Opinion
No. C4-02-107.
Filed July 16, 2002.
Appeal from the District Court, Hennepin County, File No. P30160506.
Mark A. Gray, (for appellant Horky-Iverson)
Amy Klobuchar, Hennepin County Attorney, Coleen M. Brady, Assistant County Attorney, (for respondent Fairview University Medical Center)
This opinion will be unpublished and may not be cited except as provided by Minn. Stat. § 480A.08, subd. 3 (2000).
UNPUBLISHED OPINION
Appellant Gale Horky-Iverson challenges her commitment as mentally ill, claiming that the district court failed to provide sufficient findings to support her commitment; and that no evidence was presented showing that she posed a substantial likelihood of physical harm to herself or others. Because the district court's findings are sufficient to support her commitment, and the evidence supports the district court's finding that she posed a substantial likelihood of physical harm to herself or others, we affirm.
FACTS
Appellant is a 50-year-old woman who has been diagnosed as suffering from paranoid schizophrenia. On November 3, 2001, appellant went to the Fairview University Medical Center emergency room and reported that she had awakened at 3:30 a.m. believing she had been "date raped," and that she had found an injection wound at the base of her spine. She further reported that she was injected with date rape drugs at night and requested a radiologist test for "radio-isotope and nuclear poisoning" studies. Appellant would not comply with a medical examination. She was admitted to the hospital and transferred from the emergency room to the psychiatric unit.
Hospital records indicate that appellant was very difficult to redirect and became aggressive towards anyone who questioned her theories. Appellant reported that her body was being invaded by "microscopic isotopes" causing her to make inadvertent bodily movements while driving. She believed that she was being used as a guinea pig for a drug that changes a person's facial features by injections of proton particles into her nose, ears, base of skull, and spine. Additionally, appellant believed that songs on the radio were messages directed at her, and the people who injected her were able to speak through her. Appellant also believed that her 10-year-old son was being abused by her ex-husband and stepchildren and they were forcing him to be involved in pornography.
Appellant was placed on a 72-hour hold. Hospital records indicate that appellant was agitated, intrusive, aggressive, irritable, and angry. Appellant's intrusiveness agitated other patients and escalated to the point of hospital staff placing her in seclusion.
In a November 14, 2001, report, Dr. Roger C. Sweet, Ph.D. noted that "[appellant] has been physically threatening and the doctor is uncomfortable meeting with her without an emergency beeper." Dr. Sweet also noted that appellant remained argumentative during their interview and her mood was hostile. Additionally, appellant was intrusive toward staff and, since being hospitalized, her behavior had become more agitated. She appeared thin and was dehydrated.
Appellant does not believe she is suffering from any psychosis and, as a result, refuses to take any medication. Dr. Sweet notes that appellant's condition will continue to deteriorate and lead to potential harm. Subsequently, the hospital staff determined that its acute care facility was not the best environment for treatment. On November 7, 2001, a petition was filed for judicial commitment in Hennepin County District Court. On November 20, 2001, the district court filed its order committing appellant as "mentally ill" to the Anoka Regional Treatment Center.
DECISION
On appeal from a judicial commitment, this court applies a "clearly erroneous standard of review and must determine whether the district court's findings of fact are supported by the record as a whole." In re Kunshier, 521 N.W.2d 880, 884 (Minn.App. 1994). The question of whether the record supports the district court's conclusion that a person meets the necessary elements is a question of law that is reviewed de novo. In re Linehan, 518 N.W.2d 609, 613 (Minn. 1994).
A mentally ill person is defined as one with a substantial psychiatric disorder who 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) (2000). The commitment statute requires the court to set out the patient's conduct that forms the basis for the commitment with specificity. Minn. Stat. § 253B.09, subd. 2 (2000). This court has upheld commitments where the findings were scanty, although legally sufficient. In re King, 476 N.W.2d 190, 194 (Minn.App. 1991); In re Adams, 352 N.W.2d 117, 119 (Minn.App. 1984). Here, the district court found that [appellant] has a vast array of paranoid delusions, ranging from being date raped to being an unwilling participant in a pornography ring to being a guinea pig for an experiment in changing DNA. She explains all of these delusions at great length with a variety of pseudo-scientific theories. She is obsessed with these delusions and she becomes angry and threatening at anyone who challenges her delusions. In the hospital, she has had to be secluded for her threatening behavior. She has accused several people, including her ex-husband, a local musician and a local television personality, of being part of this conspiracy against her. She is potentially a danger to these people if she were to act out on her firmly held beliefs that they are trying to harm her.
Appellant contends that there was no showing that she posed a substantial likelihood of physical harm to herself or others. This determination is essential, because there is no constitutional basis for an involuntary commitment if a person is not dangerous and can live safely in freedom. O'Connor v. Donaldson, 422 U.S. 563, 575, 95 S.Ct. 2486, 2493 (1975). Our supreme court has emphasized that the substantial likelihood of physical harm "must be demonstrated by an overt failure to obtain [necessities] * * * or by a recent attempt or threat to harm self or others[;]" mere speculation is insufficient. In re McGaughey, 536 N.W.2d 621, 623 (Minn. 1995) (citations omitted).
In its commitment order, the district court set forth findings of fact based on all the oral and documentary evidence before it. Appellant takes issue with the fact that there was no testimonyat the hearing of her potential to cause harm. The court, however, had substantial evidence in the record supporting the finding that appellant posed a substantial likelihood of harm to herself or others.
Appellant argues that the references to the threatening behavior do not specifically state what constituted the threat. One can infer from the circumstances that the threats were not to "stick her tongue out at someone" or "to sue the hospital/staff for malpractice" as appellant contends in her brief. Appellant's threats were so severe that the staff was forced to place her in a secured unit. The incident report related to that event indicates that appellant was a danger to herself and others and that she was continually interfering with the staff's ability to care for other patients and agitating other patients with her threatening behavior. Dr. Sweet's report states that appellant has been "physically threatening and the doctor is uncomfortable meeting with her without an emergency beeper." Again, while the doctor's report does not specify details of her threat, it is clear by the need for an emergency beeper that the doctor was in fear of physical danger.
Moreover, there was testimony at the hearing regarding appellant's potential for danger. Dr. Sweet testified that appellant was out of control and, because of her lack of insight into her psychiatric disorder, that she would become more confrontive and likely antagonizing to others, possibly leading to problems in the community. See In re Martin, 458 N.W.2d 700, 705 (Minn.App. 1990) (finding that the evidence that the person was easily provoked, verbally hostile, very close to being assaultive in the hospital, and had behavior which would be very provocative in the open community supported the determination that the person posed a substantial likelihood of harm to self or others).
Dr. Carrie Parente, M.D., testified that appellant refused to take her medication. Without her medication, appellant's delusions and paranoia are likely to increase. Further testimony indicated that appellant does not demonstrate an awareness of her situation and she denies that she has a mental illness; her lack of insight makes her particularly vulnerable. A failure to seek medical care or to provide food or sanitary shelter supports a finding that the patient poses a substantial likelihood of harm to herself by failing to provide necessities. Additionally, various doctor's notes reveal that appellant was very thin, and she suffered from dehydration. In re Anderson, 367 N.W.2d 107, 108-09 (Minn.App. 1985) (findings of significant weight loss and failure to provide food or medical care demonstrated harm to self). But cf. In re Nadeau, 375 N.W.2d 85, 87-88 (Minn.App. 1985) (where proposed patient was appropriately dressed, not malnourished, and was able to obtain shelter, and witnesses agreed she did not pose a danger to others despite her delusions, commitment standards were not met); In re Duvick, 497 N.W.2d 311, 313 (Minn.App. 1993) (finding the standard was not met where the person had dementia and refused supervision and assistance she needed, but nonetheless could provide herself with food, clothing, shelter, and medical care).
The record reveals that there was clear and convincing evidence by which the district court could make findings and conclude appellant posed a substantial likelihood of harm.