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E.P. v. Alaska Psychiatric Institute

Supreme Court of Alaska

April 24, 2009

E.P., Appellant,
v.
ALASKA PSYCHIATRIC INSTITUTE, Appellee.

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[Copyrighted Material Omitted]

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Douglas Moody, Assistant Public Defender, and Quinlan Steiner, Public Defender, Anchorage, for Appellant.

David T. Jones, Assistant Attorney General, Anchorage, and Talis J. Colberg, Attorney General, Juneau, for Appellee.

Before : FABE, Chief Justice, MATTHEWS, EASTAUGH, CARPENETI, and WINFREE, Justices.

OPINION

CARPENETI, Justice.

I. INTRODUCTION

A person addicted to various substances, whose substance abuse has caused organic brain damage, appeals his three consecutive involuntary commitments to Alaska Psychiatric Institute. We uphold his commitments, because: (1) Alaska statutes permit involuntary commitment of a person found likely to harm himself even if there is no reasonable belief treatment will improve his condition; (2) an addict whose substance abuse has caused organic damage to the frontal lobe of his brain rendering him unable to understand the dangers of his substance abuse, and impeding his ability to communicate, is " mentally ill" under Alaska's involuntary commitment statutes; (3) where the addict intends to return to the substance abuse that causes his organic brain damage if released from involuntary commitment, the addict is " likely to cause harm to himself" and " demonstrates a current intent to carry out plans of serious harm" to himself under Alaska's involuntary commitment statutes; and (4) the superior court's decision to treat the addict's objections to the masters' reports as motions for reconsideration of superior court orders was harmless error.

II. FACTS AND PROCEEDINGS

A. Introduction

A brief description of the statutory scheme governing involuntary commitment in Alaska may assist the reader in understanding the involved procedural history of this case. Alaska Statute 47.30.655 discusses " principles of modern mental health care" guiding the statutory scheme for involuntary commitment, including the principle " that persons who are mentally ill but not dangerous to others be committed only if there is a reasonable expectation of improving their mental condition." Alaska Statute 47.30.730 allows the state to petition to involuntarily commit for thirty days a person who " is mentally ill and as a result is likely to cause harm to self or others or is gravely disabled." The petition must " allege with respect to a gravely disabled respondent that there is reason to believe that the respondent's mental condition could be improved by the course of treatment sought." Under AS 47.30.740 and AS 47.30.770, the state may petition for an additional 90-day commitment after a 30-day commitment, and an unlimited number of 180-day commitments after a 90-day commitment. The same procedures apply to 90-day and 180-day commitments as to 30-day commitments, except for a few additional requirements.

B. Facts

E.P. has a history of alcohol abuse and inhaling gasoline fumes and other substances to get high (" huffing" ). These actions have

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led to several commitments, both voluntary and involuntary to the Alaska Psychiatric Institute (API). Huffing has damaged the frontal lobe of E.P.'s brain, resulting in dementia, personality disorder, and not otherwise specified psychosis. He has poor judgment and insight, and as a result cannot grasp the severe health consequences of huffing. E.P. is addicted to huffing.

E.P. stayed at API voluntarily from March until May 2007. In May 2007 API discharged E.P. to an assisted living facility in Big Lake. Within twenty-four hours, he got drunk, huffed gas, and became " assaultive" or " physical." The record is vague about this event. The police were involved in an unspecified way, but apparently E.P. was not charged with any crime. E.P. returned to API the next day. Throughout the current proceedings, E.P. has maintained that, if discharged from API, he will likely go back to huffing. The parties do not dispute that API does not have the capability to treat or improve his substance abuse problem: Commitment there can only prevent him from huffing by restricting his access to gasoline and other inhalants.

C. Proceedings

1. The 30-day commitment

In August 2007 E.P. decided he wanted to leave API. API petitioned to commit him involuntarily for thirty days. Standing Master Andrew Brown heard the petition on August 3, 2007. Dr. Kahnaz Khari of API testified for API, and E.P. testified on his own behalf.

Dr. Khari testified that huffing gas has damaged E.P.'s frontal lobe, and that huffing has caused his mental health problems. She testified that as a result of this damage, he lacks insight and judgment and cannot understand how huffing gas harms him. She testified that she did not expect E.P.'s condition to improve at API because API is not a substance abuse treatment facility. She testified that E.P. should stay at API because API restricts his access to alcohol and inhalants. She also testified that E.P. had a history of drinking, huffing gas, and " becom[ing] assaultive" when not at API. She testified that E.P. has been a model patient during his stay at API.

E.P. testified briefly that he wanted to go back to his family. When asked if he would go back to drinking and huffing gas if discharged, he replied: " If I relapse I will.... Yeah, if I get bored I will do like I did ... the last time." His testimony was confused and garbled.

The standing master found E.P. mentally ill and as a result gravely disabled. He declined to find E.P. a danger to himself or others. E.P.'s lawyer told the master that she planned to object to his report. The standing master then issued a written report. He found that E.P.'s substance abuse had caused organic brain damage and resulting dementia. He wrote: " [E.P.] cannot perceive and understand reality. His judgment is extremely poor and he is unable to make rational decisions, as shown by his continued desire to inhale toxic substances. If he is in any type of an unsecured setting he will resume inhaling toxic substances." He acknowledged that the only benefit API could provide E.P. was a secured setting. The superior court judge signed the recommendation the next day.

The day after that, E.P. filed objections to the master's report. He argued that the statutes only allow involuntary commitment of a gravely disabled person if there is reason to believe treatment will improve that person's condition, and that treatment will not improve his condition.

API responded, and agreed with E.P.'s factual assertions and legal argument. But API argued that, although involuntarily committing E.P. for grave disability was not appropriate, the record supported involuntarily committing E.P. on the grounds that he was likely to harm himself or others. API wrote:

The evidence is clear that [E.P.] intends to return to his home village and resume his drug use. If left untreated and allowed to resume his old habits, which is his current plan, he will die. His sister, with whom he intends to reside[,] has small children who are at risk of being influenced by his behaviors, and harmed as a result.

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The superior court received the objections and response after signing the master's report, and therefore treated the objections as a motion for reconsideration of a superior court order. The superior court then denied the motion " [f]or the reasons stated in [API]'s Response to objections." The superior court did not elaborate. E.P. appealed to this court.

2. The 90-day commitment

When E.P.'s 30-day commitment ran out, API petitioned for a 90-day involuntary commitment on the on the alternative grounds that (1) E.P. was gravely disabled or (2) he was likely to harm himself or others. Standing Master Andrew Brown held a hearing on the petition on September 5, 2007. Dr. Khari was the only witness. The fact findings from the 30-day commitment were admitted as evidence. Dr. Khari testified that E.P.'s condition had not improved since the 30-day commitment hearing. But she testified that he was a model patient, and had exhibited no dangerous behavior. She testified that he still planned to continue huffing gas if discharged, which would further damage his brain. Dr. Khari also testified that E.P.'s verbal communication is limited. " [A]fter ... a couple of sentences, he usually turns around and gives you a smile, that's something actually not appropriate in the context of what we are talking [about]." The master committed E.P. on grounds of grave disability.

Again E.P.'s lawyer told the master she intended to object to his report. But again the master sent his report immediately to the superior court, which signed it Before the ten-day period for objections had run. E.P. made similar objections to those he made in the thirty-day proceeding. This time he added the argument that AS 47.30.655(6) requires a reasonable belief that treatment will improve a person's condition if the person is gravely disabled or if the person is likely to harm himself. He argued that he can ...


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