This opinion will be unpublished and
may not be cited except as provided by
Minn. Stat. ß 480A.08, subd. 3 (2002).
STATE OF MINNESOTA
IN COURT OF APPEALS
In the Matter of the Civil Commitment of:
Omot Akway Omot,
Filed January 14, 2003
Hennepin County District Court
File No. P59960182
Stephen D. Radtke, Suite 236, 10800 Lyndale Avenue South, Bloomington, MN† 55420 (for appellant)
Amy Klobuchar, Hennepin County Attorney, John L. Kirwin, Assistant County Attorney, C-2000 Government Center, 300 South Sixth Street, Minneapolis, MN† 55487 (for respondent)
††††††††††† Considered and decided by Minge, Presiding Judge, Lansing, Judge, and Shumaker, Judge.
U N P U B L I S H E D†† O P I N I O N
††††††††††† On appeal from his indeterminate commitment as a person who is mentally ill and dangerous to the public, Omot Akway Omot contends that the record of the initial and review hearings does not support the findings that he suffers from a substantial psychiatric disorder that grossly impairs his judgment, his behavior, and his capacity to recognize reality,† to reason, or to understand.† He also maintains that the evidence at the review hearing was insufficient to show that he continued to present a danger to the safety of others.† Because the findings address and meet the statutory standards and are fully supported by the record, we affirm.
††††††††††† Omot, who was born in Sudan, has a history of significant mood swings, disorganized thought, and symptoms of depression, beginning when he arrived in this country in 1996.† Although these symptoms temporarily improved after mental-health treatment, he periodically refused to take his anti-depression medication and repeatedly threatened his parents.† In November 1997, Omot was charged with second-degree assault after he threatened his mother with a knife.† The next year, he was diagnosed with bipolar disorder with psychotic features.
††††††††††† In September 1998, when Omotís father attempted to enlist a teacherís help in getting Omot to take his medication, Omot responded by becoming angry and stabbing his father in the back and head numerous times with a knife.† Omot was determined incompetent to stand trial on the ensuing assault charges and was sent to Willmar Regional Treatment Center.† Reports completed at the treatment center noted that he had been hallucinating shortly before the assault.† He was later hospitalized at Fairview Hospital.†
After his release from Fairview, Omot lived independently with a relative, but he once more refused to take his medication and resumed making threats to his family.† On August 31, 2001, two police officers and a caseworker, responding to a call from Omotís father, entered the apartment where Omot was living and attempted to talk to him about the medication issue.† When Omot headed for the kitchen, an officer, concerned that he might get a knife, walked toward him.† Omot grabbed her and punched her a number of times in the head and face.† After assault charges were filed stemming from this incident, Omot was found to be incompetent to stand trial, placed in a secure treatment facility, and referred for commitment proceedings.
††††††††††† At the initial commitment hearing in April 2002, a psychiatrist who had treated Omot at Hennepin County Medical Center, as well as two court-appointed psychologists, testified that Omot suffered from a schizoaffective disorder, which is a substantial psychiatric disorder of perception, mood, and thought.† The psychiatrist testified that the disorder grossly impaired Omotís judgment; Omot had admitted experiencing auditory hallucinations and at one point thought his food was being poisoned.† Although Omotís illness had stabilized on medication, he had difficulty making a connection between his aggressive acts and his illness and realizing that the medicine was helping him.† Both psychologists and the psychiatrist expressed their concern that Omot would engage in future acts causing serious harm to himself or others.† Following their recommendations, the district court ordered Omot committed as mentally ill and dangerous.
††††††††††† At the review hearing held in August 2002, a forensic psychiatrist reported Omotís diagnosis as schizoaffective disorder, bipolar type, and testified that the disorder grossly impaired his judgment.† Omot had experienced misperceptions of reality, including the belief that tests of his blood-sugar levels for diabetes were actually injections of malaria, and the intermittent belief that he does not have a mental illness.† Omot had also established a behavior pattern of compliance with medication, discontinuance of medication, and rapid decompensation.† The psychiatrist concluded that even when Omot was on medication, there was a possibility, to a reasonable psychological and psychiatric certainty, that he would engage in acts capable of inflicting serious physical harm on another person.† She testified that the onset of Omotís symptoms triggered his anger.† When asked what he would do if he started feeling those symptoms, he was unable to answer.† Omotís treatment report from the Minnesota Security Hospital noted that although he could acknowledge that he was mentally ill, it was not clear that he would voluntarily seek treatment for his mental illness.† The report provided a guarded prognosis based on Omotís past history, his lack of insight into his mental illness, and his need for medication.
The district court ordered indeterminate commitment, finding that Omot continued to satisfy the requirements for commitment as a person who was mentally ill and dangerous. †This appeal followed.
D E C I S I O N
The district court may order involuntary commitment on a finding that a proposed patient is a person who is mentally ill and dangerous.† Minn. Stat. ß 253B.18, subd. 1 (2002);see also Minn. Stat. ß 253B.18 (2000) (previous statutory provision, similar in material part, under which Omot was initially committed).† A mentally-ill and dangerous person is ďa person (a) who is mentally ill; and (b) who as a result of that mental illness presents a clear danger to the safety of others as demonstrated by the facts that (i) the person has engaged in an overt act causing or attempting to cause serious physical harm to another and (ii) there is a substantial likelihood that the person will engage in acts capable of inflicting serious physical harm on another.Ē† Minn. Stat. ß 253B.02, subd. 17 (2002).
On review, this court is limited to examining whether the district court complied with the requirements of the commitment statute and whether the commitment is justified by findings based on evidence received at the hearing.† In re Knops, 536 N.W.2d 616, 620 (Minn. 1995).† Factual findings of the district court will not be set aside unless clearly erroneous.† Minn. R. Civ. P. 52.01.† In reviewing fact-findings, we examine the record in the light most favorable to the district courtís decision.† Knops, 536 N.W.2d at 620.† When factual findings rest almost entirely on expert testimony, the district courtís evaluation of credibility is particularly significant.† In re Joelson, 385 N.W.2d 810, 811 (Minn. 1986).† This court reviews de novo the legal question of whether clear and convincing evidence supports the district courtís conclusion that appellant meets the standards for commitment.† Knops, 536 N.W.2d at 620.
After the district court makes an initial commitment of a person as mentally ill and dangerous, a second hearing is required to review the written report of the treatment facility.† Minn. Stat. ß 253B.18, subd. 2 (2002).† If the court then finds that the patient continues to be a person who is mentally ill and dangerous, the court must order commitment for an indeterminate period of time.† Minn. Stat. ß 253B.18, subd. 3 (2002).† At the hearing, the court must ďconsider all competent evidence relevant to the respondentís present need for continued commitment.Ē† Minn. R. Civ. Commitment 23(e).† The proponent of indeterminate commitment has the burden of establishing by clear and convincing evidence that the statutory requirements for commitment continue to be met.† Id.
Omot first argues that the state did not meet its burden of establishing, by clear and convincing evidence, that he was a person who was mentally ill at the time of the initial commitment and review hearings.† See Minn. Stat. ß 253B.02, subd. 13(a) (2002) (defining mental illness to include organic brain disorder or substantial psychiatric disorder that grossly impairs judgment, behavior, reason, and ability to recognize reality); see also Minn. Stat. ß 253B.02, subd. 13(a) (Supp. 2001) (materially similar statute in effect at time of initial commitment hearing).† Omot contends that his illness had stabilized on medication and claims that expert testimony failed to establish that his psychiatric disorder grosslyimpairedhis judgment, his behavior, and his capacity to recognize reality, to reason, or to understand.
††††††††††† But the medical evidence from both hearings supports the district courtís conclusion that Omot met the statutory requirements for commitment.† Omotís treating psychiatrist at Hennepin County Medical Center reported that Omotís disorder affected his ability to reason and understand, and that Omot had difficulty connecting his aggressive acts to his mental illness.† The psychiatrist from the Minnesota Security Hospital stated her opinion that Omotís judgment remained grossly impaired, that he did not have insight into his mental illness, and that he did not really understand his need for medication.† She testified that his limited understanding of his mental illness at the time of the review hearing was a risk factor for him.† She also noted that he could decompensate even while on medications and that he could not yet recognize such decompensation and report it to medical professionals.† The Minnesota State Hospital report provided a guarded prognosis, based on Omotís past history, his lack of insight into his illness, and his need for medication.
††††††††††† This court has upheld a district courtís determination that a patient was still mentally ill and dangerous at a review hearing, even though the patientís symptoms went into remission when he was taking medication.† In re Malm, 375 N.W.2d 888, 891 (Minn. App. 1985).† Omot attempts to distinguish Malm because it addressed the issue of dangerousness, rather than the issue of mental illness that Omot raises in this case.† But the court in Malm specificallynoted that the patientís mental illness continued, and if he failed to take his medication or consumed alcohol, he would ďalmost certainly experience a recurrence of his symptoms.Ē† Id. †The recurrence of such symptoms must be predicated on the continuing mental illness for which the patient was initially committed.
The testimony established that Omot continues to suffer from a schizoaffective disorder and that he runs the same risk of having his symptoms recur if he were released from a secure treatment facility at this time, with an attendant inability to recognize and control those symptoms on his own.† We therefore conclude that the district courtdid not err in its determination that Omot continues to be a person who is mentally ill, despite his current compliance with a treatment regimen in a secure setting.
††††††††††† Omot also argues that the state did not sustain its burden of proving, by clear and convincing evidence, that he continued to be dangerous at the time of the review hearing.† He points to testimony indicating that he was taking his medication, that his psychosis may be in remission, and that he was not currently experiencing hallucinations.† But this court has noted that a patientís conduct in an artificial hospital environment is not conclusive on the question of dangerousness if expert testimony establishes that the patient remains mentally ill and dangerous.† In re Welfare of Hofmaster, 434 N.W.2d 279, 281 (Minn. App. 1989).
Medical testimony indicated that Omotís progress, even on medication, was tenuous and that absent continued commitment, Omotís delusions, misperceptions, or violence could result in a fatality.† The record establishes Omotís difficulty in adhering to a prescribed treatment regimen in an unstructured setting:† when Omot was previously released from treatment, he failed to take his medication and resumed his assaultive behavior.† No expert at either hearing recommended his release.† The district court properly concluded that Omot met the statutory criteria for a person who is mentally ill and dangerous, and the court did not err in ordering his initial and indeterminate commitment.†