Opinion
No. A05-1812.
Filed January 17, 2006.
Appeal from the District Court, Hennepin County, File No. 27-MH-PR-05-658.
Mary Ferris Jensen, (for appellant Halvorson)
Amy Klobuchar, Hennepin County Attorney, John L. Kirwin, Assistant County Attorney, Adult Services Section, (for respondent Hennepin County)
This opinion will be unpublished and may not be cited except as provided by Minn. Stat. § 480A.08, subd. 3 (2004).
UNPUBLISHED OPINION
Appellant Anna Halvorson challenges two orders issued by the district court committing her as mentally ill and authorizing the involuntary administration of neuroleptic medication. Because clear and convincing evidence supports the district court's determination that appellant presents a substantial likelihood of harm to herself, we affirm the commitment under Minn. Stat. § 253B.02, subd. 13(a)(1), (3) (2004). But because the order authorizing the involuntary administration of neuroleptic medication lacks specificity, we reverse and remand to allow the district court an opportunity to amend that order.
FACTS
Appellant is currently 33 years old. She was first hospitalized for mental illness when she was 21, and has had several psychiatric hospitalizations since that time. She is diagnosed with schizoaffective disorder, bipolar type.
In April 2005, appellant was living in her own apartment and ceased taking her medications. As her mental condition began to deteriorate, she became delusional and paranoid, isolated herself in her apartment, and stopped answering phone calls from her mother.
On June 20, a county outreach worker went to appellant's apartment to evaluate her mental status. The worker was unable to thoroughly evaluate appellant because she was "very hyper and unable to concentrate on the questions asked her." An emergency hold was placed on appellant because the worker believed that she was "quite vulnerable in the community."
Appellant's bizarre, intrusive, and sometimes aggressive behavior continued for the next two and one-half weeks, until her commitment trial. At trial, one witness testified that appellant's "extreme disorganization would cause a threat to herself." Another testified that appellant's behaviors would make her "very vulnerable" in the community. Appellant exhibited disorganized thoughts and speech throughout her testimony; she did, however, claim that her symptoms worsen in hospital settings.
The court-appointed examiner testified that during his examination, appellant talked constantly in a "word salad" fashion and seemed to be responding to her own verbalizations rather than to his questions. The examiner testified that he did not observe any behavior by appellant that would present a danger to others; he further testified that he did not believe appellant was suicidal or likely to harm herself physically. Rather, he testified that he was concerned about appellant's unwillingness to take her prescribed medications, about her vulnerability "if left to her [own] devices," and about her increasingly disorganized thoughts when she has no contact with others.
The district court found that as a consequence of her mental illness, appellant "engages in grossly disturbed behavior or experiences faulty perceptions" and that she is "almost completely unable to communicate on a meaningful level." The court concluded that appellant "would be utterly unable to provide for her needs outside of the hospital" and that her condition is "almost certain to result in harm to herself either through self-neglect or at the hands of others." The court finally authorized the administration of "any FDA-approved neuroleptic medications."
DECISION I.
On appeal in a civil commitment case, this court is limited to examining whether the district court complied with the requirements of the commitment statute. In re Knops, 536 N.W.2d 616, 620 (Minn. 1995). We review the record in the light most favorable to the district court's decision and affirm the district court's findings unless they are clearly erroneous. Id. As the trier of fact, the district court is entitled to resolve factual conflicts and weigh the credibility of witnesses. See Minn. R. Civ. P. 52.01.
To civilly commit a person, the district court must find by clear and convincing evidence that the person is "mentally ill" as defined by Minnesota law. See Minn. Stat. §§ 253B.02, subd. 13(a) (defining mentally ill), .09, subd. 1 (setting out standard of proof) (2004). Here, it is undisputed that appellant suffers from a "substantial psychiatric disorder" that "grossly impairs [her] judgment, behavior, capacity to recognize reality, [and] to reason or understand." Minn. Stat. § 253B.02, subd. 13(a). The dispute arises over whether the record establishes that appellant's disorder "poses a substantial likelihood of physical harm to self or others." Id.
Appellant argues that speculation as to whether a person may, in the future, fail to obtain necessary food or medical care or may attempt or threaten to harm herself or others is not sufficient to justify civil commitment. See In re McGaughey, 536 N.W.2d 621, 623 (Minn. 1995) (reversing civil commitment order, where record failed to establish that patient would refuse to take medications outside hospital environment and witnesses testified that patient would probably provide for himself and that he did not pose danger either to himself or to community). While a district court may not engage in speculation about future harm, the court is not required to delay commitment until a person is actually harmed "so long as the danger of [his or her] condition ha[s] already become evident." In re Terra, 412 N.W.2d 325, 328 (Minn.App. 1987).
The record here described appellant's behavior as "intrusive" and as violating the boundaries or "personal space" of others. Appellant was also described as "manic, psychotic and disorganized," "agitated and uncooperative," and "aggressive." There were numerous incidences in which she was observed as yelling loudly and incoherently, and making delusional and paranoid statements. As the witnesses in this case testified, appellant's behavior would make her vulnerable in the community because it would likely be misunderstood by others and would so irritate others as to create a substantial risk of physical reprisal and constitute a threat to her safety. When, as here, the evidence establishes that the person's behavior is likely to outrage others and provoke an attack on the vulnerable person, the substantial likelihood of harm standard is met. See, e.g., In re Gonzalez, 456 N.W.2d 724, 729 (Minn.App. 1990) (affirming commitment where evidence supported district court's finding that person's manic conduct, which "may outrage others and result in an attack on him," posed a likelihood of harm to himself).
Appellant further insists that the record shows that she was living safely on her own and that the evidence of her "intrusive" behavior in the artificial environment of the hospital fails to support the conclusion that she is likely to suffer any physical harm in the community. As the county notes, however, "it is common for conduct following hospital admission to partially or fully provide the `harm' basis for commitment," particularly in a case like this when appellant's behavior outside the hospital could not be assessed because, due to her mental illness, she isolated herself from her caretakers and could not be adequately evaluated.
We therefore affirm the district court's order committing appellant as mentally ill.
The county insists that the evidence also supports a finding that appellant poses a risk of harm to others. While the evidence shows that appellant has been verbally and, at times, physically aggressive towards others, none of the witnesses claimed that appellant poses a risk of harm to others and the district court did not make such a finding. We therefore decline to affirm her commitment on this ground.
II.
Appellant challenges the order authorizing the administration of neuroleptic medications because the order fails to identify the specific medications that can be administered, as required by In re Civil Commitment of Raboin, 704 N.W.2d 767, 771 (Minn.App. 2005). The county concedes that the order fails to satisfy the requirements of Raboin. We therefore reverse and remand to allow the district court to amend this order. While the county insists that no further evidentiary hearing is necessary, appellant should be given an opportunity to present, and the district court should be allowed to consider, any additional relevant evidence.
Finally, appellant challenges that portion of the order authorizing the use of a nasogastric tube if necessary. Because appellant's psychiatrist indicated that such method of administration was not necessary, the provision allowing the use of a nasogastric tube should be omitted on remand.