This opinion will be unpublished and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:
Filed June 13, 2000
Hennepin County District Court
File No. PO8531338
Gregory R. Solum, 5275 Edina Industrial Boulevard, Suite 105, Edina, MN 55439 (for appellant)
Amy Klobuchar, Hennepin County Attorney, Carolyn A. Peterson, Assistant County Attorney, A-2000 Government Center, Minneapolis, MN 55487 (for respondent)
Considered and decided by Randall, Presiding Judge, Lansing, Judge, and Willis, Judge.
Appellant Susan Govern challenges her commitment as mentally ill and the order authorizing administration of neuroleptic medication. The record supports the district court's determinations on both issues. We affirm.
In December 1999, Susan Govern was a student at the University of Minnesota taking courses to enter a doctoral program. In early December, a church pastor brought her to the attention of Hennepin County. Govern, in a catatonic state and requiring assistance for almost all activities, was hospitalized on December 12. The next day, the county petitioned for Govern's commitment as mentally ill. After a hearing, a referee proposed, and the district court signed, an order granting the county's petition. In January 2000, the county sought permission to administer neuroleptic medication to Govern. After a hearing, another referee issued a proposed order granting the county's request, and the district court signed that order.
1. Govern challenges the finding that, as a result of a mental illness, she "engages in grossly disturbed behavior or experiences faulty perceptions, and she poses a substantial likelihood of causing physical harm." See Minn. Stat. § 253B.02, subd. 13(a) (1998) (defining "mentally ill person" as one who, among other things, has "instances of grossly disturbed behavior or faulty perceptions and poses a substantial likelihood of physical harm to self or others"). Clear and convincing evidence is required to find a person mentally ill. Minn. Stat. § 253B.09, subd. 1 (1998). We will not set aside a district court's findings regarding mental illness unless those findings are clearly erroneous. In re Zemple, 489 N.W.2d 818, 820 (Minn. App. 1992).
Citing In re Duvick, 497 N.W.2d 311 (Minn. App. 1993), Govern alleges that the record does not support a finding that she engaged in "grossly disturbed behavior." Duvick does not involve similar behavior and merely stands for the proposition that commitment of a person as mentally ill is improper absent "grossly disturbed behavior." 497 N.W.2d at 313. Here, the record shows Govern's decompensation included her (a) going through what her case manager referred to as an "amazingly fast" deterioration; (b) becoming catatonic and verbally incoherent when she spoke; (c) needing help to walk, eat, clean herself, and use the restroom; (d) having hallucinations; (e) becoming delusional, trying to take her shirt off in the hall of the hospital, and otherwise not dressing properly; (f) making statements rendering it unclear whether she was suicidal; and (g) trying to elope from the hospital and, on one occasion, requiring seclusion. This record supports the district court's finding of grossly disturbed behavior.
The commitment statute requires that the substantial likelihood of physical harm be shown by "an overt failure to obtain necessary food, clothing, shelter, or medical care or by a recent attempt or threat to harm self or others." In re McGaughey, 536 N.W.2d 621, 623 (Minn. 1995) (citing Minn. Stat. § 253B.02, subd. 13 (1994)). On this point, the bulk of Govern's argument on appeal is an improper attempt to get this court to reassess the weight and credibility of evidence presented to the district court by a mental-health case manager and Govern's social worker. "The function of the appellate court is not to reweigh the evidence, but rather to determine if the evidence as a whole sustains the trial court's findings." In re Salkin, 430 N.W.2d 13, 16 (Minn. App. 1988), review denied (Minn. Nov. 23, 1988). Moreover, the remainder of Govern's argument addresses her ability to function when she has not decompensated and notes the availability to her of the materials necessary for self-care (e.g., an apartment, food, funds, etc). Govern's ability to care for herself when she is functioning normally does not address her inability to do so when she has decompensated. And the record shows that her most recent decompensation left her unable to eat, walk, or speak coherently. How she cannot be a danger to herself if she decompensates to this degree is unclear. Thus, the record supports the district court's findings regarding the elements of mental illness.
2. If a district court finds a person "mentally ill," it "shall" commit the person to the "least restrictive" treatment program capable of addressing the person's needs. Minn. Stat. § 253B.09, subd. 1 (1998). Here, the district court committed Govern to in-patient treatment. Govern challenges that determination. Placement decisions are not altered unless clearly erroneous. In re Kellor, 520 N.W.2d 9, 12 (Minn. App. 1994), review denied (Minn. Sept. 28, 1994). Also, voluntary treatment is preferred over involuntary commitment and treatment. Minn. Stat. § 253B.04, subd. 1(a) (Supp. 1999).
Noting the preference for voluntary treatment and alleging that her catatonia was "short lived and transitory," Govern alleges in-patient treatment was not the least restrictive treatment. But testimony indicates that Govern's catatonia subsided because, after being hospitalized, she was given medication.
Govern also alleges that commitment is improper because she has a "substantial support network" in the states of Minnesota and New York and that there is no evidence that her returning to New York was inappropriate. While Govern allegedly has people in Minnesota and New York who would help care for her if she needed it, she testified that it is "difficult for me to take the medications." This testimony, combined with Govern's history of not taking medication and the fact that Govern's failure to take her medications apparently precipitated the decompensation generating these proceedings, justifies the district court's finding that a stayed commitment is "inappropriate at this time." The district court's finding that "[Govern's] plan to return to New York is not feasible at this time because no treatment has been arranged for her once she gets there" is consistent with the testimony of Govern's attending physician.
A mental-health case manager testified that Govern's treatment team believed that if Govern were released and did not take medication, she would decompensate and be unable to provide food, clothing, and shelter for herself. Govern attempts to cast doubt on this testimony by noting that the case manager was unaware that Govern had an apartment and funds available to her and by pointing out that, at the time of the commitment hearing, there had been no request for a court order allowing medication. There are several problems with this argument. First, Govern is, essentially, attacking the credibility of the case manager. See Minn. R. Civ. P. 52.01 (providing due regard shall be given district court’s opportunity to judge witness credibility). Second, the events producing this appeal involved a decompensation of a degree that would render her unable to care for herself, even if it happened in her own apartment. Third, since the commitment hearing, a request for a court order allowing medication has been granted. And, at the hearing addressing administration of medication, Govern's "big issue" was identified as her refusal to take medication. The evidence regarding the degree of Govern's decompensation, the danger to her should it happen again, and her refusal to take medication supports the district court's selection of in-patient treatment.
3. Without court approval, a treatment facility is not to administer 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). A district court must first determine whether the committed person has the capacity to decide whether to take neuroleptic medication. Minn. Stat. § 253B.092, subd. 8(d), (e); see Minn. Stat. § 253B.092, subd. 5(b) (listing factors to be considered in making ruling on capacity). If the district court finds that the person lacks capacity and that the evidence does not indicate what the person would do if the person had capacity, the district court must decide whether to allow administration of neuroleptic medication. Id., subd. 7(c).
A person is presumptively able to decide whether to take neuroleptic medication. Minn. Stat. § 253B.092, subd. 5(a) (1998). In determining whether a party actually has the capacity to make that decision, the district court "shall" consider the factors listed in Minn. Stat. § 253B.092, subd. 5(b) (1998). Here, the district court ruled that Govern lacked the capacity to make this decision. On appeal, Govern addresses each element of the statutory test for capacity. The county addresses only Govern's awareness of her mental illness under Minn. Stat. § 253B.092, subd. 5(b)(1), and argues that she lacks sufficient awareness of her condition to make an informed decision.
It is undisputed that Govern is intelligent and has some understanding of both her mental illness and the effects of taking neuroleptic medications. At the Jarvis hearing, however, Govern's treating physician testified that (a) Govern "somewhat" understands the reason for her hospitalization but minimizes it greatly; (b) Govern's continued failure to take her medications will result in the same symptoms that produced her hospitalization and will do so "sooner, rather than later"; (c) Govern has "some understanding" of the benefits and risks of treatment but not a full understanding; (d) monitoring of Govern while she is taking the medications will allow the medication's side effects to be adequately managed; (e) non-medication-based responses to Govern's condition have been considered "many times" in the past and do not work; (f) a reasonable person in Govern's position and with her background would take the medications; (g) the benefits of taking the medications "definitely" outweigh the associated risks; (h) most medical experts believe that the medication prescribed for Govern is the best anti-psychotic medication available; and (i) a recent surgery Govern underwent was minor and did not preclude her from taking the medications. Similarly, the court-appointed expert testified that (a) anti-psychotic medications are reasonable and necessary in this case; (b) while Govern is "well aware" of many of the risks associated with taking the medications, she fails to appreciate fully the risks of not taking the medications; (c) the severity of Govern's illness suggests that the balance in this case weighs in favor of taking the medications; (d) none of the side effects of the medications precludes her from taking them; (e) Govern lacks the capacity to make an informed decision on the issue both because she fails to understand the severity of her illness, which causes her to underestimate the risks of not taking the medications, and because there is a "mildly" delusional component to the religious aspect of her opposition to taking the medications; (f) it would be in Govern's best interests if the county's petition to administer the medications were granted; and (g) if Govern does not take her medications, she will decompensate. This record contains clear and convincing evidence supporting the district court's determination that Govern lacks the capacity to make an informed decision regarding whether to take neuroleptic medications.
4. With exceptions not relevant here, if a district court concludes that a party lacks the capacity to make decisions regarding whether to take neuroleptic medications, it must make that decision for the party. Minn. Stat. § 253B.092, subd. 7(a) (1998). In doing so, the district court must base its decision on what a reasonable person would do, considering the factors listed at Minn. Stat. § 253B.092, subd. 7(c). Govern alleges she should not be required to take neuroleptic medication because (a) the risks outweigh the benefits; (b) there are alternative treatments; and (c) she has religious convictions that eschew use of medications except in the most dire of circumstances.
The balance of the risks and benefits, as well as the viability of alternative treatments, are addressed by the expert testimony discussed above.
Citing In re Nadeau, 375 N.W.2d 85 (Minn. App. 1985), Govern alleges her religious beliefs support not requiring her to take neuroleptic medications. Nadeau is distinguishable. There, a district court ruled a woman mentally ill based partially on her failure to take care of her medical needs. This court reversed, noting that the woman's religious views caused her to refuse pain medication. Id., 375 N.W.2d at 87. The crux of the reversal, however, was that the record lacked evidence that the woman presented a danger to herself or to others, a prerequisite to being found "mentally ill" under the provision relevant to that case. Nadeau, 375 N.W.2d at 87-88.
Here, Govern told the court-appointed expert that her (Govern's) religious views oppose the use of medications unless "absolutely necessary." We will not use this testimony to reverse the district court's ruling allowing the administration of neuroleptic medications because (a) it is possible this conviction on Govern's part is partially based on her belief that God told her she did not need the medication; (b) except to prevent decompensation, neuroleptic medication is not "absolutely necessary" for Govern until she decompensates, at which point she lacks the capacity to make a decision about whether to take the medication; (c) Govern's decompensation generating this appeal was so severe that she does not remember how incapacitated she was, and, lacking a clear memory of the degree of her incapacity, she (even while functioning normally) cannot appreciate the dangers associated with her decompensating; and (d) her attending physician testified that if she does not take medication, she will decompensate again, "sooner, rather than later[.]"
 Govern argues that her relatively unimpaired physical condition at the time she was admitted to the hospital supports her arguments that she does not need to be committed and that she does not need neuroleptic medication. These arguments are misdirected. The reason Govern's physical condition had not significantly deteriorated by the time she was admitted to the hospital was not because she did not decompensate severely, but because when she did decompensate, she did so in a church and the pastor was able to get her help promptly.