In re T.C.

• Decision Date: 12 October 2007
• Docket Number: No. 06-402.,No. 06-293.,06-293.,06-402.
• Citation: 2007 VT 115,940 A.2d 706
• Parties: In re T.C.
• Court: Vermont Supreme Court

940 A.2d 706

2007 VT 115

In re T.C.

No. 06-293.

No. 06-402.

Supreme Court of Vermont.

October 12, 2007.

Laura A. Gans, Vermont Legal Aid, Inc., Waterbury, for Appellant (06-293) and Appellee (06-402).

William H. Sorrell, Attorney General, Montpelier, and David Bond, Assistant Attorney General, Burlington, for Appellee (06-293) and Appellant (06-402).

Present: REIBER, C.J., DOOLEY, JOHNSON, SKOGLUND and BURGESS, JJ.

SKOGLUND, J.

¶ 1. These consolidated cases arise from two separate family court proceedings involving T.C. In the first, T.C. appeals from the Washington Family Court's order granting the State's request for involuntary administration of medication. That order was stayed pending appeal. In the second, the State appeals the family court's order denying the State's application for continued treatment, and releasing T.C. from the Vermont State Hospital (VSH). Because we affirm the family court's denial of the motion for continued treatment, we do not, reach the merits of the involuntary medication order.

¶ 2. T.C. is a forty-five-year-old man. On April 7, 2006, he was involuntarily committed on a ninety-day order of nonhospitalization by the Bennington Family Court after some of T.C.'s family members filed a petition. The court did not issue written findings of fact or conclusions of law, so the basis for the commitment is not in the record. The court revoked the nonhospitalization order on May 5, 2006 and ordered T.C. to be hospitalized at VSH for the duration of the commitment order. At VSH, T.C. refused all psychiatric medications.

¶ 3. On May 30, 2006, the State filed a petition with the Washington Family Court seeking an order for involuntary medication of T.C. The court, Judge Toor presiding, held a bench trial on June 9, 2006. T.C.'s brother, his sister, and his brother's fiancee testified for the State. In addition, the State presented the testimony of a second-year resident in psychiatry who had begun working with T.C. one week before the hearing. Craig Van Tuinen, M.D., a board-certified psychiatrist with over fifteen years of experience who had reviewed T.C.'s records and interviewed T.C. on two occasions, testified on behalf of T.C.

¶ 4. The psychiatry resident testified that T.C. was friendly and cooperative and that he denied, that there was anything wrong with him. T.C. believed he was in the hospital because his family was conspiring against him and had put him there. The doctor noted that his initial impression had been that T.C. suffered from a delusional disorder but that currently he was considering a diagnosis of schizophrenia. He testified that T.C. did not acknowledge any mental illness, and thus, did not see the need for medication. In addition, he refused the drugs because he did not want to be "like a zombie."

¶ 5. The family court found T.C. was mentally ill and that his mental illness had manifested itself several years ago with strange behaviors, including his belief that someone was taking pictures of him, manipulating the images and publishing them. He thought strangers were out to get him, and that there were video cameras in some new furniture. He once confronted a stranger with a camera because he was sure she had taken pictures of him. T.C.'s relationships with members of his family deteriorated during this, period gas well. He expressed a belief that they were' conspiring against him, and he had become physically aggressive with his siblings.

¶ 6. The court found that T.C. had not exhibited delusional thoughts since coming to VSH but did not find this fact significant. Nor did the court find Dr. Van Tuinen's testimony helpful, noting that "[Dr. Van Tuinen] does not believe that [T.C.] has a mental illness, [but] that issue has already been addressed by the earlier court's finding that he is a patient in need of treatment." The family court issued an involuntary medication order, and T.C. appealed.

¶ 7 July 3, 2006, the Commissioner of Health filed an application for continued treatment, as the original commitment order expired after ninety days. See 18 V.S.A. § 7620. To succeed on an application for continued treatment, the State must show, by clear and convincing evidence, that the patient is in need of further treatment as defined by statute. Id. §§ 7616(b), 7621(b), (c), (e). A "patient in need of further treatment" is either:

(A) A person in need of treatment; or

(B) A patient who is receiving adequate treatment, and who, if such treatment is discontinued, presents a substantial probability that in the near. future his condition will deteriorate and he or she will become a person in need of treatment.

Id. § 7101(16). A "person in need of treatment," in turn, is:

a person who is suffering from mental illness and, as a result of that mental illness, his or her capacity to exercise self-control, judgment or discretion in the conduct of his or her affairs and social relations is so lessened that he or she poses a danger to himself, to herself, or others,

(A) A danger of harm to others may be shown by establishing that:

(i) he or she has inflicted or attempted to inflict bodily harm on another; or

(ii) by his or her threats or actions he or she has placed others in reasonable fear of physical harm to themselves; or

(iii) by his or her actions or inactions he or she has presented a danger to persons in his or her care.

(B) A danger of harm to himself or herself may be shown by establishing that:

(i) he or she has threatened or attempted suicide or serious bodily harm; or

(ii) he or she has behaved in such a manner as to indicate that he or she is unable, without supervision and the assistance of others, to satisfy his or her need for nourishment, personal or medical care, shelter, or self-protection and safety, so that it is probable that death, substantial physical bodily injury, serious mental deterioration or serious physical debilitation or disease will ensue unless adequate treatment is afforded.

Id. § 7101(17).

¶ 8. The State's application for continued treatment was heard on August 11, 2006. The court, Judge Reiss presiding, took testimony from Dr. Gellman, a second-year resident at VSH who had been working with T.C. for less than three weeks, and again from Dr. Van Tuinen, who had, since the hearing on involuntary medication, again met with T.C. for a forty-minute session. No family members testified. Dr. Gellman testified that T.C. was able to discuss his daily routine at the hospital and his life outside the hospital without exhibiting any symptoms of delusional thought process. He testified that T.C.'s illness manifested itself in his refusal to accept his family's version of events that took place in 1999-2000, and that, when confronted with his family's version of events, he became angry.

¶ 9. Dr. Van Tuinen testified that T.C. may have suffered from depression and substance abuse in the past but that, during his admission to VSH, he had exhibited a consistent mental status in which no thought disorder had been reported. He found no support for a diagnosis of schizophrenia. He noted that there was "some question about a disorder of perception."^* He noted that family members had reported significant delusions, and agreed that T.C. may have suffered from a delusional disorder, but suggested that the reported delusions all occurred in 1999-2000, when T.C. suffered from and was treated for substance abuse. The doctor opined that T.C.'s substance abuse may have contributed to his delusions. Dr. Van Tuinen further opined that T.C.'s version of past events was not implausible. He described a discordant family relationship evidenced by police reports documenting assaults on T.C. by his sister and her boyfriend. He noted that all but one of the reports of T.C.'s allegedly bizarre behavior come from family members, and related to past events. Dr. Van Tuinen opined that T.C. did not, as of the hearing, present a danger to himself or to others.

¶ 10. The family court found that the State had not met its burden to prove by clear and convincing evidence that T.C. was a patient in need of further treatment: The court first noted that the State had not successfully demonstrated that T.C. suffered from schizophrenia. Based on Dr. Van Tuinen's testimony, and the testimony of staff who had observed T.C. while at VSH, the court found that the criteria for schizophrenia were not satisfied in T.C.'s case: there was no evidence of hah lucinations; no disorganization in his speech, thought or behavior; he was not noted to have a flat affect; he was engaged in social relations on the unit and was friendly and cooperative. The court further found that the State had failed to prove by clear and convincing evidence that, as a result of a mental illness, T.C. presented a continuing danger of harm to himself or to others. The family court dismissed the State's application for continued treatment and released T.C. The State appeals.

¶ 11. The State challenges the trial court's refusal to afford preclusive effect to the findings and conclusions of the prior medication order and the initial commitment order. The State also contends that the trial court erred in construing the relevant statutes so narrowly that it refused to consider T.C.'s dangerous behavior prior to his commitment and mental status during the period of commitment as sufficient to meet its burden of proof under the "patient in need of further treatment" evaluation. 18 V.S.A. § 7101(16). Finally, the State asserts that the trial court's findings are clearly erroneous in some respects.

¶ 12. This Court reviews a trial court's findings of fact in the light most favorable to the prevailing party, "disregarding the effect of modifying evidence, and we will not set them aside unless they are clearly erroneous." In re M.B., 2004 VT 58, 116, 177 Vt. 481, 857 A.2d 772 (mem.). We "uphold the court's conclusions if they are consistent with the controlling law and are supported by the findings."...