Opinion
No. CX-01-117.
Filed June 26, 2001.
Appeal from the District Court, Mower County, File No. P3-00-1819.
Brandon V. Lawhead, Donaldson V. Lawhead, (for appellant William Rounsaville)
Patrick A. Oman, Mower County Attorney, Jonathan Olson, Assistant Mower County Attorney, (for respondent petitioner)
Considered and decided by Randall, Presiding Judge, Schumacher, Judge, and Anderson, 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This opinion will be unpublished and may not be cited except as provided by Minn.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UNPUBLISHED OPINION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 seeks review of the district court's order committing him to a regional treatment center as chemically dependent. Appellant argues that clear and convincing evidence was not presented to establish that (a) he meets the statutory definition of a chemically dependent person and (b) commitment to St. Peter Regional Treatment Center is the least restrictive alternative. Because we conclude that there was clear and convincing evidence to support the district court's decision to commit appellant as chemically dependent, we affirm.
FACTS
Appellant William Rounsaville was admitted to Austin Medical Center (AMC). He was severely intoxicated and his brother had to intervene to counter appellant's threat to hang himself. At the time, appellant was a 50-year-old male who had been drinking since he was about 10 years old. Upon admission to AMC, appellant's blood-alcohol concentration (BAC) was .281. Shortly after being admitted, appellant experienced chest pains. Appellant suffers from coronary heart disease and underwent triple bypass surgery in March 1999. Currently, his heart pumps at only 40% capacity. Appellant has a family history of heart problems. His father died from a heart-related condition, his sister has had two double-heart attacks, and his brother had the same bypass surgery as appellant.
Appellant's social worker petitioned to commit him as a chemically dependent person. After a hearing on January 5, 2001, the district court concluded that appellant is chemically dependent and in need of treatment. The court ordered his commitment to an inpatient treatment program at St. Peter Regional Treatment Center, which lasts (normally) 42 days and is followed by an aftercare program.
DECISION
In reviewing a commitment determination, the appellate court considers whether the district court followed the statutory requirements and whether the district court's findings are clearly erroneous. In re Duvick, 497 N.W.2d 311, 312-13 (Minn.App. 1993). The district court's commitment determination will be overturned if its findings are insufficient to support commitment. See In re McGaughey, 536 N.W.2d 621, 624 (Minn. 1995) (reversing commitment determination because district court's findings were insufficient). The appellate court views the record in the light most favorable to the district court's decision. In re Knops, 536 N.W.2d 616, 620 (Minn. 1995).
I. Chemically Dependent Person
Respondent asserts that appellant did not raise the issue of whether appellant met the statutory definition of a chemically dependent person in district court, either during examination or closing argument. This assertion is incorrect. The burden was on respondent to prove by clear and convincing evidence that appellant is chemically dependent. See Minn. Stat. § 22253B.09, subd. 1 (2000) (stating district court may commit patient if, among other things, it finds by clear and convincing evidence that patient is chemically dependent).
A chemically dependent person is defined as any person
(a) determined as being incapable of self-management or management of personal affairs by reason of the habitual and excessive use of alcohol, drugs, or other mind-altering substances; and (b) whose recent conduct as a result of habitual and excessive use of alcohol, drugs, or other mind-altering substances poses a substantial likelihood of physical harm to self or others as demonstrated by (i) a recent attempt or threat to physically harm self or others, (ii) evidence of recent serious physical problems, or (iii) a failure to obtain necessary food, clothing, shelter, or medical care.
Minn. Stat. § 253B.02, subd. 2 (2000). As we previously stated, the district court may commit a person to a treatment program "[i]f the court finds by clear and convincing evidence that the proposed patient is * * * chemically dependent" and "finds that there is no suitable alternative to judicial commitment." Minn. Stat. § 253B.09, subd. 1.
The district court based its finding that appellant is chemically dependent on the following factors: (a) appellant drinks a case of beer per day, (b) both psychologists testified that appellant is incapable of self-management when drinking, (c) appellant's inability to self-manage coupled with his heart problem poses a significant concern for his well-being, and (d) on one occasion while appellant was drinking, he threatened to hang himself.
A. Self-Management
Appellant argues that clear and convincing evidence was not presented to support the district court's finding that appellant is chemically dependent because appellant believes that he is capable of self-management. To support this argument, appellant asserts that he is well nourished, well dressed, has adequate housing, and can pay for his medical care. Appellant further argues that he made a conscious choice to drink in the past, but he is willing to stop.
Self-management "refers to one's handling of the ordinary occurrences of daily life." In re Heurung, 446 N.W.2d 694, 696 (Minn.App. 1989). One who can self-manage performs the ordinary activities of daily life, copes with ordinary stresses, and independently cares for oneself. Id.
At the commitment hearing, Sue Heiny, a social worker for Mower County, testified that during her pre-petition screening of appellant, he told her that he was drinking every day. Appellant also told Heiny that he does not have a job and he has attempted to get social-security disability because of his heart condition, but his application was denied. Appellant testified that he can live at his current residence for the next five years, paying $100 per month in rent. After he sold his house, appellant paid off his debts and stated that he "pretty much spent the rest wasting it." When asked how he planned to provide and care for himself, appellant responded, "I still got a little bit of money. I got things that I can sell, whatever." He testified that he cannot work because of disc problems in his lower back, his heart, and the fact that he gets short of breath very easily.
Dr. Rosemary Linderman, a licensed psychologist requested by the district court to perform a psychological evaluation on appellant, testified that appellant was unable to self-manage. She testified that appellant has completed at least three inpatient chemical dependency treatments: one in Florida in 1980 and two at St. Peter. He has been in detox three times. At the time of his last detox, his BAC was .281, and the time before that, his BAC was .179. Appellant's history presently includes drinking up to one case of beer a day. Although appellant testified that he could stop drinking because he had done so in the past for two and one-half years and that he makes a conscious choice to drink, Dr. Linderman testified that
[i]n spite of having treatment and in spite of being in detox, [appellant] demonstrates an inability to stop drinking and openly identifies that he will quit when he is ready and not until then.
Dr. Linda Marshall, also a licensed psychologist, reached a conclusion similar to Dr. Linderman's. Dr. Marshall testified that appellant has "demonstrated he has a loss of control over his alcohol consumption."
The record demonstrates that appellant has no job and seemingly no means to obtain one, a limited source of income, drinks excessively on an habitual daily basis, has little control over his ability to abstain from drinking, and had BAC's each time he was admitted to the hospital for detox. We can affirm the district court's conclusion that there is convincing evidence of appellant's inability to self-manage.
B. Likelihood of Harm to Self
Although appellant does not specifically address this prong of the statute, he does point out in his brief that his entire family has heart problems. By making this statement, he implies that his condition is the result of hereditary factors rather than his alcohol abuse. We disagree. Despite his heart condition, appellant refused to take cardiac medication prescribed by his doctor. Appellant stated that he does not believe drinking interferes with his heart condition, and he denied attempting to hang himself. He conceded that he might have made a statement to the effect that he should hang himself, but he maintained that he was not serious about it.
Dr. Linderman opined that the combination of appellant's excessive drinking, his inability to stop drinking, and his heart condition posed a substantial risk of harm to himself. She stated that appellant has "cardiac problems that his physician has identified are made worse because of his chronic and habitual use of alcohol." Dr. Linderman further testified that appellant was admitted to the hospital twice earlier in the year, and each time "he was identified as both intoxicated and experiencing chest pain."
Heiny's, Dr. Linderman's, and Dr. Marshall's reports submitted to the court all indicate that appellant is depressed. Appellant told Dr. Linderman that he did not have much to live for and expressed hopelessness. Dr. Marshall's report indicates that appellant told her that alcohol made him depressed. When she informed him of his doctor's opinion that his continued drinking could be life threatening due to his heart condition, appellant replied, "That's okay, what have I got to look forward to anyway."
Because appellant refuses to take his cardiac medication, continues to drink heavily even though he is aware that his drinking is life threatening, and suffers from severe depression, we conclude there is clear and convincing evidence that appellant poses a substantial likelihood of harm to himself.
The testimony and psychological evaluations presented to the district court are sufficient evidence to support the district court's finding that appellant is chemically dependent.
II. Least Restrictive Alternative
After finding that a person is chemically dependent, if the district court finds
that there is no suitable alternative to judicial commitment, the court shall commit the patient to the least restrictive treatment program * * * which can meet the patient's treatment needs.
Minn. Stat. § 253B.09, subd. 1 (2000). The district court must consider a wide range of dispositions and treatment alternatives, and "[t]he court shall also consider the proposed patient's treatment preferences and willingness to participate in the treatment ordered." Id. The district court's findings must be specific and must identify the less-restrictive alternatives considered and rejected and the reasons for rejecting each alternative. Id., subd. 2 (2000).
At the hearing, only two treatment facilities were discussed: Fountain Center and St. Peter. Appellant argues that the district court failed to consider Dr. Marshall's opinion that a stay of commitment would be the least restrictive alternative if appellant were willing to voluntarily enter and complete treatment. Appellant also argues that the district court failed to make specific findings regarding other least restrictive alternatives and failed to consider appellant's willingness to enter a voluntary inpatient treatment program at Fountain Center. Appellant contends that he previously experienced success after completing a voluntary inpatient treatment program and was able to stay sober for two and one-half years.
Although appellant's brief indicates that his sobriety was the result of treatment at Fountain Center, there is no evidence in the record to support this statement. Instead, the record demonstrates has entered treatment at St. Peter on at least two occasions.
At the hearing, appellant's attorney asked Dr. Marshall:
I would like for you to assume that [appellant] has now stated that he would like to abstain from alcohol and would be willing to go into some type of treatment, is your opinion changed as to least restrictive alternative?
Dr. Marshall answered, "If he were to say that, I would recommend stay of commitment." When asked for a reason for her answer, she responded:
Based on his being amenable to voluntarily entering treatment, completing treatment and following a set of criteria aftercare plan * * * . If he would not follow those, then commitment should be pursued.
(Emphasis added.)
At one point during the hearing, appellant did testify that he was willing to enter Fountain Center on an inpatient basis. He stated that he had participated in St. Peter's program in the past, and he did not believe that St. Peter's program could teach him anything new. But, he also testified that he did not believe that he needed to enter an inpatient treatment program at all. Based on this testimony, it is unclear whether appellant was actually willing to enter treatment voluntarily. Thus, the portion of Dr. Marshall's answer relied on by appellant is irrelevant. Instead, the latter portion of Dr. Marshall's answer, that appellant should be committed if he was not willing to voluntarily enter treatment, is more pertinent because appellant has not truly expressed his willingness to voluntarily enter an inpatient treatment program.
Heiny's, Dr. Linderman's, and Dr. Marshall's reports all recommended committing appellant for inpatient treatment. Heiny testified that she did not consider Fountain Center because St. Peter would better meet appellant's needs due to his recent suicide attempt. Heiny believed that St. Peter had a better mental health treatment program than Fountain Center and that, in her experience, "people have done much better when they went to St. Peter." Dr. Linderman recommended committing appellant because, at the time of his evaluation, he refused voluntarily inpatient or outpatient treatment. She testified that she believed inpatient treatment at St. Peter was the better choice because it has a more organized aftercare program, which would better serve appellant's needs. Dr. Marshall also recommended commitment because appellant had refused to enter treatment voluntarily at the time of his evaluation. But Dr. Marshall also testified that if Fountain Center were able to meet his needs regarding treatment of his depression and if it were an inpatient program, she "would not have any problem with it."
The district court found that appellant should be committed to the St. Peter facility for inpatient treatment. The pre-printed form the court used as its order stated:
[T]he following less restrictive alternatives (dismissal of petition, voluntary out-patient or in-patient care, informal admission to treatment facility, appointment of guardian or conservator, release before commitment, stayed commitment, etc.) were considered and rejected for the following reasons:
After this pre-printed language, the court supplied the following information: "both [doctors] believe inpatient treatment is necessary and when coupled with appropriate [aftercare] will best meet [appellant's] needs at this time." This constituted the basis for the court's decision that appellant should be committed.
While the district court's findings could have been more extensive, we conclude that the findings are adequate. The record supports the district court's determination. Heiny, Dr. Linderman, and Dr. Marshall all recommended committing appellant. See In re King, 476 N.W.2d 190, 194 (Minn.App. 1991) (concluding sufficient evidence sustained district court's findings on least restrictive treatment program where expert opinion supported court's finding, even though findings were scant). Further, Fountain Center and St. Peter were the only treatment programs discussed at the hearing. Although appellant expressed a willingness to enter Fountain Center, at least at one point during the hearing, Heiny and Dr. Linderman each believed that St. Peter would better serve appellant's needs because of its aftercare program and because it could better address appellant's depression. The district court's finding that St. Peter was the least restrictive alternative for appellant was not clearly erroneous.