In re Maricopa County Superior Court No. MH XXXX-XXXXXX

• Decision Date: 05 June 2003
• Docket Number: No. 1 CA-MH 02-0009.,1 CA-MH 02-0009.
• Citation: 69 P.3d 1017,205 Ariz. 296
• Parties: In the Matter of MARICOPA COUNTY SUPERIOR COURT NO. MH XXXX-XXXXXX.
• Court: Arizona Court of Appeals

69 P.3d 1017

205 Ariz. 296

In the Matter of MARICOPA COUNTY SUPERIOR COURT NO. MH XXXX-XXXXXX.

No. -0009.

Court of Appeals of Arizona, Division 1, Department B.

June 5, 2003.

Richard M. Romley, Maricopa County Attorney By Jean Rice, Deputy County Attorney, Phoenix, Attorneys for Appellee.

Maricopa County Public Defender, By Lawrence S. Matthew, Deputy Public Defender, Phoenix, Attorneys for Appellant.

OPINION

IRVINE, Judge.

¶ 1 When a psychiatric resident conducts the mandatory examination of an individual who is the subject of a petition for court-ordered, involuntary evaluation or treatment, Arizona Revised Statutes ("A.R.S.") section 36-501(11)(a) (2003) requires that the resident be supervised in the examination. We hold that although the supervising physician need not be physically present during the examination, the State must be able to present admissible evidence demonstrating that the resident was actually supervised by an attending physician with respect to the examination of that particular patient. No such evidence was presented in this case. We therefore vacate the trial court's decision and remand for proceedings consistent with this opinion.

FACTS AND PROCEDURAL HISTORY

¶ 2 Dr. Carol Kline Olsen filed a petition for a court-ordered evaluation, asserting that the appellant was persistently or acutely disabled as a result of a mental disorder. Dr. Jasbir Bisla then filed a petition for court-ordered treatment, in which he also alleged that the appellant was persistently or acutely disabled due to a mental disorder. As required by A.R.S. § 36-520(B) (2003), Dr. Bisla and Dr. Habibur Rahman, a psychiatric resident, provided affidavits supporting the petition. Dr. Bisla's affidavit concluded that the appellant "presented very psychotic" and refused treatment while in jail. Dr. Bisla also noted that the appellant was "very vague and evasive and appear[ed] to be responding to internal stimuli."

¶ 3 Dr. Rahman stated in his affidavit that the appellant was "mumbling and constantly responding to his inner stimuli," and "unable to continue conversation," and that he exhibited "grandiose ideation." A resident supervision affidavit was also attached and signed by a doctor. The signature was illegible and the form did not specify which resident was under supervision, which patient was being examined, or which doctor was acting as the supervising psychiatrist.

¶ 4 The appellant moved to dismiss the petition for court-ordered treatment, arguing that the incomplete resident supervision affidavit rendered the statutorily required affidavits invalid. At the hearing, the appellant's counsel argued that the supervising psychiatrist must attend the evaluation in person. Because Dr. Espinoza, the supervising psychiatrist, had not been present for the evaluation, counsel argued that the petition for court-ordered treatment was void. The State responded that the supervising psychiatrist is only required to discuss with the resident the resident's interview of the defendant and the intended contents of the affidavit and review the affidavit before it is submitted. After hearing argument, the trial court denied the motion.

¶ 5 The trial court then heard testimony from the appellant's psychiatric counselor at the Madison Jail, the appellant's case manager for mental health treatment, and a business acquaintance who had known the appellant for two years. The appellant also testified on his own behalf. At the conclusion of the testimony, the trial court stated that it had considered the petition for court-ordered treatment, the affidavits of Dr. Bisla and Dr. Rahman, and the evidence presented by the witnesses at the hearing. The trial court found that the appellant was persistently or acutely disabled due to a mental disorder; that the appellant was unwilling to accept voluntary treatment; and that there were no alternatives to court-ordered treatment. The court ordered that the appellant undergo a combined inpatient and outpatient treatment program until he was found to be no longer persistently or acutely disabled, but not to exceed 365 days. The appellant timely appealed. We have jurisdiction pursuant to A.R.S. § 36-546.01 (2003).

DISCUSSION

¶ 6 The appellant raises two issues¹ on appeal:

1. Did the trial court err by denying the motion to dismiss when the supervising doctor did not attend the evaluation performed by the psychiatric resident? 2. Should the order for involuntary treatment be vacated because the State did not present the testimony of the physicians who evaluated the appellant?

We review questions of statutory interpretation de novo. Mental Health Case No. MH 94-00592, 182 Ariz. 440, 443, 897 P.2d 742, 745 (App.1995). "Because involuntary treatment proceedings may result in a serious deprivation of appellant's liberty interests, statutory requirements must be strictly met." In re Maricopa Superior Court Number MH XXXX-XXXXXX, 203 Ariz. 351, 353, ¶ 8, 54 P.3d 380, 382 (App.2002).

I. Supervising Psychiatrist

¶ 7 The appellant argues that the trial court erred in denying the motion to dismiss because the psychiatric resident who evaluated the appellant was not "supervised in the examination." Section 36-501(11)(a) provides, in pertinent part:

A psychiatric resident in a training program approved by the American medical association or by the American osteopathic association may examine the person in place of one of the psychiatrists if he is supervised in the examination and preparation of the affidavit and testimony in court by a qualified psychiatrist appointed to assist in his training, and if the supervising psychiatrist is available for discussion with the attorneys for all parties and for court appearance and testimony if requested by the court or any of the attorneys.

(Emphasis added.) The appellant argues that the statute requires the supervising psychiatrist to be physically present for the examination. In this case, the supervising psychiatrist was admittedly not present in the room when the resident interviewed the appellant.

¶ 8 The State argues that the dictionary definition of "supervision" does not explicitly require physical presence, citing Webster's Encyclopedic Unabridged Dictionary of the English Language 1429 (Portland House, New York 1989) ("To oversee ... during execution or performance; superintend; have the oversight and direction of."). The State also argues that "the normal arrangements and expectations in medical residency programs" allow residents to conduct various procedures outside the presence of the supervising physicians. Finally, the State contends that a psychiatric examination "is not similar to an invasive or a life-threatening procedure, such as a surgery" and that a discussion of the case after the resident's examination is sufficient.

¶ 9 "If the statute's language is clear and unambiguous, we give effect to that language and do not apply any other rule of statutory construction." MH XXXX-XXXXXX, 203 Ariz. at 353, ¶ 12, 54 P.3d at 382. We must, however, "read the statute as a whole, and give meaningful operation to all of its provisions." Matter of Commitment of Alleged Mentally Disordered Person, 181 Ariz. 290, 292, 889 P.2d 1088, 1090 (1995) (quoting Wyatt v. Wehmueller, 167 Ariz. 281, 284, 806 P.2d 870, 873 (1991)).

¶ 10 The statute requires that the resident be enrolled "in a training program approved by the American medical association or by the American osteopathic association." A.R.S. § 36-501(11)(a). The State discusses at length the nature of the supervision in such programs. It appears that residents receive individual supervision and "that the attending physician shall determine the competency of each resident at any given point in time to provide patient care, and shall also determine how to best supervise the resident." It does not appear in the record before us, however, that the supervision required in a residency program always involves supervision with regard to each individual patient. We believe the Legislature intended to require something more than general supervision when it specified that a resident must be "supervised in the examination." The question before us is how to define that something more.

¶ 11 The statute requires that a resident be supervised in performing three distinct activities. A qualified psychiatrist must supervise the resident (1) in the examination, (2) in the preparation of the affidavit, and (3) in testimony in court. A.R.S. § 36-501(11)(a). The parties have offered no legislative history and we have found none. The Legislature added the provision regarding residents to the statute in 1983. 1983 Ariz. Sess. Laws ch. 253, § 2. Prior to such amendment, both of the physicians examining the patient and reporting their findings had to be qualified psychiatrists, or at least experienced in psychiatric matters. A.R.S. § 36-501(8)(a) (1982).

¶ 12 We believe the Legislature intended to allow residents to be full participants in the involuntary treatment process. Not only does this further the education of the residents by preparing them for participation in legal proceedings that may arise in their later practices, but it reflects the realities of the role residents play in providing evaluation and treatment in a teaching hospital environment. Equally, the Legislature recognized that important liberty interests are at stake and that residents, although possessing medical licenses, are not yet fully qualified psychiatrists. It therefore required that they be supervised in both their examination of the patient and reporting their findings to the court. Recognizing that questions could arise about the opinions or qualifications of a particular resident, the Legislature also required that the supervising psychiatrist be available for discussions with the attorneys and for court appearances.

¶ 13 We interpret this requirement as an attempt to avoid turning each involuntary treatment hearing into a battle...