Maricopa County Cause No. MH-90-00566, Matter of

• Decision Date: 03 September 1992
• Docket Number: No. 1,MH-90-00566,CA-CV,1
• Parties: , 3 NDLR P 86 In the Matter of MARICOPA COUNTY CAUSE NO.90-648.
• Court: Arizona Court of Appeals

Page 1042

840 P.2d 1042

173 Ariz. 177, 3 NDLR P 86

In the Matter of MARICOPA COUNTY CAUSE NO. MH-90-00566.

No. 1 CA-CV 90-648.

Court of Appeals of Arizona,

Division 1, Department D.

Sept. 3, 1992.

[173 Ariz. 179] Dean W. Trebesch, Maricopa County Public Defender by Gary F. Forsyth, Deputy Public Defender, Phoenix, for appellant.

Grant Woods, Atty. Gen. by Vicki Gotkin Adler, Asst. Atty. Gen., Phoenix, for appellee.

OPINION

EHRLICH, Judge.

L.R. ¹ appeals from an order committing him to the Arizona State Hospital ("ASH") for inpatient treatment and subsequent supervised outpatient treatment. The court found that L.R. was persistently or acutely disabled as the result of a mental disorder, in need of treatment and either unwilling or unable to accept voluntary treatment.

On appeal, L.R. challenges the constitutionality of Ariz.Rev.Stat.Ann. section ("A.R.S. s") 36-501(29), which establishes "persistently or acutely disabled" as a category for the involuntary commitment of the mentally ill. He argues that the statute is overbroad and vague and that its application violates substantive and procedural due process rights. L.R. further maintains that, even if the statute under which he was involuntarily committed is constitutional, there was insufficient evidence to support the conclusion that he was persistently or acutely disabled.

We hold that A.R.S. § 36-501(29) is constitutional. We further conclude that the evidence supported the order of involuntary treatment.

I. FACTUAL AND PROCEDURAL BACKGROUND

L.R. suffers from schizophrenia, paranoid type. He is "chronically mentally ill" as defined by A.R.S. § 36-550(3). ² In July 1990, L.R. admitted himself to the Maricopa County Medical Center because he was afraid that he would harm other people by acting on command hallucinations he was experiencing. He called the voice within him "John," and "John" was making all of his major decisions. L.R. previously had received treatment for his mental illness but, some months prior to his admission to the medical center, he had stopped taking the anti-psychotic medication.

On August 6, 1990, L.R. was transferred to ASH. While there, he believed that his parents had hired many of the patients to spy on him for them. L.R. told several hospital employees that "John" wanted him to get a gun for protection after he got out of the hospital. Then, and against his doctors' advice, L.R. attempted to sign out of ASH because "John" had told him to do so. As a result, the hospital's chief medical officer petitioned the superior court for court-ordered inpatient and outpatient treatment for L.R.

At the hearing on the petition, Dr. Marcelle Leet, a psychiatrist who was treating L.R., testified that, in her opinion, L.R. was persistently disabled because he suffered from symptoms of schizophrenia involving auditory hallucinations and paranoid delusions and that, if he acted on those, it could be dangerous for himself and others. She specifically noted that his persecutory delusions and paranoid ideations were painful psychic experiences for him that adversely affected his relationships with other people and his ability to function outside of the hospital. In fact, L.R. already had engaged in assaultive behavior against members of his family. Dr. Leet believed that if L.R. were released from the hospital, he could act on his fear that other people wanted to harm him, which could lead to an altercation and injury.

Because the doctors had not yet found a medication to effectively treat L.R.'s illness without debilitating side effects, Dr. Leet wanted L.R. to remain at ASH so that they could try other medications and monitor his progress. She testified that L.R. was ambivalent about treatment and that she did not believe that he would comply with outpatient treatment. Dr. Leet had discussed the advantages and disadvantages of inpatient treatment with L.R. and, although she believed that he had some understanding of the treatment alternatives, she concluded that his decision-making was influenced by the command hallucinations such that he was unable to give an informed consent or make a decision regarding his treatment. Dr. Leet recommended that L.R. stay at the hospital for six months so that they could attempt to find an appropriate medication, stabilize him and get him ready for outpatient treatment. She further recommended that the court order the full 365 days of combined inpatient and outpatient treatment allowed by law.

Another psychiatrist, Dr. Laxman Patel, testified regarding his interviews with L.R. at ASH. He noted that L.R.'s judgment was impaired as exhibited by the fact that L.R. had no idea where he would live if discharged from ASH, planning to stay on the streets beside the freeway until "John" could find him a place to live. It was Dr. Patel's opinion also that L.R. was persistently and acutely disabled and that he should receive combined inpatient and outpatient treatment for 365 days.

The court found clear and convincing evidence that L.R. was persistently and acutely disabled as the result of a mental disorder, in need of treatment and either unwilling or unable to accept voluntary treatment. It ordered L.R. to undergo combined inpatient and outpatient treatment until he was found to be no longer persistently or acutely disabled as a result of his mental disorder, the treatment period not to exceed 365 days, with the period of inpatient treatment not to exceed 180 days. L.R. timely appealed from this order.

II. DISCUSSION

A. Mootness

A preliminary issue to be resolved is whether L.R.'s appeal is moot. His involuntary treatment ended on August 29, 1991, but our jurisdiction is not necessarily defeated once the challenged order has expired if the dispute is capable of repetition yet evading review. KPNX Broadcasting Co. v. Maricopa County Superior Court, 139 Ariz. 246, 250, 678 P.2d 431, 435 (1984), citing Nebraska Press Ass'n v. Stuart, 427 U.S. 539, 546, 96 S.Ct. 2791, 2796, 49 L.Ed.2d 683 (1976). See also In re McMullins, 315 Pa.Super. 531, 462 A.2d 718, 720 (1983) (appeal not moot because involuntary commitment order affects important liberty interest and most such orders expire before appellate review possible). L.R. has been identified as chronically mentally ill and thus may be subject to petitions for involuntary treatment in the future; certainly, other similarly-situated persons will be subject to such petitions. Because appeals usually are not briefed and decided in less than the 365-day maximum period of treatment allowed by law, appeals from these orders would evade review if made moot by the expiration of the order. In addition, a challenge to the constitutionality of a mental health treatment statute involves a matter of continuing and substantial public interest, such that it is appropriate for us to consider the issue. Thus, we decide this appeal on its merits.

B. Alleged Unconstitutionality of A.R.S. § 36-501(29) ³

"If the court finds by clear and convincing evidence that the proposed patient is as a result of mental disorder, a danger to himself, is a danger to others, is persistently or acutely disabled or is gravely disabled and in need of treatment, and is either unwilling or unable to accept voluntary treatment, the court shall order him to undergo" either outpatient treatment, combined inpatient and outpatient treatment, or inpatient treatment for a time not to exceed certain specified periods. A.R.S. § 36-540(A). In this case, the court found that L.R. was persistently or acutely disabled, in need of treatment and either unwilling or unable to accept voluntary treatment.

L.R. now argues that A.R.S. § 36-501(29), defining "persistently or acutely disabled," particularly as read with § 36-501(22), defining "mental disorder," ⁴ is vague and overbroad because it could subject nearly anyone suffering from a mental disorder to involuntary treatment and because it is indefinite and cannot be understood by persons of common intelligence. He also argues that court-ordered treatment based upon a persistent or acute disability violates the patient's substantive and procedural due process rights because this standard is unconstitutionally vague.

Overbreadth and vagueness are different concepts as they pertain to due process. ⁵ A mental health involuntary treatment statute is overbroad if its application could result in the hospitalization of mentally-ill persons who are neither dangerous nor incapable of adequately caring for themselves. See Project Release v. Prevost, 722 F.2d 960, 972 (2d Cir.1983). Such a statute is vague if "it lacks ascertainable standards of conduct and is so vague, imprecise and indefinite that persons of common intelligence must necessarily guess at its meaning and differ as to its application." In re Slabaugh, 16 Ohio App.3d 255, 475 N.E.2d 497, 499 (1984). See also State v. Tocco, 156 Ariz. 110, 113-14, 750 P.2d 868, 871-72 (App.1988) ("Only where a statute proscribes no comprehensible course of conduct at all is it unconstitutional as applied to any set of facts."); State v. Jacobson, 121 Ariz. 65, 70, 588 P.2d 358, 363 (App.1978) ("essential test of vagueness is whether the legislative enactment may be understood by persons of common intelligence"). Alleged overbreadth primarily concerns substantive due process because it questions whether the statutory standards "provide a constitutionally adequate basis for detention." LaBelle, 728 P.2d at 142. The question of vagueness implicates "the procedural due process requirements of fair notice of the conduct warranting detention and clear standards to prevent arbitrary enforcement by those charged with administering the applicable statutes." Id. Although the arguments regarding overbreadth and vagueness overlap to some extent, we first analyze L.R.'s arguments regarding overbreadth. L.R. maintains that application of A.R.S. § 36-501(29) could subject to involuntary treatment every person with a mental disorder...