The Massachusetts Supreme Judicial Court waded into the debate over psychiatric patients in hospital emergency rooms Thursday.

The central question in this case is how long hospital emergency rooms can hold someone who is civilly committed to psychiatric treatment. Most committed patients first go to emergency rooms, where doctors determine if the patient should be placed in a psychiatric facility and where.Although state law says a psychiatric patient can be involuntarily hospitalized for up to three days, many stay in the ER much longer. A lower court ruled that a hospital must adhere to the same three-day limit.

"If the person is brought to a psychiatric hospital right away, they have right to counsel, appointed counsel, an emergency hearing. In the ER, there's none of that. It's a no man's land," Chief Justice Ralph Gantz said during the hearing.

Emily Kanstroom Musgrave, attorney for Massachusetts General Hospital, argued that the three-day clock should begin once someone is placed in a psychiatric facility, not once they're admitted to the ER. She said the emergency team has to look at the specific needs of every patient:

"It's not a no man's land," she said. "It's a place where the person is being kept safe, cared for, triaged and assessed, because getting to the facility involves a complicated assessment that involves not only finding a bed in an appropriate facility but ensuring, as I say, that bed is appropriate." 

Kanstroom Musgrave said if there are time limits, patients who might harm themselves or others would have to be released.

Documents in this case were impounded to protect patient confidentiality, but, according to the lower court ruling, the patient in this case was held in the MGH emergency room for five days before going to a psychiatric facility.

Karen Owen Talley, an attorney with the state public defender agency representing the patient, said three days should be the maximum someone can be involuntarily held, regardless of the facility.

"If the alternative argument, the one the appellate division ultimately utilized is accepted, that's a period three business days," Owen Talley said.

"Then what happens if they can't do it in three business days?" asked Justice Barbara Lenk.

"Then the person needs to be discharged," Owen Talley replied.

State department of mental health data show that, in 2018, the Section 12 law was used tens of thousands of times.

The court is expected to make its ruling in the next few months.

This story comes from the New England News Collaborative, eight public media companies, including The Public's Radio, coming together to tell the story of a changing region, with support from the Corporation for Public Broadcasting.