Steele v. Hamilton Cnty. Cmty. Mental Health Bd.

• Decision Date: 18 October 2000
• Docket Number: No. 99-1771,99-1771
• Citation: 2000 Ohio 47,90 Ohio St.3d 176
• Parties: STEELE, APPELLANT, v. HAMILTON COUNTY COMMUNITY MENTAL HEALTH BOARD, APPELLEE.
• Court: Ohio Supreme Court

90 Ohio St.3d 176

2000 Ohio 47

STEELE, APPELLANT, v. HAMILTON COUNTY COMMUNITY MENTAL HEALTH BOARD, APPELLEE.

No. 99-1771

SUPREME COURT OF OHIO

Submitted June 6, 2000

October 18, 2000

[Cite as Steele v. Hamilton Cty. Community Mental Health Bd. (2000), 90 Ohio St.3d 176.]

Public welfare — Hospitalization of mentally ill persons — State's interest in protecting its citizens outweighs an involuntarily committed mentally ill patient's interest in refusing antipsychotic medication, when — Physician may order forced medication of an involuntarily committed mentally ill patient with antipsychotic drugs, when — Court may issue an order permitting hospital employees to administer antipsychotic drugs against the wishes of an involuntarily committed mentally ill person, when.

1. When an involuntarily committed mentally ill patient poses an imminent threat of harm to himself/herself or others, the state's interest in protecting its citizens outweighs the patient's interest in refusing antipsychotic medication. Authority for invoking the state's interest flows from the police power of the state.

2. Whether an involuntarily committed mentally ill patient poses an imminent threat of harm to himself/herself or others warranting the administration of antipsychotic drugs against the patient's will is uniquely a medical, rather than a judicial, determination to be made by a qualified physician.

3. A physician may order the forced medication of an involuntarily committed mentally ill patient with antipsychotic drugs when the physician determines that (1) the patient presents an imminent danger of harm to himself/herself or others, (2) there are no less intrusive means of avoiding the threatened harm, and (3) the medication to be administered is medically appropriate for the patient.

4. When an involuntarily committed mentally ill patient, who does not pose an imminent threat of harm to himself/herself or others, lacks the capacity to give or withhold informed consent regarding his/her treatment, the state's parens patriae power may justify treating the patient with antipsychotic medication against his/her wishes. In re Milton (1987), 29 Ohio St.3d 20, 29 OBR 373, 505 N.E.2d 255, modified.

5. Whether an involuntarily committed mentally ill patient, who does not pose an imminent threat of harm to himself/herself or others, lacks the capacity to give or withhold informed consent regarding treatment is uniquely a judicial, rather than a medical, determination.

6. A court may issue an order permitting hospital employees to administer antipsychotic drugs against the wishes of an involuntarily committed mentally ill person if it finds, by clear and convincing evidence, that (1) the patient does not have the capacity to give or withhold informed consent regarding his/her treatment, (2) it is in the patient's best interest to take the medication, i.e., the benefits of the medication outweigh the side effects, and (3) no less intrusive treatment will be as effective in treating the mental illness.

APPEAL from the Court of Appeals for Hamilton County, No. C-980965.

On July 26, 1997, appellant, Jeffrey Steele, was taken by a police officer to University of Cincinnati Hospital ("University Hospital") after appellant's family reported that appellant was "seeing things and trying to fight imaginary foes." After observing appellant, a hospital physician noted that appellant was "responding to internal stimuli," and the physician recommended that appellant be "hospitalized for [the] protection of others and for stabilization/treatment ofpsychosis." In accordance with R.C. 5122.10, appellant was detained at University Hospital.

On July 29, in accordance with R.C. 5122.11, R. Gregory Rohs, M.D., a University Hospital physician, filed an affidavit in the Court of Common Pleas of Hamilton County, Probate Division, stating that appellant, because of his mental illness, posed a substantial and immediate risk of physical impairment or injury to himself as manifested by evidence that he was unable to provide for his basic physical needs. Dr. Rohs's affidavit also stated that appellant had a history of odd and paranoid behaviors, including refusing to eat food prepared by his family, talking to himself, making threats to his family, forcing himself to throw up every morning, and failing to bathe or groom. While detained at University Hospital appellant exhibited substantially identical behavior. Dr. Rohs's affidavit indicated that, while appellant was hospitalized, appellant was withdrawn, did not maintain his hygiene, appeared to have disorganized thought processes, seemed to be responding to internal stimuli, refused medications, and appeared guarded and suspicious. The affidavit concluded that appellant was most likely suffering from paranoid schizophrenia.

In accordance with R.C. 5122.141, the probate court ordered a hearing, to be held on August 1, on Dr. Rohs's affidavit. The court further ordered that appellant was to be detained at University Hospital pending the outcome of the hearing. Pursuant to R.C. 5122.14, the court appointed a psychiatrist, Cyma Khalily, M.D., as an independent expert to examine appellant and report her findings to the court. An attorney was appointed to represent appellant. See R.C. 5122.15.

At the conclusion of the August 1 hearing, the probate court found, by clear and convincing evidence, that appellant was mentally ill, and the court ordered that appellant be committed to a hospital. R.C. 5122.15. As a result ofthe court's ruling, appellant remained involuntarily hospitalized at University Hospital.

Thereafter, University Hospital sought an order from the probate court permitting appellant's transfer to the Pauline Warfield Lewis Center ("Lewis Center"). The motion stated that the transfer was in appellant's best interest because, due to his mental illness, appellant was unable to comply with his required treatment and he needed long-term treatment and/or forced medication care. The probate court granted University Hospital's motion, and appellant was transferred to the Lewis Center on August 12.

On September 26, appellee, Hamilton County Community Mental Health Board, sought a court order permitting the Lewis Center employees to administer antipsychotic medication¹ to appellant without his informed consent. A hearing on the motion for forced medication was held on October 31.

Three psychiatrists testified at the hearing: Dr. Michael Newton, appellant's treating physician at the Lewis Center; Dr. Paul Keck of University Hospital; and Dr. Cyma Khalily, the psychiatrist appointed by the probate court. All three physicians testified that appellant was suffering from a form of schizophrenia, that in the hospital environment appellant was not an immediate danger to himself or others, that appellant lacked the capacity to give or withhold informed consent, that antipsychotic medication was the only effective treatment for appellant's illness, that the benefits of the medication outweighed the side effects, and that appellant's illness, without treatment, prevented him from being released from the hospital.

At the conclusion of the October 31, 1997 hearing, the magistrate orally denied the motion for forced medication. The magistrate's decision was centered on his finding that appellee had not shown by "clear and convincing evidence that [appellant] represent[ed] a grave and immediate danger of serious physical harm to himself or others."

Subsequently, the magistrate, on December 3, filed findings of fact and conclusions of law in support of his decision. In part, the magistrate's report concluded that, at the time of the hearing, appellant suffered from a form of schizophrenia that resulted in "a substantial disorder of thought [that] grossly impair[ed] his behavior and judgment," requiring "treatment that include[d] in-patient hospitalization and highly supervised care." The magistrate also found that appellant was not violent or suicidal or disruptive to the ward in any way. In addition, the magistrate found that appellant lacked the capacity to give or withhold informed consent regarding treatment. The magistrate concluded that appellant should not be forcibly medicated.

Appellee, on December 15, filed objections to the magistrate's findings of fact and conclusions of law, arguing that "a showing of dangerousness is not required by Ohio law or statute in order to grant the authority for forced medications." After hearing arguments on the objections, the probate judge, on February 19, 1998, remanded the matter to the magistrate "for clarification of the Magistrate's Findings of Fact regarding the severity or gravity of [appellant's] mental illness."

The magistrate's rehearing was held on May 22 and May 29, 1998. Following the rehearing, the magistrate again denied appellee's motion for court-ordered medication of appellant. On November 9,² the probate judge filed an opinion and entry upholding the magistrate's findings of fact and conclusions of law on rehearing. In its opinion, the court held that Ohio policy only "authorize[d] the forced medication of psychotropic drugs upon a showing that the patient has a serious mental illness, is a danger to his or her self or to others within the institution, and the treatment is in the patient's medical interest."³

On December 8, appellee appealed the probate court's ruling to the Court of Appeals for Hamilton County. The court of appeals reversed the judgment of the probate court and held that "an applicant need not prove that an involuntarilycommitteed [sic] patient poses a risk of danger to himself or others to obtain an order to forcibly medicate the patient, when the applicant has otherwise shown that medication is in the patient's best interest, and when the patient lacks the capacity to give or withhold informed consent for such treatment."

This cause is now before this court pursuant to the allowance of a discretionary appeal.

D. Shannon Smith and James R. Bell, for appellant.

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