Psychiatric patients may not be held for extended periods in emergency rooms during an involuntary hospitalization without a judge being alerted, the state supreme court ruled Thursday.

The Maine Supreme Judicial Court is enforcing a limit of five days, with a judge’s approval, for someone to be held in an emergency room against their will. A judge must be notified within 24 hours, the court said.

The ruling came against a backdrop of an uptick in mental health worries during the pandemic and a shortage of psychiatric hospital beds in the state.

The court ruled unanimously in the case of a patient who was held for a month against his will last year in the LincolnHealth Miles Campus Hospital emergency room in Damariscotta.

“This case is important because it reaffirms that people who are experiencing mental illness or have disabilities still have due process rights,” said Emma Bond, attorney for the American Civil Liberties Union of Maine. She described the ruling as a “road map” for hospitals to follow.

Hospital staff filled out the necessary paperwork for emergency involuntary hospitalization every 48 hours but never sent the paperwork to a judge because the patient was awaiting placement in a psychiatric hospital. Without an official placement, the hospital contended, a judge couldn’t endorse the application for involuntary committal.

A lower court judge upheld the hospital’s handling of the case. The patient, who was delivered to the hospital by police, was released after 30 days.

The Maine Supreme Judicial Court acknowledged there’s no relief that can be provided to the patient, but decided to take up the case because of its importance and to offer guidance in such situations.

State law allows two additional 48-hour extensions after the initial 24-hour period if a judge accepts a hospital form explaining that the patient poses the likelihood of serious harm due to mental illness and if a hospital has been unable to find a placement in a psychiatric hospital, the court said.

If there are no psychiatric beds available, and the patient is still a danger, then the process can be restarted by going back to a judge, the court said.

The hospital thought it was working in the patient’s and community’s best interests and was following forms and instructions provided by the Maine Department of Health and Human Services, said James Bailinson, attorney for MaineHealth, which is the hospital’s owner.

“What’s good about the opinion is that it provides some clarity in an area that had a lot of unresolved issues. It tells the hospital what procedures to follow,” the attorney said.

The court said the judge has some flexibility, but the judge’s involvement is key to the process. In this case, the patient had been held in the emergency room for 25 days by the time the patient took the matter to a judge.

The court also ruled that the judge should have applied a stricter standard of “clear and convincing evidence” instead of a “preponderance of the evidence” for involuntarily holding someone against their will.

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