In re Pima Cnty. Mental Health No. 20200860221

• Decision Date: 03 February 2022
• Docket Number: 2 CA-MH 2021-0003
• Citation: 252 Ariz. 442,504 P.3d 951
• Parties: IN RE PIMA COUNTY MENTAL HEALTH NO. 20200860221
• Court: Arizona Court of Appeals

252 Ariz. 442

504 P.3d 951

IN RE PIMA COUNTY MENTAL HEALTH NO. 20200860221

No. 2 CA-MH 2021-0003

Court of Appeals of Arizona, Division 2.

Filed February 3, 2022

Pima County Mental Health Defender's Office, Tucson, By Molly Pettry, Counsel for Appellant

Laura Conover, Pima County Attorney, By Tiffany Tom, Deputy County Attorney, Tucson, Counsel for Appellee

Vice Chief Judge Staring authored the opinion of the Court, in which Judge Eckerstrom concurred and Presiding Judge Espinosa dissented.

STARING, Vice Chief Judge:

¶1 In this appeal from an involuntary-treatment order, appellant G.B. argues the trial court committed reversible error because the physicians’ affidavits in support of the petition for court-ordered treatment failed to include the results of her physical examinations, in violation of A.R.S. § 36-533(B). She also contends the physicians failed to consider pertinent information about her particular circumstances, rendering the evidence insufficient to find her persistently or acutely disabled (PAD). Because the physicians’ affidavits did not strictly comply with § 36-533 and were insufficient as a matter of law, we vacate the involuntary-treatment order.

Factual and Procedural Background

¶2 We view the facts in the light most favorable to sustaining the trial court's order. In re Maricopa Cnty. Mental Health No. MH 2008-001188 , 221 Ariz. 177, ¶ 14, 211 P.3d 1161 (App. 2009). In February 2021, G.B. transferred her care to St. Mary's Hospital from Tucson Medical Center (TMC) because she felt TMC was not providing the help she needed for her unexplained gastrointestinal complaints. Specifically, she opposed psychiatric treatment recommended at TMC. G.B., who was seventy years old and weighed approximately eighty-three pounds, was diagnosed at St. Mary's with a delusional disorder, as well as malnutrition and cachexia.¹ She refused the medications prescribed for the delusional disorder. Also at St. Mary's, she received a dietary consultation to assess her nutritional needs, and, despite expressing an interest in gaining weight, she repeatedly complained that the recommended food was not what she had ordered or needed.

¶3 According to Randy Claxton, a social worker at St. Mary's, G.B. "clearly had believed ... that the doctors and the team were against her." Despite the doctors’ efforts to develop a rapport with G.B., she continued to believe they were "trying to harm her with the medication and treatment [they] were prescribing," which included Depakote, Haldol, and Risperdal. After G.B. had been at St. Mary's for a little over a week, she insisted on being discharged, but her medical team felt that they had not made any progress because she was unwilling to participate in the prescribed treatment and her weight was "in a dangerous area." As a result, Claxton filed an application for an involuntary evaluation of G.B., alleging that she was gravely disabled or PAD. The next day, James Ojeda evaluated G.B. and completed a pre-petition screening report, concluding that the PAD standards were met and "the involuntary evaluation process should proceed."

¶4 On March 5, 2021, a petition for court-ordered evaluation of G.B. was filed. That same day, the trial court signed an order for evaluation. G.B. was transferred to Banner University Medical Center – South Campus, where psychiatrists Dr. Rohit Madan and Dr. Michael Colon each evaluated her and completed affidavits. Banner² subsequently filed a petition for court-ordered treatment, again alleging that G.B. was PAD and requesting combined inpatient and outpatient treatment.

¶5 The trial court held a two-part hearing, during which Claxton, Ojeda, and Madan testified. Consistent with his affidavit, Madan testified G.B. was suffering from "Unspecified Psychosis and likely Delusional Disorder, Somatic type." Madan's and Colon's affidavits, with attached PAD addendums and written reports, were admitted into evidence. G.B. presented testimony from a counselor, an acupuncturist, and a craniosacral therapist,³ all of whom had treated her in the past. She also called as witnesses Dr. Michael Christiansen, a psychologist, who completed an independent evaluation, and her niece. At the conclusion of the hearing, the court found by clear and convincing evidence that, as a result of a mental disorder, G.B. was PAD and in need of a period of mental health treatment. The court therefore ordered that G.B. receive treatment for "one year with the ability to be re-hospitalized, should the need arise, in an inpatient psychiatric facility for a time period not to exceed 180 days."⁴ This appeal followed. We have jurisdiction pursuant to A.R.S. § 36-546.01.

Discussion

¶6 Involuntary-treatment proceedings generally begin with a petition for evaluation. See A.R.S. § 36-523. An "[e]valuation" is a "professional multidisciplinary analysis that may include firsthand observations or remote observations by interactive audiovisual media and that is based on data describing the person's identity, biography and medical, psychological and social conditions," and it can be completed by "[t]wo licensed physicians ... who shall examine and report their findings independently." A.R.S. § 36-501(12)(a). If, based on that evaluation, it is believed that, as a result of a mental disorder, the patient is PAD, generally, a petition for court-ordered treatment shall be prepared, signed, and filed. A.R.S. § 36-531(B). Section 36-533(B), A.R.S., provides as follows:

The petition shall be accompanied by the affidavits of the two physicians who participated in the evaluation and by the affidavit of the applicant for the evaluation, if any. The affidavits of the physicians shall describe in detail the behavior that indicates that the person ... has a persistent or acute disability ... and shall be based on the physician's observations of the patient and the physician's study of information about the patient. A summary of the facts that support the allegations of the petition shall be included. The affidavit shall also include any of the results of the physical examination of the patient if relevant to the patient's psychiatric condition.

(Emphasis added.)

¶7 On appeal, G.B. maintains that the order for involuntary treatment should be vacated based on the physicians’ failure to strictly comply with the procedures in § 36-533(B). Specifically, she contends that "results of [her] physical examination ... were not included in the physicians’ affidavits." In addition, she maintains "the physicians failed to study pertinent information about [her]."

¶8 We review questions of statutory interpretation de novo. In re Maricopa Cnty. Mental Health No. MH 2006-000749 , 214 Ariz. 318, ¶ 13, 152 P.3d 1201 (App. 2007). And, when interpreting a statute, our primary purpose is to give effect to the intent of the legislature. In re Maricopa Cnty. Superior Court No. MH 2001-001139 , 203 Ariz. 351, ¶ 12, 54 P.3d 380 (App. 2002). The "best evidence of that intent" is the statute's plain language. Id. When the "language is clear and unambiguous, we apply it without resorting to other methods of statutory interpretation." Hayes v. Cont'l Ins. Co. , 178 Ariz. 264, 268, 872 P.2d 668, 672 (1994) ; see also In re Coconino Cnty. Mental Health No. MH 95-0074 , 186 Ariz. 138, 139, 920 P.2d 18, 19 (App. 1996) ("When the legislature has spoken with such explicit direction, our duty is clear.").

¶9 Arizona has long recognized that the liberty interests at stake in involuntary-treatment proceedings compel strict statutory compliance. See In re Commitment of Alleged Mentally Disordered Pers. , 181 Ariz. 290, 293, 889 P.2d 1088, 1091 (1995) ("Because such proceedings may result in a serious deprivation of liberty ... the statutory requirements must be strictly adhered to."); In re Burchett , 23 Ariz. App. 11, 13, 530 P.2d 368 (1975) (commitment proceedings "void" if "[p]roceedings to adjudicate a person mentally incompetent [not] conducted in strict compliance with statutory requirements"); Maricopa Cnty. No. MH 2001-001139 , 203 Ariz. 351, ¶ 8, 54 P.3d 380 (requiring strict compliance); cf. Riggins v. Nevada , 504 U.S. 127, 134, 112 S.Ct. 1810, 118 L.Ed.2d 479 (1992) (Forced medication "represents a substantial interference with [a] person's liberty." (quoting Washington v. Harper , 494 U.S. 210, 229, 110 S.Ct. 1028, 108 L.Ed.2d 178 (1990) (recognizing potentially severe, debilitating, and even fatal side effects of antipsychotic medication))); Large v. Superior Court , 148 Ariz. 229, 236, 714 P.2d 399, 406 (1986) ("To the extent that medication is administered forcibly for the purpose of controlling behavior, it is a bodily restraint insubstantially different from the shackles of old.").⁵

¶10 Our supreme court's decision in Commitment of Alleged Mentally Disordered Person well illustrates the requirement of strict statutory compliance. There, the court addressed the statutory requirement that the evidence at an involuntary-treatment hearing include "testimony of two or more witnesses acquainted with the patient at the time of the alleged mental disorder ... and testimony of the two physicians who participated in the evaluation of the patient." A.R.S. § 36-539(B) ; see Commitment , 181 Ariz. at 292, 889 P.2d at 1090. "Four mental health professionals ... attempted to examine and evaluate [the patient]." Commitment , 181 Ariz. at 291, 889 P.2d at 1089. One doctor interviewed him for approximately thirty minutes, and the patient refused to speak with the others. Id. The interviewing doctor and two others concluded the patient suffered from "a major mental disorder." Id. The interviewing doctor and one other testified as experts at the subsequent involuntary-treatment hearing. Id. The other two doctors "submitted written reports as acquaintance witnesses." Id. The trial court found the patient was "likely suffering from schizophrenia" and "ordered involuntary commitment and treatment for up to 180 days." Id. at 292, 889 P.2d at 1090.

¶11 Our supreme...