Myers v. Alaska Psychiatric Institute, S-11021.

• Citation: 138 P.3d 238
• Decision Date: 30 June 2006
• Docket Number: No. S-11021.,S-11021.
• Parties: Faith J. MYERS, Appellant, v. ALASKA PSYCHIATRIC INSTITUTE, Appellee.
• Court: Supreme Court of Alaska (US)

Page 238

138 P.3d 238

Faith J. MYERS, Appellant, v. ALASKA PSYCHIATRIC INSTITUTE, Appellee.

No. S-11021.

Supreme Court of Alaska.

June 30, 2006.

James B. Gottstein, Law Project for Psychiatric Rights, Inc., Anchorage, for Appellant.

Michael G. Hotchkin, Assistant Attorney General, Anchorage, and Gregg D. Renkes, Attorney General, Juneau, for Appellee.

Before: BRYNER, Chief Justice, MATTHEWS, EASTAUGH, FABE, and CARPENETI, Justices.

OPINION

BRYNER, Chief Justice.

I. INTRODUCTION

Faith Myers, after being involuntarily committed to the Alaska Psychiatric Institute, appealed a superior court order approving nonconsensual administration of psychotropic drugs by the institute. She argues that the statutes relied on by the court in approving the medication violate the Alaska Constitution's guarantees of privacy and liberty. We agree. In keeping with most state courts that have addressed the issue, we hold that, in the absence of emergency, a court may not authorize the state to administer psychotropic drugs to a non-consenting mental patient unless the court determines that the medication is in the best interests of the patient and that no less intrusive alternative treatment is available.

II. FACTS AND PROCEEDINGS

Faith Myers has suffered with mental illness for over twenty years. Her symptoms have included paranoia, dizziness, and vivid hallucinations. She has been hospitalized on a number of occasions and, at times, a regimen of psychotropic medication has seemed to improve her condition.

In 2001 Myers weaned herself off of psychotropic medication, believing that the drugs actually worsened her condition. She has described herself from this time forward as an advocate for the mentally ill.

In February 2003, as a result of concerns expressed by Myers's daughter and neighbors, Myers was involuntarily committed to the Alaska Psychiatric Institute (API). Once admitted, Myers refused to discuss treatment options with institute doctors. API then filed a petition with the superior court requesting authorization to medicate Myers without her consent.

Myers responded by challenging the constitutionality of the statutory scheme that authorizes facilities to administer psychotropic drugs without first securing a patient's consent. She argued that Alaska's constitutional rights to liberty and privacy guarantee her the "right to be free from unwanted mind-altering chemicals." She asserted that the state can abridge this right only when necessary to advance a compelling state interest. In her case, Myers believed that API had "not come close" to making this requisite showing and had also failed to show that involuntary medication was a "[least] restrictive means" of advancing any state interest.

Myers also challenged "the [statutory] limitation on a court's authority to modify or restrict a treatment plan." The statute authorizing court-ordered administration of psychotropic medication provides that once a court "determines that [a] patient is not competent to provide informed consent," the court "shall approve the . . . proposed use of psychotropic[s]."¹ On its face, this provision does not seem to allow the court to consider whether the proposed treatment plan would actually be in the patient's best interest, leaving that decision completely to the treating facility's physicians.

During Myers's hearing on API's petition, two institute psychiatrists testified that, in their opinion, administering psychotropic medication to Myers would be appropriate. Myers countered with testimony from two expert psychiatrists who "forcefully present[ed] their differing views on the advisability of administering [psychotropic] medications to patients suffering from schizophrenia." The first testified that psychotropic medication is not the only viable treatment for schizophrenia. While acknowledging that psychotropic medications played an accepted role in the "standard of care for [the] treatment of psychosis," he advised that, because such drugs "have so many problems," they should be used "in as small a dose for as short a period of time as possible." Myers's second expert offered more specific testimony that one of the drugs that API proposed to administer to Myers — Zyprexa — was, despite being "widely prescribed," a "very dangerous" drug of "dubious efficacy." He based this testimony on a "methodological analysis" of the studies that led the food and drug administration to approve Zyprexa for clinical use.

At the conclusion of the hearing, the superior court found that Myers "lacked . . . insight into her own condition" and did "not appreciate that she suffers from a mental disorder." Although it noted that Myers understood the debate about the advisability of psychotropic medication and had articulated a "reasonable objection to the proposed medication," the court nonetheless ruled that she lacked the capacity to make informed decisions regarding her treatment. Construing Alaska's statutes as not allowing it to make an independent determination of Myers's best interests, the court did not consider Myers's expert evidence on the point and authorized API to administer psychotropic medications to Myers based on API's own assessment of Myers's best interests.

The court nevertheless noted that it found Myers's case "troubling" — so much so that it issued an additional order addressing in detail the arguments presented in the parties' pre-hearing briefs. In the order, the court found it troubling that Alaska's statutory scheme prevented it from considering the merits of API's treatment plan, or weighing the objections of Myers's experts. Because it believed that the statute unambiguously limited the superior court's role "to deciding whether Ms. Myers has sufficient capacity to give informed consent," the court felt constrained to adhere to its literal meaning. Yet the court nevertheless emphasized that it found this limitation to be problematic:

Where a patient, such as Ms. Myers, has a history of undergoing a medical treatment she found to be harmful, where she is found to lack capacity to make her own medical decisions and a valid debate exists in the medical/psychiatric community as to the safety and effectiveness of the proposed treatment plan, it is troubling that the statutory scheme apparently does not provide a mechanism for presenting scientific evidence challenging the proposed treatment plan.

Myers now appeals.

III. DISCUSSION

Echoing the superior court's concern, Myers contends that Alaska's statutory scheme violates her constitutional rights to liberty² and privacy.³ The central question she raises is whether the state may force an unwilling mental patient to be treated with psychotropic drugs without first obtaining a judicial determination that this treatment is in the patient's best interests and that no less intrusive course of treatment is available.

Myers argues that the right to refuse forced medication is fundamental and that API cannot abridge this right without first showing that medication would advance a compelling state interest and that no less intrusive alternative is available. She further contends that our state's constitutional liberty and privacy guarantees require that courts authorizing the administration of psychotropic medications must find, first, that the requested course of medication is in the patient's best interests; and, second, that the patient would presently consent to the treatment if capable of making an informed decision.

In response, API initially contends that this appeal should be dismissed as moot because Myers was released from API soon after the superior court issued its ruling, so she never actually received the authorized course of treatment. As to the merits of Myers's constitutional claim, API denies that Myers's interest in refusing unwanted psychotropic medication is fundamental. Because Myers has been judged unable to make informed decisions about her mental health condition, API analogizes her status to the status of minors, who, API claims, generally receive "a different level of constitutional protection." Therefore, API argues, in order to justify medicating Myers without her consent, the state needs only to show that this treatment would advance something "less than a compelling state interest." API further contends that, "as a committed mental patient," Myers "has a competing constitutional interest in receiving treatment for her illness."⁴ It asserts that the state's "duty to provide [Myers] with treatment" amounts to a legitimate state interest — one that we should deem sufficient to overcome Myers's objections.

A. Alaska's Current Statutory Provisions

To place these arguments in perspective, we must begin by considering Alaska's statutory provisions governing treatment of mental patients. Alaska law recognizes and addresses a distinct class of drugs called "psychotropic medications."⁵ Psychotropic drugs "affect the mind, behavior, intellectual functions, perception, moods, and emotions"⁶ and are known to cause a number of potentially devastating side effects.⁷

[M]ost common . . . are the temporary, muscular side effects (extra-pyramidal symptoms) which disappear when the drug is terminated; dystonic reactions (muscle spasms, especially in the eyes, neck, face, and arms; irregular flexing, writhing or grimacing movements; protrusion of the tongue); [and] akathesia (inability to stay still, restlessness, agitation) . . . Additionally, there are numerous other nonmuscular effects, including drowsiness, weakness, weight gain, dizziness, fainting, low blood pressure, dry mouth, blurred vision, loss of sexual desire, frigidity, apathy, depression, constipation, diarrhea, and changes in the blood.⁸

Courts have observed that "the likelihood [that psychotropic drugs will cause] at least some temporary side effects appears to be undisputed"⁹ and many have noted that the drugs may — most infamously — cause Parkinsonian syndrome and tardive...