In the Matter of the Civil Commitment of:  Peggy Ann Harvey.

In the Matter of the Civil Commitment of:  Peggy Ann Harvey. A05-581, Court of Appeals Unpublished, September 6, 2005.

This opinion will be unpublished and

may not be cited except as provided by

Minn. Stat. § 480 A. 08, subd. 3 (2004).

 

STATE OF MINNESOTA

IN COURT OF APPEALS

A05-581

 

In the Matter of the Civil Commitment

of:  Peggy Ann Harvey.

 

Filed September 6, 2005

Affirmed

Peterson, Judge

 

Hennepin County District Court

File No. MH-PR-05-36

 

James S. Dahlquist, 270 Grain Exchange Building, 301 Fourth Avenue South, Minneapolis, MN  55415 (for appellant Harvey)

 

Amy Klobuchar, Hennepin County Attorney, John L. Kirwin, Assistant County Attorney, C-2000 Government Center, 300 South Sixth Street, Minneapolis, MN  55487 (for respondent)

 

            Considered and decided by Wright, Presiding Judge; Toussaint, Chief Judge; and Peterson, Judge.

U N P U B L I S H E D    O P I N I O N

PETERSON, Judge

            In this appeal from the order committing her to the Anoka Metro Regional Treatment Center as mentally ill and chemically dependent, appellant (a) contends that she does not pose a serious likelihood of physical harm to herself; (b) denies that she habitually used alcohol or drugs; and (c) contends that the least-restrictive treatment alternative is a highly structured outpatient setting.  We affirm.

FACTS

            On January 7, 2005, a friend of appellant Peggy Ann Harvey called appellant's mother to report that appellant had taken pills and was not doing well.  Appellant's mother talked to appellant.  Appellant's voice was slurred, and she admitted drinking and taking one of her psychiatric pills.  Her mother called 911.  The paramedics who responded took appellant to a hospital, and she was treated against her will for a drug overdose.  When her stomach was emptied, hospital personnel found green pill fragments, and appellant was placed on a respirator. 

            When appellant regained consciousness, she acknowledged taking a "handful" of pills and acknowledged that she had been drinking.  She initially denied that she made a suicide attempt and stated that she wanted to sleep for three to four days.  She said that she was disappointed that she survived and argued that life and death decisions should be left to the person involved.   

            Appellant's mother petitioned for appellant's commitment as mentally ill, and a referee conducted a hearing on the petition.  At the hearing, a member of appellant's treatment team, Dennis Geer, testified about appellant's condition.  Dr. Nicholas Rogers, appellant's psychiatrist, diagnosed appellant as suffering from a severe depressive disorder and as chemically dependent, with polysubstance or alcohol abuse.  During prior admissions, appellant had cocaine in her system, and during the present admission, she had an alcohol concentration of .24.  Appellant has a secondary diagnosis of posttraumatic-stress disorder, arising out of a sexual assault that occurred several years ago, and a mixed-personality disorder.

            Geer explained that appellant does not want chemical-dependency treatment and wants to be released.  He explained that she externalized blame for her situation on others, especially her mother, and she does not have any insight into the fact that she put herself into significant danger by overdosing on a handful of medications while consuming alcohol.  Instead, she maintains that she displayed a momentary lapse of judgment.

            The treatment team recommended commitment to the Anoka Metro Regional Treatment Center for inpatient treatment, particularly for chemical-dependency treatment, because appellant is not willing to enter treatment voluntarily and she poses a substantial likelihood of physical harm to herself because she needs ongoing medical care, her housing is in jeopardy, and she poses a suicide risk.

            Appellant acknowledged that she suffers from posttraumatic-stress disorder and major depression.  She testified that she has been seeing a psychiatrist as an outpatient for the last several years and would like to continue treatment with that psychiatrist.  She denied being chemically dependent and claimed that she only uses alcohol socially.  She claimed that although she was presently unemployed, she has a job waiting for her as a home-healthcare worker.  She also testified that she has an apartment and acknowledged having been behind on her rent, but she asserted that she was now one month ahead and denied being served with an unlawful-detainer notice.  She does not believe that she needs inpatient treatment, and she denied that she tried to kill herself in the incident that led to her hospitalization.

            The court-appointed examiner, psychologist Dr. Terry Nelson, testified that he agreed that appellant suffers from depression, posttraumatic-stress disorder, and alcoholism and/or alcohol abuse.  He testified that appellant is chemically dependent and has a history of excessive and habitual alcohol use, with a pattern of binge use.  He acknowledged that this is not the clear-cut chemical dependency in which the person suffers from organ failure, multiple detox entries, and high blood-alcohol concentrations over a period of time, but he believed that inpatient treatment is necessary.  He explained that less-restrictive alternatives would be available only under very strict guidelines, which would require appellant's full understanding, cooperation, and agreement.

            The referee recommended committing appellant as mentally ill and chemically dependent to the Anoka Metro Regional Treatment Center, and the district court adopted the recommendation and ordered the commitment.  This appeal followed.          

D E C I S I O N

            When reviewing a commitment, this court is limited to examining whether the district court complied with the requirements of the commitment act.  In re Janckila, 657 N.W.2d 899, 902 (Minn. App. 2003).  Findings of fact justifying commitment "shall not be set aside unless clearly erroneous, and due regard shall be given to the opportunity of the trial court to judge the credibility of the witnesses."  See Minn. R. Civ. P. 52.01; In re Schaefer, 498 N.W.2d 298, 300 (Minn. App. 1993).  A commitment may be reversed if the findings are insufficient to support the commitment.  In re McGaughey, 536 N.W.2d 621, 624 (Minn. 1995).  The commitment must be supported by clear and convincing evidence.  Minn. Stat. § 253B.09, subd. 1(a) (2004).  Whether the evidence is sufficient to show that the standards for commitment are met is a question of law reviewed de novo.  In re Knops, 536 N.W.2d 616, 620 (Minn. 1995). 

I.

            Appellant argues that she does not pose a threat of serious harm to herself or others.  Under the commitment act,

"Chemically dependent person" means any person (a) determined as being incapable of self-management or management of personal affairs by reason of the habitual and excessive use of alcohol, drugs, or other mind-altering substances; and (b) whose recent conduct as a result of habitual and excessive use of alcohol, drugs, or other mind-altering substances poses a substantial likelihood of physical harm to self or others as demonstrated by (i) a recent attempt or threat to physically harm self or others, (ii) evidence of recent serious physical problems, or (iii) a failure to obtain necessary food, clothing, shelter, or medical care.

 

Minn. Stat. § 253B.02, subd. 2 (2004) (emphasis added).

            In the commitment act, the definition of "mentally ill person" also includes the requirement that the person "poses a substantial likelihood of physical harm to self or others as demonstrated by . . . a recent attempt or threat to physically harm self or others."  Minn. Stat. § 253B.02, subd. 13(a)(3) (2004). 

            A substantial likelihood of physical harm must be demonstrated by an overt failure to obtain necessities or by a recent attempt or threat to harm self or others; mere speculation is insufficient.  McGaughey, 536 N.W.2d at 623.  But this does not mean that "the person must either come to harm or harm others before commitment as a mentally ill person is justified."  Id.; In re Harvego, 389 N.W.2d 266, 268 (Minn. App. 1986).  The "statute requires only that a substantial likelihood of physical harm exists."  McGaughey, 536 N.W.2d at 623.

            The district court found that a substantial likelihood of physical harm was shown by the fact that appellant "recently was feeling depressed and was heavily intoxicated when she took an overdose of prescription medications in an attempt to kill herself."  Appellant denies attempting to kill herself.  But there is evidence that when appellant regained consciousness at the hospital, she said that she had taken a "handful" of pills and had been drinking.  She also said that she was disappointed that she survived, that life and death decisions should be left up to the individual, and that she should have been left alone to die.

            In light of this evidence, the district court's finding that appellant "took an overdose of prescription medications in an attempt to kill herself" is not clearly erroneous.  The fact that appellant attempted to kill herself is sufficient to show that appellant poses a substantial likelihood of physical harm to herself.

II.

            Appellant denies that she habitually uses alcohol, drugs, or other mind-altering substances and claims that she drinks alcohol only in social settings.  The district court found that appellant's habitual and excessive use of alcohol and cocaine was demonstrated by

                        her long history of chemical abuse with many prior exposures to CD treatment; the fact that within the past three years she was committed as a chemically dependent person but eloped from treatment; her admission that she is chemically dependent, that alcohol and crack are her chemicals of choice, and that she used chemicals regularly during the two months preceding her current hospitalization; the fact that her BAC was .24 when she was most recently admitted to the hospital; and the fact that she recently made a very serious suicide attempt while she was intoxicated that required her admission to the emergency room.

 

            There is evidence that appellant has a long history of alcohol and drug abuse and that she has unsuccessfully participated in chemical-dependency treatment.  The court-appointed examiner testified that appellant has a history of excessive and habitual alcohol use and that she has a pattern of binge use.  Also, while in the hospital after her suicide attempt, appellant told a hospital interviewer that she had resumed alcohol use after a period of sobriety and was a "binge drinker."

            In light of this evidence, the district court's finding that appellant habitually and excessively used alcohol is not clearly erroneous.

III.

            Appellant argues that the best treatment alternative for her is a highly structured outpatient setting and contends that she was not committed to the least-restrictive treatment alternative.

            The commitment act requires that, before committing a person, the court must consider reasonable alternative dispositions, including voluntary outpatient care.  Minn. Stat. § 253B.09, subd. 1(a).  The court shall commit the person only if "it finds that there is no suitable alternative to judicial commitment."  Id.  In determining the least-restrictive treatment alternative, the district court is required to "consider the proposed patient's treatment preferences and willingness to participate voluntarily in the treatment ordered."  Id., subd. 1(b).  The district court's findings as to the least-restrictive treatment alternative will not be reversed unless clearly erroneous.  In re Dirks, 530 N.W.2d 207, 211 (Minn. App. 1995).

            The district court found that the least-restrictive treatment alternative for appellant is commitment to inpatient treatment.  The court considered outpatient treatment but rejected that option because appellant has a long history of chemical dependency and has not been able to remain sober and clean while in the community.  The district court found that appellant recently made a serious suicide attempt by overdosing and that she needs treatment before she can be safely returned to her apartment.  The court also found that appellant denies that she is chemically dependent and that she needs treatment. 

            Appellant's treatment team recommended commitment to the Anoka Metro Regional Treatment Center for inpatient treatment because appellant is not willing to enter chemical-dependency treatment voluntarily.  The court-appointed examiner also testified that inpatient treatment is necessary and explained that outpatient treatment would be available only under very strict guidelines, which would require appellant's full understanding, cooperation, and agreement.  Appellant explicitly testified that she did not need chemical-dependency treatment.

            In light of this testimony, the district court's finding that inpatient treatment is the least-restrictive, appropriate treatment alternative for appellant is not clearly erroneous.  Appellant's testimony that she does not need chemical-dependency treatment indicates that appellant does not fully understand her condition and that she would not agree to and cooperate with chemical-dependency treatment.  Therefore, because appellant's understanding, cooperation, and agreement are necessary for outpatient treatment, inpatient treatment at the Anoka Metro Regional Treatment Center is the least-restrictive, appropriate treatment alternative.

            Affirmed.