Opinion
No. C0-01-1843.
Filed February 26, 2002.
Appeal from the District Court, Hennepin County, File No. PX9660549.
Mary Ferris Jensen, (for appellant)
Amy Klobuchar, Hennepin County Attorney, John L. Kirwin, Assistant County Attorney, (for respondent)
Considered and decided by Harten, Presiding Judge, Anderson, Judge, and Stoneburner, Judge.
This opinion will be unpublished and may not be cited except as provided by Minn. Stat. § 480A.08, subd. 3 (2000).
UNPUBLISHED OPINION
Appellant challenges his civil commitment claiming that there was not clear and convincing evidence that he poses a substantial risk of physical harm to self or others. He argues that his refusal to obtain a proper diagnosis of his mental disorder is not the same as refusing to obtain treatment and that his aggressive behaviors are neither recent nor severe enough to justify commitment. Because we conclude that appellant has refused to obtain crucial medical care for his impairment, thereby substantially risking bodily harm to himself and others, we affirm.
FACTS
Appellant is a 23-year-old male who has been diagnosed with a psychotic disorder resulting from either a schizophrenic process or an organic disease of the brain.
The cause of appellant's disorder is unknown. During an earlier commitment, doctors discovered that appellant had a disorder of the white matter in his brain. Tests and consultations ruled out most causes for this disorder. A blood sample sent to a lab to rule out or confirm a rare genetic brain disorder was lost in the mail and appellant has refused to allow more testing. Appellant's treating psychiatrist at that time diagnosed him with either schizophrenia or metachromatic leukodystrophy (MLD), with a high likelihood that he has the latter disease. MLD is a progressive disorder that leads to severe neurological difficulties. The court-appointed examiner for the present commitment proceeding testified that there is most likely an organic cause of his illness and that unless treated, his condition will progressively deteriorate and could become terminal.
Appellant has visual and auditory hallucinations. In November 1996, appellant threw a Molotov cocktail out of his window to protect himself from CIA agents whom he believed were following him. In December 1997, appellant called the police to report that his sister had broken her neck; his sister was fine. In October 2000, appellant heard what he believed to be his mother snapping the bones of her infant granddaughter (his niece). He hit his mother on her shoulder with a closed fist hard enough to cause bruising. The baby was uninjured but appellant's mother left the house with her granddaughter because she feared for their safety. On October 30, 2000, appellant called 911 to report the kidnapping of a woman in a park by four men. There was no evidence of any kidnapping. When police searched appellant, they found he was carrying a knife and a bb-gun. Appellant told police that he could not remember details of the kidnapping because he blacked out after seeing black squirrels. Appellant told one psychologist that he did not hear voices except "the voice box thing that echoes throughout the city." He also told that interviewer, "[y]our eyeball DNA is landing on me." Hennepin County filed a petition for commitment on November 2, 2000, after appellant's false kidnapping report, but that petition eventually was dismissed.
In July 2001, the district court decided that appellant was incompetent to stand trial for the criminal charge of carrying a bb-gun in public, suspended the criminal charges, and filed a petition to commit appellant for mental illness. After a commitment hearing, a district court referee issued a proposed order for commitment of appellant as mentally ill. On August 30, 2001, the district court adopted the order and committed appellant to the Anoka Metro Regional Treatment Center. This appeal followed.
DECISION
A district court can order the commitment of a person to a suitable treatment facility, if the court finds by clear and convincing evidence that the person is mentally ill. Minn. Stat. § 253B.09, subd. 1 (2000).
A mentally ill person is defined as follows:
(a) * * * 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) failure to obtain necessary * * * medical care as a result of the impairment; or
(2) a recent attempt or threat to physically harm self or others.
Minn. Stat. § 253B.02, subd. 13(a) (2000).
On appeal, this court is limited to an examination of the trial court's compliance with the statute, and the commitment must be justified by findings based upon evidence at the hearing. In re Knops, 536 N.W.2d 616, 620 (Minn. 1995). The record is viewed in the light most favorable to the trial court's decision, and findings of fact shall not be set aside unless clearly erroneous. Id. Whether the evidence is sufficient to meet the standard for commitment is reviewed de novo. Id.
Although appellant has consistently denied that he is mentally ill, he does not contest the district court's finding that he has a mental illness. Rather, he claims there was not clear and convincing evidence that he poses a substantial likelihood of physical harm to self or others.
The district court found that appellant poses a substantial likelihood of causing physical harm as demonstrated by his continuing failure to obtain proper diagnosis and treatment for the significant organic cerebral dysfunction he is suffering * * *.
Medical reports and hearing testimony show that appellant likely has an organic disorder, probably metachromatic leukodstrophy, and that his condition will worsen unless treated. Appellant has consistently denied even having a mental illness and he has refused to obtain a diagnosis for his illness. He also is not taking his medications.
Appellant argues that his failure to obtain a diagnosis is not the same as the failure to obtain treatment. But none of the evidence, except appellant's denials of mental illness, suggests that appellant does not need treatment; by refusing to obtain a diagnosis he is preventing doctors from determining the proper treatment. Moreover, evidence of appellant's refusal to take necessary medications itself constitutes cause for commitment as mentally ill under section 253B.02, subdivision 13(a). See In re Allen, 451 N.W.2d 68, 70-71 (Minn.App. 1990). Appellant's condition prevents his gaining insight into the probability that he has a life-threatening impairment if left untreated.
The district court's analysis considered appellant's bizarre and hazardous behavior as indicative of his persistent failure to obtain medical care necessary for him to avoid physical harm to himself and others. We agree that without treatment appellant poses a substantial likelihood of physically harming himself by impairing his own mental health thereby causing him to behave in a manner that invites physical retaliation from others or police involvement. Moreover, without treatment appellant poses a danger to others because he has attacked others based on his hallucinations and most recently has been carrying a knife and bb-gun in public.
Appellant notes that if a test shows he has an organic disorder, any treatment would be highly intrusive and uncertain to have any effect. But determination of appropriate treatment depends upon this diagnosis of appellant's disorder, which has not yet been finalized. In any event, problematic treatments have not been held to justify reversal of civil commitment. See In re Wolf, 486 N.W.2d 421, 424 (Minn. 1992) (court noted that even though a proposed treatment is problematic, the state could still commit a person as chemically dependent).
We conclude that the evidence supports the district court's finding that appellant poses a substantial risk of physical harm to self and others because he has consistently refused to obtain medical care.