In Re MH 2006-000490

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IN THE COURT OF APPEALS STATE OF ARIZONA DIVISION ONE ) ) ) ) ) ) ) ) ) ) ) IN RE MH 2006-000490 1 CA-MH 06-0013 DEPARTMENT A O P I N I O N FILED 3-22-07 Appeal from the Superior Court in Maricopa County Cause No. MH 2006-000490 The Honorable Steven K. Holding, Commissioner REVERSED AND REMANDED Andrew P. Thomas, Maricopa County Attorney by Geraldine Roll, Deputy County Attorney Attorneys for Appellee Phoenix James J. Haas, Maricopa County Public Defender by Tennie B. Martin, Deputy Public Defender Attorneys for Appellant Phoenix B A R K E R, Judge ¶1 opinions We address the legislative requirement for physician in involuntary mental health proceedings under Arizona Revised Statutes ( A.R.S. ) section 36-539(B) (2003). We hold that a physician s testimony that sets forth facts from which a qualifying opinion may be derived, but fails to actually set forth such requirement. an opinion, does not satisfy the statutory Accordingly, we reverse and remand. I. ¶2 In August 2005, Appellant was admitted to Desert Vista Behavioral Health Center ( Desert Vista ) on a court ordered mental health evaluation. Subsequent to the evaluation, he was placed on court ordered treatment. Appellant was hospitalized for of 180 days, the maximum period time permitted before another petition was required to continue involuntary treatment. On March 9, 2006, the medical director of Desert petitioned for a second court ordered evaluation. Vista The director believed that Appellant was in need of continued care because Appellant has no understanding of his mental condition, displays violence and aggressive behavior, is unable to care for his basic needs, and requires twenty-four hour supervision. ¶3 On March Michael Hughes. 10, 2006, Appellant was examined by Dr. Dr. Hughes stated that [Appellant s] thought process was grossly disorganized, as Appellant gave nonsensical answers to judgment. to-one most questions and demonstrated poor insight and Dr. Hughes remarked that Appellant requires a one- sitter for 16 hours per day to assist him personal needs and to prevent him from wandering. with his He stated that Appellant is incapable of caring for himself and requires professional assistance. Dr. Hughes 2 concluded by diagnosing Appellant with chronic paranoid schizophrenia and severe mental retardation, necessary and to stated ensure medications, which that that prevent involuntary hospitalization Appellant continues taking him reverting back was from his to a psychotic state. ¶4 Appellant was also examined by Dr. Sead Hadziahmetovic on March 10, 2006. Dr. Hadziahmetovic noted that the hospital had difficulty placing Appellant in an appropriate environment due to his low level of functioning. improved still in the time experienced wander. He movements with patient s insight since beginning irritability described Appellant difficulty and and a as However, Appellant had treatment, tendency to experiencing communicating. judgment although are very He physically involuntary stated, poor, he the and . . . he apparently qualifies as someone who was internally preoccupied with internal auditory/visual stimuli, whether hallucination they or were in something the form else. of Dr. Hadziahmetovic noted that Appellant is unable to take care of himself, and requires help providing for food, clothing, and hygiene. He concluded that Appellant required continued inpatient treatment for his well-being and the well-being of others, and gave mental retardation, moderate to severe, as his sole diagnosis. 3 ¶5 On March 14, 2006, Dr. Hughes petitioned the court to order Appellant to continue to undergo mental health treatment. The petition included Hadziahmetovic opinions. the regarding affidavits their of Dr. respective Hughes and examinations Dr. and On March 21, 2006, a hearing regarding the petition for treatment was held. At the hearing, the court admitted the affidavits of the two physicians in lieu of their testimony. During closing arguments, Appellant s attorney pointed out that Dr. Hadziahmetovic s diagnosis concluded only that Appellant suffers from mental retardation, which does not constitute a mental disorder treatment. for the purposes of court ordered mental See A.R.S. §§ 36-501(26) (Supp. 2006) and -533(B) (2003). The court ruled, however, that although Dr. Hadziahmetovic s diagnosis was mental retardation, his extensive description of Appellant s condition was sufficient to find that Appellant is Accordingly, ordered gravely the trial treatment. jurisdiction disabled pursuant court due to granted the Appellant timely to §§ A.R.S. a mental petition disorder. for court We have appealed. 36-546.01 (2003) and 12- 120.21 (2003). II. A. ¶6 Appellant raises one issue on appeal. He argues that Dr. Hadziahmetovic s diagnosis of mental retardation alone was 4 insufficient as a matter of law to support an order involuntary treatment following a hearing under § 36-539(B). for We agree. ¶7 As to appeals generally, in reviewing a trial court s factual findings on appeal we will sustain these findings unless they are clearly erroneous or unsupported by any credible evidence. Federoff v. Pioneer Title & Trust Co. of Ariz., 166 Ariz. 383, 388, 803 P.2d 104, 109 (1990). Matters of statutory interpretation, however, are questions of law that are reviewed de novo. Arnold v. Ariz. Dep't of Health Servs., 160 Ariz. 593, 603, 775 P.2d 521, 531 (1989). B. ¶8 Arizona law permits courts to order involuntarily undergo mental health treatment. 533(A). a person to See A.R.S. § 36- The petition for court ordered treatment must allege: That the patient is in need of a period of treatment because the patient, as a result of mental disorder, is a danger to self or to others, is persistently or acutely disabled or is gravely disabled. A.R.S. § 36-533(A)(1). affidavits of two The petition physicians must describing, also based include upon an examination, the behavior which indicates that the person, as a result of mental disorder, is a danger to self or to others, is persistently A.R.S. § or acutely 36-533(B) disabled (emphasis or added); 5 is gravely see, e.g., disabled. Matter of Coconino County Mental Health No. MH 95-0074, 186 Ariz. 138, 139, 920 P.2d 18, 19 (App. 1996) (reversing an order for involuntary treatment because the petition failed to include two physician affidavits). substantial disorder Mental of the thought, cognition or memory. mental disorder is disorder person's is defined as a emotional processes, A.R.S. § 36-501(26).1 However, a statutorily defined to exclude [c]onditions that are primarily those of drug abuse, alcoholism or mental retardation. A.R.S. § 36-501(26)(a) (emphasis added). ¶9 In addition to the affidavits, [t]he evidence presented by the petitioner or the patient at the hearing shall include the testimony of . . . the two physicians who performed examinations in the evaluation of the patient. A.R.S. § 36- 539(B). The physicians are required to testify as to their opinions concerning 1 whether the patient is, as a result The pertinent provision reads in full as follows: 26. "Mental disorder" means a substantial disorder of the person's emotional processes, thought, cognition or memory. Mental disorder is distinguished from: (a) Conditions that are primarily those of drug abuse, alcoholism or mental retardation, unless, in addition to one or more of these conditions, the person has a mental disorder. A.R.S. § 36-501(26)(a). 6 of mental disorder . . . gravely disabled . . . . Such testimony shall state specifically the nature and extent of the . . . grave disability. Id. (emphasis added).2 In lieu of in-court testimony, a court may admit or take judicial notice of the physicians affidavits appended to the petition. See Matter of Coconino County No. MH 1425, 176 Ariz. 525, 528, 862 P.2d 898, 901 (App. 1993), rev d on other grounds, 181 Ariz. 290, 889 P.2d 1088 (1995) (holding that it was not error for the trial court to admit reports of two physicians in lieu of testimony, stating [n]othing in the statute requires that the testimony be oral ). 2 The entire portion of A.R.S. § 36-539(B) that pertains to physician testimony is as follows: The evidence presented by the petitioner or the patient shall include the testimony of two or more witnesses acquainted with the patient at the time of the alleged mental disorder and testimony of the two physicians who performed examinations in the evaluation of the patient. The physicians shall testify as to their personal examination of the patient. They shall also testify as to their opinions concerning whether the patient is, as a result of mental disorder, a danger to self or to others, is persistently or acutely disabled or is gravely disabled and as to whether the patient requires treatment. Such testimony shall state specifically the nature and extent of the danger to self or to others, the persistent or acute disability or the grave disability. If the patient is gravely disabled the physicians shall testify concerning the need for guardianship or conservatorship, or both, and whether or not the need is for immediate appointment. (Emphasis added.) 7 ¶10 When interpreting a statute, our primary purpose is to effectuate legislative intent, and a statute s plain language is the best evidence of that intent. In re Maricopa County Super. Ct. No. MN 2001-001139, 203 Ariz. 351, 353, ¶ 12, 54 P.3d 380, 382 (App. 2002). The provisions of Title 36 have been set forth by the legislature with precision. Id. The legislature is well aware that we have required parties to comply with [the provisions of Title 36] interests at issue. with exactness given the liberty Id. at 354, ¶ 15, 54 P.3d at 383 (citing In re Coconino County No. MH 1425, 181 Ariz. 290, 293, 889 P.2d 1088, 1091 (1995)). may result in a Because involuntary treatment proceedings serious deprivation of appellant's liberty interests, statutory requirements must be strictly met. Id. at 353, ¶ 8, 54 P.3d at 382. C. ¶11 As described above, the language of § 36-539(B) requires that physicians provide their opinions as to whether the patient is disabled as a result of mental disorder. Hadziahmetovic s affidavit, however, stated that Dr. Appellant suffer[s] from a mental disorder diagnosed as . . . mental retardation, retardation moderate alone is to not severe. a mental involuntary commitment may be based. By definition, disorder upon mental which A.R.S. § 36-501(26)(a); see Vanderheiden v. Super. Ct. In and For County of Maricopa, 8 182 Ariz. 370, 374 n.3, 897 P.2d 672, 676 n.3 (App. 1994) ( The civil commitment statutes distinguish a mental disorder, defined as a substantial disorder of the person s emotional processes, thought, cognition or memory, from conditions which are primarily those of . . . mental retardation. ) (quoting A.R.S. § 36-501(22)(a), (26)(a)). the Although predecessor Dr. version of Hadziahmetovic s A.R.S. § affidavit 36-501 gave a thorough description of Appellant s unfortunate state, which the trial court found sufficient to establish that Appellant in fact suffers from a mental disorder, that description did not meet the requirement of an opinion as required by § 36-539(B). fact, Dr. Hadziahmetovic s opinion reflected only In mental retardation, moderate to severe, which is expressly excluded as a qualifying mental disorder under the statute. A.R.S. § 36- 501(26)(a). ¶12 We are not free to deviate from legislatively mandated requirements. Janson v. Christensen, 167 Ariz. 470, 471, 808 P.2d 1222, 1223 (1991) ( the best and most reliable index of a statute's meaning is its language and, when the language is clear and unequivocal, construction ). State v. is determinative of the statute's We honor the plain language of a statute. Jackson, 117 (App. 2005). it 210 Ariz. 466, 471, ¶ 26, 113 P.3d 112, Just as we do not inflate, expand, stretch or extend a statute to matters not falling within its expressed 9 provisions, City of Phoenix v. Donofrio, 99 Ariz. 130, 133, 407 P.2d 91, 93 (1965), neither do we deflate, defeat, or disregard statutory terms the legislature has expressly included. See also In Re MH 2004-001987, 211 Ariz. 255, 258, ¶ 14, 120 P.3d 210, 213 (App. 2005). opinion, in addition Thus, a physician must actually state an to the underlying facts from which an opinion may be derived or inferred, to satisfy the statutory requirements for an involuntary commitment under A.R.S. § 36539(B). ¶13 Accordingly, as the opinion requirement of § 36- 539(B) was not met, it was error for the trial court to order that Appellant undergo involuntary mental health treatment.3 ruling, however, does not preclude Dr. Hadziahmetovic Our from supplementing his opinion in light of the requirements of § 36539(B).4 3 Because we hold that § 36-539(B) was not met, we need not decide whether Dr. Hadziahmetovic s affidavit met the requirements of § 36-533. 4 Voluntary care for Appellant s severe mental retardation could potentially be sought pursuant to A.R.S. § 36518 (2003). An individual may seek voluntary care for treatment of a mental disorder or other personality disorder or emotional condition. A.R.S. § 36-518(A) (emphasis added). Informed consent for such treatment may be given by the individual, or the individual s guardian or agent subject to the requirements of A.R.S. § 36-518(A). 10 III. ¶14 For the Hadziahmetovic s foregoing affidavit A.R.S. § 36-539(B). reasons, we not the did meet hold that requirements Dr. of As such, it was error for the court to order Appellant to undergo involuntary treatment. We therefore reverse and remand. _____________________________ DANIEL A. BARKER, Judge CONCURRING: ________________________________ G. MURRAY SNOW, Presiding Judge ________________________________ DONN KESSLER, Judge 11

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