# Appendix — Secretary of Public Welfare of Pa. v. Institutionalized Juveniles > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/brief%3Amicro_IA40385005_1099%3A04 ## Record - **Collection:** Supreme Court brief - **Document type:** Appendix - **Published:** January 1, 1979 - **Citation:** 442 U.S. 640 ## Text 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 Vv 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 ne edamame ~~ i pen Se tae a Mpa ines Teeter aie ee ee ed Complaint 17a f 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. (c) Except where application for admission 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) > 4 ~ m3 x > & tating 4, ters ~—« i * tel wp eed tae, PA te gt A It POOLE ~~ fe AT | ote Te? eS a Le rn i | Nati’ tie lp hte he ae fee Os 4 OS ath I Aad ae ae 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? pie y AOA ee ar | line oe — ee = “mahal | _* ¢ a ie a ee.) a ae 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. > el ee. o> —S 7+ =. -— . . — 2 ~—- ~~ | w=. _ —— 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. y= *- mn § > - a> F? gc 2. eee 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? t. 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 2+ — nai — - ~ 22 i > ~ ade Be es Pe ee Ce) ees SD — A Se ee ye ae ee ee 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? ‘ ; j : : : 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? “iv Ths ee Np eee, a be Te ee ee _ Ses eee oo mee, Labo Stata oie, TN BO RS Se =— ane = ate sn eae a eee a ee og SALE Ei eee tt Dien ue pe Rie eRe ON? oe a 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- a ae | —_—s ie 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 H: 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 ene wt) Su A Se, i. a er he Eg ee tee ee eT en ee a a ee res 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 — ee ae ee oe ed eee EP oes eT ae ae Peed - a a. ty Oy “ be a “2 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 Q. Let me ask you this. As far as the named indi- viduals in this particular lawsuit, could you tell me if they are currently in the institution? MR. ABRAMSON: She has to answer your other question for us. A. Just a moment. First of all, I am going to cor- rect the first number. Speaking of those admissions, there are 16 that did not object at the time of admission. There are eight that objected, and the remainder are not compe- tent, are severely retarded or psychotic, and cannot make an adequate judgment. Q. Now, of those who objected at admission, what, if you will, deference did you give to their objection? How do you cope with an objection? A. Well, it depends on individual instances again. If they are under a 406 or 408 as three were— Q. So, three of the six who objected were under 408 (108) or 406? A. That’s correct. Q. Court commitment? Some of the remainder of the remaining— (Discussion off the record.) BY MR. ROTH: Q. (Continued) For clarification of the record, what you have indicated is 16 did not object, eight ob- jected, and of the eight who objected, three came under the court committed procedure, with regard to Section 408 or Section 406; is that correct? A. That’s correct. Q. Some of the remainder of those who objected were under 402 or 403, and there would be five? A. Correct. ee ne ee SS eed sw ke 118a Dr. Barbara Armstrong—Cross Q. Could you tell us what deference you gave to ob- jections of those committed under 402 or 403? A. They were advised to write to the hospital di- rector of their desire to leave. We thoroughly researched their charts. It must be noted that on my list, only one of Mr. Ferleger’s plaintiffs remains. However, of this list, none so instituted the writing of a letter to the hospital director, so there was no formal action taken by them, even though they had been (109) advised of the proper action to institute their discharge. Q. Of those five, Dr. Armstrong, who objected, did you also notify their parents that they were objecting? A. No, we did not. In this same procedure, if they would have written to the hospital director, the parents would be told at the weekly parent conference. They were not notified by a specific phone call. Had they initiated the writing of a letter to the hospital director— Q. But the parents subsequently were notified? A. Correct. Q. Of the named plaintiffs in this case, how many remain in Haverford State Hospital? A. None remain, however, Kevin Bartley is con- tinued on short-term leave, as previously explained, for ad- ministrative purposes only. This allows him to procure transportation from both Delaware County and Chester County to attend Delaware County’s intermediate special adolescent school. Q. Do you know— MR. FERLEGER: Is Kevin Bartley the only person on any sort of leave, and are the other people discharged? (110) THE WITNESS: They are. Dr. Barbara Armstrong—Cross 119a BY MR. ROTH: Q. (Continued) According to your personal knowl- edge, do you know when those children objected, who are being represented by opposing counsel, whether opposing counsel proceeded to process any writs of habeas corpus to have these people released? MR. FERLEGER: Objection. That doesn’t have any relevance to either this proceeding or the court. A. To my knowledge, they were filed. Q. Dr. Armstrong, I just want to emphasize again: does your institution hospitalize anyone who does not re- quire hospitalization? MR. FERLEGER: Objection. That is repeti- tious of two of your questions and five of mine. A. I cannot answer for anyone, Mr. Roth, as I pre- viously stated. By experience at this institution as director of the Adolescent Service and my experience, of which 99 percent is with juveniles, | may say, on rare occasions | will do a professional colleague a favor and do his duty, which may require my admitting an adult. Very rarely un- der those circumstances do I (111) encounter an adult admitting their requiring admission. Q. I gather from what you said, if your institution feels that a child no longer is in need of institutionaliza- tion, that you effect the proper procedure in order to have that child discharged or released; is that correct? A. That’s correct. (Discussion off the record.) BY MR. ROTH: Q. Dr. Armstrong, in your professional opinion, do you feel that anyone, be it juvenile or adult—and this is 120a Dr. Barbara Armstrong—Cross general—could best be evaluated by a psychiatrist, as your institution has, and by that procedure implemented, to de- termine whether or not that person needs institutionaliza- tion? MR. FERLEGER: Objection. What do you mean by “best’’? BY MR. ROTH: Q. (Continued) Could be evaluated by your insti- tution in order to determine whether or not this person needs institutionalization? A. Could you repeat that? MR. FERLEGER: Objection. I think you are misleading the witness. (112) BY MR. ROTH: Q. In other words, what I am asking you is if any persons had wanted to be admitted to your institution— and I believe we are all well enough aware that we are now going into the realm of medical, professional, psychiatry evaluation—would it be your opinion that your institution could do this and does it? MR. FERLEGER: Objection. The law is quite clear. Despite the requirements of the institution, a person cannot be commitied solely on sight recom- mendations of any number of doctors. So, the fact that Dr. Armstrong thinks that— MR. ROTH: I am merely asking her in her professional opinion. MR.FERLEGER: Whether Dr. Armstrong feels that a doctor should have authority to evaluate and sign people into hospitals, in reference to adults in Dr. Barbara Armstrong—Redirect 121a this state, it is quite clear that doctors do not have that authority. BY MR. ROTH: Q. (Continued) Can you answer that question without referring to any legal procedures, which Mr. Fer- leger has led you to believe are incorrect? MR. FERLEGER: I mean you are trying to (113) limit her answer. BY MR. ROTH: Q. (Continued) Can you answer my question, please? A. (Can you repeat the question again? Q. From what I see, your institution, notwithstand- ing the voluntary admission, can make an independent de- termination to preclude admitting some patients? A. That’s correct. Q. By the same token, can your institution make an independent determination to ascertain whether a person needs institutional care? A. The institution does so by examination. The psy- chiatrist can, as I understand the present law, recommend hospitalization. They cannot institute it. Q. Fine. But your institution can preclude the ad- mission of someone under 402 or 403 if it feels that per- son does not need to be institutionalized? A. That’s correct. Redirect Examination BY MR. FERLEGER: Q. What are the names of the persons in Exhibit A who objected to hospitalization? You referred to the num- ber originally as eight in response to Mr. Roth. 122a Dr. Barbara Armstrong—Redirect (114) A. I want to make it clear that you are ask- ing me tor my professional opinion, which is based on memory, and it may well be that you will not find evi- dence of this in any record. However, in your questioning, you did not confine yourself to written facts, so I am giv- ing my opinion. _ + bee Kevin Bartley; two is John Cross; three is Mi- chael King; four is Ben Mosco; five is Thomas Hocken- berry—we are including No. 405? Q. Yes. A. Graber, James. And we are including 408; right? Q. Yes. A. Elizabeth Schriber. Q. How about Rhinehart? A. He preferred to come rather than go to jail. Richard Burns; Anita Jenkins; Stephen Willett. MR. ROTH: That’s all? THE WITNESS: That’s the best I can do. BY MR. FERLEGER: Q. By my count, the number of names you have is 10 who objected. A. You may be right. Q. Of the remaining people, how many of them ob- jected (115) to being hospitalized during the time of their hospitalization at any time during the time of their hos- pitalization? A. We are using the definition of objected, as I have heard them object? Q. Or you know from your associates that he ob- jected or gave written notice? A. None have given written notice. Dr. Barbara Armstrong—Redirect 123a Of these other people. None on the entire list. And how about in any way to staff members” I have to add, insofar as my knowledge, it’s in- Pr OPO complete. What are you going to do about competent and in- competent people? Q. If they have objected, then say so. Then say ob- jected, but incompetent people. If they are incompetent, why don’t you say— A. I will run down the entire list. Q. Except for the ten people you just mentioned. A. Timothy Baer, objected, not competent. MR. ROTH: You also included Timothy Baer as one of the 10, didn’t you? THE WITNESS: No, Bartley. (116) A. (Continued) Mary Lou Gallagher. Q. What about Suzanne Garrelli? A. She came voluntarily. Mary Lou Gallagher objected and signed out against medical advice, which I previously stated. Stephen Gentile, not competent. Pollock, Michael, objected and obtained his own court hearing. He is under 406. Do you want the resolution of that? Q. No. A. Okay. David Rhinehart objected. Michael Vantine objected. David Parmet is not competent. William Cutilli is not competent. Thomas Taylor objects. del: paver ee mmee . BS? ae ey rugs: Fe 4 are a ed ee ee atte. xh - =~, = ee! se”ClUl Se 124a Dr. Barbara Armstrong—Redirect Peggy Ann Saunders is retarded, minimally compe- tent, 10 objection. Walter Lucas is not competent. MR. ROTH: Had Walter Lucas objected? THE WITNESS: Not to my knowledge. They are part of the Adolescent Service. BY MR. FERLEGER: Q. The others what? A. In this list are even a number of children who (117) were not accepted into the Adolescent Service by virtue of either being too severely brain damaged or too retarded to participate in the program. Q. Doctor, with reference to being accepted into your program or not being part of your program— A. By virtue of present retardation, they are consid- ered not competent. Q. Which are they? A. Walter Lucas. Q. Point No. 2, you stated that the social worker, every 30 days, gives notice to the juveniles that are there under 402 or 403 commitment. In what way do they give at notice? : A. They verbally inform both the child and the par- ents. Either the parents are notified by telephone or in- formed by the weekly conferences. Q. Is the fact that this information has been given to parents noted on the medical charts? A. No, it is part of the routine procedure. However, in checking with the social service department, since the papers of a 403 are to be resigned every 30 days, the re- signing itself is sufficient notification and, therefore, no no- tation is made. Dr. Barbara Armstrong—Redirect 125a Q. What is the notification of parents? (118) A. That the child is notified verbally. Q. Dr. Armstrong, two or three months ago, David Purcell of your staff kindly invited me to come to one of your staff meetings, and at that meeting, certain proce- dures happened, and I would like to describe it for you and ask you whether that procedure of your staff is typi- cal. This follows with reference to what Mr. Roth asked you about. A patient had given a letter to the staff, expressing his desire and intention, if permitted, to leave. This mat- ter was brought before the staff members as an assembled staff of psychiatric aides, doctors, and there was a discus- sion by the staff of the person’s history and progress, and there was a discussion about the person’s family situ- ation. Then, there was a consensus agreement that the person was not yet ready to leave the hospital, and the staff member who received the letter was instructed to tell the patient that right now, he can’t leave. Is that the normal procedure? MR. ROTH: I object. First of all, you are do- ing the testifying about a conference which we haven't established whether Dr. Armstrong was part of. (119) Secondly, if you want to testify, we can put you on the stand. Thirdly, as far as the information goes, as far as I can gather, is strictly hearsay, and based on only part. Now, if you want to ask Dr. Armstrong about the procedure that is utilized, you may do so. MR. FERLEGER: Your objection is noted. ¥ ee ~*s | ~~ a 126a Dr. Barbara Armstrong—Redirect BY MR. FERLEGER: Q. (Continued) Is that procedure that which is typically followed? A. I think, as I previously stated, Mr. Ferleger, in dealing with children, particularly disturbed children which we are speaking of, one cannot have a typical procedure. There are general cases, but actually, there are many ex- ceptions as well. Q. The procedure I described, is that one which— MR. ROTH: I object to that question, and again, because there has been no foundation laid ap- propriately in order— MR. FERLEGER: Depositions don’t require foundations. MR. ROTH: We are questioning and (120) cross-examining Dr. Armstrong according to law, and accordingly I advise you with regard to questions and answers that may be asked, if the proper foundation is not laid for a question then it obviously is of no matter whatsoever. If you want to ask about the pro- cedures, fine. If you want to ask Dr. Armstrong to be a little more help to you, you can ask if she is aware of this particular meeting, according to her personal knowledge. I do not want you to mislead her since I do not know for a fact that the actual situation which you allegedly stated has occurred, and asking her whether that procedure is a uniform pro- cedure is questionable. I have no basis of knowing the validity of that conference per se. BY MR. FERLEGER: Q. (Continued) Dr. Armstrong, assuming hypo- thetically the procedure I described happened as I de- Dr. Barbara Armstrong—Redirect 127a scribed it, is that one of the A roced such a notice, that your staff ites for dealing with A. Is it one of the procedures? Q. Yes. A. Hypothetically, Okay. (121) Q. Assumin g the facts I stated a that Py of the procedures that your staff hin ; - That’s one of the procedures. There is, however Q. What if the professi “y best medical interests ad ~ ng salt feel it fo not in the A. I would disagree with you: sa would say the best interests of Se om interests, | Q. If the professional ; . judgment abou i terest of the child conflicts with the densa ton recommendations, then pepe you would feel obliged to agree to 128a Dr. Barbara Armstrong—Redirect A. That’s the truth. However, to date, that has not happened. (Discussion off the record.) BY MR. ABRAMSON: | Q. With reference to Mr. Roth’s question concern- ing the follow-up—all of the procedures which take place while a young person is at Haverford, I notice in particu- lar, with reference to Miss Vicki Mathews, in the summary prepared for her, there is reference made to this continual evaluation and coordinated efforts. In particular, I notice reference is made to the recommendation concerning Deve- reux School for this patient. A. Yes. . Q. And my question is—I don’t see it here on this summary—do you recall if the patient, Vicki Mathews, es pressed any feelings as to her opinion of Devereux Schoo being a boarding school? ate A. Yes, I recall, specifically, Vicki Mathews’ opin- jon. Victoria Mathews is one of the patients that fits the category of being non-volitional on occasions, and on other occasions she would admit to myself and Dr. Rosen that she had problems, and on other occasions, (123) she had not, and therefore, resisted any additional psychiatric care. As you can see by her record, she had been through os Irving Schwartz Institute and the Philadelphia Chil Guidance Clinic before she reached us. This is a particu- larly difficult individual to handle, so that the recommenda- tion for a private facility was made more on the basis of this being something that the patient and her family could accept, rather than feeling that our facility was incapable of handling her. Dr. Barbara Armstrong—Redirect 129a BY MR. FERLEGER: Q. Where is Devereux School? A. Devereux School is a multitude of schools. The main office is in Devon. Q. Is it in Pennsylvania? A. One is in Pennsylvania. One is in Massachusetts. One is in Connecticut, and one is in California, and one is in Texas. Q. Do you know which branch Vicki is in? A. Yes. As general director and director of that Adolescent Service of which we speak, it becomes neces- sary to deal with directors of similar residential settings. Q. Can you tell me? (124) A. Their recommendation was that she go to Texas, and that is indeed where she went. Q. Do you know what town? A. Victoria. Q. Would you call Vicki Mathews a non-volitional patient? * A. At times. Q. Is Mark Weand a non-volitional patient? A. At times. | Q. And what about Leslie Levine? A. At times. Q. And Kevin Bartley? A. At times. Q. And what about Steve Gentile? A. He was Dr. Hammer’s patient, and his opinion is that he was severely psychotic and not competent to exercise judgment, and my comment is I feel his objec- tion is one that you cannot take heed to. His objection is not realistic. 130a Dr. Barbara Armstrong—Recross Q. Do! understand that he has made objections, but because of the medical factors you mentioned, you don’t feel they have substance? A. That’s correct. MR. FERLEGER: I have no further (125) questions. Recross-Examination BY MR. ROTH: Q. Dr. Armstrong, now, we have been talking about objections, and I only have one question with regard to these objections. What is the nature of these objections? Are some of them inconsistent one day or they are object- ing the next day, or complaining, or are they up and down, if you will, like a yo-yo, objecting one day, and something where they are objecting the next day? Do you have an instance of this sort with regard to that type of objection? Are these types of objections consistent and repeated? A. Yes and no. Some indeed are reflections of the child’s ambivalence toward their illness, such as Kevin Bartley, and Vicki Mathews, and Mark Weand. One day they feel they can handle the problems themselves. Then when confronted with their own behavior, such as Mr. Weand’s drug taking or Miss Mathew’s suicide gestures, such as lacerating their wrists, their behavior is difficult to deny and the patient acknowledges the presence of his problems and has some psychiatric difficulty. In other in- stances such as the case of (126) Mr. Burns, who is in un- der 406, his diagnosis is that of personality disorder. With- out going into the nature of such a diagnosis, it allows for consistent repetitive resistance toward any communication and resistance toward being hospitalized. Dr. Barbara Armstrong—Recross 13la Q. Dr. Armstrong, with regard to the number of in- dividuals that you have in your institution, is your specific program running at full capacity? A. Almost full capacity. Q. Is there a great turnover in terms of your institu- tion wishing to release juveniles once they have attained their prospective or whatever professional terms you ~ utilize? MR. FERLEGER: Objection. A great turnover with regard to the institution’s desires? BY MR. ROTH: Q. (Continued) I said: a great turnover in the number of patients, juveniles. A. Again, I would have to answer you that with Dr. Smith’s research department, we are in the process of compiling adequate statistical data which I haven’t cur- rently been able to get compiled. I can’t give you figures of our average length of stay or discharge and admission rate. All I can tell you is that some patients (127) stay for two or three weeks. Some stay for several months. Their lengths of stay are based on their need for hospitali- zation. BY MR. FERLEGER: Q. In the ambivalence toward hospitalization, ask- ing to leave one day or objecting one day, and not the next, that is true of adults as well, isn’t it? MR. ROTH: Objection. A. Some, I would say. Q. Is it true of some adults? A. Yes. One cannot generalize about any statement regarding the psychiatric status of one individual. Q. It is true of some adults and some juveniles? Dr. Barbara Armstrong—Recross 132a Certification BY MR. ROTH: Q. With regard to ambivalence, is ambivalence pre- cipitated by the conditior of the patient? A. Yes. MR.ROTH: Thank you. MR. FERLEGER: I have nothing else. (Witness excused.) (Oral examination concluded) (128) CERTIFICATION I hereby certify that the proceedings and evidence are contained fully and accurately in the notes taken by me on the oral examination in the above cause, and that this copy is a correct transcript of the same. Patricia M. Kosmalski I have read the foregoing transcript of testimony given by me in the above matter, and hereby certify that it is true and correct to the best of my knowledge and belief. Witness’ signature Exhibit A 133a (129) | EXHIBIT A Ss CLASS ACTION SUIT t Commit- 4 ame Age ment Assigned Bartley, Kevin 16 403 D>. Arms Baer, Tim 17 406 Dr. Rosen ramon ge 17 403 Dr. Rosen arrelli, Suzanne 16 403 Dr. Armstrong Clark, Beatrice 13 403 Dr. Lustig Geiger, Deborah 16 403 Dr. Kratsa King, Michael 14 403 Dr. Rosen Edwards, Elizabeth 15 403 Dr. Armstrong Gallaghe Mary Lou 15 403 Mrs. Parrish Gentile 17 Dr. Hammer Ellen, [Illeg’ Golden, Sally 14 403 a Hutchins, Judy 17 403 Dr. Lustig McCauley, Mary Ellen 16 403 Dr. Armstrong Pollock, Nick 17 406 Dr. Armstrong Bob Schoenhul Mosco, Ben 16 403 Dr. Hammer ‘ty David Brosel Hockenberry, Tom 15 403 Dr. tomy Kathy Olsen. Thompson, Terry 18.9403 Dr. Somme Brehm, Nancy 18 403 Dr. Armstrong Moss, Allen 16 403 Dr. Kratsa Kathy Olse Graber, James 17 405 Dr. a 134a Name Rhinehart, David Schriber, Elizabeth Burns, Richard Barnett, Willard Vantine, Michael Osbourne, Sue Parmet, David Cutilli, William Jenkins, Anita (130) Willett, Stephen Taylor, Thomas Saunders, Peggy Ann Lucas, Walter 16 14 17 15 15 16 16 17 16 16 14 17 Exhibit A Commit- Age ment 408 408 406 403 403 403 403 403 408 408 403 403 18.5 403 Assigned Dr. Kratsa Dr. Kratsa Dr. Lustig, Bob Schoenhultz Dr. Kratsa Dr. Hammer Dr. Wochiehowski Dr. Kratsa Dr. Lustig Dr. Rosen Exhibit B 135a (131) EXHIBIT B NAME: Baer, Timothy AGE ON ADMISSION: 14 BIRTHDATE: COMMITMENT: 1. Date on original and present: 5/15/69 2. Type on original and present: 404 3. Changes type and when: 10/16/72 406 ADMISSION: 1. Admitting Physician: Fong 2. Reasons for Admission: Homocidal & suicidal ideation. Hallucinating, phobic Ron-Rual 3. Who reported behavior: Family DIAGNOSIS: 1. Admission Note: Schiz. child- hood type 2. New Case Conference Note: Childhood schiz. 3. Discharge and date: Still in 4. Present: PROGRESS: (Very brief summary of hospital courses; where admitted; doctor; what program; current Status) Long, stormy Hospit., mainly on closed wards; with multiple somatic complaints, physical attacks on staff, self-destructive behavior. Presently on closed wd, on grounds, priv (132) K.O. 2-21-73 NAME: Barnett, Willard, 14-6 AGE ON ADMISSION: 14 BIRTHDATE: 8-18- 58 COMMITMENT: 1. Date on original and present: 1-8-73 : tlt EE , ADMISSION: 1. Admitting Physician: Dr. Arm- tron o, 2 >. Reasons for Admission: Suicidal gestures 3. Who reported behavior: Pt & social worker DIAGNOSIS: 1. Admission Note: Adolescent Adjust. Rx 2. New Case Conference Note: 3. Discharge and date 4. Present: PROGRESS: (Very brief summary of hospital course: where admitted, doctor, what program, current tatus) go" Liz is a pt of Dr. Armstrong in the Open Unit Bld. 9. She in involved in the school program, & group therapy 2x a week. Exhibit B 143a (141) 2/7/73 KO NAME: Deborah Geiger, 16.7 AGE ON ADMISSION: 16 BIRTHDATE: 7-13- 56 COMMITMENT: 1. Date on original and present: 1-17-73 2. Type on original and present: 403 3. Changes type and when: None ADMISSION: 1. Admitting Physician: Dr. Kratza 2. Reasons for Admission: Chaos in life; multiple destructive tendencies 3. Who reported behavior: Parents DIAGNOSIS: 1. Admission Note: Reactive dis- order 2. New Case Conference Note: None 3. Discharge and date 4. Present: PROGRESS: (Very brief summary of hospital course: where admitted, doctor, what program, current status) Involved in the school program, group therapy 2 x a week. Dr. Kratza is her doctor. Family Fx. Mostly cooperative. No meds (142) NAME: Gallagher, Mary Lou AGE ON ADMISSION: 15 BIRTHDATE: 9/15/ 57 144a Exhibit B COMMITMENT: 1. Date on original and present: Original 8/28/72 Present 10/26/72 2. Type on original and present: Original 403 Present 403 3. Changes type and when: ADMISSION: 1. Admitting Physician: Dr. Wic- off 2. Reason for Admission: Rebellion, aggressive behavior. Runaway, threatening to take drugs. Refusing out-patient care. 3. Who reported behavior: Father, Mr. Joseph Gallagher Mother, Mrs. Gallagher DIAGNOSIS: 1. Admission Note: unsocialized agressive reaction of adolescence. 2. New Case Conference Note: 3. Discharge and date 2/12/73 AMA 4. Present: PROGRESS: (Very brief summary of hospital course: where admitted, doctor, what program, current status) Marylou was a pt of Dr. Armstrong in the Open Unit. While there, she had at least 2 serious episodes of drug taking, and 2 elopements, which necessitated her transfer to the closed unit. She was admitted into the drug program at HSH on 2/6/73 on 2/12/73 she was discharged AMA. (143) Date: 2-22-73 NAME: Steve Gentile AGE ON ADMISSION: 17 BIRTHDATE: 3-20-54 Present Age: 18.11 . Exhibit B 145a COMMITMENT: 1. Date on original and : gine ginal and present: 2. Type on original and present: 403 3. Changes type and when: ADMISSION: 1. Admitting Physician: Dr. Ivins 2. Reasons for Admission: Pt is extremely violent striking family, biting father. 3. Whoreported behavior: Father DIAGNOSIS: 1. Admission Note: Schizophrenia, acute undifferentiated 2. New Case Conference Note: Schiz., Chronic undifferentiated 3. Discharge and date 4. Present: PROGRESS: (Very brief summary of hospital course: where admitted, doctor, what program, current status) Pt is under care of Dr. Hammer. At present he is in the closed unit. He has been in the Open unit at times, but became increasingly bizare & became assaulting to his father the last tiie he was in the Open unit. (144) 2/7/73 K.O. NAME: Tom Hockenberry, 15.8 e AGE ON ADMISSION: 15 BIRTHDATE: 5-28- COMMITMENT: 1. Date on original present: Sept 20, 1972 - : 2. Type on original and present: 403 (original & present) 3. Changes type and when: None 146a Exhibit B ADMISSION: 1. Admitting Physician: Dr. Biuitt 2. Reasons for Admission: Tom had been on Qualude, Marijuana, LSD, History in Montgomery Coun- ty Home of overtly psychotic behavior and a bizare suicide attempt. He had threatened and assaul:ed his father. 3. Who reported behavior: Pt and Father DIAGNOSIS: 1. Admission Note: Drug depen- dence 2. New Case Conference Note: Adolescent & Drug Rx accompanied by mixed drug abuse 3. Discharge and date 4. Present: Same PROGRESS: (Very brief summary of hospital course: where admitted, doctor, what program, current status) Tom was admitted to 4so. He was assigned to Dr. Hammer, of the adolescent service. He was transferred to Bld. 9 Sept. 29, 1972. Oct 9 he was transferred back to Bld. 4 for acting out behavior. Oct 25 he was transferred to Bld. 9. 11/1—Tom eloped—on return was placed on 4s0. 2/5—Trans to Bld 9 Attends school program, music therapy, 2 group therapies/wk. Takes Meds (145) Date: 2/15/73 NAME: Hutchins, Judy AGE ON ADMISSION: 17 BIRTHDATE: 9/20/ 55 Present Age: 17 COMMITMENT: 1. Date on original and present 11/27/72 2. Typeon original and present: 403 Exhibit B 147a 3. Changes type and when: ADMISSION: 1. Admitting Physician: Wendell 2. Reasons for Admission: bizarre behavior 3. Whoreported behavior: Parents, BSU DIAGNOSIS: 1. Admission Note: R/o Acute Schizophrenic reaction 2. New Case Conference Note: Acute schizophre- nic reaction 295.4 3. Discharge and date: 295.4 2/8/73 4. Present: PROGRESS: (Very brief summary of hospital course: where admitted, doctor, what program, current status) Admitted to Bldg 4. Rx'd with Phenothiazines: Accepted to Adolescent Service to Dr. Lustig Transferred to Bldg 9. Rx’d with milieu, family & pharmaco-therapy. (146) Feb. 7, 1973 NAME: Golden, Sally AGE ON ADMISSION: 14.8 BIRTHDATE: 4- 13-58 Present Age: 14.10 COMMITMENT: 1. Date on original and present: 12-15-72 2. Type on original and present: 403 3. Changes type and when: ADMISSION: 1. Admitting Physician: Coin C. Lindquist, M.D. 2. Reasons for Admission: Suicide attempt, idea- tion. 3. Who reported behavior: Pt. DIAGNOSIS: 1. -Admission Note: 1 Psychoneu- rotic depression of suicidal ideation 2. Adol. Adj Rx with hysterical feature 148a Exhibit B 2. New Case Conference Note: 3. Discharge and date 4. Present: ; PROGRESS: (Very brief summary of hospital course: where admitted, doctor, what program, current status) Admitted to #4 12.15 Transferred to + 9 12.18 Dr. Armstrong Attended School, O.T., A.T., Gp.T., Rt. until started school full day. Family Tx Takes meds No problem (147) 2/7/73 K.O. NAME: Micheal King, 14.7 AGE ON ADMISSION: 14 BIRTHDATE: 7-3- 58 COMMITMENT: 1. Date on original and present: 11/2/72 2. Type on original and present: 403 3. Changes type and when: None ADMISSION: 1. Admitting Physician: Dr. Arni- s a Reasons for Admission: Mike stayed in his room at home for 43 days, refused O.P. help; has severe school phobia & refused to attend school 3. Who reported behavior: Mother DIAGNOSIS: 1. Admission Note: Schizoid Per- sonality, Severe 301.2 Exhibit b 149a 2. New Case Conference Note: Schizoid person- ality with school phobia 3. emia and date PROGRESS: (Very brief summary of hospital course: where cimitted, doctor, what program, current status) Mike was admitted directly to the adolescent unit. He is involved in school here, and 2 group Tx a week. He is a pt of Dr. Rosen. He is cooperative on the unit, but the staff feels that his will be a long stay. Cooperative. Takes meds (148) K.O. 3s0 2-21-73 NAME: Lucas, Walter 19.3 y.o. AGE ON ADMISSION: 17. BIRTHDATE: 10.- 30-53 COMMITMENT: 1. Date on original and present: 7-31-70 8-29-72 2. Type on original and present: 416 402 3. Changes type and when: ADMISSION: 1. Admitting Physician: Dr. New- man 2. Reasons for Admission: Transfer for ESSH retardation, “schiz, process” Chronic brain syndrome 3. Who reported behavior: Paul Goldberg of ESSH DIAGNOSIS: 1. Admission Note: Mental retar- dation with Psychosis R/o Schiz, latent type 150a Exhibit B 2. New Case Conference Note: Moderate mental retardation 3. Discharge and date 4. Present: . PROGRESS: (Very brief summary of hospital course: where admitted, doctor, what program, current status) 24 times in seclusion from Aug. 13, 1970 to 6-8-72 Pt on 3S—Dr. Lawrence In the School Program on 3So He is a behavior problem—Impulsive (149) D.B. Date: 2/21/73 NAME: McCauley, Mary Ellen AGE ON ADMISSION: 16 BIRTHDATE: 2/ 26/56 Present Age: 16.11 COMMITMENT: 1. Date on original and present 11/7/72 2. Type on original ad present: 403-403 3. Changes type and when: Admission: 1. Admitting Physician: Dr. Wicoff 2. Reasons for Admission: Seceral & Alcohol Over- dose—Temper Tantrums and rebellious behavior at home reaction of adolescence. 3. Who reported behavior: Dr. Fitti, BSU III; Parents DIAGNOSIS: !. reaction of adolesence. 2. New Case Conference Note: 3. Discharge and date 4. Present: Admission Note: Adjustment Exhibit B 15ia PROGRESS: (Very brief summary of hospital course: where admitted, doctor, what program, current status) Mary Ellen is a pt of Dr. Armstrong. She is enrolled in the school program, has group Tx 2 times a week. She has individual therapy with Mrs. Thompson. (150) NAME: Mosco, Benjiman AGE ON ADMISSION: 12-20-57 (15.2 yrs.) COMMITMENT: 1. Date on original : a riginal and present: 2. Type on original and present: 403 a A he type and when: None ION: 1. Admitting Physician: . g Physician: Mary P. 2. Reasons for Admission: Behavior R : problem: Sexual acting out, foul language, physically abusing step- mother, running away, crashing family car, drugs. : : Who reported behavior: Step-mother, Gandenzia ace . _ DIAGNOSIS: 1. Admission Note: 308.4, Unso- cialized aggressive reaction of adolescence. 2. New Case Conference Note. Same 3. Discharge and date: 11/22/72—STL: newed 12/22/72 en acy 4. Present: PROGRESS: (Very brief summary of hospi course: where admitted, doctor, what program aaa status) : Pt. admitted to closed unit on 5/15/72 and was transferred to uti Open unit on the Adolescent Service on ° l4yrs. BIRTHDATE: 152a Exhibit B 5/23/72 under the care of Dr. Hanno. Received a vidual & group therapy and was enrolled in the speci education school program. . ; Family was seen in 10/72, 11/72, & 12/72 in family therapy with Family Service. (Media). Presenily pt. is an STL—+to be discharged as soon as father comes to hospital to sign papers. (151) 2/7/73 EL NAME: Moss, Alan AGE ON ADMISSION: 15 yrs BIRTHDATE: 3- 24-57 (15.11 yrs) ir COMMITMENT: 1. Date on original and present: 1-10-73 2. Type on original and present: 403 3. Changes type and when: None Zi ADMISSION: 1. Admitting Physician: G. P. Kratsa, MD. 2. Reasons for Admission: Depressed and suicidal 3. Who reported behavior: Patient DIAGNOSIS: 1. Admission Note: Depressive Reaction 2. New Case Conference Note: 3. Discharge and date 4. Present: PROGRESS: (Very brief summary of hospital course: where admitted, doctor, what program, current status) Patient admitted to Closed Unit (5s) on 1-10-73 and was transferred to Bldg 9 on 1-13-73, Adolescent Service under care of Dr. Kratsa. Attended program on Unit, OT, Exhibit B 153a Art Therapy, Recreation Therapy & Group Th. Was en- tered into School Program Bldg 2 on 1/24/73. Family was seen 1/13/73; 1/19/73; 2/2/73 in Family Therapy. Further Neurological Studies are indicated and have been scheduled. (152) K.O. (IN) 2-21-73 NAME: Osbourne, Sue 16.4 7 AGE ON ADMISSION: 16 BIRTHDATE: 10- 7-56 COMMITMENT: 1. Date on original and present: 1-22-73 2. Type on original and present: 403 3. Changes type and when: ADMISSION: 1. Admitting Physician: Dr. Wic- off 2. Reasons for Admission: Taking 1.V. metha- drine for 2 yrs 3. Whoreported behavior: Pt. DIAGNOSIS: 1. Admission Note: Habituation —Methadrine with recent hallucinations auditory & visual 2. New Case Conference Note: Adjustment Rx of Adolesc. with drug abuse. 3. Discharge and date 4. Present: PROGRESS: (Very brief summary of hospital course: where admitted, doctor, what program, current Status) Pt admitted to drug program—1 No.—Dr. Zal. Involved in group therapies. ————_ > ¢ * — 4 . % to ws ee la y veine ie a) ¥ ‘: s a” eS es ‘ 154a Exhibit B (153) K.O. 2-21-73 id—16.8 NAME: Parmed, David— AGE ON ADMISSION: 16 (35) BIRTHDATE: 61- COMMITMENT: |. Date on original and present: 3. Changes type and when: ADMISSION: |}. Admitting Physician: Dr. Siegel for Admission: Transfer from ESSH SIAGNOSIS: 1. Admission Note: Childhood Schiz. E: Pollock, Michael (Nick) — ON ADMISSION: 16 BIRTHDATE: 12-18 . . = re IMIMENT: 1. Date on origine! and present: 11-2-72 Exhibit B 155 2. Type on original and present: 406 3. Changes type and when: ADMISSION: 1. Admitting Physician: David N. Wicoff, M.D. 2. Reasons for Admission: Patient describes dis- sociative state while stealing a car and breaking into an- other. Several past suicidal attempts. Has heard voices & has had visual hallucinations. Judgment inmature im- pulsive. Suspiciousness 3. Whoreported behavior: Patient. DIAGNOSIS: 1. Admission Note: Border line Psychosis w/depression Drug Habituation—LSD 2. New Case Conference Note: Schizoid person- ality, severe 3. Discharge and date 4. Present: PROGRESS: (Very brief summary of hospital course: where admitted, doctor, what program, current status.) Institutionalized since 5 years old. 11-8-72 refused A.M. MEDS “doesn’t want it” 11.14 needed additional meds for agitation. 11.16 off grounds returned by guards & nurses. 11-25 refused AM MEDS 12.6 agitated & fearful, banging hand on wall, threatening, talking of hurting himself and dying. Transfer to Bidg 4 12.8 refused same meds 12.28 pt. reported pains in hand & wrist from agita- tion & hitting a window 12.28 refused meds 1.1.73 broke glass in candy machine in lobby 156a Exhibit B 1.2 refused all meds 1.3 extreme agitation—put fist & arm through win- dow—cut’s , 1.5 reported severe headache and difficulty breath- ing from “anxiety” 1.7 reported extreme depression over weekend & drug usage (155) 1.10 scratched arm with razor in suicidal gesture postponement of an appt. ee 122 stated he was “losing control”—requested meds. 1.29 reports LSD usage over weekend—upset by flashbacks— Transfer to Bldg 4 1.30 refused AM meds 11 31 Return to Bldg 9 2.4 Pt. eloped 2.6 returned by Mrs. Iverson—laceration of left wrist, self-inflicted To Bldg 4 2-12 Return to Bldg 9— —Pt. asks consistantly for help but responds mini- mally to attempts by the staff — MED Feb Prelixin 5 mgm QID Donnatal tab + TID Multivits + OD Artane + mgm QID Peotafrave 50 mgm TID [triangle] QID Benadryl (elix) 100 mgm H.S. Exhibit B 157a Thorazine 10 mgm PRN (f : or Flashbacks or Halluci- Mellaril 75 mgm PRN (agitation) Calfeoget tab (headache) Tigan 250 mgm PRN D/C Thorazine 50 mgm Im PROGRAM School in bldg —daily Art Recreation. Therapy—daily Group Therapy—2x weekly Indiv. Therapy—2x weekly Counseling (Brassell)—On Demand (156) NAME: Saunders, Peggy Ann AGE ON ADMISSION: 17 3/15/55 B - DATE: 3/10/55 in wan COMMITMENT: 1. Date on original ; 2/2/73 = and present: 2. Type on original and present: 403 3. Changes type and when: ADMISSION: Admitting Physician: Wicoff 2. Reasons for Admission: Retarded, Brain dam- aged management [legible] 3. Who reported behavior: School DIAGNOSIS: 1. Admission Note: Mental Explosive BEHAV Retard 1582 Exhibit B of hospital PROGRESS: (Very brief summary course: where admitted, doctor, what program, current status) Closed Ward. (157) Date: 2/15/73 NAME: Taylor, Thomas AGE ON ADMISSION: BIRTHDATE: 5/27/58 Present Age: 14 . COMMITMENT: 1. Date on original and present: 2/2/73 2. Type on original a 403 3. Changes type n: es ADMISSION: 1. Admitting Physician: Gold 2. Reasons for Admission: Suicidal ideation 3. Who reported behavior: Children’s Cottage DIAGNOSIS: 1. Ngecer yaad Adjustment reaction of adolescence with suicidal pz 2. New Case Conference Note: Schizophrenia, latent 295.5 aS tidicees tind die | 4. Present: 295.5 PROGRESS: (Very brief summary of hospital course: where admitted, doctor, what program, current Exhibit B 159a (158) 2/7/73 NAME: Terence Thomson Present Age: 18.9 AGE ON ADMISSION: 17.4 BIRTHDATE: 3- 3-54 COMMITMENT: 1. Date on original and present: 8/20/71 2/7/73 2. Type on original and present: 403 403 3. Changes type and when: None ADMISSION: 1. Admitting Physician: B. H. Armstrong, MD. 2. Reasons for Admission: Destructive to house breaking furniture; impaired judgment, pre occupation with exhibitionistic sex, threatening sexual & physical to mother. 3. Whoreported behavior: Parents. DIAGNOSIS: 1. Admission Note: Undiff. Schiz. Reaction 295.99 Mental Retardation 310 Very inactive, even babyish when with his parents. Pt. has done well in school, adjusted well to Adolesc. pro- ing (eg. Bakery), later get job, live at home. Needs to be 160a Exhibit B communicative, responsible, grown-up in relationship with his parents. (159) K.O. 2-21-73 NAME: Vantine, Michael 16. OY.O. AGE ON ADMISSION: 15 y.o. BIRTHDATE: 2-7-57 COMMITMENT: 1. Date on original and present: 8-24-72 2. Type on original and present: 403 3. Changes type and when: None ADMISSION: 1. Admitting Physician: Dr. Arm- strong >. Reasons for Admission: Transfer from Friends Hospital due to lack of funds; history of barbiturate depen- dency, seizures. Suicidal attempt 6 wks prior to admission. 3. Who reported behavior: Child case worker DIAGNOSIS: 1. Admission Note: Schiz, latent type; adjustment Rx of adolesence with depression; mini- mal cerebellar dysfunction 2. New Case Conference Note: 3. Discharge and date 4. Present: PROGRESS: (Very brief summary of hospital course: where admitted, doctor, what program, current status) 9-18-72—cut arm, not seriously 1 1-8-72—-suspected of selling drugs at school 11-13-72—attempted to hang himself 12-11-72—stole medications fr 9So medication cabinet Exhibit B 161a = - 1-72—possible drug overdose -26-72—drinking, & found wi ) ng th pills in his pos- Dr. Hammer's pt. when not in Bld 9 he is a pt of 4so (160) February 21, 1973 NAME Graber, James AGE ON ADMISSION:17 BIRTHDATE: 4 yao t Age: 17 yrs. Prunes MITMENT: 1. Date : _- on original and present: : are on original and present: 405-403 , ges type and when: Changed anim type to 403 on = ADMISSION: 1. Admitting Physician: Dr. Wic- 2. Reasons for Admission: Valium Overdose - dal ret assaultive behavior in the home. ted : reported behavior: Mrs. Virginia Ow (Child case worker) Father Francis Seri of Msr. Bonner H. S.) hie guia DIAGNOSIS: 1. Reaction. 2. New Case Conference Note: 3. Discharge and date 4. Present: PROGRESS: (Very brief summary of hos re where admitted, doctor, what program, — Pt. evaluated & accepted by adolescent Service Transferred to open building 2/2/73 under care of Dr. Gus Kratsa. Eloped 2/13/73. Current on U.A. Admission Note: Depressive Exhibit B (161) Date: 2/14/73 NAME: Anita Jenkins AGE ON ADMISSION: Present Age: COMMITMENT: 1. 405—11/29/72 2. Type on original and present: 405—408 12/5/ 162a 16 BIRTHDATE: Date on original and present: 72 3. Changes type and when: 405—408 ADMISSION: 1. Admitting Physician: Dr. Wic- off 2. Reasons for Admission: charges of assault & battery while at Sleighten Farm. 3. Who reported behavior: Sleighten Farm DIAGNOSIS: 1. Admission Note: 1. Mild Men- tal Retardation 2. Antisocial personality 2. New Case Conference Note: Unsocialized aggres- gressive vxn of adolescence 3. Dicharge and date 4. Present: Unsocialized aggressive vxn of adoles- cence PROGRESS: (Very brief summary of hospital course: where admitted, doctor, what program, current status) Admitted to 5N—Dr. Wojcrechosk Acute Treatment Unit—I.C.U, | Program: individual therapy, school tutoring, group therapy (5N), remotivation group, occupational therapy Current status—controllable aggressive tendencies, but tends to be provocative with vulnerable, Individual She attends school and group, but is easily discouraged and feels worthless. She goes weekly for weekend visits at home. Exhibit B 163a (162) K.O. 2-22-73 NAME: Rhinehart, David 16.4 y.o a AGE ON ADMISSION: 16yo BIRTHDATE: 10. “be ee 1. Date on original and present: -11-73 2. Type on original and present: 408 3. Changes type and when: f ADMISSION: 1. Admitting Physician: Dr. Wic- ) 2. Reasons for Admission: Court 3. Whoreported behavior: Parents DIAGNOSIS: 1. organic brain syndrome antisocial 3. Discharge and date 9 gers 4. Present: PROGRSS: course: status) David had been in the adolescent service under Dr. Kratsa’s care in the Closed Unit. He was transferred to the open unit. While there he stole a car. He was trans- (Very brief summary of hospital where admitted, doctor, what program, current ferred to the Closed Unit again. He has sinee had a Court hearing at which time (163) K.O. 2-22-73 4N NAME: Schriber, Elizabeth 14.3 164a Exhibit B AGE ON ADMISSION: 14 BIRTHDATE: 11- 25-58 COMMITMENT: 1. Date on original and present: 1-25-73 De — 2. Type on ori : 3. + lh type and har enaee indefinitely 2-4-73 ADMISSION: 1. Admitting Physician: Dr. Wic- off 2. Reasons for Admission: 10 day evaluation at request of court 3. Who reported behavior: DIAGNOSIS: 1. Admission Note: Adjustment Rx of Adolescence; suicide attempt and ideation 2. New Case Conference Note: 3. Discharge and date 4. Present: PROGRESS: (Very brief summary of hospital course: where admitted, doctor, what program, current status) Pt is on 4No, Adolescence service. Dr. Kratsa is her doctor. She is enrolled in VAS. She will be transferred from the Closed unit to the Open unit shortly. (164) K.O. 2-23-73 (4S) NAME: Willett, Steve, 16.9 yo AGE ON ADMISSION: 16 BIRTHDATE: 4-26- Exhibit B 165a 4 COMMITMENT: 1. Date on original and present: 1-23-73 2. Type on original and present: 408 3. Changes type and when: Extention on 2-2-73 for 30 days per Judge Reed ADMISSION: 1. Admitting Physician: Dr. Wic- of 2. Reasons for Admission: Violation of probation 3. Who reported behavior: Judge Reed (7) DIAGNOSIS: 1. Admission Note: Runaway rx of adolescence (7?) 2. New Case Conference Note: Adolescent adjust- ment rx R/o Drug dependence 3. Discharge and date 4. Present: PROGRESS: (Very brief summary of hospital rosy where admitted, doctor, what program, current status Steve is a pt of Dr. Kratsa on 4So. Adolescent service, locked building. Court hearing 2-21-73—recommendation to be sent to St. Gabriel. 166a Exhibit C (165) EXHIBIT C HAVERFORD STATE LEVINE, Leslie 9645 1 SUMMARY This is the first Haverford State Hospital admission for this 15 year old, white, single, 10th grade student admitted here 10-11-72 on a 403 commitment signed by her mother. The patient’s mother and her two sisters were seen along with the patient by Dr. Arenowitz at Base Service Unit III for 9 sessions during the months prior to admission because of family quarrels. On the day of admission the patient felt as she stated “closed in” by the mother and she threatened the mother with a kitchen knife. The mother contacted Dr. Arenowitz who recommended hospitalization at Haverford State Hospital. The patient’s, parents have been separated since the patient was approximately 5 years of age. Patient did not see her father again until March, 1971. During the past 2 school years Leslie and her mother have had battles over everything Leslie has wanted to do. Subsequently, Leslie began having problems in school. In an effort to help her finish the school year she was sent to Florida from March to June, 1971, and February to June, 1972, to live with her father and step-mother and complete the school year. Les- lie idolizes her father although the period spent with him and her step-mother were not idealic because of the step- mother making her do domestic duties. On admission here the patient was admitted to a closed ward and evaluated by the Adolescent Service on Exhibit C 167a October 12, 1972. She was than transferred to the open adolescent building where she remairod until discharge. She was placed on Stelazine 2 mgs. tid until November 13th when psychiatric medications were discontinued. While on the open ward she participated in group therapy twice a week, was assigned a counselor and seen individ- ually by either Dr. Armstrong or Dr. Rosen as was needed. She also attended school regularly. She and the family were seen by Dr. Lustig on a regular basis in Family Psy- chotherapy. New Case Conference held on October 16, 1972, revealed a diagnosis of Adolescent Adjustment Reaction. Psychological testing revealed a 15 year old girl function- ing within the average range of intelligence with indica- tions that her poor school achieyement had been due to basic difficulty in handling specific facts. She revealed a tendency to overlook details. She seen as a highly infantile iidividual who responded hostily to the environment and who used all her resources to contain her negative feelings. It was felt that at times of stress, particularly when related to quarrels with her mother, acting out behavior was highly likely. Electroencephalogram, neurological and routine lab studies were all normal. Routine physical examination was normal. (166) On the open ward patient remained’ rather with- drawn, socializing minimally with the patients and staff. If an incident occurred, she seemed always to be present but denied any active participation in the scene. Finally towards the second week in October she became involved with another patient in a number of incidents in which 168a Exhibit C she broke minor rules on the floor, became verbally abusive, began to tease another patient and she was trans- ferred to the closed unit on October 18th. On the closed ward she soon settled down, attending school and was given limited ground privileges. She was transferred back to the open ward on October 23rd where she remained on no medication until her discharge. Both the patient and her mother wish the patient to live with her father in Florida and complete the school year as done in the past. Both agreed to our recommendation of individual therapy while living with the father in Florida. Because of the chaotic family situation in Florida discharge had to be de- layed until its resolution. When this was done the patient was discharged on | 1-16-72. DIAGNOSIS: Adolescent adjustment reaction. RECOMMENDATIONS: Patient to live with father in Florida and continue out-patient and individual therapy in Florida. Howard Rosen, M.D. HR/dmn/ Is (167) HAVERFORD STATE HOSPITAL WEAND, Mark SUMMARY: PSYCHIATRIC HISTORY: This 15 year old white boy was admitted to HSH on 6-24-72 under a 402 commitment following transfer from Osteopathic Hospital where he had remained overnight. His admission there was precipitated by ingestion of ap proximately 8 Valium and possible glue sniffing. While Exhibit C 169a under the influence of drugs the patient tried to kill his uncle with a knife. At the time of his admission to HSH he was still intoxicated from the use of drugs and was ex- tremely hostile; at that time it was not possible to perform an adequate mental status examination. Subsequent men- tal status the following day revealed the patient to be oriented in all spheres and to exhibit no evidence of psy- chosis. However marked impulsivity and immature judg- ment were present. Past psychiatric history included the pati RR 8 eae oe ene pe te ey A court evaluation on February 20, 1972. Mark has a 114 year history of underacheiving, truancy and drug abuse. Psychological Evaluation was done by the court Ping tetteilentaibesimeaetean cen (the dull normal range of intelligence.) It was noted that he His parents were divorced in 1960. His mother lives with an unmarried brother and sister and the maternal grandmother. Mark has a 17 year old sister. New Case Conference was held on 3 . diagnosis at that time was 309.14 _ — brain syndrome, Valium and others, and 306.4 Unsocial- ized aggressive reaction of adolescence. During the month of July the patient was seen by Dr Rashkis in group therapy twice pcr week. pea > he was transferred to Adolescent Service Open Unit. He received no medication other than Benedryl 100 mgmh.s. Subsequent laboratory tests, EEG and Ex- amination were all within normal limits. On the open unit the patient attended group therapy twice a week and was seen individually once a week by Dr. Armstrong. 170a Exhibit C After approximately 3 weeks it was decided in Staff Con- fanetd Gat Go geitente Seay ans Sree Sine’ therapy. This was begun in early August on a once a basis. prt meng top pc ne areca in most sessions. In one session the sister came, (168) and in one other session the maternal grandmother came. Due to complaining of being depressed the patient was placed on Tofranil 25 mgm t.i.d. for 3 days then To- franil 50 mgm ti.d.. Tofranil was discontinued on 8-21- 72 with no effect at that time. Patient was placed on Elavil 25 mgm t.i.d. for 3 days and then Elavil 50 mgm t.i.d.. On 8-10-72 the patient was transferred to 5 South Adolescent Service Closed Unit due to his having taken 3 Tuinal and having sustained an unsteady gait, slurred speech and uncontrolled behavior while in the open build- ing. He was transferred back to the Adolescent Service Open Building on 8-14-72. ne ye pee that he felt he was being kept in the hospital against will and he denied that there was any problem other than his drug usage. However it was apparent from his be- per tptster dyads Sareea orem ob ig ton marked passive-aggressiveness disproportionate tility and suspicion in dealing with others. The patien was considered appropriate for the Adolescent Program because of his personality problems, the drug abuse was judged by the staff to be symptomatic of these problems. tt was the best judgment of the Adolescent Service physi- - given sufficient tient was a weekend pass and he was given Elavil for 3 dosages a day for 4 days. He took the entire dose at one time and arrived in a comatose state back at Exhibit C i71a this hospital; he was transferred to Bryn Mawr Hospital and remained in the Intensive Care Unit for 24 hours be- fore being transferred to the closed unit in Adolescent Therapy. Patient continued to be very angry, sullen and unreachable. Family Therapy was continued with varying numbers of the family present. Patient continued in the Special Education School Program. He also continued in group therapy twice per week. Following the overdose of med- ication patient was placed on no medication with the ex- ception of the small amount of Thorazine for agitation 25 mgm which was continued for 7 days and than discon- tinued. In October, family therapy consisted of the pa- tient and his mother only, this was an attempt to allow them to break away from the mother’s primary family and to live in an apartment. The patient was placed on Short Term Leave on 10-18-72. He was to become involved in out-patient therapy prior to discharge. On 10-24-72 the patient was brought back to the Adolescent Service by the police after being questioned due to false accusation of stealing. He also appeared to be on drugs and was re- guested to give a urine sample which he refused. He (169) then superficially slashed his wrist and was readmitted to the closed building. He was transferred back to the Ado- lescent Service Open Unit on 10-26-72. He was again placed on Short Term Leave on 11-1-72 with the under. standing that he become actively involved in out-patient Psychotherapy at B.S.U. II and to continue in HSH Special Education Program. He was on no psychiatric medication. In all, patient was seen in group therapy 28 times, family therapy 8 times and individual therapy 7 times. BHA/dmn Barbara H. Armstrong, M.D. 172a Exhibit C (170) HAVERFORD STATE GENTILE, Stephen 7100 SUMMARY This 18 year old, white male has been a patient since August 24, 1971, when he was admitted under Section 403 (signed by parents) for his having become violent and aggressive towards his family and younger children in his neighborhood. A previous hospitalization from 12-29-70 to 4-21-71 terminated when patient was discharged against medical advice from unauthorized absence. His diagnosis at that time was—Schizophrenic Reaction, chronic undif- ferentiated type. At the time of admission and subsequent- ly the patient presented with confusion, disorientation, inappropriate affect, often giggling without apparent cause, ideas of reference, unprovoked aggressive acts toward Staff and considerable degree of hostility in the form of restless- Chemotherapy and a course of ECT from September- October 1971, had only marginal involvement for the pa- tient. This examiner assumed management of Stephen's case starting in January of 1972. More reality contact and less confusion was noted in March and medication was readjusted. Patient was extremely resistant to being transferred to the open unit of the Adolescent Service. He frequently refused structure and support. The Adoles- cent Staff was able to maintain him in the open unit from May through continual support but only with some dif- ficulty. Patient became confused, was involved in anti- social acting-out and fecal smearing, and was transferred to a closed unit from August 4 to October 9, 1972. He returned to the open unit after he became better able to Exhibit C 173a handle a less structured envi ili 7 Ss st environment and after he stabilized Since his return to the open unit, pati i , patient has been in famil thera Fa tg ahon y Py on a weekly basis. His weekends home rom Haverford State Hospital have been uneventful, al- though parents report patient has difficulty in socialization stays close to the family and is uneasy when in public. Currently, the patient is placed on the followi . . a. . med- mca Artane 1 mg. bid, Benadryl tay ape —_ 300 mgs. gid. He has been scheduled for group Meee peice Per week and individual therapy once per Pare eee has attended group therapy 33 times, In- Therapy 16 times and Family Therapy 12 times. 174a Exhibit C (171) HAVERFORD STATE MATHEWS, Vicki - SUMMARY Psychiatric History This is the first Haverford State eerste for this 15 year old, white, 9th grade student, no fom this hospital 8-9-72 on a 403 commitment, —_ a parents. She was brought to the hospital by page psychiatric evaluation with the approval of bene = Superintendent Dr. Phillips, after being open. park in an incoherent, assaultive state along several young men. Patient had run away from home approxi- mately 10 days prior to admission. fy pie bie! : , ‘ine Th patent nd er iy a enn Cane they sought individual pyehotherapy for hep wih above. The patient has failed and repeated 7 a The family states that she has a reputation as = - tramp” and that her siblings are embarrassed by havior. She has been picked up by the police on several occasions although no charges were pressed. one Exhibit C 175a casion last year she ran away to Elkton, Maryland and stayed away overnight on several other occasions. At age 3 years, Vicki was evaluated at the University of Penn- sylvania for stammering. In the second grade the parents and the child were seen by Dr. Herman Staples when Vicki refused to go to school. On initial status patient appeared as a small adoles- cent, oriented fully and unsteady of gait. There was much evidence of anger and hostility. She admitted trying to commit suicide while in jail (multiple scratches on both wrists and arms)——“What do I have to live for—a bunch of shit!” She admits to having abused drugs for 6 to 7 months (Quaalude and Tuinal) and said that she had 2 Tuinals that morning. Prior to this she smoked hashish and marijuana. She vented much hostility towards her family, particularly her father, “My family is screwed up. What can I do? I tried running away and it just got me in jail.” In addition, the patient told her father that she had been raped the night before. (172) Psychological testing was done and compared to the report from the Irving Schwartz Institute (which the fam- ily was very reluctant to release to us) . Based on this re- port there was no evidence of a thought disorder. The patient was currently functioning on a lower average range of intelligence, giving evidence of bright, normal and even superior learning capacities, only partially utilized at the time of testing. (Negative attitudes toward school and clear deficit in school related tasks suggest this area as the focal point of much of her current difficulties.) In gen- eral, she was seen as a frightened girl, who was attempting to strike out at her surroundings in self defense. 176a Exhibit C Social Service workers’ impression was that the par- ents have been seeking professional help since she was 3 years old. The family has been extremely critical of past professional psychiatric help and they see Vicki’s problem as an individual one and not as one of the family or be-_ tween the marital partners. They are very eager for place-_ ment outside of the home. Hospital Course Progress in the hospital. The patient was admitted to a closed facility. For the first 48 hours she required psychotropic medication and confinement in order to help her to control herself. She remained unsteady of gait and verbally abusive. Within a few days, however, she settled down and received ground privileges. On August 9, 1972 she claimed to have been struck by another patient while making a telephone call. She eloped from the hospital that weekend. On August 23, 1972 she was transferred to the open adolescent facility and on August 25, 1972 the family was seen to preliminar- ily sound them out on future planning. Mrs. Mathews, in particular, did not desire Vicki to return home. The pre- liminary recommendations of the Adolescent Service were conveyed to the family in that the patient needed a struc- tured, residential school setting and should not return to the family. Meanwhile, the patient continued on no medication; she attended group therapy on a twice a week basis; she was assigned to an individual counsellor, and was seen individually by either Dr. Rosen or Dr. Armstrong, as required. Exhibit C 177a (173) On September 5th, the patient became in i agitated. She refused to 8° to school, which toni that ‘week and was quite obviously concerned about dispo- sition. The agitation increased with a number of incidents on the ward, including threatening to elope and smoke pot so that ultimately the patient was transferred back to a closed ward on September 12, 1972. She remained there for approximately 3 days and soon calmed down and a we me attend school from the closed building on vi ,a nef ar nd then was returned to the open unit At Staff Conference in mid-September two recom- mendations were made—one for fadidonital schooling since it seemed desirable to remove the patient from the family setting because the family had been so rejecting of her and Scapegoating her. In view of the patient’s ap- parent willingness for residential placement, and financial resources, a school such as Devereaux which is a residential treatment center, was recommended to them Secondly, if the patient’s financial resources would not permit private residential placement, it was recommended that the family take the patient to court to be declared reap a the patient was not considered suitable ic sc ucati i wad 7m ona because of the long history of The patient was informed of the Adolescent ice’ recommendations and the family was again a a Interviews were arranged at Devereaux for the family and the patient. The patient also made application to the George Junior Republic School in New York State : On the ward the patient was started on Hal } tid. and Cogentin 1 mg. tid. The patient recone 1782 Exhibit C attend group and school uneventfully until the second week in October. At that time she became anxious and refused to attend certain assigned activities and became verbally abusive, breaking minor restrictions on the ward, especially harassing other patients. An attempt was made to deal with this on the open ward administratively but this failed and the patient had to be transferred to the closed ward again on 10-18-72. She remained there only a couple of days and saw that she was inappropriate in how she had acted. She was transferred back to the open ward 10-20-72 where she remained until her discharge on 11-7-72. On admission, physical exam was unremarkable, Neurological exam was normal. EEG and routine admis- sion studies were normal. GYN consult dated August 14, revealed no signs of forced sexual intercourse (see history —patient denied having intercourse as stated to father). Marital introitus. (174) Patient sustained a lower urinary tract infection and was treated with penicillin. Her medication at time of discharge was Cogentin 1 mg. tid. and Haldol 1 mg. tid. Diagnosis: Passive aggressive personality, aggressive type 301.81 Disposition: Discharge 11-7-72 to the parents for transfer to the Devereaux School. HBR/em Howard B. Rosen, M.D. Exhibit C 179a (175) HAVERFORD STATE BARTLEY, Kevin 8369 1 SUMMARY sonality Disorder. He was transferred i of the adolescent service and came arn hee itiataie ing his hospital stay. This patient has been teract with the staff and other patients in agp tila way often asking to be hurt and punished. ce. structiveness or aggressiveness toward the staff became 180a Exhibit C Since April, 1972, many referrals have been made to- ward finding a suitable school-vocational program in the community. Because of his being multi-handicapped with an organic seizure disorder and his emotional lability in the past, he had not been accepted. Efforts to work with his mother to allow her to become more receptive to his return to his home and community have been difficult, but have also improved considerably in recent months. The patient was evaluated 11-20-72 by Elwyn for con- sideration for their schoo! work program and it appears he may start there in the near future. Since 11-22-72, he has been on short term leave. Delays in finding transporta- tion to our Special Education Program at Haverford State Hospital finally are being worked out. Diagnostically, he remains 1) Organic Brain Syn- drome with Epilepsy and 2) Personality Trait Disturbance, explosive type with depressive features. Tests have indi- cated his ability to work in a school vocational program and it is anticipated he will be discharged to Base Service Unit for follow-up care and controlled by chemotherapy once he has begun this program. (176) Patient was placed on the following medica- tions: Phenobarbital gr. 1 tid, Dilantin 100 mgs. tid and Valium 5 mgs. qid and Benadryl 150 mgs. hs plus 1 green placebo. Patient has been scheduled for group therapy twice per week during his hospital stay. In all patient was in group therapy 42 times. Since January, 1972, he has been seen individually by Dr. Hammer in an approximate once per week basis. Actual attended sessions number 16 times. 1s Carl Hammer, M.D. Appearances 181a Philadelphia, Pennsylvania May 10, 1973 HEARING Before: Honorable John Gibbons, J., Circuit Court Judge. Honorable Thomas A. fates Masterson, J., District Court . ae Raymond J. Broderick, J., District Court Appearances: David Ferleger, Esq., Stanl ; * ey Abramson, . Ron- ald Soskin, Esq., 121 South 18th Street, Jom Sows Pennsylvania 19103, Attorneys for Plaintiffs. Barry A. Roth, Esq., Assistant Attorn , Esq., ey General, partment of Justice, Room 323, Health & Welfare Suns ing, Harrisburg, Pennsylvani Pins ylvania 17120, Attorney for De- Pw JUDGE GIBBONS: May we have the appear- MR. FERLEGER: My name is David torney for the plaintiffs Your Honor. ee MR. ROTH: My name is B the defendants. Annas: terme terse ded JUDGE MASTERSON: A General? re you a Deputy Attorney 182a Colloquy MR.ROTH: Assistant Attorney General. JUDGE MASTERSON: You are an Assistant At- torney General? MR.ROTH: Yes, Your Honor. MR. FERLEGER: Your Honor, this is Stanley Abramson, who is going to be a graduate from Rutgers Law School and this is Ronald Soskin, who will be a graduate from Pennsylvania Law School. JUDGE MASTERSON: We have reviewed the papers in this case. Let me ask this general question: Does the promulgation of the regulations effective May ist with respect to children 13 to 15 cure the as far as the plaintiffs are concerned as to that children? MR. FERLEGER: No, Your Honor. JUDGE MASTERSON: Why not? (4) MR. FERLEGER: The reason being that the —on two grounds. From a due process point of view the regulations allow children to be brought into an institution and deprived of their liberties solely by reason of exam- inations of doctors. That is in a non-emergency situation. JUDGE MASTERSON: That can be done in the Mental Health Act as to adults on the certification of two doctors. You or I, or anybody else can be dumped in for ten days or something like that. MR. FERLEGER: In 1971 in the Dixon case, a three Judge court in the Western District ruled that sec tion of the Mental Health Act unconstitutional. It can't be done any more. the emergency situation, is by Court commitment. : What happens in the emer- 184a Colloquy atric ward with an emergency (6) is deprived of his liberty, and yet if you ask the child did he want to go to the hos- pital, in 99 cases out of 100 he would object. It seems to me we can’t look at it quite as simplist- ically, the due process point. It is more involved. MR. FERLEGER: Well, at first Your Honor I was responding to the Judge’s question about children 13 and older under the regulations. In response to your comment I think it is a little bit different when it is deprivation of liberty, which means institutionalization in an institution for mental health treatment. There are a number of cases which I have cited, one being Heryford v Parker which involved a 9 year old. In that case the Court held that when this 9 year old feeble-minded child was to be committed to live at an in- stitution for a period of time, not to have a broken arm fixed, but to live in an institution, that a Guardian Ad Litem had to be appointed. JUDGE GIBBONS: It may be that a guardian pro- cedure at some point would be and even necessary, but my difficulty with approaching (7) this solely from a due process standpoint is that a suicidal child is just as much in need of emergency medical attention as is a child with a broken arm. If you surround the treat- respect to lower income people, build in a tendency 1ot to resort to treatment. There seems to me to be a good deal more involved here than the due process problem. Colloquy 185a ; MR. FERLEGER: I agree completely with what you said for the suicidal child who acts out in a way that is self-destructive. That situation, I think, clearly is the kind of thing that presently can be dealt with through the emer- gency procedure. There is no problem at all, I don’t think, in any county in Pennsylvania with a parent bring- ing in a child who is going to kill himself. The problem is, for example at Haverford State Hospital, the majority of children are brought there not for the kind of behaviors which are delinquent, stealing and running away from home. For that kind of thing there is no emergency. JUDGE GIBBONS: You may be able to (8) estab- lish that. We can’t accept that as the fact. c: MR. FERLEGER: I understand that. JUDGE GIBBONS: But no matter whether even if that is true the process of getting the child to the . keeping in mind that presumptively until 18 the parent has a firm obligation to do so, can’t be made so difficult that we would be defeating the purpose of the hospitals. JUDGE MASTERSON: It seems to problem is having a procedure for someone independent parent and the child to review the facts concerning the child's institutionalization. I don’t think that that re- view should occur before the institutionalization, because I agree with Judge Gibbons that that may have a deterrent effect on people having their children institutionalized when they need to be. And it seems to me that due pro- cess, meaningful due process, is served if the procedure is available so that the unwilling child can have an indepen- dent person review the facts with respect to his institution- alization, and that’s why my own preliminary is that the 186a Colloquy May ist regulations pretty much take the steam out of your case as to the 13 to 18 year olds. MR. FERLEGER: There have been very few en [Text truncated at 120,000 characters. The full text is on the page linked above.] --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/brief%3Amicro_IA40385005_1099%3A04. Public record. Not legal advice.