Buttonow v. Director, Central Islip State Hospital, 29 N.Y.2d 385 (1972)

A mentally ill patient converted from involuntary to voluntary status in a hospital setting is entitled to the same judicial review and assistance from the Mental Health Information Service as patients involuntarily committed, ensuring equal protection under the law.

Summary

This case concerns the rights of an adjudicated incompetent, Josephine Buttonow, who was initially involuntarily committed to Central Islip State Hospital. After five years, she filed a voluntary application to remain, converting her status. Her committee challenged this conversion, arguing it deprived her of legal protections afforded to involuntary patients. The New York Court of Appeals held that to preserve the statute’s constitutionality, patients converted from involuntary to voluntary status must receive the same judicial review and Mental Health Information Service assistance as involuntary patients.

Facts

Josephine Buttonow, an adjudicated incompetent, was admitted to Central Islip State Hospital in 1961 under an involuntary certification order.
In 1966, following an interview with a hospital psychiatrist, Buttonow filed a “voluntary application” to remain, converting her status to voluntary under Mental Hygiene Law § 71.
Buttonow’s committee (guardian) received notice after the conversion and initiated a special proceeding, claiming the conversion was invalid because it deprived Buttonow of legal protections.

Procedural History

The Supreme Court, Special Term, granted the committee’s petition, declaring § 71 unconstitutional due to the lack of judicial review and Mental Health Information Service involvement for voluntary patients.
The Appellate Division affirmed, but on different grounds, holding that an adjudicated incompetent lacks the legal capacity to consent to a change from involuntary to voluntary status.
The New York Court of Appeals granted leave to appeal.

Issue(s)

1. Whether the Supreme Court had jurisdiction over the proceeding challenging the status conversion.
2. Whether an adjudicated incompetent can consent to the conversion of their status from involuntary to voluntary admission in a mental hospital.
3. Whether the Mental Hygiene Law § 71 is constitutional if it does not afford the same protections to patients converted from involuntary to voluntary status as it does to those initially involuntarily committed.

Holding

1. Yes, because Section 100 of the Mental Hygiene Law expressly grants the court jurisdiction over the custody of a person incompetent to manage themselves due to mental illness.
2. Yes, because an adjudication of incompetency does not preclude a person from acting in matters involving their personal status, and the statute specifically states that “legal capacity to contract” is not required for voluntary admission.
3. No, because to preserve the statute’s constitutionality, the law must be interpreted to provide the same rights to judicial review and Mental Health Information Service assistance to patients converted from involuntary to voluntary status.

Court’s Reasoning

The Court found that the Supreme Court has jurisdiction over matters concerning incompetents due to statutory provisions. It emphasized that an adjudication of incompetency does not strip an individual of all personal agency, citing the ability to marry or make a will as examples.
Addressing the core issue, the Court acknowledged the benefits of voluntary admission for mental health treatment. However, it underscored the significantly greater protections afforded to involuntary patients, including mandatory court review of detention and required assistance from the Mental Health Information Service. It quoted People ex rel. Kaminstein v. Brooklyn State Hosp., noting concerns about hospital officials inducing cooperative patients to forego their rights.
The Court held that denying these protections to those converted from involuntary to voluntary status would raise grave constitutional doubts concerning equal protection and potentially due process. It cited Baxstrom v. Herold, emphasizing that distinctions must be relevant to the purpose of the classification.
To avoid invalidating the statute, the Court interpreted it to require that converted patients receive both a right to judicial hearing and review, and the same assistance from the Mental Health Information Service as involuntary patients. This approach aligns with the Court’s established practice of construing statutes to uphold their constitutionality. The court stated: “In short, then, we preserve the constitutionality of the statute before us by reading into it a requirement (1) that a mentally ill patient, converted from involuntary to voluntary status, be accorded a right to judicial hearing and review of his change in status as well as of his continued retention in such changed status and (2) that he be afforded the same sort of assistance from the Mental Health Information Service as is now furnished those who are in hospitals on an involuntary basis.”