# 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%3A05 ## Record - **Collection:** Supreme Court brief - **Document type:** Appendix - **Published:** January 1, 1979 - **Citation:** 442 U.S. 640 ## Text VOLUME II—Pages 435a-86% MiChar, RODAK, JR., CLERK APPENDIX in the Supreme Court of the Ynjted 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.; RAYMOND C-.; WILLIAM B.; FRANCIS B.; MARIA L.; THOM- AS W.; NANCY LOUISE D.; GINA S.; and GEORGE S§., 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 Relevant Docket Entries ..................... la Complaint—November 16, 1972 .............. 8a Er 24a First Set of Interrogatories to Defendants ....... 25a en ce seccevccecs 29a Order Dated April 25, 1973 .................. 3la Motion for Sealing of Affidavits and Protection of eS EE on db ipcens 32a ED EE Oe PE 34a Pre-Trial Oral Examination of Dr. Barbara Arm- strong: Direct Examirfition ................. 42a Cross-Examination .................. 108a Redirect Examination ............... i21la Recross-Examination ................ 130a Exhibit A—Class Action Suit ............. 133a Exhibit B—Individual Patient Summaries ... 135a Exhibit C—Individual Patients Summaries ... 166a Hearing, May 10, 1973 ................0205.. 18la Incarcerated Juveniles—Why? The Mental Institu- _ tionalization of Juveniles in Pennsylvania . 210a Argument on Plaintiffs’ Motion for a Class Action Determination and on Defendants’ Motion To Dismiss, April 16, 1974 .................. 232a Order Dated April 29, 1974 .................. 269a a ear OF Se ee 271a Final Pre-Hearing Order .................... 274a Summaries of Selected Patients ............... 317a Pre-Trial Oral Examination of Dr. Max Sugar: ER Liv uWeweceead 365a eee 383a Redirect Examination ............... 432a Volume II Redirect Examination (cont’d.) .............. 435a Recross-Examination ................ 442a Deposition of Dr. Joel S. Feiner, M.D.: Se I oe CN ce a cw etees 465a Cross-Examination .................. 484a Order Dated August 21, 1974 ................ 521a The Evidence: Evidentiary Hearing, First Day ............ 525a PLANTIFFS’ EVIDENCE: Dr. Henry O. Kandler: Direct Examination .....i........... 537a Cross-Examination ................¢. 540a EE ee 541a ee ee 548a Redirect Examination ............... 580a Recross-Examination ................ 581la Examined by the Court .............. 582a ii Dr. Michael A. Ingall: re 6 Sb ost et ceceeewe 586a EDs ons wedblecks eebs 597a Dr. Eli Charles Messinger: Direct Examination .......,.......--- 614a Cs ata ew edccedee’s 633a Examined by the Court .............. 636a DEFENDANTS’ EVIDENCE: Dr. Levon Donald Tashjian: rr ee. . wos poedic oe ems 643a eg. et cca eee se 659a Evidentiary Hearing, Second Day: DEFENDANTS’ EVIDENCE: Dr. Levon Donald Tashiian: rr ds. . . eeene et ene 662a Redirect Examination ............... 671a Examined by the Court .............. 672a Dr. Derek Harry Miller: Direct Examination ................. 673a eee reeéhen se 704a Dr. James F. Masterson: Direct Examination ................. 717a ID gc wc cc ccccececees 729a Redirect Examination ............... 740a Evidentiary Hearing, Third Day ............-.. 743a Defendants’ Exhibit No. 1—Questionnaire ...... 772a Defendants’ Exhibit No. 4#—Admission Note of D.D. 774a Defendants’ Exhibit No. 5—Admission Note of DT: oscecbntecoddh onwadban tie tees - 780a re rer teers oe. Opinion of the United States District Court for the Eastern District of Pennsylvania .......... 783a Onder, july 24, 1975 ..... se decne ey Oe 813a Dissenting Opinion, District Court ............ 8144 Court’s Proposed Order—September 16, 1975 .... 824a Defendants’ Exceptions to Court’s Proposed -Order—October 17, 1975...............4.. 833a Final Order—November 17, 1975 ............. 843a Notice of Appeal to the Supreme Court of the SE Sc ce bundede sede esaselee san 853a Reeceetias Gee OTM .n oo coc cecccsesceneses 856a Western Union Telegram ...................- 864a cape aneen bbadtad 865a Volume IT! ets: Datiies . 06.200 0deeKaens ds J —s" . ae Se ee fm bet SS SS Bea ae Ps RK A pee ae 5 : ~~ Fier a iM re Sele AE SES andl PIAS oa ie Yee ta) 2 i aie Tt eas} * ax vtilk.ad _~— wl eee FS ee ee ee ee ohn 494a Dr. joel S. Feiner—Cross MR. FERLEGER: That question is so vague. Of course sometimes people do. Sometimes people don’t. MR. ROTH: Mr. Ferleger, if you want to ob- ject, I don’t like the idea of your testifying on behalf of the (40) doctor. THE WITNESS: Obviously sometimes people do, because all of us that work there in any service capacity are overwhelmed, and whether we reach as many people as need our services, I can’t tell you and I seriously doubt it. BY MR. ROTH: Q. Do you find that because—obviously I would think you would have some understanding of the environ- ment in which you work that either people are hesitant or refuctant to contact attorneys or doctors. A. Or people are simply demoralized and over- whelmed with such a variety of problems, that it is hard to set priorities, and their experience with service agencies is so demoralizing that they seek other solutions, often desperate ones. Q. Do you feel that by having a juvenile participate in a judicial proceeding prior to any admission, that this may cause a reluctance on the part of any parent to utilize this system in that area? A. I think it would certainly dignify the whole sys- tem to the juvenile. Q. I didn’t ask you that, I asked you whether or not it would? A. I would tend to think not, because my experience often is, (41) as I have mentioned, that parents very often are there at the behest of another agency, such as the Dr. Joel S. Feiner—Cross 495a school, and they are doing it because somebody who they have been led to believe has their interest in heart has sent them to a facility, and they are going ahead with it, because they feel that the consequences of not going ahead with it are worse, and they have been led to believe that hospitalization can be a benign situation, so I would say that very often availability of legal help in these situations is a tremendous relief to everybody involved. Q. Now, in Pennsylvania are you aware of how a juvenile may end up at an institution? MR. FERLEGER: The question is not clear as to whether you mean whether the statutes are in the doctor’s awareness. MR. ROTH: I am asking the doctor—of course he is aware of the sections being questioned, and | am also asking practically if you had any awareness. THE WITNESS: No practically I haven’t. I haven’t worked in Pennsylvania. BY MR. ROTH: Q. Okay. With regard to the procedural safeguards, if you will that L.attached to a juvenile— (42) MR. FERLEGER: Are you referring to the regulations? MR. ROTH: Yes. I believe there was a statement made earlier by your attorney— MR. FERLEGER: I am not Dr. Feiner’s attor- ney. Apel ee oe ASS - SRP so ee P NG ORNS eee Ly + hee en ee De ee fe nr ae y RE CSS mmammanamerca sarah Sea ENT TT SSE Ee RR 496a Dr. Joel S. Feiner—Cross MR. ROTH: By counsel for Plaintiffs, who is using you as a witness, that there was a brief evalua- tion done prior to admission of juveniles in institu- tions. Now, according to your reading of the regula- tions, do you find that necessarily—do you find any words in there that say “Brief evaluation’’? THE WITNESS: No. BY MR. ROTH: Q. Now, with regard to the process in Pennsylvania, there are base service units. Do you know what base ser- vice units are? A. 1 do not. Q. With regard to the procedure in Pennsylvania whereby a juvenile is—well, let me ask you this, strike that. What is your understanding, based upon your reading of the regulations of how a juvenile would arrive at ar institution? MR. FERLEGER: I think the regulations speak (43) for themselves. If Dr. Feiner wants, he car read them, because the only thing he has to base his understanding on is a text of the regulations, so any interpretation of that would be irrelevant and super- fluous. MR. ROTH: Well, the question remains doc- tor, and it is essential, as you know, Mr. Ferleger that Dr. Feiner knows what is in question, and his opin- ion of the same, and I am asking you, based on your reading of the regulations and so forth, can you tell me what your understanding of Pennsylvania proce- dures are for the commitment of a juvenile? Dr. joel S. Feiner—€ross 497a THE WITNESS: I do nat understggd—it does not indicate the patient flow, if you will. & have sim- ply been made awake that theg [are] # numigr of juveniles who end up in a hoagital still against their will regardless of what is presemted. BY MR. ROTH: Q. And how did you arrive at that factor that ju- veniles are hospitalized against their will in Pennsylvania? A. I have been apprised through the material fur- nished regarding this case. Q. What specific instances are you referring to? A. Well, | would say in general that if I am asked about—I mean if you want to ask me some specifics about some specific (44) cases, I would be happy to comment on them. I think I actually am, in testifying in regard to the invobuntary hospitalization of juveniles. MR. FERLEGER: I might note for the record that Mr. Roth has stipulated to tables and statistics which were written with his assistance and help indi- cating that juveniles do in fact on occasion object to commitment, and that, it seems to me, is not a dis- puted aspect of this case. We know that some chil- dren don’t want to be in hospitals and some children do. ." BY MR. ROTH: Q. There is no dispute as to the objection. The question remains as to how you know that juveniles are incorrectly admitted to institutions in Pennsylvania? A. I did not say incorrectly. Q. Inappropriately? A. I said “Against their will.” ( BEST GOPY AVAILABLE | ox Cpe RO oes ae Bete X. + 7S Be > nee ey ee +.» wtetbbt rag at =, Sten gS yah 4-% Foes __ 3 ¢ rs AER SR INS Fi) Pepe Oe oh ey ft ante, SO eae ae TE re EE eee EET eg TENE gee gs a a, ee PO at og Soa’ Fo Ee Oe OR TS + eRe a i FT z 502a Dr. Joel S. Feiner—Cross i part of this, you see even if the psychiatrist does do an evaluation of the situation, it still does not lead to the im- plementation of a treatment plan that includes the entire family or that includes a psychiatrist orientation,.in part because many facilities are just not tooled up to do crisis work, and they only have one alternative, which is to hos- pitalize. I am suggesting that it is important that clinics and emergency rooms and other facilities be tooled up to in- tervene immediately so that whatever facts they do discover can be included in an appropriate treatment plan. Q. Well, you said that when any great alteration occurs and you felt that psychiatry should not be able to make the determination, that they should submit their evaluation. Would that also occur for any other treatment plan other than institutionalization, in your mind? MR. FERLEGER: I object to that question. | believe he has already testified that institutionaliza- tion is a much different, more serious process than other kinds of treatment. THE WITNESS: I will consider Mr. Ferleger’s objection to be consistent with my belief. BY MR. ROTH: (51) Q. Now, you stated that Dr. Sugar talks about the traditional point of view and that your point of view is more innovative; is that correct—or better? A. I'd say that. Q. Based on your experience, I mean? A. I’d say that my point of view offers more alterna- tives. | Q. Is your point of view better, based on your three years of experience? Dr. Joel S. Feiner—Cross 503a A. Does it help me for people? Dvcves it work for me? Does it work for others that have used it? Does the literature say that it works? I’d have to answer yes. Q. Well, where do you arrive at this new innova- tion? MR. FERLEGER: Excuse me, that is a total misstatement of his testimony. THE WITNESS: Absolutely. I have no—I’m sorry— MR. FERLEGER: He stated on the report that this is a development in the total field of child pey- chiatry over the past ten years. Dr. Feiner didn’t think it up, it was taught to him and every other person who studied child psychiatry in the past ten years. It is Dr. Sugar who is behind the times. We are not talking about innovations, we are talking about regu- lar practice established—accepted (52) practice. BY MR. ROTH: Q. Well Doctor, let me ask you this: If this is established practice, why is the first state or one of the few states whose statwees and laws are be- coming attacked as unconstitutional, why aren’t ether states utilizing judicial procedures prior to admission of juve- niles by parents, if this is so recent or if it has been going om for ten years? A. What I am suggesting is that what is going on fr ten years is a treatment motility that I am suggesting be applied for more situations than it currently is. It is likely that it is being applied in many places in Pennevl- venia. I simply am reflecting to you the current state of the art as I know it, from what I read and the meetings that I attend and the colleagues | consult. 504a Dr. Joel S. Feiner—Cross Q. Let me ask you this, in terms of what goes on in Pennsylvania and for example if I had a child and were having that child admitted to an institution, as the ulti- mate, if you will and so I went through—let’s take it, if I were from a poor socio-economic background, could not afford a private psychiatrist at the outset to evaluate my child, et cetera, et cetera, including home life or anything which you might think was relevant which goes on in Pennsylvania and I went to this (53) base service unit where I evaluated my child, made recommendations they went through their entire process, okay, and then there was a recommendation that the best alternative, after mak- ing other recommendations of other outpatients through the county mental health mental retardation unit, of which there are numerous ones throughout the state, if they found in the best interest of the child that institutionaliza- tion would be a paramount and then I went to the instigu- tion and the director, then, according to the laws as you have read them in Pennsylvania has another independant psychiatric examination made to make certain that the child does not need institutionalization and that occurs and the child is detained in the institution receiving treatment, knowing full well that according to the safeguards that he objects at any time within 48 hours thereafter he is going to be afforded counsel and go through a hearing, do you find that to be inappropriate? A. You say so much that, first of all I question the child is already receiving treatment. I think a child strong- ly believes that he is not—that he does not feel that it is necessary for him to be in an institution is not likely to acquiesce to the kinds of appropriate treatmen: within the first 48 hours, so I can certainly question that aspect of your assumption. Dr. Joel S. Feiner—Cross 505a. (54) Q. Well, Doctor let me clarify — you don’t misunderstand this. It is not necessarily within the first 48 Hours, it is within 48 hours whenever he makes the objection, if he makes the objection at admission or subsequent thereto— we are talking about within 48 hours after that; objection counsel will be afforded him? “%. A. Yes. I simply am saying I do not see why it can’t be done before hand. After all, you have talked about an», elaborate procedure that goes from one place to another . © interpose this procedure before the child is admitted seems that it’ will afford more alternatives in case the child’s position is upheld. It will decrease the amount of alienation, and those 48 hours are more in which the child hes to stew and will afford the opportunity for a recon- ciliation if that is going to be the fact—I mean after all, if we say that there is going to be a judicial hearing and we recognize the fact that the child in fact may be upheld fn his request, it is not inevitable that they are going to agree—I would assume that all of the recommendations @e to be adhered to. Q. But doctor, that assumes that when a juvenile is evaluated through the base service unit and implemen- tation of (55) any programs as to occur, it doesn’t occur wntil after institutionalization and that isn’t necessarily ap? A. I don’t understand that. Q. In other words when a person is being evaluated, either in New York—lI’m sure through your ceunty health mental retardation units or in Pennsylvania, | woubd as- sume that psychiatrists, when they see that the problem exists are going to establish procedures to he@p the puve- wile—they are not just going to sit by and not help them? 506a Dr. Joel S. Feiner—Cross A. Yes, I think that is probably true, but I think we can’t presuppose that amount of good will aii of the time when we are dealing with somebody’s rights, and I would assume that during this time the psychiatrist would be attempting to establish a rapport with this client, to perhaps do some persuasion to feed back observations, to make recommendations, and so on and even if that isn’t— and if that isn’t taken up by the child, I think the child should still have resource to other avenues before he is hospitalized. Q. Well, what about the fact that when the child is hospitalized, that treatment begins when he becomes hospitalized? A. What treatment are you talking about? MR. FERLEGER: Objection. MR. ROTH: I am talking about the fact that (56) recommendation and treatment plans that have been initiated prior to his institutionalization have occurred and the treatment program continues. MR. FERLEGER: Objection, that question must be objected to on the basis of Mr. Roth is tes- . tifying about some treatment plans that are estab- lished for some unknown patients. That is not part of the record in this case. If Mr. Roth wants to ask the doctor about his experience as director of his mental health center, then he can testify about whether or treatment takes place there, but you certainly can’t testify and Mr. Roth can’t testify about some alleged treatment in Pennsy]lvania. Dr. Joel $8. Feiner—Cross 507a BY MR. ROTH: Q. Now Doctor, you have testified that rather than having someone stew for 48 hours—and I am merely ad- vising you that that is not necessari#y the case, and | am saying if in fact a person does receive treatmest, compinu- Ous treatment, arcn’t those needs of the persom met? A. Mr. Roth, I’d Kike to correct a miscenception | think you are implying, that is a person does not receive treatmem, a treatment is a collaborative effort, and a per- son does not have treatment poured into him. Psychiatric treatment is a long arduous affair which involves the de- velopment of a (57) relationship of trust, and it camnot be done in a coercive way, so when you say “treatment,” I question what in fact you mean. Q. Well, when I say “treatment,” of course not be- ing a psychiatrist | am saying that some plan has been es- tablished by a psychiatrist that of evaluating the juvenile prior to as well as at admission, and that that plan, what- ever it be is continuing, and I.am saying assuming that were to occur, how—why do you feel, then that a hearing subsequent thereto, if necessary could not be held? A. Because I question the possibility of treatment occurring under those circumstances, and I question the possibility that we are not, by enforcing this coercive situa- tion, ruling out this patient for any subsequent treatment, at any opportunity in the future to voluntarily seek help from a mental health facility. My feeling is that this ex- perience is more likely than not to be a negative one. Q. Doctor, are you ever aware of situations where, because of reliance upon a judicial system, whether it be for an emergency hearing—no, I am sorry, whether it be for an emergency or non-emergency that the judicial proc- ess has been slowed to the extent that the person has com- DRE 6 POR Br yelling and I am sorry you are so sensitive that you can’t listen. THE WITNESS: I am amazed that that—at your hypotheses, but I won’t question that, but I have not (59) heard of such a case, quite frankly. MR. FERLEGER: Mr. Roth— to make his (60) train, then we will be glad to con- tinue it to another day. MR. ROTH: Well, I have numerous questions | for you, Dr. Feiner. BY MR. ROTH: Q. Dr. Feiner, do you feel thet there are differences 508a Dr. Joel S. Feiner—Cross Dr. Joel 8. Feiner—Cross 5098 mitted suicide because they weren’t able to get into the MR. FERLEGER: Your questions are becom- 4 institution right (58) away? ing a bit redundant and far afield from the case. Dr. "4 A. Weil, I— Feiner has to leave in about two minutes in order to zs ; J, make a train, and if you have any relevant questions a MR. FERLEGER: I don't see how that is rele- to ask, I wish you’d ask them now so that the deposi- a vant. That procedure is for children. When we have ; gh ener af vampires tion can be concluded. a judicial proceedings in Pennsylvania for adults, and a if Mr. Roth is suggesting that adults be treated as MR. ROTH: Mr. Ferleger, with all due respect, 4 children in Pennsylvania, that question is irrelevant. I have many more questions to ask of Dr. Feiner. 4 MR. ROTH: Notwithstanding Mr. Ferleger’s With regard to that, the Notice of Deposition 4 gratuitous remarks— says ‘‘Is expected to be completed within two hours.” 5 THE WITNESS: I would like to add. if you Subsequent to that time, we had correspondence with 5 are hypothesizing an emergency situation, that isn’t oe oe staff indicating that we a = additional ‘ the statute under question. time, and there was no objection to thy. "i MR. ROTH: I am not asking you about this MR. FERLEGER: If we need additional time i: statute under question, I am asking you in your pro- for relevant questions, I have no problem with that. % fessional opinion, or in your knowledge, have you MR. ROTH: Well, I think the Court can very = ever heard of situations where a person perhaps died well determine what questions are relevant and ir- 2 with their rights on? selouant *% . “34 a See Could you lower your voice, MR. FERLEGER: You are asking irrelevant - Mr. Roth? You are yelling. questions. They don’t seem to me to be appropriated = MR. ROTH: Mr. Ferleger, I am sorry, I am not if we can’t conclude by the time that Dr. Feiner has E between juveniles and adults in terms of their self-aware- MR. ROTH: Mr. Ferleger, I would li . Om, 1 wouts Hike to com ness regarding use of institutions, of they needed to? tinue with the examination. 510a Dr. Joel S. Feiner—Cross A. No. Q. In other words you read Dr. Sugar’s deposition and he felt that youngsters have a lot of hormonal changes, secondary changes, growth changes—he felt that these do not become complete at the late adolescent years, and he felt that there was very much a distinction between adults and juveniles in terms of development? A. Well, you didn’t ask me that question. Of course there are. You asked me regarding the use of institutious, and I suggested— Q. In regards to their awareness, I am sorry? A. In regards to their awareness, [ think they are individualized, and I wouldn’t be repared to make a gen- eralization. I have seen numerous adults who were not prepared to take advantage of the institutions available to them in this society. (61) Q. Well, one of the thrusts of this lawsuit is to have sections under the act declared unconstitutional which treat juveniles differently from adults. Is that your understanding? A. Yes. Q. And there is a possibility that if that were so done, that juveniles would be afforded the same rights as adults to admit and release themselves? A. That’s correct. ©. Now, do you feel a child aged 5 would have any capacity at all to even make that determination whereas an adult aged 19—-where are the differences? A. Obviously there are significant differences, but if—I can foresee a child with an Advocate participating in a situation in which the child is realized into another situation or home. Dr. Joel S. Feiner—Cross Sila Q. Do you think it is feasible that that occur, if— you know—for juveniles to admit and releasé themselves as adults do in Pennsylvania? A. Do I think it is feasible? Q. In your professional opinion? A. I would not be here if I did not think it was feasible. Q. How would a 3 year old even approach that? MR. FERLEGER: Mr. Roth, your questions— (62) and I am waiting for you to ask about the 314 and 41 and the 4 and % year old—your questions are just prolonging this deposition in a ridiculous man- ner. Obviously—and your own Dr. Sugar testified that 13, 14, 15, 16 and 17 year old kids could go in and out of institutions. We are not talking about— MR. ROTH: Do you have an objection? MR. FERLEGER: For younger children— MR. ROTH: Are you testifying or do you want to object? MR. FERLEGER: This is my objection, Mr. Roth, for younger children as the doctor testified, an Advocate is the one who would be speaking to the court, not the 3 vear old and for a 17 year old severe- ly retarded person it would be an Advocate or a. guardian ad litem. Your questions are just absurd. BY MR. ROTH: Q. The question still remains, Doctor, in terms of the procedures which plaintiffs seek. A. I cannot foresee that possibility of the child speaking for himself, but should the possibility ever come up, I would think that those rights would extend—I mean oe Mi od tty iti ll“ ki a SOR =| | 4 a “4 ss + 17 38 o€ j wt 4 lee + : 4X ra EE Pe a TAS, Yeon, wes ass ogee Be ee ep to ane 512a Dr. Joel S. Feiner—Cross —it is certainly unlikely, if not impossible that that would occur (63) with a 3 or 5 year old, but where are you going to draw the line? There are certainly some sophisti- cated 9 and 10 year olds, just as there are some very naive 30 and 40 year olds. Q. Well, do juveniles who need hospitalization nec- essarily recognize it? A. I think that juveniles need hospitalization on oc- casion, and often do recognize it. I think that adults who need hospitalization often do not recognize it, also. Q. I am asking about juveniles. Do you have juve- niles that tend to avoid reflection and introspection? A. Juveniles may make their needs known through behavior. Q. Let me ask you this. Is it your testimony in part that you feel parents really do npt operate in context of this situation for the well- being of their children? A. No. Q. Do you feel by and large parents do? A. I think it is a very mixed bag. I am suggesting where there are enough indications where they don’t re- quire some protection, and I hope to work in a situation where we see numerous cases of child abuse and neglect— I am quite sensitized to that possibility. We are not talking about one case. (64) Q. Have you ever admitted a child to an in- stitution? A. Yes, I have. Q. To which institution? A. Ihave admitted a child to Bronx Municipal Hos- pital Center. Q. Were you the admitting physician? Dr. Joel S. Feiner—Cross 513a A. Yes. Q. And how did that occur? A. That occurred by my following the procedures that were available to me at that time and operating under the guide lines which the institution functioned. I have since been able to participate in changing that situation to make it more flexible, and to decrease the possibility of a child being admitted under those cizcumstances. Q. Do you admit many children to instrutions? A. No. I have not admitted a child to an institution personally in some time. Q. Are you opposed to institutions? A. Absolutely not. Absolutely not. I am not talking against admitting children to institutions, I think they serve useful ‘unctions, serve a useful function when used ap- peopriately. I will mention another alternative which is being used as well, and that is day treatment centers where children spend their days in a community setting living at ' (65) Just to add another alternative to the family of peychiatrists. Q. When a juvenile comes to your facility, how long — occurs in terms of making a recommendation of her or not the juvenile needs an alternative type of care? A. What procedure usually occurs? MR. FERLEGER: That has already been tes- tified to, Mr. Roth. THE WITNESS: It has been testified to. We will gather as much information as we can, and as many contexts as we caa involving as many people who can provide information and opinions. 514a Dr. Joel S. Feiner—Cross BY MR. ROTH: Q. In the clinic where you work, how many psy- chiatrists are therc and how many patients come in daily? MR. FERLEGER: Objection, Mr. Roth. Dr. Feiner has to leave in—as a matter of fact right now for a train. If you have relevant questions, I wish you'd ask them quickly so we can conclude the depo- sition today rather than continuing it. If you want to submit Interrogatories, if you have any relevant questions left, that is fine, but the number of patients at his institution is irrelevant. BY MR. ROTH: (66) Q. How many patients come into your facility daily? A. Maybe 50. I—you know, I really have to leave. I have an important and professional commitment in New York. Q. Dr. Feiner, I have still several questions. Do you often testify? A. No, not often at all. Q. How many times have you testified in the pest year? A. None. Q. In the past 3 years? A. Once or twice. Q. Are you being compensated for your testimony? A. No, I am not. Q. In your opinion, if a methodology of treatment occurred once the juvenile was seen by whomever in terms of psychiatric evaluation, if a treatment plan were estab- lished at that point, and if there were any alteration of that treatment plan in terms of either having the patient be seen at a facility many times a week or having the pe- Dr. Joel S. Feiner—Cross 515a tient institutionalized or anything of that sort, do you think at that point a judicial hearing should occur? A. I think a judicial hearing should be available to a person at any time they chose to request it, and I think that it is the mental health person’s legitimate responsi- bility (67) to explore that request, but when—lI don’t think he can do more than explore it, and under its mean- ing and the reason for it occurring at that particular point. Q. What would happen if—if you started a treat- ment program for a juvenile and the juvenile objected to that treatment program, do you think a hearing should be afforded at that time and that the treatment program should stop? A. No. I think the juvenile would—I would try to persuade, I’d try to prescribe, and if the juvenile then chose not to participate in treatment, despite all of the technical maneuvers available to me, I would not be able to treat that person, nor would I want to coerce them into treat- ment, because I would think that I would lose them for the possibility of treatment forever. There are often occasions where juveniles will want a taste treatment, a little bit to see what it is like when they are brought there—they want to see who is this doctor, what is it all about, and then they will leave, because they want to come in on their own, and I have segn this hap- pen a number of times where a juvenile has terminated treatment orally; they have said “Fine.” They have gone out, they have done what they have had to do and they have come back on their own and treatment has really be- gun at that pomt. (68) Q. But the question still. remains, you feel if a juvenile objects to any point and wants a jadicial hear- ing, that a judicial hearing should ooeur; is that correet? Met va. 2a et er sae) aa a. "i : 4 5 ISR b> ees “e4 % « r a. =. vs 1) * : a 29 4h ” i: = s) a lone “il ¥ er -. 516a Dr. Joel S. Feiner—Cross A. Are you talking about a juvenile in a hospital? Q. No, I am talking about when you establish a plan, if the juvenile doesn’t want to participate in the plan— A. Oh, if I am an outpatient therapist for this ju- venile, I regard that completely as a voluntary contract. We use the term “contract” not in your terms, but we have established very early an understanding between us that this is completely voluntary; that it is completely confi- dential and at any time either one of us feels that things aren’t working out and I reserve that right myself, to say that this is a situation that I don’t think I can deal with, I reserve—we each reserve the right to terminate that re- lationship. Q. But with regard to the question itself, if, in the best interests, in your professional opinion as a psychiatrist you feel that the juvenile should be treated, either on an outpatient basis or any other basis and the juvenile objects at that time, you feel that a heartng should be afforded the juvenile? MR. FERLEGER: He testified— MR. ROTH: He didn’t answer the question. (69) MR. FERLEGER: —that that implies the institutionalization, not outpatient treatment. THE WITNESS: I have never heard of a sites tion— MR. ROTH: I am aot asking you what you have heard, I am asking you your professional optn- ion, Doctor. MR. FERLEGER: Well, an opinion about something that doesn’t happen is sort of useless. Dr. Joel S. Feiner—Cross 517a THE WITNESS: I would have serious feelings that if a court determined the juvenile had to stay in treatment that anything useful could be accomplished under those circumstances. BY MR. ROTH: Q. Well, don’t you feel that juveniles could be nega- tive to admissions anywhere to institutions or day care pro- grams but nonetheless be still co-operative in the treat- ment program itself? A. Well, maybe. Maybe. Maybe a certain percent- age are, but not certainly not a hundred percent. Q. Do you find that juvenilese—just by the mere chronological age are recalcitrant and as a resu&t object to agy type of methodology? : A. Oh, no, I find that recalcitrant is part of the pro- gram (70) and part of the give and take that people deal with kids have to learn to understand. Q. Yes, but as that being part of the charm, isn’t that part of the effect of objecting to anything? A. It is not for me to coerce. I am a service em- ployer::.! am a therapist. Q:.. Based on your experience, don’t you find that juveniles generally object to confinement of any sort? MR. FERLEGER: Most adults, I know object to confinement of any sort. MR. ROTH: I am sorry, I am asking the ques- tion to Dr. Feiner. ; “THE WITNESS: That is the kind of idea I was trying to phrase. I think that we have @ue process situations, because most human beings o€$ect to con- finement. If you will excuse nm, I really have te go. 518a Dr. Joel S. Feiner—Cross MR. ROTH: Well, I still have many questions. MR. FERLEGER: How many questions? MR. ROTH: Several. MR. FERLEGER: Three? MR. ROTH: Several. MR. FERLEGER: Is several three or twenty? MR. ROTH: It would also depend upon (71) Dr. Feiner’s responses. MR. FERLEGER: Well, at this point do you have three or twenty? MR. ROTH: I have several. MR. FERLEGER: Well then, we will have to conclude the deposition. Would you like to continue the deposition to another date? MR. ROTH: I would like to finish. MR. FERLEGER: Or one mare minete or @, if you have several we can get them done. MR. ROTH: Mr. Ferleger, it t a shame that when you sent out the notice you seld it was going to be at least two hours, and then in contact with your own staff members, if asked if we could go be- yond that because we knew we would need time, we were assured of that. MR. FERLEGER: At that point, we didn’t know that Dr. Feiner ha@ another commitment at 5:00, and we heave, of course the same problem thet Dr. Joel S. Feiner—Cross 519a we had when you wanted the deposition of Dr. Sugar restricted, because he had to go give a speech and I cooperated at that point, and we finished the deposi- tion in time for him to make the speech. MR. ROTH: Oh, Mr. Ferleger, you showed up (72) 45 minutes late. How cam you say you coop- erated? Dr. Feiner, let me ask you this, now, you have ‘testified on direct examination that you think con- finement to a general hospital is different, for example you brought up the illustration about someone who is affected with tuberculosis would be different than a mental illness, if you will. Why don’t you think a hearing, prior to admission of a general hospital should occur? 3 - THE WITNESS: As far as I know, I meen I can’t be specific about the law, but I think that there are probably Jehovah’s Witnesses who do avail them- selves of those opportunities. BY MR. ROTH: Q. Well, I am asking you, though, in epnfinement of any person to an institution, be it a general hospital or a state institution, don’t you think—gou know—for ¢ ju- venile that a due process hearing should occur? A. Iam looking— Q. Go ahead. A. I think that there is some substantial differences between a physical illness and emotional! difficulties. Q. Don’t you think parents, as you testified could misutilize a situation and put their juvenile, their child in- to a general (73) hospital? ° oo ias = he te owe) Mier ost 520a Dr. Joel S. Feiner—Cross A. Oh, sure, sure, and may be there should be due process. MR. FERLEGER: Do you have further ques- tions, Mr. Roth? MR. ROTH: Yes. MR. FERLEGER: Okay, the deposition will be continued to a date that I will notify you of, Mr. Roth. Thank you, Dr. Feiner. MR. ROTH: You can show on the record that I object to the continuation of the deposition on the basis that I was assured that I would be able to fully cross-examine the witness. I have not completed my cross-examination of the witness; that I was told the deposition would occur for at least two hours and more, and in subsequent conversation with Mr. Fer- leger’s staff and confirmation in writing of the same— MR. FERLEGER: We have no problem with the deposition being finished, so that Mr. Roth will be able to finish his questions, and that is the very reason why we have continued the deposition, so that all parties can have the benefit of Dr. Feiner’s tesei- mony. MR. ROTH: Well, } question the whole depo- sition in terms of Mr. Ferleger’s misleading an unfair and inappropriate statements Perey: the length of the deposition. (74) (Whereupon at 3:18 the deposition wes adjourned.) Order Dated August 21, 1974 521a File L IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA Civil Action Number 72-2272 Kevin Bartley, ct al., Plaintiffs v. Haverford State Hospital, et al., Defendants ORDER AND NOW, this 21st day of August, 1974, after consideration of the parties’ proposed Final Pre-Hearing Order and after a conference in chambers on July 30, 1974 regarding said order, it is hereby ORDERED: 1. Final hearing and argument herein shall take place on September 9, 1974 beginning at 10:00 A.M. in a courtroom to be designated, and on September 11 from 9:30 A.M. to 1 P.M. 2. Pre-trial briefs are not required. Any briefs which the partics may wish to submit must be filed on or before September 3, 1974. 3. The partics’ Final Pre-Hearing Order, filed in- cluding their stipulation of facts and other matters, is 522a Order Dated August 21, 1974 fully approved and adopted by the Court together with the following amendments and additions. References are to the pages and paragraphs of said order. a. Defendants shall be permitted to call as witnesses Dr. Derck Miller of the University of Michigan and Dr. James Masterson of the Cornell Hospital in New York. b. The “Discharge and Readmission Data” (Page 10, Par. 3) shall not be admitted. c. The question of monetary liability of De- fendants shall be bricfed if and when it becomes an issuc herein (Page 10, Par. 4). d. Paragraphs 1 through 8 at pages 14 through 18 are admitted and included in the factual stipula- tion. Defendants shall be permitted to comment on and to make a statement on these facts. Defendants may prepare an exhibit by September 2, to be ap- proved for accuracy and completeness by Plaintiffs, regarding the admission of the following patients’ cases listed on pages 14 and 15 (noted here by institutional number) : Pennhurst #402 Polk 413,173 Polk 413,077 Western #281 Western #288 Polk # 13,212 Western +144 Western #15 Westcrn #67 Western #131 Order Dated August 21, 1974 523a In their review of patient records for the purpose of preparing this exhibit, the parties shall protect the confidentiality of the patients’ records. e. The Plaintiffs’ witnesses are as indicated at page 19 of the aforesaid order. The Defendants’ witnesses are: Dr. Derck Miller University of Michigan Ann Arbor 48104 Levon Tashians, M.D. Institute of Pennsylvania Hospital! 111 North 49th Strect Philadelphia, Pa. 19139 Barbarba Armstrong, M.D. Haverford State Hospital 3500 Darby Road Haverford, Pa. 19041 Dr. James Masterson 60 Sutton Place South New York, N.Y. James Gibbs, M.D. Director of Child and Adolescent Psychiatry Sheppard-Pratt Hospital Baltimore, Md. 21215 Both partics agree not to contact the witnesses with- out approval and presence of ypposing counsel. f. Plaintiffs’ Exhibits 2 and 3 may be offered at the hearing (page 21) and the Court will determine their admissibility and weight. ier cre aes 7. 43 524a Order Dated August 21, 1974 Appearances 525a g. Plaintiffs may take the deposition of Dr. Joel Finer in Philadelphia, Pa. which deposition may be admitted as a trial deposition. IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA h. Plaintiffs shall submit three copies of Dr. Barbara Armstrong’s deposition to the Court with those portions to be admitted underlined in red. All Civil Action No. 72-2272 portions on which the parties disagree shall be admitted. i. The deposition of Dr. Max Sugar may be [Title omitted in printing. ] admitted as a trial deposition. j. The submitting parties shall give the other EVIDENTIARY HEARING parties notice of the contents of their summaries as early as possible. By the Court: First Day " ae iy aston be Philadelphia, Pa., September 9, 1974 Dated: 8/21/74 (10:00 a.m.) Before: Hon. Iohn J. Gibbons, C. J. Hon. Daniel H. Huyett, 3rd, J. Hon. Raymond J. Broderick, J. Present: David Ferleger, Esq., Attorney for Plaintiffs, Mentai | Patient Civil Libertics Project, Philadelphia, Pa. 19107. 4 Barry Roth, Esq., Assistant Attorney General, Darius i G. C. Moss, Esq., Assistant Attorney General, Attorneys | for Defendants, Office of Legal Counsel, Department of Public Welfare, Harrisburg, Pa. 17120. 526a Colloquy (2) (All Counsel and parties being present, the fol- lowing transpired in open court.) JUDGE GIBBONS: Mr. Roth, the first item of busi- ness I suppose is your motion to dismiss, and I should ad- vise you we have concluded we will take that under ad- visement and you should proceed with the testimony. MR. ROTH: Thank you. MR. FERLEGER: Just for the record, your Honor, I think you have forgotten that I think that was already taken care of in a previous order. JUDGE GIBBONS: _I think it may have been, but I see it is listed. MR. FERLEGER: I wasn’t aware of that. JUDGE HUYETT: How did we take care of it in the previous order? MR. FERLEGER: In your April 29th order after our meeting, you asked me to draft the order which allowed the case to be maintained as a Class Action, dropped Haverford Hospital as a Defendant, appointed myself as guardian and denied the motion to dismiss. JUDGE GIBBONS: Well, it is listed this morning. Whether that is a renewal or otherwise, we will take it under advisement. Mr. Ferleger, do you have a witness? (3) MR. FERLEGER: Yes, your Honor. This morning we have three witnesses to present to the Court, all expert psychiatrists. The first is Dr. Henry Kandlcr. He will testify re- garding his expcricnces as a psychiatrist and working with lawyers. | Colloquy 527a Our other two witnesses will follow. To save time, rather than making any statement, I'd like to call Dr. Henry Kandler to the stand. MR. ROTH: Your Honor, if I may, I would like to make some specific requests of this Court and I’d like to do that now if that would be appropriate with regard to— JUDGE GIBBONS: We cannot tell whether it would be, until we hear the requests. MR. ROTH: May I be given the opportunity to pre- sent them now? JUDGE GIBBONS: Yes. MR. ROTH: Thank you, your Honor. | appropriate this time, your Honor, to present sev- eral matters before your Court. The first being through an oversight, | was under the impression that I had submitted the admission notes of Alan Moss and Donn Dickel. The opposing counsel (4) had submitted affidavits by these two youngsters who are at the Haverford State Hospital and I had spoken to Judge Huyett through his law clerk, Mr. John Langel indicating I would like to introduce into the record the admission notes of those two juveniles. I am prepared to have Dr. Kratsa, who was the ad- mitting psychiatrist, testify to these admission notes. I am also prepared to have affidavits submitted by him which I have now. I sent a letter to your Honorable Court on September 3rd, indicating the admission notes of these two youngsicrs. I know this has not yet been introduced into evidence by opposing counsel. However, | would like to reserve =H 528a Colloquy that right to introduce these notes in order to further elu- cidate the position by the Defendants in this case. JUDGE GIBBONS: Do you have any objection? MR. FERLEGER: Yes, I do, your Honor. These affidavits of the Plaintiffs were filed on April 25, 1973, under an order—special order protecting the confidentiality and the rights of the affiants. Mr. Roth, not only knew about it since 1973, but never mentioned any desire to submit any (5) counter affidavits, cither in the pretrial order negotiations or in our meetings with Judge Huyett. I think that once the final prehearing order has been entered that it is improper to suddenly on the day of trial or week before it, to decide that you want to submit counter affidavits. JUDGE GIBBONS: Do you have any substantive objection? MR FERLEGER: No. I am sure that the copies of the admission notes that Mr. Roth has are accurate copies. JUDGE GIBBONS: You may do that and you can have them marked with the clerk and sometime before it is necessary to make reference to them. MR. ROTH: Fine. I shall admit them now. We will not be making reference to them in the hear- ing, your Honor. JUDGE GIBBONS: We won't take the time. But I charge you with the responsibility of getting them ap- propriately marked in evidence before it is necessary to make reference to them. MR. ROTH: Thank you. ’ Colloquy 529a 1 do have several other matters and again, I appre- ciate your indulgence. With regard to our regulations which were (6) pro- mulgated and adopted back in September, 1973, we had a hearing in April and I bad indicated to the Court at that time how those regulations were being affectuated [sic] and in particular, I indicated a compilation of statistics compiled by Mr. Ralph Phelps of the Office of Mental Health in order to show the Court what was happening in each instance where juveniles objected to subsequent admission. At that time it was my impression it had been intro- duced into the record and in order to insure that, | would prefer to introduce that also before your Honor. Again, I had alerted this situation to his Honor Judge Huyett through Mr. Langel last week and I am prepared to have Mr. Phelps come down from Harrisburg in order to tes- tify to his compilation of these statistics. JUDGE GIBBONS: Mr. Ferleger? MR. FERLEGER: Your Honor, with reference to that, that was discussed as Mr. Roth indicates and I noted at that time that I had two clients who had objected to institutionalization who weren’t listed on that summary sO it was clear to me that factually that summary was in- correct with regard to at least two of my clients and I imagine with regard to other people across the state. It purported to be a summary of all cases across the state in which these new regulations had been (7) involved and I don’t see how, especially with non-state hospitals and | know for a fact that two cases are not listed on there, | don’t see how this can be introduced into evidence at 530a Colloquy all and I really don’t see the relevance of it to this Court’s proceedings. MR. ROTH: Your Honors, if | may? JUDGE GIBBONS: 1 think he would be entitled to cross-examine. The summary could go in if you had a witness here that he could cross-examine. I don’t think it could, otherwise. MR. ROTH: With regard to Mr. Ferleger’s com- ment, the number of objections had not been listed by in- dividual name. It just had been listed as to the number of objections and how the institutions handled those ob- jections at the time. JUDGE GIBBONS: I think you had better produce the witness and lay the groundwork for the introduction of the summary, so that Mr. Ferleger can cross-examine and object. JUDGE BRODERICK: May I suggest something? JUDGE GIBBONS: Yes. JUDGE BRODERICK: May I suggest if the sum- mary is corrected there could be an agrecment to it, but otherwise, as Judge Gibbons has just indicated you will have to follow that procedure. (8) MR. ROTH: Thank you, your Honor. With regard to the prehearing order, we did agrec that the Commonwealth would supply the admission pro- files, if you will, of ten patients selected by the plaintiffs. I had sent these patients’ profiles on to this Honorable Court and to Mr. Ferleger sometime ago and we would like to introduce those into evidence, also. Colloguy 53la I have not heard of any objections prior to this time from opposing Counsel with regard to those ten patients’ profiles. JUDGE GIBBONS: Mr. Ferleger? MR. FERLEGER: I have no objection. JUDGE GIBBONS: They will be marked in evi- dence and again, rather than delay the witnesses, I charge you with the responsibility of having them appropriately marked before they need to be referred to. MR. ROTH: Thank you, your Honor. Again, thank you for this time. With regard to our witnesses, your Honor, we had five witnesses and we have narrowed that to four wit- nesses. We have excluded Dr. Armstrong. Now, it has been my review of the situation with these witnesses that each witness will take approximately an hour to an hour and a half. Today, we are going to begin with Dr. Tashjian. On Wednesday, we anticipate (9) calling Drs. Masterson, Miller and Gibbs. Now, with regard to the time limit on Wednesday which will be from 9:30 to 1:00 o’clock, pursuant to your Court order, it would be appreciated if we could continue this for another day—to present Dr. Gibbs. All these gentlemen are from out of state, Michigan, New York, Baltimore. I am prepared to have Dr. Gibbs come on Wednesday if you so desire. I have alerted Judge Huyett through his law clerk, to this situation. JUDGE GIBBONS: _I think we will have to antici- pate only getting through two on Wednesday. Our collec- 532a Colloquy tive judgment is that by the time cross-examination is finished, it will be so close to one o’clock as to make it impossible to complete the third doctor and we don’t think it is appropriate to have him make two trips. Therefore, you can assume that we will continue with his testimony on a subsequent date and that closing argu- ment will be held on that same date. MR. ROTH: Thank you, your Honor. JUDGE GIBBONS: Monday, October 7, 1974, we will convene at ten o’clock and complete the testimony. Any rebuttal testimony should be presented at that time and we will proceed with closing argument. If need be, (10) we will continue on the 8th of October. We will advise you of the courtroom. MR. FERLEGER: Thank you, your Honor. MR. ROTH: Thank you, your Honors. Your Honors, with regard to the pretrial deposition of Dr. Max Sugar, that deposition I would like to intro- duce into the record, also. Now, I have provided the Court with a rather lengthy summary of that deposition some time ago and last week, I did receive the signed copy—the signed original— of Dr. Sugar’s deposition by him and I had advised him, you know, pursuant to Court Rule 30, that he ought to state in an accompanying letter any objections that he had to form and substance. Dr. Sugar mercly changed some words around on the original deposition. He has supplied me with that, but not provided me with reasons. I can assure this Honorable Colloquy 533a Court, as well as Mr. Ferleger, that there has been no changes as to substance. Nonetheless, I’d like to introduce that pretrial depo- sition, as well as the changes on xerox sheets which I have, and reserve it for Mr. Ferleger’s objections. JUDGE GIBBONS: Mr. Ferleger, any objections to that course? (11) MR. FERLEGER: No, I haven’t seen the cor- rections and I’d like to. I might note, just for the record, that Dr. Finer, who was deposed by the court order in this case, I’m still wait- ing for the court reporter’s transcript, because we did not have time for Mr. Roth to finish his questions and he has agreed to submit interrogatories and we hope that will be done by October the 7th. MR. ROTH: That was my next point. Hopefully, | will have that done by October 7th. In any event, I will have that certainly done before the record is closed in this case. With regard to Dr. Armstrong’s deposition which was taken, I believe, in March of 1973, your Honors, we have agreed that Mr. Ferleger would underline portions agreed upon and those portions disagreed upon would be ad- mitted into evidence. I have not yet received that, although I have received several papers from Mr. Ferleger just a few minutes ago and | believe one of those papers does refer to the depo- sition of Dr. Armstrong. I haven’t had a chance to read any of these. However, I just wanted to indicate to the Court that } am agreeable to submitting the deposition of Dr. Armstrong in its entirety, {f necessary. Lee SS © 534a Colloquy (12) JUDGE GIBBONS: All right. Again, | charge you to have it appropriately marked. All of these deposi- tions have to be marked in evidence. MR. ROTH: Fine. Your Honor, | believe Mr. Ferleger will be introduc- ing that deposition in accordance with our agreement. JUDGE GIBBONS: If it is your offer, you, Mr. Fer- leper, are responsible to having it marked in evidence. MR. PFERLEGER: Certainly, your Honor. MR. ROTH: With regard to my understanding of what is in the record, specifically, we are requesting that all the interrogatories and answers are in the record and especially the answers to— JUDGE GIBBONS: Have they been marked in evi- dence? JUDGE HUYETT: They have not heen marked, MR. ROTH: No, they haven't. 1 believe we dis- cussed that at the prehearing conference and | believe we decided they would all be introduced into the record. MR. FPERLEGER: There was no decision to aban- don marking them. JUDGE GIBBONS: They should be marked, (15) because they are not in the record for appeal purposes, unless they have been admitted into evidence. JUDGE HUYETT: 1 would suggest that Counsel get together before October 7th and give them the next ~ ene SuenEND Oe Chay Gay Means ae Seep ay eee Oe formally admitted into the record. Just because somethin, Colloquy 5350 has been docketed and filed, does not make it part of te record for appeal purposes. MR. ROTH: Thank you, your Honor, we shall do 0, Again, | had spoken to Judge Huyett through Mr. Langel last weck, regarding the submitting the biographics of the expert witnesses and perhaps we can arrive at a stipulation with regard to that. Neither Mr. Ferleger nor | have exchanged the Cur- riculum Vitaes of the witnesses and it would be my feeling at this point, your Honor, although I'd like to expedite the hearing that perhaps we should hear the qualifications and if your Honors feel we should submit the biographies, we will, but I think it is necessary to hear the qualifica- tions. JUDGE HUYETT: Are these fairly short? MR. PERLEGER: Just to let you know what the plaintiffs are doing. You have, | handed up this morning before you arrived, Plaintiff's Exhibit Numbers (14) 1, 2, mber 1, the Court has already ordered, it may itted. Numbers 2 and 3, the Court has given us on to submit them here this morning. Dr. Leon Ginsburg, as | explained to Judge Huyett in a paper filed, he is in South America. The affidavit has been filed for more than a year, | believe, although Mr. Roth has told me that he did not get it when we originally sent it out, Exhibits 4, 5, and 6, are the resumes of our experi witnesses and | would move, maybe to expedite things, for the admission of all of our Exhibits at this time. 5 36a Colloquy JUDGE GIBBONS: Move the admission of each Curriculum Vitae as the witness is on the stand, so it ap- pears in the same part of the record. JUDGE HUYETT: Are they too long to read? My thought is to save time and if the Curriculum Vitae is short it could be read and this would be supple- mented by a few questions, rather than going through a long procedure of questions and answers. MR, FERLEGER: What I was anticipating was hav- ing my witnesses describe the most salient points of their qualifications and leave a lot of the listings of articles and talks to the written material, JUDGE GIBBONS: Just mark the Curriculum (15) Vitae as each witness gets on the stand and present those highlights that you think are appropriate by question. MR. FERLEGER: 1 will, your Honor. JUDGE GIBBONS: Anything else, Mr. Roth? MR. ROTH: Yes, your Honor. With regard to my brief which was submitt , two weeks ago, ! would just lke 0 note @ correction on page 22 and it appeared that the citation of Logan versus Arafch, that should be Volume 346, your Honor. I'm sor- ry for that, Your Honor at this time, thaf is all 1 have. Thank you again. MR. FERLEGER: Dr. Kandler. Dr. H. O. Kandler—Direct 5370 HENRY O. KANDLER, sworn. THE CLERK: Would you state your full name? THE WITNESS: Dr. Henry O. Kandler. Direct Examination BY MR. FERLEGER: Q. What is your address? A. My office is 124 East 84th Street in New York City. — Q. What is your occupation? A. 1 am a psychiatrist, Q. Weak’ ome. geen oun 6 Se Sais PRY see (16) current affiliations or appointr ? A. Yes, 1 am Assistant Clinical Professor of Psychiatry at the Albert Einstein College of Medicine and | am Associate Attending Psychiatrist at the Bronx Municipal Hospital Center, QO. Have you been associated with any hospitals in the state hospital system? | A. Yes; for a period of five years | was Super ing Peychlatriet ot Bronx State Hoople Psychiatry at both the medical school and hospital. Q. What do you do in that capacity? A. Primarily, | supervise trainees, fellows and resi- dents who work in the clinic right now and I am also in charge of the school consultation program and have sore administrative duties as far as the clinic is concerned. 538a Dr. H. O. Kandler-—Direct Q. Por how long have you been involved in the area of child psychiatry or adolescent psychiatry? A. For 16 years. This clinic job is a new one for me. For the past 16 years, | have been involved in in-patient psychiatry. (17) O. What facilities? A. At the same facilities that | have mentioned, ©. Can you estimate the number of children in- volved that were under your responsibility or supervision? A. We admit somewhere between 60 and 100 ado- lescents a ycar, depending on how those s were set up. 1 was usually, during this period of time, in charge of one ward, So that would be about one-third of them. So, | estimate that | have been in perhaps direct charge of 400 adolescents who have been admitted to our hospital. Q. Do you work with children or families of chil- dren in your private practice? A. Adolescents, yes. Not younger children. Q. Dr. Kandler, you have seen the Curriculum Vitae that you gave me and it is now in the Court's hands. Is that an accurate summary of your qualifications and background? A. Yes, MR. FERLEGER: Your Honors, I'd like to move for the admission of Plaintiff's Exhibit Num- her 4, JUDGE GIBBONS: Number them in sequence as to whatever the next plaintiff's number is. JUDGP HUYETT: Were your Exhibits 1, 2, and 3 admitted at the prehearing conference? Colloquy 539a (18) MR. PERLEGER: Yes, Exhibits 2 and 3, your Honors ordered we'd be allowed to submit for a ruling today. JUDGE HUYETT: Where are Exhibits 1, 2, and 3, physically? Have they been marked? MR, FERLEGER: Exhibit 1 has already been docketed and filed, Exhibit 3 has already been dock- cted and filed and Exhibit 2 has been docketed and filed, as well, MR, ROTH: If 1 may, your Honor, as I recall the Exhibits were disagreed upon in our statement of facts and it is up to the Court in order to determine the probative value today, MR. PERLEGER: Except for Number 1, Num- ber 1, Judge Huyett ordered admitted. JUDGE HUYETT: Where is there a reference to these in the prehearing order? MR. FERLEGER: In your order issued after our last conference, at paragraph 3(f), your Honor ordered that plaintiff's Exhibits 2 and 3 may be of- fered at the hearing and the Court will determine their admissibility and weight. MR. ROTH: Exactly. In that order, it does not say anything about Exhibit 1, It was my under- standing that this Exhibit was not admitted. (19) JUDGE GIBBONS: Let's not talk about Exhibit | at this point. Let's get a number for whot you referred to as “Exhibit 4,” The previous Exhibits have been given numbers 1, 2, and 3 in the prehearing order and this will be 540a Dr. H. O. Kandlere—Cross marked Exhibit 4 which will be admitted in evi- dence. Give the Clerk a copy for the Court to file. (Whereupon, the Curriculum Vitae of Dr. Kand- ler was marked Plaintiff's Exhibit 4 in evidence as of this date.) MR. ROTH: 1 do have some questions with regard to the witness’ qualifications. JUDGE GIBBONS: You may examine now on his qualifications. MR. ROTH: Thank you, your Honor. MR. FERLEGER: Your Honor, if Mr. Roth is just going to question with regard to the extent or stature of his qualifications, | think he should hold that for cross-examination, but if he wants to ques- tion— JUDGE GIBBONS: He may examine on his qualifications at this point. MR. FERLEGER: Thank you, your Honor. MR. ROTH: Thank you. (20) Cross-Examination BY MR, ROTH: QO. Dr. Kandler, would you please indicate to me if you are Board certified in general psychiatry? A. No, I am not, Q. Are you Board certified in child psychiatry? A. No, | am not, Dr. H. O. Kandler—Direct 541a Are you Board eligible in general psychiatry? Yes. Are you Board eligible in child psychiatry? . I am not sure—I think you have to have the general first. Q. Can you please explain the difference between Board eligibility and Board certification? A. The difference is taking an examination and passing it. Q. Is it not true, Doctor, that Board certification indicates an acceptable level of expertise in that area of psychiatry? A. I personally don’t believe so. Q. Does not that Board certification indicate what I just revealed to you? A. I don’t believe so, no. MR. ROTH: Your Honor, at this time, I will reserve questions with regard to his experience (21) and history in general and child psychiatry for cross- examination. >O>O Continued Direct Examination BY MR. FERLEGER: Q. Dr. Kandler, as you know, this lawsuit involves the rights of children to have pre-mental commitment ju- dicial hearings. That involves the relationship between the law and psychiatry. Have you had any experience with lawyers being in- volved in commitment proceedings and can you describe that experience? A. Yes, rather extensively. ~ 542a Dr. H. O. Kandler—Direct In New York State for several years now, we have had a mental health information service, which was set up by state law and which is an arm of the Court that is re- sponsible for commitment proceedings and under this pro- gram, every hospital has a lawyer or there are lawyers re- sponsible for several hospitals if the service is small, who is available to all patients—all patients, that includes chil- dren, adolescents and adults, to discuss with them their rights and to help them with any complaints they have about being in the hospital. Q. Have you had contact as a psychiatrist with one of these lawyers for your patients? A. Yes, extensively. (22) Q. Do you have any opinions regarding the benefit or disadvantage to those juvenile patients of such contact with attorneys? A. | think it is proven over the years to be an ad- vantage. The advantages are several-fold. First of all, it relieves the psychiatris: from wearing two hats, from both having to be responsible with sceing that a patient is apprised of his rights and explaining some- thing that he is not an expert in while at the same time being a psychiatrist. I think it leaves him free to make a reasonable judg- ment and recommendation to a patient about hospitaliza- tion and treatment without at the same time having to say, “However, if you don’t agree, you can go to Court and have this reviewed.” I think at the same time it provides for better legal advice for the patient, because there is an expert who is well versed in these rights advising the patient. Dr. H. O. Kandler—Direct 543a Q. Do you feel that your treatment of juveniles is hindered at all by the juveniles being represented by an attorney? A. Not at all. I find it helpful. Q. In cases where there is a disagreement about the need for treatment, do you find that the adversarial (23) stance of the lawyer ever interferes with the best interests of the juvenile? A. I haven't found it so. I think what happens is that it does not come to a hearing. I think the mere fact that that possibility exists leads to both from the legal point of view and from the psychiatric point of view, the best compromise solution being found to help the patient. Q. Dr. Kandler, 1 wonder if you would give us your opinion regarding the reliability of parents of possibly dis- turbed youngsters as the source of information with re- gard to commitments? In other words, do you think that parents should be relied upon to make applications for the commitment of children? A. Well, I think some parents are reliable and some parents are less reliable. Some parents are very angry at their children and would like to have the children placed somewhere else and some parents are honestly mistaken in their judgments. So | think you get a whole panorama of possibilities. ©. Do you feel that there would be any advantages from a prior judicial hearing for the commitment of a ju- venile (24) in a non-emergency situation? A. I think the advantage is an indirect onc. In a sense that when the possibility of a hearing ex- ists, then those agencies or people that consider that it is in the best interests to have the child placed in a hospital, 544a Dr. H. O. Kandler—Direct have to make sure that the child or adolescent is thor- oughly worked up and the case is thoroughly understood and there is an agreement it is in the best interest of the child. The advantages, it makes a better situation before- hand, putting everybody on notice to do a better job. Q. Are there any therapeutic aspects to the child in having a hearing or representation by Counsel or an advo- cate? A. I think there are two. First of all, | think what happens is that rather than arbitrarily railroading a child into the hospital, the situa- tion has to be explained to the child very thoroughly and this also goes on once the child is in the hospital that the staff makes an effort to try to explain to the child why he is there and why it is necessary for him to be in the hos- pital and what type of treatment his is getting and I think that makes a better treatment. (25) In psychiatry it is difficult to treat a patient without the cooperation of the patient and even at times during an emergency situation one has to admit a patient quickly against his will. Nevertheless, eventually, you need the cooperation of the patient. Even if it is only as simple as taking medication, if the patient leaves the hospital and discontinues taking the medicine it is harmful. Especially in the case of psychotherapy. The second advantage is it gives the child a sense of irust and responsibility, because he has some other alterna- tive. He can go for advice to someone who is an expert, who may cither advise that the child cooperate in the treatment or suggest that the child have a hearing and try to get out of the hospital. Dr. 11. O. Kandler—Direct 545a Q. I! understand that in New York, as the law is in the City of New York, the hearings are on a challenge to a commitment once it’s been accomplished. Do you see any reason why your comments would not apply to the treatment situation as well? A. In gencral, no. There are emergency situations in psychiatry and there must be some procedure by which one can safeguard the patient from harming himself or other people when the situation is one of immediacy. Otherwise, I think it would apply. (26) Q. You are generally familiar with the emer- gency provisions of the Pennsylvania Mental Health Law. Do you think— JUDGE GIBBONS: Wait a moment. Ask him, is he, first. Q. Dr. Kandler, are you familiar generally with the fact that Pennsylvania has emergency provisions for com- mitment procedures? A. I know they do. Q. Do you feel those procedures are generally ade- quate for the emergency where— A. 1! don’t know the details enough of the Pennsyl- vania law. Q. Thank you. Dr. Kandler, would you please explain whether or not you feel there are differences between institutional. in- patient juveniles in a psychiatric facility as opposed to out patient care or gencral medical care, differences which merit a prior hearing? A. Well, I certainly do. 546a Dr. H. O. Kandler—Direct I think when you lock someone up, you deprive him in large measure of control of his life and I think this ought to be done carefully. Q. Dr. Kandler, do you know whether there are any national medical or psychiatric standards regarding the (27) provisions of legal counsel for due process to chil- dren? A. Probably the most pertinent one is in the latest accreditation manual for psychiatric facilities serving chil- dren and adolescents. Q. Who published that or wrote that? A. This is published by The Joint Commission on Accreditation of Hospitals. Q. Whoare they? A. This is an organization that was formed over 20 years by the American College of Surgeons and Physicians and The American Hospital Association and The Medical Association and Their Approval of Hospital Facilities. In this instance Psychiatric facilities for children very often determines whether they get funds and is certainly involved in their getting federal funds and let me quote, they have several sections— JUDGE GIBBONS: Mr. Ferleger, before the doctor refers to this document, will you have it marked for identification? MR. FERLEGER: Certainly, your Honor. (Above referred to manual entitled, “Psychiatric Facilities Serving Children and Adolescents,” was marked plaintiffs’ Exhibit 7 for identification as of this date.) JUDGE HUYETT: What is the exact de- scription? Dr. HH. O. Kandler—Direct 547a (28) MR. FERLEGER: That is the “Accredita- tion Manual Serving Chilc ren and Adolescents,” copy- right number 1974, and paid for by a grant from the National Institute of Mental Health. I think that a reference to the law regarding Medicare and Medicaid provisions will show that these standards are adopted by the Congress as the standards of Medicare and Medicaid aid to Hospitals. JUDGE GIBBONS: Have you seen it, Mr. Roth? MR. ROTH: I have only seen it briefly. Of course, it is not being introduced into evi- dence. So we reserve objection to that, your Honor. Continued Direct Examination by Mr. Ferleger: Q. Are these standards generally accepted by child psychiatrists and proper standards for care of children in facilities? A. Yes, and throughout this they make a distinction between the standards that shall be made and those stan- dards that ought to be met. So, it is both a standard, plus a guide for the kind of improvement that should be im- plemented. Q. What do they say with regard to due process and legal advice for children? A. “The psychiatric facility serving children (29) and adolescents shall know the dignity and protect the rights of all its patients and their families. Every effort shall be made to safeguard the legal and civil rights of patients and to make certain that they are kept informed 3 548) Dr. H. O. Kandler—Cross of their rights, including the right to legal counsel and all other requirements of duc process when necessary.” Let me add the reason | became involved with this, because | am setting up a day hospital at this moment and as a part of the budgeting for that facility, there is the budgeting for an attorney involved to provide the help to children in this facility? © ° MR. FERLEGER: No further question. JUDGE GIBBONS: Are you going to offer that document? MR. FERLEGER: No, I am not, your Honor. JUDGE GIBBONS: All right. Mr. Roth? MR. ROTH: Your Honor, would you indulge us for just a moment, please? JUDGE GIBBONS: Yes. MR. ROTH: Thank you. Cross-F xamination BY MR. ROTH: Q. Dr. Kandler, would you please indicate what ex- perience (30) you nave and the Cusation of Chas enpert ence in admitting adolescen’ A. I have been affiliated with the in-patient services of Bronx Municipal Hospital Center for 16 years and while being on that staff | was for five years supervising psy- chiatrist at Bronx State Hospital. . Dr. 11. O. Kandler—Cross 549 Both of these facilities are run by the Albert Einstein College of Medicine, so it is possible to have responsibili- ties in both areas. Q. Would those facilities be considered an institu- tion? A. I'm not sure of the medical definition of institu- tion. Certainly the State Hospital would be considered an institution. The other is a city hospital with a large psy- chiatric facility. Q. The ones you work with are the city hospitals? A. And for five years a state hospital. JUDGE GIBBONS: Both in-patient facilities? THE WITNESS: Yes. worked there for five years, were you the admitting psy- A. 1 wes fiase of oft cntietant Gescter of 0 Sweet unit which we used for training purposes for our residents. As such, there were five residents on my ward. I was re- sponsible for the ward and ! supervised them with all (31) their cases on the ward. Now, in that particular instance, we didn’t do par- ticularly the admission, but when they were referred to us, we screened them. In other words, they would have often been at the city hospital and we would select them as being appropriate for this facility for their So, it was a selection process, rather than an A. | dia’ eutentand Go quietien. in ott @ ? 550a Dr. 1. O. Kandler-—Cross Q. Well, in the sense, Doctor, that you testified with regard to out-patient treatment as well as in-patient. io gan beter srong ane ile Gama ene ate iene tial facility, and in the State of Pennsylvania, a state men- tal hospital? A. 1 think there were instances where patients have benefited from hospitalization. Q. Now, Doctor, with regard to some statements you made, you indicated that a lawyer should see a juve- nile; is that correct? A. 1 think it is very helpful, yes. ©. When do you think the lawyer ought to sce the juvenile? A. Well, | think there are two instances. is after. I think before one has to be very careful to be able to admit a patient quickly when a patient is in danger of hurting himself or someone else. There has to be some ees OY ee eo eee ane ychological difficulties. It is something that has to be slanned and if there is an objection by the child, I see no soe Aeteghredcnsmicuphe-wsepusiepiew ime oteant Now, what happens is that one of the p pevchiary is that it prognosis iv difficult and certanh edicting future behavior is most difficult, so I think it be available to someone after they are in the hospital. Sometimes somebody is upset for a couple of days and then they improve and in a time like that if they are not easily discharged, they ought to have some recourse available. that manual indicate ifs a hearing should be held my a ju venile prior to admitting into an in-patient residential [a- cility? A. Not that I recall, Q. Doctor, would you please explain the admissior (33) procedures there, with regard to juveniles? Let me be a little more specific. _ May a juvenile be admitted by a parent in New York? A. Only a doctor can admit a patient to the hospi- tal, Q. May the parent make application for admissior of the juvenile to the hospital after the doctor has recom- mended hospitalization? A. Yes, they may. Q. Is there a hearing afforded to a juvenile prior to his hospitalization? A. Well, that's an interesting question. It is not excluded, us 5 ave mover come canaen & fn O. Well, Doctor, iat mo otk vow thes You have testified with regard to the admission pro- cedures in New York in some ter u“ ATTY r w IGS your euperionss, 1 i in fact in low thet 0 joventie fs given o heaslan gular 60 01 Umission” A. He is not given one, but I think—I hits, 1s want te canto tee 0 Nd on otk tar ons on. der the way that I read the law, but this is not my area of competence. a treatment for him or her or to recommend in-patient residential care? 552a Dr. H. O. Kandler-—Cross A. After my evaluation, yes. I may want other people to help me in that evalua- tion. Q. Do you feel you need a corroborating opinion before placing a youth into any program? A. Not necessarily. No. Q. When a juvenile comes to you and | would as- sume— MR. ROTH: Strike that, please. ©. Let me ask you this. Does a juvenile who needs help, let us say, come to you generally through his parents? A. That would probably be—with his parent, not necessarily through his parent. Q. With his parent? A. Yes. Q. When the parent and juvenile— A. I mean, 1 want to elaborate that. Very often it may be the child's wish to see someone and the parent acquiesces. Our problem is treating chil- dren who want treaiment without the parents’ knowing, not the other way around. ©. When the parent is before you end the juvenile is before you, do you formally evaluate the juvenile? (35) A. As well as the parent. Q. Do you feel in some circumstances, it is im- portant to review the parents? A. Nearly always. ture in terms of the development and growth of children? A. What do you mean by “family structure’? Dr. H. O. Kandler-—Cross 5530 QO. For example, you have testified that some par- ents are reliable and they bring their child to an institu- tion and you observe their behavior pattern and you testi- fied that some are not as reliable and some are unreliable, and I am questioning how important is the family struc- ture in terms of allowing the parent to seek this type of help for their juvenile—for their child? A. 1 am still not sure of what you mean by “family structure”. ©. Doctor, | will take it from another avenue and I think it will clarify it more. Do you think that parents generally operate in the best interests of their children? A. Generally. | Q. Do you think that parents have a callous disre- gard for their children and are merely attempting to plop their children into institutions? MR. FERLEGER: Objection as to the phrasing (36) of the question. JUDGE GIBBONS: Overruled. Q. Please answer the question, A. It happens. | think the majority of parents have the best interests of their children at heart. | think mostly where | am concerned about the is- sues that we are talking about here is— ©. Doctor, | am sorry to interrupt you. I'd like— JUDGE GIBBONS: That is a responsive an- swer. A. I think some parents callously would like to get rid of their children, though the biggest nunsber of chil- 554a Dr. H. O. Kandlere—Cross dren who may not get the best possible treatment occurs where there is ignorance on the part of the parent. Q. I'm sorry, | didn't get that. A. “Where there is ignorance on the part of the par- ent.” Q. Do you feel there would be a conspiracy between parents and physicians and psychiatrists to place children into institutions? A. No, I don't think so. ©. Doctor, do you feel that most parents don't want to be separated from their children? A. Most parents do not, ©. Do you think that parents who have economic means and arc able to doctor-shop in order to obtain treat- ment for their child without recommendations for institu- tionali (37) zation are better equipped as parents than those who come from poor socio-economic backgrounds and cannot doctor-shop? VR. FERLEGER: 1 object to the question. | don't understand the question, myself. }UDGE GIBBONS: Do you understand it, Doc- tor? THE WITNESS: 1 think I understand what he is driving at. JUDGE GIBBONS: Objection overruled. A. 1 don't think the variable is money. I think the variable is knowledge. There may be some slight correlation between educa- tion and money. However, | think very few of us, when we are in trouble seek a second opinion. 1 think this is Dr. H. O. Kandler—Cross 555a a problem that is generally true. I think the population at large isn’t discriminating enough in selecting all of their physicians. Q. We are talking about the education and aware- ness of parents of meeting their children’s needs, | would assume, and would you not feel that parents who perhaps may have a bit more education and are able to afford, if you will, more expensive treatment, generally doctor-shop, not necessarily to find one who will recommend institu- tionalization, but in order to find an evaluation (38) where they will not have to be separated from their child? A. 1 think people doctor-shop to find a physician that agrees with them and that may be right or it may be wrong. Q. Doctor, under— A. As a matter of fact, there is a study that people overweight tend to go to doctors overweight. And | think the same thing is true in psychiatry, that there are so many modalities of treatment that people try to find somebody who agrees with their opinion. Q. Isn't that precipitated by the fact that parents do not want to be separated from their children? A. That is not the issue at this juncture. 1 don’t think that that issue comes up. I think if they think about it at all, they are more likely to think they can’t handle the situation, rather than worrying that the child would be forcibly taken away from them. Q. Are you familiar with the procedure of parents making application for their children in Pennsylvania? A. Somewhat. Q. Would you please explain what you think the situation is for voluntary admission of children by par- ents? 556a Dr. I. O. Kandler—Cross A. The parent can petition to have the child institu- tionalized. (39) Q. Do you know what the safeguards pro- vided are for the screening of the child prior to institu- tionalization? A. Prior to this case, there were none, but since this case, regulations have been set up that children from 13 to 18 can have legal advice, but there are no provisions for children under 13. Q. Doctor, | do not think you have been totally in- formed about the safeguards. With regard to juveniles, in order to get your opinion on whether or not this procedure is acceptable to you as a professional— A: Juveniles at what age? Q. It refers to youths from age zero to age 18. We are not restricting ourselves to juveniles or adolescents, but any juvenile 18 and younger, whether he is mentally re- tarded or mentally disabled may not be admitted to an in- stitution until he is referred from a recognized medical fa- cility, mental health, mental retardation therapist or men- tal health agency— MR. FERLEGER: Mr. Roth is reading from the regulations and I must object. JUDGE GIBBONS: He is laying the ground- work for a question and don’t object until he asks the question. MR. FERLEGER: His necessity to read it may also necessitate that Dr. Kandler have it in front of (40) you in answering the question. JUDGE GIBBONS: Bring it up and let the wit- ness look at it. Dr. H. O. Kandler—Cross 557a MR. ROTH: May we have a moment, please? JUDGE GIBBONS: Are you referring to an- nex “a” to title 55? MR. ROTH: Yes, I seem to have it atiached to something— JUDGE GIBBONS: I have handed him our copy. Q. Can we look at page | and under numbers 1 and 2, it indicates how juveniles are, if you will, reviewed pri- or to their ultimate admission into an institution and in a form of summary, what basically occurs is that there is a referral unit and that referral unit be an individual therapist or a base service unit in Pennsylvania who will evaluate the child and we assume total evaluation of fami- ly, et cetera, in order to come to a disposition of whether or not the juvenile or child should be afforded admission into an institution. Subsequently, the parent takes that child to the in- stitution which is recommended by the referral unit and the director at that institution causes an individual exami- nation to occur. Now, at that point, if the individual examination cor- roborates the first, then admission is (41) made of the ju- venile by the parent. Now, do you think, since you have already testified that you feel confident to make a recommendation to ei- ther institutionalize or recommend mental treatment for a juvenile, do you think their screening devices are appro- priate? MR. FERLEGER: Objection, your Honor. 558a Dr. H. O. Kandler—Cross The question is not making recommendations. Dr. Kandler had not been asked whether admission should occur on a recommendation of his or anybody else’s. We don’t question the right of referral agencies to make recommendations. All we question is who the decision maker should be. JUDGE GIBBONS: Overruled. You may answer the question. A. The procedure sounds very good on paper, but unfortunately, there is a large gap between outlined pro- cedures and the quality of the kind of evaluation the pa- tient gets and my concern is with that quality. I don’t know the details of what the examination con- sists of. It isn’t spelled out at all in this regulation. It can be a five minute chat with someone. I think it is good as far as it goes, but the only way for me to judge whether the procedure is good, | would have to know the pcople who are making the (42) cxamination, what kind of tests are done and so forth. Q. Well, Doctor, assuming—now, assuming that the evaluation is done according to, if you will, generally ac- cepted principals in psychiatry, would that satisfy you? A. It would satisfy me. 1 would have one worry about it and that is even carefully done psychological evaluations, the prediction of behavior is rather limited. People change and an evalua- tion takes a couple of months and it takes another month to get someone ,into an institution and there might be a vast change in an adult or child for that matter and | don’t think it is enough for this evaluation to have taken place before hospitalization. Pir. HW. O. Kandler—Cross 559a I think after hospitalization, equal care has to be taken and there must also be alternative judgments avail- able after one is hospitalized, especially one which de- prives one of his freedom. Q. This case does not involve the right to treatment. The plaintiffs have not made any allegation that treatment is not being afforded to juveniles— A. I was talking about keeping somebody institu- tionalized. I think that should be reviewed periodically. Q. Doctor, without going far afield, that is a neces- sary part of treatment. (43) Do you not evaluate as part of your treatment process, a person prior to his admission to a facility as well as subsequently? A. Ido. Q. Don’t you consider that part of the treatment process? A. Absolutely. Q. Now, assuming again, Doctor, that although on paper, we do not have outlined what one must do, a psy- chiatrist or a base service unit or anything of that sort in order to evaluate a juvenile, but recognizing them for ac- ceptable facilitics, do you feel that that two-step process is acceptable to you in terms of the recommendation that may be made to the parents as to whether or not the child does need institutionalization? A. It is difficult for me to answer that dircctly the way you put the question. I know from experience that even though there arc regulations that the criteria for admission to an institution varies widely from city to city. I know that is true in New York City. 560a Dr. H. O. Kandler—Cross it is better when you have more than one judgment. No institution ought to be forced to treat someone who they don’t think belongs in the institution and therefore, the director or his delegate should judge (44) whether somebody ought to be in his facility. It is hard for me to say this is adequate because so much depends on how this is done and I know from ex- perience that the statistics for admission to equal facilities within the same area vary widely. Q. If you felt that parents and physicians and psy- chiatrists are acting in sort of a conspiracy to place chil- dren into institutions and as I recall— A. 1 found no conspiracy between the three of them. I think at times families cannot handle their children and try everything possible to get people into a hospital without necessarily relying on expert advice and I think most of the difficulty comes because unfortunately, there are nowhere near adequate facilities to take care of those people who need to have care. There is not enough staff to do the job the way it ought to be properly done and things are slipshod. Q. Do you feel for exampie, yourself, as a profes- sional, if | were to come to your place and if I had a child and brought that child to you and you evaluated the child and the child did not need institutionalization and I said, “T really want this child’ in your institution,” would you put the child in the institution? A. No, the parent would take the child to someone else, (45) presumably somcone more prone to institution- alizing of children. Q. Along with those procedures, we do have a pro- cedure and again reading down the page and particularly, Dy. HW. O. Kandler—Cros: 56la I alert you to number 6, we do have a procedure where every juvenile, age 13 or older, is given notice of the rea- sons for his admission and he is provided with a telephone number of the person who made application for him, which, by the way, Doctor, is limited to a parent, guardi- an, a person standing in locus parentis and he will be alf- forded counsel if he objects subsequently to admission and! you have testified according to your law, there is no law indicating a juvenile must be given a hearing prior to admission and that the J.C.H. standards do not indicate this should be done. Do you think a juvenile should be afforded this type of procedure? A. Here it states, “13 or older.” It eliminates younger children and | would disagree with that, and, secondly, excepting emergency children, it is a dangerous thing to remove a child from his environment and family and so forth and I think if there is serious conflict between the parents involved, including objection from the child, I think the child ought to have some representation, whether it be a psychiatrist or lawyer of his (46) choosing and | think this will help the children at a future time, if the child is convinced that what is being done for him is in his interests rather than anyone else’s. I think it will help treatment in the future immeasurably. JUDGE GIBBONS: Doctor, you indicated that you disagrecd with the cut of age of 13 for notice purposes. Do you have ari opinion as to at what age a no- tice provision would be meaningful? THE WITNESS: Well, I thought about that question. 5624 Dr. H. O. Kandler—C ross it is difficult for me to answer that. Thirteen is not a bad breaking point, because we arbitrarily di- vide adolescents and children. | think younger chil- dren need protection and | have been in contact with the deputy director of our Mental Institute Division and they are concerned about that because they ere less able to make decisions and ask for help and they consider it a specific duty of theirs to look in on the situation in our children’s ward. As to the actual notification of a piece of paper, that would be an adequate breaking point, but some rep esentation for these children should be made. They are less able to object, to be able to get a second opinion. (47) Cross-Fxamination Continued BY MR. ROTH: ©. Doctor, with regard to the advantages of having a hearing prior to the admission of a juvenile, as | under- stood your response to that type of question from oppos- ing Counsel, you felt that it is better to treat a child who is cooperative, rather than one who is uncooperative; is that correct? A. Absolutely. ©. Do you feel that by providing a hearing, where a judge might order a child to be institutionalized, that that is going to affect the child's attitude in cooperating with treatment? A. tt would be better if that were not necessary, but at times, rarely, but at times, a child has to, or an Ur. Ht. O. Kandler—Cross 5630 adult for that matter, has to be institutionalized in order to begin the treatment. The purpose of treatment is to make the child cooper. ate with the treatment. In New York State, we specifically request—we are requested by the Mental Health Law that we reduce the degree of institutionalization. It is not good to have some- one, except for an emergency situation, to be admitted against their will. Q. Doctor, in your experience, do you feel that gen- erally adolescents will not tell you when they are depressed (48) because they wish to avoid the entire affair? A. Adolescents take a different form than adults. 1 am not so sure that few of them complain. They won't call it depression. | think adolescents complain and complain a lot. Perhaps they complain more than adults. The form of their complaint will take other forms. Com- plaints about authority and school and parents and so forth. They will less rarely come in and say they arc de- pressed, because depression as we know it in adults is something which reaily occurs more frequently with adults. Q. Is it not true that juveniles have a reputation as being unmotivated for treatment? A. Ido not find it so. Q. You do not find that juveniles resent authority and constantly are rebelling to types of authority? A. To authority, yes. | think that is a part of grow- ing up. Q. Do you not feel that being facility is a type of authority? A. Well, that depends whether you do it voluntarily or not. The true sense of the word, not the way the law in Pennsylvania defines it. 564a Dr. H. O. Kandler—Cross Q. Do you know of any juveniles that really like the idea of going into an in-patient residential facility? (49) A. Absolutely. In our wards we have more trouble discharging patients than bringing them into the hospital. They want to stay. Q. Deo you find that juveniles who are objecting are really not objecting in the sense of you and | saying, “No, I don’t want to do something,” but it is really a so-called plea for help in which they want somebody to help them? A. That is sometimes true. Q. Now, one thing I don’t want this Court to be misled with, Dr. Kandler, oe Se Now, don't you feel, oo ain ii did ton what percentage of juveniles or children, rather, come to you do you not recommend for in-patient residential treat- ment? A. In my private practice, it is very, very rare. Our statistics at Jacoby Hospital—first of all, ado- lescents, some 30 to 40 percent of our adolescents that come to our service come from a Family Court. Out of the remainder, we admit between 20 and 30 percent. So that means that 60 percent, 70 percent would be . referred elsewhere—those that appear in our emergency room, 70-80 percent, rather would be referred (50) to your clinic or some other social agency. Twenty to thirty percent of those coming to our emergency room are ad- mitted. Other facilities, however, this may be double that number. Q. are spr ran, antrum ong Dr. 1. O. Kandler—Cross 565a Now, ap Save Glaaly wae Ges yon have comes mitment provisions in Q. a oe ae ee A. fe ol Every juvenile where? Q. That is being admitted to a facility. A. There are different facilities, different situations, different hospitals. | can’t answer that. Q. For example, I believe Mr. Ferleger indicated to ment? MR. FERLEGER: | did not. MR. ROTH: Strike that. I'm sorry. deals with an emergency provision and states, ‘One is dan- (51) hearing—" A. Yes. to fie these fiasits, if you will, ~ aah deepal other,” do you feel, Doctor, that a juvenile may be a po- tential emergency situation if help is not given right away? A. Are you asking whether a situation would get worse if someone is not admitted, even though if it is not an emergency? Q. If he is not immediately treated. A. That is possible, but he can also get better. 566a Dr. H. O. Kandler—Cross I have known instances where hospitalization has been put off and the need for hospitalization has disap- peared. Q. Don't you feel it could be traumatic for a juvenile to be in a hearing and all sorts of facts coming out about his need for institutionalization are before him? Don’t you think that could be traumatic for a juve- nile? A. It can be, but my experience has been that it is helpful for the patient to know what other people think of him, including diagnosis. Q. Doctor, wan Hee fe Sp cone Lacsenesne tion is that a hearing occur prior to instieutionslization, do you not feel— A. 1 recommend it ought to be available. I think it ought to be avoided if possible, but it ought to be avail- able. Q. In other words, if there is a conflict between the juvenile and the parent, do you feel that a hearing should be given? A. 1 think a hearing should be available to the per- son who objects to being hospitalized. Q. Do you find any problem witn giving that hear- ing after the person is hospitalized? You know, precipitating— A. 1 think hospitalization is a very serious affair and unless it is an emergency situation, this possibility ought to exist before. I am interested in forcing the system to have proper care beforehand so a hearing won't be necessary, so all parents can come to the conclusion what is the best treat- ment for the patient. * Dr. H. O. Kandler—Cross 567a Q. Let's assume that we use the safeguards we have in Pennsylvania, where somebody is screened at step one, O> o> 664a Dr. L. D. Tashjian—Cross state, except for Haverford and Norristown; isn’t that right? A. Ingeneral, yes Q. So, that when you testified that you do a full-day evaluation, you do not know if the state hospitals or state facilities for the retarded which typically have fewer staff, you don't know if they are as extensive as you are per- sonally in your evaluations; isn’t that right? A. No, I must say, if I can state this, that I do a fair amount of teaching and in the places that I do teach, I do recommend my form of evaluation as a standard form of evaluation. Q. 1 understand that. I hope your students follow your recommendation. Now, Dr. Tashjian, with regard to the replies that your Institute made to the defendants’ interrogatories which will be part of the record in this case, you testified that you were familiar with those replies; is that right? A. Yes. Q. And, you are aware, are you not, that those re- plies indicate that in 1972, there were no Section 406 Court (176) commitments to the Institute; is that right? MR. ROTH: Objection, your Honor. Dr. Tashjian testified with regard to the partic- ular patient profiles that I had alerted him to. He has not said on direct examination that he was aware of all the responses to that questionnaire. MR. FERLEGER: Mr. Roth, can we stipulate that this is the response and no Court commitments were reported by the Institute of Pennsylvania Hos- pital in 19727 Dr. L. D. Tashjian—Cross 665a To save time, let me withdraw that question. Q. Isn't it correct, Doctor, that the Institute gen- erally receives few Court commitments of juveniles, most of your patients are voluntary, signed in by their parents; isn’t that right? A. Most of them come in under a 403, rather than a 406. Q. Most of them, as you testified, are people whose family can afford $120.00 a day, plus additional costs; is that right? A. Yes, either because of personal monies that they have or health insurance that they have of one form or another. Q. So, you do not have the experience with lower middle class or lower class people who form most of the patients in our state hospital system; is that right? (177) MR. ROTH: Objection, your Hor>r. It’s not been established that lower socio-eco- nomic backgrounds are the primary persons who are in the institutions. MR. FERLEGER: I think the Court can almost take judicial notice of the fact that people in state hospitals are not the people who can afford the $120.00 a day that the Institute charges. JUDGE GIBBONS: No, I don’t think I can. Sustained. Q. Dr. Tashjian, you testified that 90 to 95 percent of the juveniles who are sought to be admitted to the In- stitute object to being there— A. To being brought in there. Q. To being brought in there? ’ Z ll we . 666a Dr. L. D. Tashjian—Cross A. Yes. Q. Now, Dr. Tashjian, what proportion of those juveniles do you feel are competent to voice an objection? MR. ROTH: Objection, again, your Honor. I am sorry, it is misleading. However, Dr. Tash- jian testified approximately 99 percent voiced an ob- jection. JUDGE GIBBONS: Well, 99, 95, of those who voice an objection, what percentage in your opinion are competent? (178) THE WITNESS: I don’t know what either of you mean by “competent.” I'd like to answer that question, but I would like a clarification of what you mean by “competent.” Q. With regard to the individual case that you were going to testify about and with regard to your institution’s responses to the interrogatories, are you aware of the fact that your institution noted “yes” or “no” with regard to the question of competency? JUDGE GIBBONS: I think you have to show that to the Doctor. MR. FERLEGER: Certainly. JUDGE GIBBONS: In the second place, I think his objection to your question is well taken. Do you mean competency in the legal sense or in some other sense? Q. Dr. Tashjian, by “competency,” I compe- tency to object, whether that juvenile had the capacity to voice an objection and know that that person was objecting to being in the institution. p Dr. L. D. Tashjian—Cross 667a A. Okay, I am aware—competency in medical or psychiatric sense, that the person’s disturbance was not such so that there was extreme confusion or extreme dis- orientation of thought. In that regard, I would say that they were competent. (179) Q. How many were competent; what pro- portion? A. Just scanning over the list, | would say the ma- jority were. Q. Dr. Tashjian, adults also object to being in men- tal hospitals; isn’t that correct? A. Yes. Q. And, a certain proportion of those adults are competent in the sense we have been using it and another proportion are not competent to object; is that right? And, Dr. Tashjian— JUDGE GIBBONS: Just a moment. When you nod your head, the court reporter won’t pick up that. He can’t see you. Please respond audibly. A. Could you start again, so 1 will know what I am— Q. Dr. Tashjian, you just nodded your head affirm- atively to the question of whether or not some proportion of adults who object are competent and some proportion are incompetent. A. Yes, from a medical and psychiatric standpoint. Q. When adults object to involuntary commitment, you understand the law, do you not, the law in Pennsyl- vania is that they are entitled to a commitment hearing under Section 406; is that right? A. Yes. 668a Dr. L. D. Tashjian—Cross (180) Q. Dr. Tashjian, is it not possible that— MR. FERLEGER: Strike that. Q. Dr. Tashjian, you testified that participation in Court hearings weakens an already weakened family situ- ation and that in those family situations—this is with re- gard to juveniles—there is already verbal violence or phys- ical violence. Now, I take it that your testimony is that in many of these cases, we don’t have a typical, normal, stable fam- ily; is that right? 7 MR. ROTH: Objection, your Honor. I don’t believe that Dr. Tashjian has testified that a hearing weakens an already weakened family situation. MR. FERLEGER: I have notes of three sep- arate people and I| think the record will indicate what his testimony is. JUDGE GIBBONS: I recollect that he did so testify. JUDGE BRODERICK: It is my recollection. He may not have testified in those exact words but that is the impression | got. Let’s ask him if he so testified. THE WITNESS: My recollection is that I did testify that way. (181) JUDGE BRODERICK: Very well. Q. You will agree that these situations, these fam- ilies who were in this turmoil, who seek to have a child admitted to the hospital, you would agree these are not Dr. L. D. Tashjian—Cross 669a the normal, stable, healthy families from a psychiatrist’s point of view? A. I would have to qualify that in the sense that the impression can get around that families of disturbed ad- olescents are monstrous in their deviation from the norm. I would qualify it by saying that families can have any one of us as perents, that family structure can be weak- ened by crises, can be weakened by family crises, can be weakened by crises among one or more of the family’s members in the family during this time. I don’t want the Court to have the impression that families of disturbed adolescents are beyond the pale. If that distinction is clear, that then I would say, yes, that families of disturbed adoles- cents are often themselves disturbed. Q. Dr. Tashjian, I want to show you a piece of paper marked plaintiffs’ Exhibit 8. MR. FERLEGER: I have three copies for the Court. JUDGE BRODERICK: All right. (182) TUDGE GIBBONS: Plaintiffs’ Exhibit 8 for identification? MR. FERLEGER: Yes, your Honor. Q. Do the photographs in plaintiffs’ Exhibit 8 for identification accurately reflect facilities at your Institute of Pennsylvania Hospital? A. Yes, they do. Q. Now, Dr. Tashjian— A. Tashjian. Q. Excuse me. 670a Dr. L. D. Tashjian—Cross In plaintiffs’ Exhibit 8, you notice a list of activities that are available at the Institute. Would you read that list to us and indicate whether that list is accurate? MR. ROTH: Objection, your Honor. I find this questioning is irrelevant. MR. FERLEGER: I am willing to explain, your Honor, that the purpose— JUDGE GIBBONS: We know your purpose. You are making the point that the facilities at the Institute are not typical. MR. FERLEGER: The further point I wish to make, your Honor, is with reference to Dr. ‘Tashjian’s testimony that children once they get there don’t want to leave; that the reason may be that because the situ- ation (183) is so much more attractive and so much more playful than their own homes— JUDGE GIBBONS: I don’t think you need to pursue this any further. MR. FERLEGER: Okay. JUDGE GIBBONS: I have made the point that this private institution is more luxurious than state institutions. MR. FERLEGER: No further question, Doctor. JUDGE GIBBONS: Mr. Roth? MR. ROTH: Just a few questions, please. Dr. L. D. Tashjian—Redirect 671la Redirect Examination BY MR. ROTH: Q. I believe Mr. Ferleger indicated on cross-exam- ination that he sought you as a witness; is that correct? A. Yes, it is. Q. Why did you not appear as Mr. Ferleger’s wit- ness? A. Well, I weighed very carefully both sides of the case at hand and decided that my own philosophy, my own professional beliefs lay more on your side than on his side. MR. ROTH: No further questions, your Honor. JUDGE GIBBONS: Doctor, is it fair to say that respectable psychiatric opinion exists which would (184) differ from your own as to the issues in this case? THE WITNESS: Yes. Yes, it is, sir. JUDGE GIBBONS: From the medical or psy- chiatric point of view, rather than from a due process point of view, is there any medical or psychiatric reason for distinguishing between adolescents and young adults for purposes of a precommitment hear- ing? THE WITNESS: Are you defining an age point, sir, in the distinction? JUDGE GIBBONS: Suppose you define an age point. I think the law defines the age point as 18. THE WITNESS: Well, if we say adolescents are 13 to 18 and young adults from 18 up to 25, yes, I think there are medical and psychiatric reasons for making such a differentiation along the lines which ot? ue) 672a Dr. L. D. Tashjian—Examined by Court I have sketchily presented Monday, that it’s pre- sumed in general—and certainly there are exceptions in both sides of 18—that a young person by the time he would have reached his 18th birthday, will have navigated the major issues of his developing into an autonomous person and developing a personal sense of identity which is separate and distinct from that of his family. It is presumed that he will in a psychological sense have reached maturity and be able to make judgments in his own regard. (185) JUDGE GIBBONS: I suppose you would testify that for the under 13’s, it is a fortiori case that they have not reached that state of develop- ment? THE WITNESS: I don’t understand the term, sir. JUDGE GIBBONS: Let me ask it this way.@ Would you make the same distinction between young adults and children under 13? THE WITNESS: Yes, I would, because the child under 13 has much less developed psycholog- ically than the adolescent. JUDGE GIBBONS: Thank you, Doctor. MR. FERLEGER: If it please the Court, for the purpose of the photographs Dr. Tashjian has identi- fied, | move the admission of plaintiffs’ Exhibit 8. JUDGE GIBBONS: For what they are worth, it will be admitted in evidence. Dr. D. H. Miller—Direct 673a (Whereupon, the brochure referred to above, was marked plaintiffs’ Exhibit 8 in evidence as of this date.) MR. ROTH: Dr. Miller. DEREK HARRY MILLER, sworn. THE CLERK: Would you state your full name? THE WITNESS: Derek Harry Miller. JUDGE GIBBONS: Mr. Roth, would you please (186) keep your voice up today. We had a little dif- ficulty hearing you on Monday. MR. ROTH: Yes, your Honor. Direct Examination BY MR. ROTH: Q. What is your profession, please? A. I am a physician and psychiatrist. Q. Are you licensed to practice medicine and: psy- chiatry? A. Yes. Q. Where are you licensed? A. I am licensed in Michigan. I am licensed in parts of Canada. I am licensed in Great Britain and Northern Ireland and various dominions. Q. What medical schools are you a graduate of? A. Leeds, Engiand. Q. Where did you intern? A. I interned at Leeds University and another in- ternship in Canada. Q. Where did you perform your residency? 674a Dr. D. H. Miller—Direct A. In Canada and a residency in the Menninger Foundation, Topeka, Kansas. Q. What is your medical specialty? A. Psychiatry and in particular adolescent psychia- try. Q. What specialized training have you received in the field of child psychiatry and adolescent psychiatry? (187) A. When I was a resident in Topeka, we had a special course in child psychiatry. We did not, in those days, have a special course in adolescent psychiatry. Adolescent psychiatry is a relatively new subdivision of child psychiatry or psychiatry as a whole and I would have to say that my learning in adolescent psychiatry was one which I guess I sort of led the field in with a group of other people and that I and some other psychiatrists, in the 50’s, started to work very significantly with adoles- cents. There had been some work before 1939, but not very much. Q. Doctor, are you a diplomat of any Board of . Psychiatry? A. Yes, I am a diplomat in Great Britain in that I am a member of the Royal College of Psychiatrists. I also have a higher medical qualification in psychia- try. That is to say, in Britain, you graduate in medicine with an M.B. I have also an M.D. It is like a Doctor of Medical Science in this country. It is sort of one-up on the standard medical degree, if I may put it that way. Q. Doctor, have you ever taught psychiatry? A. Yes. Q. Have you ever taught adolescent psychiatry? Dr. D. H. Miller—Direct 675a (188) A. Yes, indeed. Q. Where have you taught adolescent psychiatry? A. I taught adolescent psychiatry in England at various colleges of the University of Sussex, Oxford, Cam- bridge and at the Tavistock Clinic which is a private non- profit-making foundation in England which is run by the National Health Service and is unique in the world. In this country I teach at a number of universities. I teach at a regular basis at the University of Michigan. Q. What is your current position? A. What? Q. Where is your current position and what is it? A. Currently I am chier of the adolescent service at the University of Michigan in the Department of Psychia- try. I am associate chairman of the Department of Psy- chiatry. Q. Have you authored any psychiatric articles or books which have been published. A. Yes, a great many. MR. ROTH: At this time, your Honors, I would like to introduce into evidence Dr. Miller’s Curric- ulum Vitae, which I have marked as defendant’s Ex- hibit 11. JUDGE GIBBONS: Would you show it to (189) Mr. Ferleger? MR.ROTH: Yes. JUDGE GIBBONS: It will be admitted. (Whereupon, the Curriculum Vitae of Dr. Miller was received in evidence and marked defendants’ Exhibit 11 as of this date.) JUDGE GIBBONS: I hear no objection; is that correct? Rina ; 676a Dr. D. H. Miller—Direct MR. FERLEGER: That’s correct. Continued Direct Examination BY MR. ROTH: Dr. Miller, how long have you been practicing child and adolescent psychiatry? A. Since about 1955. Q. Does your practice include family psychiatry? A. I don’t believe you can treat adolescents without also treating families. Q. Doctor, throughout this hearing, the terms “child,” “infant,” “youth,” “adolescent,” and “juvenile” have been used interchangeably. Would you please tell us when these terms come into being in connection with human development? A. Yes, broadly, many of these terms as you know, as is always the case in the English language, are used multiply. One looks at infants as human beings up (190) until the age two. The word “child” is used, interestingly, | sometimes for people up to the age of about 18. Although I think from a medical point of view it probably makes more sense to talk about a child as being a human being up until the age of puberty. “Adolescence” is a stage of development and within that age which is crudely con- sidered to cover the teenage years, there are at least three developmental periods which are sharply defined. There is a period which lasts about three years in which we are responding to the physical changes of puber- ty. If you are going to put age norms on, this period ends Dr. D. H. Miller—Direct 677a at about 14, 15. At about the age of 14, 15, in Western society, generally human beings begin to get interested in a fairly significant way in things that go on outside the family. Generally, the great flush of growth is over. There is another stage of human development which is middle adolescence, a period in which we are learning to get a sense of ourselves and that lasts about three years and during this period of human development, we are be- ginning, as it were, to ease ourselves away from our fam- ilies, although, interestingly, we get very conformist to family norms. The 15, 16, 17 year old, roughly in this period, is not rebellious at all. They are really very (191) conformist and the last phase of adolescence is one of the periods which is not related to physical growth, and that is a peculiar development associated with our society in which we give people an interesting moratorium. We say, “You must train for certain adult roles in society, but while you are training for these roles in some way, we insist on treat- ing you as if you were not yet adult.” For example, we do this with money; we do this with responsibility about marriage, and so on. So you get a rather prolonged period called “late adolescence,” in which people learn to cope with the identity they have already got. Within this period there is a fluctuating re- lationship to families. That is, through the pubertal period, I would say that in terms of human development, you’d have to say that the family-peer relationships and extra parental-adult relationships are all extremely significant and the family needs to be reinforced in its values for the child by what adults and social networks who are not in the family say about the family, if I make the point. 678a Dr. D. H. Miller—Direct After the age of 15, a healthy—15 is arbitrary be- cause it may be 17 in some people—after the age of 15, the family as it were is a very necessary back cloth against which development will take place. Having had your healthy family hopefully, about the time (192) you are 15 or 16, you are ready to launch into society somewhat, but you still need to check back, if I can put it this way, with your family. Now, with children or adolescents who are psycho- logically disturbed, the family relationships clearly are dif- ferent. Insofar as adulthood is concerned, there have been interesting definitions of it. One definition is, which I think is nice, by the time you are an adult you are able to predict the likelihood of your prebehavior insofar as it will affect your future possibilities. Or, by the time you are adult, you are able to tolerate being frustrated without necessarily inflicting pain on other human beings. You are adult when you are able to hold your worries and hold your anxieties and not make other people suffer, because of your psychological pain. Q. Are adults and adolescents psychologically the same? A. No, they are psychologically quite different. Perhaps a good demonstration of this would be the issue of the relationship of human beings to time. For example, an adult, and I am talking about a healthy adult, generally has a fair concept of the future. An adolescent is still rather present oriented. Now there are different developmental rates in men and women. Women reach adulthood chronologically a year or two before men. So, for example, you constantly (193) get into trouble on campuses when young couples Dr. D. H. Miller—Direct 679a live together as they currently do in that the women often, they have a great sense of the future and they say and feel, if you really loved me, you would want to live with me forever. The young man of 18, 19, in this late adoles- cence phase still doesn’t have a great sense oi the future and they are very much wanting things here and now and get anxious, but people start talking about what you do now will affect you or should go on for a very long time. There are many examples. Q. You have talked in terms of the normal adoles- cent and adult. How would that be viewed in terms of the abnormal or the disturbed, if you will, adolescent and adult? A. There is a very important point about disturb- ance, that is never ubiquitous [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%3A05. Public record. Not legal advice.