This opinion will be unpublished and
may not be cited except as provided by
Minn. Stat. § 480A.08, subd. 3 (1998).
STATE OF MINNESOTA
IN COURT OF APPEALS
In the Matter of:
Beverlee Jean Odencrans.
Filed January 25, 2000
Affirmed; motion granted
Hennepin County District Court
File No. P99960296
Ruth Y. Ostrom, 270 Grain Exchange, 301 Fourth Avenue South, Minneapolis, MN 55415 (for appellant Odencrans)
Amy Klobuchar, Hennepin County Attorney, John St. Marie, Assistant County Attorney, C-2000 Government Center, Minneapolis, MN 55487 (for respondent Hennepin County)
Considered and decided by Anderson, Presiding Judge, Short, Judge, and Foley, Judge.
U N P U B L I S H E D O P I N I O N
Appellant Beverlee Jean Odencrans challenges her commitment as mentally ill, contending there was insufficient evidence to show she met the standard for harm or that the court committed her to the least restrictive alternative. She also disputes the order authorizing medication and contends there was insufficient evidence that she refused the medication. Respondent moves for a correction or modification of the record to supply exhibits missing from the record. We affirm the commitment and order authorizing medication and grant the motion.
Appellant, age 67, has a long-standing diagnosis of bipolar affective disorder. She also suffers from end-stage renal failure, requiring dialysis. She refused some of her medication, leading to decompensation and behavioral problems, and then declined a dialysis session. The nursing home she had been residing at referred her to the Hennepin County Medical Center.
Dr. Nicholas Rogers, appellant’s treating psychiatrist, testified that she frequently refused blood tests and dialysis treatment while hospitalized. Consequently, he declared a medical emergency, and the hospital sedated her so that she could undergo dialysis treatment and receive neuroleptic medication.
Dr. Rogers explained that appellant was generally aware of neuroleptics and their side effects and risks, having received such medication over the years. But appellant does not believe she is mentally ill, that she needs psychiatric or medical treatment, that she has renal failure, or that she needs dialysis treatment. At the hearing, appellant confirmed these beliefs.
Dr. Rogers prescribed the neuroleptic medication Haldol to treat appellant’s psychotic symptoms, with the hopes she would then cooperate with medical treatment. While this particular medication is not ideal, it has the advantage of being injectable should appellant refuse oral dosages. Because appellant suffers from renal failure, dialysis is "imperative and lifesaving." Dr. Rogers acknowledged that appellant has some degree of tardive dyskinesia, exhibiting some tongue and lip movements, as well as tremors. He explained it would be preferable to switch to other medication once appellant begins to cooperate.
Dr. Gary Fischler, a psychologist and the court-appointed examiner, concurred with Dr. Rogers’s opinion. He explained that appellant has no understanding of her mental illness or the need for treatment. Without appropriate treatment, she is unlikely to be able to care for her needs, particularly her medical needs.
The district court committed appellant as mentally ill and authorized the use of neuroleptic medication. Odencrans appeals.
D E C I S I O N
An appellate court will not set aside district court findings of fact unless clearly erroneous. Minn. R. Civ. P. 52.01; In re McGaughey, 536 N.W.2d 621, 623 (Minn. 1995). This court need not defer to the district court on issues of law. In re Stilinovich, 479 N.W.2d 731, 734 (Minn. App. 1992).
Respondent first contends that appellant failed to preserve issues for appeal as to the sufficiency of the evidence because she agreed to submit the matter on the medical records and an exhibit attached to the petition for commitment. But the matter was not submitted entirely on the medical record; appellant’s psychiatrist testified and was cross-examined by appellant, and the court-appointed examiner and appellant testified as well. Appellant is not objecting to the admissibility of the records but instead is challenging the sufficiency of the evidence to support the commitment and medication order. She did not waive these arguments below.
We next address the merits. The district court must determine by clear and convincing evidence whether the person is mentally ill. Minn. Stat. § 253B.09, subd. 1 (1998). A mentally ill person is defined as one who has an organic disorder of the brain or substantial psychiatric disorder and
poses a substantial likelihood of physical harm to self or others as demonstrated by:
(1) a failure to obtain necessary food, clothing, shelter, or medical care as a result of the impairment; or
(2) a recent attempt or threat to physically harm self or others.
Minn. Stat. § 253B.02, subd. 13(a) (1998).
The district court found that appellant, who is elderly and suffers from renal disease and a recent exacerbation of her mental disorder, could not secure her basic needs if she were discharged to live independently. It determined that without judicial intervention, she would likely refuse to receive dialysis, creating a life-threatening situation. The court also referred to appellant’s intrusive and didactic manner with other patients, leading one of them to kick her in the leg.
Appellant contends that because the district court did not find she made a recent attempt or threat to harm herself or others, there was insufficient evidence to support the commitment. But the statute does not require both an inability to provide necessities and a recent attempt or threat to cause harm; it requires either. Id.; see In re Emond, 366 N.W.2d 689, 692 (Minn. App. 1985) (basing commitment on patient’s inability to provide necessities, as demonstrated by recent failure to seek medical care for open sores on her face or to provide food or sanitary shelter). Failure to seek medical care for a life-threatening condition meets the standard of harm for commitment as mentally ill.
Appellant also contends that there was insufficient evidence to show she was committed to the least restrictive alternative. If the district court finds that a person is mentally ill, it must consider a range of alternative dispositions before ordering commitment. Minn. Stat. § 253B.09, subd. 1. If it determines that there is no suitable alternative to commitment, it "shall commit the patient to the least restrictive treatment program" that can meet the patient’s needs. Id. The district court decision will not be reversed unless it was clearly erroneous. In re King, 476 N.W.2d 190, 193 (Minn. App. 1991).
The district court found that appellant’s illness could not be adequately treated by dismissal of the petition, voluntary inpatient or outpatient care, the appointment of a guardian or conservator, or a conditional release. It explained she was too symptomatic to be placed at a nursing home. It determined that the least restrictive available placement was commitment to the Hennepin County Medical Center, with a backup commitment to the Anoka Metro Regional Treatment Center.
Appellant contends there was insufficient evidence to show she required hospitalization. She claims she could receive dialysis at a hospital while residing at the nursing home and notes that she was provisionally discharged to a nursing home 24 days after her commitment. She also asserts the district court did not adequately consider the possibility of appointing a conservator or guardian, possibly her son.
All of these alternatives appellant suggests would have required her cooperation with dialysis, and there is no evidence that, given the state of her mental illness, she would have cooperated. The district court was not clearly erroneous when it committed appellant to the Hennepin County Medical Center, with a backup commitment to the Anoka Metro Regional Treatment Center, as the least restrictive alternative. See In re Adams, 352 N.W.2d 117, 119 (Minn. App. 1984) (upholding decision that least restrictive alternative was commitment to hospital, where patient was not medically stabilized and did not acknowledge need to take medication regularly or to bring behavior under control, and no community program was presently willing to accept him).
Appellant next challenges the district court order authorizing the involuntary administration of neuroleptic medication. A facility may not administer without court approval neuroleptic medication to a committed person who refuses it. Minn. Stat. § 253B.092, subd. 8(a) (1998); Jarvis v. Levine, 418 N.W.2d 139, 150 (Minn. 1988). The court must first determine whether the person has the capacity to make the decision. Minn. Stat. § 253B.092, subd. 8(d), (e); see Minn. Stat. § 253B.092, subd. 5(b) (setting out factors to consider in making determination of capacity). If the court determines the person lacks capacity and if evidence as to what the person would do if the person had the capacity is lacking, the court must make the decision. Id., subd. 7(c). In doing so, the court must base its decision on what a reasonable person would do, considering:
(1) the person’s family, community, moral, religious, and social values;
(2) the medical risks, benefits, and alternatives to the proposed treatment;
(3) past efficacy and any extenuating circumstances of past use of neuroleptic medications; and
(4) any other relevant factors.
The district court found that the neuroleptic medication was prescribed to relieve symptoms of delusional, tangential thinking, irritability, and hypormania. The court noted that appellant is exhibiting symptoms that are likely tardive dyskinesia caused by her long-term use of antipsychotic medications; because the symptoms were still relatively mild, the benefits she would obtain from the neuroleptic medication outweighed the risks. Without such medications, she would likely spend the rest of her life in a mental hospital. It found this was the best treatment that could render further institutionalization unnecessary.
Appellant contends that she has valid reasons for objecting to the administration of medication because she suffers from tardive dyskinesia. See Jarvis, 418 N.W.2d at 146 (describing tardive dyskinesia as "neurological condition that is permanent and irreversible," ranging in severity from mild to life-threatening). Given the fact that her renal failure was caused by treatment of her mental illness with Lithium, she contends her reluctance to take neuroleptic medication is understandable. Further, appellant contends that Haldol, the specific neuroleptic medication that Dr. Rogers prescribed, is not even the proper medication. She cites his testimony that he is treating appellant with this medication because it can be injected if she refuses to take it orally. Appellant concludes that the court thus failed to consider the particular facts concerning the medical risks and benefits of treatment or the past efficacy and extenuating circumstances concerning the past use of neuroleptics as required by statute. See Minn. Stat. § 253B.092, subd. 7(c) (listing factors to consider).
The evidence showed that appellant suffers from bipolar disorder, a severe mental illness with psychotic features, which affected her ability to comply with life-saving dialysis treatment. While Haldol may not have been the ideal medication in some ways, we cannot ignore Dr. Rogers’s assessment that it was the most appropriate at the time because it is injectable or that use of medication was necessary to prevent appellant’s death from failure to accept dialysis. Further, Dr. Rogers hoped that in the future, the use of neuroleptics in conjunction with mood stabilizers would improve appellant’s illness, allowing the decrease or discontinuance of neuroleptics. Under these facts, the district court was not clearly erroneous in authorizing involuntary administration of neuroleptic medication.
Finally, appellant contends that there was insufficient evidence for the district court to conclude that she was refusing to take neuroleptic medication voluntarily and that the order is an attempt to preempt her medication noncompliance in the future. While the district court found that appellant sometimes takes prescribed neuroleptic medication voluntarily, there was clear and convincing evidence in the record to show appellant has refused medication, necessitating a medication order.
Affirmed; motion granted.[*] Retired judge of the Minnesota Court of Appeals, serving by appointment pursuant to Minn. Const. art. VI, § 10.
No further details about this fact were provided to the district court.