In re PINAL COUNTY MENTAL HEALTH NO. MH-201000029.

• Decision Date: 06 October 2010
• Docket Number: No. 2 CA-MH 2010-0001.,2 CA-MH 2010-0001.
• Citation: 225 Ariz. 500,240 P.3d 1262
• Parties: In re PINAL COUNTY MENTAL HEALTH NO. MH-201000029.
• Court: Arizona Court of Appeals

225 Ariz. 500

240 P.3d 1262

In re PINAL COUNTY MENTAL HEALTH NO. MH-201000029.

No. 2 CA-MH 2010-0001.

Court of Appeals of Arizona,Division 2, Department B.

Oct. 6, 2010.

James P. Walsh, Pinal County Attorney By Craig Cameron, Florence, Attorneys for Appellee.

Mary Wisdom, Pinal County Public Defender By Lisa M. Surhio, Florence, Attorneys for Appellant.

OPINION

ECKERSTROM, Judge.

¶ 1 After a hearing on a petition for court-ordered treatment, the trial court found by clear and convincing evidence that appellant is persistently and acutely disabled as a result of a mental disorder and is either unable or unwilling to accept treatment voluntarily. Pursuant to A.R.S. § 36-540(A)(2), the court ordered that appellant receive inpatient and outpatient treatment for not more than 365 days, including no more than 180 days of inpatient treatment. Appellant contends there was insufficient evidence to support the order because neither of the two psychiatrists who examined him conducted an in-person, physical examination as required by A.R.S. §§ 36-533(B) and 36-539(B). For the reasons set forth below, we vacate the order.

Factual and Procedural Background

¶ 2 The appellant was examined by two psychiatrists, Dr. Michael Vines and Dr. Vincent Krasevic. Dr. Vines was in the same room as appellant when he observed and interviewed him. In Vines's affidavit, under the heading “Mental Status” and the subheading “Emotional process,” he reported that appellant walked with a limp, had “a history of spina bifida,” made good eye contact, appeared relaxed, and wore long hair and a beard. Vines did not testify he had conducted any other bodily examination of the appellant, nor did he suggest appellant's behavior or condition made such an examination impracticable.

¶ 3 Dr. Krasevic examined appellant remotely by a “Telemed” video conferencing system rather than in person. Krasevic indicated both in his affidavit and testimony that he had reviewed available documentation on appellant, including a drug screen and a report of his vital signs taken by a nurse practitioner. Like Dr. Vines, Dr. Krasevic's observations of appellant's physical appearance and behavior were focused on his mental status.

¶ 4 Appellant contended below that Dr. Krasevic had not conducted a physical examination and that the state had therefore “failed to meet the strict requirement ... under the mental health statutes that two physicians actually perform examinations and evaluations of the patient.” The trial court found the state had met its burden and the evidence presented was sufficient to conclude appellant was persistently and acutely disabled as a result of a mental disorder.

Discussion

¶ 5 “The requirements of ... most of the provisions of Title 36 ... are set forth with precision and clarity. When the legislature has spoken with such explicit direction, our duty is clear.” In re Coconino County Mental Health No. MH 95-0074, 186 Ariz. 138, 139, 920 P.2d 18, 19 (App.1996). Because a person's involuntary commitment “may result in a serious deprivation of liberty,” strict compliance with the applicable statutes is required. In re Coconino County No. MH 1425, 181 Ariz. 290, 293, 889 P.2d 1088, 1091 (1995). A lack of strict compliance “renders the proceedings void.” In re Burchett, 23 Ariz.App. 11, 13, 530 P.2d 368, 370 (1975).

¶ 6 The issues raised in this appeal involve questions of statutory interpretation, which are questions of law that we review de novo. In re MH 2006-000749, 214 Ariz. 318, ¶ 13, 152 P.3d 1201, 1204 (App.2007). When interpreting a statute, our primary purpose is to give effect to the intent of the legislature. In re Maricopa County Superior Court No. MH 2001-001139, 203 Ariz. 351, ¶ 12, 54 P.3d 380, 382 (App.2002). The “best evidence of that intent” is the plain language of the statute. Id. If the language of a statute is not clear, we “determine legislative intent by reading the statute as a whole, giving meaningful operation to all of its provisions, and by considering factors such as the statute's context, subject matter, historical background, effects and consequences, and spirit and purpose.” Zamora v. Reinstein, 185 Ariz. 272, 275, 915 P.2d 1227, 1230 (1996).

¶ 7 Before a petition for court-ordered treatment may be filed, the proposed patient must first be evaluated. A.R.S. § 36-533(B). An evaluation is “a professional multidisciplinary analysis based on data describing the person's identity, biography and medical, psychological and social conditions” performed by a group of health care professionals, including “[t]wo licensed physicians, who shall be qualified psychiatrists, if possible ... and who shall examine and report their findings independently.” A.R.S. § 36-501(12). Section 36-533(B) provides, inter alia, that the petition for court-ordered treatment

shall be accompanied by the affidavits of the two physicians who conducted the examinations during the evaluation period ... [which affidavits] shall describe in detail the behavior which indicates that the person, as a result of [a] mental disorder, is ... persistently or acutely disabled ... and shall be based upon the physician's examination of the patient and the physician's study of information about the patient.

(Emphasis added.) Absent a stipulation, the two physicians who execute the affidavits must testify at the hearing on the petition “as to their personal examination of the patient.” A.R.S. § 36-539(B). “Examination” is defined as “an exploration of the person's past psychiatric history and of the circumstances leading up to the person's presentation, a psychiatric exploration of the person's present mental condition and a complete physical examination.” § 36-501(14) (emphasis added). Together, §§ 36-533(B) and 36-501(14) require that two physicians must each personally conduct a “complete physical examination” of the patient. See In re MH 2008-000438, 220 Ariz. 277, ¶¶ 14, 16, 205 P.3d 1124, 1127 (App.2009).

¶ 8 In this case, the parties dispute the meaning of the phrase “complete physical examination” and therefore reach different conclusions about the nature and scope of that examination. The appellant asserts the phrase contemplates a conventional physical examination like that conducted by any physician to evaluate a patient's overall medical health. The state counters that, in the context of a psychiatric evaluation, the legislature intended to require only “observations of a proposed patient, [his or her] demeanor, presentation, ability to communicate with the doctor, and expressions.” In short, the state suggests a physician may comply with the requirement by conducting a remote visual observation of the patient, evaluating his or her presentation only for signs of mental illness.

¶ 9 In our view, a plain reading of the pertinent statutory language compels the conclusion that the legislature intended to require a physical examination directed at evaluating the patient's overall medical health. As discussed above, § 36-533(B) unambiguously requires that two physicians participate in the “evaluation” of the patient. Section 36-501(12) clarifies that the required “evaluation,” of which a “complete physical examination” is a component, includes an analysis not only of the patient's “psychological” condition but also his or her “medical” condition. Thus, the legislature's stated goals for the broader evaluation suggest it intended the physical examination to encompass both the medical and psychological aspects of a patient's health.

¶ 10 Moreover, § 36-501(12) specifies that the examination-including the “complete physical examination”-must be conducted not by psychologists, but rather by “licensedphysicians, who shall be qualified psychiatrists, if possible.” Thus, the statute expressly requires that the person conducting the complete physical examination have medical training in addition to some background in evaluating mental illness. This further suggests that the “complete physical examination” contemplated by the legislature be one directed at the overall medical status of the subject.

¶ 11 Nor can we harmonize the state's suggestion that the examination may be a limited one, confined to a visual assessment of the patient's presentation, with the legislature's requirement that the physical examination be “complete.” See City of Phoenix v. Phoenix Employment Relations Bd., 207 Ariz. 337, ¶ 11, 86 P.3d 917, 920-21 (App.2004) (“Courts ... give meaning to each word, phrase, clause, and sentence so that no part of the statute will be void, inert, redundant, or trivial.”). And the state offers no other textual support for its narrow interpretation of what the “complete physical examination” must entail.

¶ 12 To the contrary, the legislative history of the current statute demonstrates that the requirement of a “complete physical examination” was first introduced as part of a comprehensive legislative scheme designed in part to protect the severely mentally ill from medical neglect. Previous versions of our code also required an “examination” or “personal examination” by physicians prior to a civil commitment. Ariz. Rev.Code 1928, § 1769; Ariz.Code 1939, § 8-301; Ariz.Code 1939, § 8-307 (Supp.1952); A.R.S. § 36-507(B) (1956); 1958 Ariz. Sess. Laws, ch. 84, § 1 (former A.R.S. § 36-514(B)). But these examinations were apparently limited in scope and related only to the mental health of the patient. See 1958 Ariz. Sess. Laws, ch. 84, § 1 (allowing court to make orders “necessary to provide for examination into the mental health of the person” under former A.R.S. § 36-510(A)); cf. Ariz. Rev.Code 1928, § 1772 (requiring “an examination into the alleged insanity” of incarcerated person by physician as prerequisite to commitment in state hospital).

¶ 13 This changed in 1974, when the legislature repealed our prior mental health statutes, 1974 Ariz. Sess. Laws, ch. 185, § 1, and for the first time required a “complete physical examination” of...