Pierce v. Pemiscot Hospital: Federal Judge Takes a Psychiatric Inmate’s Rights Seriously


On June 13, 2014, United States District Court Judge Carol E. Jackson issued a Memorandum and Order decision holding that a former psychiatric inmate was allowed to bring federal civil rights claims under 42 U.S.C. §1983 against hospital personnel when the hospital continued to hold her against her will after authorization had expired.  The court also held that at that preliminary stage the former patient could maintain her action for battery for forced drugging.  The procedural setting is called “summary judgment,” which is whether, based on facts that are not in dispute, either side is entitled to win as a matter of law.  To the extent facts are in dispute summary judgment cannot be granted.


Ruth Pierce, then an 84 year old widow, was court-ordered into the hospital on what is called an ex parté petition upon the allegation that “she had displayed mental instability and threatened bodily harm to others.”  Ex parté means without her being informed or given a chance to present her side. Under Missouri law, the hospital had to file a petition for a further period of detention to hold her more than 96 hours.  The hospital never filed such a petition and then later tricked Ms. Pierce into signing a voluntary admission form.  It came out that it is standard procedure in Missouri to ignore the 96 hour rule.

The defendants, Dr. Pang, and Ms. Moore moved to throw the case out of court on various grounds, such as Ms. Pierce did not file a health care affidavit required in medical malpractice cases and that they were immune.

42 U.S.C. §1983 allows people to sue for violations of federal civil rights, including constitutional rights, against people acting “under color of state law,” meaning implementing state law or acting under the authority of state law.  Money damages are allowed as well as injunctions and to obtain rulings on what the law is.

The Ruling

In her Memorandum and Order decision, Judge Jackson took Ms. Pierce’s rights seriously and, reading through it, one gets a sense that the court was offended by the cavalier attitude of hospital personnel towards their patients’ rights.  More specifically, the court held that Ms. Pierce was allowed to go forward with her claims against Dr. Pang and Ms. Moore for unlawful psychiatric confinement under the United States Constitution as well as state law claims for false imprisonment, and battery for forced drugging.

More specifically, with respect to being detained without due process of law, the court noted:

To establish a procedural due process violation, plaintiff must demonstrate that she has a protected liberty interest at stake and that she was deprived of that interest without due process of law. “For more than a century the central meaning of procedural due process has been clear: Parties whose rights are to be affected are entitled to be heard; and in order that they may enjoy that right they must first be notified. It is equally fundamental that the right to notice and an opportunity to be heard must be granted at a meaningful time and in a meaningful manner.”  “These essential constitutional promises may not be eroded.”

“[F]or the ordinary citizen, commitment to a mental hospital produces a massive curtailment of liberty, and in consequence requires due process protection.” (“It is undisputed that ‘civil commitment for any purpose constitutes a significant deprivation of liberty that requires due process protection.’”). Even where a patient’s initial confinement is founded on a constitutionally sound basis, it cannot constitutionally continue after that basis no longer exists.

With respect to the battery claim, the Court held:

To establish battery based on lack of consent, “a plaintiff is only required to prove the occurrence of unconsented touching.”  Therefore, plaintiff must plead and prove that she did not give consent or that she withdrew consent.

Many people have argued that forced drugging that was not properly authorized is a battery and this court agreed.

Ms. Pierce also filed what is known as a substantive due process claim.  The Court held:

[T]he state violates substantive due process when it infringes “fundamental” liberty interests, without narrowly tailoring that interference to serve a compelling state interest

In sum, the Court basically held that Ms. Pierce was allowed to go forward with these claims and later set November 17, 2014 as the date for jury trial.  However, since then the defendants have moved to file what is known as an interlocutory appeal, meaning to appeal before the case is over and to put the trial on hold until such an appeal is filed.  As of this date the court hasn’t ruled on these motions.

The Importance of Taking Such Cases

In my first blog on MadInAmerica.Com, A Three Pronged Approach to Mental Health System Change, I wrote about how taking strategic cases can force changes in the mental health system.    It is clear that if the Court’s ruling is upheld, it can result in dramatic improvement in the way people are treated in Missouri psychiatric hospitals.

In my 2008 law review article, Involuntary Commitment and Forced Psychiatric Drugging in the Trial Courts: Rights Violations as a Matter of Course, I point out that while the article specifically addresses Alaska’s involuntary commitment and forced drugging regimes, the same thing happens throughout the country with just the details being different.  Ms. Pierce’s case illustrates that this is so.

The Court’s ruling is on all fours with what PsychRights has been asserting since its founding in 2002.   I talked about these principles in Role of Litigation in a Strategic Approach to Mental Health System Change (YouTube video of whole talk) at NARPA-the National Association of Rights Protection and Advocacy in 2013.  I start talking about these legal principles at 32:36.

Kudos to Jim Bruce for taking this case.  We need more like him.

Thanks to Susan Stefan for bringing this decision to my attention.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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Jim Gottstein, JD
Law, Alternatives and Change: Law, Alternatives and Change: A Harvard-educated lawyer and long time activist for change in the mental health system writes about law as it relates to psychiatric rights and fostering truly helpful, non-coercive alternatives to the current system. Jim's book, The Zyprexa Papers, chronicles the dramatic events surrounding his subpoenaing and releasing secret, damning Eli Lilly documents and surviving the resulting legal onslaught by Lilly, as well as his battles fighting the forced drugging of Bill Bigley for whose case the documents were subpoenaed.


  1. Yeah, the facts of this case are so common that if the plaintiff here wins, it will affect cases throughout the whole country. How arrogant these people are! And that of course is very common too. Thanks for bringing this to our attention, Jim.

    Forced drugging as battery? How great it would be to establish that. Of course it always has been, but the courts have ignored it right along.

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    • The laws already establish that forced drugging is a battery. It becomes an assault if they do it with force.

      The only way it is not a battery or assault is if done lawfully by following laws on forced drugging in her resprective state. But because her detention itself was illegal they obviously didn’t follow those rules, making it a crime.

      Regardless of if they followed the rules you can always sue if excessive use of force was used or for the forced drugging. It is always a battery but its a matter of if you can get an attorney or legal argument together to combat it. Injuries from drugs are well established also, so medical negligence is another possible way to get damages.

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      • “The only way it is not a battery or assault is if done lawfully by following laws on forced drugging in her resprective state. But because her detention itself was illegal they obviously didn’t follow those rules, making it a crime.”

        The person administering the drugs would have to be aware that the detention was unlawful before forced drugging would be considered a crime. The “good faith” defense would be offered, and accepted.

        I don’t know about the US but where I live it’s the ace on the bottom of the deck. The only way that the “good faith” defense would be invalid is if there had been an act of negligence.

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    • I honestly anything will change until the people who infringe on others rights are prosecuted and severely punished. I am currently living in Europe and following waht is going on here. There were 2 recent cases from Poland and Germany, which are strikingly similar. In each a man was held for about 8yrs in a psych ward (in case of Poland also forced drugged) with paranoid schizophrenia diagnosis. In both cases it was used as cover up after the person in question threatened to expose corruption (in Germany I think it was in a bank, in Poland in local government). After the year long ordeal both men were finally released but of course none of the “doctors” were held responsible. Until people who lock others up against the law face zero consequences we are doomed. And these are only the most publicized, political cases – I’m not even mentioning countless other cases of “malpractice” resulting in death, people forced to wear underwear over their heads to be laughed at, children injected with saline as a punishment, people strapped in restraints and left in their extrements… all reported in press. Guess how many people faced criminal charges over that? For me the only real way forward is complete abolishment of forced psychiatry.

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    • Don’t think you could demonstrate mens rea s1w2f3.

      Often wondered what would happen if as a doctor I just walked up to a woman in the street and began examining her breasts. According to our Chief Psychiatrist I’d be in the clear because I’m a doctor and I implied consent.

      Thats one of the little cons they use in our system. Imply consent where it could not possibly be assumed.

      It would be quite an achievement if civil rights were extended to all citizens.

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      • The problem you guys face is lack of legally mandated attorney representation during these state sponsored forced treatment procedures.

        It is technically a battery any time a medical treatment of any kind is done without informed consent and without following the laws. Unfortunately the laws do permit forcing of procedures but strict due process applies. I am not sure a forced catheter would ever be considered legal because you have the right to refuse even life saving treatment even if found incompetent . a procedure exists in most states to override only for certain things, usually forced psychiatric care or times of emergency (you cannot even speak and may die without intervention).

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  2. This appeared in our news the other day


    Police drop charges against a woman being unlawfully deprived of her liberty by hospital staff, when she tried to stop them committing a crime against her.

    Police would obviously have statements of admissions from the hospital staff, and deprivation of liberty is a serious offence. I wonder when charges will be preferred. Not holding my breath.

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  3. Thanks for this, Jim.
    And for all you do.

    If memory serves, it was the U.S. Supreme Court that also ruled that forced psychiatric imprisonment is a “massive curtailment of liberty.”

    My question for any/all shrinks who continue to think they can lock someone up without due is simple:

    What is it about massive con is it that you don’t understand?
    And if you think it’s a “therapeutic” thing to lock someone up like a dog in a kennel…
    You first!


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  4. This is great but my experience is that lawyers won’t take these cases.

    My civil rights were violated right from the start, the hospital intake strip search I believe violates my 4th amendment rights. Then the injection threats in response to rejecting a neuroleptic overdose including Haldol. Then that hearing was not held on time so authorization to hold had expired.

    All this abuse happened after I voluntarily went for alcohol detoxification on my own no coercion but then got labelled “bipolar mixed” evidenced by “speech is rapid” and all that crap on my medical records to justify a month long nightmare.

    Why did all this happen to me ? You have the same people making money keeping the beds full wile using no medical tests deciding who is ‘sick’ and who is well. A glaring conflict of interest that should be illegal.

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    • Anyway I am glad to see the forced drugging is a battery charge even though having lived it I think rape is a better description of being forced to have those psychiatric chemicals forced/coerced into in ones bloodstream.

      False imprisonment is an outside the body violation , forced drugging is an inside the body violation. The difference is monumental.

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        • I want to explain to the readers that it may in fact be a criminal matter of what is happening but prosecutors rarely take these issues up as criminal even if people get severely hurt as a resul of the violations. Jim probably speaks jursdictionally in that the laws tend to push this issue towards a civil issue and that is generally your only option for help if the police/prosecutors refuse to protect you. And just because the law authorized something or made it look legal, does not in any way shape or form actually make it legal .. Unfortunately having a lack of remedy or way to pursue your case makes it legal.

          We know the state is being allowed to criminally abuse citizens through the law. . this is the only reason it is seen as legal in any way shape or form. http://www.obamasweapon.com/

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      • I should have filed a lawsuit myself.

        I just searched “file lawsuit without an attorney” many pages came up and this seems to be one of the better ones “PRO SE PACKAGE, A SIMPLE GUIDE TO FILING A CIVIL ACTION” http://www.caed.uscourts.gov/caed/documents/forms/civil/prosepack.sightimpaired.pdf

        It’s really sad because one of the most common reactions to psychiatric inpatient abuse is stating “I am going to sue this place”. I must have heard it 50 times yelled in the hallway by different people during my stay in that snakepit but the reality is it’s way way to difficult and these ‘hospitals’ know it.

        And they have no problem threatening patients with the legal system, when I stated there would be street justice outside the hospital on even ground if they carried out their threats of forced injection needle assault for my pill refusal I am the one accused of breaking the law and threatened with charges.

        For that my medical records state I was placed on ‘assault precautions’ .

        I really can’t put into words for some who never lived it exactly how bad this situation was stuck between swallowing that overdose of brain damage pills with their horrible effect on my mind and body functions or face down a possible needle assault. I chose the latter because swallowing that many pills including Haldol was not an option for anyone who cares about their health and life.

        There was no need for any of this. I could have been on my way in 2 or 3 days and back to my recovery with a lesson learned about drinking but instead I had to endure this $20,000 nightmare for refusing to get all screwed up on psych pills and then have to detox from them when it was over and endure nasty insomnia , anxiety… All those nasty neuroleptic withdrawals and withdrawal from that ‘mood stabilizer’ pill they tried to force that included possible seizures !

        Seizures, great. All my experience with psychiatry, including everything I saw in that place confirms one thing, Psychiatry is a disgusting crime against humanity that needs to be held accountable, that’s why I do all this posting online.

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        • ….For that my medical records state I was placed on ‘assault precautions’

          They broke into your body and thus they naturally fear retribution. Society allows a person to defend their turf with deadly force (at least in many US states). If you had become delusional enough in their eyes to consider yourself a person and not a mental patient, the treat to them would have been real.

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  5. “Ruth Pierce, then an 84 year old widow, was court-ordered into the hospital on what is called an ex parté petition upon the allegation that “she had displayed mental instability and threatened bodily harm to others.” Ex parté means without her being informed or given a chance to present her side.”

    Are there any protections in this system?

    For example, does the petition need to be completed by someone with the authority to do so?

    Does this authority need to actually observe the behaviour, or can they accept the word of someone who may have motive to lie?

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    • You might read the decision, but the most important protection is that the hospital has to file a further petition if they want to hold the person more than 96 hours and then the person gets a court hearing where she can present her side. The hospital’s holding Ms. Pierce for months without such a hearing is what Ms. Pierce sued over.

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      • “Under chapter 632, Mo. Rev. Stat., any adult can file an ex parte application for detention of another person for evaluation and treatment, supported by an affidavit that the respondent is “suffering from a mental disorder and presents a likelihood of serious harm to himself or to others”. §632.305″ (p.9).

        Wow, if only I’d known this when I wanted to have a party when I was 18. I could have had my parents banged up in a mental institution for 96 hours by signing a piece of paper?

        Still, better late than never, I do have a neighbour I don’t like the look of.

        That is even worse than our system here in Western Australia. How would an adult know whether a person was suffering from a mental disorder? Do they issue the DSM like phone books to every home?

        In our system an Authorised Mental Health Professional must sign a statutory declaration of observed facts. What they do to get around this is present hearsay as if they actually observed them and the detention looks lawful. So we have legal protections that are overcome with an act of fraud. Nobody ever gets caught though because the Chief Psychiatrist just says what’s on the Form doesn’t matter, and refuses to look at any evidence.

        It does mislead the public into a false belief that they are protected though.

        Thanks Jim.

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  6. There is something really smelly about the conspiracy to get Ms Pierce to sign the voluntary admission form.

    Dr Pang makes the comment about tricking Ms Pierce. The evidence from Van Sickle informing Ms Pierce that she had been tricked by Jeffers and DeProw, and then the striking out of the notation about the paperwork being signed as an error by Johnson. CYA?

    I’d be having a good hard look at the Pang – Jeffers relationship. If they were aware that Ms Pierce was being unlawfully detained (and it seems from the evidence that they were) then surely conspiring to cover this would be criminal?

    I understand the reasons that this is being perused via the civil courts as the burden of proof is lower, but if I were an investigator I’d be putting some heat on Jeffers.

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    • As a nurse that works for this company and some of these have been coworkers, I assure you it is a good psych unit. Dr. Pang is a good doctor and Jeffers is a good nurse.

      84 years old in a psych unit — of course she wants to go home.
      psychotic — of course she doesn’t want medication.

      until you have worked with psych, it’s hard to understand.

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      • Not really hard to understand.

        Good people sometimes do bad things, it is how they react when their integrity is tested that is the true test of their worth. Attempting to have someone sign a document that will conceal evidence of a possible criminal act and then smearing the character of witnesses is hardly ‘good’ behaviour.

        No special career path required to understand that.

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      • People who drugs others against their will (also known as psychiatric rape) aren’t good doctors.

        “of course she wants to go home” “of course she doesn’t want medication.”
        Yeah, so? If she wants to be home then she should go home. You people are so arrogant to think that when someone does not want to listen to you it means they’re crazy. Forced psychiatry has to be abolished. I’ve got enough of the “good people” who commit crimes against humanity. Auschwitz criminals were also “good people” with families and dogs and throwing lovely parties for their friends.

        “until you have worked with psych, it’s hard to understand.”
        Until someone abuses you and rapes you it’s hard to understand (well at least when you have negligible empathy and need to learn these things from experience).

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  7. Thank you. We need more people like you.

    My “legal council” at the hospital occurred when I was so drugged on benzos I don’t even remember it and my lawyer turned out not to speak English (I was held in a “hospital” in Austria), which she as my “legal representative” didn’t think was a problem. Also she told me I should not file any complaints against the hospital because she knows the doctors there and they are all good people. So much about due process.

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  8. Like I said. I am a nurse for thi
    s company . Its a small county hospital. Resolutions is the psych un it. There are good people there.
    forced psych care is a necessity sometimes. This lady was not safe to be home alone. When u are court ordered then guess what? U have not rights! You cannot say no to medication. I agree if someone doesn’t want meds then u shouldn’t force them unless its an injection to calm someone down..

    Example…24 yr old that lives in a group home and is a ward of the state is hearing voices to hurt someone. They refuses psych help. Theh have a power of attorney who says they have to come. They get to our unit and hallucinating and buck wild. We give a shot whether they say yes or not.
    when u aren’t in urban right mind then u cannot make sound decisions.

    I understand ur rape comment. Ill say this about the comment before mine. How about I have been truly, physically raped before.

    All these people seen was the dollar signs.

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    • Nurse Ratched- I don’t know if this is a real story or not. But let’s assume it is. You seem to have trouble putting a sentence together but with your degree in changing sheets and bedpans maybe you can get through it. If the 24 year old is in a group home they are being monitored every single day to take their neuroleptic/ssri/anti-epileptic cocktail. Why are they still hearing voices? Is it because neuroleptics have no specific “antipsychotic property” and they are making this person’s voices and paranoia worse? If so then what is the point in forcing them to get more detrimental useless “help?” nurse Ratched? So you can enjoy seeing someone dragged into a tiny windowless room and have their pants pulled down and give them their “shot” of the same drug they’re already on? So that your hospital (and you as their employee) can siphon off this person’s Medicaid for a couple months? Where is the logic here Ratched? Your only “reasoning” in this misspelled barely coherent paragraph is “I HAVE THE AUTHORITY! I CAN DO WHAT I WANT! IF THE PSYCHOS MISBEHAVE THEY GET PUNISHED!!!!!!!!!!!!!!” That isn’t the way an intelligent calm person thinks or behaves Ratched.
      Nurse Ratched, maybe this human being you’ve dehumanized into a subhuman because of your fear and hatred towards them was going “buckwild”(an animal term) because he/she was taken away from a place they had gotten used to living in with friends/some degree of freedom/contentment and had been violently forced into a prison full of cold sadistic hateful monsters like you.
      https://www.youtube.com/watch?v=EPfKc-TknWU Also Ratched, you should watch this documentary. It’s about woman with “schizophrenia.” She was sexually abused by her stepfather and her mother did nothing to stop him. She has hostile violent voices towards her mother because of this. She is completely cured of the symptoms of “schizophrenia” through empathetic caring therapy and no brain disabling psychosis worsening neuroleptics. She is now a nurse and is probably 10 times better at your job than you are.

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