In re Breault, A19-1484

942 N.W.2d 368

In the MATTER OF the Civil COMMITMENT OF: Lindsay Evan BREAULT.

A19-1484

Court of Appeals of Minnesota.

Filed March 9, 2020

James P. Conway, Nicole A. Raebel, Jaspers, Moriarty & Wetherille, P.A., Shakopee, Minnesota (for appellant Lindsay Evan Breault)

Ronald Hocevar, Scott County Attorney, Todd P. Zettler, Jody Kieser Kisting, Assistant County Attorneys, Shakopee, Minnesota (for respondent Scott County)

Considered and decided by Jesson, Presiding Judge; Ross, Judge; and Smith, John, Judge.^*

OPINION

JESSON , Judge Civil commitment patient Lindsay Evan Breault challenges a district court order authorizing medical staff to involuntarily administer neuroleptic medication to her. Breault argues that Minnesota Statutes section 253B.092, subdivision 8 (2018) requires the district court to find that a patient is currently refusing medication before it can authorize involuntary administration. Alternatively, Breault contends that the district court’s finding that a reasonable person in her position would consent to treatment with neuroleptic medication is not supported by the record. Because we conclude that the district court correctly applied the law and because the record supports its findings, we affirm.

FACTS

Appellant Lindsay Evan Breault has a history of mental illness, which led to civil commitment on two prior occasions.¹ Breault’s current commitment began in August 2019 when police responded to a call that Breault threatened to harm her child with a rubber mallet. Upon arrival at her residence, police observed Breault "speaking nonsensically" and describing hallucinations. Following this encounter, Breault was admitted to the hospital.

At the hospital, Breault was "delusional" and "acutely psychotic and paranoid." Based on her symptoms, doctors provisionally diagnosed her with paranoid schizophrenia and recommended neuroleptic medication to treat her condition.² But Breault refused the medication.

Roughly one week after her admission to the hospital, a petition was filed seeking Breault’s civil commitment. Simultaneously, respondent Scott County sought a court order authorizing the involuntary administration of the prescribed neuroleptic medication. About two weeks later, the district court held a hearing on the petition. At the hearing, which Breault did not attend, the court heard testimony from the physician tasked with examining Breault.³ His testimony focused on three topics: Breault’s compliance with taking the prescribed neuroleptic medication, her past experiences with neuroleptic drugs, and the benefits and risks of the medication.

Beginning with Breault’s medication compliance, the physician explained that when he drafted his report, Breault was not taking medication. However, he stated that he had since learned that in the three days before the hearing, which was held on August 22, 2019, Breault was taking the prescribed medication. But the physician also indicated that he was unsure of Breault’s exact level of compliance, testifying,"[w]ell, I know that she refused medications when she initially came in. I don't know what her compliance has been since August 15."

The physician then turned to Breault’s past experiences with neuroleptic medication. Based on his review of available medical records, he testified that there was no indication that Breault suffered negative side effects from neuroleptic medication. But the physician informed the court that he did not have Breault’s records from past hospitalizations. And while the physician knew Breault was previously hospitalized, he admitted that he did not know if she was prescribed neuroleptic medication. But he assumed doctors prescribed neuroleptic medication for Breault in the past based on her documented medical condition.

Finally, the physician addressed the benefits and risks associated with the prescribed medication, Invega. He testified that the drug has relatively few side effects. Although the drug can cause weight gain and tardive dyskinesia,⁴ the physician explained that there was no evidence Breault suffered from that condition. Further, the physician noted that taking the drug could make less-invasive forms of treatment appropriate in the future. In the physician’s professional opinion, Breault could remain in a psychotic state for a prolonged—if not indefinite—time period if she did not take the medication. He therefore opined that the benefits of taking the prescribed drug outweighed the risk of harm.

Along with the physician’s testimony, the district court took judicial notice of the reports authored by the civil commitment examiner and the guardian ad litem. Both reports recommended civil commitment and a court order authorizing involuntary administration of Breault’s medication. Each report focused on Breault’s inconsistent compliance with taking the prescribed medication, noting that during the hospitalization, Breault’s behavior ranged from adamant refusal of medication to compliance.

After the hearing, the district court found by clear and convincing evidence that Breault has a mental illness and committed her as mentally ill. Additionally, finding that Breault lacked capacity to make decisions regarding treatment with neuroleptic medication, the court issued an order authorizing its involuntary administration. Breault appeals, contesting only the court’s authorization of involuntary administration of neuroleptic medication.

ISSUES

I. Is this appeal moot because Breault asserts that she will voluntarily take the prescribed medication?

II. Before authorizing the involuntary administration of neuroleptic medication under Minnesota Statutes section 253B.092, subdivision 8, must the district court find that a patient is currently refusing those medications at the time of the hearing?

III. Does the record support the district court’s finding that a reasonable person in Breault’s position would consent to treatment with neuroleptic medication?

ANALYSIS

Before civilly committing an individual based on mental illness, a court must first find that clear and convincing evidence proves that the patient is mentally ill. Minn. Stat. § 253B.09, subd. 1(a) (2018). If the patient is mentally ill and no suitable alternative to judicial commitment exists, the court "shall commit the patient to the least restrictive treatment program or alternative programs which can meet the patient’s treatment needs."⁵ Id.

The court’s involvement does not end upon a patient’s commitment.⁶ Often, doctors recommend neuroleptic medication as a form of treatment for patients committed as mentally ill. That medication can have serious negative side effects including tardive dyskinesia and metabolic syndrome. Steven K. Erickson et al., Legal Fallacies of Antipsychotic Drugs , 35 J. Am. Acad. Psychiatry Law 235, 238 (2007); see also Jarvis , 418 N.W.2d at 146 (describing tardive dyskinesia ). But neuroleptic medication often improves cognitive functioning—including memory, attention, and executive functioning—in many individuals with certain types of mental illness. Erickson, supra , at 242. And essentially, these medications may reduce psychotic symptoms, such as hallucinations, delusions, and thought disorganization. See id.

Although patients are presumed to have capacity to make decisions about treatment with neuroleptic medication, when a patient either lacks capacity or refuses to consent, medical staff often seek judicial determinations related to the administration of that medication. See Minn. Stat. § 253B.092, subds. 5, 8. Minnesota law provides the path for doing so. It begins with the premise that court approval is necessary before medication can be administered involuntarily in nonemergency situations. Id. , subds. 3, 8(a). Determining whether a patient has capacity to make decisions about neuroleptic medication is the first step in the court process. Id. , subd. 5. If a court finds that the patient has capacity, the patient’s wishes must be followed. Id. , subds. 4, 8(d). If the patient lacks capacity, the court evaluates whether the patient expressed what they would do regarding neuroleptic medication "when the person had the capacity to make a reasoned decision." Id. , subd. 7(b). Again, if clearly expressed, the patient’s wishes control. Id. But if the court does not have evidence of the wishes of a patient without capacity, it must evaluate what a reasonable person would do, considering the four factors detailed in the statute. Id. , subd. 7(c)(1)-(4). In cases where the court concludes that a patient lacks capacity and determines that a reasonable person would consent to treatment with neuroleptic medication, it may authorize the involuntary administration of the prescribed drug. Id. , subd. 8(e).

With this backdrop in mind, we turn to Breault’s case. First, we address respondent’s argument that this appeal is moot. Having concluded that it is not, we evaluate Breault’s arguments. We begin by interpreting Minnesota Statutes section 253B.092, subdivision 8, concluding that a patient’s recent, inconsistent compliance in taking prescribed neuroleptic medication is a sufficient basis to determine that the patient "refuses to consent to treatment with neuroleptic medications." Then, we evaluate the district court’s findings regarding whether a reasonable person in Breault’s position would consent to treatment with neuroleptic medication. Because the district court did not erroneously apply the law and because its findings of fact are supported by the record, we affirm.

I. A patient’s assurance of voluntary compliance with a prescribed neuroleptic medication regimen does not render moot a challenge to an order authorizing involuntary administration of that medication.

Before we turn to Breault’s arguments, we must address the threshold question of whether this appeal is moot, as respondent contends.⁷ According to respondent, Breault conceded that she lacked capacity to make medication decisions and indicated that she would...