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:
John H. Hegerle.
Filed October 28, 1997
Toussaint, Chief Judge
Hennepin County District Court
File No. P7-97-60003
Marilyn B. Knudsen, East 1314 First National Bank Building, 332 Minnesota Street, St. Paul, MN 55101 (for appellant Hegerle)
Considered and decided by Toussaint, Chief Judge, Amundson, Judge, and Harten, Judge.
John Hegerle appeals his commitment to the Veterans Affairs Medical Center (VA) as mentally ill, arguing (1) there was insufficient evidence to show he posed a substantial likelihood of physical harm to himself or others, (2) there was insufficient evidence to show he was committed to the least restrictive alternative, and (3) the district court improperly delegated its judicial authority to the VA. Because we conclude (1) there is clear and convincing evidence in the record to support the district court findings that Hegerle posed a substantial likelihood of physical harm to himself or others and that the VA was the least restrictive alternative, and (2) the district court did not improperly delegate its authority to the VA, we affirm.
District court findings will not be set aside unless clearly erroneous. Minn. R. Civ. P. 52.01; In re McGaughey, 536 N.W.2d 621, 623 (Minn. 1995). On questions of law, this court need not defer to the district court. In re Stilinovich, 479 N.W.2d 731, 734 (Minn. App. 1992).
A mentally ill person is defined, in relevant part, as one suffering from an organic disorder or a substantial psychiatric disorder who
poses a substantial likelihood of physical harm to self or others as demonstrated by:
(i) a failure to obtain necessary food, clothing, shelter, or medical care as a result of the impairment, or
(ii) a recent attempt or threat to physically harm self or others.
Minn. Stat. § 253B.02, subd. 13(b) (1996). The district court must find a person mentally ill by clear and convincing evidence. Minn. Stat. § 253B.09, subd. 1 (1996).
The district court found Hegerle suffers from dementia and paranoid schizophrenia and poses a substantial likelihood of causing physical harm. The district court relied on Hegerle's inability to live independently, manage his diabetes, and obtain medical care, and a verbal altercation Hegerle engaged in with another patient, which escalated when he put a lit cigarette to the other patient's pants and the other patient shoved him to the ground, fracturing his hip. Hegerle was hospitalized and confined to a wheelchair at the time of the hearing. The record further revealed that Hegerle would be hospitalized for an additional three months.
Hegerle disputes the factual basis for some of the findings and contends the findings are insufficient in any event to show he was substantially likely to physically harm himself or others. The district court found that Hegerle put a lit cigarette to another patient's pants and determined that Hegerle did not understand he caused a safety hazard when he threw lit cigarettes on the floor of his home. The record supports the district court's findings that Hegerle engaged in a recent attempt or threat to physically harm others. Minn. Stat. § 253B.02, subd. 13(b)(ii).
Next, Hegerle disputes the finding that he was unable to care for his diabetes and refused necessary medical treatment, claiming the evidence did not show that his glucose level was beyond reasonable limits, that he did not seek medical attention, or that he did not take his prescribed medication. Dr. Chris Meadows, the court-appointed examiner, testified Hegerle was not aware of the care required to monitor his glucose level, and explained that he reused needles, used insulin that was more than six months old, and consumed alcohol. Hegerle's VA social worker testified that the week before the hearing, Hegerle did not cooperate with treatment and had to be convinced to take his medication and be more mobile. While Hegerle attempts to explain or minimize his conduct, the findings are supported by the evidence and show he was unable to provide himself with necessary medical care. Minn. Stat. § 253B.12, subd. 13(b)(i).
Hegerle next argues there was insufficient evidence to support the finding he could not live independently, citing the fact that he has lived independently twice. The record, however, showed Hegerle reentered the VA based on his sister's concerns, had delusional thoughts about food and people and was unable to attend to his personal hygiene. Dr. Meadows described Hegerle as homeless. Hegerle, however, contends these findings are unsupported by evidence from personal observations of witnesses. Hegerle's own testimony showed he was delusional, could not care for his personal hygiene, and threw lit cigarettes on the floor at home.
Finally, Hegerle contends the district court should not have relied on test results to show he could not live independently. He cites Dr. Meadows' testimony that he was able to testify more clearly at the hearing than during his interviews. Likewise, Hegerle claims, he would do better at living independently than the test results would show. The district court's reliance on the test results was not clearly erroneous and supports the findings that Hegerle was unable to live independently and provide necessities. Id.
The district court findings show clear and convincing evidence that Hegerle was substantially likely to physically harm himself or others as a result of his mental illness.
Hegerle challenges the district court's decision to commit him to the VA. If the district court finds a person is mentally ill, it shall commit the patient to the least restrictive alternative if there is no alternative to judicial commitment. Minn. Stat.
§ 253B.09, subd. 1. The court's decision will not be reversed if not clearly erroneous. In re King, 476 N.W.2d 190, 193 (Minn. App. 1991).
The district court found that the least restrictive placement was commitment to the VA after considering and rejecting board and care facilities because they were unable to cope with Hegerle's present behavior and needs. Hegerle would consider only independent living. The district court noted Hegerle would probably need hospitalization until June because of his physical condition, but once he is physically ready for discharge, his treatment team must then decide the least restrictive appropriate placement.
Hegerle contends the evidence did not address his present needs, but only his future needs, which he deems irrelevant to the issue. He cites Dr. Meadows' ambivalence as to whether he was capable of living in the community, and his belief that the most appropriate facility would be a board and care facility where Hegerle would have more freedom. Hegerle again cites the fact that he lived successfully in the community previously and contends he can care for himself.
The VA social worker testified Hegerle's treatment team recommended commitment to the VA until his hip heals sufficiently, and then placement at a nursing home; Hegerle refused, and would agree only to independent living. Dr. Meadows testified that while an assisted care facility would be appropriate, independent living was not realistic due to concerns about Hegerle's psychological problems, his inability to monitor his diabetic condition properly, and safety concerns regarding extinguishment of cigarettes. Because of his lack of cooperation, however, the option of an assisted care facility was not pursued. Dr. Meadows further noted Hegerle needed continued care at the hospital, and believed that inquiries as to assisted care facilities were premature at that time.
Based on this record, the district court had clear and convincing evidence regarding Hegerle's condition that supported commitment to the VA, and its decision is not clearly erroneous. See In re Butler, 379 N.W.2d 233, 235 (Minn. App. 1985) (district court found no alternative disposition to commitment at hospital where patient denied need for treatment or medication and refused voluntary treatment and psychologist recommended residential treatment center).
Hegerle finally argues that the district court improperly delegated to the VA its judicial authority under Minn. Stat. § 253B.09 to commit him to the least restrictive alternative. The district court found Hegerle would need to continue hospitalization based on his current physical condition for some three months, and at that time the decision should be made as to
what the least restrictive, appropriate placement would be. If he continues to refuse to consider any options, he will likely have to be placed in a nursing home. If he believes at that time that there is a placement that is less restrictive than the treatment team's choice and that is appropriate and available, he may bring the issue before the court by means of a .17 petition.
At the time of the commitment hearing, as discussed above, the VA was the least restrictive alternative. The court's comment that when Hegerle's physical condition improved he could be provisionally discharged, most likely to a nursing home, was not improper or incorrect. The head of a treatment center may provisionally discharge the patient. Minn. Stat. § 253B.15, subd. 1 (1996). The patient may petition for relief at any time. Minn. Stat. § 253B.17. The district court did not improperly delegate its authority by responding to testimony as to Hegerle's future placement.