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:
Susan K. Bublitz.
Filed January 6, 1998
Hennepin County District Court
File No. P69760316
Hubert H. Humphrey III, Attorney General, Julie K. Harris, Assistant Attorney General, 445 Minnesota Street, 900 NCL Tower, St. Paul, MN 55101 (for respondent petitioner for commitment)
Michael O. Freeman, Hennepin County Attorney, Thomas LaVelle, Assistant County Attorney, A-2000 Government Center, 300 South Sixth Street, Minneapolis, MN 55487 (for respondent petitioner for medication authorization)
Considered and decided by Toussaint, Chief Judge, Randall, Judge, and Foley,**
Retired judge of the Minnesota Court of Appeals, serving by appointment pursuant to Minn. Const. art. VI, § 10. Judge.
Appellant Susan Bublitz challenges her commitment ill to the Anoka Metro Regional Treatment Center as a mentally ill person and the order authorizing involuntary administration of neuroleptic medication. She contends the district court did not have clear and convincing evidence to support its decisions. We affirm.
Bublitz's conservator initiated her admission to the inpatient psychiatric unit at Fairview University Hospital. Jane Otto, a social worker on the unit and a member of appellant's treatment team, believed that Bublitz would be at great risk if discharged because she was unable to care for herself, was vulnerable to exploitation by others, and did not maintain her nutritional and physical needs. Otto explained that Fairview provided only short-term acute care, and believed that Bublitz needed an extended stay. The hospital recommended commitment to the Anoka Metro Regional Treatment Center.
Bublitz's psychiatrist, Dr. Joseph Gendron and the court-appointed examiner, psychologist James N. Alsdurf, filed examiner's reports and diagnosed her with paranoid schizophrenia, chronic, and recommended commitment to a state hospital for long-term care. Bublitz testified that she would like to return to Fairview after the hearing, and then ultimately return home. She believed that she could take care of herself if she received some assistance.
At the Jarvis hearing, psychiatrist Mark Willenbring diagnosed Bublitz with chronic paranoid schizophrenia. While Bublitz's treating psychiatrist prescribed neuroleptics, Bublitz refused the medication. Dr. Willenbring believed treatment was necessary and reasonable and that Bublitz was not competent to decide for herself whether to take the medication. Bublitz testified that she preferred to take natural products, and she would like to return home rather than remain in the hospital setting.
A mentally ill person is defined as
any person who 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 (a) is manifested by instances of grossly disturbed behavior or faulty perception; and (b) 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 (1996). A district court must find a person mentally ill by clear and convincing evidence. Minn. Stat. § 253B.09, subd. 1 (1996). This court will not disturb the findings unless clearly erroneous and will give due regard to the district court's determination of the credibility of witnesses. Minn. R. Civ. P. 52.01.
The district court found Bublitz was ill with chronic paranoid schizophrenia, a substantial psychiatric disorder of her thought, mood, and memory, which grossly impaired her judgment, behavior, capacity to recognize reality, and ability to reason or understand. Bublitz contends that the district court did not have clear and convincing evidence to support this finding, and that the district court erred in disregarding her testimony and finding the testimony of other witnesses to be credible.
Bublitz's psychiatrist and the court-appointed psychologist diagnosed Bublitz with chronic schizophrenia and social workers Marty and Otto described Bublitz's symptoms. In contrast, Bublitz merely testified she could live in the community with assistance after a short stay at the hospital. Thus, the district court had clear and convincing evidence from the mental health professionals to support its decision that Bublitz was ill with a substantial psychiatric disorder under Minn. Stat. § 253B.02, subd. 13(a).
Bublitz next challenges the district court's findings as to the likelihood of harm to herself. A district court must determine whether the patient is substantially likely to physically harm herself or others through a failure to obtain necessities or a recent attempt or threat to harm self or others. Minn. Stat. § 253B.02, subd. 13(b). The district court found Bublitz met this standard based on her recent frequent references to suicide and her inability to make decisions relating to her basic needs. Her severe thought disorder limited her ability to express herself, she experienced hallucinations and paranoia, she was confused and had poor insight. If left to her own devices, she might not obtain the treatment and support she needs.
Bublitz asserts that the district court did not have clear and convincing evidence to support the decision, contending she has the ability to provide for her personal needs with the assistance of health and social service providers and the court-appointed conservator. But testimony showed that even with such assistance, Bublitz had been unable to provide for her needs. The district court findings that Bublitz could cause self-harm through the threats of suicide and inability to care for herself are supported by the testimony and provide clear and convincing evidence to show the standard was met.
Bublitz next challenges her placement at Anoka. After finding a person is mentally ill, the district court must commit the patient to the least restrictive alternative. Minn. Stat. § 253B.09, subd. 1; In re Moll, 347 N.W.2d 67, 70 (Minn. App. 1984). The court must consider the patient's preferences. Minn. Stat. § 253B.09, subd. 1. The decision will not be reversed unless clearly erroneous. In re King, 476 N.W.2d 190, 193 (Minn. App. 1991).
The district court considered and rejected supportive living and group homes. It concluded they would be unable to cope with Bublitz's behavior and needs, noting she had been incapable of cooperating with support services. It cited her paranoia, indecision, and poor insight, and found she would not cooperate with treatment and was not sufficienctly cognitively intact to participate in group therapy.
Bublitz argues the district court failed to commit her to the least restrictive alternative because it failed to consider her preference to receive treatment at Fairview University Hospital and then return home. She also asserts that she was willing to obtain mental health counseling and treatment.
Fairview was able to provide only short-term care and the mental health professionals explained Bublitz required longer-term care at Anoka. The district court considered supportive living or a group home, but found neither could meet Bublitz's needs. The district court's findings are supported by the record and are not clearly erroneous.
A person is competent to decide about treatment with neuroleptic medications only if she or he is aware of having the mental disorder, has sufficient knowledge about the medication and mental disorder and does not base the refusal on delusional beliefs. Id. at 673. The district court found that Bublitz had no insight into her mental illness, was incompetent to understand the risks and benefits, and denied she was mentally ill.
Bublitz argues she has the ability to address her personal needs in all respects, including accepting or rejecting medication. She asserts she is a competent decision-maker and does not need a court order to impose treatment. We conclude Bublitz's position is contrary to the evidence received and credited by the district court. Psychiatrist Willenbring testified that Bublitz did not believe she is mentally ill, did not understand the reasons for her hospitalization or the nature and extent of her problems, and did not believe medication would be beneficial. He explained she did not have the capacity to comprehend the risks and benefits of the proposed medication or to decide whether such treatment is necessary and reasonable. Thus, the district court's decision that Bublitz is not competent to decide about medication is supported by clear and convincing evidence and is not clearly erroneous.
Bublitz next disputes whether the neuroleptic medication was necessary and reasonable, contending she would prefer to be treated through natural methods. In making this determination, the district court must consider the effect of the medication, risk of adverse side effects, experimental nature of the treatment, acceptance by medical community of the state, extent of intrusion, and patient's ability to decide whether treatment is reasonable. Jarvis, 418 N.W.2d at 144-45 (quoting Price v. Shepard, 307 Minn. 250, 262-63, 239 N.W.2d 905, 913 (1976)).
Dr. Willenbring testified Bublitz suffered from chronic paranoid schizophrenia and that her thought disorder, delusions, hallucinations, isolative behavior, and lack of self-care were the target symptoms for the medication. He explained that the nature of her condition was sufficiently severe and of such duration that the benefits of the neuroleptic medication would outweigh the risks. He discussed the other factors and concluded that the recommended medication was appropriate and there are no alternative forms of treatment.
The district court had clear and convincing evidence from which to conclude that the treatment was necessary and reasonable.