This opinion will be unpublished and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: Susan T. Carey.
Filed January 4, 2005
Gordon W. Shumaker, Judge
Hennepin County District Court
File No. MH-PR-04-549
Gregory R. Solum, 7625 Metro Boulevard, Suite 140, Edina, MN 55439 (for appellant Carey)
Amy Klobuchar, Hennepin County Attorney, John L. Kirwin, Assistant County Attorney, C-2000 Government Center, 300 South Sixth Street, Minneapolis, MN 55487 (for respondent State of Minnesota)
Considered and decided by Shumaker, Presiding Judge; Halbrooks, Judge; and Huspeni, Judge.*
GORDON W. SHUMAKER, Judge
Appellant challenges her commitment as mentally ill, arguing (a) she was improperly committed for the sole purpose of authorizing forced neuroleptic medications; and (b) commitment was not the least restrictive alternative because appellant has a guardian with power over her medical treatment decisions.
Appellant Susan T. Carey has a long history of mental health treatment that dates back to 1999. In 2002, appellant was diagnosed with schizoaffective disorder. She experienced delusions that included repeated claims of serious medical problems, resulting in more than fifty medical appointments and twelve emergency room visits during a six-month period. The district court ordered appellant’s commitment and authorized treatment with neuroleptic medications. This court affirmed. In re Carey, No. C0-03-261 (Minn. App. Aug. 5, 2003).
In January 2004, the district court determined that appellant was not in need of further care based upon a six-month treatment report and discharged her from commitment. Appellant was subsequently placed by her guardian in a nursing home facility. In June 2004, appellant was transferred to the Fairview University Medical Center because she had stopped taking her medications for more than a week and began to experience delusions. She claimed that staff at the nursing home had abused her, that the staff at the hospital was “causing violence to her,” and that she suffers from cancer. While she was at Fairview, the psychiatrists declared a medical emergency when appellant continuously refused to eat or drink anything.
Fairview subsequently filed a petition for commitment and a petition to authorize treatment with neuroleptic medications. Following a hearing, the district court committed appellant as mentally ill and authorized use of neuroleptic medications. Appellant now challenges her commitment.
D E C I S I O N
When reviewing a commitment, this court is limited to an examination of whether the district court complied with the Minnesota Commitment and Treatment Act (Act), Minn. Stat. ch. 253B (2002). In re Schaefer, 498 N.W.2d 298, 300 (Minn. App. 1993). “[T]he commitment must be justified by findings based upon evidence at the hearing.” In re Knops, 536 N.W.2d 616, 620 (Minn. 1995) (quotation omitted). The record is viewed in a light most favorable to the district court’s decision, and findings of fact shall not be set aside unless clearly erroneous. Id. The commitment may be reversed if the findings are insufficient to support the commitment. In re McGaughey, 536 N.W.2d 621, 624 (Minn. 1995).
Before an individual may be committed as mentally ill, the district court must find that person mentally ill by clear and convincing evidence. Minn. Stat. § 253B.09, subd. 1 (2002). “We review de novo whether there is clear and convincing evidence in the record to support the district court’s conclusion that appellant meets the standards for commitment.” In re Thulin, 660 N.W.2d 140, 144 (Minn. App. 2003) (quotation omitted). Under the Act, a person is mentally ill of he or she
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.
Minn. Stat. § 253B.02, subd. 13(a) (2002). Mental illness can be demonstrated by the failure or inability for reasons other than indigence to obtain necessary food, clothing, shelter, or medical care as a result of the impairment, or by an attempt or threat of physical harm to self or others. Id., subd. 13(a)(1)-(3).
Appellant concedes that she was diagnosed with paranoid schizophrenia with symptoms of disorganization, paranoia, and delusions, but argues that it was undisputed that she was not substantially likely to harm herself, others, or property. The court-appointed examiner reported that appellant had not attempted to physically harm herself or others. But at the hearing there was testimony that, while appellant was in the hospital, she had refused to eat any food and needed an IV line to receive adequate nutrition. Appellant had also removed her clothing and pulled out her IV. During the weekend prior to appellant’s commitment hearing the psychiatrists at the hospital declared a medical emergency because appellant “was not eating or drinking, and remained so agitated that she required restraints.” Because the record, when viewed in a light most favorable to the decision, reveals that appellant was starving herself by refusing to eat anything, we conclude that the record adequately supports the district court’s finding that appellant “poses a substantial likelihood of causing physical harm.” See Minn. Stat. § 253B.02, subd. 13(a)(1) (2002) (showing harm by failure to obtain necessities); In re Knapp, 351 N.W.2d 391, 393 (Minn. App. 1984) (finding likelihood of harm shown by failure to obtain food and other necessities).
Appellant argues that commitment was not necessary because her guardian could have petitioned for an order authorizing use of neuroleptic medications. This court recently held that a private guardian may consent, without prior court approval, to the administration of neuroleptic medications to an incapacitated individual who is not civilly committed. In re Guardianship of Welch, 686 N.W.2d 54, 56 (Minn. App. 2004) (concluding that neuroleptic medication is included among the necessary medical care for which guardians may give consent under Minn. Stat. § 524.5-313(c)(4)(i) (Supp. 2003)). When the incapacitated individual objects to the neuroleptic medications, the constitutional analysis under Price v. Sheppard, 307 Minn. 250, 262, 239 N.W.2d 905, 913 (1976), must be applied. Welch, 686 N.W.2d at 56-57.
Appellant asserts that because the guardian believed that she had complete authority over appellant, except for the administration of neuroleptic medications, the sole purpose of appellant’s commitment was to administer neuroleptic medications. But this argument ignores the district court’s finding that commitment and continued hospitalization were necessary for appellant “to stabilize.” In addition, the district court found that appellant was harming herself by refusing food and removing IV tubes. Therefore, the purpose of appellant’s commitment was more than merely a means for the district court to authorize use of neuroleptic medications.
Appellant also argues that, because the administration of neuroleptic treatment could be accomplished without commitment, appropriate less restrictive alternatives to commitment were available. The district court must make factual findings for any suitable, less restrictive alternative to judicial commitment that the court carefully considered and rejected, and reasons for the rejection. Minn. Stat. § 253B.09, subd. 2 (2002). This court will not reverse a district court’s findings as to the least restrictive treatment program that can meet an individual’s needs unless the findings are clearly erroneous. Thulin, 660 N.W.2d at 144.
Here, the district court considered several alternatives to committing appellant:
The least restrictive, appropriate, available placement is commitment to the Fairview University Medical Center and the Anoka-Metro Regional Treatment Center. The Court considered placement in an apartment or nursing home, but rejected this due to the fact that [appellant] needs continued hospitalization in order to stabilize. [Appellant] opposes living anywhere except her own apartment, and she was unable to live there even with extensive services. [Appellant’s] conservator testified at the hearing that placement by the conservator would be ineffective because [appellant] is unlikely to stay voluntarily at such placement and the conservator has no means to force [appellant] to stay. Finally, a commitment is required so that an Order to force medications may be obtained. Without a commitment, there is no legal authority for forcing medications absent a Jarvis order.
Appellant does not claim that any of these findings are clearly erroneous, but she argues that, because appellant’s conservator can petition for authorization to consent to neuroleptic medications, commitment was not necessary. We disagree.
Appellant’s argument does not account for the limited power and authority of her guardian. Although a guardian may establish a place of residence for the ward, the guardian may not place the person into a regional treatment center unless (1) placement follows a commitment hearing, (2) for outpatient services, or (3) for temporary care not to exceed 90 days. Minn. Stat. § 524.5-313(c)(1) (Supp. 2003). The court-appointed examiner expressed concern that appellant was unable to appreciate her relationship with her guardian, lacked the capacity to cooperate with the guardian, and blamed her guardian for her situation. The examiner testified that when asked about her guardian, appellant stated, “I hate her. She’s lied about some things that happened at HCMC. She’s supposedly my guardian, but I hate her.” Moreover, the district court specifically found that, although appellant’s guardian could place her in a facility, the guardian has no means to compel appellant to stay there. Therefore, we conclude that the district court properly considered and rejected other less restrictive alternatives and properly concluded that commitment was the least restrictive option for adequately treating appellant’s illness.