Schuoler, In re
| Decision Date | 07 August 1986 |
| Docket Number | No. 51133-1,51133-1 |
| Citation | 723 P.2d 1103,106 Wn.2d 500 |
| Parties | In re the Detention of Loretta SCHUOLER. Neal McCARTHY, M.D., and Lenor Hains, MHP, Respondents, v. Loretta SCHUOLER, Appellant. |
| Court | Washington Supreme Court |
Bothwell & Lorello, Thomas Bothwell, Yakima, for appellant.
Jeffrey C. Sullivan, Yakima County Prosecutor, John C. Monter, Deputy County Prosecutor, Yakima, for respondents.
John H. Hertog, Jr., George Yeannakis, Seattle, for Seattle-King County Public Defender Assn.
Michael Mirra, Steilacoom, for Evergreen Legal Services.
Neil Sarles, Seattle, for American Civil Liberties Union.
Kurt W. Melchior, Jan T. Chilton, A. Megan Evans, San Francisco, Cal., Robert M. Schaefer, Vancouver, for International Psychiatric Ass'n for the Advancement of Electrotherapy.
Ken Eikenberry, Atty. Gen., Karen McCarty Lundahl, Asst. Atty. Gen., Olympia, for State.
Appellant Loretta Schuoler challenges the trial court's authorization of electroconvulsive therapy (ECT) pursuant to the involuntary commitment statute. We agree that the ECT hearing below violated both statutory and due process requirements.
A friend brought Schuoler to the Yakima Valley Memorial Hospital on August 11, 1983. At that time Schuoler was disoriented and refused to take the medication that had been prescribed for her during an earlier admission. She had not been eating or sleeping well and was unable to communicate her birthdate or address when questioned by the admitting mental health professional. This was her fourth admission to the hospital due to mental illness since March 1983.
A hearing was held on August 16, 1983, pursuant to RCW 71.05.230, to determine whether there was probable cause to involuntarily commit Schuoler for evaluation and treatment for 14 days. The trial court found Schuoler to be "gravely disabled" and authorized a 14-day involuntary commitment.
At the hearing, the treating psychiatrist, Dr. Neal McCarthy, asked the court to authorize ECT for Schuoler. Her attorney objected because she had received no notice that authorization for ECT would be requested. She also asked that Schuoler be examined by another mental health professional, as required by RCW 71.05.370(7). The trial court set a hearing on the authorization of ECT for the next morning.
After the hearing to determine probable cause for commitment, the prosecutor informed Schuoler's attorney that two psychiatrists were available to interview Schuoler and to testify on her behalf at the hearing on the next day. Schuoler's attorney originally agreed to the appointment of Dr. Frank Hardy, but later objected to his appointment at the ECT hearing after discovering that Dr. Hardy supported the authorization of ECT for Schuoler.
The evidence before the court in the ECT hearing consisted almost entirely of the testimony of Drs. McCarthy and Hardy. Both psychiatrists testified that ECT is a medically accepted form of treatment for patients who are mentally ill, particularly those suffering from depression. Both discussed the benefits and risks of ECT, and testified that ECT was the indicated treatment in a case such as Schuoler's, where the patient had shown no improvement while on drug therapy and had in the past been able to function outside of a mental institution as the result of ECT. Dr. Hardy testified that without ECT Schuoler might regress into a vegetative state and be confined to the back wards of a state hospital for the rest of her life.
Ms. Schuoler's attorney challenged the physicians' testimony. She proved that despite Dr. McCarthy's assertion that ECT had helped Schuoler 2 years earlier, Schuoler had actually returned to the hospital within a week of treatment. The attorney also tried to introduce evidence that a Seattle psychiatrist had diagnosed Schuoler differently than McCarthy.
After this testimony the trial court concluded that there were medically accepted indications that ECT would benefit Schuoler and that any risks of the treatment were minimal. The court ordered Schuoler to undergo ECT at the discretion of her treating psychiatrist. Her request for a stay pending appeal was denied. The case was transferred to this court from Division Three.
Initially we should point out that since the trial court refused to stay Schuoler's treatment pending appeal this case is moot. This court cannot provide effective relief for the parties involved. See State v. Turner, 98 Wash.2d 731, 658 P.2d 658 (1983). Nevertheless, we will decide the merits of the controversy. We have repeatedly issued opinions on otherwise moot questions that are of substantial public interest. See, e.g., Dunner v. McLaughlin, 100 Wash.2d 832, 676 P.2d 444 (1984).
Schuoler raises several challenges to the trial court's order that she submit to ECT. The court acted pursuant to RCW 71.05.370, which provides:
Insofar as danger to the individual or others is not created, each person involuntarily detained, treated in a less restrictive alternative course of treatment, or committed for treatment and evaluation pursuant to this chapter shall have, in addition to other rights not specifically withheld by law, the following rights ...
* * *
(7) Not to consent to the performance of shock treatment or surgery, except emergency life-saving surgery, upon him, and not to have shock treatment or nonemergency surgery in such circumstance unless ordered by a court pursuant to a judicial hearing in which the person is present and represented by counsel, and the court shall appoint a psychiatrist, psychologist, or physician designated by such person or his counsel to testify on behalf of such person; ...
Schuoler argues that a court cannot order ECT pursuant to RCW 71.05.370(7) for a nonconsenting individual without relying on the guardianship proceedings of RCW 11.88 and 11.92. Schuoler also argues that the court's order of ECT violated her constitutional right to refuse treatment. Schuoler challenges the procedures of RCW 71.05.370(7) to be so inadequate that the statute violates her procedural due process rights. Finally, she argues that the court below abused its discretion when it denied her motion for a continuance. We examine each contention in turn.
Schuoler argues that a court cannot order ECT for a nonconsenting patient without first determining that person's competency. Schuoler argues that if the person is found competent, the court cannot order ECT against that person's wishes. If instead the person is found incompetent, Schuoler argues that the court must appoint a guardian and proceed under the guardianship statutes, RCW 11.88 and 11.92.
We disagree that the Legislature intended courts to undertake competency determinations and guardian appointments in conjunction with ECT hearings. Although the guardianship statutes and the involuntary commitment statute may apply to some of the same people, the statutes operate independently to achieve different purposes. The purpose of the guardianship statutes is to provide a means by which another person may exercise the decisionmaking power of an individual who is not legally competent to make decisions. RCW 11.92.040; In re Ingram, 102 Wash.2d 827, 838-39, 689 P.2d 1363 (1984). The involuntary commitment statute provides for the needs of a different group of people, individuals who are a danger to themselves or to others, or who are gravely disabled. These individuals may or may not be legally competent. RCW 71.05.450.
Guardianship proceedings would in large part be superfluous to ECT hearings. The guardianship statute specifically denies guardians the power to consent to ECT; instead, the statute directs guardians who believe such treatment to be necessary to petition a court for an order. RCW 11.92.040. 1 Thus, even if a guardian were appointed for purposes of a 71.05.370(7) hearing, the statutes direct that a court, not the guardian, make the decision to administer or withhold ECT.
We acknowledge that a guardian could be useful to a limited extent in an ECT hearing. Nevertheless, we do not agree with Schuoler that appointment of a guardian in an ECT hearing is necessary. A major goal of the involuntary commitment and treatment scheme of RCW 71.05 is to replace inappropriate, indefinite commitments with prompt evaluation and short term treatment. RCW 71.05.010(1), (2). 2 Appointment of a guardian is a timeconsuming process , and could frustrate the goals of RCW 71.05.
Our conclusion that a court does not need to appoint a guardian for an ECT hearing does not mean that a court does not need to consider a patient's wishes about ECT. This court has recognized the "fundamental principle" that competent adults have a right to determine what shall be done to their own bodies. See Smith v. Shannon, 100 Wash.2d 26, 666 P.2d 351 (1983). See also RCW 7.70.050. This right is grounded in both common law and constitutional principles. In re Ingram, supra; In re Colyer, 99 Wash.2d 114, 119, 660 P.2d 738 (1983). See also People v. Medina, 705 P.2d 961, 967 (Colo.1985); Holmes v. Silver Cross Hosp., 340 F.Supp. 125 (N.D.Ill.1972). In In re Ingram, supra, we ruled that a court asked to make a substantive medical treatment decision for an incompetent individual must attempt to decide as that individual would if competent.
An individual's right to refuse ECT is an especially important issue because of the nature of ECT. Electroconvulsive therapy is a highly intrusive medical procedure. Adverse side effects of ECT are documented in both the record and scholarly articles. "Memory loss [both short and long term] has long been recognized to be a prominent effect of electroconvulsive therapy (ECT)." American Psychiatric Ass'n, Task Force Report 14, Electroconvulsive Therapy 57 (Sept. 1978). Impairment of ability to learn new material is cumulative with successive treatments, and it has been demonstrated that bilateral ECT (the type to be administered to...
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