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finding that appellant posed a substantial likelihood of physical harm to herself because she refused to allow medical personnel to conduct a medical examination
Summary of this case from In Matter of Civil Commitment of AndersonOpinion
No. C6-02-660.
Filed October 1, 2002.
Appeal from the District Court, Hennepin County, File No. P10160410.
James S. Dahlquist, (for appellant)
Amy Klobuchar, Hennepin County Attorney, John L. Kirwin, Assistant County Attorney, (for respondent)
Considered and decided by Lansing, Presiding Judge, Randall, Judge, and Klaphake, Judge.
This opinion will be unpublished and may not be cited except as provided by Minn. Stat. § 480A.08, subd. 3 (2000).
UNPUBLISHED OPINION
On appeal from commitment as mentally ill, Donna Zienty disputes that the record is sufficient to support a finding that she poses a substantial likelihood of physical harm to herself or others and that dual commitment to the Hennepin County Medical Center and the Anoka Metro Regional Treatment Center is the least-restrictive means of treating her condition. Because the findings address and meet the statutory standards and are fully supported by the record, we affirm.
FACTS
Donna Zienty has a history of schizophrenia, and, since 1994, has been hospitalized at least four times for paranoid delusions. She was last released from commitment in November of 2001 and was able to obtain assisted housing. Four months later, staff from Hennepin County Medical Center's outreach program visited Zienty's apartment and observed that Zienty had sold nearly all of her furniture, had no food in her apartment, and had packed all of her belongings in a bag. On further inquiry, the staff learned that Zienty had stopped paying rent, had returned her key to the front desk, and had terminated all disability benefits. Zienty told the staff that God had instructed her not to pay her rent.
The outreach staff took Zienty to the Crisis Intervention Center at the Hennepin County Medical Center. Zienty was uncooperative, refusing both to answer questions and to allow medical personnel to check her vital signs. When her treating physician attempted to conduct a medical evaluation, Zienty ignored his questions and tried to remove herself from his presence. Unable to perform a cognitive assessment, her physician relied on her psychiatric history and the unorthodox series of events that brought her to the crisis center to diagnose Zienty as paranoid schizophrenic. He recommended that Zienty be committed.
At the commitment hearing, the district court took testimony from past caseworkers, an attending nurse, and a court-appointed examiner. Each of these witnesses characterized Zienty's behavior as delusional and testified to her overall lack of cooperation. Based on this testimony, as well as Zienty's own reaffirmation of her beliefs that she did not need housing or financial assistance, the court found that Zienty possessed "grossly disturbed behavior and faulty perceptions" that would likely result in harm to Zienty or others. The court concluded that Zienty was schizophrenic and ordered dual commitment to the Hennepin County Medical Center and the Anoka Regional Treatment Center.
Zienty appeals, contending that she is not mentally ill because she does not pose a substantial likelihood of harm to herself or others. Additionally, she contends that even if she were mentally ill, in-patient treatment is not the least-restrictive means through which her illness can be effectively treated.
DECISION I
Involuntary commitment is justified when the district court finds that a proposed patient is a mentally ill person. Minn. Stat. § 253B.09, subd. 1 (2000). 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) (2000). A likelihood of harm may be shown by 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), (2). 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 (2000).
The district court's finding that Zienty is schizophrenic with "grossly disturbed behavior and faulty perceptions" that would likely lead her to harm herself is fully supported by medical testimony. Zienty's treating physician diagnosed Zienty as paranoid schizophrenic with a significantly distorted perception of reality. The record demonstrates that Zienty's distorted perceptions affected her ability to interact with people whose services were necessary to ensure her health and safety. The court-appointed medical examiner stated that Zienty refused to submit to a medical examination and, after reviewing her record and observing her testimony in court, concurred in her treating physician's diagnosis that she suffered from paranoid schizophrenia.
Other evidence confirms that Zienty's mental illness presents a threat of harm to Zienty. The outreach staff who visited Zienty's apartment reported that she had no food. The attending nurse testified that Zienty refused to eat any food that was not in a sealed package when it was presented to her and that this dietary peculiarity made it difficult for her to maintain a reasonably balanced diet. Zienty defended these eating habits by explaining that she had previously been drugged by food served to her by others.
Zienty's current caseworker testified that Zienty would not cooperate when the caseworker applied for emergency funding to maintain Zienty's current residence. Evidence demonstrated that Zienty believes she has been directed by God to stop paying rent, and Zienty stated at the hearing that she could not be compelled to ignore these directives. Unable to properly feed herself, maintain shelter, or allow medical professionals to examine her, Zienty poses a substantial danger to herself. 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 record demonstrates 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.
The factors that led the district court to find that Zienty is a mentally ill person within the meaning of Minn. Stat. § 253B.02, subd. 13, also justify the court's dual commitment to the Hennepin County Medical Center and the Anoka Metro Regional Treatment Center. Zienty is unable, on her own, to obtain housing, adequate nutrition, and medical care. Zienty's former social worker testified that Zienty was previously released from commitment based on Zienty's promise to continue her medication and to cooperate with her social worker. Following release, Zienty contacted the social worker to terminate her outpatient treatment program. Zienty refuses to take medication voluntarily because she believes she has been directed by God not to take the medication. At the hearing, Zienty claimed both that she was exercising her religious freedom by not taking her medication and that she could not be compelled to ignore what she believed to be directives from God. A mentally ill person's consistent refusal to take prescribed medication supports a finding that inpatient commitment is the least-restrictive method of treatment. In re Lufsky, 379 N.W.2d 255, 257 (Minn.App. 1986) (holding that mentally ill person's record of resistance to and unsuccessful completion of outpatient treatment makes inpatient commitment appropriate).
The district court considered and rejected outpatient care, voluntary admission to a treatment facility, appointment of a guardian or conservator, and community-based treatment plans. The court concluded that none of these options was suitable because Zienty refuses to cooperate with others to treat her illness and because long-term supervision is necessary to stabilize her symptoms.
The district court properly reviewed all treatment options and did not err by committing Zienty to the Hennepin County Medical Center and the Anoka Metro Regional Treatment Center. Any less-restrictive alternative would not ensure that Zienty's condition would stabilize or that she would continue taking her prescribed medication.