In re Froehlich

961 N.W.2d 248

In the MATTER OF the Civil COMMITMENT OF: Matthew Shawn FROEHLICH.

A20-1437

Court of Appeals of Minnesota.

Filed May 10, 2021

Tanner Holten, Reynolds, Harbott, Knutson & Larson, P.L.L.P., Crookston, Minnesota (for appellant Matthew Froehlich)

Keith Ellison, Attorney General, Brandon Boese, Assistant Attorney General, St. Paul, Minnesota (for respondent Haron Manwa, on behalf of the Minnesota Department of Human Services)

Considered and decided by Bratvold, Presiding Judge; Bjorkman, Judge; and Bryan, Judge.

BJORKMAN, Judge

Appellant challenges the district court's order authorizing the involuntary administration of neuroleptic medication, arguing that (1) the preponderance-of-the-evidence standard established in Minn. Stat. § 253B.092, subd. 6(d), for a determination of incapacity violates his right to privacy under the Minnesota Constitution, and (2) the record does not support the court's decision because his mental-health advance directive states that he does not consent to neuroleptics. Because we discern no error in the district court's legal analysis and the record supports its factual findings, we affirm.

FACTS

Appellant Matthew Froehlich is a 41-year-old man with schizophrenia spectrum disorder and bipolar disorder. He has been civilly committed numerous times because of his mental illness. His current civil commitment began September 9, 2020. Treatment providers sought to administer neuroleptic medication, but Froehlich refused, denying any mental illness. Because they believed Froehlich's behavior posed a risk of harm to himself and others, treatment providers administered the injectable neuroleptic Haldol to Froehlich on an emergency basis. And on September 14, respondent Haron Manwa, a psychiatric nurse practitioner, filed a petition on behalf of the Minnesota Department of Human Services, seeking court authorization to involuntarily administer neuroleptic medication to Froehlich.

The district court appointed two examiners to assess Froehlich's capacity to make decisions regarding the use of neuroleptic medications and the appropriateness of the proposed medications. Each examiner spoke with Froehlich and reviewed his medical history, including his past civil commitments. At a hearing, both examiners and Manwa opined that Froehlich lacks capacity to make decisions regarding the administration of neuroleptic medication. Manwa also testified that he proposes to continue treating Froehlich with Haldol until he stabilizes, and then transition to Latuda, which Froehlich has responded to well in the past but requires his compliance because it can only be administered orally. The examiners agreed that the proposed medications are part of standard treatment for Froehlich's condition.

To counter this evidence, Froehlich presented his April 2012 mental-health advance directive, in which he states, among other things, that in the event of incapacity, he "do[es] not consent to any psychotropic medication."¹ And Froehlich's mother testified. She explained that she assisted Froehlich in completing the advance directive and believed that, at that time, he had capacity to make decisions about his use of neuroleptic medications. She stated that Froehlich wanted to avoid using neuroleptic medication because of "adverse reactions." But she acknowledged that Froehlich had been taking Latuda until a disruption with his prescription led him to halve his dosage and then discontinue the medication in August 2020, precipitating his decompensation and this commitment. She also agreed that Froehlich "needs to use some neuroleptics to get better."

The district court determined by a preponderance of the evidence that Froehlich currently lacks capacity to decide for himself whether to consent to neuroleptic medication and did not clearly state a reasoned opposition to neuroleptics. The court also determined that the treatment is reasonable and necessary, and authorized the involuntary administration of Haldol and Latuda. Froehlich appeals.

ISSUES

I. Does the requirement in Minn. Stat. § 253B.092, subd. 6(d), that the petitioner

prove the patient's incapacity by a preponderance of the evidence infringe on the patient's constitutional right to privacy?

II. Does the record support the decision to authorize neuroleptic medication?

ANALYSIS

Doctors often prescribe neuroleptic medication to treat patients who are civilly committed because of mental illness. Breault , 942 N.W.2d at 373. Such medication can improve cognitive function and reduce psychotic symptoms but may also "have serious negative side effects." Id. ; see Jarvis , 418 N.W.2d at 145-46 (concluding that neuroleptic medication constitutes "intrusive" treatment). The Minnesota Constitution affords each individual, including civilly committed patients, a right to privacy that includes the right of "a competent person" to refuse such intrusive medical treatment. Jarvis , 418 N.W.2d at 148. And the legislature established safeguards in Minn. Stat. § 253B.092 to protect this right.

Principal among these safeguards is a "rebuttable presumption that a patient has the capacity to make decisions regarding administration of neuroleptic medication." Minn. Stat. § 253B.092, subd. 5(a). Absent an emergency, if a patient refuses consent, the medication "may not be administered without a court order." Id. , subd. 8(a); see id. , subd. 3 (providing for short-term involuntary treatment with neuroleptics). A patient's treatment provider may petition for court authorization to administer neuroleptics despite the patient's refusal. See id. , subd. 8(a). A court "may" grant the petition if it finds that (1) the patient lacks capacity and (2) analysis of statutory factors shows that a reasonable person would choose to permit the administration of neuroleptic medication under the circumstances. Id. , subd. 8(c), (d); see id. , subd. 7 (articulating factors district courts consider when determining whether it is appropriate to authorize administration of neuroleptic medication to a patient who lacks capacity).

I. The requirement in Minn. Stat. § 253B.092, subd. 6(d), that the petitioner prove incapacity by a preponderance of the evidence does not violate a patient's right to privacy.

The constitutionality of a statute is a question of law that we review de novo. In re Kindschy , 634 N.W.2d 723, 729 (Minn. App. 2001), review denied (Minn. Dec. 19, 2001). We presume that statutes are constitutional, and the party challenging the constitutionality of the statute "has the onus of establishing beyond a reasonable doubt that the statute violates a claimed right." In re Schmidt , 443 N.W.2d 824, 826 (Minn. 1989).

Under Minn. Stat. § 253B.092, subd. 6(d), the petitioner "has the burden of proving incapacity by a preponderance of the evidence." Froehlich argues that the statute is unconstitutional because a clear-and-convincing-evidence standard is necessary to protect the constitutional right to privacy recognized in Jarvis . We disagree.

The origin of the clear-and-convincing-evidence standard that Froehlich urges is In re Peterson , in which we considered the neuroleptic-medication statute that the legislature passed in response to Jarvis .² 446 N.W.2d 669, 671-72 (Minn. App. 1989), review denied (Minn. Dec. 1, 1989). That statute (the precursor to what is now Minn. Stat. § 253B.092 ) did not prescribe a standard of proof for a petitioner seeking court authorization to administer neuroleptic medication. Id. at 672. We generally regard such an omission as a signal that the legislature intended the preponderance-of-the-evidence standard to apply. C.O. v. Doe , 757 N.W.2d 343, 353 (Minn. 2008). But mindful that the legislature required clear and convincing evidence for initial commitment decisions, we concluded that "the legislature intended that persons seeking to administer neuroleptic medications must prove by clear and convincing evidence that such medication is necessary." Peterson , 446 N.W.2d at 672. We observed that this higher standard of proof reflects "the gravity of such intrusive treatment and the necessity for extensive safeguards" recognized in Jarvis . Id. We did not address whether the clear-and-convincing-evidence standard also applies to the question of a patient's capacity to decide whether to take neuroleptic medication. See id.

Since Peterson , the legislature has substantially amended and clarified the law regarding the administration of neuroleptic medication. See Breault , 942 N.W.2d at 375 (summarizing statutory changes, including 1997 enactment of Minn. Stat. § 253B.092 ). In doing so, it did not prescribe a different standard for proving the necessity of neuroleptic medication, effectively adopting the clear-and-convincing-evidence standard. See In re Civil Commitment of Ince , 847 N.W.2d 13, 21 (Minn. 2014) (stating that judicial construction of a statute becomes "part of the statute as though written therein" (quotation omitted)); Breault , 942 N.W.2d at 378 & n.11 (reciting the Peterson standard and noting the legislature has not prescribed a different standard). But for proving incapacity, the legislature expressly prescribed the lower preponderance-of-the-evidence standard. Minn. Stat. § 253B.092, subd. 6(d).³

In urging us to strike down this preponderance standard, Froehlich characterizes the issue of incapacity as merely a subset—like medical necessity—of the broader question of involuntary administration of neuroleptic medication. But they are distinct issues, with distinct consequences. See Jarvis , 418 N.W.2d at 148 n.7 (distinguishing between a patient's "incompetence" and whether to forcibly administer neuroleptics). Only the medical-necessity step of the statutory process affects a patient's ability to control "the integrity of [his] own body." See id. at 148. Froehlich has not persuaded us that applying the lower standard of proof on the issue of incapacity infringes on his right to privacy.

"[A] preponderance-of-the-evidence standard signals that the...