Opinion
No. C8-02-1633.
Filed: March 11, 2003.
Appeal from the Hennepin County District Court, File No. P10160410.
Ruth A. Gaydos, (for appellant)
Amy Klobuchar, Hennepin County Attorney, John L. Kirwin, Assistant County Attorney, (for respondent)
Considered and decided by Minge, Presiding Judge, Lansing, Judge, and Shumaker, Judge.
This opinion will be unpublished and may not be cited except as provided by Minn. Stat. § 480A.08, subd. 3 (2002).
UNPUBLISHED OPINION
On appeal from involuntary commitment as mentally ill, Donna J. Zienty contends the record is insufficient to support her commitment to Hennepin County Medical Center and Anoka Metro Regional Treatment Center as the least-restrictive means of treatment. She also contends the district court erred by finding that she lacked capacity to decide whether to take neuroleptic medications. Because the district court's determinations meet the statutory standards and are supported by the record, we affirm.
DECISION
Appellant Donna J. Zienty is a 41-year-old woman with schizophrenia. Since 1994, Zienty has been committed six times, including the July 31, 2002 commitment she is appealing here. In the past, Zienty's manifestations of schizophrenia have included depression, attempted suicide, paranoid delusions, disrobing in public and walking through sprinklers, claims that she was the Antichrist and Satan, and command hallucinations from God.
In July 2002, Hennepin County Medical Center (HCMC) filed a petition for judicial commitment and a written request for authorization to impose treatment, including neuroleptic medications. As required when a treatment center seeks to treat a non-consenting adult with neuroleptic medications, a Jarvis hearing was held. Minn. Stat. § 253B.092, subd. 8(a) (2002); Jarvis v. Levine, 418 N.W.2d 139, 148 n. 7, 150 (Minn. 1988).
Neuroleptic medications are traditional anti-psychotics frequently prescribed to treat symptoms such as hallucinations, paranoia, and delusional beliefs.
Involuntary commitment is justified when the district court finds that a proposed patient is a mentally ill person. Minn. Stat. § 253B.09, subd. 1 (2002). A mentally ill person is one who has a "substantial psychiatric disorder" that is "manifested by instances of grossly disturbed behavior or faulty perceptions and poses a substantial likelihood of physical harm to self or others." Minn. Stat. § 253B.02, subd. 13(a) (2002). A likelihood of harm may be shown by, among other things, a recent attempt or threat of physical harm or by a failure to obtain necessary food, clothing, shelter, or medical care. Minn. Stat. § 253B.02, subd. 13(a)(1), (3). The district court's findings on this determination will not be set aside unless clearly erroneous. Minn.R.Civ.P. 52.01; In re Knops, 536 N.W.2d 616, 620 (Minn. 1995). The evidence supporting the district court's findings must be clear and convincing. Minn. Stat. § 253B.09, subd. 1.
I.
Zienty challenges the court's determinations that she is mentally ill, poses a likelihood of harm to herself and cannot take care of herself. Zienty also challenges that there was no less-restrictive method of treatment than commitment and that she did not have the mental capacity to determine whether she should take neuroleptic medications.
The district court's findings that Zienty is schizophrenic with "grossly disturbed behavior and faulty perceptions" were fully supported by medical testimony. Zienty's physician reported Zienty's inability to communicate with HCMC staff, which was evidenced by her staring at the wall, remaining in bed with the covers pulled tightly over her head, or pacing in circles for eight to ten hours a day. In addition, at the time Zienty was brought into HCMC, she had been in the same clothing for seven weeks and made no attempt to shower or perform other basic hygiene unless prompted to do so by the nursing staff.
Other evidence confirms that Zienty's mental illness presents a threat of harm to Zienty. At the time Zienty was admitted to HCMC, she had no food in her apartment, her refrigerator was turned off, and she had to be encouraged to eat by the nursing staff at HCMC. In addition, Zienty refused to speak with housing workers about her possible eviction from her apartment, and she had canceled her financial assistance. Zienty also was uncooperative with the medical staff at HCMC, refusing attempts to take her blood pressure, conduct any lab work, or administer any kind of medication. Credible testimony indicated that it was possible for Zienty to harm others and to provoke others to harm her.
Because Zienty is unable to properly feed herself, maintain shelter, or allow medical professionals to examine her, Zienty poses a substantial danger to herself under Minn. Stat. § 253B.02, subd. 13(a)(1). The evidence clearly and convincingly supports the district court's order for commitment. See In re Schaefer, 498 N.W.2d 298, 300 (Minn.App. 1993) (concluding that commitment is appropriate when there is a failure to obtain necessary food, clothing, shelter, or medical care).
II.
Zienty also challenges the district court's determination that commitment to an in-patient treatment facility is the least-restrictive means of treating her illness. A court may commit a person to involuntary in-patient treatment if it finds, after considering all other reasonable dispositions, no suitable alternative disposition. Minn. Stat. § 253B.09, subd. 1. A judicially committed person must be committed "to the least restrictive treatment program * * * which can meet the patient's treatment needs." Id. This court can reverse a district court's findings as to the least-restrictive treatment program to meet the patient's needs if the findings are clearly erroneous. In re Kellor, 520 N.W.2d 9, 12 (Minn.App. 1994), review denied (Minn. Sept. 28, 1994). Minnesota law requires the district court to carefully consider reasonable alternatives to involuntary commitment. Minn. Stat. § 253B.09, subd. 1. These alternatives might include voluntary outpatient care, voluntary admission to a treatment facility, or appointment of a guardian or conservator. Id.
Here, the district court determined that Zienty was acutely ill with schizophrenia, considered less-restrictive dispositions, and determined that voluntary outpatient care, voluntary admission to a treatment facility, appointment of a guardian or conservator and release before commitment were all inappropriate dispositions, and there was no suitable alternative to judicial commitment. Because Zienty exhibits unusual behavior including muteness, pacing, isolation, and aggression, and because Zienty is unable to communicate with her care staff, cooperate with housing support personnel, or keep her financial affairs in good order, it is not an abuse of discretion for the district court to order involuntary commitment. Any other less-restrictive alternative would not ensure stabilization of Zienty's condition.
III.
Court approval is required to administer neuroleptic medication to a person who refuses it. Minn. Stat. § 253B.092, subd. 8(a); Jarvis, 418 N.W.2d at 150. Minnesota law presumes a patient is capable to decide whether to take neuroleptic medication. Minn. Stat. § 253B.092, subd. 5(a) (2002). If the patient refuses to take neuroleptic medications, the court must first determine whether the patient has capacity to make the decision. Minn. Stat. § 253B.092, subd. 8(a). To determine if the patient has the capacity, the court must consider the following factors:
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;
whether the person demonstrates an understanding of treatment with neuroleptic medications and the risks, benefits, and alternatives; and
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.
Minn. Stat. § 253B.092, subd. 5(b) (2002). Disagreeing with one's physician regarding the use of neuroleptic medications is not evidence of an unreasonable decision. Id.
Here, the court made numerous findings regarding Zienty's situation. The court found that Zienty was unaware of the reasons for her hospitalization, the nature of her illness, the consequences and benefits of taking neuroleptic medications, or any alternative treatments instead of taking these drugs. In addition, the court found that while Zienty was able to communicate her desire not to take the medication, her decision was not a reasoned one. Because Zienty refused to discuss her situation with anyone, the court found it was impossible to determine whether her decision was based on delusions.
The court also addressed Zienty's ability to state her wishes at a time when she did have capacity to do so. The court found that she had not previously stated what her decision would be as it relates to taking neuroleptic medications. In addition, the court found Zienty did not have any known moral, religious, or social values that would prohibit her from taking the medication.
Based on these findings and a determination that the benefits of the proposed treatment use of neuroleptic medications outweighed the medical risks of the treatment and that no alternative treatment would be as effective in treating appellant's mental illness, the court concluded that appellant lacked the capacity to give or withhold consent to take the medication and the administration of the medications to appellant was reasonable and necessary to treat her mental illness.
Here there was sufficient evidence for the court to determine appellant's inability to capably determine whether to take the medication. Her care team reported Zienty's behavior to the court. The court could determine her competence by her behavior. While Zienty did on occasion express what she wanted, it was usually in the form of a one-word request such as "pop." This is not sufficient to show enough evidence of understanding to support a capacity to understand.
We uphold the administration of neuroleptic medications based on appellant's behavior.