may not be cited except as provided by
Minn. Stat. § 480A.08, subd. 3 (1996).
STATE OF MINNESOTA
IN COURT OF APPEALS
Filed July 15, 1997
Hennepin County District Court
File No. P89760012
Gregory R. Solum, 5275 Edina Industrial Boulevard, Suite 105, Edina, MN 55439 (for appellant Zamfir)
Hubert H. Humphrey, III, Attorney General, Terri D. Yellowhammer, Assistant Attorney General, 445 Minnesota Street, Suite 900, St. Paul, MN 55101-2127 (for respondent)
Michael O. Freeman, Hennepin County Attorney, E. George Widseth, Assistant County Attorney, A-2000 Government Center, Minneapolis, MN 55487 (for respondent)
Considered and decided by Randall, Presiding Judge, Toussaint, Chief Judge, and Kalitowski, Judge.
The trial court committed appellant as mentally ill and authorized involuntary administration of neuroleptic medication. Valeriu Zamfir appeals from the commitment and the Jarvis order. We affirm.
Appellant was brought to the crisis unit of the Hennepin County Medical Center for evaluation and a petition for commitment was filed. A member of appellant's treatment team testified appellant is adamantly opposed to treatment and has no insight into his illness. With appellant's delusional system and grandiosity, he is "an accident waiting to happen." While appellant is able to feed and clothe himself adequately, he may no longer be able to make ends meet because of the large expenses he is incurring to pursue his delusional beliefs; he paid out of his own pocket for an expensive medical test in an effort to prove he had implants. The treatment team member testified appellant poses a danger to himself or others.
Dr. Terry Nelson, a psychologist and court-appointed examiner, diagnosed appellant with schizophrenia, paranoid type. If his belief system were challenged or threatened, he would have the capacity to physically harm someone with a weapon. Dr. Nelson also believed that while appellant has been able to care for himself, it is becoming increasingly difficult because of his expenditure of large sums of money to pursue his delusional beliefs. Dr. Nelson recommended appellant be treated with neuroleptic medication and psychotherapy in a hospital setting.
The trial court committed appellant as mentally ill with schizophrenia, paranoid type. A Jarvis hearing was then held. Appellant personally insisted that he did not want his attorney to represent him because the attorney had not talked to him about the case. Further, he claimed there was a conflict of interest because his attorney was a "government" attorney, and appellant had disputes with the government. The court indicated it would allow appellant to obtain another attorney to represent him in the future, but ruled that the hearing would go forward that day. The court advised appellant he had to be represented and that his attorney had the legal expertise. The court told his attorney to object if necessary, but otherwise not to be involved.
The court then questioned the court-appointed examiner and psychiatrist, Dr. Hildegard Graber. Dr. Graber diagnosed appellant with delusional disorder of the persecutory type. He is competent except as to his delusional system. She found that the recommended medication was necessary and reasonable. Although appellant has been taking his medication while hospitalized, he does not have a competent understanding of the benefits. He adamantly denies that he has a mental illness and stated he would not continue taking the medication after he is discharged.
Appellant personally examined Dr. Graber about supersonic airplanes, bugs implanted in government offices, and the FBI. Appellant also testified as to the use of people by the government as guinea pigs.
The trial court determined appellant was not competent, that the use of medication was necessary and reasonable, and that the benefits outweighed the risks. It authorized administration of neuroleptic medication to appellant.
Valeriu Zamfir appeals his commitment and the Jarvis order.
Appellant challenges only the finding that he posed a substantial likelihood of causing physical harm. This can be shown by a failure to provide necessary food, clothing, shelter, or medical care or by a recent attempt or threat to physically harm self or others. Minn. Stat. § 253B.02, subd. 13(b); see In re Gonzalez, 456 N.W.2d 724, 729 (Minn. App. 1990) (likelihood of harm to self shown where person refused to apply for medical assistance, could not provide for own shelter, and engaged in conduct that could outrage others and result in attack).
The trial court found that appellant posed a substantial likelihood of causing physical harm as demonstrated by his recent spending of resources for medical tests to try to locate the implants, when he needed this money to pay his rent. It also cited his pending loss of current housing due to the fact he carried knives around the apartment in a manner perceived as threatening by his roommate, particularly in view of his comments to the roommate that the implants could "cause him to kill."
Appellant challenges certain findings of fact. Our review of the record shows the evidence and inferences from the evidence support the trial court findings, which are not clearly erroneous. See McGaughey, 536 N.W.2d at 623 (findings not set aside unless clearly erroneous).
Appellant also argues that even if these findings are not clearly erroneous, they do not show the standards for commitment were met. See Minn. Stat. § 253B.02, subd. 13(b) (requirement of substantial likelihood of physical harm to self or others). He argues that his choice to spend part of his wages on medical tests is not grounds for involuntary commitment because choosing a lifestyle "few would voluntarily choose" does not justify involuntary commitment. See In re Nadeau, 375 N.W.2d 85, 87-88 (Minn. App. 1985) (reversing commitment because proposed patient did not meet statutory definition of mentally ill, despite fact she chose lifestyle few others would choose). Further, he argues that the trial court did not find that he made a recent attempt or threat to physically harm himself or others, but instead addressed the reasonableness of his roommate's fearful perceptions.
The experts agreed that appellant's expenditures in pursuit of his delusional beliefs made it difficult for him to provide for himself. The trial court assessed the evidence and determined appellant's conduct was threatening and that loss of his housing was pending. The trial court properly determined that appellant met the statutory standard for commitment. Minn. Stat. § 253B.02, subd. 13(b).
2. Appellant next argues that the trial court did not have clear and convincing evidence to conclude that treatment with neuroleptic medication was necessary. Administration of neuroleptic medication to an incompetent, nonconsenting committed person requires court approval. Jarvis v. Levine, 418 N.W.2d 139, 144-45, 148 n.7 (Minn. 1988); see Minn. Stat. § 253B.03, subd. 6c (1996) (addressing administration of neuroleptic medication to committed persons). The party seeking authority to impose treatment must prove by clear and convincing evidence that the treatment is necessary and reasonable, which is to be determined by consideration of six factors. Jarvis, 418 N.W.2d at 144-45 (discussing relevant factors). A trial court's findings will not be reversed unless clearly erroneous. In re Martin, 527 N.W.2d 170, 172 (Minn. App. 1995).
Appellant first claims that because he does not meet the definition of mentally ill, he is not committable, and, therefore, the Jarvis order is not reasonable. We have upheld the commitment, and this argument therefore fails.
Appellant next challenges the necessity of the treatment, contending the medication has not been effective and he is competent to decide for himself whether treatment is desirable. See Jarvis, 418 N.W.2d at 144 ("the court shall determine the necessity and reasonableness of the prescribed treatment"). At the time of the hearing, appellant had received neuroleptic medication for only a short time. Dr. Graber testified that the medication was effective and that the benefits outweighed the risks. The fact that medication had not been effective yet to treat appellant's symptoms did not mean the treatment is not necessary and reasonable.
The clinical definition of competency to refuse neuroleptic medication is as follows:
(1) [A]n 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) (citation omitted). If any of the criteria is lacking, the patient is incompetent. Id. The trial court found that appellant denies he is mentally ill and does not have the ability to understand and to use information about his mental illness, its symptoms, and treatment. It concluded that he was not competent to give or withhold consent for the use of neuroleptic medication.
Appellant cites evidence as to his abilities and Dr. Graber's conclusion that except for his alleged delusions, he is "a competent and responsible young man." As appellant acknowledges, however, Dr. Graber specifically testified her statement did not mean that he was competent with regard to his delusions. The trial court had clear and convincing evidence from which to conclude that appellant was incompetent to decide whether or not to take the neuroleptic medication.
3. The final issue concerns appellant's legal representation at the Jarvis hearing. A patient has the right to be represented by counsel. Minn. Stat. § 253B.03, subd. 9 (1996); Minn. R. Civ. Commitment 3.01. Neither the statute nor the rules gives a patient the right to represent him or herself. See id. (containing no such provisions). The intent is that the patient not be permitted to waive the right to representation. Minn. R. Civ. Commitment 3, cmt. B; In re Irwin, 529 N.W.2d 366, 371 (Minn. App. 1995) (trial court that denied patient's motion to represent himself but allowed his participation in cross-examination of some witnesses did not abuse its discretion), review denied (Minn. May 16, 1995).
Appellant now argues on appeal that the trial court denied him the effective assistance of counsel and he should be given a new trial because it allowed him to represent himself. In re Dibley, 400 N.W.2d 186, 190-91 (Minn. App. 1987) (patient claimed ineffective assistance of counsel but failed to establish counsel's action prejudiced results), review denied (Minn. Mar. 25, 1987). Appellant has not discussed any specific evidence that he believes should have been considered or excluded, and the record supports the Jarvis order. Appellant has shown no prejudice, and we see no reason to reverse. See id.
[ ]1 This issue only applies to the Jarvis hearing; appellant was fully represented by counsel at the commitment hearing.