In the Matter of the Necessity for the 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was outdated and insufficient to support concluding that he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 ...