Opinion
No. A04-2312.
Filed May 3, 2005.
Appeal from the District Court, Wright County, File No. P0-04-1936.
Robert W. Adams, (for appellant).
Terry David Frazier, Wright County Attorney Office, (for respondent).
Considered and decided by Toussaint, Chief Judge; Schumacher, Judge; and Halbrooks, Judge.
This opinion will be unpublished and may not be cited except as provided by Minn. Stat. § 480A.08, subd. 3 (2004).
UNPUBLISHED OPINION
Appellant challenges the district court's order authorizing the involuntary administration of neuroleptic medication, arguing that the court's finding that she lacked the capacity to refuse the medication was clearly erroneous. Because the record supports the district court's decision, we affirm.
DECISION
At the outset, respondent Wright County asserts that this appeal is moot because appellant Lorri Renee Larsin is now taking her neuroleptic medication voluntarily. But the only reference to appellant's compliance is found in the district court's January 5, 2005 order, where the court stated, "although [appellant] has been resistant to treatment requests, she has made modest improvement in the last couple of weeks and has requested to participate in chemical dependency treatment and is complying with medication requests." Because the record does not contain any other information concerning the "voluntary" nature of this decision or appellant's current status, we reject respondent's assertion and address the merits.
Minnesota law presumes a patient is capable of deciding whether to take neuroleptic medication, and court approval is required to administer neuroleptic medication to a person who refuses it. Minn. Stat. § 253B.092, subds. 5(a), 8(a) (2004). When a patient has refused to take neuroleptic medication, the district court must first determine whether the patient has capacity to make that decision. Id., subd. 8(b) (2004). In determining a person's capacity, the court shall consider:
(1) whether the person demonstrates an awareness of the nature of the person's situation, including the reasons for hospitalization, and the possible consequences of refusing treatment with neuroleptic medications;
(2) whether the person demonstrates an understanding of treatment with neuroleptic medications and the risks, benefits, and alternatives; and
(3) whether the person communicates verbally or nonverbally a clear choice regarding treatment with neuroleptic medications that is a reasoned one not based on delusion, even though it may not be in the person's best interests.
Id. Disagreeing with one's physician regarding the use of neuroleptic medications is not evidence of an unreasonable decision. Id.
The burden rests with the person seeking to administer the medication to prove, by clear and convincing evidence, that the patient lacks capacity to give or withhold consent. In re Thulin, 660 N.W.2d 140, 145 (Minn.App. 2003). If this burden is met, the district court must then decide whether the medication should be administered. Minn. Stat. § 253B.092, subd. 7(a), (c) (2004). In reaching this decision, the court should consider what a reasonable person would do, considering: "(1) the person's family, community, moral, religious, and social values; (2) the medical risks, benefits, and alternatives to the proposed treatment; (3) past efficacy and any extenuating circumstances of past use of neuroleptic medications; and (4) any other relevant factors." Id., subd. 7(c). This court will not reverse the district court's findings unless they are clearly erroneous. In re Schauer, 450 N.W.2d 194, 196 (Minn.App. 1990).
Here, the district court found that appellant "does not have the ability to understand and use information about [her] mental illness, its symptoms, and treatment, or to determine whether neuroleptic medication is reasonable and necessary." Consequently, the court found that appellant was not competent to withhold her consent to the neuroleptic medication.
We conclude that the record amply supports these findings. At the Jarvis hearing, all three experts agreed that appellant is mentally ill and would benefit from neuroleptic medication. Furthermore, Richard Kokkila, M.D. testified that while appellant is intelligent and could communicate with him, she was not competent to make decisions regarding the administration of neuroleptic medication. Robert Jeub, M.D. agreed, stating that appellant does "not have the ability or the capacity to make a logical decision associated with the use and the side effects of neuroleptic medication." Dr. Jeub's opinion was based, in part, on appellant's "total lack of insight or lack of understanding" of her illness. Additionally, Maureen Hackette, M.D. testified that appellant was not competent to make decisions regarding her treatment because "all of her decision-making . . . is affected by her delusional beliefs." Dr. Hackett further explained that appellant does not have the cognitive ability to understand any risks associated with the medication because she cuts off any discussion of neuroleptic medication based on her belief that she is not mentally ill. Therefore, the record contains clear and convincing evidence supporting the district court's finding that appellant lacked the capacity to make decisions regarding the administration of neuroleptic medication.
We also conclude that the district court's decision to order the involuntary administration of the medication was proper. The court found that appellant's condition had improved while she was previously taking the medication, and that she would likely experience a "marked and protracted subsidence of psychotic mental activity" once she resumed taking the medication. The court also found that the risks of adverse side effects from the medication were "slight" in relation to the benefits, that the therapy had neither a research objective nor an experimental character, and that there was a general acceptance of the validity and efficacy of neuroleptic medications by the psychiatric medical community. These findings are supported by the testimony of all three experts and, therefore, they are not clearly erroneous.
Because the district court applied the proper standards, and clear and convincing evidence supports the district court's finding of incapacity and its decision to authorize the involuntary administration of neuroleptic medication, we affirm. See In re Janckila, 657 N.W.2d 899, 904 (Minn.App. 2003) (affirming administration where doctors testified appellant did not understand his illness or his need for medication); Thulin, 660 N.W.2d at 145 (affirming administration where appellant had no insight into illness, doctors testified that benefits outweighed risks, and appellant would be closely monitored).