State v. C.C. (In re C.C.), A146999

• Citation: 258 Or.App. 727,311 P.3d 948
• Decision Date: 09 October 2013
• Docket Number: A146999,101071218.
• Parties: In the Matter of C.C., Alleged to be a Mentally Ill Person. STATE OF OREGON, Respondent, v. C.C., Appellant.
• Court: Oregon Court of Appeals

258 Or.App. 727

311 P.3d 948

In the Matter of C.C., Alleged to be a Mentally Ill Person.

STATE OF OREGON, Respondent,

v.C.C., Appellant.

A146999; 101071218.

Court of Appeals of Oregon.

Submitted on Nov. 02, 2012.

Decided Oct. 9, 2013.

Connie L. Isgro, Judge pro tempore.

Rebecca Carter filed the brief for appellant.

John R. Kroger, Attorney General, Anna M. Joyce, Solicitor General, and Joanna L. Jenkins, Assistant Attorney General, filed the brief for respondent.

Before SCHUMAN, Presiding Judge, and WOLLHEIM, Judge, and NAKAMOTO, Judge.

WOLLHEIM, J.

Appellant appeals a judgment of involuntary civil commitment, contending that the record is insufficient to support the trial court's determination that he was a danger to self as a result of a mental disorder. ORS 426.005(1)(e)(A).¹ In particular, appellant contends that evidence pertaining to his refusal to take insulin for his insulin-dependent diabetes was legally insufficient to establish the requisite danger to self. We disagree and, thus, affirm.

Appellant asks that we review this matter de novo. We conclude that this is not an “exceptional” case that warrants de novo review. ORS 19.415(3)(b); seeORAP 5.40(8)(c) (“The Court of Appeals will exercise its discretion to try the cause anew on the record or to make one or more factual findings anew on the record only in exceptional cases.”). Accordingly, “we view the evidence, as supplemented and buttressed by permissible derivative inferences, in the light most favorable to the trial court's disposition and assess whether, when so viewed, the record was legally sufficient to permit that outcome.” Dept. of Human Services v. N. P., 257 Or.App. 633, 639, 307 P.3d 444 (2013) (stating our standard of non- de novo review of the facts, in the context of a juvenile court's determination of jurisdiction under ORS 419B.100(1)(c)). “We are bound by the trial court's findings of fact that are supported by evidence in the record.” State v. A.D.S., 258 Or.App. 44, 45, 308 P.3d 365 (2013) (citing ORS 19.415(3)(b)). Consistently with the standard of review, the record discloses the following facts that are material to our review.

Appellant, a 23–year–old man, was diagnosed with Type I diabetes when he was approximately 14 years old and has since been dependent on the daily use of insulin and frequent daily blood-sugar monitoring to manage the disease. In 2010, appellant told his family and friends that God speaks to him “from the heart,” offering directives. Appellant believed that “the Holy Spirit dwells in [his] head and [his] mind and [his] heart,” and that God designed a “mission” for him to follow—a journey to Cartagena, Columbia, to operate a coffee plantation. Both appellant and his father testified that, before the onset of auditory delusions, appellant actively and successfully managed his treatment for diabetes by following an insulin regime. Appellant kept a “meal blog” and self-administered insulin shots, as well as testing his blood sugar level “at every meal and then before * * * bed.”

In May 2010, appellant stopped taking insulin for a period of one or two days because he believed that God had healed his diabetes. Friends and family were able to convince him that not taking insulin was a mistake. Appellant's father testified to a noticeable and “pretty scary” change in appellant's behavior around June 2010. Appellant began to act aggressively around his family; he had “explosive” episodes involving swearing and “relentless” confrontation. Between July and September 2010, appellant saw two psychiatrists. One prescribed medication consistent with a diagnosis of bipolar disorder. However, appellant would not take that medication because he was “not mental.”

Appellant continued hearing voices. In early October 2010, he deviated from his usual routine, failing to call his parents from a transit center from which they ordinarily picked him up. His parents found appellant in Olympia, Washington, where he had made contact with an ex-girlfriend in an unsuccessful attempt to bring her on his mission. Appellant adamantly refused to return home with his father and subsequently refused to accept diabetic supplies from his mother. On October 12, appellant traveled to Portland, where he met with a cousin; however, he also declined his cousin's offer to get insulin. His cousin provided appellant with dinner and a hotel room.

The following day, police officers were dispatched to the hotel to conduct a welfare check and found appellant alone in his room, in his underwear. He appeared tired but was capable of discussing his situation. Appellant readily admitted that he had ceased taking insulin five or six days earlier. The officers contacted Project Respond, requesting an evaluation. The Project Respond evaluator recommended hospitalization because appellant's grandiose thought and command hallucinations put appellant at risk for serious physical harm—risk that “his body would shut down due to blood sugar issues.” As a result of that evaluation, appellant was hospitalized.² At the ensuing civil commitment hearing, appellant testified that his blood-sugar level had been elevated, between 300 and 400.³

At the time of the hearing, appellant had little or no money and was dependent on others to satisfy his needs for food and shelter. Appellant demonstrated considerable awareness of the risks associated with failing to take insulin. For example, he testified that, once a person's blood sugar reaches levels of 400 to 500, the person could lapse into a diabetic coma and experience blindness and other organ damage. As appellant remarked, “it's my eyesight and my kidneys and my toes. And I'm very aware that that's some serious crap * * *.” ⁴

Appellant adamantly believed that his body was invulnerable to the deleterious effects of diabetes because God would “sustain [his] blood sugar supernaturally.” He explained:

“I trust you, Lord, to this degree. I know this is crazy, but I trust you with the blood sugar. He said, ‘Just eat anything. You still have diabetes, but I'm going to sustain it, so it doesn't affect your blood—your nerves or your organs.’ Okay. So I said, ‘Okay, Lord.’ ”

He further explained that he was concerned about his parents' interference and intervention; he believed that “[t]he Lord told [him] this would happen, they would be following [him] * * * in the name of Satan, in the name of niceness.” Appellant denied that he was bipolar, rejected treatment for mental illness, and stated that he did not want prescribed medication to treat bipolar disorder upon his release. However, the record shows that appellant's rejection of a bipolar diagnosis is, at least in part, also a result of his delusions. For example, appellant testified that “[t]he Lord is also saying I don't have bipolar disorder.” Appellant also testifiedthat he wanted to obtain a credit card and travel to California to continue fulfilling his “plan.”

Both court examiners attributed appellant's delusions to a bipolar disorder. One examiner concluded that appellant's delusions, “impulsivity,” and “unrealistic plans” created a risk that the examiner believed “can be life threatening.”

The trial court determined that appellant was mentally ill and posed a danger to himself and entered a judgment ordering his civil commitment for a period not to exceed 180 days. ORS 426.005(1)(e)(A). In reaching that determination, the trial court stated:

“[T]he concern to me here is * * * that [appellant] has to listen to and comply with these hallucinations or these voices from God, that there is no option not to follow through with them. * * * He also has been told to ignore the assistance from friends and family. And in particular I was concerned about when the cousin testified that he offered to bring [him] to the hospital to obtain more supplies for his insulin, he didn't * * * God is telling him to ignore the assistance being offered to him.”

On appeal, appellant argues that the trial court's determination that he posed a danger to himself rests on legally insufficient evidence. For the reasons that follow, we disagree.

A court may order involuntary commitment of a person for up to 180 days if the court finds clear and convincing evidence that, as a result of a mental disorder, the individual is, inter alia, “[d]angerous to self.” ORS 426.005(1)(e)(A); ORS 426.130(1)(b)(C). As we have held in “danger to self” civil commitment cases, an individual's mental disorder must, at minimum, cause the individual to act in a way very likely to result in physical harm in the near future. State v. T.R.O., 208 Or.App. 686, 691, 145 P.3d 350 (2006) (citing State v. T.S.W., 186 Or.App. 404, 409, 63 P.3d 1258 (2003)). “Specifically, the requisite danger to self cannot be based on mere unsubstantiated apprehension or speculation. Rather, it must partake of a particularized, and highly probable, threat to [the] appellant's safe survival, including a risk of substantial harm, in the near future.” State v. B. B., 240 Or.App. 75, 84, 245 P.3d 697 (2010) (internal quotations omitted).

Appellant invokes our decision in State v. T.L.H., 202 Or.App. 63, 65, 121 P.3d 17 (2005), contending that the evidence here was legally insufficient to establish the requisite serious, near-term risk of harm from his refusal to take insulin for his diabetes. In T.L.H., the appellant, a 49–year–old woman diagnosed with a schizoaffective disorder and diabetes, refused medication for both the psychological disorder and the diabetes.⁵ The trial court determined that the appellant was a danger to herself. Id. On appeal, we reversed, holding that the record was deficient with respect to the specific risks attending the appellant's diabetic condition and that “concern about potential future dangers to [the] appellant from acting in response to her auditory hallucinations [was] too attenuated and speculative to satisfy the ‘clear and convincing’ standard.” Id. at 71, 121 P.3d 17.

Here, we are presented with a...