may not be cited except as provided by
Minn. Stat. § 480A.08, subd. 3 (1998).
STATE OF MINNESOTA
IN COURT OF APPEALS
In the Matter of: Patrick R. Grande.
Filed February 23, 1999
Hennepin County District Court
File No. P39033745
Ronald L. Thorsett, 7328 Ontario Blvd., Eden Prairie, MN 55346 (for appellant Grande)
Michael A. Hatch, Attorney General, Terri D. Yellowhammer, Assistant Attorney General, 900 NCL Tower, 445 Minnesota St., St. Paul, MN 55101-2127 (for respondent St. Paul Regional Treatment Center)
Considered and decided by Davies, Presiding Judge, Peterson, Judge, and Halbrooks, Judge.
Appellant Patrick Grande, who is committed as mentally ill and dangerous, challenges the trial court's order authorizing the Minnesota Security Hospital to administer neuroleptic medication to him without his consent. We affirm.
Since 1993, appellant has been committed to the Minnesota Security Hospital as mentally ill and dangerous. His treatment includes neuroleptic medication, but staff recently began to suspect that he has been "cheeking" his medication and then spitting it out. The suspicion was confirmed when a blood test showed the medication level was below the therapeutic range. Appellant acknowledges that he has been taking few of the prescribed pills, explaining that he wanted to avoid their sedative effect.
In August 1998, appellant became so angry and agitated while talking to a psychiatrist that he picked up a metal chair to threaten the psychiatrist. The hospital administered neuroleptic medication to him without his consent on an emergency basis and then filed a petition for authorization to administer the medication without his consent on a non-emergency basis.
Appellant opposes administration of neuroleptic medication, contending that he is not mentally ill and that the medication causes intolerable side effects. The district court authorized the security hospital to administer the medication and Grande appeals.
If a committed patient refuses to consent to treatment with neuroleptic medication, a facility may not administer the medication until a court grants approval. Minn. Stat. § 253B.092, subd. 8(a) (1998); Jarvis v. Levine, 418 N.W.2d 139, 150 (Minn. 1988). The court must first address whether the patient has the capacity to decide whether to take the medication. Minn. Stat. § 253B.092, subd. 8(d), (e) (1998). In deciding whether the person has sufficient capacity, the court must 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.
Id., subd. 5 (1998). The patient's decision is not rendered unreasonable merely because the patient disagrees with the physician's recommendation. Id.
Appellant challenges the district court's finding that he lacks the capacity to decide whether to take medications. He first contends that he is not mentally ill because his symptoms are in remission. He also notes that he has earned the highest security status possible, maintained a job, and functioned normally despite minimal doses of medication. He further contends he has demonstrated an understanding of his situation by being able to rationally discuss the side effects from past treatment. Finally, he contends that he opposes the use of the medications, not because of a delusion, but because he wants to avoid uncomfortable and potentially dangerous side effects.
Dr. Thomas Gratzer, appellant's treating psychiatrist, and Dr. Burton Orr, the court-appointed examiner, testified that appellant suffers from a major mental illness. As to his claim that he is in remission and has been functioning well with minimal medication, Dr. Orr explained that, because neuroleptics are metabolized very slowly, the intermittent doses appellant took slowed the reappearance of his symptoms. Further, appellant has recently exhibited more symptoms, including increased irritability and anger. Dr. Orr agreed with Dr. Gratzer that appellant does not appreciate the scope of his symptoms and has limited insight into his mental illness. Dr. Orr explained that appellant cannot knowingly appreciate the potential benefits of the medication and, therefore, cannot weigh benefit against risk. The district court did not err by finding that appellant lacks the capacity to decide whether to take medication based on this expert testimony.
Once the court has determined that a person lacks capacity to make decisions about administration of neuroleptics, the court must examine whether the person clearly expressed his or her opinion about taking neuroleptic medications when the person had the capacity to make a reasoned decision. Minn. Stat. § 253B.092, subd. 7(b) (1998). There was no evidence that appellant, who has been committed as mentally ill and dangerous since 1993, expressed such an opinion.
Lacking such evidence, the court must make a decision based on what a reasonable person would do considering:
(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) (1998). Appellant contends the district court erroneously concluded that treatment with neuroleptic medication was necessary and reasonable. He contends medication was not necessary to treat his symptoms because the symptoms did not arise from a mental illness, but were a normal reaction to stressful circumstances. He denies threatening his psychiatrist. He argues he has done well without medication and that the side effects were troublesome.
In contrast, Dr. Orr and Dr. Gratzer both testified that medication would reduce appellant's symptoms. Without it, he was at risk to become angry and aggressive, as he was in August, or to relapse to the full-blown psychotic state he experienced when committed in 1993. Dr. Orr testified that medication had been effective until appellant stopped taking the full dose.
The experts discussed the medication's side effects. Dr. Gratzer explained medication could alleviate the short-term side effects and that appellant showed no symptoms of tardive dyskinesia, a serious side effect. Dr. Orr testified that most of the side effects appellant suffered in the past were attributable to neuroleptic medications no longer prescribed for appellant. While appellant does not suffer significant side effects from his current medication, Dr. Orr acknowledged the full extent of the side effects may not yet be apparent due to the very low dose appellant has been taking. Even so, he testified that there would be more benefit than risk from the medication.
The district court did not err by concluding that the treatment was necessary and reasonable and authorizing the security hospital to administer medication to appellant.