Opinion
No. C9-99-1029.
Filed December 7, 1999.
Appeal from the District Court, Hennepin County, File No. P59960148.
Ruth Y. Ostrom, (for appellant).
Mike Hatch, Attorney General, and Amy Klobuchar, Hennepin County Attorney, John R. Owen, Assistant County Attorney, (for respondent).
Considered and decided by Halbrooks, Presiding Judge, Klaphake, Judge, and Anderson, Judge.
This opinion will be unpublished and may not be cited except as provided by Minn. Stat. § 480A.08, subd. 3 (1998).
UNPUBLISHED OPINION
The trial court committed appellant Judith Paulson to the Anoka Metro Regional Treatment Center as mentally ill. Paulson appeals, contending that there was insufficient evidence to support the commitment, and that she was not committed to the least restrictive alternative. Because we find sufficient evidence in the record to support Paulson's commitment and conclude commitment is the least restrictive alternative under the circumstances in this case, we affirm.
FACTS
Appellant Judith Paulson is a 48-year-old woman. She is a high school graduate and has worked steadily in the computer programming and data entry fields. Due to health problems, unrelated to her mental illness, Paulson was unable to work for several months and was evicted from her apartment on March 27, 1999. She then moved in with her brother for a few days.
Paulson has a history of mental health treatment. She first reported becoming depressed in high school. She was hospitalized for seventy-two hours in 1988. She received outpatient treatment at Hennepin County Mental Health Center and in California during the 20 years she lived there. She returned to Minnesota five or six years ago, and began treatment on an out-patient basis with Stephen Kind, M.D. She began taking Navane, a neuroleptic, in 1991 and has also taken anti-depressants. But, Paulson stopped taking her neuroleptic in mid-February 1999 and her antidepressant in March 1999. Paulson indicated she discontinued the medications because she had developed extreme side effects.
On April 1, 1999, Paulson decided to take a vacation in Door County, Wisconsin. She left the Twin Cities area at 8:00 p.m., got lost trying to find an alternate route around Stillwater, and ran out of gas in Washington County. She then received a ride to a bar from a passerby. When she was unable to obtain assistance at the bar, she decided to walk back to her car at 1:00 a.m. Her car was three or four miles away.
While walking to her car, Paulson was stopped by an officer from the Washington County Sheriff's Department. The officer took her into custody and transported her to Dakota County Receiving Center (detox center). While at the detox center, Paulson set off fire alarms, called 911, and started a small fire in a metal waste basket.
On April 2, 1999, Paulson was transported from the detox center to Regions Hospital, where she was put on a 72-hour hold. Upon admission to the hospital, it was noted that Paulson was babbling, giggling, and laughing inappropriately. She also exhibited paranoia in answering questions. During her stay at the hospital, Paulson was uncooperative with normal hospital procedures and refused to submit to tests required to assess her medications. Additionally, she told her treating physician, Steven Lutzwick, M.D., that she thought about returning to the hospital with a machine gun.
On April 14, 1999, Regions Hospital filed a petition requesting the judicial commitment of Paulson as mentally ill and chemically dependent. The district court appointed James Alsdurf, Ph.D., to examine Paulson.
At the hearing on the petition, Janet Johnson, a mental health social worker at Regions Hospital, testified to a diagnosis of alcohol abuse, psychosis, and depression. She described Paulson as guarded and dismissive and expressing feelings of paranoia. She testified Paulson believed that the staff was out to get her and that Paulson stated she wanted to go out and drive recklessly or start a fire in her living room. Johnson also indicated Paulson was uncooperative with hospital procedures and would not submit to the tests necessary for administration of her medications. Further, she stated Paulson lacked insight, was noncompliant with medication, and was sarcastic and hostile, but not aggressive.
Dr. Alsdurf, called as the court's examiner, diagnosed Paulson as suffering from schizoaffective disorder. He stated the disorder results in substantial disorder of Paulson's thoughts and perception, which results in a gross impairment of her judgment with substantial risk of harm to herself. He also testified Paulson was in need of inpatient treatment and her lack of cooperation necessitated that it be involuntary commitment. Dr. Alsdurf, however, testified he did not believe Paulson presented a threat to others.
Paulson's brother, Mark Paulson, and father, John Paulson, testified on her behalf. Mark Paulson testified he only sees Paulson occasionally and had no knowledge of whether or not she was taking medication. Mark Paulson also testified that he had never known Paulson to be assaultive, violent, or unable to care for herself.
John Paulson testified that he would be "happy" to have Paulson live with him and he would provide for her. He indicated he would like her to take her medication, but would give her a place to live even if she were not doing so. He was not aware of any alternatives for Paulson's care.
Paulson then took the stand on her own behalf and testified that she stopped taking her medication in February. She also admitted the facts leading up to her hospitalization.
Paulson explained she started the fire at the detox center because she felt that the detox center was understaffed and that a real fire could put herself and other detainees in danger. She had hoped that the fire and the sounding of the fire alarm would automatically unlock the doors and she would be able to leave the building. She also indicated that she did not know if starting the fire was the proper way of handling the situation.
With regard to living with her father, Paulson stated it "would be an option of last resort," because he lives in a small trailer. Finally, she indicated she had been employed through a temporary agency for the past few years and was an employee in good standing. She also believed one of her brothers would loan her money until she was employed again.
On April 28, 1999, the trial court entered an order committing Paulson as mentally ill to the head of the Anoka Metro Regional Treatment Center (AMRTC). The court concluded the record established by clear and convincing evidence that Paulson is a mentally ill person as defined by Minn. Stat. § 253B.02, subd. 13 (1998), and is in need of commitment. This appeal followed.
DECISION
When reviewing a commitment judgment, we view the record in the light most favorable to the district court's decision. In re Knops, 536 N.W.2d 616, 620 (Minn. 1995).
Findings of fact, whether based on oral or documentary evidence, shall not be set aside unless clearly erroneous, and due regard shall be given to the opportunity of the trial court to assess the credibility of the witness.
Minn.R.Civ.P. 52.01. Whether the evidence is sufficient to meet the standard for commitment is a question of law, which we review de novo. Knops, 536 N.W.2d at 620.
To commit a person as mentally ill, the district court must have clear and convincing evidence that the person is "mentally ill," as defined by the Minnesota Commitment and Treatment Act ("Commitment Act"), Minn. Stat. §§ 253B.01-.23 (1998). See Minn. Stat. § 253B.09, subd. 1 (setting out the clear and convincing standard). The Commitment Act defines a mentally ill person as:
[A]ny 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) 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(a).
The statute requires that the substantial likelihood of physical harm must be demonstrated by an overt failure to obtain necessary food, clothing, shelter, or medical care or by a recent attempt or threat to harm self or others. Minn. Stat. § 253B.02, subd. 13(a)(1), (2); Enberg v. Bonde, 331 N.W.2d 731, 736-38 (Minn. 1983).
Therefore, speculation as to whether the person may, in the future, fail to obtain necessary food, clothing, shelter, or medical care or may attempt or threaten to harm self or others is not sufficient to justify civil commitment as a mentally ill person.
In re McGaughey, 536 N.W.2d 621, 623 (Minn. 1995). But, this does not mean that "the person must either come to harm or harm others before commitment as a mentally ill person is justified." Id.
The statute requires only that a substantial likelihood of physical harm exists, as demonstrated by an overt failure to obtain necessary food, clothing, shelter, or medical care or by a recent attempt or threat to harm self or others.Id. at 623-24.
1. Physical harm
Here, the trial court concluded that there was clear and convincing evidence that Paulson is mentally ill as defined by Minn. Stat. § 253B.02, subd. 13, and is in need of commitment. Paulson contends the facts in the record are insufficient as a matter of law to support the trial court's conclusion. She argues that the record contains no overt act demonstrating an attempt to harm herself or others, and that testimony regarding a need for future hospitalization is inadequate.
We recognize the civil commitment standard is rigorous, and, in light of this standard, believe the question of whether Paulson is a mentally ill person, as defined by the Commitment Act, presents a close question. There is no evidence that Paulson has previously been committed, and in the past, she successfully managed her illness with outpatient treatment. Her brother testified he has never seen her engage in any type of behavior that was injurious to herself or others. Although Dr. Alsdurf testified that she did not pose a substantial likelihood of harming others, he also opined she will reach a point where she will be in specific need of inpatient hospitalization because she refuses to take her medication. According to Dr. Alsdurf, Paulson is "probably capable of functioning, with the support of her family for a brief period of time."
The uncontroverted testimony is that Paulson cannot sustain herself over time without medication, and she refuses to undergo the necessary tests in order to receive medication. Her treating physician stated that, given her lack of insight and noncompliance with medications, he believes she will be at risk for acting on delusions and she needs further treatment and medication. Also, according to Dr. Alsdurf, Paulson is utterly determined not to work with anyone on an outpatient basis. Finally, as a result of her faulty perceptions and impaired judgment, Paulson engaged in a series of actions and threats which may have resulted in harm to herself or others.
Paulson decided to take a vacation when she was evicted and unemployed and in need of financial assistance. She ran out of gas and accepted a ride from a stranger. She spent several hours at a bar and then decided to walk three or four miles to her car at 1:00 a.m. When she was placed in the detox facility, she activated fire alarms, called 911, and set a small fire in a wastebasket because she thought she was in an unsafe situation. At Regions Hospital she was hostile, uncooperative, and refused her medication. She also told a nurse she felt like driving recklessly or setting a fire in her living room, and suggested she would return to the hospital with a machine gun.
Thus, although Paulson has not yet injured herself or others, the trial court is not required to delay commitment until she or someone else is actually harmed. McGaughey, 536 N.W.2d at 623. "[S]o long as the danger of [her] condition had already become evident," the court may order commitment. In re Terra, 412 N.W.2d 325, 328 (Minn.App. 1987) (quotation omitted). Accordingly, the testimony of Dr. Alsdurf, social worker Johnson, and Paulson's medical records support the conclusion that the danger of Paulson's condition is imminent. She has failed to obtain necessary medical care and there is a substantial likelihood she will engage in activity harmful to herself.
2. oLeast restrictive alternative
Paulson contends the court failed to carefully consider alternatives to commitment as required by Minn. Stat. § 253B.09, subd. 1. She argues the court should have considered placement with her father or brother and completely failed to consider a dual commitment to AMRTC and a "half-way" house.
Although the trial court's findings regarding the least restrictive alternative are sparse, we conclude there is sufficient evidence to support its determination that there is no suitable alternative to commitment. See In re Melcher, 404 N.W.2d 309, 312 (Minn.App. 1987) (upholding trial court finding that commitment to the hospital was the least restrictive alternative where patient required stabilization on medication and no expert recommended release).
The court stated it considered voluntary inpatient and outpatient care, the appointment of a guardian, conditional release, and placement in a community hospital or an outpatient program, but rejected them due to their inability to cope with Paulson's needs and Paulson's refusal to cooperate with treatment. This is supported by Johnson's testimony that Paulson refused to submit to tests necessary for the administration of her medication, and that Paulson's treating physician believes she is unlikely to accept further treatment and medication without court-ordered commitment.
It is also supported by Dr. Alsdurf's testimony that Paulson's judgment capacity is impaired. She recognizes she needs her medication to function, but refuses to cooperate with efforts to provide her with it and is determined not to work with anyone on an outpatient basis. Under the circumstances of the instant case, the trial court's decision that commitment to AMRTC was the least restrictive placement is supported by the evidence in the record.