Melanie L. Outagamie Cnty. v. Melanie L.

• Decision Date: 11 July 2013
• Docket Number: No. 2012AP99.,2012AP99.
• Citation: 833 N.W.2d 607,2013 WI 67,349 Wis.2d 148
• Parties: In the matter of the mental commitment of MELANIE L. Outagamie County, Petitioner–Respondent, v. Melanie L., Respondent–Appellant–Petitioner.
• Court: Wisconsin Supreme Court

349 Wis.2d 148

833 N.W.2d 607

2013 WI 67

In the matter of the mental commitment of MELANIE L.Outagamie County, Petitioner–Respondent,

v.Melanie L., Respondent–Appellant–Petitioner.

No. 2012AP99.

Supreme Court of Wisconsin.

Argued Feb. 26, 2013.

Decided July 11, 2013.

For the respondent-appellant-petitioner, there were briefs by Suzanne Hagopian, assistant state public defender, and oral argument by Suzanne Hagopian.

For the petitioner-respondent, there was a brief by Mark G. Schroeder, assistant corporation counsel, and Outagamie County, and oral argument by Mark G. Schroeder.

An amicus curiae brief was filed by Kristin M. Kerschensteiner, Madison, on behalf of Disability Rights Wisconsin.

DAVID T. PROSSER, J.

[349 Wis.2d 152]¶ 1 This is a review of an unpublished decision of the court of appeals,¹ affirming a decision of the Outagamie County Circuit Court ² that granted Outagamie County's (the County) petition for the extension of an involuntary medication order against Melanie L. (Melanie).

¶ 2 Originally the County sought and obtained a court order for Melanie's mental health commitment under Chapter 51. The court committed Melanie to the County for outpatient care and custody for a period of six months. The court also issued an order for involuntary medication and treatment. Melanie did not challenge either of these two orders.

¶ 3 Shortly before the end of the six months, the County sought, and the circuit court granted, an extension of both orders for an additional 12 months.

¶ 4 With respect to the latter order, the County relied on Wis. Stat. § 51.61(1)(g) 4.b.³ to establish that Melanie was incompetent to refuse medication. The statute provides:

4.... [A]n individual is not competent to refuse medication or treatment if, because of mental illness ... and after the advantages and disadvantages of and alternatives to accepting the particular medication or treatment have been explained to the individual, one of the following is true:

....

b. The individual is substantially incapable of applying an understanding of the advantages, disadvantages and alternatives to his or her mental illness ... in order to make an informed choice as to whether to accept or refuse medication or treatment.

Wis. Stat. § 51.61(1)(g) 4.b.

¶ 5 Melanie appealed only the extension of the involuntary medication order. She contended that the County did not meet its burden of proving her incompetent to refuse treatment under Wis. Stat. § 51.61(1)(g) 4.b.

¶ 6 Specifically, Melanie argued that the examining doctor's opinion that she was incompetent to refuse medication did not satisfy the statutory standard because the doctor testified that Melanie was not “capable of applying the benefits of the medication to her advantage” rather than that she was substantially incapable of applying an understanding of the advantages, disadvantages, and alternatives to her mental illness in order to make an informed choice as to whether to accept or refuse medication. Melanie also argued that the circuit court misapplied the statutory standard by relying too heavily on her mental illness to support the medication order, even though there was evidence that she could apply an understanding of the advantages, disadvantages, and alternatives of medication to her mental illness.

¶ 7 The court of appeals affirmed, concluding that the examining doctor's report and testimony, along with other evidence in the record, supported the circuit court's findings. In short, the court of appeals agreed that Melanie could not apply the “advantages of taking or the disadvantages of not taking psychotropic medication to her present circumstance.” Outagamie Cnty. v. Melanie L., No. 2012AP99, 2012 WL 1838867, unpublished slip op., ¶ 13, (Wis.Ct.App. May 22, 2012) (internal quotation marks omitted).

¶ 8 We reverse the court of appeals. The circuit court misstated the burden of proof. In any event, the County failed to prove by clear and convincing evidence that Melanie was “substantially incapable of applying” an understanding of the advantages, disadvantages, and alternatives of her prescribed medication to her mental illness in order to make an informed choice as to whether to accept or refuse the medication. The County did not overcome Melanie's presumption of competence to make an informed choice to refuse medication.

¶ 9 In particular, the medical expert's terminology and recitation of facts did not sufficiently address and meet the statutory standard. Medical experts must apply the standards set out in the competency statute. An expert's use of different language to explain his or her conclusions should be linked back to the standards in the statute. When a county disapproves of the choices made by a person under an involuntary medication order, it should make a detailed record of the person's noncompliance in taking prescribed medication and show why the noncompliance demonstrates the person's substantial incapability of applying his or her understanding of the medication to his or her mental illness.

I. FACTUAL BACKGROUND AND PROCEDURAL HISTORY

¶ 10 Melanie is a 25–year–old woman living in Outagamie County who suffers from mental illness.

¶ 11 Melanie first experienced issues with her mental health in January 2009 when she was living in Michigan. At that time, Melanie's symptoms included insomnia, depression, paranoia, and “a delusional belief that other persons had been attempting to poison her or harm her in other ways.” Melanie called in sick to her place of work and stayed home, terrified. With her mother's help, she voluntarily admitted herself to Henry Ford Macomb Hospital where she was detained for nine days and diagnosed with major depressive disorder, with psychotic features. Melanie “responded favorably” to Risperdal, an antipsychotic medication, while at the hospital, and was instructed upon her release to continue taking Risperdal and participate in outpatient counseling. However, she stopped using Risperdal when her prescription ran out because she said she could not afford it and because she did not like Risperdal's side effects. Melanie also claimed that she could not afford outpatient counseling.

¶ 12 In 2010 Melanie moved to Wisconsin to “kind of start over.” She lived with a number of roommates in Neenah, then moved into her own apartment in Appleton. She completed a one-semester certified nursing assistant program at Fox Valley Technical College, and she worked in retail at a department store. Although she was not taking any medication during this time, Melanie reported no problems, and her records did not indicate any problems until early February 2011.

¶ 13 On February 3 Melanie left work early because she felt anxious and paranoid.⁴ Melanie's boyfriend later found her wandering around her apartment complex in a confused, disoriented state. He took her to St. Elizabeth Hospital where she was treated.

[349 Wis.2d 156]¶ 14 In the early hours of February 4, an officer from the Appleton Police Department interviewed Melanie and her boyfriend about her condition. The officer filed a Statement of Emergency Detention to hold Melanie in temporary protective custody at St. Elizabeth. The Statement listed the officer, another officer, and Melanie's boyfriend as witnesses. It was approved for filing by Kate Siebers (Siebers), a crisis caseworker for the County.

¶ 15 On February 7, 2011, the circuit court held a probable cause hearing as required by Wis. Stat. § 51.20(7).⁵ The court found probable cause to believe that Melanie was mentally ill, a proper subject for treatment under Chapter 51, and dangerous to herself or others. The court also found probable cause to order involuntary medication pending a final determination. In particular, the court concluded—under the statutory standard of Wis. Stat. § 51.61(1)(g) 4.b.—that Melanie was “substantially incapable of applying an understanding of the advantages, disadvantages and alternatives to ... her condition [i.e., mental illness] in order to make an informed choice as to whether to accept or refuse psychotropic medications.” The court ordered a final hearing and directed two medical experts to evaluate Melanie before her release from St. Elizabeth Hospital.

¶ 16 Dr. David Warner, a psychologist, evaluated Melanie at St. Elizabeth on February 11. Dr. Warner reported that at the time of his examination, Melanie's symptomshad subsided and she was taking Seroquel,⁶ an antipsychotic medication, and Ativan,⁷ a medication for anxiety. Dr. Warner reported that Melanie was of average intelligence, able to understand and answer questions, and that her “thought processes were generally coherent and goal directed.” However, due to Melanie's “paranoia and delusions of persecutions,” Dr. Warner concluded that her “insight and judgment regarding her loss of contact with reality were impaired.”

¶ 17 Dr. Warner diagnosed Melanie with Psychotic Disorder, Not Otherwise Specified (NOS). He concluded that Melanie's psychotic disorder “grossly impaired her judgment, behavior, and capacity to recognize reality.” Dr. Warner opined that Melanie was “marginally incompetent to refuse treatment with psychotropic medication,” concluding that although she was able to express a basic understanding of the advantages, disadvantages, and alternatives to treatment with psychotropic medication in general terms, she had not applied “this information to her mental illness consistently in order to make an informed choice as to whether to accept or refuse psychotropic medication or treatment.” He added:

It is my opinion that she is dangerous to herself primarily because she is likely incompetent to refuse treatment with psychotropic medication and there is a substantial probability, based on her treatment records and recent acts and omissions, that she will suffer severe mental and emotional harm.... Given her history of not following her prescribed psychotropic medication schedule ... it is my opinion that she is unlikely to...