may not be cited except as provided by
Minn. Stat. §480A.08, subd. 3 (2002).
IN COURT OF APPEALS
Matter of the Civil Commitment of:
Hennepin County District Court
File No. P20260135
Richard G. McGee, 8028 Morgan Circle, Brooklyn Park, MN 55444 (for appellant Jimmy Dorian)
Mike Hatch, Attorney General, David A. Rowley, Assistant Attorney General, 445 Minnesota Street, Suite 900, St. Paul, MN 55101 (for respondent Anoka Metro Regional Treatment Center)
Considered and decided by Peterson, Presiding Judge, Willis, Judge, and Mulally, Judge.
U N P U B L I S H E D O P I N I O N
In this appeal from an order authorizing the administration of neuroleptic medication, appellant Jimmy Dorian argues that the district court exceeded its authority when it authorized the medication because (1) he has not been diagnosed as psychotic, and (2) the medication to be administered is not a neuroleptic medication. We affirm.
Dorian has been diagnosed as suffering from major depressive disorder, impulse control disorder, and alcohol dependency. Dorian was committed as mentally ill and chemically dependent to respondent Anoka Metro Regional Treatment Center (AMRTC). In March 2002, Dorian attempted suicide and told hospital staff that he had nothing left to live for.
AMRTC filed a petition in district court seeking authority to administer neuroleptic medication to Dorian without his consent. AMRTC alleged that Dorian suffered from a major mental illness and lacked the capacity to consent to treatment with neuroleptic medications and that the benefits of treatment with neuroleptic medications outweighed the risks.
Dr. Mary MacDonald, an AMRTC senior staff psychiatrist and Dorian’s treating psychiatrist, stated in an affidavit:
3. Psychosis is a term that signifies a gross impairment in the perception of reality, with symptoms that may include delusions and hallucinations. Neuroleptic (sometimes referred to as antipsychotic) medications improve mental functioning through a decrease in the psychotic symptoms of mental illness, including psychotic thinking, distorted perceptions, emotional disturbance, and pathological behaviors. Neuroleptic medications are a subclass of psychotropic medications.
4. Neuroleptic medications are separate, different, and distinct from other classes of psychotropic medications such as sedative-hypnotics, anti-anxiety agents, (minor tranquilizers), or antidepressants. These latter medications have no practical antipsychotic effects in that they do not affect the core symptoms of the illness, and are not acceptable substitutes for neuroleptics in the treatment of psychosis.
* * * *
14. The primary indication for treatment with neuroleptic medication is the presence of a mental illness with psychotic symptoms.
MacDonald also stated in her affidavit that neuroleptic medications alleviate the symptoms of mental illness that provoke aggression or self-harm and often make patients more amenable to other types of treatment, including behavioral therapy, social skills training, individual psychotherapy, and family therapy.
MacDonald wanted to treat Dorian with Olonzapine, also called Zyprexa, to help stabilize his mood and help him with impulse control, but he consistently refused to take psychiatric medications. MacDonald testified that Dorian did not fully understand his mental illness and the reasons for his hospitalization and lacked insight into his mental illness and chemical-dependency problems. MacDonald did not believe that there were acceptable alternative treatments to medication and testified that if Dorian continued to refuse treatment with Olonzapine,
it’s highly likely that he will start drinking again and become more angry, and possibly more suicidal and act out either by harming someone else or by another suicide attempt.
The court-appointed examiner, Dr. William Orr, opined that it was reasonable, necessary, and in Dorian’s best interest to be treated with antipsychotic medication. Orr testified that Dorian suffered from a significant mental illness and significantly diminished capacity to make a decision regarding treatment with an antipsychotic medication.
Orr explained that the Food & Drug Administration (FDA) had recently reclassified Olonzapine as a psychotropic medication, which means that it has mood-stabilizing, as well as antipsychotic, effects. Orr testified that a psychotropic medication is not necessarily the same thing as a neuroleptic medication. Orr explained:
A neuroleptic as defined medically is a drug that lesions or interferes with the nervous system. * * * For many years in medicine we had medications that we used to treat psychotic symptoms, for example Haldol. And it worked very well but it also had side effects on the central nervous system producing movement disorders. And because it produced those movement disorder side effects they were also referred to as neuroleptics because they seemed to change the motor part of the nervous system. So antipsychotics also were sometimes -- the synonymous word became neuroleptics. My understanding is that the term neuroleptic was used by the State of Minnesota when it drew up its Jarvis statute. Rather than using the term antipsychotic they went with the synonym neuroleptic.
Now, in the past five to eight years we have newer antipsychotic medications that have a much, much lower incidence of producing the side effects on the motor part of the nervous system. And so these are -- so the synonymous term neuroleptic is virtually never used by medical professionals when talking about antipsychotics. Psychotropic is any medication that helps the body in such a way as to help the psychological or psychiatric functioning. That’s what psycho and tropic means. So as the new antipsychotics have been developed we call them antipsychotics. We don’t call them neuroleptics. And as we’re finding out that these newer medications clearly seem to have benefits and realms beyond just psychotic illnesses such as the use of Olonzapine for mood stabilization. It has actually been re-classified as a psychotropic medication by the FDA. So that’s why Olonzapine is not really discussed amongst medical professionals in my knowledge as a neuroleptic. That’s why it is used as an antipsychotic because it’s good for psychotic illnesses. And that’s why it’s called a psychotropic because it’s used successfully for other conditions rather than just psychotic ones.
The district court found that Dorian lacked the capacity to make decisions regarding the administration of neuroleptic medication. The court also found:
9. [Dorian] does not receive the fullest possible benefit from the psychosocial treatment such as milieu, group, recreational and occupational therapy and is unable to participate in individual therapy successfully because of his mental illness. The use of neuroleptic medication will relieve the interference caused by the mental illness and will permit [Dorian] to derive increased benefit from psychosocial therapy.
10. When [Dorian] had the capacity to make a reasoned decision he has not clearly stated what he would do regarding the administration of neuroleptic medication in this current situation. A reasonable person in [Dorian’s] current situation would consent to the administration of neuroleptic medications.
a. [Dorian] has no known family, community, moral, religious, or social values that would prohibit the taking of neuroleptic medications.
b. The benefits of the proposed treatment to [Dorian] outweigh the medical risks of the treatment.
c. No alternative treatment will be as effective in treating [Dorian’s] mental illness.
11. The use of neuroleptic medication as an inpatient and outpatient is the best treatment, according to contemporary professional standards, which could render further custody, institutionalization or other services to [Dorian] unnecessary.
Statutory interpretation is a question of law that is reviewed de novo. Hince v. O’Keefe, 632 N.W.2d 577, 582 (Minn. 2001). When interpreting a statute, the court must give effect to its plain meaning and take into account the structure of the statute and the context of the disputed language. In re Robledo, 611 N.W.2d 67, 69 (Minn. App. 2000). Any ambiguity in the commitment law must be construed against the state and in favor of the person being deprived of liberty. In re Colbert, 464 N.W.2d 505, 507 (Minn. 1991).
Minn. Stat. § 253B.092, subd. 1 (2002), states that “[n]euroleptic medications may be administered to patients subject to * * * civil commitment as mentally ill or mentally ill and dangerous only as provided in this section.” The court may authorize the involuntary administration of neuroleptic medication if the court finds that the patient lacks capacity to decide whether to take neuroleptic medication. Id., subd. 8(e) (2002). The following factors are to be considered when deciding whether to authorize the involuntary administration of neuroleptic medication:
(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.
Id., subd. 7(c) (2002).
Dorian argues that the district court erred in authorizing the involuntary administration of Olonzapine because AMRTC’s petition to administer neuroleptics is premised on a diagnosis of psychosis, and he has not been diagnosed as psychotic.
Arguably, there is an inconsistency between (1) the statement in MacDonald’s affidavit that “[t]he primary indication for treatment with neuroleptic medication is the presence of a mental illness with psychotic symptoms” and (2) her testimony that Dorian had not exhibited any psychotic symptoms since he had been under her care and that psychotic symptoms were not the reason for seeking authority to administer Olonzapine to Dorian. But MacDonald testified that her affidavit submitted in support of AMRTC’s petition was a form affidavit executed by Anoka doctors with every petition to authorize the involuntary administration of neuroleptic medications and was not tailored in any way to address Dorian’s case.
MacDonald also testified that neuroleptic medications alleviate the symptoms of mental illness that provoke aggression or self-harm and make patients more amenable to other types of treatment, including behavioral therapy, social skills training, individual psychotherapy, and family therapy. And Orr testified that medications that are called antipsychotics are “used successfully for other conditions rather than just psychotic ones.” This testimony indicates that the use of neuroleptic medications is not limited to treating psychotic symptoms.
Dorian also contends that Minn. Stat. § 253B.092 (2002) does not apply to psychotropic drugs, and Orr testified that the drug AMRTC wanted to administer was reclassified by the FDA from a neuroleptic medication to a psychotropic medication. But in Jarvis v. Levine, in determining the standard governing medication orders under the Minnesota constitution, the supreme court noted:
The terms “neuroleptic,” “major tranquilizer,” “psychotropic” and “antipsychotic” are used interchangeably in the literature to describe this classification of drugs. Although “antipsychotic” is the most widely used term, medical literature suggests that “neuroleptic” is more medically precise in describing the effects, i.e., sedation of the nervous system.
418 N.W.2d 139, 140 n.1 (Minn. 1988) (citation omitted).
Orr explained that because the side effects of antipsychotic medications on the nervous system have been reduced in recent years, the new antipsychotic medications are no longer referred to as neuroleptics in the medical community. Jarvis and Orr’s testimony indicate that for purposes of Minn. Stat. § 253B.092, the term neuroleptic includes psychotropic and antipsychotic drugs.