In re D.L.B., DA 15-0489
| Decision Date | 03 January 2017 |
| Docket Number | DA 15-0489 |
| Parties | In the MATTER OF: D.L.B., Respondent and Appellant. |
| Court | Montana Supreme Court |
For Appellant: Chad Wright, Chief Appellate Defender, Kristen L. Peterson, Assistant Appellate Defender, Helena, Montana.
For Appellee: Timothy C. Fox, Montana Attorney General, Katie F. Schulz, Assistant Attorney General, Helena, Montana, Thomas P. Meissner, Fergus County Attorney, Craig R. Buehler, Special Deputy County Attorney, Lewistown, Montana.
¶ 1 D.L.B. appeals the order of the Tenth Judicial District Court, Fergus County, recommitting him for a period of up to six months to the Montana Mental Health Nursing Care Center (Nursing Care Center) in Lewistown. We affirm, and state the issue as follows:
Did the District Court err by extending D.L.B.'s commitment to the Nursing Care Center?
¶ 2 D.L.B. is a 75-year-old male who, unfortunately, has suffered from mental illness his entire adult life. He was originally diagnosed with paranoid schizophrenia
after his first psychotic episode, at age 22. Since this initial diagnosis, D.L.B. has been involuntarily committed to mental hospitals throughout his life. D.L.B.'s May 2015 Mental Health Assessment for Recommitment states that he has been involuntarily committed to mental health hospitals at least six times and that other "[r]ecords indicate [that] he [has] likely had other psychiatric hospitalizations through the years, but [complete] information is not available."1 D.L.B.'s last four hospital commitments, in 2004, 2011, 2012, and 2014, were to the Montana State Hospital (MSH).
¶ 3 D.L.B.'s psychosis
centers around a fear of the Nazis and of being persecuted by them. He also suffers from delusions regarding an imaginary wife and children who reside in Canada. Critically, he has a pervasive history of medication noncompliance arising from his belief that he does not suffer from a mental illness.
¶ 4 D.L.B.'s 53-year history of mental illness evidences a relatively predictable and cyclical pattern, typically beginning with a psychotic episode. During these episodes, he acts out and is a physical danger to himself, as well as to others. The episodes typically result in an involuntary commitment of D.L.B. to a mental health hospital, where he is medicated and begins to stabilize. After improving, D.L.B. is transferred from the hospital to a mental health nursing care facility, where supervision helps him to stay on his medication and maintain stability. After he is released from the mental health nursing care facility to a community based rehabilitation center or treatment program, he typically stops taking his medicine, leading to another psychotic episode and a repeat of the cycle.
¶ 5 At the July 8, 2015, recommitment hearing, the District Court verbally summarized D.L.B.'s condition as follows:
¶ 6 In 2014, D.L.B. was living at a rehabilitative center in Dillon when he again refused to take his medicine. He decompensated to the point that he "believed staff at the facility were contracting with the Nazi's [sic] to torture him and inflict pain on him with infrared devices." He became verbally aggressive and attempted to physically strike the staff, leading to his commitment to MSH on September 23, 2014. On March 24, 2015, after he had stabilized, D.L.B. was transferred from MSH to the Nursing Care Center. Based on his behaviors, however, D.L.B. was considered an elopement risk. At the Nursing Care Center, D.L.B. received regular medical and psychiatric care. Despite this care, D.L.B. continued to have visual hallucinations and paranoid delusions
, be verbally and physically aggressive toward the staff, refuse to take his medication, and isolate himself. On June 2, 2015, the State filed the subject petition to extend D.L.B.'s commitment to the Nursing Care Center for further evaluation and treatment.
¶ 7 In support of the petition, the State submitted a report by Susan Stevens (Stevens), a Mental Health Professional.2 Stevens' report explained that D.L.B. had a long history of medication noncompliance and, consequently, a recurring inability to successfully live independently in community-based placements, despite his receipt of supportive services. She also opined that:
[A]s a result of [D.L.B.'s] mental illness he presents as a danger to self and potentially others when he is medication non-compliant. Commitment proceedings should not be dismissed. [D.L.B.] presents as a danger to self due to florid psychosis
(delusions and hallucinations). He has an extensive history of becoming medication non-compliant then decompensates very quickly and becomes confused and unable to meet and maintain his most basic needs of food, clothing, shelter, health, and safety.
He potentially presents as a danger to others due to his recent history of becoming verbally and physically aggressive towards others.
¶ 8 On July 8, 2015, an adjudicatory hearing was held at the Nursing Care Center. Debbie Moore (Moore), Director of Nursing at the Center, testified that D.L.B. continued to exhibit characteristic behaviors of paranoid schizophrenia
such as auditory hallucinations, delusions, false beliefs that people were plotting against him, and delusions of grandeur. While noting that D.L.B. was "beginning to do well," she stated that he continued to deny the need for medication and to make statements about not wanting to take medication. Moore opined that D.L.B. continued to meet the admission criteria for the Nursing Care Center based on his continued delusions, paranoid thoughts, and a lack of judgment and insight into his mental health needs. Stevens testified that the Nursing Care Center was a lesser restrictive environment than D.L.B.'s prior placement at MSH, and opined that D.L.B. was not yet ready for a less restrictive, community based placement. At the conclusion of the hearing, the District Court orally extended D.L.B.'s commitment to the Nursing Care Center for a period of not more than six months. A written order was entered on July 16, 2015, which did not specify under what statutory provisions D.L.B. was being re-committed.
¶ 9 D.L.B. appeals.
¶ 10 We review commitment orders to determine whether a district court's findings of fact are clearly erroneous and its conclusions of law are correct. In re S.G.R. , 2016 MT 70, ¶ 13, 383 Mont. 74, 368 P.3d 1180 (citing In re S.M. , 2014 MT 309, ¶ 13, 377 Mont. 133, 339 P.3d 23 ). A finding of fact is clearly erroneous if it is not supported by substantial evidence, if the district court misapprehended the effect of the evidence or if, after a review of the entire record, we are left with a definite and firm conviction that a mistake had been made. In re S.G.R. , ¶ 13 (citing In re Mental Health of L.K. – S. , 2011 MT 21, ¶ 14, 359 Mont. 191, 247 P.3d 1100 [hereinafter In re L.K. – S. ] ). Whether a district court's findings of fact meet statutory requirements is a question of law that we review for correctness. In re S.G.R. , ¶ 13 (citing In re L.L.A. , 2011 MT 285, ¶ 6, 362 Mont. 464, 267 P.3d 1 ).
¶ 11 Did the District Court err by extending D.L.B.'s commitment to the
¶ 12 Arguing that Montana's involuntary commitment statutes require that a recommitment meet the identical standards of an original commitment, D.L.B. contends that the District Court's findings are insufficient to satisfy the commitment criteria under § 53–21–126(1)(a), (b), or (c), MCA, and that the evidence satisfies recommitment only under § 53–21–126(1)(d), MCA. Commitments ordered pursuant to § 53–21–126(1)(d), MCA, may only be made "to a community facility or program or an appropriate course of treatment ... and may not require commitment at the state hospital, a behavioral health inpatient facility, or the Montana medical health nursing care center." Section 53–21–127(7), MCA. D.L.B. thus argues that his recommitment to the Lewistown Nursing Care Center violates these provisions. In essence, D.L.B. asserts that these statutes must be narrowly interpreted and that the criteria stated in § 53–21–126(1)(a)-(d), MCA, are the only appropriate considerations in determining whether recommitment should be ordered.
¶ 13 The State responds that the § 53–21–126(1), MCA, criteria must be evaluated in the context of a recommitment. Noting that this statute states that, when "determining whether the respondent requires commitment and the appropriate disposition...., the court shall consider " the listed criteria, the State argues the statute does not prohibit consideration of additional circumstances related to a respondent, including, in a recommitment proceeding, a respondent's relevant medical history and continuing treatment requirements. Section 53–21–126(1), MCA (emphasis added). The State contends that, when placed in this context, the District Court's findings are sufficient to support recommitment.
¶ 14 Section 53–21–128(1), MCA, provides that "[n]ot less than 2 weeks" before the expiration of a commitment, the professional person in charge of the patient at the place of commitment may petition the district...
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