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In re Necessity for Hospitalization of Linda M.

Supreme Court of Alaska

March 22, 2019

In the Matter of the Necessity for the Hospitalization of LINDA M.

          Appeal from the Superior Court No. 3 AN- 17-021 38 PR of the State of Alaska, Third Judicial District, Anchorage, Jennifer Henderson, Judge.

          Laurence Blakely, Assistant Public Defender, and Quinlan Sterner, Public Defender, Anchorage, for Linda M. David T. Jones, Assistant Attorney General, Anchorage, and Jahna Lindemuth, Attorney General, Juneau, for State of Alaska.

          Before: Bolger, Chief Justice, Winfree, Stowers, Maassen, and Carney, Justices.

          OPINION

          MAASSEN, JUSTICE.

         I. INTRODUCTION

         The district court found that a woman charged with several misdemeanors was incompetent to stand trial and committed her to a state hospital. The hospital later brought petitions in the superior court for civil commitment and involuntary medication. The woman moved to dismiss or stay the proceedings, contending that the superior court was an improper forum because of the criminal case pending in the district court. The superior court denied the motion, asserted its jurisdiction to hear the case, and granted the hospital's petition for authority to administer medication.

         The woman appealed. We hold that the superior court properly asserted its jurisdiction over the civil commitment and involuntary medication petitions and that the superior court did not err in finding that involuntary medication was in the woman's best interests. We therefore affirm the superior court's orders.

         II. FACTS AND PROCEEDINGS

         Linda M.[1] was charged with several misdemeanor criminal offenses. The district court found her incompetent to stand trial and, pursuant to AS 12.47.110, ordered that she be committed to the Alaska Psychiatric Institute (API) for restoration of competency. The commitment order noted that "Defendant may not be involuntarily medicated pursuant to this order." The commitment was to last 90 days unless Linda was rendered competent earlier or the criminal charges were otherwise "disposed of according to law."

         Linda entered API in late July 2017. While there she hit and spat on staff members and hit another patient, leading API to believe she was likely to cause harm to herself or others. On August 9 API filed a petition to have Linda civilly committed for 30 days under AS 47.30.730, even though she could not leave API in any event because of the competency commitment order in her criminal case. API also petitioned for authority under AS 47.30.839 to medicate Linda, without her consent, with chlorpromazine (Thorazine) and diphenhydramine. These petitions were filed in the superior court, the venue specified by the civil commitment statutes.[2]

         Linda obj ected and moved to dismiss or stay the superior court proceedings, arguing that any decisions about medication should be made by the district court overseeing the competency commitment in her criminal case. A hearing was set for August 23.

         On August 17 API filed an emergency motion for an order authorizing the administration ofcrisis medication, asserting a high likelihood ofsituations requiring the "immediate use of medication in order to preserve the life of, or prevent significant physical harm to, [Linda] or another person"[3] before the scheduled hearing. Linda again raised her objection to the superior court's jurisdiction and contested the medication petition on its merits, arguing that API had made an insufficient showing that involuntary medication was necessary.

         The superior court held an emergency hearing on August 18 and took testimony from Linda's treating psychiatrist, Dr. Michael Alexander. Dr. Alexander testified that Linda had already been put on crisis medication three times; each time she had spit on a nurse and once she had punched another patient in the face. Dr. Alexander opined that the only alternative to administering medication was to leave Linda in a locked room and hope she would calm down on her own. The superior court, after some consideration, denied Linda's procedural arguments at least on an emergency basis and granted the emergency motion for crisis medication.

         At the August 23 hearing, the superior court returned to the procedural motion, denied it, then turned to the merits of the involuntary medication petition. The court heard from the court visitor, [4] who testified that Linda was incapable of giving informed consent because she did not accept her diagnosis of schizophrenia and was incapable ofrationally participating in treatment decisions. The court visitor did believe, however, that Linda's objections to the medication based on her pregnancy were reasonable.

         Dr. Alexander again testified, describing Linda's diagnosis ofschizophrenia and his plan for involuntary medication. He testified that Linda had "ongoing" and "persistent" paranoia and delusions that would not go away without medication. He testified that Thorazine was the best medication for her because she had successfully taken it in the past without side effects and that other, similar medications had "a greater risk ofcausing ongoing problems for both her and for the child." Linda then testified on her own behalf, describing what she believed to be the side effects of the medication and asserting mistreatment by API staff and her parents, involving, among other things, putting excess gluten in her food and implanting metal in her body so they could track her by computer.

         The superior court found by clear and convincing evidence that Linda had a mental illness - schizophrenia - and that because of it she was substantially likely to harm herself or others if not treated. It found that she was incapable of giving or withholding informed consent to treatment, that it was in her best interests that she be treated with Thorazine as Dr. Alexander proposed, and that there were no available less intrusive means to adequately treat her. The court therefore authorized involuntary medication of Linda in both crisis and non-crisis situations.

         Linda appeals both the superior court's ruling that it had jurisdiction over the medication petition and its decision to grant that petition.

         III. STANDARD OF REVIEW

         We decide de novo questions of statutory[5] and constitutional[6] interpretation and jurisdiction.[7]" 'Factual findings in involuntary commitment or medication proceedings are reviewed for clear error,' and we reverse those findings only if we have a 'definite and firm conviction that a mistake has been made.' "[8] However, "[w]hether those findings meet the . . . statutory requirements is a question of law we review de novo.[9]

         IV. DISCUSSION

         A. The Superior Court Did Not Err By Hearing The Civil Commitment And Involuntary Medication Petitions.

Linda contends that the superior court erred when it denied her request to dismiss or stay civil commitment and involuntary medication proceedings; she argues that the only proper forum for such proceedings was the district court in which the criminal case was pending. She contends that under Sell v. United States[10] the court in the criminal case must consider the question of involuntary medication "even [if it is sought] for reasons other than [competency] restoration"; that Alaska's competency statute does not contemplate the commencement ofcivil commitment proceedings during the criminal commitment; and that allowing simultaneous criminal and civil proceedings will result in various practical problems. We disagree.

         In Sell the United States Supreme Court required a court in a criminal case to make four essential findings before it could order an incompetent defendant to undergo involuntary medication for the purpose of restoring competency: (1) "that important governmental interests are at stake"; (2) "that involuntary medication will significantly further those concomitant state interests"; (3) "that involuntary medication is necessary to further those interests"; and (4) "that administration of the drugs is medically appropriate, i.e., in the patient's best medical interest in light ofhis [or her] medical condition."[11] The Court emphasized that this four-part test applied only when the trial court was considering whether involuntary medication was necessary to significantly "further a particular governmental interest, namely, the interest in rendering the defendant competent to stand trial."[12] "[I]f forced medication is warranted for a different purpose, such as the purposes set out in [Washington v.] Harper related to the individual's dangerousness, or purposes related to the individual's own interests where refusal to take drugs puts his health gravely at risk," then whether medication is warranted to restore competency need not even be considered.[13] The Court noted that "courts typically address involuntary medical treatment as a civil matter, and justify it on these alternative, Harper-typQ grounds," citing as one example Alaska's statutes for the appointment of guardians with the authority to make medical decisions for incapacitated persons.[14] "Ifa court authorizes medication on these alternative grounds, the need to consider authorization on trial competence grounds will likely disappear."[15] A court that is asked to approve involuntary medication for competency purposes should therefore "ordinarily determine whether the Government seeks, or has first sought, permission for forced administration ofdrugs on these otherHarper-typQ grounds; and, if not, why not."[16]

         Sell thus explicitly contemplates that, despite pending criminal charges, a state may seek authority to involuntarily medicate a committed defendant for reasons other than the defendant's competency to stand trial. The standards for granting such authority in Alaska are well defined:

[T]he State must prove - by clear and convincing evidence - "that the committed patient is currently unable to give or withhold informed consent regarding an appropriate course of treatment" and that the patient never refused such treatment while previously competent. If the court determines that the patient is not competent to make the decision, the court must next determine whether the medication is in the patient's best interests.[17]

         Factors the court is required to consider in determining the patient's best interests in this context ...


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