Opinion
No. A04-221.
Filed July 20, 2004.
Appeal from the District Court, Hennepin County, File No. P0-01-60141.
James S. Dahlquist, (for appellant Ray-Vaughan).
Amy Klobuchar, Hennepin County Attorney, John L. Kirwin, Assistant County Attorney, (for respondent Hennepin County).
Considered and decided by Shumaker, Presiding Judge; Peterson, Judge; and Anderson, Judge.
This opinion will be unpublished and may not be cited except as provided by Minn. Stat. § 480A.08, subd. 3 (2002).
UNPUBLISHED OPINION
Appellant Francheska Ray-Vaughan challenges her commitment as mentally ill, arguing that there was insufficient evidence to show that she posed a substantial likelihood of causing physical harm to herself. We affirm.
Appellant's last name is spelled a variety of ways in the district court file. We use the spelling in the district court order from which this appeal is taken.
FACTS
Francheska Ray-Vaughan was admitted to the Fairview University Medical Center on November 29, 2003, after getting a ride to the hospital with friends. She had not slept for two days and was not taking her medication. She was described as "uncooperative, noncommunicative, unable to follow simple instructions, disheveled in appearance, tearful, laughing inappropriately, [and] hostile during [the] clothing search."
Ray-Vaughan's social worker testified at the commitment hearing. Ray-Vaughan's treatment plan includes taking neuroleptic medication and participating in groups on the hospital unit. Ray-Vaughan initially took the medication only sporadically and then refused completely. She began attending the groups only as of the week of the commitment hearing.
Ray-Vaughan has engaged in sexually inappropriate behavior, including lifting her shirt to expose herself when first admitted; showing a male psychiatric technician a tattoo on her breast; and telling a technician that she "would sleep with anyone." The social worker testified these actions make her vulnerable and create a danger for her.
The social worker testified that safe and structured housing is also a concern. When Ray-Vaughan was admitted to the hospital, she had been living with a friend, but she no longer wants to return there. The social worker testified that she is not psychiatrically stable enough to negotiate a place to live upon discharge. Placement at a group home was not an option because those facilities require residents to take prescribed medication, and Ray-Vaughan is not complying with her medication prescription.
Another problem for Ray-Vaughan is her inability to provide food for herself. Her social worker explained that her confusion is such that it would be difficult for her to follow through with shopping and preparing meals.
In addition, Ray-Vaughan's condition has been worsening. She exhibits more psychotic symptoms, such as looking over her shoulder, speaking and laughing to herself, and displaying a startle response upon approach. Recently, she has also begun referring to herself in the plural, with such statements as, "We don't want to take medication." She does not exhibit insight into her mental illness or her need for treatment, and she consistently denies that she has psychiatric symptoms, that she needs medication, or that she has a history of psychiatric problems and treatment.
In summary, the social worker concluded that Ray-Vaughan would be unable to provide for herself with necessary food, shelter, or medical care if released. Further, she is considered vulnerable due to her poor insight, impulse control, and boundaries.
Dr. James Jacobson, a psychologist and court-appointed examiner, testified that Ray-Vaughan suffers from schizoaffective disorder. Ray-Vaughan's inability to provide for her needs is very crucial. Dr. Jacobson noted that she remains psychotic, she has no place to live, and she has not received her social security funds. She tested positive for drugs upon admission to the hospital. Further, based on her sexual inappropriateness with males in the hospital and her statements that she would "sleep with anyone," he believed she was sexually vulnerable.
The district court determined that Ray-Vaughan is ill with a schizoaffective disorder and that she poses a substantial likelihood of causing physical harm to herself because she is unable to care for her needs and is sexually vulnerable. The court committed her as mentally ill. This appeal followed.
DECISION
In reviewing a commitment as mentally ill, an appellate court will not set aside findings by the district court unless clearly erroneous. In re McGaughey, 536 N.W.2d 621, 623 (Minn. 1995). The issue of whether the facts are sufficient to meet the standards for commitment is a question of law which will be reviewed de novo. In re Knops, 536 N.W.2d 616, 620 (Minn. 1995).
A court must find a person mentally ill by clear and convincing evidence. Minn. Stat. § 253B.09, subd. 1(a) (Supp. 2003). A person who is mentally ill is defined as one with a substantial psychiatric disorder that "poses a substantial likelihood of physical harm to self or others." Minn. Stat. § 253B.02, subd. 13(a) (2002). This harm may be demonstrated by one or more of the following: "a failure to obtain necessary food, clothing, shelter, or medical care as a result of the impairment; [or] . . . a recent attempt or threat to physically harm self or others. . . ." Id. While findings as to the likelihood of harm cannot be based on speculation, the person need not come to actual harm before commitment is justified. McGaughey, 536 N.W.2d at 623. The district court here found that Ray-Vaughan was "unable to care for her needs due to her extremely disorganized thinking."
Ray-Vaughan first argues that she shows no signs of malnutrition or failure to obtain food. The social worker, however, testified that Ray-Vaughan's confusion is such that she did not believe Ray-Vaughan would be able to follow through with shopping and preparing meals. As to housing, Ray-Vaughan asserts that she has demonstrated her ability to find housing because she lived with a friend for several months before her commitment. The testimony, however, indicated that she no longer wants to live with that friend, that she is no longer receiving her social security disability check, and that she was not psychiatrically stable enough to negotiate a place to live upon discharge. A group home was not an option because medication compliance was required, and Ray-Vaughan was refusing to take her medication.
As to medical needs, Ray-Vaughan points to the fact that she admitted herself to the hospital on a voluntary basis. But the social worker testified that Ray-Vaughan's compliance with her neuroleptic medication prescription was initially sporadic, that she then refused medication, and that she had only begun attending groups on her unit pursuant to her treatment plan the week of the hearing. Further, testimony indicated her psychiatric condition was worsening.
This court has upheld a commitment based on the person's inability to provide for his own needs, where he was unemployed, had no other income, had no place to live, used drugs, and opposed treatment for his worsening condition, and the psychiatric social worker believed he was unable to care for his needs. In re Harvego, 389 N.W.2d 266, 268 (Minn.App. 1986). Similarly, the district court here had clear and convincing evidence from which to conclude Ray-Vaughan could not provide for her needs.
Ray-Vaughan also argues that there was no evidence that she posed a substantial likelihood of danger to herself based on her sexual vulnerability. She contends that her comment that she would "sleep with anyone" and the finding as to her "flirtatious behavior" were insufficient to support the finding that she posed a danger to herself. While Ray-Vaughan's sexual vulnerability is a factor that may be considered, the evidence in this case is quite speculative and would not in itself be sufficient to support the commitment. See McGaughey, 536 N.W.2d at 623 (holding mere speculation insufficient to support commitment). But, as extensively discussed above, because there was clear and convincing evidence that Ray-Vaughan posed a substantial likelihood of physical harm to herself based on her inability to obtain necessities, her commitment as mentally ill is affirmed.