Opinion
No. C2-96-1522.
Filed December 17, 1996.
Appeal from the District Court, Hennepin County, File No. P99460215.
Michael J. Biglow, (for Appellant J.S.G.)
Hubert H. Humphrey, III, Attorney General, Steven J. Lokensgard, Assistant Attorney General, (for Respondent William Erickson, Medical Director of St. Peter Regional Treatment Center)
Considered and decided by Peterson, Presiding Judge, Klaphake, Judge, and Davies, Judge.
This opinion will be unpublished and may not be cited except as provided by Minn. Stat. § 480A.08, subd. 3 (1996).
UNPUBLISHED OPINION
Appellant J.S.G. argues that the trial court improperly authorized the hospital to treat him involuntarily with neuroleptic medication. We affirm.
FACTS
J.S.G. was committed to the Minnesota Security Hospital for an indeterminate period as mentally ill and dangerous based on his mental illness diagnosis and his acts of arson and vandalism. This court affirmed. In re J.S.G., No. C5-95-967 (Minn.App. Sept. 26, 1995). This court also upheld an order authorizing the involuntary administration of neuroleptic medication to J.S.G. In re J.S.G., No. C6-95-1268 (Minn.App. Sept. 26, 1995).
On December 21, 1994, the trial court issued an order sealing the file. This court will treat the appeal as confidential.
The hospital filed another petition for authorization to treat J.S.G. with neuroleptic medication. At the hearing, Dr. Stanley Shapiro, J.S.G.'s psychiatrist at the hospital, and Dr. Thomas Folsom, the court-appointed examiner and psychiatrist, testified that J.S.G.'s mental illness should be treated with neuroleptic medication, which will allow him to gain insight into his mental illness and receive full benefit from his behavioral therapy. J.S.G. has not shown significant side effects from the medication he is currently taking. Dr. Shapiro found J.S.G.'s symptoms of delusions and paranoia have already improved somewhat as a result of his medication. Dr. Folsom explained that while J.S.G.'s core defensiveness will never completely disappear, it will lessen with medication.
The psychiatrists agreed that J.S.G. was not able to decide whether treatment with neuroleptics was necessary. Dr. Folsom explained J.S.G. was not competent to make a decision because he does not feel he has a mental illness. Dr. Shapiro testified that J.S.G.'s lack of insight will interfere with his ability to understand his need for, or benefits of, the medication.
J.S.G. testified that without a Jarvis order, he would ask to be taken off the medication. He feels he can function well without the medication and he wants to avoid side effects, although he acknowledged the medication made him feel a little more relaxed. J.S.G. also explained that he is competent to make his own decisions about medication because he has met his behavioral objectives at the hospital, understands the information about his proposed treatment, and has done well in his studies on schizophrenia and drug use. He believes he exhibits more insight than some of his treating psychiatrists, and he asserts that he has been open to alternative explanations of his symptoms. He is not convinced that he suffers from schizophrenia and cited his drug use as a teenager and the fact that he was adopted as possible explanations for his symptoms.
The trial court found that J.S.G. was not competent to give or withhold consent for the use of neuroleptics and that treatment of his mental illness with neuroleptics was necessary and reasonable. J.S.G. appeals.
DECISION
Trial court findings of fact must be affirmed if not clearly erroneous. Minn.R.Civ.P. 52.01; In re Schauer, 450 N.W.2d 194, 196 (Minn.App. 1990). Conclusions of law may be reversed if the trial court erred. In re Stilinovich, 479 N.W.2d 731, 734 (Minn.App. 1992).
A facility seeking to treat a nonconsenting committed patient with neuroleptic medication must obtain judicial review before beginning treatment. Jarvis v. Levine, 418 N.W.2d 139, 150 (Minn. 1988); Minn. Stat. § 253B.03, subd. 6c(e)-(o) (1996). The party seeking authority to impose treatment with neuroleptics must prove by clear and convincing evidence that treatment is necessary and reasonable and that the person is incompetent to refuse the treatment. Jarvis, 418 N.W.2d at 148 n. 7; In re Peterson, 446 N.W.2d 669, 672-73 (Minn.App. 1989), review denied (Minn. Dec. 1, 1989).
1. The supreme court has stated that the following criteria should be considered in determining the necessity and reasonableness of proposed treatment:
In making the determination the court should balance the patient's need for treatment against the intrusiveness of the prescribed treatment. Factors which should be considered are (1) the extent and duration of changes in behavior patterns and mental activity effected by the treatment, (2) the risks of adverse side effects, (3) the experimental nature of the treatment, (4) its acceptance by the medical community of this state, (5) the extent of intrusion into the patient's body and the pain connected with the treatment, and (6) the patient's ability to determine for himself whether the treatment is desirable.
Jarvis, 418 N.W.2d at 144 (quoting Price v. Sheppard, 307 Minn. 250, 262-63, 239 N.W.2d 905, 913 (1976)).
J.S.G. contends that the neuroleptic medication provides no measurable benefits, causes side effects, presents risks, and is therefore not necessary and reasonable. He cites Dr. Folsom's testimony that his defensiveness, the core delusion, has not gone away and will never disappear.
The trial court found that J.S.G. experienced no significant side effects, and that the use of neuroleptics will relieve the paranoia, defensiveness, and delusional thinking caused by mental illness and allow appellant to derive increased benefit from psychosocial therapy. It determined that the treatment was necessary and reasonable. These findings are supported by the expert testimony and are not clearly erroneous.
2. J.S.G. next contends the trial court's determination that he is not competent to consent to or refuse medication is erroneous. A mentally ill person is competent to refuse medication if the person has
(1) an awareness of having a mental disorder; (2) sufficient knowledge about medication and the mental disorder; and (3) a refusal that is not based on delusional beliefs.
Peterson, 446 N.W.2d at 673. All three factors must be present to determine that a patient is competent to decide about medication. Id. Those advocating the use of involuntary medication need not disprove all three bases in order to prevail. Id.
The trial court found that J.S.G. at times admits he may have a mental illness. It further found that he has been unable to accept the fact he has experienced a mental disorder, denies overwhelming evidence that he has a mental illness, attempts to rationalize and minimize his symptoms, and cannot objectively weigh the risks and benefits of the medication.
J.S.G. argues that although he is unconvinced of his mental illness, he continues to discuss openly the possibility that schizophrenia is one of the causes of his symptoms. While the testimony indicates that J.S.G. is beginning to acknowledge the possibility of alternative explanations for his symptoms, including mental illness, this is far from showing an awareness that he has a mental disorder. The trial court's findings are supported by the record and are not clearly erroneous.
The trial court also found J.S.G. does not have the ability to understand and use information about his mental illness, its symptoms, and treatment. J.S.G. disagrees, contending he has the capacity to assimilate the relevant facts and citing his ability to function, work two jobs in the hospital, take correspondence courses, and discuss the risks and benefits of medication with his doctor. He asserts he refused because of side effects and the lack of benefits. While J.S.G. is able to grasp many facts, the record shows he fails to understand the facts directly relevant to his illness, as well as the risks and benefits of treatment. The trial court's findings are supported by the record and are not clearly erroneous.
The trial court had clear and convincing evidence to conclude that J.S.G. was not competent because he did not have an awareness of having a mental disorder and did not have sufficient knowledge about the medication and the mental disorder.