Minn. Stat. sec. 480A.08, subd. 3 (1996).
STATE OF MINNESOTA
IN COURT OF APPEALS
Filed June 16, 1998
File No. P8-97-60544
Douglas F. McGuire, MSB Center, Suite 400, 1401 West 76th Street, Richfield, MN 55423-3966 (for appellant)
Michael O. Freeman, Hennepin County Attorney, John P. St.Marie, Assistant County Attorney, A-2000 Government Center, 600 S. Sixth Street, Minneapolis, MN 55487 (for respondent)
Hubert H. Humphrey, III, Attorney General, Piper K. Aafedt, Assistant Attorney General, 445 Minnesota Street, Suite 900, St. Paul, MN 55101 (for respondent)
Considered and decided by Davies, Presiding Judge, Toussaint, Chief Judge, and Harten, Judge.
U N P U B L I S H E D O P I N I O N
Appellant Corrine Sutherland appeals from a civil commitment and an order authorizing the administering of neuroleptic drugs. She alleges that there is no clear and convincing evidence to support the court's findings (1) that she is mentally ill, (2) that she poses a substantial likelihood of harm to herself, (3) that the treatment center is the least restrictive available treatment option, (4) that she does not have the capacity to decide whether to take medication, and (5) that treatment with neuroleptic medication is necessary and reasonable. We affirm.
Appellant's mother testified that two years before the hearing, appellant started to become paranoid about people following her and accused her brother and his partner of setting it up. She quit her job. She started to work at a hotel and then "she just started to really go downhill." She could not function and was fired. After that, appellant just lounged around her parents' home. Because appellant could not take care of herself, her family provided her with food, shelter, and all her other daily needs but has since discontinued doing so because appellant requires treatment.
Appellant's mother went on to testify that while at home appellant heard noises and failed to recognize her family. Appellant told her mother that her mind was dark. She began to ask her mother if she was really her mother. She told her mother that she heard a high-pitched squeal, explosions, and voices. She entered a sweepstakes and believed that she won but suspected that her family took the money. The incident that led to appellant's hospitalization occurred when, after two weeks of consistently denying that her family members were who they said they were, appellant and her mother slapped each other. Appellant was then hospitalized but continued to hear voices and noises, including the high-pitched sound.
Psychologist Terry Nelson testified that appellant suffered from schizophrenia and that because of her unwillingness to cooperate, there was no less restrictive treatment than involuntary commitment to a regional treatment center. He believed that she would have a difficult time providing for her daily needs without her family's support.
Psychiatric social worker supervisor Dennis Geer testified that appellant displayed symptoms of major mental illness. He opined that appellant suffers from an illness that makes her believe that the people around her are imposters. She also has psychotic hallucinations, including a belief that people put medicines or poisons in her food and water, that the building vibrates, that the lights in her bedroom put pressure on her brain, and that a metal plate behind her bed influences her thinking.
Geer testified that appellant is uncooperative, refusing medication and an MRI. He opined that she would not be able to care for herself without her family. He added that there was a risk that she would strike out, and thus subject someone to physical danger, as a result of her condition. Geer knew of no available alternative treatment less restrictive than involuntary commitment in a regional treatment center.
Appellant testified that she is confused because of the people in her life resemble her immediate family, but are not her family. She claimed to hear the high-pitched noise and feel vibrations in the courtroom during the hearing. She believed that someone put a numbing agent in the glass of water available to her during the hearing. Nonetheless, she does not believe that she suffers from mental illness and does not believe that hearing noises and voices is symptomatic of mental illness; she will not agree to take medication.
In a report, HCMC staff physician Dr. Nicholas Rogers diagnosed appellant with major depressive disorder with psychotic features, differential diagnosis schizoaffective disorder versus schizophrenic disorder, and recommended antidepressant/neuroleptic medication. On January 12, 1998, the district court adjudicated appellant mentally ill and committed her to the Anoka-Metro Regional Treatment Center.
On January 22, 1998, a second petition was filed to authorize administration of neuroleptic medication, and a hearing was conducted the next day.
Staff psychiatrist Dr. James McCoy testified that appellant's diagnosis was "psychotic disorder NOS," which he considers a major mental illness, but appellant refuses all medication. Dr. McCoy opined that appellant did not understand the risks and benefits of treatment with neuroleptic medication. He believed that no less risky forms of treatment could effectively treat appellant's mental illness.
Psychiatric specialist and appointed examiner Dr. William Orr testified that it was reasonable and necessary that appellant receive neuroleptic medications and that appellant was not competent to decide whether she should take the medications. He maintained that the benefits of medication outweighed their risks.
Appellant testified that she was refusing medication because she did not want to suffer the side effects, such as dizziness and blurred vision. She maintains that she does not need medication or treatment. On January 28, the district court issued an order authorizing the use of neuroleptic medication. Appellant challenges both the commitment and the authorization to administer medication.
D E C I S I O N
Appellant contends that five of the district court's determinations are not supported by clear and convincing evidence.
1. Finding of Mental Illness
Minnesota law defines "mentally ill person" as follows:
"Mentally ill person" means 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
is manifested by instances of grossly disturbed behavior or faulty perceptions and poses a substantial likelihood of physical harm to self or others as demonstrated by:
(1) a failure to obtain necessary food, clothing, shelter, or medical care as a result of the impairment * * *.
Minn Stat. § 253B.02, subd. 13 (Supp. 1997). To order commitment, a court must find an individual mentally ill by clear and convincing evidence. Minn. Stat. § 253B.09, subd. 1 (Supp. 1997).
The referee heard expert testimony of Geer and Dr. Nelson, diagnosing appellant as mentally ill, and of appellant's mother describing appellant's behavior. The referee also witnessed manifestations of appellant's mental illness in the courtroom when she testified personally. There is clear and convincing evidence that appellant has a psychiatric disorder.
The referee heard the testimony of Geer and appellant's mother that appellant could not care for herself, Dr. Nelson's testimony that appellant would have a difficult time providing for her daily needs without her family's support, and appellant's testimony that demonstrated her manifest incapacity to comprehend reality. There is clear and convincing evidence that appellant presented a likelihood of harm to herself or others.
2. Least Restrictive Alternative
If the district court finds that a person is mentally ill, and that there is no suitable alternative to commitment, it shall commit the patient to the least restrictive treatment program that can meet the patient's needs. Minn. Stat. § 253B.09, subd. 1.
Geer and Dr. Nelson testified that no less restrictive alternative to commitment at a regional treatment center was available for appellant. Appellant's mother testified that appellant no longer would be allowed to live at home. Despite appellant's assertions that she could return to her parents' home, there is proof by clear and convincing evidence that involuntary commitment to a regional treatment center is the least restrictive alternative available.
3. Capacity to Decide Use of Medication
In determining a person's capacity to make decisions regarding the administration of neuroleptic medication, the court shall consider:
(1) whether the person demonstrates an awareness of the nature of the person's situation, including the reasons for hospitalization, and the possible consequences of refusing treatment with neuroleptic medications;
(2) whether the person demonstrates an understanding of treatment with neuroleptic medications and the risks, benefits, and alternatives; and
(3) whether the person communicates verbally or nonverbally a clear choice regarding treatment with neuroleptic medications that is a reasoned one not based on delusion, even though it may not be in the person's best interests.
Disagreement with the physician's recommendation is not evidence of an unreasonable decision.
Minn. Stat. § 253B.092, subd. 5(b) (Supp. 1997).
The referee heard testimony from Dr. McCoy that appellant did not understand the risks and benefits of treatment with neuroleptic medication, and from Dr. Orr that appellant lacked the capacity to decide whether she should take the medications. The referee also heard appellant's testimony that demonstrated appellant's delusions.
There is clear and convincing evidence pursuant to Minn. Stat. § 253B.092, subd. 5(b), that appellant lacks the capacity to decide whether to take medication.
4. Whether Medication Reasonable and Necessary
If the court finds that the patient lacks capacity to decide whether to take neuroleptic medication and has applied the standards set forth in subdivision 7, the court may authorize the treating facility and any other community or treatment facility to which the patient may be transferred or provisionally discharged, to involuntarily administer the medication to the patient.
Minn. Stat. § 253B.092, subd. 8(e) (Supp. 1997).
If a patient who lacks capacity to decide whether to take neuroleptic medication did not clearly state his or her wishes as to taking such medication at a time when the patient did have capacity, the district court must make the decision
based on what a reasonable person would do, taking into consideration:
(1) the person's family, community, moral, religious, and social values;
(2) the medical risks, benefits, and alternatives to the proposed treatment;
(3) past efficacy and any extenuating circumstances of past use of neuroleptic medications; and
(4) any other relevant factors.
Minn. Stat. § 253B.092, subd. 7(c) (Supp. 1997).
The referee heard Dr. McCoy's testimony that no treatment less invasive than neuroleptic medication could effectively treat appellant's mental illness, and also Dr. Orr's testimony that it was reasonable and necessary that appellant receive antipsychotic medications and that the benefits involved in taking the medication outweighed their risks. We conclude that there is clear and convincing evidence to commit appellant as mentally ill and that treatment with neuroleptic medication is reasonable and necessary pursuant to Minn. Stat. § 253B.092, subd. 7(c).