A jury found Victor Zigmund not guilty of criminal charges by reason of insanity. The court placed him in a maximum security hospital facility for the treatment of mentally ill and dangerous patients.
The Right to Spit
On April 24, 1997, Zigmund confronted hospital staff regarding delays in sending out his legal mail. According to hospital staff, Zigmund threw his pencil and spit at staff members. After consultation with a psychiatrist, the hospital staff placed Zigmund in seclusion in four-point restraints. While Zigmund was restrained, another psychiatrist, Dr. John Young, examined him and found him agitated, hitting the mattress with his head, biting the straps and cursing. Dr. Young ordered a tranquillizer. Zigmund stayed in restraints and seclusion from 4 pm to 11:30 am the following morning.
Zigmund filed suit claiming a violation of free speech because he could not express himself freely without being penalized. He further claimed a due process violation due to the seclusion and restraints he endured for over eighteen hours. Hospital staff filed for summary judgment.
In determining the rights of an institutionalized person, the US District Court looked to the law developed in cases concerning persons confined in correctional institutions. The needs of the penal institution impose limitations on constitutional rights. A Prison regulation which impinges on inmates’ constitutional rights is valid if it is reasonably related to legitimate penological interests.
The court found that hospital’s policies did not prevent Zigmund from expressing his disagreement with the decisions of staff members. In fact, the hospital plan specifically provided for patient involvement in individual treatment plans.
Checking the Restrained
But the imposition of seclusion and restraints presented a closer issue. In Youngblood v. Romeo, 457 U.S. 307 the US Supreme Court held that persons confined in state facilities are entitled to reasonable care and freedom from undue bodily restraint. But the patient’s rights are not absolute and must be balanced against the state interests in protecting the patients and staff from violence and in training and treating the patients. Decisions of the professionals regarding the treatment of patients are presumptively valid, and liability is imposed only if there is a substantial departure from accepted professional standards. Bell v. Wolfish, 441 U.S. 520. There is no constitutional right to the least restrictive environment. Society for Good Will to Retarded Children, Inc. v. Cuomo, 737 F.2d 1239.
The Court then considered the hospital’s written policies. The policy provided that seclusion and restraints are not to be used for more than three hours without reassessment of the physician and only after other less restrictive measures have been attempted. In light of this clear policy, the court found it could not conclude as a matter of law that the hospital’s use of seclusion and restraints for eighteen hours did not substantially depart from accepted professional standards. Summary judgment denied as to use of seclusion and restraints, granted on all other grounds.
