Opinion
No. C9-97-1429.
Filed December 2, 1997.
Appeal from the District Court, Hennepin County, File No. P09560162.
James S. Dahlquist, (for appellant Bauer).
Michael O. Freeman, Hennepin County Attorney, Peter J. Stiehm, Assistant County Attorney, (for respondent).
This opinion will be unpublished and may not be cited except as provided by Minn. Stat. § 480A.08, subd. 3 (1996).
UNPUBLISHED OPINION
Appellant Frances Bauer argues that the district court had insufficient evidence to commit her as mentally ill and order involuntary administration of neuroleptic medication. We affirm.
FACTS
Frances Bauer, age 79, suffers from alcohol-induced dementia. The district court had committed Bauer as chemically dependent previously and this court affirmed. In re Bauer , No. C9-96-576 (Minn.App. June 25, 1996). Bauer then transferred to a facility in Illinois and the chemical dependency commitment was discharged.
Bauer returned to Minnesota and began residing at Whittier Health Center. She refused food and high blood pressure medication and would not cooperate with Whittier's attempts to take her vital signs or perform assessments. Within a short period of time, the Crisis Intervention Center of the Hennepin County Medical Center (HCMC) assessed her and admitted her to HCMC. While there, she cooperated more often but still refused her high blood pressure medication. She threatened to commit suicide and harm her sons.
Petitions for appellant's commitment as mentally ill and for a Jarvis order were filed on June 5, 1997. Psychologist Terry Nelson, the court-appointed examiner, and HCMC social worker Philip Krasowski recommended commitment to HCMC and the Anoka Metro Regional Treatment Center (AMRTC) with provisional discharge to a community facility when appropriate. Krasowski also pursued a conservatorship for Bauer. Psychiatrist William Orr testified that Bauer needed treatment with neuroleptic medication but was not competent to make this decision herself.
By agreement of the parties, the district court dismissed the portion of the petition seeking Bauer's commitment as chemically dependent.
Bauer testified that she wanted to live in an apartment and obtain a full-time job. She agreed she would accept housekeeping assistance and home medical care and take her prescribed medication.
The district court committed Bauer as mentally ill to HCMC and AMRTC, and authorized involuntary administration of neuroleptic medication. Bauer appeals.
DECISION
District court findings will not be set aside unless clearly erroneous. Minn.R.Civ.P. 52.01; In re McGaughey , 536 N.W.2d 621, 623 (Minn. 1995). On questions of law, this court need not defer to the trial court. In re Stilinovich , 479 N.W.2d 731, 734 (Minn.App. 1992).
I.
Bauer first contends that the district court did not have clear and convincing evidence that she posed a substantial likelihood of physical harm.
A mentally ill person is defined in relevant part as one who has the requisite organic disorder of the brain or substantial psychiatric disorder and poses a substantial likelihood of physical harm to self or others as demonstrated by
(i) a failure to obtain necessary food, clothing, shelter, or medical care as a result of the impairment, or
(ii) a recent attempt or threat to physically harm self or others.
Minn. Stat. § 253B.02, subd. 13 (1996). A district court must find a person mentally ill by clear and convincing evidence. Minn. Stat. § 253B.09, subd. 1 (1996).
Bauer first argues that her actions did not show there was a substantial likelihood that she posed a physical danger to herself or others as defined by statute. The district court, however, made numerous findings indicating a number of areas in which she posed a likelihood of harm to herself or others. This included her failure to obtain necessary food and medical care, inability to live independently safely, suicidal ideation, threats to her sons, and confusion and memory impairment. See In re Martin , 458 N.W.2d 700, 705 (Minn.App. 1990) (dangerousness based on threats to assault others and behavior that could bring harm to self); In re Davis , 371 N.W.2d 91, 93 (Minn.App. 1985) (dangerousness based on inability to provide food or shelter or properly care for medical condition). The findings are supported by clear and convincing evidence.
Bauer next contends she does not need skilled nursing care but would do well in an assisted living facility. On finding a person is mentally ill, the district court must determine the least restrictive alternative. Minn. Stat. § 253B.09, subd. 1; In re Moll , 347 N.W.2d 67, 70 (Minn.App. 1984).
The district court, based on the expert testimony, found the least restrictive placement was commitment to HCMC and AMRTC. The court considered and rejected board and care facilities or nursing homes because Bauer would not cooperate. The court noted that once successfully treated, her treatment team plans to place her in a community facility that can provide structure and support. The district court decision to commit appellant to HCMC and AMRTC is supported by the evidence and is not clearly erroneous. See In re Melas , 371 N.W.2d 653, 655 (Minn.App. 1985) (voluntary alternatives rejected due to patient's lack of insight into illness and refusal to cooperate with treatment).
II.
Bauer also seeks dismissal of the Jarvis order. Respondent construes her argument to mean that if the commitment is not affirmed, the Jarvis order should be dismissed. Respondent argues that because the commitment should be affirmed, the Jarvis order should be affirmed as well. We agree.
The merits, nonetheless, will be discussed briefly. The party seeking authority to impose treatment with neuroleptics must prove by clear and convincing evidence that the treatment is necessary and reasonable. In re Peterson , 446 N.W.2d 669, 672 (Minn.App. 1989), review denied (Minn. Dec. 1, 1989).
The district court determined the medication was necessary and reasonable based on testimony as to the relevant factors. See Jarvis v. Levine , 418 N.W.2d 139, 144 (Minn. 1988) (listing factors). Psychiatrist Orr testified that the medication is necessary and reasonable and would relieve some of Bauer's symptoms, discussed the risk of adverse side effects, stated the medication was not experimental, and explained this type of medication is commonly used to treat the complication of dementia.
The court must find the patient is incompetent to make the decision about neuroleptic medication. Id. at 148 n. 7. A person is competent to make the decision only if he or she is aware of having the mental disorder, has sufficient knowledge about the medication and mental disorder, and does not base the refusal on delusional beliefs. Peterson , 446 N.W.2d at 673. In this case, Dr. Orr testified that Bauer was not aware of and had no insight into her mental disorder, did not understand the benefits of medication, and thus could not properly weigh the benefits against the risks.
The district court had convincing evidence on which to base its decision that treatment with neuroleptics was necessary and reasonable.