Opinion
No. 1 CA-MH 13-0047
01-16-2014
IN RE THE MATTER OF JAMES L.
Coconino County Attorney's Office, Flagstaff By Rose Winkeler Counsel for Appellee Coconino County Legal Defender's Office, Flagstaff By Joseph Adam Carver Counsel for Appellant
NOTICE: NOT FOR PUBLICATION.
UNDER ARIZ. R. SUP. CT. 111(c), THIS DECISION DOES NOT CREATE LEGAL PRECEDENT
AND MAY NOT BE CITED EXCEPT AS AUTHORIZED.
Appeal from the Superior Court in Coconino County
No. S0300MH201100119
The Honorable Jacqueline Hatch, Judge
AFFIRMED
COUNSEL
Coconino County Attorney's Office, Flagstaff
By Rose Winkeler
Counsel for Appellee
Coconino County Legal Defender's Office, Flagstaff
By Joseph Adam Carver
Counsel for Appellant
MEMORANDUM DECISION
Chief Judge Diane M. Johnsen delivered the decision of the Court, in which Presiding Judge Kent E. Cattani and Judge Margaret H. Downie joined. JOHNSEN, Chief Judge:
¶1 Appellant appeals from an order continuing his involuntary mental health treatment. For the following reasons, we affirm.
FACTS AND PROCEDURAL HISTORY
¶2 Appellant suffers from schizoaffective disorder and polysubstance dependence. According to the record, Appellant has been a client of The Guidance Center ("Center") for several years. In 2011, the Center petitioned for court-ordered treatment because Appellant's outbursts had become violent and he refused medical treatment. The superior court granted the petition.
We view the facts in the light most favorable to sustaining the superior court's judgment. In re MH 2008-001188, 221 Ariz. 177, 179, ¶ 14, 211 P.3d 1161, 1163 (App. 2009).
¶3 In June 2012, the Center filed another petition for continued treatment, alleging Appellant remained persistently and acutely disabled. At the time, Appellant's case manager at the Center wrote in an annual review that Appellant "talk[ed] about how some people from Kingman followed him to Flagstaff" because of "gambling and or plots to hurt him" and that Appellant "believed his food was being tampered with." In addition, a psychiatrist who conducted Appellant's annual evaluation wrote that Appellant was "paranoid of being around children, afraid of convicts, and certainly paranoid about the police." The psychiatrist stated Appellant had a long history of paranoia, threatening statements to others and potentially violent outbursts, noting a time when he injured a staff member and punched holes in the walls. Without court-ordered treatment, the psychiatrist opined, Appellant "would continue to decompensate, and this could put him at risk." Appellant did not oppose the petition and the court approved it.
¶4 In July 2013, the Center petitioned to have Appellant's court-ordered treatment continued. Appellant's case manager filed an evaluation stating that although Appellant had improved during the prior year, he "continue[s] to suffer from a number of symptoms of his mental disorder" and "remains disorganized, delusional and paranoid." According to the case manager, Appellant "believes that his participation in the Behavioral Health Treatment is part of a plot against him that is orchestrated by the Havasupai Tribal Court" and that the checks he received from his fiduciary are "monitored by members of an organized crime organization."
¶5 According to the psychiatrist's annual evaluation, Appellant left the treatment facility without permission five or six times over the year. During his absences, Appellant "stopped taking any prescribed medication . . .[,] quickly decompensating into a psychotic state." The psychiatrist opined that if court-ordered treatment were not extended, "[Appellant] would likely re-enter the community, become immediately medication non-compliant and non-adherent with treatment . . . This would cause [Appellant] to actively present a serious risk to himself and others in the community due to his mental illness."
¶6 At the hearing on the petition, Appellant's case manager testified Appellant frequently complained that he wanted to discontinue his medication. The case manager testified that approximately every other month, Appellant would leave the facility without permission for one to three days at a time, during which he would stop taking his medication. The psychiatrist testified Appellant was "very resistive to treatment" at times and that when Appellant stopped taking his medication, he would "quickly decompensate" into an active schizophrenic state. The psychiatrist also testified that if court-ordered treatment were not continued, Appellant would "almost certainly [end up] back in a psychiatric hospital again." Appellant did not testify, nor did he call any witnesses. The court ordered that treatment be continued for 365 days.
¶7 Appellant timely appealed. We have jurisdiction pursuant to Arizona Revised Statutes ("A.R.S.") sections 36-546.01 (2014) and 12-2101(A)(1) (2014).
Absent material revision after the relevant date, we cite a statute's current version.
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DISCUSSION
¶8 Appellant does not dispute the superior court's findings that he is persistently or acutely disabled and in need of treatment as a result of a mental disorder, but argues insufficient evidence supported the court's finding that he is unwilling or unable to accept treatment voluntarily. Specifically, Appellant argues that leaving the group home without permission on a handful of occasions during the prior year of court-ordered treatment does not establish by clear and convincing evidence that at the time of the hearing, he was unwilling or unable to accept treatment voluntarily.
¶9 "When addressing an issue of statutory interpretation, our review is de novo." In re MH 2008-000097, 221 Ariz. 73, 75, ¶ 8, 210 P.3d 1244, 1246 (App. 2009). In construing a statute, we look first to the statute's language and strive to interpret it so as to give the statute a fair and sensible meaning. In re Wilputte S., 209 Ariz. 318, 320, ¶ 10, 100 P.3d 929, 931 (App. 2004).
¶10 Section 36-543(H) (2014) provides:
[T]he party seeking the renewal of the court order must prove all of the following by clear and convincing evidence:(Emphasis added.)
1. The patient continues to have a mental disorder and, as a result of that disorder, is either persistently or acutely disabled or is gravely disabled.
2. The patient is in need of continued court-ordered treatment.
3. The patient is either unwilling or unable to accept treatment voluntarily.
¶11 Appellant argues that it is not enough to show the patient was unwilling or unable to accept treatment at some point in the past or might not be willing or able to accept treatment in the future; instead, Appellant contends, the relevant inquiry under § 36-543(H) is the patient's mental state at the time of the hearing.
¶12 In In re MH 94-00592, 182 Ariz. 440, 443-45, 897 P.2d 742, 745-47 (App. 1995), we rejected the contention that evidence of "current behavior" was required to support a finding by the court that a person is persistently or acutely disabled within the meaning of A.R.S. § 36-501(32) (2014). We explained:
Although current behavior is certainly not irrelevant to the patient's condition, it is neither the sole nor the essential indication of the statutory criteria, i.e. incapacity to make rational and informed treatment decisions and substantial probability of harm. In evaluating a patient's mentalId. at 444-45, 897 P.2d at 746-47.
condition, physicians not only examine the patient's current behavior and statements, but also consider his treatment history and past behavior. Consideration of current behavior alone would be manifestly misleading. A patient may not display any current aberrant behavior because of intensive therapy, supervision, and medication and yet pose a danger of harm to himself because of inability to make treatment decisions if released from the therapeutically structured environment. Moreover, some patients, such as the one involved here, are behaviorally volatile. The mere fact that no aberrant behavior is occurring at the time of the hearing does not necessarily mean that no disability exists. Of course, many patients who respond favorably to treatment need not be subjected to continued court-ordered treatment. But this is a matter for medical opinion, and ultimately for the judgment of the court.
¶13 The same principle applies to the superior court's consideration of whether a patient is unwilling or unable to accept treatment voluntarily. Past behaviors and statements may demonstrate patterns that are useful and relevant to an expert witness in forming an opinion on the matter and to the court in assessing the patient's current state. Thus, a court appropriately may consider evidence of a patient's past acts when determining whether a patient is unwilling or unable to accept medical treatment for the purpose of § 36-543(H). See id.
¶14 Appellant further argues that the order for continued treatment must be vacated because there was insufficient evidence to prove he is unwilling or unable to accept treatment. "We will affirm a superior court's order for involuntary treatment if it is supported by substantial evidence." MH 2008-001188, 221 Ariz. at 179, ¶ 14, 211 P.3d at 1163. We will not set aside the court's findings unless they are clearly erroneous. MH 94-00592, 182 Ariz. at 443, 897 P.2d at 745. The evidence supporting an order for involuntary treatment must be clear and convincing. A.R.S. § 36-540(A) (2014); see also In re MH 2007-001236, 220 Ariz. 160, 165, ¶ 15, 204 P.3d 418, 423 (App. 2008).
¶15 The record contains sufficient evidence to support the court's finding that Appellant was unwilling or unable to accept treatment. The Center's psychiatrist testified Appellant has a pattern of leaving his group home without permission and stopping his medication during those absences. The psychiatrist also testified Appellant "lacks insight into his need for the medication" and resists treatment. Appellant's case manager testified Appellant routinely complained that he wanted to discontinue his medication.
¶16 Appellant argues that although the evidence may show he has not perfectly complied with his treatment plan, it does not demonstrate an "ongoing inability or unwillingness to accept treatment." He contends his "absences from the group home were infrequent and brief" and asserts he "never refused to take medication while in the group home." But Appellant disregards the evidence that he lacks insight into his need for medication and that, in the absence of such insight, the structure the group home provides is required to ensure he remains on his medications. Moreover, although Appellant was away without permission for only a few days over the prior year, his absences demonstrated a pattern of non-compliance. Based on the evidence in the record, we conclude there was sufficient evidence to support the court's finding that Appellant remains unwilling or unable to accept treatment.
CONCLUSION
¶17 For the reasons set forth above, we affirm the superior court's order.