In re MH 2008-001188
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IN THE COURT OF APPEALS STATE OF ARIZONA DIVISION ONE ) ) ) ) IN RE MH 2008-001188 ) ) ) ) ) __________________________________) DIVISION ONE FILED: 03/26/09 PHILIP G. URRY,CLERK BY: DN No. 1 CA-MH 08-0033 DEPARTMENT B OPINION Appeal from the Superior Court in Maricopa County Cause No. MH 2008-001188 The Honorable Brian S. Rees, Commissioner AFFIRMED James J. Haas, Maricopa County Public Defender By Tennie B. Martin, Deputy Public Defender Attorneys for Appellant Phoenix Andrew P. Thomas, Maricopa County Attorney By Anne C. Longo, Deputy County Attorney Attorneys for Appellee Phoenix D O W N I E, Judge ¶1 Appellant determination voluntary that mental challenges she health was the unwilling treatment. superior or She unable also court s to accept contends that documentation submitted by the evaluating physicians failed to comply with statutory requirements because it did not specifically allege that she was unwilling or unable to accept voluntary treatment. Finally, appellant claims that the superior court failed to make necessary findings on the record. For the following reasons, we affirm. FACTS AND PROCEDURAL HISTORY I. Petition for Court-Ordered Evaluation ¶2 On May 27, 2008, Mary Krolik, M.D., petitioned the superior court for an involuntary mental health evaluation of Appellant. Appellant Dr. Krolik found reasonable cause to believe that was a danger to herself and that she had refused voluntary evaluation at the Psychiatric Recovery Center ( PRC ). According to the petition, Appellant s family reported three suicide attempts within the past week. ¶3 Along Appellant s with cousin, Dr. Krolik s submitted petition, applications Yvette for evaluation and emergency admission for evaluation. Y., involuntary According to Yvette, Appellant had communicated a desire to harm herself and had recently made suicide attempts, including an overdose of pills, two separate strangulation attempts, and efforts to jump from a moving vehicle. Yvette reported that Appellant had refused a voluntary evaluation and did not recognize that she needed treatment. She also stated that Appellant had threatened 2 future suicide attempts and had said she would take people out if she had a gun. II. Petition for Court-Ordered Treatment ¶4 On May 30, 2008, Thomas Cyriac, M.D., deputy medical director at the Maricopa Medical Center, filed a petition for court-ordered treatment. persistently stated or that acutely Appellant Dr. Cyriac alleged that Appellant was disabled was and a unwilling danger or to unable self. to He accept treatment voluntarily and requested that she receive combined inpatient and outpatient treatment. ¶5 In an affidavit accompanying the petition, Dr. Cyriac stated that Appellant minimized her conduct and symptoms. He noted that Appellant had been diagnosed with bipolar disorder and had received treatment and mood stabilizers in the past. Dr. Cyriac found that Appellant had engaged in behaviors of significant danger to self. attempts, her insight was She vaguely admitted to suicide questionable, clearly reflects poor judgment. and her behavior Dr. Cyriac concluded that, given her current level of symptoms, she would benefit from close, frequent monitoring on an inpatient basis. ¶6 Joel Badeaux, M.D., also evaluated Appellant and submitted an affidavit stating that she was a danger to herself and others. mood Dr. Badeaux noted that Appellant showed symptoms of disorder, including irritability, 3 depressed mood, anhedonia, psychomotor difficulty concentrating, When about asked agitation, events and feelings recurrent leading up of worthlessness, suicidal to her hospitalization, Appellant stated, I was threatening my cousin. It s just something that comes out. ideation. I was drunk. She admitted to three overdose attempts over a period of weeks and stated that she showed her family a noose and threatened to hang herself because they threatened to dump out my liquor. Appellant further admitted telling her mother that, if she had a gun, she would try to kill herself and her mother, but stated, I was saying that metaphorically. expressed a She blamed her actions on alcohol use and willingness to accept inpatient treatment for substance abuse. She also admitted a long history of self- inflicted and cutting heroin use. Dr. Badeaux opined that outpatient treatment was not appropriate based on the severity of Appellant s symptoms and her recent behaviors. He recommended inpatient treatment on an involuntary basis. ¶7 The superior court issued a detention order for treatment and a notice of hearing. III. Hearing on Contested Petition ¶8 At the hearing on June 9, 2008, counsel stipulated to the admission of the doctors affidavits and addenda in lieu of their testimony. Appellant s mother, Adelia B., testified that Appellant had recently tried to hang herself twice and had taken 4 an overdose of sleeping pills. On one occasion, Adelia had to cut a cord from around Appellant s neck because it was wound so tightly. continue Appellant told Adelia that she would rather die than with her . . . mental pain. Adelia stated that Appellant s drinking was increasing because she didn t want to live. with Appellant had willingly gone to Mohave Mental Health Adelia treatment. once In or twice addition, a month Appellant for had a few months for voluntarily accepted a Phoenix, treatment for substance abuse in the past. ¶9 Yvette testified that, during trip to Appellant said that she didn t think anybody loved her and that she wanted to jump out of the car while it was moving. Appellant tried to unlock the car door and open it while they were traveling on the highway. Yvette stated that Appellant agreed to go to PRC, but upon arrival, she made a scene and walked out. PRC advised Yvette to take Appellant to the emergency room. ¶10 Appellant testified that she had been in the hospital for a couple of weeks prior to the hearing and that she was on medication that was helping. Prior to this, she had been seeing a drug counselor and psychiatrist in Mohave County on an asneeded basis, but they did not have her on any medications. Appellant testified that she has a history of drug abuse, though she took methadone to wean herself 5 from heroin. Appellant admitted drinking alcohol to excess, stating that she drinks alcohol every day [f]rom the moment I wake up. She denied trying to overdose on pills, stating that she had only taken two sleeping pills with alcohol because she was having difficulty sleeping. ¶11 The superior court found by clear and convincing evidence that Appellant, as a result of a mental disorder, was a danger to self and persistently and acutely disabled. It ordered involuntary treatment in a combined inpatient-outpatient program for 365 days. At the hearing, the court remarked that the current medication regimen seems to be working wonders and that Appellant does seem to be cooperative although her stability is questionable. at this point, The court found that there were no appropriate and available alternatives to courtordered treatment. The transcript does not reflect that the superior court specifically stated at the hearing that Appellant was unwilling or unable to accept voluntary treatment. However, the ensuing order for treatment and the minute entry from the hearing both include such a finding. ¶12 Appellant filed a timely notice of appeal. jurisdiction pursuant to Arizona section 36-546.01 (2003). 6 Revised Statutes We have ( A.R.S. ) DISCUSSION ¶13 Appellant alleges that the physicians persistent or acutely disabled addenda failed to comply with statutory requirements because they did not specifically allege that she was unwilling or unable to accept voluntary treatment. She also argues that she demonstrated a willingness and ability to comply with voluntary treatment. Finally, Appellant contends that the order for involuntary treatment was invalid because the court never actually found, on the record, that she was unwilling or unable to accept voluntary treatment. ¶14 We involuntary evidence. will affirm treatment the if it superior is court s supported by order for substantial Appeal in Pima County Mental Health Serv. Action No. MH-1140-6-93, 176 Ariz. 565, 566, 863 P.2d 284, 285 (App. 1993). We view the facts in the light most favorable to sustaining the trial court s judgment and will not set aside findings unless they are clearly erroneous. the related In re Appeal in Maricopa County of Mental Health Case No. MH 94-00592, 182 Ariz. 440, 443, 897 P.2d 742, 745 (App. 1995). ¶15 After a hearing, the superior court may order a person to undergo involuntary treatment in a combined inpatient and outpatient program if it finds by clear and convincing evidence that the person, persistently or as acutely a result disabled 7 of a and is mental either disorder, is unwilling or unable (2003). to accept voluntary Persistently or treatment. acutely A.R.S. disabled is § 36-540(A)(2) defined as a severe mental disorder that meets all three of the following criteria: (a) If not treated has a substantial probability of causing the person to suffer or continue to suffer severe and abnormal mental, emotional or physical harm that significantly impairs judgment, reason, behavior, or capacity to recognize reality. (b) Substantially impairs the person s capacity to make an informed decision regarding treatment and this impairment causes the person to be incapable of understanding and expressing an understanding of the advantages and disadvantages of accepting treatment and understanding and expressing an understanding of the alternatives to the particular treatment offered after the advantages, disadvantages and alternatives are explained to that person. (c) Has a reasonable prospect of being treatable by outpatient, inpatient or combined inpatient and outpatient treatment. A.R.S. § 36-501(33).1 Under the statute, an individual s current behavior is neither the sole nor the essential indication of the statutory criteria. MH 94-00592, 182 Ariz. at 444, 897 P.2d history at 746. Treatment and past behavior are also relevant. Id. ¶16 Appellant persistently or contends acutely that the disabled 1 evaluating addenda were doctors legally We cite the current version of the applicable statute because no revisions material to this decision have since occurred. 8 insufficient because they did not allege that she was unwilling or unable to accept voluntary treatment. ¶17 Arizona statutes do not We disagree. require the examining physicians affidavits and addenda to allege that a person is unable or unwilling to accept voluntary treatment. Pursuant to A.R.S. § 36-533(B), those affidavits must describe in detail the behavior indicating that the person is persistently acutely disabled as a result of a mental disorder. or The statute, however, does not mandate that the evaluating physicians allege that the patient is unable or unwilling to accept voluntary treatment. In contrast, A.R.S. § 36-533(A)(3) specifically requires that the petition for court-ordered treatment allege that the accepting patient is treatment unwilling to accept voluntarily. or incapable Dr. Cyriac s can order of petition complied with this statutory requirement. ¶18 Before the superior court involuntary treatment, it must find, by clear and convincing evidence, based on the record before it, that the patient is either unwilling or unable to accept voluntary treatment. Thus, the court must have evidence upon A.R.S. § 36-540(A). which to base a determination that a person is unable or unwilling to accept voluntary treatment. That evidence, however, need not come from the examining physicians affidavits or addenda. 9 ¶19 that In the case at bar, there was substantial evidence Appellant treatment. not was or unable to accept voluntary Drs. Cyriac and Badeaux stated that Appellant did recognize demanded unwilling a that higher receiving. her psychiatric level of care condition than was was she severe and voluntarily Dr. Cyriac opined that Appellant s lack of impulse control and significant mood disorder impaired her capacity to determine and accept needed treatment. He believed that inpatient monitoring was necessary due to Appellant s refusal of a voluntary Appellant evaluation told Dr. and Badeaux her current that, level of symptoms. she was receiving though treatment at Mohave Mental Health, she had no mental health problem or diagnosis. substantially threats and Dr. Badeaux concluded that Appellant was minimizing attempts to the seriousness her herself. harm of many He opined recent that her ability to recognize reality was impaired and that she could not make an informed decision regarding treatment at this time. Although the court considered the fact that Appellant had visited Mohave Mental Health Clinic voluntarily, it noted that she had not received appropriate care until she was required to receive inpatient Appellant s family treatment. members, The who court described also her heard from increasingly troubled condition, her threats, and her refusal to submit to a voluntary evaluation. When considered 10 together, there was substantial evidence to support the court s determination that Appellant was unable or unwilling to accept voluntary treatment. ¶20 Finally, Appellant cites In re Commitment of an Allegedly Mentally Disordered Person, No. MH-1360-1-84, arguing that the superior court may only order treatment after a finding on the record that she is unwilling or unable to accept voluntary treatment. 145 Ariz. 81, 699 P.2d 1312 (App. 1985). In that case, we held that, although the superior court found mental disorder and danger to self; it did not find unwillingness or inability to accept voluntary treatment. Id. at 82, 699 P.2d at 1313. did find voluntary that In the case at bar, the superior court Appellant unable Although treatment. was the or unwilling court did to not accept expressly recite this finding during the hearing itself, it included the finding in the minute entry from the hearing and in the final written order from which Appellant appeals, both of which are part of the record. A trial judge s statement, or lack thereof, will not detract from his express finding of statutory grounds in his formal written order. Matter of Appeal in Maricopa County, Juvenile Action No. JS-734, 25 Ariz. App. 333, 339-40, 543 P.2d 454, 460-61 (1975) (holding that trial judge s statement in the transcript that he did not find abandonment did not detract from the formal written order s express finding of abandonment). 11 CONCLUSION ¶21 Substantial evidence supports the determination that Appellant was unwilling or unable to accept voluntary treatment. The evaluating physicians documentation complied with statutory requirements. The superior court made the necessary findings. We affirm the order requiring Appellant to undergo involuntary treatment. MARGARET H. DOWNIE, Judge CONCURRING: JON W. THOMPSON, Presiding Judge DONN KESSLER, Judge 12
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