In re B.L.S.

Decision Date20 October 2006
Docket NumberNo. 20060234.,20060234.
Citation2006 ND 218,723 N.W.2d 395
PartiesIn the Interest of B.L.S. Rick Eckroth, Petitioner and Appellee v. B.L.S., Respondent and Appellant.
CourtNorth Dakota Supreme Court

Brian D. Grosinger (argued), Assistant State's Attorney, Mandan, ND, for petitioner and appellee.

Greg I. Runge (argued), Bismarck, ND, for respondent and appellant.

KAPSNER, Justice.

[¶ 1] B.L.S. appeals a district court order, involuntarily committing him to the North Dakota State Hospital ("State Hospital") and allowing him to be treated involuntarily with prescription medication. We affirm in part and reverse in part.

I

[¶ 2] B.L.S., a 44-year-old man diagnosed with paranoid schizophrenia, was incarcerated in the Morton County Correctional Center. Staff at the correctional center noticed B.L.S.'s behavior progressively worsen during his incarceration. After three months, a correctional officer petitioned the district court to involuntarily commit B.L.S. to the State Hospital. The petition alleged that B.L.S. had washed his undergarments in a toilet in which he had just defecated; taken three-hour showers; stood in the toilet, flooding his cell; refused his medications; wrote pages of incoherencies; chronically masturbated; had extreme hygiene problems; had a violent disposition; and was delusional. The officer believed that hospitalization was necessary to prevent B.L.S. from injuring himself.

[¶ 3] The court held a preliminary hearing and a treatment hearing to decide whether B.L.S. was mentally ill and whether he required treatment. B.L.S.'s psychiatrist, Dr. William Pryatel, sought a court order to involuntarily treat B.L.S. with medication. Dr. Pryatel filed a Request to Treat with Medication ("Request") on July 7, 2006, asking the court to authorize the forcible use of four medications: Risperdal, Haloperidol, Geodon, and Olanzapine. As required by N.D.C.C. § 25-03.1-18.1(1)(a), another physician, Dr. Diana Robles, certified that the prescriptions were "clinically appropriate and necessary to effectively treat [B.L.S.]" and that there was a reasonable expectation of a "serious risk of harm" if he was not treated as requested. Dr. Pryatel also submitted a Notice of Medication ("Notice I"), dated July 11, 2006, indicating that several additional medications had been given to B.L.S. prior to the hearing. Notice I provided that "[Sodium] Polystyrene, Amlodipine, Furosemide, Enalapril, Amitriptyline, Nambumetone, and Allopurinol" had been given to B.L.S.

[¶ 4] At both proceedings, the court appointed counsel for B.L.S., but he sought to represent himself. The court allowed him to do so, but did not excuse the appointed counsel. The court did not determine in either proceeding, on the record, that B.L.S. knowingly, intelligently, and voluntarily waived the right to counsel. At the treatment hearing's conclusion, the court found, by clear and convincing evidence, that B.L.S. was mentally ill, required treatment, and that forced medication was necessary. The court order specifically authorized the use of "Risperdal, Haloperidol, Geodon, [and] Olanzapine."

[¶ 5] B.L.S. appealed and, on August 28, 2006, we reversed, reaching only the waiver of counsel issue. Interest of B.L.S., 2006 ND 188, ¶ 13, 721 N.W.2d 50. We remanded the case for new proceedings on the petition. Id.

[¶ 6] On September 5, 2006, the district court held a second treatment hearing. B.L.S. again sought to represent himself. The court, however, did not approve his request. On the record, it engaged in a colloquy concerning B.L.S.'s competence to waive counsel, ruling he did not appreciate the risks of self-representation and that the appointed counsel, Greg Runge, would represent him.

[¶ 7] At the second treatment hearing, Dr. Pryatel presented another Notice of Medication ("Notice II"), dated September 5, 2006, indicating that B.L.S. had been given six medications, including: "Haloperidol Deconate, Haloperidol, Furosemide, Enalapril (Vasotec), Allopurinol, [and] Amlodipine (Norvasc)." Testimony at the second hearing disputed whether all of the listed medications had actually been given. Dr. Pryatel did not file a new Request or amend his previous Request. He testified that Haloperidol and Haloperidol Deconate were psychotropic medications used to treat B.L.S.'s schizophrenia, but the rest of the medications listed in Notice II were used to treat B.L.S.'s blood pressure, high potassium levels, and gout. B.L.S.'s counsel extensively cross-examined Dr. Pryatel on the side effects of the four psychotropic medications noticed in the Request, "Risperdal, Haloperidol, Geodon, [and] Olanzapine."

[¶ 8] At the hearing's conclusion, the court found, by clear and convincing evidence, that B.L.S. was mentally ill, required treatment, and that forced medication was necessary. Accordingly, the district court committed B.L.S. to the State Hospital for the remainder of the 90 days imposed by the original treatment order. The court also authorized the use of "Risperdal, Haloperidol, Geodon, Olanzapine, Haloperidol Deconate, . . . Furosemide, Enalapril, Allopurinol, [Amlodipine], [and] Sodium [Polystyrene]."

II

[¶ 9] On appeal, B.L.S. argues that the petitioner failed to establish, by clear and convincing evidence, that B.L.S. was mentally ill, required treatment, and that forced medication was necessary. He also argues his due process rights were violated because the district court authorized the use of more medications than were originally noticed in Dr. Pryatel's Request. The petitioner argues there was sufficient evidence to determine that B.L.S. was a mentally ill person requiring treatment, and the district court properly authorized forced medication.

III

[¶ 10] Our review of an appeal under N.D.C.C. ch. 25-03.1 is "limited to a review of the procedures, findings, and conclusions of the trial court." Interest of D.A., 2005 ND 116, ¶ 11, 698 N.W.2d 474. We review the findings of the district court under the more probing clearly erroneous standard of review. Id. A finding of fact is clearly erroneous if "it is induced by an erroneous view of the law, if there is no evidence to support it, or if, although there is some evidence to support it, on the entire evidence this Court is left with a definite and firm conviction `it is not supported by clear and convincing evidence.'" Id. (quoting Interest of J.D., 2002 ND 50, ¶ 13, 640 N.W.2d 733 and Interest of R.N., 513 N.W.2d 370, 371 (N.D.1994)).

[¶ 11] B.L.S. argues there was no clear and convincing evidence to support the finding that he is "mentally ill" and a "person in need of treatment." The statute defines "mentally ill person," in pertinent part, to include "individual[s] with an organic, mental, or emotional disorder which substantially impairs the capacity to use self-control, judgment, and discretion in the conduct of personal affairs and social relations." N.D.C.C. § 25-03.1-02(11) (2005). Section 25-03.1-02(12)(b)-(c), N.D.C.C., provides that a "person requiring treatment" is one who:

is mentally ill . . . and there is a reasonable expectation that if the person is not treated there exists a serious risk of harm to that person, others, or property. "Serious risk of harm" means a substantial likelihood of:

. . . .

b. Killing or inflicting serious bodily harm on another person or inflicting significant property damage, as manifested by acts or threats;

c. Substantial deterioration in physical health, or substantial injury, disease, or death, based upon recent poor self-control or judgment in providing one's shelter, nutrition, or personal care.

A Morton County correctional officer testified that B.L.S. had engaged in bizarre activities such as washing his undergarments and hands in an unflushed toilet. He also testified that B.L.S. had extreme hygiene issues, indicating that he had "poor self-control or judgment in providing [for his] . . . personal care." This behavior supports the district court's finding of mental illness.

[¶ 12] Dr. Pryatel testified that he evaluated B.L.S. and diagnosed him with schizophrenia. B.L.S. has been hospitalized at the State Hospital approximately ten times in the last fifteen years. All of B.L.S.'s prior diagnoses have been consistent with Dr. Pryatel's most recent evaluation. Dr. Pryatel also testified B.L.S. has been engaging in sexually aggressive and predatory behavior while at the State Hospital. B.L.S. had cornered female staff and had exposed himself. Dr. Pryatel stated this behavior reinforces the necessity for treatment because B.L.S. is delusional in that he believes the female staff members "want him sexually." This behavior also supports the court's finding that B.L.S. manifested threatening behavior while at the State Hospital. Finally, Dr. Pryatel testified B.L.S. needs medical treatment in order to adequately care for his physical health. Although Dr. Pryatel testified that some of his medical conditions had improved under treatment, he indicated they remained life-threatening if left untreated. Interest of M.M., 2005 ND 219, ¶ 11, 707 N.W.2d 78 (holding that due to mental illness, the respondent was not able to make rational medical decisions, posing a "serious risk of harm" if left untreated). B.L.S.'s conduct and serious medical conditions support the determination that B.L.S. is mentally ill and a person in need of treatment. Cf. Interest of P.B., 2005 ND 201, ¶ 9, 706 N.W.2d 78 (citing Interest of K.G., 2005 ND 156, ¶ 7, 703 N.W.2d 660) (noting that past conduct can be an indication of future risks in mental health appeals).

[¶ 13] Based on the record, there was sufficient evidence to support the court's findings. Therefore, the district court's findings that B.L.S. is mentally ill and requiring treatment were not clearly erroneous and we will not disturb them on appeal. M.M., 2005 ND 219, ¶ 11, 707 N.W.2d 78; see also N.D.R.Civ.P. 52(a).

IV

[¶ 14] B.L.S. argues that there was not clear and convincing...

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