In re In re Necessity for the Hospitalization of Abigail B. the Necessity for the Hospitalization of Jethro S.
| Citation | 528 P.3d 440 |
| Docket Number | Supreme Court Nos. S-17389/17616 (Consolidated) |
| Decision Date | 28 April 2023 |
| Parties | In the MATTER OF the Necessity for the Hospitalization of ABIGAIL B. In the Matter of the Necessity for the Hospitalization of Jethro S. |
| Court | Alaska Supreme Court |
George W.P. Madeira, Assistant Public Defender, and Samantha Cherot, Public Defender, Anchorage, for Abigail B. and Jethro S.
Laura Wolff, Assistant Attorney General, Anchorage, and Treg R. Taylor, Attorney General, Juneau, for State of Alaska.
Before: Winfree, Chief Justice, Maassen, Carney, and Henderson, Justices. [Borghesan, Justice, not participating.]
Two individuals were detained at local hospitals after they suffered psychiatric emergencies. The superior court orders authorizing the detentions required each individual to be immediately transported to an available bed at an evaluation facility. But there were no beds available, so neither individual was immediately transported. After holding review hearings at the individuals’ requests, the superior court in each case authorized continued detention. The individuals remained detained in hospitals until they were transported to evaluation facilities. They appeal the detention orders, arguing that their prolonged pre-evaluation detentions violated their substantive due process rights. Applying our recent decision in In re Hospitalization of Mabel B. ,1 we agree that the individuals’ substantive due process rights were violated because the nature and duration of their detentions were not reasonably related to the purpose of facilitating immediate transportation for evaluation.
Alaska law provides procedures for certain individuals with mental illness or grave disability to undergo involuntary commitment.2 Upon petition and a superior court's determination that there is probable cause to believe an individual is mentally ill and, as a result of that mental illness, is gravely disabled or likely to cause serious harm to self or others, the court may order that the individual be transported to an evaluation facility for further examination and evaluation of whether the person meets commitment criteria.3 In emergent circumstances, when a peace officer or particular type of licensed health professional has probable cause to believe a person is gravely disabled or mentally ill and likely to cause serious harm of an especially immediate nature to self or others, that person may be placed in protective custody pending further evaluation.4 "When a facility receives a proper order for evaluation, it shall accept the order and the respondent for an evaluation period not to exceed 72 hours," excluding weekends and holidays.5 Although the "statutes do not explicitly create any time limits between the ex parte order and transport to the facility,"6 they nonetheless "evidence a legislative intent that the respondent who is subject to an emergency ex parte order must be transported immediately to the nearest evaluation facility."7 Due to facility capacity issues, however, individuals like the respondents in this case have at times been detained for lengthy periods while awaiting evaluation.8
On January 19, 2019, Abigail9 was taken to the emergency room at Providence Kodiak Island Medical Center after her husband called the State Troopers to report she had attempted suicide. She was escorted by a Kodiak police officer, who sent the court notice of Abigail's emergency pre-evaluation detention indicating his belief that Abigail was mentally ill and that there was probable cause she was likely to cause serious self-harm based on her statements that "she wanted to kill herself" after she "admitted taking approximately 20 pills" over the prescribed amount.
When Abigail arrived at the hospital she tried to harm herself, including by pulling out her own hair, and was aggressive toward hospital staff. Abigail presented "right below" the "highest risk" level when she was admitted. The Kodiak hospital staff restrained her physically and chemically, including temporary use of four-point physical restraints and a shot of the powerful anti-psychotic drug Haldol
, which can continue having effects for up to a week and a half. The hospital would not let her leave without a court order; had she attempted to leave, hospital security would have detained her or called the police to detain her in the hospital or in jail.
A social worker at the hospital petitioned the superior court for an ex parte order authorizing Abigail's hospitalization for evaluation. The petition alleged that Abigail was mentally ill because she had tried to commit suicide by ingesting a bottle of prescription acetaminophen-codeine
while drinking three large beers. It also explained that Abigail told paramedics she "wanted to kill herself" and told an emergency room doctor that she "want[ed] [t]o die." A master recommended granting the order for hospitalization at the first available facility, and the superior court approved the master's recommendation.
Despite the superior court's order that Abigail be delivered "immediate[ly]" to the "first available bed" at an evaluation facility, she remained detained at the Kodiak hospital because there were no available beds at any evaluation facilities. Nine days after Abigail was initially detained, she filed an unopposed motion for a review hearing and argued that her detention was no longer warranted.
The superior court held the review hearing on January 30 — 11 days after Abigail's initial detention. The State presented a counselor from the Kodiak hospital as its sole witness. The counselor had interviewed Abigail on four separate days during her detention, including the day of the hearing. He testified that, in his opinion, Abigail still met the criteria for emergency hospitalization and continued to be a danger to herself. Relying on his review of Abigail's medical records and information from other clinicians, the counselor explained that Abigail had a long history of sudden mental health crises requiring restraint and the administration of medication. He also stated that Abigail had continued to express suicidal ideation
as recently as the morning of the hearing, but he did not believe she had a present plan to follow through.
The counselor further testified that Abigail was doing "a lot better" since she was admitted; she had "significantly calmed down" and did not have "any other incidents requiring restraints." He attributed most of her improvement to the Haldol
injection administered soon after she arrived at the hospital; he noted that the effects last "sometimes a week to a week and a half" and she had not yet needed another dose. But "when that medication wears off, [a person] ... could become psychotic very quickly." He assessed Abigail as "fairly pleasant" and explained that she had "been writing down some coping skills and doing some coloring," but she also "sometimes start[ed] to cry." In his opinion releasing Abigail from the hospital was "moderate to high risk" and "it's best to get someone set up on medication and have them stable and observed for a period of time" to ensure the medication is working.
Regarding the availability of evaluation facilities, the counselor explained that Abigail was third on the wait list at Alaska Psychiatric Institute (API) in Anchorage but Bartlett Regional Hospital in Juneau could accept her as soon as the Kodiak hospital could "set up transportation[,] which usually takes a day or two." He also testified that the Kodiak hospital staff had tried to place Abigail at other facilities in Fairbanks and Anchorage, but those facilities could not accept her.
Abigail then testified on her own behalf. She said she felt that she had stabilized since she first arrived at the hospital; she had identified triggers for negative thoughts and written down those triggers, her post-discharge goals, and different coping skills such as breathing, going for a walk, stretching, and yoga. Abigail agreed there was a valid concern about self-harm when she was initially detained, but she stated that she no longer had any intention of harming herself and that "today is a definite change from when I came in."
Both Abigail and the counselor also testified that Abigail was taking other medications for her condition in addition to the initial Haldol
shot: Abilify, an antipsychotic; Prozac, an anti-depressant; and Ativan, an anxiety medication. According to Abigail, she had not been prescribed Abilify before she was detained at the Kodiak hospital. Abigail explained that after discharge, she planned to return to her family in Akiak where she could obtain prescription refills and access outpatient therapy.
Once testimony and closing arguments were completed, the judge issued an oral ruling on the record. The court attributed Abigail's improvement primarily to the Haldol
injection, which would soon wear off, and noted that "there's been no testimony at this point that [the] medications are sufficient to prevent a relapse of the condition that brought [Abigail] back to the hospital." Additionally, the court found that there was no evidence to "create some confidence" that the medications and coping mechanisms combined would prevent Abigail from "immediately ... spiral[ing] down into self harm." And the court noted that Abigail had expressed suicidal ideation "as recently as this morning." Although Abigail had improved, the court determined that her condition had not yet "reached a period of stability." The court thus concluded that there was probable cause to believe that Abigail's condition would "re-emerge" if she were released and found that there was no less restrictive alternative than detention at the Kodiak hospital. The court also stated that it was "sufficient to meet constitutional requirements for due process to have this review hearing and to check the status of the evidence to make sure that it at...
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