Winnebago Cnty. v. C.L.S. (In re C.L.S.)

1

In the matter of the mental commitment of C.L.S.:

Winnebago County, Petitioner-Respondent, v. C.L.S., Respondent-Appellant.

No. 2022AP1155-FT

Court of Appeals of Wisconsin, District II

December 14, 2022

This opinion will not be published. See Wis. Stat. Rule 809.23(1)(b)4.

APPEAL from an order of the circuit court for Winnebago County: No 2022ME31 BARBARA H. KEY, Judge. Affirmed.

NEUBAUER, J. ^[1]

¶1 C.L.S. appeals from an order extending his commitment under Wis.Stat. ch. 51. The circuit court ordered him recommitted^[2]for twelve months and ordered involuntary administration of medication and treatment during that time.^[3] C.L.S. argues the circuit court erred in concluding that Winnebago County proved by clear and convincing evidence that he was dangerous under the fifth standard in Wis.Stat. § 51.20(1)(a)2.e. He also contends the circuit court failed to make the findings required under Langlade County v. D.J.W., 2020 WI 41, ¶59, 391 Wis.2d 231, 942 N.W.2d 277. This court affirms.

BACKGROUND

¶2 In January 2022, C.L.S.'s treating psychiatrist, Dr George Monese, wrote a letter to the circuit court recommending an extension of C.L.S.'s involuntary commitment. In the letter, Monese wrote that C.L.S. has a "history of bipolar 2 disorder" and tried to commit suicide several years earlier after he stopped taking medication and experienced "auditory hallucinations." Monese recommended the extension because C.L.S. told him that "even though [C.L.S.] understands he has a serious mental illness, he still has residual psychosis on and off which he fears might overpower him and lead him to stop taking medications if off commitment." Monese stated further that C.L.S. had indicated he would immediately stop taking his medications if his commitment ended.

¶3 Monese also submitted a form to the County requesting the extension of C.L.S.'s commitment and involuntary medication orders, asserting that C.L.S. "is mentally ill and his diagnosis is Bipolar II disorder," which continues to substantially impair his thought, mood judgment, and "capacity to recognize reality." In addition to C.L.S.'s mental illness, Monese wrote that he believed C.L.S. "is a proper subject for treatment" and, pursuant to the fifth standard for dangerousness, Wis.Stat. § 51.20(1)(a)2.e., "is dangerous because there is a substantial likelihood, based on his treatment record, that he would become a proper subject for commitment if treatment were withdrawn." Finally, Monese wrote that C.L.S. is "not competent to refuse medication or treatment" because Monese "recently tried to explain to [C.L.S.] the advantages, disadvantages, and alternatives to accepting a particular medication or treatment" and found C.L.S. "substantially incapable of applying an understanding of the advantages, disadvantages, and alternatives to his mental illness in order to make an informed choice as to whether to accept or refuse medication or treatment."

¶4 The County then filed a Petition for Recommitment and for Involuntary Medication or Treatment. The circuit court held a two-day hearing on the petition in March 2022 at which Monese was the only witness to testify. Monese testified that C.L.S. has been his patient since 2010 or 2011. He met with C.L.S. two days before the hearing, discussed C.L.S. with staff at the Wisconsin Resource Center, and reviewed his medical records. Monese identified C.L.S.'s diagnosis as "Bipolar disorder, type 2," which he described as a disorder of "[t]hought and mood, mostly." He agreed that C.L.S.'s condition "grossly impair[s] his judgment, behavior, [and] capacity to recognize reality" when he is "off treatment" and that C.L.S. remains "a proper subject for treatment."

¶5 When asked if C.L.S. would "become a proper subject for commitment" if his treatment were withdrawn, Monese said "certainly that will be the case," pointing to two prior instances in which he had attempted suicide after his medications were changed or stopped, one of which occurred three or four years ago.^[4] Monese also testified that C.L.S. has a history of hearing voices when he stops taking medication or when it is changed. Responding to a question about C.L.S.'s need for further treatment, Monese referenced these voices and C.L.S.'s disinclination to continue taking his medication voluntarily:

He told me frankly that he would not take the medications without a court commitment. He's ambivalent. Ambivalence is very common in people with [a] major thought disorder like he [has]. They kind of believe that they have the mental illness, they don't believe, they kind of question, and he falls in that category too and that is not surprising.

He told me that the voices told him before that he should stop taking treatment a few years ago when he attempted to hang himself and there was the case. So he's not able really to comprehend how … the medications are going to best help him and stay consistent in taking them. So the insight is very questionable.

As to "recent acts or omissions" that led Monese to believe continued commitment and treatment "would prevent further disability or deterioration," Monese testified that C.L.S. had told him "recently … he had the voices telling him you better stop taking th[ese] medications. And then he was kind of feeling that overpowering him."

¶6 When asked if C.L.S. showed "a substantial probability" that he would "lack the services necessary for his health or safety," Monese responded: "[C.L.S.] said that himself, he said if I don't have the commitment I am not going to take the medications because the voices would tell me to and I tend to listen to my voices." Monese also responded "Yes" when asked if C.L.S. had shown "a substantial probability" he would "suffer … severe mental, emotional, or physical harm resulting in loss of his ability to function independently" and "could potentially lose his cognitive or volitional control of [his] thoughts or actions" if he was not treated. As an example of the risks C.L.S. faces, Monese said that C.L.S. could "do what the voices tell him to, like hanging himself, he can suffer from that and die; or he can have debilitating neurological effects resulting from that attempted hanging or any form of attempted suicide."

¶7 In addition, Monese confirmed that C.L.S.'s mental illness renders him "incompetent" to make decisions about his medication or treatment. He testified that he identified several advantages of taking medication for C.L.S., such as the ability to better "control these bad thoughts of him wanting to kill himself" and improved mood, as well as several disadvantages ("lack of motivation, maybe tiredness, maybe some muscle stiffness"), but C.L.S. "wasn't able to use that information to his best interest."

¶8 After Monese finished testifying, the parties made their final arguments. The County argued that it proved each element for recommitment, including that C.L.S. was dangerous under the fifth standard, Wis.Stat. § 51.20(1)(a)2.e. C.L.S. argued that the most recent suicide attempt Monese had testified about occurred in 2016, and the County had not shown any "recent acts or omissions" to support a finding that he is currently dangerous. The County attributed the lack of a "recent overt act … to the fact that [C.L.S.] remains on medication" that "is beneficial and … is having a therapeutic benefit."

¶9 The circuit court determined that the County met its burden of proof. Drawing on the "very specific testimony" from Monese, it found that C.L.S. "is suffering from bipolar type 2 disorder … a substantial disorder of thought and mood that is grossly impairing his judgment, behavior, ability to meet the ordinary demands of life, [and] capacity to recognize reality." The court also found that C.L.S. would become a "proper subject for commitment" if his treatment were withdrawn. It described C.L.S.'s case as "one of the more stark cases in which the person has said if I don't take those medications, I will listen to those voices that I shouldn't be listening to" and noted his prior "serious suicide attempts." The court also found that C.L.S. would be "a significant danger to himself" "[w]ithout the proper treatment and medications." Based upon its findings, the court determined C.L.S. to be dangerous under the fifth standard, ordered C.L.S. recommitted for twelve months, and ordered the continued administration of involuntary medication.

DISCUSSION

¶10 "To prevail in a recommitment proceeding, the County must prove the same elements necessary for the initial commitment by clear and convincing evidence-that the patient is (1) mentally ill; (2) a proper subject for treatment; and (3) dangerous to themselves or others." D.J.W. 391 Wis.2d 231, ¶31.

¶11 Wisconsin Stat. § 51.20(1)(a)2.a.-e. sets out five standards for proving dangerousness. Here, the County sought recommitment under the fifth standard, § 51.20(1)(a)2.e., which required it to prove the following by clear and convincing evidence:

(1) C.L.S. is mentally ill;

(2) C.L.S.'s mental illness prevents him from making an informed choice as to whether to accept or refuse treatment;

(3) C.L.S. shows a substantial probability that he needs care or treatment to prevent further disability or deterioration, based upon his treatment history and recent acts or omissions;

(4) C.L.S. evidences a substantial probability that he will lack services necessary for his health and safety if he is left untreated; and

(5) C.L.S. evidences a substantial probability that he will suffer mental, emotional, or physical harm if left untreated, resulting in the loss of either his ability to function independently in the community or cognitive or volitional control over his thoughts or actions.

See § 51.20(1)(a)2.e., (13)(e); State v Dennis H., ...