In re Necessity for Hospitalization of G.L.

          Appeal from the Superior Court of the State of Alaska, Third Judicial District, Anchorage, Superior Court No. 3AN-17-00779 PR Erin B. Marston, Judge.

          Megan R. Webb, Assistant Public Defender, and Beth Goldstein, Acting Public Defender, Anchorage, for G.L.

          Kimberly D. Rodgers, Assistant Attorney General, Anchorage, and Kevin G. Clarkson, Attorney General, Juneau, for State of Alaska.

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

          OPINION

          WINFREE, Justice.

         I. INTRODUCTION

         A patient appeals a 180-day involuntary commitment order, arguing that the evidence presented at the commitment hearing was outdated and insufficient to support concluding that he continued posing a risk of harm to others. Because the superior court correctly applied the involuntary commitment statute in this case, appropriately considering the patient's recent history of conduct and demonstrated unwillingness to comply with treatment, we affirm the commitment order.

         II. FACTS AND PROCEEDINGS

         A. Facts Leading To Involuntary Commitment

         In 2015 then-21 -year-old G.L. was arrested after allegedly firing a loaded shotgun at buildings and people in his village.^[1] G.L. faced criminal charges related to the shooting, but the superior court ultimately ruled him mentally incompetent for criminal proceedings and in 2016 committed him to Alaska Psychiatric Institute (API) for competence restoration.

         G.L. was diagnosed with schizophrenia. He refused to consistently take medications and "was becoming increasingly psychotic and paranoid and dangerous" while at API for competence restoration. His API psychiatrist later testified that G.L. experienced "somatic delusions, " meaning he "believe[d] that things [were] happening to his body that [weren't] real." He believed, for example, that rats had infiltrated his body, that his "bones were melting, " and that "ants [were] crawling on his eyes." The psychiatrist stated that G.L. also suffered from "persecutory delusions, " meaning "he [felt] that people [were] saying things about him that [were] untrue, " including that he had been diagnosed with schizophrenia. G.L. reportedly "pace[d] the hallways muttering under his breath" and "bec[a]me increasingly violent"; he kicked inanimate objects, charged at staff, and expressed suicidal and homicidal ideation. The psychiatrist testified that G.L. "had such profound psychiatric symptoms that they were interfering with his ability to participate in any competency restoration activities."

         API petitioned the superior court for permission to involuntarily medicate G.L., but the court instead transferred G.L.'s custody to the Department of Corrections (DOC). While in DOC custody he apparently "head-butted a corrections officer." G.L.'s pending criminal charges were dismissed thereafter, and he was transferred back to API in March 2017.

         B. 30-Day Commitment And Court-Ordered Medication Petitions

         API filed a 30-day commitment petition asserting that G.L. had a mental illness and was likely to cause harm to himself or others. API stated that he had a history of violence, including the alleged 2015 shooting, and discussed his threats of suicide and his "assaultive behaviors while at API and DOC in the past 8 months." API also stated that G.L. "does not believe he has a mental illness and . . . does not intend to take medications once he leaves the hospital." G.L. stipulated to the 30-day commitment in mid-April.

         Three days before the end of his 3 0-day commitment period, API filed a 90-day commitment petition. The 90-day commitment hearing was continued until June, and in the interim API filed a petition for court-ordered administration of psychotropic medications. G.L. had been taking medications since being in DOC custody, but his API psychiatrist later testified that G.L. "had become increasingly vocal about his . .. wish not to take medications, " and in early May he altogether refused to take medications. The medications were discontinued because of adverse effects associated with intermittent use. The psychiatrist later stated that G.L.'s somatic and persecutory delusions returned while he was off medications and that he had become "increasingly symptomatic, " including trying to assault an API staff member and exhibiting angry outbursts.

         A magistrate judge considered the medication petition in mid-May, hearing testimony from the API psychiatrist, two court-appointed visitors, ^[2] and G.L. The court-appointed visitors offered conflicting testimony whether G.L. had capacity to provide informed consent. One court-appointed visitor, who had met with G.L. briefly one week before the hearing, testified that she believed he had capacity, because he "appear[ed] at that time to demonstrate rational thought process" and "expressed that he had a mental illness." But the other court-appointed visitor, who had met with G.L. the morning of the hearing, believed he lacked capacity, because he failed to "recognize that he has a mental illness" and could not participate in his treatment. This second court-appointed visitor also testified that G.L. had attacked an API staff member just a few days before the hearing and had been given crisis medications as a result.

         The API psychiatrist testified about G.L.' s history and unwillingness to take medications. She stated that during a previous API admission, he had refused to voluntarily take medications. And although he had willingly taken medications when he arrived at API most recently, the psychiatrist stated that G.L. "did not feel he really needed them" and continually stated that "he did not plan to take them when he left the hospital." She testified that his stance remained the same on the morning of the hearing. She stated that without medication, "given [her] experience with him in the past where he was either engaging in self-destructive behavior or he was assaultive, ... his behavior is going to continue to deteriorate and ... we will see those sorts of behaviors again necessitating a further crisis period."

         G.L. testified that he did not wish to take medications because he had not been medicated before the alleged 2015 shooting events and "didn't need them." He discussed what he believed were the medications' adverse side effects, including paranoia. He stated that there were "no benefits" to taking the medications and that he did not believe he had schizophrenia.

         At the end of the medication hearing the magistrate judge made oral findings, based on the psychiatrist's and G.L.'s testimony, that G.L. suffered from schizophrenia and lacked capacity to give informed consent. The magistrate recommended granting the medication petition, despite the risks associated with taking psychotropic medications, because G.L. is violent when unmedicated, and the benefits, including protecting others and alleviating some of G.L.'s suffering, outweighed the risks. The superior court affirmed the recommendation in a written order later that month.

         C. 90-Day ...