This opinion will be unpublished and
may not be cited except as provided by
Minn. Stat. § 480A.08, subd. 3 (2002).
STATE OF MINNESOTA
IN COURT OF APPEALS
In the Matter of the
Civil Commitment of
Filed December 31, 2002
Hennepin County District Court
File No. P60260235
Ruth A. Gaydos, P.O. Box 1839, St. Paul, Minnesota 55101 (for appellant)
Amy Klobuchar, Hennepin County Attorney, John L. Kirwin, Assistant County Attorney, C-2000 Government Center, 300 South Sixth Street, Minneapolis, Minnesota 55487 (for respondent)
Considered and decided by Schumacher, Presiding Judge, Halbrooks, Judge, and Hudson, Judge.
U N P U B L I S H E D O P I N I O N
Appellant challenges the trial court’s order committing her as mentally ill, arguing that the evidence is insufficient to support the trial court’s determination that she is mentally ill and that no less-restrictive alternative to commitment exists. Appellant also alleges that the trial court abused its discretion when it denied her request for a continuance. Because the record amply supports the trial court’s findings and because the district court acted within its discretion when it denied a continuance, we affirm.
Appellant, Kimberly Sadek (Sadek), is a 27-year-old woman who was diagnosed with Huntington’s disease in 1998. A symptom of Huntington’s disease is cognitive decline, leading to errors in judgment, planning, and organization and memory loss. The disease has five stages; Sadek is currently in stage III. Sadek also suffers from dementia and depression as a result of the Huntington’s disease. In July and August 2001, Sadek received care at the Huntington’s Clinic at Hennepin County Medical Center (HCMC) and the Hennepin Faculty Associates Psychiatry Clinic. After that hospitalization, Sadek continued on an out-patient basis with follow-up care, but her attendance was sporadic and HCMC discharged Sadek from its partial hospitalization program.
In December 2001, Barbara Buehl (Buehl), a caseworker with Hennepin County Mental Health Case Management, began working with Sadek. Buehl became increasingly concerned about Sadek’s ability to care for herself, in part because Buehl witnessed Sadek’s apartment in an unlivable condition on several occasions. Buehl testified that on each of four visits Sadek’s apartment was littered with trash, debris, clothes, and moldy, decayed food.
Sadek was receiving help with her housekeeping from personal care assistants (PCAs) provided through Community Assistance to Disabled Individuals (CADI). But Sadek had a contentious relationship with the PCAs, firing two of the last five provided to her. CADI subsequently terminated Sadek from the program. Sadek also has had problems managing her medication. She has overdosed on two occasions, and frequently requests increases in her medication dosage.
On April 18, 2002, at one of her infrequent clinic visits for a psychiatric appointment, Dr. Eduardo A. Colon diagnosed Sadek with dementia and depression due to Huntington’s disease and determined that Sadek was in need of commitment. On April 22, 2002, Sadek’s apartment was condemned, and she received notice of her eviction. On May 2, 2002 a petition for judicial commitment was filed, and a trial on the petition was held on May 15, 2002.
On May 15, 2002, Sadek, acting pro se, requested a continuance to retain new counsel, contact witnesses, and obtain documents she believed necessary to demonstrate self-sufficiency. The trial court denied Sadek’s request. On May 16, 2002, the trial court filed its order committing Sadek as mentally ill to the Bywood East facility and the Anoka Metro Regional Treatment Center. This appeal followed.
D E C I S I O N
Sadek argues that the record does not support by clear and convincing evidence that because of her mental illness, she has engaged in grossly disturbed behavior or experienced faulty perceptions. She further contends that the record does not support a finding that she poses a substantial likelihood of physical harm to herself. We disagree.
On appeal from a judicial commitment, our review is limited to an examination of whether the trial court complied with the statute and whether the commitment was justified by findings based on evidence at the hearing. In re Knops, 536 N.W.2d 616, 620 (Minn. 1995). The record is viewed in the light most favorable to the trial court’s decision, and the findings of fact will not be set aside unless clearly erroneous. Id. The trial court must find a person is mentally ill by clear and convincing evidence. Minn. Stat. § 253B.09, subd. 1 (2002). A mentally ill person is defined as:
[A]ny person who has an organic disorder of the brain or a substantial psychiatric disorder of thought, mood, perception, orientation, or memory which grossly impairs judgment, behavior, capacity to recognize reality, or to reason or understand, which is manifested by instances of grossly disturbed behavior or faulty perceptions 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]
* * *
(3) a recent attempt or threat to physically harm self or others.
Minn. Stat. § 253B.02, subd. 13(a) (2002) (emphasis added).
Grossly Disturbed Behavior
The trial court found that Sadek has a substantial psychiatric disorder that affects her thoughts and mood and, as a result, grossly impairs her judgment and behavior. Sadek does not dispute that she suffers from a mental illness. In addition, she has been diagnosed with dementia and depression, likely the result of the Huntington’s disease.
The record is replete with instances of Sadek’s grossly disturbed behavior or faulty perceptions. First, Dr. John Cooper, the court-appointed examiner, testified at the commitment trial that Sadek has trouble evaluating situations clearly and may, in fact, have some kind of paranoid ideation. Second, Beryl Westphal, a nurse practitioner at the Huntington Clinic, testified that she observed Sadek acting abnormally during a clinic visit in February 2002. Sadek attempted to eat a frozen dinner during the course of the examination, refusing offers to heat the food. During the same visit, Sadek had problems with her coordination resulting from an overdose of Neurotin, a drug not prescribed to her. Sadek fell several times during the exam, ultimately hitting her head on a wall as she fell into a chair in the waiting room. Sadek admitted she intentionally took the extra pills because she was nervous about the clinic visit and was trying to calm down. This was Sadek’s second overdose; in 2001, she overdosed on Lithium. Sadek’s medical records show repeated requests to increase the dosage of her medication.
The trial court found that Sadek is hostile and irritable, as evidenced by her contentious relationship with her PCAs. She fired two of the last five PCAs assigned to her, firing her most recent PCA two months before the commitment trial. Sadek’s case manager, Buehl, testified that Sadek was terminated from CADI because once the PCAs cleaned the apartment, Sadek would go behind them and clutter things up again. CADI staff believed Sadek was unsafe and unaccepting of the services being provided to her. Buehl also testified that she attempted to find a new PCA for Sadek but “some of [the providers] had already worked with her and the other ones felt that they could not handle the severity of her disability.”
Perhaps most telling of Sadek’s impaired judgment is the condition of her apartment. Sadek contends that she was ill for a period and unable to clean her apartment. But the record reveals that the condition of Sadek’s apartment was not an isolated incident. Buehl testified that she visited Sadek’s apartment on four different occasions since January 2002, and that each time Sadek’s apartment was in an unlivable state. Likewise, Michael Wilson visited Sadek’s apartment as part of HCMC’s prepetition screening process and described the apartment as a garbage house, remarking that Sadek’s apartment was one of the worst he had seen. Sadek herself testified to putting a pan of burning food in the hallway because it was smoking. In addition, while hospitalized awaiting the commitment trial, Sadek stashed both wrapped and unwrapped food throughout the room, necessitating further cleaning by hospital staff.
Sadek argues the trial court disregarded her reasonable explanations for these events and relied too heavily on information contained in medical records and witness testimony. Sadek urges this court to reassess the weight and credibility of evidence presented to the trial court. But 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). We conclude the record amply supports the trial court’s finding that Sadek has engaged in grossly disturbed behavior.
Substantial Likelihood of Physical Harm
Sadek argues there was insufficient evidence to support a finding that she could not continue to utilize the resources that she has in the past to meet her needs for food, clothing, shelter, and medical care. We disagree.
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) (citations omitted). The record indicates that Sadek lacks the type of social support necessary to live on her own. Sadek can no longer rely on her spouse to assist her with daily living activities because they are dissolving their marriage. CADI terminated Sadek from the program and will no longer provide her with a PCA. Due to the severity of her disability, coupled with her history of discharging numerous PCAs, Sadek’s chances of getting this kind of assistance through another agency are remote. Furthermore, the grossly unsanitary condition of Sadek’s apartment posed such a substantial risk of harm that Sadek has been evicted and her apartment has been condemned. There is no indication in the record that Sadek has since obtained alternative housing.
Moreover, Sadek frequently misses medical appointments and has a history of mismanaging her medication. All witnesses, including the court-appointed examiner, the nurses who treated her, and her caseworker, testified that Sadek could no longer provide for herself and, as a result, they feared for her safety. Sadek’s living skills were tested while awaiting the commitment trial, and Dr. Craig Qualey of HCMC concluded that Sadek “was completely and utterly incapable of self-care.” The record supports the trial court’s findings that Sadek has engaged in grossly disturbed behavior and poses a substantial risk of physical harm to herself. The trial court’s finding of mental illness within the meaning of Minn. Stat. § 253B.02, subd. 13 is not clearly erroneous.
Sadek argues the trial court did not adequately explore less-restrictive alternatives to commitment as required by Minn. Stat. § 253B.09, subd. 1 (2002).
We will not reverse a trial court’s determination of the least restrictive treatment program unless that finding is clearly erroneous. In re Kellor, 520 N.W.2d 9, 12 (Minn. App. 1994), review denied (Minn. Sept. 28, 1994). The trial court must consider alternative programs as well as the patient’s treatment preferences. In re King, 476 N.W.2d 190, 193 (Minn. App. 1991). The trial court must make specific findings on less-restrictive alternatives and reasons for rejecting them. Minn. Stat. § 253B.09, subd. 2 (2002).
Here, the trial court considered a number of less-restrictive alternatives including community-based nonresidential treatment, community residential treatment, partial hospitalization, and acute care hospitals. The trial court rejected these alternatives based on uncontroverted evidence of Sadek’s inability to provide for her needs. Sadek repeatedly rejected any alternative living arrangements, testifying that she “was just fine where she was.” Moreover, less-restrictive alternatives have been tried over the last year and have failed. For example, the record indicates Sadek often missed her outpatient appointments, and her sporadic attendance resulted in her discharge from the HCMC partial hospitalization program.
Although Sadek wishes to remain in her apartment, this alternative is literally an impossibility--her apartment has been condemned and she has been evicted. Even if she were to find alternative housing, it is highly unlikely that she can find another PCA. Furthermore, Sadek is in stage III of Huntington’s disease. Westphal testified that at this stage of neurological decline, a person is no longer able to earn a living, adequately manage their finances, or manage household and domestic tasks. Unless there is home supervision, an individual in stage III of Huntington’s disease cannot live alone. Because of the progressive nature of the disease, Sadek will continue to deteriorate both physically and cognitively.
The record demonstrates that the trial court complied with the statutory requirement of considering less-restrictive alternatives and provided reasons for rejecting such alternatives. Because the evidence presented supports the trial court’s conclusion that commitment is the least-restrictive alternative to meet Sadek’s needs, the trial court’s conclusion is not clearly erroneous.
Sadek argues that she was prejudiced by the trial court’s denial of her request for a continuance because she was not able to present witnesses and obtain other evidence that would support her contention that she could care for herself.
The decision whether to grant a motion for a continuance is within the trial court’s discretion. Dunshee v. Douglas, 255 N.W.2d 42, 45 (Minn. 1977). The trial court’s decision will not be reversed absent an abuse of discretion. Id. The party seeking the continuance must show that it was prejudiced as a result of the denial. In re Muntner, 470 N.W.2d 717, 719 (Minn. App. 1991), review denied (Minn. Aug. 2, 1991). The test is whether a denial prejudices the outcome of the trial. Weise v. Comm’r of Pub. Safety, 370 N.W.2d 676, 678 (Minn. App. 1985).
In this case, even if Sadek had proffered witnesses regarding her ability to care for herself, the outcome would not likely have changed. The record overwhelmingly supports the trial court’s finding that Sadek is unable to care for herself. In particular, each of Sadek’s health care, social service, and mental health providers testified that Sadek was incapable of caring for herself. Sadek has not shown that the denial of her request for a continuance prejudiced the outcome of the hearing, and we conclude that the trial court did not abuse its discretion in denying Sadek’s request for a continuance.
The trial court did not clearly err in committing Sadek as mentally ill to the Bywood East facility and the Anoka Metro Regional Treatment Center.
 Sadek also requested a new lawyer. Because Sadek desired a new lawyer, she had told her witnesses not to appear in court on the day of trial. After a recess, the trial court ruled that it would abide by the commitment defense panel procedures for appointing a new attorney and denied Sadek’s request for new counsel and a continuance.