may not be cited except as provided by
Minn. Stat. § 480A.08, subd. 3 (1996).
STATE OF MINNESOTA
IN COURT OF APPEALS
In Re: Steven Louis Harty.
Filed August 19, 1997
Hennepin County District Court
File No. P99460263
Mary Ferris Jensen, 5352 44th Ave. S., Minneapolis, MN 55417 (for appellant Steven Harty)
Hubert H. Humphrey III, Attorney General, Steven J. Lokensgard, Assistant Attorney General, 900 NCL Tower, 445 Minnesota Street, St. Paul, MN 55101 (for respondent)
Considered and decided by Harten, Presiding Judge, Parker, Judge, and Davies, Judge.
Steven Harty, who was committed indeterminately as mentally ill and dangerous, challenges the trial court's decision to authorize the use of neuroleptic medication. We affirm.
In 1995, Dr. Stanley Shapiro, appellant's treating psychiatrist, petitioned for a Jarvis order authorizing him to treat appellant with neuroleptic medication. The trial court denied the petition, finding appellant was competent to give or withhold consent. Dr. Shapiro attempted to persuade appellant to take neuroleptic medication and provided him with educational material. Appellant refused the medication, however, and Dr. Shapiro again petitioned for a Jarvis order, which the trial court granted.
At the Jarvis trial, appellant testified: (1) that he does not believe he has a mental illness; (2) that what others thought were delusions either were reality or could be explained; (3) that he did not want Dr. Shapiro to "experiment" on him; and (4) that he believed the medicine was poison because of the side effects he experienced.
Dr. Shapiro testified that appellant suffers from schizophrenia and that neuroleptics could be used to treat symptoms such as appellant's paranoid delusions, his irritability, and his social withdrawal. He also testified that appellant could ultimately be discharged from hospitalization after he gains more insight into his mental illness and need for treatment, and that, although appellant previously experienced side effects when he took neuroleptics, these can be decreased by changing the manner of administration of medicine (i.e., time of day), using side-effect medication, and trying different types of neuroleptics. Dr. Shapiro did not believe appellant had the capacity to understand his illness or to comprehend relevant facts regarding medication. He believes appellant's mental illness is sufficiently severe so that the benefits of medication outweigh the risks.
Dr. William Orr, a psychiatrist and the court-appointed examiner, diagnosed appellant with schizophrenia, paranoid type. Dr. Orr believes appellant suffers from delusional beliefs and is not competent to decide whether to take medication. Dr. Orr also noted that, although appellant can recite side effects, he displays a lack of insight and does not understand the scope of the effects of the illness on him or the benefits from medication.
The trial court determined that appellant is incompetent to decide whether to take neuroleptic medications and authorized the use of neuroleptic medication.
A treatment facility seeking to treat a nonconsenting committed patient with neuroleptic medication must first obtain judicial review. Jarvis v. Levine, 418 N.W.2d 139, 148 n.7, 150 (Minn. 1988); Minn. Stat. § 253B.03, subd. 6c(e)-(o) (1996). The party seeking the Jarvis order must prove the necessity and reasonableness of the medication by clear and convincing evidence. In re Peterson, 446 N.W.2d 669, 672 (Minn. App. 1989), review denied (Minn. Dec. 1, 1989).
Appellant disagrees with the finding that he has schizophrenia. But this court affirmed appellant's commitment as mentally ill and dangerous. In re Harty, No. C9-95-888 (Minn. App. Aug. 15, 1995). Further, the finding of mental illness is supported by clear and convincing evidence--the psychiatrists who testified at the Jarvis hearing had diagnosed appellant with schizophrenia, despite appellant's claim that he was not mentally ill. Finally, the focus of the Jarvis hearing is on treatment, not diagnosis. Peterson, 446 N.W.2d at 672.
Appellant also contends that his behavior and symptoms do not warrant violating his bodily integrity by the use of neuroleptic medication. When such intrusive treatment is proposed against the patient's wishes, the court must weigh the need for treatment against its intrusiveness. Jarvis, 418 N.W.2d at 144, 148-49 (factors to consider include effects of treatment, risks of side effects, experimental nature of treatment, acceptance by medical community, extent of intrusion and pain, and patient's competency).
Both Dr. Shapiro and Dr. Orr testified to the benefits of treating appellant with neuroleptic medication. Dr. Shapiro acknowledged that appellant had previously experienced side effects from neuroleptic medication, but explained how these can be reduced or eliminated. Although appellant testified at the hearing that he believed Dr. Shapiro wanted to experiment on him, Dr. Shapiro explained that he was not experimenting but, instead, was trying to find the most effective medication with the least side effects. There was no evidence that the medication was not widely accepted by the medical community or that the extent of intrusion and pain was anything more than that associated with a needle prick.
The final factor is whether appellant is competent to determine for himself whether the treatment is desirable. Id. A mentally disordered person is competent to refuse the medication if the person has
(1) an awareness of having a mental disorder; (2) sufficient knowledge about medication and the mental disorder; and (3) a refusal that is not based upon delusional beliefs.
Peterson, 446 N.W.2d at 673 (citation omitted). Those advocating the use of involuntary medication need only disprove one of the three to prevail. Id.
Appellant denies that he is mentally ill. Although he knows about the medication and schizophrenia, he is unable to comprehend the scope of his illness or benefits of medication. He believes the medication is poison because of the side effects. Based on Peterson, the trial court properly determined appellant was not competent to make a decision about his mental illness.
Appellant also argues that, even if he meets the Peterson criteria for incompetency, due process requires an additional inquiry as to whether he understands the consequences flowing from his refusal to take the neuroleptic medication. We find no authority or reason to adopt this extra factor and, instead, continue to rely on Peterson.
We note that there was apparently no appeal taken from the 1995 order and also that the hospital attempted to treat appellant without medication. The treatment was not effective, however, and appellant's condition deteriorated by the time of the 1997 petition. This case is comparable to a commitment case in that it requires continuing review of the patient's psychological condition. We reject appellant's law-of-the-case argument.
[ ]1 Jarvis v. Levine, 418 N.W.2d 139, 148 n.7, 150 (Minn. 1988).