Feb 19, 2009 07:00 PM

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In Turners Falls, nearly 100 miles west of where she spent decades confined in Boston psychiatric facilities, Ruby Rogers died quietly in a nursing home, a relatively anonymous end for a woman whose name is routinely invoked during Massachusetts court hearings involving the mentally ill.

“They said she just lay down and went to sleep,” said her sister, Claudette Smith of Dorchester.

Ms. Rogers, who spent her last years at the Farren Care Center, left a sweeping legacy that established key rights for the mentally ill in the Commonwealth. With Rogers v. Okin, the landmark case that bore her name, she also helped determine the course other states took to help certain psychiatric patients participate in decisions about their treatment. Courts and lawmakers elsewhere examined the precedent that Ms. Rogers and six others set with the lawsuit they filed in 1975.

As a result of that case, the mentally ill in Massachusetts must give informed consent before doctors and nurses administer medication. A doctor who believes a patient isn’t competent to grant permission must schedule what is known as a “Rogers hearing.” If the patient is found to be legally incompetent, a judge – through what is called “substituted judgment” – decides whether the patient would want to accept the prescribed treatment.

The state Department of Mental Health plans to honor Ms. Rogers, who was 71 when she died Jan. 12, during a legislative breakfast March 2 at the State House.

The case began when Richard W. Cole, only months out of law school and working for Greater Boston Legal Services, went to Boston State Hospital as an advocate for the patients and listened to their complaints. At the time, mentally ill patients could not refuse treatment in Massachusetts once they were committed to a facility such as Boston State.

Among the seven patients who took part in the court fight, he said, Ms. Rogers was notable, in part because she had voluntarily entered the hospital seeking help.

“Ruby became the lead plaintiff,” Cole said. “We decided that based on Ruby’s personality, her strength, how vibrant she was as a woman, and also because of her story, that she made the most sense to be the first name in the litigation.”

Taking the stand in US District Court in 1978, Ms. Rogers told harrowing tales. Even though her concerns about her mental stability prompted her to seek treatment, she ended up setting her hair on fire in an attempt to get transferred out of Boston State Hospital after she was repeatedly forced to take antipsychotic medications with devastating side effects.

“It felt like something was crawling on my feet and biting them,” she testified. “I didn’t sleep. . . my arms and legs were jerking, twitching uncontrollably . . . my whole body quivered. When I would put on my clothes, it would take about an hour to put my slacks on. I couldn’t put my hands up to comb my hair.”

Ms. Rogers testified that if she refused to take her medicine, “I was just seized by six or seven men and rushed into seclusion and given the needle.” Locked in the seclusion room with no toilet, she “had to go on the floor,” which was cleaned only when a nurse came by to hand out medication.

“You always felt you were smothering or dying,” she said of being confined in the room. “It felt like it was 475 degrees in there. I couldn’t breathe. Most of the time I couldn’t get water. I used to holler to get out.”

In October 1979, Judge Joseph L. Tauro issued a stern ruling in the case, which was appealed to the US Supreme Court before being sent back to state courts for adjudication.

“Whatever powers the Constitution has granted our government, involuntary mind control is not one of them, absent extraordinary circumstances,” Tauro wrote. “The fact that mind control takes place in a mental institution in the form of medically sound treatment of mental disease is not, itself, an extraordinary circumstance warranting an unsanctioned intrusion on the integrity of a human being.”

In a nod toward Ms. Rogers, he ruled that voluntary patients had the same right to refuse treatment as those committed involuntarily. And addressing issues she and others raised in testimony, Tauro wrote that “it is an unreasonable invasion of privacy, and an affront to basic concepts of human dignity, to permit forced injection of a mind-altering drug into the buttocks of a competent patient unwilling to give informed consent.”

Then and now, many psychiatrists disagreed with the ruling.

“I think it built into the law that families cannot be trusted to make decisions for their children or parents or spouses,” said Alan A. Stone, the Touroff-Glueck professor of law and psychiatry at Harvard University. “In my view, judges have no basis to make these decisions. They don’t know the patients, they don’t know the illnesses, and they don’t know the families. So we go through long, complicated hearings about whether patients should receive medications for their psychoses.”

Born in Clinchco, a tiny rural town in western Virginia, Ruby Rogers moved to Boston after high school and encouraged her younger siblings to follow.

“There was no work in Virginia for young girls or people of color, and she came here to better herself,” her sister said.

Ms. Rogers worked as a nurse’s aide at Boston City Hospital before deciding she needed help for mental illness. By then, she had six children, who went into foster care when Ms. Rogers was hospitalized, her sister said. Smith said the family has not been able to locate them.

“She loved her children dearly,” Smith said. “Before she died, that’s all she talked about.”

In addition to Smith, Ms. Rogers leaves two brothers, Robert of Hyde Park and Jessie Anderson of Mattapan; and three other sisters, Kay Tyree of Sharon, Nancy Blackley of Walpole, and Brenda Ellis of Norton, Va.

“Ruby was a beautiful person, and I miss her,” Smith said. “I’m going to take her remains to Virginia and bury her next to our mother, sometime in the spring.”

Ms. Rogers remains a presence in Massachusetts courts and in Somerville, where the Ruby Rogers Center assists those who have been patients in the mental health system.

“She was willing to put herself on the line and fight for her rights and fight for the rights of other people who were in her situation,” said Judi Chamberlain of Arlington, an advocate who formerly was program coordinator at the center.

“For all those years, Ruby hung in there, never wavered, and was a great spokesperson for what was really the core issue of the case,” said Cole, her attorney. “This really helped her as she struggled with her problems over the years, the knowledge that she had accomplished something real and important.”