Matter of Worski-Chaphe
Annotate this CaseDecided on November 6, 2008
Supreme Court, Ontario County
In the Matter of the Application of Eric Jansen, Director of Behavioral Health for Clifton Springs Hospital and Clinic, for an Order authorizing the Involuntary Treatment of Loris Worski-Chaphe A Patient at Clifton Springs Hospital and Clinic
101951
APPEARANCES:
David H. Fitch, Esq.
Underberg & Kessler, LLC
Attorney for Clifton Springs Hospital and Clinic
Kristin Dawson Henderson, Esq.
Mental Hygiene Legal Services
Attorney for Patient
Craig Doran, J.
OPINION OF THE COURT
The Court has before it an application from Eric Jansen, Director of Behavioral Health for Clifton Springs Hospital and Clinic ("CSH & C"), for an order pursuant to MHL §33.03 and 14 N.Y.C.R.R. §527.8, authorizing CSH & C to administer involuntary treatment to Lois Worski-Chaphe ("Patient"), including but not limited to, laboratory tests, psychotropic medication, including Zyprexa intramuscular injections up to a maximum doge of 40 mg, with a conversion to Zyprexa Zydis dissolving tables up to a maximum daily dose of 50 mg over her objection.
The Patient was admitted to CSH & C on October 17, 2008, pursuant to MHL §9.39; and she is currently hospitalized pursuant to MHL §9.27.
A hearing on the hospital's application was held before this Court on November 5, 2008. The [*2]Patient, Lois Worski-Chaphe, personally appeared with her assigned counsel, Kristin Dawson Henderson, Esq., Mental Hygiene Legal Services. CSH & C appeared by Underberg & Kessler, LLC., David H. Fitch, Esq., of counsel.
This Court heard testimony from Elizabeth Michaels, M.D., and from the Patient.
FINDINGS OF FACT
Based upon the sworn testimony and the evidence received by the Court at the aforementioned hearing, the Court makes the following findings of fact. The Court finds that Dr. Michaels, who is chief psychiatrist at CSH & C and the Patient's current treating psychiatrist during the current admission of the Patient, has diagnosed Ms. Worski-Chaphe as suffering from Bi-Polar Disorder type 2, currently manic with psychotic features.
According to Dr. Michaels, the sixty-three-year-old Patient was brought to the hospital by the local police department as the result of a mental health arrest after she had called the police on three occasions reporting that her brother was being murdered in the cemetery. The Patient has had a number of previous admissions for psychiatric reasons, having been diagnosed with bipolar disorder. As an outpatient, Ms. Worski-Chaphe had been followed by Dr. Yu at Seneca County Community Counseling. Apparently, the Patient was recently weaned from lithium under Dr. Yu's supervision after taking this drug for 16 years. The Patient had developed lithium toxicity. After being weaned from lithium, the Patient decompensated rapidly.
Upon admission to CSH & C, the Patient was and remains in a manic psychosis. The Patient talks to unseen others, she is sleeping poorly, she is angry and belligerent, she has kicked, spit and bitten at staff, and she has been "channeling" Dr. Yu, who through her mouth issues instructions as to how she should be treated medically.
Dr. Michaels determined within a reasonable degree of medical certainty that the Patient suffers from a mental illness, i.e. bi-polar disorder type 2, manic episode with psychotic features.
Currently, the Patient is refusing to take medications. The Patient refuses to take any
anti-psychotic medications and has been found to have "cheeked" other medications. The Patient
is compliant with attending group therapy.
Based upon Dr. Michaels' observations during visits with Ms. Worski-Chaphe
during her hospitalization and review of progress notes and other medical records, it is Dr.
Michael's medical opinion that Ms. Worski-Chaphe has a mental illness (bipolar disorder, Type
2); and that she is very much in need of continued care and treatment by way of medication. Dr.
Michaels' medical opinion is that the Patient is very much in need of mood stabilizing agents and
anti-psychotic medication.Further, according to Dr. Michaels' testimony, lesser forms of
treatment are not available to treat Ms. Worski-Chaphe. The Patient is not getting well without
medication and there is no less restrictive treatment. Dr. Michaels testified that if left untreated,
there are long term consequences that suggest sustained mania is deleterious to cognitive
function. Doctor Michaels noted that the longer a person is in a manic state, the harder it
becomes to treat and the harder it becomes to "pull them back" from the manic state.
The Patient has limited insight into her mental illness. The Patient admits that she is bi-polar, but does not recognize her manic symptoms and does not believe that she is in need of treatment.
Dr. Michaels opined that Ms. Worski-Chaphe does not understand her need for treatment. The doctor further opined that the Patient's condition will not improve without this treatment, [*3]without treatment her prognosis is poor, it is the least intrusive form of treatment and that it is in the Patient's best interest. The proposed treatment plan includes Zyprexa intramuscular injections up to a maximum daily does of 40 mg, with a conversion to Zyprexa tablets up to a maximum daily does of 50 mg.
The Patient expresses an objection to the antipsychotic medication, Zyprexa, because of its
risk of weight gain and diabetes. Dr. Michaels indicates that all antipsychotic medications run
those risks and feels that Zyprexa is preferred because it has a lesser number of side-effects than
other antipsychotic medications.
CONCLUSIONS OF
LAW
Based upon the findings of fact, this Court determines that CSH & C has proven by clear and convincing evidence that Ms. Worski-Chaphe lacks the capacity and insight necessary to make a reasoned decision regarding necessary treatment for her illness. Ms. Worski-Chaphe has a mental illness, specifically Bipolar disorder type 2, manic episode, with psychotic features. Further, the Court finds that the proposed treatment, is narrowly tailored to the needs of the Patient, giving substantive effect to the liberty interest of Ms. Worski-Chaphe; and that the benefits of the proposed treatment outweigh the risks in that this is the least restrictive alternative available. Finally, the Court finds that it is in Ms. Worski-Chaphe's best interest to receive the treatment (see Rivers v Katz 67 NY2d 485 (1986)).
Based upon the foregoing, this Court hereby orders that Clifton Springs Hospital and Clinic be permitted to involuntarily treat the Patient, including but not limited to, laboratory tests, psychotropic medication, to include Zyprexa intramuscular injections up to a maximum daily dose of 40 mg, with a conversion to Zyprexa tablets up to a maximum daily dose of 50 mg as prescribed by her treating physician, involuntarily and against Ms. Worski-Chaphe's objection.
The Court directs counsel for Clifton Springs Hospital and Clinic to submit an order in accordance herewith.
Signed this 6th day of November, 2008, at Canandaigua, New York.
Craig J. Doran
Acting Supreme Court Justice
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