In re MH 2009-000684
Annotate this Case
Download PDF
NOTICE: THIS DECISION DOES NOT CREATE LEGAL PRECEDENT AND MAY NOT BE CITED EXCEPT AS AUTHORIZED BY APPLICABLE RULES. See Ariz. R. Supreme Court 111(c); ARCAP 28(c); Ariz. R. Crim. P. 31.24 IN THE COURT OF APPEALS STATE OF ARIZONA DIVISION ONE ) ) ) ) ) IN RE MH 2009-000684 ) ) ) ) _______________________________________ ) DIVISION ONE FILED: 01/26/2010 PHILIP G. URRY,CLERK BY: GH 1 CA-MH 09-0035 DEPARTMENT B MEMORANDUM DECISION (Not for Publication - Rule 28, Arizona Rules of Civil Appellate Procedure) Appeal from the Superior Court in Maricopa County Cause No. MH 2009-000684 The Honorable Patricia Arnold, Judge Pro Tempore AFFIRMED Andrew P. by and Attorneys Thomas, Maricopa County Attorney Anne C. Longo, Deputy County Attorney Bruce P. White, Deputy County Attorney for Appellee James J. Haas, Maricopa County Public Defender by Edith M. Lucero, Deputy Public Defender Attorneys for Appellant Phoenix Phoenix W E I S B E R G, Judge ¶1 P.M. appeals from the superior court s involuntary mental-health treatment order on the ground that one of the physician witnesses failed to personally examine her as required by law and thus that she was denied due process. For reasons that follow, however, we find no clear error but instead hold that substantial evidence supports the superior court s order and affirm. BACKGROUND ¶2 On March 18, 2009, Dr. Michael Hughes filed a petition for court-ordered treatment ("COT") avowing that Appellant was persistently or acutely disabled and inpatient and outpatient treatment. when interviewed extremely at guarded the urgent and recommended combined His affidavit stated that care paranoid center, and Appellant would not was provide significant information during the interview. [She] reportedly answered most questions by saying, I can t tell you. an interview at Desert Vista by a During psychiatric nurse practitioner, Appellant said that she did not need psychiatric medications denied because being they diabetic. would make Dr. Hughes [her] noted more crazy, and that during his interview, Appellant was guarded and non-disclosing and denied that she had a psychiatric illness or needed medication for such an illness or diabetes. Nevertheless, Dr. Hughes noted a prior diagnosis of chronic paranoid schizophrenia and a history of diabetes. He completed an addendum for persistently or acutely disabled patients. 2 ¶3 In an affidavit completed the next day, Dr. Andrew Parker stated that when he informed Appellant of the purpose of the interview and its non-confidential nature, Appellant said that she would rather not be interviewed or answer questions. His affidavit additionally observed, however, that Appellant was disheveled ; her affect was blunted ; her mood depressed and anxious ; her guarded ; her thought motor processes skills impaired, restricted ; and impaired with poor insight and judgment. blocking her and cognition He noted that she was internally preoccupied and delusional and that she had been observed to be talking to herself and paranoid. His addendum stated that if not treated, she likely would continue to suffer thought severe harm, blocking, poor that her insight) mental disorder substantially (paranoia, impaired her ability to make an informed decision regarding treatment, and that she was incapable of understanding the advantages and disadvantages of treatment and of alternatives to the treatment offered but that those items had been explained to her. The petition for COT was filed later that morning. ¶4 to At a hearing on the petition, the parties stipulated admit testify. Dr. Hughes affidavit. Dr. Parker was called to He said that before meeting Appellant, he had reviewed her complete chart and also observed her as he approached her on 3 the unit and as she walked to the interview room. Once there, he had explained her right to refuse to be interviewed or to answer questions, and she had exercised her right to refuse. He said that his interaction with her had taken a minute or two. Nevertheless, Dr. Parker reiterated the specific observations contained in his affidavit for the court and stated that his observations were the basis for his opinion of Appellant s mood and thought processes. interview her because He did not make a second attempt to she had exercised her right to not participate or answer questions and he felt [he] had enough evidence. He participate in opined, the however, interview due that to Appellant did not illness, which he her characterized as schizophrenia, paranoid type. ¶5 While testifying, Dr. Parker consulted his affidavit several times without objection. 1 When asked if he had been able to discuss the advantages and disadvantages of treatment, he said, With the patient not cooperating, that would have been difficult. challenge advantages 1 On cross-examination, Appellant s counsel did not Dr. and Parker s avowal disadvantages of that he treatment had but explained the elicited that In ruling on the petition, the court stated that in addition to the testimony, it had reviewed and considered the affidavits of Dr. Parker and Dr. Hughes and their opinions that Appellant was persistently and acutely disabled. Appellant did not object to consideration of Dr. Parker s affidavit. 4 Appellant had not been physically abusive and that Dr. Parker had relied primarily on the chart to assess her insight and judgment. ¶6 A petition for court-ordered treatment must be accompanied by the affidavits of two physicians who conducted examinations of the patient as part of an evaluation. 2 A.R.S. § 36-533(B) (2009). Examination is defined as an exploration of past the person s circumstances leading up psychiatric to the history person s and of presentation, the a psychiatric exploration of the person s present mental condition and a complete (2009). physical examination. A.R.S. § 36-501(14) A complete physical examination in the context of a mental health examination, however, is not the typical annual physical but a component of a psychiatric examination, which includes observing the patient's demeanor presentation, and can aid in diagnosis. and physical MH 2008-000438, 220 Ariz. 277, 280 n. 3, ¶ 14, 205 P.3d 1124, 1127 n. 3 (App. 2009). ¶7 On appeal from court-ordered treatment, we view the evidence in the light most favorable to upholding the order. Id. at 278, ¶ 6, 205 P.3d at 1125. to determine 2 if substantial We also examine the record evidence supports the court s Evaluation is a professional multidisciplinary analysis based on data describing the person s identity, biography and medical psychological and social conditions carried out by a group of persons including two licensed physicians and two others. A.R.S. § 36-501(12)(2009). 5 judgment. In re MH 2008-000097, 221 Ariz. 73, 77, ¶ 17, 210 P.3d 1244, 1248 (App. 2009). would permit conclusion. a Substantial evidence is that which reasonable Id. person to reach the court s Furthermore, we will not overturn an order for treatment unless we find it clearly erroneous or unsupported by any credible evidence. Mental Health Case No. MH 94-00592, 182 Ariz. 440, 443, 897 P.2d 742, 745 (App. 1995). ¶8 By law, a person is considered persistently or acutely disabled if he or she suffers from a severe mental disorder that [s]ubstantially 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 alternatives to the particular treatment offered after the advantages, disadvantages and alternatives are explained to that person. A.R.S. § 36-501(33)(b) (2009). Some time ago, we interpreted this language in a case in which the patient declined to speak to either psychiatrist and thus prevented the physicians from either explaining or discussing the advantages and disadvantages of treatment and the alternatives to the treatment offered. In re Pima County MH Serv. Action, 176 Ariz. 565, 568, 863 P.2d 284, 287 (App. determinations 1993). a court There, must we make 6 acknowledged in order to the find specific a person persistently or acutely disabled, but we also held that mental health officials need not engage in a confrontation with a mentally ill patient or have the patient physically restrained in order to fulfill the letter of the requirement. This is particularly true where, as here, the record reflects a long history of mental illness, and the testimony of four witnesses . . . support[s] disorder. ¶9 the diagnosis of an acute and persistent Id. In this case, the addendum to Dr. Parker s affidavit stated that, as required, he had explained the advantages and disadvantages of treatment and the alternatives to treatment as well as the advantages and disadvantages of the alternatives. His testimony that he was unable to discuss the alternatives with Appellant given her wish not to answer questions is not inherently inconsistent explanation to with Appellant. his One testimony can regarding information explain his to another without engaging in a discussion of it. Furthermore, Dr. Parker elaborated on his observations based on his review of Appellant s chart and his brief encounter with her. ¶10 from In Dr. daughter addition Parker, that the to Dr. court Appellant Hughes heard refused to affidavit testimony take and from testimony Appellant s medications and was really scared that people were trying to break in the house, 7 that they were trying to kill her [and s]o she wouldn t sleep, was always up. banged on the She said that Appellant talked to herself, walls, and left the stove on while cooking. Appellant s case manager testified that Appellant did not want to see the doctors or take medications, said that the doctors were reading her future and her daughter was a ghost, and was concerned for the case manager s safety. ¶11 We conclude that the evidence adequately supported the court s determination acutely disabled. of Appellant s that Appellant was persistently and Dr. Parker s testimony included observations demeanor and physical presentation and permissible use of those observations as a diagnostic aid. See MH 2008-000438, 220 Ariz. at 280 n. 3, ¶ 14, 205 P.3d at 1127 n. 3. His testimony also revealed that he had examined Appellant s complete chart and thus, as A.R.S. § 36-501(14) requires, that he had explored her past psychiatric history[,] . . . the circumstances leading up to [her] presentation, [and also had conducted] a condition. psychiatric exploration Accordingly, despite of [her] present mental Appellant s refusal to be interviewed or to answer questions, Dr. Parker examined her and describe[d] in detail the behavior which indicate[d] that she was persistently or acutely disabled. A.R.S. § 36-533(B). He also attested that he had explained the treatment advantages and disadvantages as well as treatment 8 alternatives but that Appellant was incapable of understanding these matters. We find no deprivation of due process under these circumstances. CONCLUSION ¶12 For the foregoing reasons, we affirm the judgment. ____/S/____________________________ SHELDON H. WEISBERG, Judge CONCURRING: __/S/____________________________ PATRICIA K. NORRIS, Presiding Judge __/S/_______________________________ MARGARET H. DOWNIE, Judge 9
Some case metadata and case summaries were written with the help of AI, which can produce inaccuracies. You should read the full case before relying on it for legal research purposes.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
