Opinion
No. 11–P–491.
2012-05-24
Guardianship of QUIGLEY.
Accordingly, the judge applied the correct standard.
By the Court (KANTROWITZ, BERRY, & VUONO, JJ.).
MEMORANDUM AND ORDER PURSUANT TO RULE 1:28
This an appeal from an order of a judge of the Probate and Family Court continuing the involuntary administration of antipsychotic medication to a mentally ill man under guardianship, whom we shall call Quigley.
On appeal, Quigley argues that the judge (1) improperly shifted the burden of proof onto him; (2) applied the wrong standard in determining whether a substantial change of circumstances had occurred; and (3) failed to properly assess the factors considered under the substituted judgment standard. We affirm.
On July 15, 2011, the Probate and Family Court entered an order impounding “all documents filed by the parties in this action.”
1. Factual background. In July, 2004, Quigley was diagnosed with paranoid schizophrenia and involuntarily committed to a psychiatric hospital. A Probate and Family Court judge declared Quigley incompetent and, under the substituted judgment standard, approved a treatment plan involving antipsychotic medications, which was subsequently extended twice without objection by Quigley. In January, 2009, the Department of Mental Health (the department), in its capacity as Quigley's guardian, moved to extend the treatment order again, but this time, Quigley opposed it and an evidentiary hearing was held. See G.L. c. 190B, § 5–306A ( c ). Based on the opinions of two psychiatric professionals and other evidence submitted by the department, the judge determined that Quigley would wish to continue the prescribed treatment plan if he were competent and extended the treatment plan until August 30, 2011.
This appeal followed. 2. Burden of proof. Absent clear error, we accept the judge's subsidiary findings of fact and review only the conclusions drawn from those facts. Guardianship of Brandon, 424 Mass. 482, 488 (1997). Under the relevant statute, the court shall authorize treatment with antipsychotic medications “when it (i) specifically finds using the substituted judgment standard that the person, if not incapacitated, would consent to such treatment and (ii) specifically approves and authorizes a treatment plan and endorses said plan in its order or decree.” G.L. c. 190B, § 5–306A( a ), inserted by St.2008, c. 521, § 9. Each order authorizing such a treatment plan must provide for periodic review, “to determine whether the incapacitated person's condition and circumstances have substantially changed such that, if competent, the incapacitated person would no longer consent to the treatment authorized therein.” G.L. c. 190B, § 5–306A( c ). The guardian is tasked with investigating the condition of the incapacitated person and making appropriate recommendations to the court. See G.L. c. 190B, § 5–106.
The department notes in its brief that the Probate and Family Court has extended the treatment order on an interim basis. The department has already moved to extend the treatment order for another year. Accordingly, the order's termination date does not moot this appeal. Compare Guardianship of Erma, 459 Mass. 801, 804 (2011) (“The order's termination moots this appeal”).
Quigley first contends that the judge impermissibly shifted onto him the burden of proving that a substantial change in his condition or circumstances had occurred. To the contrary, the judge's extensive and specific findings make clear that the order to extend the treatment plan was based on the evidence presented by the department, which included a report, affidavit, and treatment plan by Quigley's treating psychiatric professional, the testimony of a second psychiatric professional who had previously examined Quigley, the court's earlier findings surrounding Quigley's treatment plan, and two court monitors' reports. Quigley's contention is, therefore, not availing.
3. Applied standard. Quigley next argues that the judge sought to determine whether a substantial change in circumstances had occurred since the most recent review of Quigley's treatment plan, when the correct standard is whether such a change has occurred since the original substituted judgment hearing. See Guardianship of Brandon, 424 Mass. at 488–489. Thus, Quigley argues that the judge used an incorrect standard. We do not agree. The judge's findings give ample consideration to Quigley's entire medical history and clearly establish that his condition has not changed since the initial treatment order in 2004. As the judge explained,
“[t]here is no change in [Quigley's] psychiatric diagnosis. [Quigley] continues to suffer from a mental illness diagnosed as paranoid schizophrenia. [Quigley] has continued to exhibit symptoms of a paranoid schizophrenic, including, delusions, paranoia, irritability, disorganized thinking, hallucinations, and impaired judgment. His schizophrenia is chronic in nature, meaning that his symptoms of the illness will remain with him for life. While with treatment, the severity of the symptoms may lessen but they will never totally go away. The treatment he receives serves to control the severity and extent of his symptoms, but it does not cure the underlying illness.”
Accordingly, the judge applied the correct standard.
4. Factors considered under substituted judgment standard. Lastly, Quigley argues that the judge failed to properly assess the factors considered under the substituted judgment standard, which are, “(1) the ward's expressed preferences regarding treatment; (2) his religious beliefs; (3) the impact upon the ward's family; (4) the probability of adverse side effects; (5) the consequences if treatment is refused; and (6) the prognosis with treatment.” Guardianship of Roe, 383 Mass. 415, 444 (1981). Quigley asserts that the judge failed to adequately assess his expressed preference, the impact upon his family, the consequences of refusing treatment, and the adverse side effects. The judge's findings demonstrate, however, that appropriate consideration was given to all of the pertinent factors.
We do not discount the importance of Quigley's actual preference in the substituted judgment determination. See Guardianship of Moe, 81 Mass.App.Ct. 136, 141 (2012). In this case, the evidence sufficiently established that Quigley's inability to recognize the benefits of his treatment and the risks associated with ending treatment are characteristic of his psychiatric illness. In fact, Quigley does not believe, or understand, that he has a mental illness. Quigley's preference is, therefore, not informed. See Guardianship of Roe, 411 Mass. 666, 670–671 (1992) (informed decision about medical treatment requires ability to appreciate need to control illness with, and risks involved in refusing, such medications).
Order dated July 27, 2010, affirmed.