In re Quade M.
| Docket Number | S-18390,1985 |
| Decision Date | 16 August 2023 |
| Parties | In the Matter of the Necessity of the Hospitalization of QUADE M. |
| Court | Alaska Supreme Court |
UNPUBLISHED See Alaska Appellate Rule 214(d)
Appeal from the Superior Court of the State of Alaska, Third Judicial District, Superior Court No. 3AN-21-02542 PR Anchorage, Josie Garton, Judge.
Sharon Barr, Assistant Public Defender, and Samantha Cherot, Public Defender, Anchorage, for Appellant.
Hugh P. Dowell, Assistant Attorney General, Anchorage, and Treg R Taylor, Attorney General, Juneau, for Appellee.
Before: Maassen, Chief Justice, Carney, Borghesan, and Henderson, Justices.
A man was involuntarily committed to Alaska Psychiatric Institute (API) for 90 days. He appeals the commitment order, arguing that the superior court erred when it found that he was gravely disabled and that there was a reasonable expectation his mental health would improve with further treatment. Finding no error, we affirm the commitment order.
Quade M.[1] suffers from schizoaffective disorder, bipolar type, as well as polysubstance abuse, antisocial personality disorder, and borderline intellectual functioning. Schizoaffective disorder is both chronic and degenerative, meaning that although it can be managed and its progress slowed, Quade will never be cured and will continue to deteriorate. At the time of the commitment hearing, Quade had had over 300 encounters with the police and had been committed to and discharged from API 48 times.
The commitment proceeding at issue is part of what was described by Quade's primary treatment provider as a recurring cycle. Quade is released from API, discontinues his antipsychotic medication, and, because he has been banned from all shelters in the city, lives outdoors. He then "usually breaks into someone's house for food and warmth, gets arrested, [and] goes to jail." The criminal charges are dismissed and "[h]e gets committed back to API." At that point he is usually underweight and undernourished. At API he is put on medication, stabilizes, and is eventually discharged, at which point the cycle repeats. According to the treatment provider, Quade has spent approximately 80 percent of the last four years either at API or incarcerated.
Quade is described as "extremely psychotic" when unmedicated. He suffers from disorganized thinking, which means he cannot understand how his mental illness impacts his life and wellbeing. He has volatile mood swings and can be aggressive. He can also be hypersexual - exposing or touching himself in public, doing "some inappropriate things with children," and making lewd sexual remarks to women, which has led to a 10-foot boundary rule between him and female staff at API. While he has not physically harmed anyone at API, he has had to be secluded or deescalated with an injectable medication for assaultive behavior.
When Quade is medicated, his baseline is "still psychotic but it's a much lower level." At API he takes his medications fairly consistently, receives adequate meals, is under 24-hour medical and nursing care, and receives long-lasting injectable medication as necessary. With medication he is better able to think and communicate linearly - he is more organized and less assaultive, and his disposition improves. But he does not seem to comprehend the nature of his commitment at API; he continually states his desire to leave and repeatedly tells staff that "the judge said [he] could go."
Nearing the end of a 30-day commitment, the State moved to have Quade committed for an additional 90 days. A superior court master heard testimony from advanced nurse practitioner Gerald Martone, who was Quade's primary medical provider, and one of Quade's social workers at API.
Martone, reflecting on how his patient's condition had changed since the 30-day hearing, testified that Quade remained "gravely disabled" and "unable to care for himself outside an institutional setting." He did not believe Quade would be safe in the community if released because of his pattern of leaving API only to be recommitted soon after and because of his unwillingness to go to appointments or take medication to manage his condition in an outpatient setting.
Martone believed that this most recent stay at API had improved Quade's condition, noting that Quade had gained weight since initially appearing "undernourished" when admitted, that he had "slight improvement in terms of his volatility," and that consistent medication had slightly improved his impulse control. Martone also indicated, however, that many of Quade's behavioral problems, such as intrusiveness, loudness, and hypersexuality, persisted, and he suggested that Quade would see more improvement if he took his mood stabilizer medication more consistently.
Martone testified that "as a clinical matter" Quade would likely "continue to improve" if he remained at API, though he would inevitably deteriorate when released. Martone described the expected improvement: Martone explained that following his recent release from a 90-day commitment Quade stayed out of his usual cycle of incarceration and recommitment "for a good period of time" in part because of the long-lasting effect of two different injectable antipsychotic drugs he had received while at API. But Martone cabined his optimism by recognizing that Quade's condition is extreme, lifelong, and chronic; although it can be managed, it can never be cured.
Martone also opined that he "want[ed] to believe [Quade] can do better." He said that the lack of safe housing for individuals with mental illnesses was "society's failure," and he considered it inhumane and an "indignity" to Quade to release him into the community. He regretted that Quade disliked being in an institution, explaining that he wished there were an alternative but that releasing Quade from API would be "deleterious" and "not . . . in his best interests."
Finally, Martone expressed concern for Quade's safety if discharged from API in February given the likelihood that he would lack shelter from the extreme cold "unless he breaks into someone's home." Martone described Quade on one of his earlier admissions as having frostbite so severe that he almost lost part of his hand; Martone worried that it would happen again.
Quade's social worker at API testified next, explaining that he had interacted with Quade during five of Quade's stays, spanning several years. The social worker described Quade's baseline when medicated as "still psychotic but it's a much lower level"; "he gets to the point where he can communicate and he's not yelling at people and he has a linear thought process." The social worker confirmed that off medication Quade was "extremely psychotic," "very aggressive, threatening, yelling, [and] very incoherent." But Quade was then doing as well as he ever did; the long admission and "having . . . stability for . . . over two months has been good for him."
The master found that Quade was gravely disabled, noting that it was not a particularly close question. To support this finding, the master cited evidence that Quade could not attend to his basic needs or survive in the winter. She found that Quade was "unable to care for himself outside of an institutional setting."
The master credited Martone's testimony that Quade's condition could still improve. She observed that Quade, when medicated, can verbalize his needs, is less psychotic, and can communicate linearly without aggressiveness and yelling. But absent medication he would "continue to suffer the severe and abnormal extreme psychosis that he experiences." Ultimately, the master recommended that the State's 90-day petition be granted.
Quade objected to the recommendation. He argued that there was insufficient evidence to support the findings that he was gravely disabled, that he was unable to provide for his basic needs if discharged immediately, and that he was incapable of surviving safely on his own. He also argued that the master mistakenly applied a "best interests" test that is irrelevant in involuntary commitment cases. Finally, Quade objected to the master's finding that continued commitment could improve his condition.
The superior court overruled Quade's objections. The court found that the master's findings were well supported by evidence that Quade was "extremely psychotic," had "no insight into his illness," "fail[ed] to adequately nourish himself," lacked "access [to a] shelter as a result of his illness," and engaged in "hypersexual aggression . . . with no awareness of the consequences of his behavior." The court found, "Taken together, this conduct does not reflect eccentricity or flouting social norms or even a personal choice and instead reflects severe distress and a significant impairment of his ability to function independently." The court concluded that the master had applied the correct legal standard and had properly credited Martone's testimony that Quade's condition could improve with further treatment.
Quade appeals.
"We review the superior court's factual findings in involuntary commitment or medication proceedings for clear error and reverse those findings only if we have a 'definite and firm conviction that a mistake has been made.' "[2] We review de novo whether the factual findings meet the statutory requirements for involuntary...
To continue reading
Request your trial