Opinion
No. C1-00-2232.
Filed May 29, 2001.
Appeal from the District Court, Hennepin County, File No. P00060503.
Terry L. Hegna, (for appellant)
Amy Klobuchar, Hennepin County Attorney, John L. Kirwin, Assistant County Attorney, (for respondent)
Considered and decided by Halbrooks, Presiding Judge, Lansing, Judge, and Huspeni, 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This opinion will be unpublished and may not be cited except as provided by Minn.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UNPUBLISHED OPINION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 her commitment as mentally ill, arguing that she does not pose a substantial likelihood of causing harm to herself or others. Appellant also contends that the record does not support the district court's conclusion that she lacks the capacity to give or withhold consent to the administration of neuroleptic medications. Because there is support in the record for the decisions of the district court that appellant is mentally ill and that she lacks capacity to give or withhold consent to administration of neuroleptic medications, we affirm.
FACTS
Appellant Apasha Blocker, a 24-year-old college graduate, suffers from a "psychotic disorder, not otherwise specified" with a "schizophrenaform disorder." As a result, appellant visited several twin cities metropolitan-area hospitals on numerous occasions during the month of November 2000.
On November 9 and 20, 2000, appellant, exhibiting "bizarre behavior," visited Hennepin County Medical Center (HCMC). On November 26, she visited three hospitals, including HCMC, telling hospital personnel that she was homeless and that a man who offered her a place to stay sexually assaulted her. She refused a sexual assault examination and was subsequently released.
On November 27, 2000, Minneapolis police brought appellant to the HCMC Crisis Intervention Center (CIC) after finding her lying prone on the ground praying. She was released. The next day Minneapolis police again brought appellant to CIC after observing her in front of a church wiping up spittle and dirt from the ground using her hands and face. Appellant had second-degree frostbite on two of her fingers and abrasions on her face.
During appellant's visits to HCMC and CIC, she talked about her religious beliefs, and told staff that "God is telling me you are the nucleus of all my problems." Appellant also appeared to be responding to auditory hallucinations on several occasions. Based on the frequency and nature of appellant's numerous visits to the hospital, HCMC recommended judicial commitment.
At the trial, Phillip Krasowski, a registered nurse at HCMC, testified on behalf of the HCMC treatment team, and stated that medical personnel diagnosed appellant as suffering from "psychotic disorder, not otherwise specified, and we also have a provisional diagnosis of schizophrenia versus bipolar affective disorder, manic, with psychotic features * * *." Krasowski testified about appellant's anger, explaining that on one occasion, appellant attempted to leave the hospital, only to be returned by force with the help of four security guards. Krasowski further testified that HCMC lab tests showed that appellant had low protein and albumin levels, indicating malnutrition.
Dr. Catherine Carlson, an examiner for the court, diagnosed appellant as suffering from "psychosis, not otherwise specified, and with a rule out or a possible diagnosis of schizophrenaform disorder." Dr. Carlson testified that appellant's disorder substantially affected her thought and mood and grossly interfered with her judgment, behavior, and her ability to recognize reality, reason, and understand. Dr. Carlson further testified that appellant is incapable of giving informed consent or refusing to give consent because she does not believe she has a mental illness.
Dr. John Cooper, the court's second examiner, testified that his assessment of appellant was not significantly different than the statements made by Krasowski and Dr. Carlson relating to appellant's mental state.
Appellant testified on her own behalf, stating that she received a full track and field scholarship from the University of Minnesota and graduated in 1999. She explained that she lives in Minneapolis, has food and clothing, and knows how to access medical care. Appellant told the court that she was exercising her religion when picked up by police, and expressed her desire to go home without any treatment.
The district court committed appellant as mentally ill, and ordered the use of neuroleptic medication for the duration of the commitment order.
This appeal followed.
DECISION I.
A district court's findings of fact in a commitment matter will not be reversed unless an appellate court determines that they are clearly erroneous. In re McGaughey, 536 N.W.2d 621, 623 (Minn. 1995). The commitment may be reversed if the findings are insufficient to support the commitment. Id. at 624.
A mentally ill person is defined as one with a substantial psychiatric disorder which
poses a substantial likelihood of physical harm to self or others as demonstrated by:
(1) a failure to obtain necessary food, clothing, shelter, or 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 (2000). The district court must find a person mentally ill by clear and convincing evidence. Minn. Stat. § 253B.09, subd. 1 (2000).
Because appellant does not challenge the determination that she suffers from a substantial psychiatric disorder, the question we must address is whether there was clear and convincing evidence that appellant posed a substantial likelihood of physical harm to herself or others as a result of her mental illness. Minn. Stat. § 253B.02, subd. 13.
To meet the statutory requirements, there must be a showing of an overt failure to obtain necessities; speculation whether the person may in the future fail to obtain such necessities is not sufficient to justify commitment. McGaughey, 536 N.W.2d at 623. Thus, a commitment will be reversed if there is insufficient evidence to show the likely physical harm to the patient or others. In re Nadeau, 375 N.W.2d 85, 87-88 (Minn.App. 1985) (reversing commitment where all witnesses agreed patient posed no danger to others, was appropriately dressed, not malnourished, and had obtained shelter).
This is not to say, however, that the person must either come to harm or harm others before commitment as a mentally ill person is justified.McGaughey, 536 N.W.2d at 623.
The supreme court has cautioned that speculation on whether a person will, in the future, fail to obtain necessary food, clothing, shelter, or medical care is not sufficient to justify civil commitment. Id. The court has conjointly recognized, however, that commitment need not be delayed until irreparable harm is suffered when the danger of a person's condition has already become evident. Id.
Appellant argues that there was not clear and convincing evidence that she presented a danger to herself because the record does not show a failure to provide adequate food, shelter, or clothing for herself, and she has not attempted to harm herself or others. The district court relied, in part, upon the following in determining that appellant presented a danger to herself:
Recent conduct in public and in the hospital setting where she has been held pursuant to this Court's order. [Being] found by Minneapolis police prone on the sidewalk in front of a church. * * * [Her] story of homelessness and of being taken in by a man who then sexually assaulted her. * * * [Her refusal] to cooperate with a sexual assault examination and [becoming] so agitated when it was proposed that she was ultimately taken to the Crisis Intervention Center and ultimately admitted for inpatient psychiatric care. * * * [B]lood tests [revealing] low protein and albumin levels * * * indicative of recent inadequate nourishment. [Claiming] that these tests are fabricated. * * * [Claiming] to have a place to live but [unable to] reconcile that claim with her initial statements to hospital staff that she is homeless.
Appellant first challenges the district court's finding that she did not have adequate nourishment. Appellant cites Krasowski's testimony that she did not receive any medical intervention for poor nutrition and had a "good appetite." In addition, appellant states that although the lab results show that she had low protein and albumin levels, these results were "just below" normal ranges (appellant has a protein level of 6.2 and 6.3-8.2 is normal; appellant's albumin level was 3.5 and 3.8-5.1 is normal).
Appellant next addresses the district court's finding regarding her housing situation. Appellant contends that the district court did not expressly find appellant homeless, but stated that appellant failed to reconcile her contention that she has an apartment with her statement to hospital staff that she was homeless. Appellant contends that because she testified as to her apartment address, there is not clear and convincing evidence that she is homeless.
Finally, appellant asserts that she has adequately clothed herself. She acknowledges that her fingers were frostbitten, but contends that she has never been frostbitten before, and she was wearing gloves at the time of her injury.
In summary, appellant contends that the facts are insufficient to show she is likely to harm herself. She explains that she was doing nothing but exercising her religious beliefs, and poses no danger to herself. As a result, appellant contends that she is not mentally ill within the meaning of Minn. Stat. § 253B.02.
Although each of appellant's actions, viewed in isolation, might not alone provide a sufficient basis for a commitment, when considering all the behaviors together, we conclude that the district court did not err in concluding that it had clear and convincing evidence indicating that appellant was substantially likely to pose a threat of physical harm to herself based on her inability to care for herself. The district court did not clearly err in finding that appellant met the standards for commitment as mentally ill. See In re Terra, 412 N.W.2d 325, 328 (Minn.App. 1987) (holding that commitment need not be delayed until irreparable harm is suffered when the danger of a person's condition has already become evident).
II.
Appellant next challenges the district court order authorizing the involuntary administration of neuroleptic medication, arguing that the evidence did not support a finding that she lacked capacity to give or withhold consent to take neuroleptic medications. A facility may not administer neuroleptic medication to a committed person who refuses it without court approval. Minn. Stat. § 253B.092, subd. 8(a) (2000); Jarvis v. Levine, 418 N.W.2d 139, 150 (Minn. 1988). The court must first determine whether the person has the capacity to make the decision. Before authorizing the involuntary treatment of a patient, the court must first find that the patient lacks the capacity to decide whether to take the medication. Minn. Stat. § 253B.092, subd. 8(e) (2000). Capacity is determined by considering:
(1) whether the person demonstrates an awareness of the nature of the person's situation, including the reasons for hospitalization, and the possible consequences of refusing treatment with neuroleptic medications;
(2) whether the person demonstrates an understanding of treatment with neuroleptic medications and the risks, benefits, and alternatives; and
(3) whether the person communicates verbally or nonverbally a clear choice regarding treatment with neuroleptic medications that is a reasoned one not based on delusion, even though it may not be in the person's best interests.Id., subd. 5(b) (2000). Disagreement with the physician's recommendation is not evidence of an unreasonable decision. Id.
In support of its conclusions that appellant lacked capacity to refuse or consent to the administration of neuroleptic medication, the district court found appellant to be (1) unaware of her situation; (2) unaware of the reasons for hospitalization; (3) unaware of the possible consequences of refusing treatment with neuroleptic medications; and (4) unable to demonstrate an adequate understanding of treatment with neuroleptic medications, and the risks, benefits, and alternatives to treatment with these drugs. The district court also found that (1) appellant has objected to treatment with neuroleptic medication because she does not believe she is mentally ill; (2) appellant's choice is not a reasoned choice; and (3) appellant's choice appears to be based on a delusion.
The record supports the district court's findings. Dr. Carlson stated
I don't believe that at the present time [appellant] is capable of giving informed consent or informed refusal. She doesn't believe she has a mental illness, doesn't understand what the medications are designed to treat or that she would even have symptoms that would require medications. * * * She is not willing to participate in any kind of treatment voluntarily * * *.
We conclude that there was clear and convincing evidence for the district court to find appellant lacked capacity to give or withhold consent to the involuntary administration of neuroleptic medication.