may not be cited except as provided by
Minn. Stat. § 480A.08, subd. 3 (1996).
STATE OF MINNESOTA
IN COURT OF APPEALS
In the Matter of:
Filed October 28, 1997
Toussaint, Chief Judge
Hennepin County District Court
File No. P49134087
Michael O. Freeman, Hennepin County Attorney, John St. Marie, Assistant County Attorney, A-2000 Government Center, Minneapolis, MN 55487 (for respondent)
U N P U B L I S H E D O P I N I O N
Calvin Cade appeals his commitment as mentally ill, arguing there was insufficient evidence to show (1) he met the standards for commitment, and (2) judicial commitment was the least restrictive alternative. He also appeals the order authorizing the involuntary administration of electroconvulsive therapy (ECT), contending this treatment was not necessary and reasonable because (1) he is competent to decide whether to take ECT treatment, and (2) ECT treatment is not presently necessary. Because we find there is clear and convincing evidence in the record to support the district court findings that (1) the standards for commitment were met, (2) judicial commitment was the least restrictive alternative, and (3) Cade was not competent to decide whether he needed ECT treatment, and (4) ECT treatment is presently necessary and reasonable, we affirm.
Findings of fact will not be reversed unless clearly erroneous. In re McGaughey, 536 N.W.2d 621, 623 (Minn. 1995). A commitment will be overturned if the findings do not provide clear and convincing evidence to support the conclusion that the person meets the standards for commitment. Id. at 624.
Cade had been committed previously as mentally ill, and a petition was filed to continue his commitment. Minn. Stat. § 253B.13, subd. 1 (1996). According to section 253B.13, subd. 1, the standard for continued commitment is set out in Minn. Stat. § 253B.12, subd. 4, as follows:
In determining whether a person continues to be mentally ill * * *, the court need not find that there has been a recent attempt or threat to physically harm self or others, or a recent failure to provide necessary food, clothing, shelter, or medical care. Instead, the court must find that the patient is likely to attempt to physically harm self or others, or to fail to provide necessary personal food, clothing, shelter, or medical care unless involuntary commitment is continued.
(Emphasis added); cf. Minn. Stat. § 253B.02, subd. 13 (1996) (setting out standard for initial commitment).
The district court found that if Cade were not involuntarily committed, he would likely fail to provide necessities. The district court further concluded that Cade believed he had been "cured" of his mental illness and did not need ECT treatment. While Cade claimed he would continue taking neuroleptic medication, the district court found this unlikely because of Cade's belief that he was not mentally ill. The record revealed that Cade has a lengthy history of relapses into a life-threatening catatonic state in which he is unable to consume food or water.
Cade testified that he (1) did not say he was cured, but instead indicated he felt better, (2) recognizes his mental illness and need for treatment, and simply disagrees with the treatment plan for continued commitment and ECT treatment. Cade argues the court's conclusion was entirely speculative given his current good condition and the safeguards contained in his plan to live with his brother after discharge. See McGaughey, 536 N.W.2d at 623 (commitment may not be based on speculation).
The district court, rather than crediting Cade's opinion that Cade did not need ECT therapy or commitment, relied on the opinions of the medical personnel, his social worker and his guardian ad litem. The record supports the district court's finding by clear and convincing evidence that without commitment in a structured setting and treatment, Cade is likely to relapse into life-threatening catatonia in which he will be completely unable to provide necessities for himself. The district court's findings of fact are not clearly erroneous where there is support based on expert testimony. In re Knops, 536 N.W.2d 616, 620 (Minn. 1995).
Cade also argues that the district court failed to make all the necessary findings to determine that he was "mentally ill" as required by Minn. Stat. § 253B.12, subd. 4. Our review of the order shows the district court made the necessary findings, which are supported by clear and convincing evidence. See Minn. Stat. § 253B.02, subd. 13(a).
Cade next contends judicial commitment is not the least restrictive alternative. When continued commitment is ordered, the court must indicate that less restrictive alternatives have been considered and provide reasons for rejecting them. Minn. Stat. § 253B.12, subd. 7. A district court's decision that judicial commitment to a hospital is the least restrictive alternative will not be reversed if not clearly erroneous. In re Hieb, 355 N.W.2d 319, 321 (Minn. App. 1984).
Cade contends that his plan to live with his brother and continue to see his psychiatrist and take medication, while monitored by his brother and his brother's girlfriend, was the least restrictive alternative. The district court credited and relied on the unanimous opinions from the mental health professionals, social worker, and guardian ad litem that Cade needed continued commitment and that release to his brother was not a good alternative, based on his need for a structured facility and continued treatment with ECT and neuroleptic medication. The district court's conclusion is supported by clear and convincing evidence and is not clearly erroneous.
Finally, Cade challenges the necessity and reasonableness of ECT treatment. When a patient is incompetent or refuses intrusive treatment such as ECT, the district court must determine the necessity and reasonableness of the treatment by balancing the need for treatment against its intrusiveness. Price v. Sheppard, 307 Minn. 250, 262-63, 239 N.W.2d 905, 913 (Minn. 1976) (setting forth factors to balance in making determination); see Minn. Stat. § 253B.03, subd. 6c (1996) (procedures for administration of neuroleptic medication). Cade contends he was competent to make a decision about ECT treatment and there was no evidence he presently required treatment.
A person is competent to refuse intrusive treatment when 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.
In re Peterson, 446 N.W.2d 669, 673 (Minn. App. 1989), review denied (Minn. Dec. 1, 1989). All three factors must be present to show competency, and those seeking
permission to treat the patient need not disprove all three to prevail. Id.
Cade asserts that (1) he is competent to decide whether to receive ECT treatment because he understands he has a mental illness that can cause him to lapse into a catatonic state, (2) after discussing the risks and benefits of treatment with his doctor, he has decided that ECT is simply not desirable for him, and (3) he knows ECT treatment is necessary to treat catatonia. The district court found, however, that Cade did not understand he still has a mental illness, despite his claims to the contrary, and that he requires treatment with ECT to prevent a relapse back into catatonia. Thus, the district court concluded that Cade does not possess sufficient knowledge about his mental disorder and its treatment, and is not competent to decide whether he needs ECT treatment. Id.
Cade also argues that he does not need ECT treatment presently, citing the fact he has not suffered a relapse since the last court order. Instead, he argues this treatment should be used only when he feels signs of the catatonia returning. Thus, he contends the court order was based on speculation that he could relapse into catatonia rather than on present medical necessity. As Cade notes, the district court may not authorize future intrusive treatment without present medical necessity. In re Kinzer, 375 N.W.2d 526, 532 (Minn. App. 1985).
Medical testimony specifically indicated the ECT treatment was necessary at the time of trial to prevent relapses. Unlike Kinzer, the court here had evidence that Cade presently needed ECT treatment and its decision is not clearly erroneous.