MR. ROTH: Objection. I would appreciate her

answering One question at a time.

MR. FERLEGER: I withdraw my previous

question.

BY MR. FERLEGER:

Q. (Continued) Do you have a list here today?

A. Yes, I have such a list.

Q. May I have such a copy of it?

A. You may have a copy, but not now, because |

don’t (18) have one. We have a copy of the data ab-

stracted from all the charts, so to have the information.

Colloquy 5la

MR. FERLEGER: We can save some time if

you are agreeable that when I make a copy of this

list, that can be adopted as part of her testimony.

MR. ROTH: I would like to see the list. I

would like to—am I correct in assuming the people

whem you are representing, Mr. Ferleger, have given

you their consent to see any records or charts about

them; in other words, not only representing them in

name, but in substance, and they have given their

consent for you to see any information about them?

MR. FERLEGER: Yes. Our complainants have

given us authorization, and the hospital to release rec-

ords to us.

MR. ROTH: As part of the record, if any pa-

tient comes against the record to indicate—as you

have indicated on record now—that you have full

consent of every patient whom you represent?

MR. FERLEGER: That’s absolutely correct.

(19) MR. ROTH: Through the patient him-

self?

MR. FERLEGER: Through the patient.

MR. ROTH: As far as I am concerned, you

can make a copy now. I notice that Dr. Armstrong

has notes on the back of this. I would appreciate

that just the actual typing and not her notes be copied.

MR. FERLEGER: For the record, these are

two sheets of paper titled, “Class Action Suit,” on

which are four columns: Names, Age, Commitment,

Assigned.

52a Dr. Barbara Armstrong—Direct

This will be marked as Exhibit A for identification.

(A document entitled, “Class Action Suit,” was

marked for identification as Exhibit A.)

BY MR. FERLEGER: .

Q. Dr. Armstrong, the named plaintiffs in this case,

Kevin Bartley, Steve Gentile, Leslie Levine, Vicki

Mathews, and Mark Weand, are you familiar with these

people?

A. Yes, I am.

Q. They have been patients at the hospital?

A. Yes.

Q. Have you consulted and read their medica! rec-

(20) A. Yes, I have.

QO. I would like to ask you a little bit about those

people.

Kevin Bartley was committed, wasn’t he, on Novem-

ber 30, 1971, by his mother?

A. That’s correct.

Q. From your knowledge of him at the time he was

committed and the time after that, he would have preferred

not to have been in the hospital?

MR. ROTH: Objection.

A. Kevin—

MR. ROTH: Do you want to rephrase your

question?

MR. FERLEGER: No.

MR. ROTH: Do you want to repeat it, please?

I would like to hear it again.

Dr. Barbara Armstrong—Direct 53a

BY MR. FERLEGER:

Q. At the time he was committed and after that,

Kevin would have preferred not to have been at the hos-

pital; isn’t that correct?

MR. ROTH: Objection. First, I think I would

like to make certain under what section Kevin Bari-

ley came. Has that been established?

MR. FERLEGER: I think it can be (21) es-

tablished by Exhibit A.

MR. ROTH: You are referring to a specific

case. You ought to refer to the commitment proce-

dure utilized.

What commitment procedure?

MR. FERLEGER: That wasn’t part of my ques-

tion. If you want to, you can ask that on cross-exam-

ination.

MR. ROTH: You better first get to whether he

was committed or admitted.

MR. FERLEGER: That has nothing to do with

whether he has objected.

MR. ROTH: You have asked whether he ob-

jected to commitment. The question is whether or

not he was admitted or committed and the appropri-

ate section.

BY MR. FERLEGER:

Q. (Continued) Do you know under what section

Kevin Bartley was admitted or committed?

A. He was committed under Section 403 by his

mother.

54a Dr. Barbara Armstrong—Direct

Q. On November 30, 1971, do you know?

A. That’s correct.

Q. Was that against his will or with his will?

A. There is no evidence in the admission note or in

(22) his chart that indicates in writing that he objected.

Q. Dr. Armstrong, we are not confined to the rec-

ord. I am asking you of your own personal knowledge of

him.

MR. ROTH: Objection.

MR. FERLEGER: I haven’t finished my ques-

tion.

MR. ROTH:

line of the question.

Go ahead.

BY MR. FERLEGER:

Q. (Continued) Of your own personal knowledge

—first of all, do you know what Kevin looks like?

A. Certainly.

Q. Have you spoken to him?

A. Yes.

Q. Were you a psychiatrist at the hospital?

A. I was the director of the services under which

he was under. Dr. Carl Hammer was the individual psy-

chiatrist.

Q. Have you spoken, during the course of his stay,

to Dr. Hammer about Mr. Bartley?

A. Certainly.

Q. Of your own knowledge, was Kevin Bartley

willing and happy to stay at the hospital?

(23) A. Are you asking if he verbally expressed to

me a desire to leave; is that your question? I don’t fol-

low your question.

I know. I am objecting to the

Dr. Barbara Armstrong—Direct 55a

Q. Of your personal knowledge, was Kevin Bartley

a willing patient at the hospital?

MR. ROTH: Objection. Willing for what?

MR. FERLEGER: Willing to stay at the hos-

pital.

MR. ROTH: Objection. My objection is based

on the point, you can’t ask another question unless

you withdraw your other question: whether Kevin

Bartley, after he was committed, immediately objected

to it. She answered he had not, and you asked her

whether he was a willing patient. My question is:

which question do you want the doctor to answer?

I object on the basis that if you are going to ask ques-

tions, let her answer them.

MR. FERLEGER:

answer for a little while.

MR. ROTH: But you have asked two ques-

tions.

MR. FERLEGER: | asked more than two.

MR. ROTH: On this particular phase.

(24) BY MR. FERLEGER:

Q. (Continued) On Kevin Bartley, my first ques-

tion is: was he a willing patient at the hospital? In other

words, did he desire of his own volition to remain at

Haverford State Hospital to get treated with whatever ser-

vices your unit provides?

A. Then, I can answer you: yes and no. On occa-

sion, he wished to go home with his mother, who, until

approximately a month ago, did not wish him at home,

I have been waiting for an

56a Dr. Barbara Armstrong—Direct

and on other occasions, he requested to stay. So, both are

true: yes and no.

Q. Isn't it true; had it not been for his mother mak-

ing the application, had it not been the fact that she had

initiated the commitment, that he wouldn't have stayed

there?

A. No, that’s not true. He stayed until it seemed

advisable, until he attained sufficient ego control and be-

havior control. He was given to explosive outbursts.

Q. Did he think he had a problem with his ego con-

trol?

A. He thought he had a problem controlling his tem-

Q. He stayed because it was medically advisable?

A. Psychiatric.

(25) Q. He needed to stay at the hospital because

of a psychiatric opinion?

A. Well, | would say he did not accept this. We do

fulfill the psychiatric needs through the care and facilities

of the hospital.

Q. Did he disagree with that psychiatric opinion?

A. On occasions.

Q. Even when he disagreed—

MR. ROTH: Objection. You are harassing the

witness.

MR. FERLEGER: I am in the middle of a

question.

MR. ROTH: You are harassing the witness.

You are going over the same question three tithes.

MR. FERLEGER: You don’t know the end of

this question. I am in the middle of it.

per

Dr. Barbara Armstrong—Direct 57a

BY MR. FERLEGER:

Q. (Continued) Even at the time he objected, he

would not have been free to leave the hospital, isn’t that

true?

A. No, that is untrue. The mechanism is set up for

giving notice, providing that the applicant was willing, he

would have been signed out against medical (26) advice,

even though determined medically and psychiatrically that

he remain.

Q. But under those procedures, if the applicant is

unwilling, he couldn’t have signed out against medical

advice?

A. That's true. I qualified my answer by stating

when he was ready to leave, he was in fact discharged and

not retained for reasons other than psychiatric.

Q. On long-term leave and—

A. Short-term leave. That, I would like to qualify

for the record, is for administrative purposes, in order

to provide the child the service he needs, namely, trans-

portation from two counties, to Delaware County Inter-

mediate for specified schooling.

Q. Leslie Levine, do you know who she is?

A. Yes, I do.

Q. When and under what section of the Act was

she committed?

A. Leslie was admitted on a 403 commitment signed

by her mother on 10/11/72.

Q. Where does her mother live?

MR. ROTH: Objection.

BY MR. FERLEGER:

Q. (Continued) Where does she live?

(27) A. In suburban Delaware County. I will give

you the chart.

58a Dr. Barbara Armstrong—Direct

Q. Where does her father live?

MR. ROTH: Objection.

A. In Florida.

Q. Are her parents married, separated or divorced?

MR. ROTH: Objection.

Divorced.

You read her records, didn’t you?

Yes.

. You read her records and also the other patients’

under your care?

A. Incompliance with your order, we have prepared

summaries specifically for this deposition on all adoles-

cents in the hospital, including the plaintiffs and all others,

which includes those not under my care.

Q. May I have them, please?

(Discussion off the record.)

(Copies of patients’ summaries were handed to

Mr. Ferleger.)

BY MR. FERLEGER:

Q. Dr. Armstrong, I have received from you and

your counsel summaries of the commitments of every ju-

venile now in your unit, or in your unit as of February

15th.

(28) A. In the entire hospital.

Q. Thank you. In the entire hospital at Haverford

State Hospital as of the date noted, I suppose, on the sum-

maries; is that correct?

A. No, as of Mr. Abramson’s advising us, the date

we received your deposition request. What is that, Febru-

ary 23rd?

OF Oe

Colloquy 59a

MR. FERLEGER: I also received dated sum-

maries of the named plaintiffs in this lawsuit.

For the record, for the named plaintiffs, as I

said before, I received their consent to seeing their

records

(Discussion off the record.)

MR. FERLEGER: For the record, there are in-

dividuals whose brief summaries I have been given

from whom we have not received specific consent.

These are individuals who are 18 years of age or un-

der, and who have been ordered by the court, mem-

bers of the class, plaintiffs of this lawsuit.

MR. ROTH: I would just like the record to re-

flect—and Mr. Ferleger can correct me if I am wrong

—that from the statement he has mode ,

he has received the consent of (29) all patients to

receive and review their medical charts and al! ma-

terial relating thereto.

MR. FERLEGER: | have received consent to

look at records of both juveniles and adults at the

hospital in two ways. With respect to the named

plaintiffs in this case, I received, on individual sheets

of paper signed by them, specific consent to see rec-

ords, and specifying the hospital release those records.

With respect to other persons, including those

persons whose summaries will be marked as Exhibit

B, I have received consent to see their records by

reason of a contract with Haverford State Hospital,

approved by Dr. William Beach, a defendant in this

case, Deputy Secretary for Mental Health of Pennsyl-

vania, which allows access to all patients’ records at

Colloquy

MR. ROTH: I would like to make a statement.

In addition thereto, I have been informed by—and

perhaps misled by—the opposing counsel, that he

had received consent from all patients in this case,

which included permission to receive and review

their records. With regard to viewing these records,

and having (30) given these records under the be-

lief and assurances by opposing counsel that he had

received the consent of the patients, I hereby charge

that unless he has received that consent, that those

records are subject to the rules of confidentiality.

MR. FERLEGER: For the record, plaintiffs

certainly agree to abide and respect the confidentiali-

ty of patients who plaintiffs represent and the plain-

tiffs in their class in this matter.

The contract with Haverford State Hospital, ap-

proved by Dr. William Beach, signed by Dr. Kremens,

and approved by Mark Leopold, Assistant Attorney,

in Paragraph 11, the hospital agrees to give access to

all patients’ records and to all areas of the hospital

to its professional staff and members. We will abide

by the same rules governing hospital personnel hav-

ing such access.

My questions now are directed to specific sum-

maries of the named plaintiffs from whom we have

specific consent, which will be marked as Exhibit C.

ceived by Mr. Ferleger from Dr. Armstron

marked for identification as Exhibit B.)

(Individual patient summaries for named plain-

tiffs were received by Mr. Ferleger from Dr. Arm-

strong and marked for identification as Exhibit C.)

Dr. Barbara Armstrong—Direct 6la

BY MR. FERLEGER:

Q. Dr. Armstrong, the statements in all these ex-

hibits are true, aren’t they?

A. Yes.

Q. As far as you know?

A. Yes, as far as I know.

Q. You are willing to incorporate them into your

testimony?

A. Yes.

Q. With that, we can dispense with reading over

every word?

A. Fine.

Q. With reference to Leslie Levine who was at

Haverford, do you know where she is now?

MR. ROTH: Objection.

A. No, I don’t.

Q. Do you know if she went to Florida to live with

ne eter tte Oe (32)

MR. ROTH: Objection. The witness has al-

ready answered your question as to where she is since

she left the institution.

BY MR. FERLEGER:

Q. Do you know if the patient and her mother

agreed to your recommendations to individual therapy

while living with her father in Florida?

MR. ROTH: Objection. There has been no

foundation laid on this.

MR. FERLEGER: Yes, if this summary of Les-

lie Levine is true.

62a Dr. Barbara Armstrong—Direct

MR. ROTH: If you are going to indicate a part

of it, indicate the foundation for it.

BY MR. FERLEGER:

Q. (Continued) Have you read the summary?

A. Certainly.

Q. Did you help prepare it?

A. Certainly.

Q. Did you in fact prepare it?

A. No.

Q. With reference to Leslie Levine and with refer-

ence to the summary and with reference to what actually

happened to her, to your knowledge from medical records,

(33) did Leslie and her mother agree to the hospital’s

recommendation of individual therapy while living with

the father in Florida?

MR. ROTH: Objection.

BY MR. FERLEGER:

Q. (Continued) Will you answer? .

MR. ROTH: No. I want to elaborate.

First, you have just admitted a summary of this

person.

Second, you indicated you did not want to go

through the summaries with her verbatim, and have

already asked Dr. Armstrong if the summaries are

true and accurate to the best of her knowledge, and

she has answered yes.

Now, you are taking the summaries and admit-

ting or deleting parts of them, and also asking ques-

tions about the child’s care and treatment subsequent

to her release from the institution.

Dr. Barbara Armstrong—Direct 63a

MR. FERLEGER: No, I wasn’t. All I asked is

if she and her mother agreed to something. I didn’t

ask if anything happened to her after.

MR. ROTH: Would you like to make a state-

ment of proof?

(34) MR. FERLEGER: No,

MR. ROTH: Then I wish to register a special

objection.

BY MR. FERLEGER:

Q. (Continued) Answer the question.

MR. ROTH: Please repeat the question.

BY MR. FERLEGER:

Q. Leslie—do you know her mother’s name?

A. Her first name?

MR. ROTH: Objection. It’s not relevant.

BY MR. FERLEGER:

Q. Her last name is Levine?

A. -Yes.

Q. While Leslie Levine was at that hospital, did

Leslie and Mrs. Levine, her mother, wishythe patient to

live with her father in Florida?

A. Mr. Ferleger, I will answer your question by

stating that at the last family conference with Dr. Lustig,

who was Leslie’s individual and former therapist, they

agreed that she would live with her father upon discharge

and then they would follow the child on individual thera-

py. That's the extent of my knowledge.

Q. Why didn’t she go home to live with her mother?

A. As the summary indicates, part of Leslie’s (35)

diagnosis of adolescent adjustment reaction, was extreme

64a Dr. Barbara Armstrong—Direct

difficulty functioning within her mother’s surroundings

and with the siblings. It was not psychiatrically wise to

repeat that living experience.

Q. And she did better with the father?

A. That’s what the history indicates.

Q. With reference to Mark Weand, he was com-

mitted under Section 402, June 23, 1972, isn’t that true?

A. I have June 24th.

Q. At that time, did he wish to become a patient at

Haverford State Hospital, to your knowledge?

A. At the time of his admission he was exhibiting

symptoms of being under the influence of unknown

drugs—

Q. Can you answer this question, please—

MR. ROTH: Let her answer.

A. He was not able to respond appropriately to any

external stimulus.

Q. Your summary doesn’t show that he was not

able to respond to external stimulus.

A. 1! says, “Still intoxicated.”

Q. It says, “Extremely hostile.”

A. I would say being intoxicated.

Q. “Being intoxicated,” does that mean you can’t

respond to any —

(36) A. It does mean any. I would say so.

Q. Subsequently, he was referred to and seen by a

psychiatrist?

A. Right.

Q. At the time, did he desire to remain and become

a patient at Haverford State Hospital?

A. I can’t answer that question. I don’t know at

that time.

Dr. Barbara Armstrong—Direct 65a

Q. What was the first time you saw him?

A. As indicated in the record, he was placed in a

closed unit and was seen by Dr. Harold Rashkis.

Q. What is the first time you saw him?

A. I was answering. When he was transferred to

the open unit on 7/12, I then saw the patient.

Q. At that time, did he wish to remain at Haver-

ford State Hospital and remain a patient there?

A. You will have to tell by what indications you

wish. He gave no indication, written or oral, to the staff.

He indicated—I have the date as approximately two

months thereafter—that he wished to leave. At that par-

mon time there was no written or verbal expression

made.

Q. At that time later, two months, was he permit-

ted to leave? :

(37) A. At that time, for the record, he wrote to

the Adolescent staff, not the hospital director, and he was

not permitted to leave. It was felt he was not ready to

leave, psychiatrically.

Can I add to my answer?

Q. Yes.

A. In addition, it is to be noted that approximately

two months thereafter, on September 3rd, the patient was

suspected of taking an overdose of drugs.

Q. Dr. Armstrong under some questions I am sure

your counsel will ask on cross-examination, and it will

save us a lot of time if you try to answer my questions

and not anticipate things or add things.

MR. ROTH: I really don’t think you can elabo-

rate on a question you ask her.

MR. FERLEGER: Of course not. The fact that

he attempted to take an overdose of drugs doesn’t

66a Dr. Barbara Armstrong—Direct

mean anything about the staff not allowing him to

leave.

MR. ROTH: Dr. Armstrong, you just answer

his questions, no more, no less.

BY MR. FERLEGER:

Q. (Continued) Just in general, in your experi-

ence at Haverford State Hospital, there are some children

(38) who are happy to be there and happy to get care,

and there are some who aren’t and don’t want to be there?

A. No, I don’t think anybody is happy to be in a

mental hospital. There are some who are willing to ad-

mit that they have problems and who want care, and there

are some who aren’t willing.

Q. So, there are some who desire to be there and

want to get treatment, and some who don’t desire to be

there and don’t want treatment?

A. That’s true.

Q. Some of these persons, juveniles, are committed

there by courts; isn’t that true?

A. True.

Q. Some are either signed in on application of their

parents; isn’t that right?

A. That's right, true.

Q. There are a number of individuals in your unit

who have come in, juveniles, because they want to come

in themselves; isn’t this true?

A. They are.

MR. ROTH: Objection. I am sorry, counselor.

I am not sure I understand the question. If I don’t

understand, then Dr. Armstrong may not.

Dr. Barbara Armstrong—Direct 67a

(39) BY MR. FERLEGER:

Q. Are there some juveniles who have problems,

who appeared stating. “I need psychiatric help. I want to

be a patient”—who presented themselves, without their

parents?

A. Yes.

Q. Are they accepted as patients?

MR. ROTH: Objection. Can you indicate what

you mean by “‘juveniles’’?

MR. FERLEGER: For all purposes, when I

say “juveniles,” I am referring to persons 18 years

of age or under.

BY MR. FERLEGER:

Q. (Continued) Are people like that admitted?

A. They can only be admitted under the Mental

Health and Retardation Act, which means that they must

have someone, either a parent or guardian, and in the ab-

sence of either, someone to make a loco parentis applica-

tion for them to get in.

Q. So, persons 18 years of age or under who wish

to be committed and their parents refuse to make applica-

tion, you don’t take them in as patients?

MR. ROTH: Objection. I think the question

has already been answered.

(40) BY MR. FERLEGER:

Q. (Continued) You can answer it.

A. There are methods by which we can.

Q. What methods?

A. We would contact the parents and contact the

county agency, in this case, the Child Care Agency of

Delaware County, and attempt to have guardianship

68a Dr. Barbara Armstrong—Direct

changed from parent to agency, and have the agency com-

mit the child.

Q. Over the past four years, how many times has

that happened?

A. Ican’t give you a number.

Q. Approximately how many per year?

MR. ROTH: I will register an objection.

A. Iam not good at making estimates. It happened

not infrequently. I can’t give you a number.

Q. In your treatment program of juveniles, do you

have a different program for court committed patients, as

opposed to patients who are committed under 402, or 405,

or is it the same program?

MR. ROTH: Objection. I would like coun-

selor to specify whether people are treated different-

ly, if that’s what he is getting at, in terms of psychi-

atric help; is that your (41) question?

MR. FERLEGER: By treatment, I mean pro-

fessional psychiatric programs.

MR. ROTH: You are asking about profession-

al—you are asking about whether participation varies

according to what section of the law—

MR. FERLEGER: That is a better phrasing.

MR. ROTH: Fine.

A. No. The program is set up to meet the needs of

individual children, and the type of commitment has no

bearing, except wherein the child—let me see how you

should record this. You will need a closed facility for

approximately a year or longer for someone who is com-

mitted under a murder one charge. Otherwise, for 408 or

Dr. Barbara Armstrong—Direct 69a

406 court commitment: are treated, given ground privi-

leges, and. accessability to adolescent closed and ope

buildings, as their condition indicates.

Q. As their condition indicates, except for extraor-

dinary cases, some criminal charge or court orders, other-

wise it makes no difference what section the person is

committed under?

MR. ROTH: Objection. You are misleading

the witness.

(42) MR. FERLEGER: Why doesn’t she tell

me?

MR. ROTH: You are just taking her answer

and turning it around to mislead her. I object to her

answering that at all. You are misleading her com-

pletely. She just testified, as I understand it, that it

depends on the needs of the person who is admitted—

if you heard the beginning.

BY MR. FERLEGER:

Q. Then when you say, “Depending on the needs

of a particular patient,” then you are—

MR. ROTH: Are you going to specify the spe-

cific sections and use that, or I feel I must reject the

premise of your question.

MR. FERLEGER: If Dr. Armstrong is mislead,

I am sure she will tell you.

THE WITNESS: Okay. I am mislead.

BY MR. FERLEGER:

Q. (Continued) Thank you. Your answer earlier,

with reference to—concerning whether the professional

treatment program differs upon the court commitment,

70a Dr. Barbara Armstrong—Direct

what I understood you to say is that except in certain ex-

ceptional circumstances— the example you gave us is

someone who needs a closed facility because of a (43)

murder one charge—except in those exceptional circum-

stances, the treatment does not vary because of the type of

court commitment—voluntary or court commitment?

A. Isn't that what I said?

Q. Iam asking you.

A. That’s what I said.

Q. Now, in your experience, what relationship have

you seen between the progress and outcome of the treat-

ment of juveniles with reference to whether they were com- —

mitted by court or committed through application of the

parents?

A. I can’t answer that. The only way I could tell

is if we did adequate research.

BY MR. ABRAMSON:

Q. Along that line, but not trying to ask a question

that might require extensive research, when you have your

meetings with different patients that come under the ado-

lescent unit—

A. Adolescent Service.

Q. —Adolescent Service, do you seem to get the

impression from them there may be some antagonism,

based on the manner in which they were committed?

Should | explain that more?

(44) A. Yes.

Q. In other words, what I am getting at: you meet

with juveniles and you see them in your office personally,

as I understand it, and you also observe them in the build-

ing, and I believe you have also seen all the patients who

are currently there as of February 23rd. So, what I am

sort of getting at is: do you feel you ever get any feedback

Dr. Barbara Armstrong—Direct 7la

from them with reference to the manner in which they

were committed? Do they complain to you or give any

specific comments about the commitment procedure? Do

they feel any abuse as far as they are personally concerned?

Do you get any kind of a feedback from young people?

MR. ROTH: I object to this line of question-

ing. It is completely irrelevant on the fact there are

provisions in the Mental Health Act which qualify

why a person is court committed.

I even question whether or not there is any rele-

vancy at all to this line of questioning.

I would request an offer of proof.

BY MR. ABRAMSON:

Q. (Continued) Answer the question.

A. Did I notice as the administrator of the unit, any

difference in the attitude of the kids toward their (45)

treatment, with reference to the kind of

Q. No, sort of getting away from the disti cnn be-

tween types of commitment now. f

The fact that you are there on a permanent basis, and

you have certainly, I believe, a great deal more contact

with the patients, especially with the juvenile patients,

than we do— -

A. I have contact only with juveniles.

_ Q. —in that sense, I thought you might be able to

enlighten us as to any feedback that you have received

from juveniles in reference to their commitment, whatever

section they were committed under; do you ever have com-

ments from them?

A. Whether they are placed there against their will

or with their will?

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72a Dr. Barbara Armstrong—Direct

MR. ROTH: I object. I think Dr. Armstrong

has answered that in a general term before, when you

said whether people like to stay at the institute or

not. I think she adequately answered that. You are

giving a general question, yet you want her to answer

it specifically.

MR. ABRAMSON: Perhaps I can be more spe-

cific.

(46) BY MR. FERLEGER:

Q. Can you answer the question?

A. No, I can’t. I don’t understand it.

BY MR. ABRAMSON:

Q. Have you ever had one of the juvenile patients

make a statement to you concerning the manner in which

he was committed?

A. Certainly.

Q. Have these statements from juveniles, minors,

concerning the manner ia which they were committed, ever

reflected any dissatisfaction on their part?

A. Certainly.

Q. Do you feel, professionally speaking, the manner

in which they were committed may have had a negative

effect on their psychological well-being or mental well-

being?

MR. ROTH: Objection.

BY MR. FERLEGER:

Q. Can you answer it?

MR. ROTH: The objection is founded upon

the basis of the Act itself, where the hospital doesn’t

admit anybody it feels doesn’t need help.

bara Armstrong—Direct 73a

MR. FERLEGER: Dr. Armstrong can still (47)

give her personal opinion.

A. The manner in which they are committed hasn't

any negative effect on their psychological well-being.

I think the only way I can answer your question is to

address myself to the question of someone’s being there

of their own volition or not being made available of the

treatment, and it makes no difference under what manner

one is committed, be it loco parentis, or parent, or court.

Whatever the circumstance, when someone is unwilling to

accept treatment, it is difficult to treat them. The fact they

are unwilling is negative psychologically, not the manner.

Q. Thank you. Dr. Armstrong with reference to ju-

veniles who were signed in by their parents at the hos-

pital, do you think you just, professionally, would have a

better chance to treat these juveniles if they were com-

mitted by the court, as opposed to having been signed in

by their parents?

MR. ROTH: Objection.

A. I would have to answer that question the way

I answered previously. In my professional opinion,

where I am not concerned with the legality, but the treata-

bility of an individual, it matters to those of us as thera-

pists, whether the person presents himself (48) as willing

or unwilling. The agency that does the unwilling commit-

ment is not so relevant.

Q. .So you don't think it makes such a difference

whether the juvenile is committed by his parents, as op-

posed to having been committed unwillingly by the court?

A. I am sure it makes a difference.

Q. What difference?

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74a Dr. Barbara Armstrong—Direct

A. By the fact that parents—and parents on whom

they thrive—have a psychological attachment to their chil-

a What is the difference—do people have—to chil-

dren, as opposed to the court, which has no psychological

attachment?

I know that is a difficult question.

A. I'm afraid it depends on the individual case.

Q. Incases where you experienced contact, can you

tell me what difference it makes to the particular child?

MR. ROTH: Objection. You are going on hy-

potheticals.

MR. FERLEGER: I am asking on a specific

instance.

MR. ROTH: What instance are you referring

(49) to?

MR. FERLEGER: In specific, the instance of

the children mentioned in Exhibit A.

MR. ROTH: Mark Weand or the entire list?

BY MR. FERLEGER:

Q. (Contnived) Just, if you would, like, outline

for us, in your discretion, persons signed in by parents—

tell us what difference it made to them in their case or

their treatment, whether they were committed by their

ts, as opposed to court?

ee The only way I can answer that is to go into each

and every individual case. I couldn't generalize. There is

no way I can give a generalized statement.

MR. ROTH: I object to the whole line of ques-

tioning. What you are doing: you are asking her for

Dr. Barbara Armstrong—Direct 75a

an assumption of how it differs for one who is court

committed, how it differs for one voluntarily com-

mitted, and how it differs for one who is court com-

mitted, and I think the rules speak for themselves, in

commitment procedures. She has indicated several

times it is impossible to answer that question.

MR. FERLEGER: I am askingefor her (50)

professional opinion, not an assumption.

BY MR. FERLEGER:

Q. In the Leslie Levine case, that is the case where

I understand she didn’t get along with her mother and

siblings, and her mother is the applicant for her commit-

ment. In that case, would it have made any difference to

her or to her treatment if the court had committed her, as

opposed to her mother applying for her commitment?

A. I can’t answer that. That presupposes knowledge

I don’t have. In qualifying the admission, it was not be-

cause she didn’t get along with her parents or her mother,

but she can't behave . Specifically, she

chased her mother with a kitchen knife and threatened to

hill her.

I can't answer that it matters what agency committed

her.

Q. Do you think the hostility that she evidenced

toward her mother was increased or decreased by the fact

her mother surrendered her to the hospital against her

will?

A. - My judgment is that it would be increased.

Whether that in fact occurred, I can’t say.

Q. Wouldn't there be less or an increase in hostility

(51) or none at all if an impartial court admitted her?

A. I don't know.

76a Dr. Barbara Armstrong—Direct

MR. ROTH: Objection. She has answered that

question repeatedly now.

. ABRAMSON:

ne rm Dr. Armstrong, I notice on the list of juvenile

patients, which was labeled Exhibit A, names of two

young people in particular that attracted my attention. I

would like to direct questions about them.

One is a young man, Allen Moss, whom I believe is

currently still at the hospital.

A. That's correct.

Q. Specifically with reference to Allen, has he in-

dicated to you or any member of your staff any facts with

reference to the manner in which he was committed? Per-

haps I should add the exhibit also shows he was commit-

ted under Section 403 of the Mental Health and Retarda-

tion Act. His records would show that he was admitted

by his parents; is that correct?

A. That's correct.

Q. Has he indicated to you or members of your staff,

any specific comments concerning the manner in which he

admitted?

es A. 1 have not heard of any. Mr. Moss is directly

(52) the patient of Dr. Gus Kratsa, K-r-a-t-s-a. Whether

at individual therapy he has given some indication, I don’t

know.

Q. In other words, in the summary, there are no

notes making reference to his original admission to the

hospital or anything that took place at that time?

A. There are no notes in the summary.

I can add he was transferred from the University of

Pennsylvania, and he admitted to being depressed and sui-

cidal.

Dr. Barbara Armstrong—Direct 77a

Q. Doctor, with reference to the third female pa-

tient, Deborah Geiger, the exhibit shows her age to be 16,

and the type of commitment, under Section 403 of the 1966

Act, and I believe the specific record of her commitment

shows she was also committed by her parents.

A. The record so states, Mr. Abramson, however, it

also indicates that she wished to be committed, and it

was impressed upon her by Dr. Kratsa that under the Men-

tal Health Act, it was necessary that her mother sign her

in.

It is a general requirement of the Mental Health Act

that we-ask the juveniles to sign the 403 paper themselves.

(53) Q. But Allen Moss, how did he come to get

to the hospital?

MR. ROTH: Objection.

BY MR. FERLEGER:

Q. How did Allen Moss come to be a patient at the

hospital?

A. The social worker from the University of Penn-

sylvania called our in-take social worker and arranged a

wansfer from the University. He was deemed to be too

suicidal to remain in their setting, which is not a psychi-

atric hospital. He was in their ward.

Q. Then his parents signed him in?

A. Yes.

Q. When did his parents sign him in, as of what

date?

A. ‘As of 1/10/73.

Q. When was he transferred physically from the _

University of Pennsylvania?

A. The same day.

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78a Dr. Barbara Armstrong—Direct

BY MR. ABRAMSON:

Q. So that I can assume then, the specific records

that you have, the summary for Deborah Geiger, don’t in-

dicate anything with reference to her admission, other

(54) than the comments you have already made?

MR. ROTH: Objection. That is misleading,

Mr. Abramson. You indicated, “according to spe-

cific records of the summary.”

MR. ABRAMSON: I am sorry.

BY MR. ABRAMSON:

Q. (Continued) According to the records of the

summary you have here before you, doctor, can I assume

then, other than the comments you have made, there is

nothing else making reference to what took place at that

time?

A. No, you can’t assume that. The entire chart has

additional data. | have extracted some material.

Q. The summary doesn’t show additional informa-

tion concerning her admission?

A. You have a summary before you. I don’t see that

it has any additional information.

@. From your knowledge of her specific chart, do

you recall any specific information on her chart concern-

ing her admission; from her chart, which is not with us

today, do you recall any specific information concerning

her admission?

A. That she expressed a desire to Dr. Kratsa to come

to the hospital. It’s present on her admission, (55) yes.

Q. From your personal knowledge, could you con-

vey any other information concerning her admission, other

than what you have already given us?

A. What kind?

Dr. Barbara Armstrong—Direct 79a

Q. Concerning the manner in w .

mitted, her onteede at the time, any foot ymca

A. She was interviewed in the open unit. Her fami-

ly was subsequently interviewed, and she requested admis-

sion as an alternative to running away. She was consid-

ered to be quite upset, despondent, and in need of some

treatment, and perhaps the living facilities of the hospital

were available and the open unit was offered to her, which

she accepted.

Q. Do you recall any information which has come

to your attention from a member of your staff concerning

the manner in which her parents made her available to

your staff at the hospital; in other words, do you have any

information concerning how she got to the hospital, other

than the fact she came with her parents?

A. Her mother drove her.

BY MR. FERLEGER:

Q. With all the experience you have had with ju-

veniles, would you just tell me—and this is an (56) open-

ended question—whether or not you see any reason, or

what reasons you do see for juveniles not to be entitled

to a 406 court hearing before they can be presented to the

hospital against their personal will?

MR. ROTH: Objection.

MR. ABRAMSON: will you talk to that issue

please?

MR. ROTH: Dr. Armstrong is not qualified to

testify on law as you feel it should be.

MR. FERLEGER: I do not wish her to testify

on law.

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80a Dr. Barbara Armstrong—Direct

MR. ROTH: You have agreed to her qualifi-

cations as an expert witness with regard to her treat-

ment of juveniles specifically, and you have focused

on these questions, and in part, you have gone awry.

As far as I am concerned, you are turning this

into a fishing expedition. If that is going to continue,

I will make the appropriate motion to dispense with

the deposition.

BY MR. FERLEGER:

Q. (Continued) Can you answer that question,

please? |

A. You will need to restate the question.

(57) (The reporter read the last question as fol-

lows: |

“Q. With all the experience you have had with

juveniles, would you just tell me—and this is an open-

ended question—whether or not you see any reason,

or what reasons you do see for juveniles not to be en-

titled to a 406 court hearing before they can be pre-

sented to the hospital against their personal will?’’)

A. You are asking for my individual opinion?

Q. Yes, as a human being and psychiatrist.

A. My opinion is only in that area in which I am

qualified to speak, and that is quality medical care.

Were the 406 hearing a legal procedure set up to

function in a rapid manner, so that the child involved

could get adequate care as soon as required, there would

be no reason. However, in reality, that does not exist, and

I find that insisting upon a court procedure for the ad-

mission of an acutely ill child would deprive the child in

some instances, in many cases, of rapid institution of ade-

quate psychiatric treatment.

Dr. Barbara Armstrong—Direct 8la

Q. The need for rapid institution and psychiatric

treatment could be met, couldn’t it, by some emergency

procedure, don’t you think?

(58) MR. ROTH: Objection.

A. As I understand the present Mental Health and

Retardation Act, the emergency dures under a 405

are extremely difficult to comply With and do not fit all

the circumstances in presenting an acutely ill child. Spe-

cifically, one must be acutely and observatively homicidal

or suicidal and have committed such an act in order to

qualify. There are a number of ill children that do not

fit that definition.

Q. You said in your answer before, if there was a

406 or other court procedure which would get this effec-

tive care quickly for acutely sick children, then, as a pro-

fessional, that would be satisfactory to you?

A. Are you saying if there was only a court proce-

dure or additional?

Q. If there were two proceedings: one where the

child could come in to you and get the care, of his own

personal volition, and the other one, where there was a

rapid and fair court procedure.

A. I don’t think that would, in my own opinion—I

think that is too restrictive. I also think there should be

a provision for adequately trained medical personnel to

effect admission rapidly without requiring a court pro-

ceeding.

(59) Q. Would that go to adults as well?

A. I am not qualified to speak for adults.

Q. Are you a psychiatrist?

A. Yes. That’s an unfair question, and I am not

going to answer that.

82a Dr. Barbara Armstrong—Direct

Q. You are a psychiatrist?

A. That’s correct.

Q. To your knowledge, is there anything different

about acute psychiatric problems of adults, which would

require that adults also have the procedure you are sug-

gesting, where qualified medical personnel could commit

them without a court hearing?

A. I will have to answer your question this way.

Yes, I am a psychiatrist, and I have been trained to work

with adults first, but I have not practiced adult psychiatry

in eight years. There are considerable differences with the

acutely ill child, as opposed to acutely ill adult, particu-

larly with reference to the degree of personality growth.

Therefore, I can’t answer your question.

Q. What are those differences?

MR. ROTH: Objection. This has become a

fishing expedition. We are supposed to be focusing

on Sections 402 and 403 of the Act. (60) Now you

are going off on a tangent about adults and children

and are talking in terms of generalities. It is becom-

ing a fishing expedition.

MR. FERLEGER: Mr. Roth, if you will read

the complaint, the first cause of action of the com-

plaint alleges violation of equal protection, in terms

of the way two classes of juveniles are treated, as

well as a difference in the treatment between adults

and children.

MR. ROTH: Notwithstanding—

MR. FERLEGER: This is not a fishing expedi-

tion to ask questions not only proper on deposition,

but even admissible in court.

Dr. Barbara Armstrong—Direct 83a

MR. ROTH: That is questionable, Mr. Fer-

leger. I appreciate your unrestricted judgment that

this is admissible in court.

Secondly, as far as the questions concerning ju-

veniles, along with adults, I believe Dr. Armstrong

has already testified, notwithstanding your repeated

harassing questions about adults, that she not be

asked to testify to the nature of adults treatment or

anything of that sort, since she has not been exposed

to (61) them for the past eight years, and does treat,

specifically, juveniles.

THE WITNESS: We better qualify that. Okay?

I will have to change my statement regarding dealing

with adults. I certainly deal with adults as far as

their being family members, and have, in the past

four years, restricted myself to adolescent psychiatry,

and no adult patients per se.

MR. FERLEGER: Thank you.

MR. ROTH: Dr. Armstrong does state she was

trained first in adult psychiatry. I don’t think you

would want to impune her qualifications. I am just

objecting to your—

MR. FERLEGER: The question i asked her:

what are the differences in the acute psychiatric prob-

lems of adults versus children—

MR. ROTH: And Dr. Armstrong answered

that one of the problems involved is the determina-

tion upon permanment development. Now, to go

through the whole list of them, I suggest you consult

your nearest book on psychiatry and look for your-

self, otherwise, it would take forever.

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84a Dr. Barbara Armstrong—Direct

You are talking in generalities. As (62) in-

volved among children, psychiatry is—

BY MR. FERLEGER:

Q. (Continued) Can you tell us any major dif-

ferences between adult psychiatric difficulties and child

psychiatric difficulties?

A. That would, Mr. Ferleger, take the better part

of an afternoon. I can’t do that. There are multitudinous

ego functions that are not developed to the extent that are

adults’, and to go into each one entirely is too involved.

Q. With reference to those differences in these ill-

nesses between adults and children, those illnesses would

make, in your opinion, a sort of different procedure neces-

sary for adults and children?

A. I couldn't say that.

Q. Are there differences between psychiatric prob-

lems in children which, in your opinion, would make it

essential there be different procedures for bringing them

into the hospital?

MR. ROTH: I object to that line of question-

ing. I think, Mr. Ferleger, or | am—at least I hope I

am—well enough aware of the Act to know there are

different procedures for adults, as well as procedures

for juveniles (63) in the case of their commitments

or admissions.

MR. FERLEGER: Mr. Roth, I was not asking

for or eliciting your opinions. I am asking for Dr.

Armstrong's opinions.

BY MR. FERLEGER:

Q. (Continued) Can you answer that?

A. Tell me the question again.

Dr. Barbara Armstrong—Direct 85a

MR. FERLEGER: Read it back.

tia (The reporter read the pending question as fol-

“Q. Are there differences between psychiatric

problems in children which, in your opinion, would

make it essential there be different procedures for

bringing them into the hospital?”)

A. There are differences between adults’ and chil-

dren’s psychiatric problems. We have established that.

Whether that, therefore, indicates a different procedure

for admission to be followed, I can’t answer that.

Q. In your psychiatric opinion— é

MR. ROTH: She just indicated she can’t an-

swer it.

MR. FERLEGER: Let me try to clarify the

question.

(64) BY MR. FERLEGER:

Q. (Continued) Psychiatrically, you can’t

then, if I understand you correctly, there are differences

which require different procedures; is that a statement of

what your feeling is?

A. No.

MR. ROTH: Would you clarify the question

please? :

BY MR. FERLEGER:

Q. Would you say what you said then?

MR. ROTH: Say your question.

MR. FERLEGER: My question—there is no

need for me to repeat it. This deposition will show

what the question is.

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86a Dr. Barbara Armstrong—Direct

She said she can’t answer specifically, and I am

asking her to state her feelings.

MR. ROTH: She can’t answer with a state-

ment. You have asked for her professional and per-

sonal opinion.

MR. FERLEGER: Dr. Armstrong was about to

say something.

BY MR. FERLEGER:

Q. (Continued) Dr. Armstrong, is your position

that you cannot say that there are differences between

(65) the mental illness of adults and juveniles, which

would require different procedures for admission or com-

mitment to a hospital?

MR. ROTH: Objection. Dr. Armstrong has

already answered that question.

A. I didn’t say I cannot. What I said was I can-

not state, on the basis of the fact there are differences in

the kind of problems that children have, as opposed to

adults. That in itself, therefore, indicates a difference in

admission procedures which should be followed. Certain-

ly the child should be allowed the same facilities as adults.

Specifically, children should be allowed to sign themselves

into a hospital, assuming they have adequate judgment.

This is one of the difficulties in dealing with a child, and

what you have to determine upon examination at the time

of admission by a qualified psychiatrist. That's one of the

major differences, and that’s their ability to judge situa-

tions adequately.

Insofar as the admission procedure followed, as a

conclusion to the assumption and statement, there are dif-

ferences between mental illness in children and adults, but

I can’t answer as to the procedure.

Dr. Barbara Armstrong—Direct 87a

Q. In your opinion, do you think the judgment of

(66) parents, or guardians, or persons standing in loco

parentis is sufficient for proper commitment of children

to mental hospitals?

A. I think, under the Mental Health and Retarda-

tion Act, at the time the child is examined—

Q. In your opinion, not under the Mental Health

ct.

A. I think the answer is yes and no.

Q. Can you explain that?

A. There are some instances where the parents are

qualified, the child would not be admitted, which is my

answer, under the Mental Health and Retardation Act—

the parents would be judged to be qualified. However, on

occasions, parents’ judgments could be questioned.

Q. Unless the professional person, you included,

felt the parents were qualified to make the determination?

A. Certainly. To elucidate, a psychotic parent could

not admit a child because he would be judged not to be

competent to judge.

BY MR. ABRAMSON:

Q. In your experience at Haverford State Hospital

—in your professional experience, can you recall any (67)

specific incidents of what you would consider abuses of

the admission procedure by parents of young people?

A. I think you are referring to a conversation we

had, Mr. Abramson, in checking into the particular cases.

The child we were discussing, I believe, was committed

under Section 406, so I can’t recall that.

Q. You can’t recall any case in which a parent has,

under Section 402 or 403, for reasons other than the best

interests of the child—

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88a Dr. Barbara Armstrong—Direct

MR. ROTH: Objection. I believe Dr. Arm-

strong has answered the question.

MR. FERLEGER: It was not asked. I believe

she has answered that according to the Mental Health

Act at the time when persons under 18 are admitted,

those doing the application are judged to be compe-

tent.

BY MR. FERLEGER:

Q. Once those persons are judged to be competent,

then the child is admitted?

A. If the child appears to need admission.

Q. Have you, in your experience, ever come across

an incident—I want you to think about this carefully—

where parents have used the fact that they were able to

petition and could apply under 402 and 403—have (68)

used that fact in order to manipulate the child or the Act,

contrary to the psychiatric interests of the child?

MR. ROTH: Objection. That question has

been asked and answered.

BY MR. FERLEGER:

Q. (Continued) Can you answer that?

MR. ROTH: Furthermore, on the basis of ha-

rassing the witness.

A. That is a difficult question to answer. At the

same time, | don’t know if you are referring to the Ex-

hibit A list.

Q. Iam not referring to any exhibit list. I am re-

ferring to your past four years at Haverford State Hospital.

A. I don’t know. I can’t attempt to give you an an-

swer, no. I am sure it occurs.

Dr. Barbara Armstrong—Direct 89a

BY MR. ABRAMSON:

Q. In reference to that statement, do I understand

you to say the present admission procedure, as followed

by Haverford State Hospital, in accordance with the Men-

tal Health and Retardation Act, allows for such abuses in

your opinion?

A. No, it doesn’t, because the child is examined on

admission, and that has to be based on a qualified (69)

psychiatric determination that the admission is necessary

psychiatrically.

Q. I think that, Doctor, what I am asking is: does

the procedure as followed by Haverford State Hospital,

in accordance with the Mental Health and Retardation

Act, allow for abuses, not on the part of the hospital or

on the part of the admitting physician or whatever, but on

the part of the parents? !n other words, in their motiva-

tion.

MR. ROTH: Objection. The question has been

asked and answered.

BY MR. ABRAMSON:

Q. (Continued) I am not asking now for an .

cific incidents or anything like that. I am asking aa

personal opinion as far as the procedure goes, whether it

allows for abuses, not on the part of the hospital, but on

the part of parents who signed it, to apply as a part of the

admission process. They do speak to the admitting physi-

cian; they do have the opportunity to convey their thoughts

and their opinions about their child or are given some con-

sideration by meeting the physicians. Given those facts, as

I understand them, does the doctor feel, personally, that

the procedure allows for abuses on the part of parents,

again, not on (70) the part of the hospital?

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90a Dr. Barbara Armstrong—Direct

A. I don’t think that that’s an adequate question,

because the child is examined by a qualified psychiatrist,

and were the child, regardless of what the parents stated,

not in need of hospitalization, the child would not be hos-

pitalized.

Y MR. FERLEGER:

: Q. Stopping short of the decision of whether the

child is in need of hospitalization, let’s assume you have

examined the child and you decided, does the procedure,

as Mr. Abramson asked you, allow for abuse, even in ini-

tiating the application?

MR. ROTH: I object to that question. Dr.

Armstrong is a psychiatrist who examines and deter-

mines whether or not the patient is a prospective pa-

tient, let's put it that way, and is in need of institu-

tional care. What motives are behind the parents

placement of the child into the institution is complete-

ly out of the scope and knowledge of Dr. Armstrong.

She is not dealing with the parents in admitting the

child.

MR. FERLEGER: You heard she does speak

to the parents.

(71) MR. ROTH: But you are trying to use

that as a weapon in saying the parents are abusing

the procedure.

MR. FERLEGER: I am not saying that.

MR. ROTH: That is completely out of the

scope of this deposition. Dr. Armstrong can, not

only testify as a professional involved, but also in

terms of whether or not the prospective complainant

needs to be admitted.

Dr. Barbara Armstrong—Direct 9la

BY MR. FERLEGER:

Q. (Continued) We haven’t given her a chance to

answer that question.

A. I can answer you only insofar as what I said

before. The parents’ motives are examined. The child

also is examined, and if his admission is determined to be

necessary, admission takes place.

Q. You have examined parents’ motives?

A. interview parents.

Q. And professionally, you consider their motives

and try to make an evaluation of their motives?

MR. ROTH: Objection. Dr. Armstrong dis-

cusses the admission with the parents. She does not

examine the motives of these parents, and these

inuendoes made are incorrect.

(72) BY MR. FERLEGER:

Q. (Continued) Do you examine the motives of

the parents? I think you stated you—

MR. ROTH: She does not. If you are going

to mislead, I am not going to let her answer.

BY MR. FERLEGER:

Q. (Continued) Dr. Armstrong, do you under-

stand what the word motives means?

A. Youcan explain it to me.

Q. Do you not examine the motives of the parents

who seek admission and commitment of their child?

A. Generally, what I examine is the presenting prob-

lem of the child. At the same time, it is not possible to

examine motives of the parents at all times.

Q. But sometimes?

A. It depends on an individual case, what the cir-

cumstances are involved.

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92a Dr. Barbara Armstrong—Direct

Q. Didn’t you state earlier, in answer to my ques-

tion, that you did examine motives of the parents?

A. No, | interview parents.

OQ. In that interview, as I think you answered

earlier, you examine the motives of the parents?

MR. ROTH: Objection. She already (73) in-

dicated she does not examine the motives as you have

indicated. She indicated that she interviews the

parents.

MR. FERLEGER: This record will speak for

itself.

A. It’s not the admission procedure to examine

motives of applicants, but the admission procedure is to

_ examine the needs of the child, based on the psychiatric

roblems the patient presents.

: Q. One of the ways of doing that is by the informa-

tion gotten from various informants.

MR. ROTH: Objection. It is misleading. You

are saying information from sources other than the

psychiatrist. From my understanding, it is Dr. Arm-

strong’s testimony that the person is admitted based

on the psychiatric evaluation of the child or juvenile

in this case, as it is determined whether or not this

juvenile needs to be admitted.

BY MR. FERLEGER:

Q. Dr. Armstrong, when parents apply to have their

child admitted, the normal procedure is to speak also to

the parents; is that so?

A. Yes.

(74) Q. And the parents talk to you?

A. Correct.

Dr. Barbara Armstrong—Direct 93a

Q. Do they tell you things about their child?

A. Certainly.

Q. Those are things you consider in making your

professional evaluation?

A. But it is—an attempt is continually made to

base any admission or observation on historical data that’s

presented by the parents. It is not a specific examination

of the motives behind the facts.

Q. The parents present you with historical data

about the child and you try to evaluate that and find in

it, whatever psychiatrically relevant things there are?

A. Itis based on continual examination of the child.

The data isn’t taken at face value.

Q. Have you found a case where some or all of that

historical data was incorrect or fallacious?

A. I would say any historical data is subject to the

interpretation of the person presenting it.

Q. Have you found a case where the parents, in

your opinion, intentionally gave false information about

a child they were presenting?

A. I don’t know how I would determine that.

(75) Q. Have you ever found that to be true, either

later on through other conversations or through social

work history records?

A. That’s historical data related by parents which

is fallacious in part?

Q. Yes.

A. Iam sure that occurs. You are asking me for

data I can’t give you.

Q. In those instances where the information is

fallacious or incorrect, the only way you have of checking

that is by your asking the patient, or other individuals, or

doing your own investigation?

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94a Dr. Barbara Armstrong—Direct

i has already been

MR. ROTH: Objection. It ,

indicated that when the child becomes a ——-

patient at Haverford, that Haverford un ergoes

own independent psychiatric examination.

. FERLEGER:

na 0. oo" Okay. Can you answer the ques

tion?

A. You will have to repeat the question. |

(The reporter read the pending question.)

igation i ilable data.

. Any investigation is made by the avai

The ae Mervin procedure is that we request any

school records, neurological rpm te yg

ephalograms, medical examinations,

otis taal evaluations, or other ancillary data be

: ~ the function of an admitting physician to -

a private investigator or check out the total ore nl Z

each fact. This is usually when Aree are — a abe

data that’s considered in the total eva |

pore evaluation depends upon the presenting child and

ats , ted child usually doesn’t have a law-

yer with him or her?

2 apaee interview the parents in or out of the

resence of the child? -

: A. As you are familiar, there are multiple ways =

conducting psychiatric examinations. me ey on : -

individuals background and preference, either the en -

family can be interviewed together, the child and paren

~ be interviewed without other family members, the

child may be interviewed individually, and the parents

may be interviewed immediately.

Dr. Barbara Armstrong—Direct 95a

Q. Are the parents under oath at that time?

A. No.

Q. Is the child under oath?

A. No.

(77) Q. When you interview the parents privately,

is the child informed of the content of those conversa-

tions?

A. Certainly.

Q. In what way?

A. If the child is not present, then the usual pro-

cedure, xt least at Adolescent Services at Haverford, is to

ask the child if the child would like to remain present.

If the child does not wish to do so, the contents of the

interview are explained to the child.

Q. By whom?

A. The examining psychiatrist.

Q. So, in every case then where the parents are

interviewed, the child can be present if she wants to, in

your Service?

A. That’s correct.

(A recess was taken at 12:00 0’clock.)

(The deposition reconvened at 12:10 p.m.)

BY MR. ABRAMSON:

Q. Dr. Armstrong, first I would want to ask you a

specific question, in that what I would like to know is:

since you have been at Haverford State Hospital, can you

recall any incident in which you felt professionally that

there was a juvenile at the hospital, for however short a

period, who in your opinion, did not require (78) the

facilities of the hospital for medical reasons?

A. I can answer that most specifically by stating:

in the American Psychiatric Association’s diagnostic man-

ual, the diagnostic manual called a diagnosis incorrect as

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96a Dr. Barbara Armstrong—Direct

based on the psychiatric factors found, and that diag-

nosis was given one child in four years, namely, Cheryl

Ann Masagee, M-a-s-a-g-e-e.

However, in reviewing Cheryl’s chart, she was placed

in a hospital by a civil court commitment on a 406.

Q. With reference to this specific individual, may

I ask how long she remained at Haverford State Hospital,

not the specific number of days, but do you recall—

A. Approximately three months. To qualify that,

it was necessary to: one, change custody of the child for

her best interest from her mother who had pressed the

court for the 406 commitment, to the child care agency

of Delaware County, which needed a court hearing; and

secondly, a suitable placement for her, in acting in her

best interests, was required. The court proposed to place

her in a juvenile detention home, which the Adolescent

Service at Haverford State Hospital felt inadvisable, and

the child did not wish. Subsequently, a foster home was

found by the Legal Aid Vocational (79) Department and

was accepted.

Q. Now, specifically with reference to the pro-

cedure at Haverford, when a young person at the time of

admission is found to be in need of care or treatment un-

der the Act, is it always possible for them to go directly

to the juvenile building or Building 9; is it always pos-

sible for them to be immediately transferred to Building 9

for care and treatment?

A. The way the Adolescent Service is set up at this

particular hospital, namely, Haverford State Hospital, the

Adolescent Service operates both a closed service and an

open service. The open services mentioned is at Building

9, and admission to the open service is contingent upon

the child’s ability to maintain adequate social behavior

in an open setting.

Dr. Barbara Armstrong—Direct 97a

Where the child is too ill or too impulsive and un-

able to contain their behavior, it is necessary that they be

placed in the closed unit.

Q. In the event that a young person is found to be

in a suitable state for the open unit, either at the initial

admission procedure or following a period of time in the

closed unit, will he immediately be transferred to the open

unit, or is that contingent upon there being a vacancy in

the open unit?

(80) MR. ROTH: I object to this line of ques-

tioning. I mean I don’t understand the methodology

of the admission and commission procedure attached

in this case.

BY MR. FERLEGER:

Q. (Continued) Can I explain it, or is it clear

what I am asking?

A. I believe [ understand your question. I would

like to, before I answer that, state two sentences which

are not diverting from your question. The Adolescent

Services as set up at Haverford is a service whereby ad-

mission to the service must be in accordance with certain

criteria, and that includes some degree of order in the

intellectual capacity for survival, in the open building.

When their condition allows, they are transferred to the

open setting.

Two, it is contingent upon the availability of the

beds. However, the hospital administration has expanded

the capacity for children a hundred percent in the past

four or six months, so that in fact the requirement of wait-

ing for a place is usually no more than approximately two

to three days.

Q. Have you in your experience been confronted

with a situation in which the young person was in the

98a Dr. Barbara Armstrong—Direct

(81) closed or locked building and it was felt that they

were suitable for transfer to the open unit, but yet, this

transfer was held up for more than the approximate period

of two or three days because of non-availability of space

for them?

A. Prior to the availability of the additional half

of the building it was true, but again, as the general situa-

tion was, it was no more than the maximum of a week.

Q. Thank you. The next question is more of a gen-

eral nature than a specific nature. Getting back to the

admission procedure, when a patient comes in with their

parent to the hospital, and at some point it becomes clear

to the child he is being brought to the hospital to be

evaluated, with the possibility they may be admitted to

the hospital, do you feel professionally that the knowledge

of their impending commitment or admission to the hos-

pital may have an effect on the image, what they present

to the admitting physician, or perhaps, on their mental

state at the time of the admission procedure?

MR. ROTH: I object on the basis that this

question has been asked before and answered be-

fore.

(82) A. It may. It would depend, as I answered

before, on the degree of volition with which the child

presents itself. If the child is willing to come, it’s a posi-

tive effect. If the child is negative regarding admission,

the knowledge may have an effect and it may not. There

is no general situation that may be given.

Q. You mentioned there was a practice at Haver-

ford State Hospital, I believe, where if the child was

favorable to admission, that you often allow them to sign

the formal papers, as well as their parents?

Dr. Barbara Armstrong—Direct 99a

A. This is the practice of the Adolescent Service

itself, and the child is requested to sign in ali instances;

and in my personal dealings, the child has so done.

Q. In all instances, as I understand you to say, this

is where the child was favorable to admission?

A. Right.

Q. This question may seem rather basic, but do you

feel tha: allowing them to sign themselves in is beneficial

to—

A. It allows them to have responsibility over their

subsequent fate. So, it is rather obvious—

Q. Responsibility over their subsequent fate?

A. Intheir admission.

(83) Q. In other words, so that they are on record

as favoring it? Is that what you mean? Because I under-

stand it wouldn’t affect their release. The fact they signed

initially would not require that they signed to be released?

A. If I can amplify the procedure of the Adolescent

Service again. wherein a 403 voluntarily committed child,

18 or under, wishes to be released, they are so advised

by our staff to write to the hospital director of their de-

sire to leave, and within the 10 days subsequent, their

parents are notified, either by the child, which is re-

quested, or by the staff—and in all cases, by the staff—

and a conference is held, and either the commitment is

then recommended to be changed to a 406 or the child

may be released. This is amplified in the present Mental

Health and Retardation Act. Because, under the Act, it

states that the applicant or someone acting on the appli-

cant’s behalf, must write to the hospital director—in this

case, the child—and this gives them their constitutional

right guaranteed them by law.

mo € a Ate

100a Dr. Barbara Armstrong—Direct

Q. If the applicant does not wish to consent in

writing, solely by this fact, the child would not gain the

release?

(84) A. Yes, it does not affect their release. It

does in the Adolescent Service, however, in all instances

that I can currently remember. There may be exceptions

that have caused the social service to reflect their views,

to change the commitment to a civil court commitment.

Q. But you don’t know whether this procedure or

other ones is followed in other facilities across the state?

A. Ihave no knowledge.

BY MR. ABRAMSON:

Q. With reference again to the admission procedure,

in the event an admitting physician does not feel that the

juvenile brought in by the parents is in need of care and

treatment at the facility, is there anything, to your knowl-

edge, to prevent the parents from then attempting to ad-

mit the child to another facility within the state?

A. No. To my knowledge, there is no legal ma-

chinery that protects the child. There is no central clear-

ing agency that has all daily admissions and evaluations

in a memory bank, so to speak.

(Discussion off the record.)

BY MR. FERLEGER:

Q. Do you have, Dr. Armstrong, all correspondence,

books, records, and documents relating to placement (85)

criteria of the Department of Public Welfare for admis-

sion or commitment of juveniles, as you were requested

to bring?

A. I consulted with the hospital director regarding

your request. Haverford State Hospital has no additional

Dr. Barbara Armstrong—Direct , 10la

records, documents, books, or correspondence relating to

admission, other than the Mental Health Act itself.

Q. The Department of Public Welfare, do they have

any other such records or documents?

MR. ROTH: I object to that. I don’t think

Dr. Armstrong can answer as to what they have. She

can only answer for the institution she is employed

by.

MR. FERLEGER: If she can’t answer, she can

tell us.

A. I don’t know.

Q. Have you seen, Dr. Armstrong, the answers to

the first set of interrogatories that were signed by Mr. Roth?

A. Yes, I have.

Q. Do you have them here?

A. Yes.

(The witness handed a document to Mr. Fer-

leger.)

(86) BY MR. FERLEGER:

Q. Now, in your experience at Havorford State

Hospital, is it correct that the standards used for admis-

sion or commitment of juveniles and those standards used

for adults are the same, namely, that they’re based upon

the Mental Health Act standards for the mentally dis-

abled and in need of care and treatment?

A. I don’t understand your question.

Q. I will rephrase it. What are the criteria for ad-

mission or commitment of juveniles to Haverford?

MR. ROTH: Objection. I am not certain I

understand the question. Are you talking about a

professional opinion, whether or not the child is in

need of institutionalization, or the law itself?

‘

;

102a Dr. Barbara Armstrong—Direct

MR. FERLEGER: I am asking what the cri-

teria are. ‘

MR.ROTH: With regard to what?

MR. FERLEGER: Admission or commitment

of juveniles. You seem to—

MR. ROTH: I don’t understand your question.

MR. FERLEGER: You seemed to understand

it well enough in the interrogatories. I am (87)

asking the same question you answered and gave your

name to.

MR. ROTH: I would like the question clari-

fied for the witness.

BY MR. FERLEGER:

Q. (Continued) Dr. Armstrong, what are the

standards or criteria you used in an attempt of admitting—

MR.ROTH: Objection.

A. Iwould say—

MR. ROTH: I can object on behalf—

MR. FERLEGER: You can permit her to an-

swer.

MR. ROTH: I am merely objecting on the

basis of what I understand is the Mental Health

and—

MR. FERLEGER: You are answering for her,

and your objection is fine, but do not answer for her.

MR. ROTH: I am not answering for her.

A. The criteria are the same criteria as in the

Mental Health and Retardation Act itself.

Dr. Barbara Armstrong—Direct 103a

Q. Which are what?

A. Idon’t have to read the entire thing?

(88) Q. The criteria you used from the Mental

Health and Retardation Act for admission or commitment

of juveniles to a facility?

MR. ROTH: At this time, would you like to

stipulate as to what section, 402 or Section 403 say,

or would you have Dr. Armstrong read it into the

record?

BY MR. FERLEGER:

Q. (Continued) Read into the record that portion

which gives the standards and criteria, if they are used,

for juveniles.

A. The entire listing of things which are under the

mental disability statement, which are under Article 1.

Q. What section of that; what section of the Act?

MR. ROTH: I object first, on the basis I don’t

know where you are going with this line of ques-

tioning. I would like an offer of proof before we

get into the Mental Health and Retardation Act of

1966.

BY MR. FERLEGER:

Q. (Continued) You are referring to Section 102,

to the definition of mental disability; is that correct?

A. That’s what I am referring to.

(89) Q. And if I understand you correctly, this

gives the definition of who suffers from mental disability,

as defined there, who would be eligible for commitment?

A. Correct.

Q. To your knowledge, that definition of mental

disability is also used for admission or commitment of

adults as well?

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104a

Dr. Barbara Armstrong—Direct

A. Tomy knowledge.

MR. FERLEGER: Dr. Armstrong and Mr.

Roth, I think we have agreed previously that in order

to dispense with the necessity of Dr. Armstrong hav-

ing here ail the medical charts of all juveniles who

are presently patients at Haverford State Hospital

and named plaintiffs, that plaintiffs’ counsel will be

permitted to examine the correspondence, book rec-

ords, and documents at Haverford State Hospital.

Do we agree, or do you want to add something?

MR. ROTH: My understanding is Mr. Ferleger

has an agreement with Haverford State Hospital

which grants him access to all the information that

he has addressed himself to, and my direction would

be that he would be allowed to review those records,

and also, it (90) would be my understanding, as I

hoped it was Mr. Ferleger’s, that he would use those

to the best interests of these patients.

MR. FERLEGER: No doubt about it. Just

to clarify things, on Exhibit A, there are three indi-

viduals there whose names there are lines through.

THE WITNESS: They are for a 408 criminal

court commitment, and in our desire to supply you

with all necessary data, we overextended available

information.

MR. FERLEGER: Our request did pertain to

all juveniles.

THE WITNESS: Then you do want them.

MR. ROTH: Your request directs itself to

voluriary admissions. Are you referring to No. 9

of interrogatories?

Dr. Barbara Armstrong—Direct 105a

MR. FERLEGER: No. Our notice of deposi-

tion refers to all juveniles who are presently patients.

David Rhinehart, age 16; Elizabeth Schriber,

age 14; and Stephen Willett, age 16.

MR. ROTH: As far as I am concerned, since

you have access to the records and we have (91)

addressed ourselves to that, you are permitted to re-

view them according to those juveniles presently in

the facility.

MR.FERLEGER: Your turn.

MR. ABRAMSON: May I ask one question?

BY MR. ABRAMSON:

Q. I wanted to ask: if a juvenile is a patient at

the hospital under either Section 402 or 403, and a parent

comes to the hospital and would like to withdraw the

child from the hospital, and the hospital has no objection,

does the hospital concern itself with the future disposition

of the child?

A. Yes. That’s a useful question, I think. The

hospital and the psychiatric staff, the psychologist, the

social service nurse, and the lab services are, as part of

their agreement to offer services in the examination, care,

and treatment of the child, are required to recommend

outpatient treatment if there is indeed a recommendation.

In Haverford State Hospital’s instance, the outpatient

clinic has been discontinued, and therefore, outpatient

care is referred to four base service units in Delaware

County. In other instances, if private therapy can be

arranged, that is recommended, in (92) addition to the

Department of Family Therapy at Haverford State Hos-

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106a Dr. Barbara Armstrong—Direct

pital. Haverford State Hospital has an agreement with

those patients involved in family therapy to continue three

months of outpatient treatment.

In all instances, if further treatment is recommended,

specific recommendations are given to both the child and

the parents. Where an additional agency is involved, such

as the probation department, the probation officer is con-

sulted prior to the child leaving, and reasonably, at least

regarding the child’s needs and the hospital’s recommenda-

tions, requirements are set up. All liaison with any social

agency is attempted to be implemented for the child’s

care, and are worked with and met with prior to dis-

charge so that the child’s care does not stop when the

child is discharged.

BY MR. FERLEGER:

Q. If the parents want the child out—if he has

given notice to withdraw the application and you feel the

child needs inpatient care, then, as I understand your tes-

timony today, there are two things that can happen to

him: either the child would be permitted to sign against

medical advice, or, in your judgment, might have to have

some child care or other (93) agency press for court com-

mitment?

A. That’s correct.

Q. Of the people listed in Exhibit A, can you tell

me if you know which persons are there as a result of

your having to do—to ask for a court commitment when

the parents wanted the child out?

When the parent wanted the child out?

That’s correct. Are there any people there?

There are none.

So that doesn’t happen very often, I guess?

Oro?

Dr. Barbara Armstrong—Direct 107a

A. Iam sorry. There is a correction. Your ques-

tion was—can you tell me your question again?

Q. Are there people listed on Exhibit A, with refer-

ence to whom the parents have asked the application be

withdrawn, with reference to whom you have had to ask

or have an agency ask the court for a 406 commitment?

MR.ROTH: Objection.

AL Never mind. You are focusing on whether the

application is withdrawn?

Q. Yes.

A. You are asking me if there are any patients whom

we have had to request the commitment be changed?

You do understand the parents have a right to disagree

with our request, and a child, where this occurred—(94)

and the resolution of the case—Mary Lou Gallagher—

against medical advice, because the parents refused to

institute a 406.

Q. Could you institute a 406?

A. There is no way in which, at any time, the hos-

pital can act in loco parentis with the parents’ disagree-

ment.

Q. Then what I stated before is incorrect; if the

parents disagree with you, your only alternative is to have

a child sign out against medical advice?

A. That’s correct.

Q. The reason is, even though you personally ad-

minister psychiatric care, you are not in a position to

apply to the court?

A. That’s correct.

BY MR. ABRAMSON:

Q. Doctor, is it also true with reference to recom-

mendations you indicated are often made following dis-

«’ eiah

ee a ee

108a DrxBarbara Armstrong—Cross

charge of a patient, when you make certain recommenda-

tions to parents for continued care or whatever you men-

tioned previously, again, the hospital has no machinery in

which to expel the complaints? _

A. No. However, it should be noted, our major

emphasis is dealing with the child, and with the (95) ex-

ception of a very small percentage, the children them-

selves, once they are worked with, are advised of their

need for treatment and they are given the available base

service unit address, phone number, et cetera, so they

themselves may seek out their treatment, regardless of

their parents’ desires. .

Q. But if a patient, a juvenile, changes his or her

mind, you don’t have authority to expel him or her?

A. No. The probation office does. We do not.

MR. FERLEGER: If the child happens to be

under probation.

No more questions.

Your turn.

Cross-Examination

a ~s — Armstrong, let’s take a hypothetical situa-

tion and follow it through. If a parent wishes to admit

a child to your institution under Section 402 or Section

403 of the Mental Health and Retardation Act, what is

the first procedure which you utilize?

MR. FERLEGER: Objection. We went through

this before, and you objected.

MR.ROTH: That is not true.

Dr. Barbara Armstrong—Cross 109a

(96) BY MR. ROTH:

Q. (Continued) What is the procedure you utilize?

A. The parent is referred to a designated social

worker of the Adolescent Service, aud what is stated as

an in-take interview is arranged with the parents, is one

instance. On other occasions and more frequently, the

entire family is given an appointment and a joint interview

with a psychiatrist and social worker is held to determine

whether or not the child requires admission and care.

Q. From what you have indicated in your exam-

ination by Mr. Ferleger and Mr. Abramson, it appears that

if a child is admitted, or applied for admission other than

by his parents, then you make a psychiatric examination.

Do you, at that time, determine, based upon your exam-

ination, whether the best interests of this child are going

to be served by institutionalization?

A. (No response)

Q. In other words, do you determine that the child

needs institutionalization, based on an independent psy-

chiatric examination?

A. Certainly.

Q. Now, if this child does not need institutionali-

zation, do you still institutionalize him?

(97) A. No.

Q. If the parents, for any motive other than the

best interests of the child, try to petition for his admission

into the institution, do you, nonetheless, still conduct an

independent psychiatric examination to determine whether

or not this child needs institutionalization?

A. Yes.

MR. FERLEGER: Do I understand you to be

inquiring into the motives—whether Dr. Armstrong

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1i0a Dr. Barbara Armstrong—Cross

’

inquires into the motives or reasons of the parents

interests in committing the child?

MR. ROTH: According to the rules of the

court, | am completely within the realm of the ex-

amination placed upon the witness before.

MR. FERLEGER: I have to ask you to clarify

the question in order to determine whether or not an

objection is necessary.

Do I understand you to be asking Dr. Armstrong

if she inquired into the motives of the parents, and

as a result of that, if the motives are improper, she

determines not to institutionalize the child?

(98) MR. ROTH: I will repeat my question

for you, if you will listen carefully.

BY MR. ROTH:

Q. (Continued) Notwithstanding the parents

for appliance for admission for their child, does

te tetas Wiaies an independent examination .

order to determine if a child is in need of institution care

A. Certainly. In all instances, 1 would say an

ination of the child is made.

i Let’s say the child is admitted to the institution.

After the child is admitted to the institution, and in

getting into what kind of care or treatment is provid

by your institution, in the event that the child is deemed

to be sufficiently capable, in accordance with ison

medical or professional terms you used, what do you i

Do you recommend to the parents, his release? t

procedures do you utilize then?

A. Repeat that.

Dr. Barbara Armstrong—Cross lila

Q. For example, after somebody has been admitted,

and because of your care and treatment, is now sufficient-

ly capable to return to society and eventually, to the family

home, what do you do at that time?

A. We recommend to the child that his discharge

be (99) effected, and we notify the parents of the same.

Q. Usually, when you do that, do the parents com-

ply with you?

A. Yes, usually,

Q. In the event that the parent wishes to release

his child from your institution, can you, at that time, in-

dicate to the parent whether or not it is in the best in-

terests of the child for him or her to be released?

A. Yes.

Q. Do you have instances where the child can be

released, notwithstanding, medically, that it would not

be in the best interests of the child to be released?

A. Certainly.

Q. If a child who is ip the institution, objects to

being institutionalized, do you follow that objection up

at all with talking with anyone about it?

A. Certainly. The child is, as previously stated,

advised by the entire staff to write a letter to the hospital

director, Dr. Jack B. Kremens, and state that he wishes to

leave the hospital. At such time, he is informed that he

must inform his parents, and the staff also does. The

staff, if the child is in need of further hospitalization,

recommends the child’s commitment, in 10 days as speci-

fied by law, be changed (100) to a civil court commit-

ment, a 406. ‘If the parents comply, this is done. If a

parent does not, then the child is discharged.

Q. The summaries which you prepared today, on

who were admitted, to wit, Exhibit B, were they—I be-

lieve—were the contents supplied in terms of requests,

ee oe

i12a Dr. Barbara Armstrong—Cross

on those summaries, which you discussed with opposing

unsel? t

a A. Yes, they were, on an unofficial basis. Mr.

Abramson has functioned as an unofficial advisor from

M«. Ferleger’s staff for the Adolescent Service, and specifi-

cally, the Service’s social worker, who made this form up

for purposes of this deposition, and checked with Mr.

Abramson as to its relevancy and completeness.

Q. Dr. Armstrong, questions have been asked of you

with regard to examination, its length of time, under 406,

as well as uncer 402 and 403. Is it your professional opin-

ion that notwithstanding the procedures under which an

applicant or court committed person comes into your insti-

tution, a substantial examination is carried out in order to

determine whether or not this juvenile in this case needs

institutionalizing?

A. Yes. I would add to my previous testimony, that

(101) in this hospital’s administrative procedure, there is

an initial examination made by the psychiatrist, and is so

designated as an admission note on the hospital record.

Subsequently, for all adolescents on the Adolescent Ser-

vice at Haverford State Hospital, there are routine studies

done, such as an electroencephalogram, a neurological ex-

amination, a medical examination, es a complete pas

f psychological tests and school evaluation, as well as a

sapehtatile sediliadall When all their data has been com-

piled, an entire staff conference is held, which is called a

new case conference, at which point the complete case is

re-examined and it is decided whether or not the child

needs hospitalization, and at ms a time, as well, an

treatment course is planned.

a : Are periodic reports made and revealed to the

patient and the parents for the basis of his continued need

to be institutionalized?

Dr. Barbara Armstrong—Cross li3a

MR. FERLEGER: I object. That is true of

every hospital. That is standard and a required psy-

chiatric practice that I don’t think any institution in

the State of Pennsylvania would say it doesn’t fol-

low. I would be horrified, and so would the doctor,

if they (102) didn’t continually work with the child

and tell the patient what was happening.

BY MR. ROTH:

Q. (Continued) Would you answer the question,

please?

A. Insofar as notifying the patient and his parents,

or the applicant if it is not the parents, of the patient’s

status, the social worker is designated every 30 days to

notify all admissions, regardless of types, of their status.

The parent or parents, or guardian, are met with, gen-

erally, weekly in some cases, to discuss the case. There is

some social work counseling done in family therapy, and

there are administrative parents conferences, the minimum

of which are held once a month.

Additionally, as far as the patients’ status and prog-

ress is concerned, in the Adolescent Service, there is a de-

tailed progress report compiled by the Department of Re-

search and Planning, in conjunction with Dr. Aaron Smith,

wherein the patient’s status is noted daily.

Q. Dr. Armstrong, you can correct me if I am

wrong: one of the questions about the distinction between

adult and juvenile was your admission procedure. Was

your (103) answer that children by and large are unable

to exercise judgment in determining whether or not they

need care? :

A. I would have to answer that question the same

as | previously answered: yes and no. Some children are

—

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114a Dr. Barbara Armstrong—Cross

able to exercise adequate judgment, depending on the na-

ture and severity of their psychiatric condition, and their

reasons thereof. To others, they are incapable. Their judg-

ment is rendered non-functional by the basis of severe psy-

chiatric problems.

Q. Dr. Armstrong, would it be your professional

opinion that it is because the child, in particular, juveniles

who are unemancipated—by that I mean living with their

parents—could best be observed by their parents who can

indicate to you that the child does need additional treat-

ment or treatment per se?

MR. FERLEGER: Objection. Not only does

Dr. Armstrong not know the legal definition of un-

emancipated, but your definition: someone living with

his parents, is incorrect under the law of Pennsylva-

nia. Under the law of Pennsylvania, a child can be

living at home and still be emancipated.

Dr. Armstrong may know, because I wrote a let-

ter, a legal opinion letter, with reference (104) to

Trevor Haviland at the hospital, whether the child

is emancipated and whether their family knows what

this means legally.

I think that makes that question improbable.

BY MR. ROTH:

Q. (Continued) Let me rephrase the question.

In an environment where you have parents and a

child living together, would you feel it is appropriate be-

cause of the relationship, because of the continual inter-

action among those pecple, for the parents to be best ap-

prised in order to indicate to you or the institution that

their child be in need of institutionalization?

Dr. Barbara Armstrong—Cross 115a

A. I would have to answer that question as I did

previously: yes and no. It would depend on the degree of

stability and absence of mental disability, and the degree

of maturity of the parents, the relationship of the child

and the parents, and again, multitudinous other facts. In

some cases, they would be the best observers, where the

interaction is positive, and where the interaction is nega-

tive, they would not be.

Q. If parents would attempt to admit their child and

your institution felt the admission was (105) inappropri-

ate, your institution would not admit the child; is that cor-

rect?

A. That’s correct.

Q. By and large, Dr. Armstrong, are most of the ju-

veniles admitted or committed to your institution done so

voluntarily by the child?

A. That requires the same estimate that Mr. Fer-

leger asked previously. Some are and some are not. To

give you a figure, if you wish, I could count them from

this list.

Q. Fine. Again, I am directing this question to the

admission from the very outset, and not to subsequent de-

velopment.

A. If the child requested admission; is that right?

Q. I am asking whether the child objected to his

being admitted.

MR. FERLEGER: Go over each name and

say—

MR. ROTH: No, I object to that.

BY MR. ROTH:

Q. (Continued) You do it on the whole basis. Say

how many for and how many against.

(Discussion off the record.)

116a Dr. Barbara Armstrong—Cross

A. I think I need to qualify it. Do you mean (106)

objected as far as I know at the time of admission, or ob-

jected at any time?

Q. Admission. I am also confining this to 402 and

403 commitments.

A. All right. Then those that did not object at all—

Q. Just strictly from admission.

A. Which must exclude six of the children on this

list who are severely mentally retarded and cannot be con-

sidered competent—there are nine.

MR. FERLEGER: Who did not or did?

THE WITNESS: Who did not object—of 403?

MR. FERLEGER: And 402 is?

THE WITNESS: Okay. That is—

BY MR. ROTH:

Q. How many objected?

MR. FERLEGER: I think it is clear that if

nine did not object, the rest objected, except for the

retarded.

THE WITNESS: No, because in addition, some

are severely psychotic and objection has no reference.

BY MR. ROTH:

Q. (Continued) If i understand, you are indicat-

ing (107) nine did not object, and that six were severely

retarded, and some of the remainder are not able to exer-

cise judgment in order to object and not object?

A. That’s correct.

Q. And you indicated, such as Steve Gentile; is that

correct?

A. For example, yes.

Dr. Barbara Armstrong—Cross 117a

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