Large v. Superior Court, In and For Maricopa County, 18273-SA

• Decision Date: 24 January 1986
• Docket Number: No. 18273-SA,18273-SA
• Citation: 148 Ariz. 229,714 P.2d 399
• Parties: , 75 A.L.R.4th 1103 Larry Wayne LARGE, Petitioner, v. SUPERIOR COURT of the State of Arizona, in and for the COUNTY OF MARICOPA, Honorable Howard F. Thompson, a judge thereof, and STATE of Arizona, DEPARTMENT OF CORRECTIONS, real party in interest, Respondents.
• Court: Arizona Supreme Court

Page 399

714 P.2d 399

148 Ariz. 229, 75 A.L.R.4th 1103

Larry Wayne LARGE, Petitioner, v. SUPERIOR COURT of the State of Arizona, in and for the COUNTY OF MARICOPA, Honorable Howard F. Thompson, a judge thereof, and STATE of Arizona, DEPARTMENT OF CORRECTIONS, real party in interest, Respondents.

No. 18273-SA.

Supreme Court of Arizona, In Banc.

Jan. 24, 1986.

[148 Ariz. 231] Charles Arnold, Phoenix, for petitioner.

Robert K. Corbin, Atty. Gen., Richard Albrecht, Asst. Atty. Gen., Phoenix, for respondents.

FELDMAN, Justice.

Larry Wayne Large (petitioner) is a prisoner committed to the custody of the Arizona Department of Corrections (DOC) and confined at the Alhambra Treatment Unit (ATU), a mental health treatment facility. On April 23, 1985, Large filed a "Petition for an Order Prohibiting Forcible Administration of Psychotropic Drugs," Maricopa County Superior Court Cause No. MH 27765. The State of Arizona filed a motion to dismiss Large's petition. The trial court granted the state's motion and dismissed the petition. Petitioner sought relief by a special action, joining the trial judge, the state and the DOC as respondents. ¹ Because petitioner has no adequate remedy by appeal and the question presented is of constitutional significance, we have accepted jurisdiction. We have jurisdiction pursuant to Ariz. Const. art. 6, § 5(1) and Rule 8, Ariz.R.P.Sp.Act., 17A A.R.S. In our review of the order granting the motion to dismiss, we must assume the truth of petitioner's allegations. Donnelly Construction Co. v. Oberg/Hunt/Gilleland, 139 Ariz. 184, 186, 677 P.2d 1292, 1294 (1984). The dismissal can be upheld only if petitioner's claim could not entitle him to relief under any facts susceptible of proof. Id.

FACTS

Petitioner pled no contest and was convicted of aggravated assault on 30 September 1982 and sentenced to five years in the state prison. He did not appeal and was placed in the custody of DOC.

On April 15, 1985, the Maricopa County Superior Court ordered petitioner transferred from the Arizona State Prison at Florence to the Alhambra Treatment Unit (ATU), a mental health inpatient treatment facility operated by DOC. The order was made pursuant to A.R.S. § 31-226, ² the court having determined that petitioner "suffer[ed] from a mental disorder to such a degree that transfer to the treatment facility was necessary to ensure adequate treatment." In fact, petitioner had already been physically transferred to ATU about seven months earlier.

From the date of his admission at ATU in September 1984, four types of records were kept on petitioner: (A) a "Comprehensive Treatment Plan" form with spaces for filling in diagnoses and treatment; (B) a "Physician's Orders" form for indicating "medicines, diet, etc."; (C) a "Physician's Progress Record" form; and (D) a "Problem List" form. Despite this seemingly elaborate system to observe and record information, the record on petitioner in the five months from September, 1984 until February 25, 1985 is sketchy. His Comprehensive Treatment Plan entry for the day of admission indicates petitioner had been diagnosed as a "schizoaffective/paranoid," for which the treatment was to

seclude, restrain, 4-point ³ in progressively increasing increments (dangerous to others) .... Any behavior or threats should be interpreted as dangerous and he must be controlled until he agrees to do so himself. Reverse procedure back out in increments.

For the next five months petitioner apparently evidenced no behavior or threat that could be interpreted as dangerous, because the Comprehensive Treatment Plan entries state only "treatment team review," signed by each of the team members. The Physician's Orders form shows no medications were prescribed during this period. The Progress Record gives no description of petitioner's behavior other than his "refusal for Rx" and a statement that he had "not reached the point where he is in need of treatment against his will." Physicians' Progress Record for October 9, 1984. Finally, his Problem List revealed only that:

1. On admission in September, 1984 petitioner refused to sign the voluntary admit form and to receive medication and his behavior was "disruptive/assaultive."

2. In November, 1984 he "manipulate[d] religious ideas to get his needs met"; (a problem that was "resolved" on April 17, 1985); he denied mental illness or need for medication and threatened legal action.

3. In December he had a small laceration on his right thumb and a pain in his left wrist; (both "resolved" January 30, 1985).

Drug Administration

Forced drug treatment appears to have been triggered by an "altercation" between petitioner and another patient on 25 February, 1985. Large contended at the time that the altercation was the other patient's fault. Because the physician concluded that the occurrence "clearly" came about as a "result of patient's continued aggressively psychotic behavior," he decided that "emergency treatment [was] required [and he began] Navaneization against patient's will to preclude further harm to patient by his own dangerous action." "Navaneization" appears to be newspeak for administration of Navane, a psychotropic drug, also referred to as a neuroleptic or antipsychotic drug. The Physician's Orders entry for February 25 indicates no specific medications or dosages; it states only "observe and chart behavior/response with meds." Three days later the entries show petitioner had been on Navane continuously and was

evaluated 72 hours after emergency Rx against his will. Patient appeared anxious but very cooperative, appropriate, much less delusional. Effects of Navane have been pronounced in modifying his psychotic behavioral responses. He still says he will not sign in and will not agree to taking medication. Assured we will continue Rx until court hearing makes decision regarding continued Rx. ⁴

On that day the doctor prescribed:

1. Navane, 20 mg. by mouth twice a day, or if refused, 10 mg. by intramuscular injection.

2. Artane, 10 mg. twice a day.

3. Cogentin, 2 mg. by intramuscular injection every five hours if symptoms are not relieved by Artane.

4. Symmetrel, 100 mg. twice a day.

Other than the antipsychotic drug, Navane, the drugs prescribed were for treating adverse side effects of antipsychotics.

Side Effects

Not all of the side effects (called extrapyramidal reactions) of antipsychotic drugs are yet known. Two of the known extrapyramidal reactions are called akathisia and akinesia.

Akathisia is characterized by "involuntary motor restlessness, constant pacing, an inability to sit still, often accompanied by fidgeting, chewing, lip movements and finger and leg movements." ... Because the anxiety induced by this restlessness is easily mistaken for underlying psychotic anxiety, it is frequently mistreated by increasing the dosage of antipsychotic medication. Akathisia may be treated with anti-parkinsonian drugs but many cases respond poorly.

Comment, Antipsychotic Drugs and Fitness to Stand Trial, 52 U.CHI.L.REV. 773, 785-86 (Summer 1985) (citations to medical references omitted). Akinesia, on the other hand, results in lack of spontaneity, lifelessness, an inability to participate in usual social activities and a disinclination to speak. Id. at 784-85. A person receiving antipsychotic medication may therefore evidence both the emotional apathy of akinesia as well as the physical restlessness and distraction symptomatic of akathisia. See id. at 786. Our courts have noted other extrapyramidal effects such as dystonia (spasmodic muscle reaction frequently involving a twisting of the neck) and a pseudo-parkinsonian syndrome (mask-like face, rigid hands). Anderson v. State, 135 Ariz 578, 580, 663 P.2d 570, 572 (App.1983). The most serious side effect of antipsychotic drugs is irreversible tardive dyskinesia, which may develop after extended use of the drugs. Gelman, Mental Hospital Drugs, Professionalism and the Constitution, 72 GEO.L.J. 1725, 1742-43 (1984). In tardive dyskinesia

[t]he tongue sweeps from side to side, the mouth opens and closes, and the jaw moves in all directions. Fingers, arms, and legs may display comparable movements; swallowing, speech, or breathing can be affected as well. The movements are uncontrollable although their intensity varies from case to case. In severe cases, the involuntary movements impede walking and even digestion. Health can be endangered, and often the victim's appearance becomes grotesque. Tardive dyskinesia is common: estimates of the disorder's prevalence rates (the proportion of patients with tardive dyskinesia at any particular time) range as high as sixty-five percent; fifteen to twenty percent is a widely accepted estimate.

Id. (citing primarily to AMERICAN PSYCHIATRIC ASSOCIATION, TARDIVE DYSKINESIA: REPORT OF THE TASK FORCE ON LATE NEUROLOGICAL EFFECTS OF ANTIPSYCHOTIC DRUGS (1979 ) (other citations omitted).

Petitioner's records do not state whether he exhibited side effects, but we assume it was the manifestation of side effects that prompted the medications to treat them. Later records likewise do not indicate whether these drugs were effective in controlling side effects. The February 28 orders were periodically reassessed and ordered continued with an upward adjustment of Symmetrel to 300 mg. daily on March 7th and with the addition of two others--Benadryl and Thorazine in mid-April of 1985. Benadryl, according to the PHYSICIANS' DESK REFERENCE (38th ed. 1984), is indicated for mild cases of parkinsonism, including drug-induced cases. Thorazine is a tranquilizer used to manage manifestations of psychotic disorders. All the drugs mentioned were administered to petitioner against his will: he consistently refused to sign informed consent for voluntary treatment and repeatedly requested to be taken off the medications. It appears that the drugs were administered to manage rather than to treat petitioner. This management procedure had been established months...