This opinion will be unpublished and
may not be cited except as provided by
Minn. Stat. § 480A.08, subd. 3 (2000).
STATE OF MINNESOTA
IN COURT OF APPEALS
Filed February 6, 2001
Itasca County District Court
File No. P7001556
John P. Dimich, 16 Northeast Third Street, Grand Rapids, MN 55744 (for appellant Jeanne Knaack)
John J. Muhar, Itasca County Attorney, W. James Mason, Assistant County Attorney, 123 Northeast Fourth Street, Grand Rapids, MN 55744 (for respondent Itasca County)
Considered and decided by Harten, Presiding Judge, Hanson, Judge, and Poritsky, Judge.*
U N P U B L I S H E D O P I N I O N
Appellant Jeanne Knaack appeals from her commitment as mentally ill, arguing that (1) the petitioner failed to demonstrate that she poses a substantial likelihood of causing harm to herself or others and (2) she was not committed to the least restrictive alternative. We affirm.
Appellant had been traveling with a male friend while he drove a truck cross-country when her behavior underwent a change. She began getting very little sleep, she spent money budgeted for living expenses on religious materials, and she began drinking alcoholic beverages. Later, appellant stopped traveling with her friend; against his wishes, she lived in his warehouse, which had no heat, water, or bathroom.
Police began to receive reports of appellant’s unusual behavior. One officer found appellant walking in a cemetery at 9:30 p.m. in her stocking feet, while drinking a rum and coke. Because she had no place to spend the night, at his suggestion, she went to a detox center. Another officer found three boxes of religious material in front of a bar, addressed to appellant.
A few days later, another officer found appellant in the back of the warehouse, with religious pamphlets scattered around the yard and a shrine-like structure by the back door. Her paranoid and rushed manner of speaking led him to believe she might have been on medication or narcotics. That evening, while on routine patrol, the officer heard loud music and found a boom box being played in the warehouse. He shut it off and then saw appellant holding a rock and crying, while stating she was trying to heal the blisters on her feet. The next day, when she said she had been eating crackers and apples and “stuff off trees,” he referred her for a psychological evaluation.
Social worker Robert Whalen diagnosed appellant with bipolar affective disorder of a manic type and of psychotic proportions. He described her as moody, impulsive, restless, and easily agitated, with a very low frustration tolerance level, switching very rapidly in mood. Appellant has a long history of psychological problems. Dr. Jacqueline MacPherson, a psychologist, concurred with this diagnosis, and stated that appellant was at risk of harm due to her extremely poor insight into her mental illness, her demonstrated inability to care for herself adequately, and her inability to process information. She recommended administration of neuroleptic medication to treat her condition and certified that with that medication it is likely appellant will be returned to normal living.
Based on appellant’s major psychiatric disturbance, her very poor insight, and her refusal to take medication, the social worker and psychologist recommended joint commitment to the University Medical Center-Mesabi, the state-operated community services at Eveleth, and the Regional Treatment Center at Brainerd. The district court found appellant mentally ill and ordered appellant’s joint commitment; the district court also authorized involuntary administration of neuroleptic medication. Knaack appeals.
D E C I S I O N
An appellate court will not reverse a district court’s findings of fact in a commitment matter unless clearly erroneous. In re McGaughey, 536 N.W.2d 621, 623 (Minn. 1995). The findings must be legally sufficient to support the commitment. See id. at 624.
A mentally ill person is one who has a substantial psychiatric disorder that
poses a substantial likelihood of physical harm to self or others as demonstrated by (1) failure to obtain necessary food, clothing, shelter, or medical care as a result of the impairment * * *.
Minn. Stat. § 253B.02, subd. 13 (2000). The district court must find a person mentally ill by clear and convincing evidence in order to commit that person. Minn. Stat. § 253B.09, subd. 1 (2000).
The failure to obtain necessities must be overt; speculation is not sufficient. McGaughey, 536 N.W.2d at 623; see In re Nadeau, 375 N.W.2d 85, 87-88 (Minn. App. 1985) (reversing commitment where all witnesses agreed patient posed no danger to others, was appropriately dressed, not malnourished, and had obtained shelter). “This is not to say, however, that the person must either come to harm or harm others before commitment as a mentally ill person is justified.” McGaughey, 536 N.W.2d at 623.
Here, the district court concluded that appellant posed a substantial likelihood of physical harm to herself because of her failure to obtain necessary food, clothing, shelter, and medical care, and because her lack of insight into her psychological condition made her particularly vulnerable and likely to engage in unsafe behavior. Appellant contends the commitment was not warranted, because the facts show she had resources to find food, clothing, and shelter, and could live safely on her own. See Nadeau, 375 N.W.2d at 87. While acknowledging that her behavior may have been somewhat disturbed, she contends it was not harmful to herself or others.
Appellant was residing in a warehouse which lacked heat, water, and a bathroom; she also spent one night at the detox center. She described her diet as including apples and crackers and “stuff off trees.” She lacked insight, consumed alcohol, and refused medication. Her condition left her vulnerable to harm or exploitation by others. See In re Gonzalez, 456 N.W.2d 724, 729 (Minn. App. 1990) (upholding commitment based on inability to provide shelter and conduct that could outrage others and trigger attack on self). While it is possible that appellant could “survive,” we agree with the district court that there is a substantial likelihood that continuing to live in these conditions will result in physical harm to appellant. See In re Schaefer, 498 N.W.2d 298, 300 (Minn. App. 1993) (upholding commitment where one diagnosed as paranoid schizophrenic resided in home with no electricity and no heat except space heater, had no apparent means to obtain food, and refused medication). The district court’s decision meets the statutory requirements for commitment.
The district court must commit the patient to the “least restrictive treatment program” which is capable of meeting the patient’s needs. Minn. Stat. § 253B.09, subd. 1. The court must consider alternative programs as well as the patient’s treatment preferences. Id.; In re King, 476 N.W.2d 190, 193 (Minn. App. 1991). The district court must make specific findings as to least restrictive alternatives and reasons for rejecting them. Minn. Stat. § 253B.09, subd. 2 (2000); see King, 476 N.W.2d at 194 (upholding commitment where findings were scanty, although legally sufficient). The district court decision will not be reversed unless clearly erroneous. King, 476 N.W.2d at 193.
The district court determined that appellant needed a highly structured environment in which the administration of medication may be supervised and monitored. Without medication, her condition will not improve. The testimony showed that a voluntary treatment program would not be successful because appellant completely denies having a mental illness or needing medication, and the structured setting of the hospital was necessary to treat her. See In re Adams, 352 N.W.2d 117, 119 (Minn. App. 1994) (upholding commitment to regional treatment center where patient not stabilized denied need for medication, and no community program would accept patient). Appellant was committed to the medical center, with the expectation that there would be flexibility to transfer her to one of the other two named facilities as appropriate.
Appellant contends that a joint commitment to a medical center, a regional treatment center, and a community-based facility necessarily cannot be a commitment to the least restrictive alternative. She asserts that the court, not the hospital administrator, should make the determination as to which facility she should be committed. Finally, she contends that the findings were inadequate.
The district court’s placement at the medical center is supported by evidence and findings and is not clearly erroneous. We note further that the “placement choice between state institutions is a prerogative of the commissioner.” King, 476 N.W.2d at 193 n.7; see also Minn. Stat. § 253B.14 (2000) (providing that Commissioner of Human Services has authority to transfer committed person from regional treatment center to any treatment facility within commissioner’s jurisdiction). Because the commissioner has the power to transfer appellant to the other facilities in any event, the district court did not err in its commitment order.
* Retired judge of the district court, serving as judge of the Minnesota Court of Appeals by appointment pursuant to Minn. Const. art. VI, § 10.