Opinion
No. 1 CA-MH 20-0062
01-07-2021
IN RE: LAILAMARYAM M.
COUNSEL Coconino County Legal Defender's Office, Flagstaff By Jillian Marini Counsel for Appellant Coconino County Attorney's Office, Flagstaff By Mark D. Byrnes Counsel for Appellee
NOTICE: NOT FOR OFFICIAL PUBLICATION. UNDER ARIZONA RULE OF THE SUPREME COURT 111(c), THIS DECISION IS NOT PRECEDENTIAL AND MAY BE CITED ONLY AS AUTHORIZED BY RULE.
Appeal from the Superior Court in Coconino County
No. S0300MH202000080
The Honorable Cathleen Brown Nichols, Judge
AFFIRMED
COUNSEL
Coconino County Legal Defender's Office, Flagstaff
By Jillian Marini
Counsel for Appellant
Coconino County Attorney's Office, Flagstaff
By Mark D. Byrnes
Counsel for Appellee
MEMORANDUM DECISION
Presiding Judge Randall M. Howe delivered the decision of the Court, in which Judge Kent E. Cattani and Judge Cynthia J. Bailey joined.
HOWE, Judge:
¶1 Lailamaryam M. appeals the trial court's order committing her to involuntary inpatient and outpatient mental health treatment. For the following reasons, we affirm.
FACTS AND PROCEDURAL HISTORY
¶2 We view the facts in the light most favorable to sustaining the trial court's order. In re MH2014-002674, 238 Ariz. 188, 190-91, ¶ 9 (App. 2015). Since 2016, L.M. had been hospitalized seven times for psychiatric treatment, most recently under court-ordered therapy in Maricopa County until December of 2019. While under court-ordered treatment and medication, L.M. found both housing and employment for the first time in many years. When the court-ordered treatment ended, however, L.M. stopped taking her medication and going to her therapy appointments. Her mental health consequently deteriorated.
¶3 In April 2020, while riding a bus from Phoenix to Chicago, Illinois, L.M. became convinced that fellow passengers were CIA agents "falsely accusing her" and got off the bus in Flagstaff. After L.M. had multiple interactions with the police over the next few days, police arrested her for disorderly conduct on April 11, 2020. L.M. told the arresting officer that she did not like white police officers, and she talked about "satel[l]ites and other random things."
¶4 While in custody, L.M. exhibited aggressive and paranoid behavior and was transferred on April 15, 2020, to The Guidance Center for an emergency mental health evaluation under A.R.S. ¶ 36-524. The next day, Dr. Courtney Keckich spoke with L.M. and subsequently petitioned for evaluation under A.R.S. § 36-523, alleging that L.M. was extremely delusional, a danger to self and others, and persistently and acutely disabled.
¶5 Drs. Kechich and Francis Gagliardi evaluated L.M. at the Center. L.M. was agitated and aggressive, threatening other patients "that
she would rape them with a machete." She answered questions by saying things such as "I could have an army invade America today for my honor." After completing the evaluation, the Center petitioned for court-ordered treatment under A.R.S. § 36-533 on April 21, 2020. The petition sought an order for treatment under A.R.S. § 36-540(A)(2), alleging that L.M. has a mental disorder that renders her persistently or acutely disabled and a danger to herself and others. On April 22, 2020, the trial court ordered that L.M. be hospitalized at the Center pending resolution of the petition.
¶6 That same day L.M. attacked four members of the Center's staff. The staff called the police, who arrested L.M. and took her to the county jail. Because no criminal charges were filed, the police returned L.M. to the Center on April 28, 2020, where she remained until the evidentiary hearing the next day.
¶7 At the evidentiary hearing, L.M., through counsel, moved to dismiss the petition, arguing that her arrest was a "discharge" and that a new petition for evaluation needed to be filed and a new evaluation occur to strictly comply with the court-ordered treatment statutes. The Center, unprepared to address this argument, asked that the hearing be continued for two days. L.M. objected to being detained if the continuance was granted. The trial court found good cause and continued the hearing for two days and ordered that L.M. continue to be hospitalized at the Center. After considering briefing and argument when the hearing resumed two days later, the trial court denied the motion to dismiss, finding that LM.'s arrest and detention at the jail did not constitute a discharge from treatment at the Center.
¶8 The trial court then heard testimony on whether L.M. should receive involuntary treatment. Dr. Keckich testified that L.M. has a psychotic disorder not otherwise specified, more likely schizoaffective disorder because of her manic tendencies. Dr. Keckich said that this was a severe mental disorder that would cause L.M. abnormal suffering if not treated, and L.M. was therefore persistently or acutely disabled. Dr. Keckich also testified that L.M.'s assaults of the Center's staff and strangers and threats to fellow patients showed that she was a danger to others as a result of her severe mental disorder.
¶9 Dr. Keckich also discussed L.M.'s ability to voluntarily accept treatment. Although L.M. was able to keep a job and a home when she was under court-ordered treatment and medication, she had a history of decompensating when not on treatment; she did not believe that she had a mental illness and her disorder substantially impaired her ability to make
informed decisions about treatment. Dr. Keckich concluded that involuntary treatment was necessary because L.M. denied that she was mentally ill.
¶10 Dr. Gagliardi testified that L.M. suffers from paranoid schizophrenia and unjustifiably believes that people seek to harm her. He noted that she was not currently on any medication, despite her previous success in treatment, because she believed she did not have a mental illness. Although L.M. had told Dr. Gagliardi that she had speech and relaxation therapies to address her needs, he explained that these were inadequate. He concluded that because L.M. had poor judgment about her illness and had made paranoid delusional threats to others, she was a danger to others and persistently or acutely disabled and required involuntary treatment.
¶11 L.M. then testified that she did not assault anyone at the Center and was falsely arrested. She stated that she was familiar with the treatments the Center's doctors had discussed with her, but that those treatments were not what allowed her to function. Rather, a great opportunity by "just and fair" people at the "meeting room" allowed her to remove all medications from her body and still work and maintain a home. She relied on relaxation techniques her previous psychiatrist had taught her before being released from court-ordered treatment, as well as other treatments by a new doctor at the Center, to address her issues.
¶12 The court found by clear and convincing evidence that L.M. was persistently and acutely disabled due to a mental disorder, in need of treatment, and was either unwilling or unable to accept voluntary treatment. The court also found that absent treatment, L.M. would be a danger to others. The court ordered combined inpatient and outpatient treatment for no more than 365 days, with inpatient treatment not to exceed 180 days. The court further determined that this treatment plan was the least restrictive alternative. L.M. timely appeals. We have jurisdiction pursuant to A.R.S. §§ 36-546.01 and 12-2101(A)(1).
DISCUSSION
¶13 L.M. raises three issues: First, the court abused its discretion in granting a two-day continuance for briefing on her motion to dismiss. Second, the court erred in denying her motion to dismiss because she had been discharged from the Center and could not be held there without a new petition for evaluation. Third, the Center did not prove by clear and convincing evidence that involuntary treatment was appropriate. These issues are meritless.
I. The trial court acted within its discretion when it granted Petitioner's request for a continuance.
¶14 L.M. contends that the trial court abused its discretion in granting the Center a two-day continuance to allow it to brief her motion to dismiss the petition for court-ordered treatment. Although the superior court must conduct a hearing on a petition for court-ordered treatment within six days after the petition is filed, the court may continue the hearing at the petitioner's request for three days for good cause. A.R.S. § 36-535(B). We review the granting of a continuance for an abuse of discretion. In re MH2003-000240, 206 Ariz. 367, 369-70 ¶ 10 (App. 2003). "A trial court abuses its discretion when it exercises discretion in a manner that is either manifestly unreasonable or based on untenable grounds or reasons." Kimu P. v. Ariz. Dep't of Econ. Sec., 218 Ariz. 39, 42 (App. 2008) (citation and internal quotation marks omitted).
¶15 The trial court did not abuse its discretion in granting the continuance. "Good cause" means a "substantial reason, one that affords a legal excuse." State v. Owens, 112 Ariz. 223, 225 (1975) (quoting State v. Churchill, 82 Ariz. 375, 380 (1957)). The purpose of requiring good cause is to prevent "[u]nnecessary and [u]nreasonable delays." Id. (quoting Churchill, 82 Ariz. at 380). L.M.'s motion presented a novel argument: her arrest and detention at the county jail for her assault of the Center's staff was a discharge from treatment, which meant that she could not be held at the Center for evaluation without a new petition. Needing time to receive briefing and to consider this novel issue, which had serious safety implications for L.M. and the public, was certainly a substantial reason, and a two-day continuance for that purpose—within the time permitted by A.R.S. § 36-535(B)—was not unnecessary or unreasonable.
¶16 L.M. further argues that the trial court had no basis to keep her at the Center involuntarily for the duration of the continuance. L.M. had the right to have a hearing on whether she should be involuntarily hospitalized during the continuation period. A.R.S. § 36-535(B). The court conducted such a hearing, and after considering testimony and documentary evidence, found that L.M.'s erratic and threatening behavior, her disordered thinking, and her denial of any mental illness was ample evidence that she should be hospitalized pending the short continuance. The trial court did not abuse its discretion in granting the short continuance and in keeping her hospitalized until the hearing.
II. The claim that the trial court erred in denying the motion to dismiss is moot.
¶17 L.M. argues next that the trial court should have granted her motion to dismiss the petition for court-ordered treatment. She notes that the procedures for court-ordered evaluation and court-ordered treatment set forth in A.R.S. §§ 36-529(B) and -535(A) contemplate that the person being evaluated will be hospitalized at the treatment facility seeking court-ordered treatment. Because the Center had discharged her from treatment when she was arrested and detained at the county jail for assaulting the Center's staff, she contends that the pending petition for court-ordered treatment was void, and any attempt to seek court-ordered treatment would have to begin again, since she was again hospitalized at the Center.
¶18 We need not consider this argument, however, because it is moot. Regardless whether L.M. had been discharged from the Center because of her arrest and detention (a decision made not by the Center but the police and caused by her own behavior), the trial court conducted an evidentiary hearing and determined that court-ordered treatment was warranted. Although the statutory requirements for ordering involuntary treatment must be strictly met, we will not set aside an involuntary treatment order unless it is clearly erroneous or unsupported by credible evidence. In re MH 2008-002393, 223 Ariz. 240, 243 ¶ 11 (App. 2009) (quotation marks and citation omitted). Any allegation of procedural irregularity occurring before the court-ordered treatment hearing that does not affect the determination that court-ordered treatment is warranted is moot. See id. The remedy for any prehearing irregularity is not dismissing the treatment petition but release through a writ of habeas corpus. Id. at ¶ 14.
¶19 L.M. does not argue that the trial court committed any error in conducting the court-ordered treatment hearing or deprived her of any due process right. Once the trial court denied her motion to dismiss, she could have asked for a stay of the hearing so that she could petition for a writ of habeas corpus asserting a deprivation of due process. But she did not do so and allowed the trial court to determine whether court-ordered treatment was appropriate. The trial court's determination that L.M. should receive involuntary treatment rendered moot her claim that her arrest and detention in the county jail for a period of days before she was re-hospitalized required the commitment proceedings to start anew.
III. Sufficiency of Evidence Under A.R.S. § 36-540(A)
¶20 L.M. further contends that the trial court erred by finding that she suffered from an acute and persistent disability and that she was a danger to others. This Court will not disturb a trial court's involuntary commitment order that the evidence substantially supports. In re Pima Cty. Mental Health No. MH-1140-6-93, 176 Ariz. 565, 566 (App. 1993). We view the facts in the light most favorable to sustaining the trial court's decision and will not set aside its factual findings unless those findings are clearly erroneous. In re Mental Health Case No. MH 94-00592, 182 Ariz. 440, 443 (App. 1995).
¶21 A court may order an individual to undergo involuntary mental health treatment if it finds by clear and convincing evidence that the individual is either unwilling or unable to accept voluntary treatment and, as a result of a mental disorder, is a danger to self or others, has a persistent or acute mental disability, or a grave disability. A.R.S. § 36-540(A). Under A.R.S. § 36-501(32), a "persistent or acute disability" means a severe mental disorder that meets the following criteria:
(a) If not treated has a substantial probability of causing the person to suffer or continue to suffer severe and abnormal mental, emotional, or physical harm that significantly impairs judgment, reason, behavior or capacity to recognize reality.
(b) Substantially impairs the person's capacity to make an informed decision regarding treatment, and this impairment causes the person to be incapable of understanding and expressing an understanding of the advantages and disadvantages of accepting treatment and understanding and expressing an understanding of the alternatives to the particular treatment offered after the advantages, disadvantages and alternatives are explained to that person.
(c) Has a reasonable prospect of being treatable by outpatient, inpatient or combined inpatient and outpatient treatment.
¶22 Here, the trial court heard evidence of L.M.'s assaults on the public, the police, and the Center's staff, which showed that she was a danger to herself and others. And the trial court heard evidence, much from L.M. herself, of L.M.'s poor understanding of her mental illness and her refusal to heed the advice of medical professionals on how to address her illness.
¶23 L.M. does not challenge this evidence. She argues only that the Center did not present sufficient evidence that the treatment advantages, disadvantages, and alternatives were explained to her. But the record shows that Drs. Keckich and Gagliardi both discussed treatment alternatives with her and the consequences of receiving no treatment, often in the face of L.M.'s denial that she suffered from any mental illness. L.M. confirmed this during her own testimony when she explained that she was familiar with the treatments the doctors were proposing but that other treatments, such as her relaxation technique and treatments suggested by another doctor at the Center, helped her function. L.M. received adequate explanation about the types of treatments she needed and the consequences of refusing treatment. The trial court had sufficient evidence to find that L.M. should be involuntarily treated.
CONCLUSION
¶24 For the foregoing reasons, we affirm