Title: K.C. v. State

State: wyoming

Issuer: Wyoming Supreme Court

Document:

K.C. v. State1989 WY 74771 P.2d 774Case Number: C-88-9Decided: 03/20/1989Supreme Court of Wyoming
K.C., 
APPELLANT (RESPONDENT),

 
 
v.

 
 
THE STATE 
OF WYOMING, APPELLEE (PETITIONER). No. 
C-88-9

 
 
Appeal from 
the District Court, LaramieCounty, Edward L. Grant, 
J.

 
 
Robert G. 
Pickering of Bailey, Pickering, Stock & 
Welch, Cheyenne, 
for appellant.

 
 
Joseph B. 
Meyer, Atty. Gen., John W. Renneisen, Deputy Atty. Gen., for appellee.

 
 
Before CARDINE, C.J., and THOMAS, URBIGKIT, MACY 
and GOLDEN, JJ.

 
 

URBIGKIT, 
Justice.

 
 

[¶1.]     Presented by this 
appeal is the difficult and socially pervasive concern of government 
responsibility - administrative, judicial and legislative - for the adequacy of 
care to be provided the mentally ill. Sufficiency of care and treatment was 
directly contested in the involuntary civil commitment of this admittedly 
mentally ill and severely disturbed adult to the Wyoming State Hospital (State 
Hospital) in Evanston, Wyoming, the state's only domiciliary institution. 
Consequently, alternative arrangements were requested, and the discretionary 
authority of the district court was questioned in this direct appeal of the 
involuntary commitment order as well as through a petition for extraordinary 
writ of prohibition. With the petition phrased in the contours of constitutional 
deprivation and functional denial, the writ was not granted at initial request. 
This court, with this combined appeal, affirms the district court's 
actions.

 
 
FACTS

 
 

[¶2.]     On March 22, 1988, an 
application for involuntary hospitalization was filed in the First Judicial 
District Court of Laramie County, Wyoming following a suicide attempt by K.C., 
an individual with a history of medical problems and prior institutionalization 
at the StateHospital. K.C., with this 
history, had been under the local supervision of the Department of Public 
Assistance and Social Services (D-PASS) as a person with a recognized mental 
disturbance. In LaramieCounty, commitment cases are initially 
handled by a designated court commissioner who immediately appoints a medical 
examiner and establishes a detention hearing with present counsel appointed to 
represent the individual. Collaterally involved in factual overlay was a pending 
divorce and the previous loss of custody of her two 
children.

 
 

[¶3.]     Hospitalized by 
emergency detention ordered as a result of the commitment petition, a hearing 
was held on March 22, 1988, eventuating a continuing order for further 
examination with a designated medical examiner and hearing on March 28, 1988. It 
is from the March 28, 1988 hearing which produced the findings of the 
commissioner and subsequent order of the district court that this proceeding 
results. The commissioner found K.C. to be a mentally ill person within the 
criteria of W.S. 25-10-101(a)(viii)1 and recommended hospitalization in 
finding "that the proposed patient is mentally ill and recommends that she be 
involuntarily hospitalized." The commissioner then further 
said:

 
 
     With regard to the 
appropriate location of the proposed patient's involuntary hospitalization, 
however, I do not feel that the WyomingStateHospital is the appropriate 
site for involuntary hospitalization. Counsel for the proposed patient argued, 
and submitted a trial brief in support, that treatment at the Wyoming State 
Hospital would violate the proposed patient's right to treatment under the 
doctrine established in Clark v. Cohen, 794 F.2d 1979[79] Third Circuit (1988) 
and Wyatt v. Stickney[,] 325 F. Supp. 781, N.D.[M.D.]Ala. (1971). The proposed 
patient has previously been hospitalized, during April and May of 1987, at the 
WyomingStateHospital. Her testimony at the hearing 
indicated that she did not receive treatment adequate, in the opinion of your 
Commissioner, to meet the constitutional right to treatment. Dr. Merrell 
testified that the proposed patient needs inpatient care for a period of at 
least six (6) months and perhaps as long as a year, depending upon the 
availability of programs transitional from the institution to the community. Dr. 
Merrell testified that to his knowledge, there are no community halfway house 
programs available in the State for psychiatric patients and that in his 
opinion, no hospital in Wyoming other than the 
StateHospital, is qualified to 
accept long-term patients (that is, patients whose condition requires a stay of 
greater than eight to ten weeks). Your Commissioner finds that counsel for the 
proposed patient has demonstrated a substantial likelihood that adequate 
treatment will not be received at the State Hospital and that other instate 
alternatives are not available.

 
 
     Pursuant to the 
provisions of W.S. section 25-10-110(j),[2] consideration of the "least 
restrictive and most therapeutic alternatives" available for involuntary 
hospitalization and the proposed patient's right to treatment, for the reasons 
set out above, I cannot recommend that the proposed patient be hospitalized at 
the Wyoming State Hospital, unless enforceable assurances are made that the 
constitutionally requisite treatment will be received.

 
 
     Therefore, it is your 
Commissioner's further recommendation that the Court enter an Order requiring 
the Department of Health and Social Services to locate and fund a placement 
either in or out of state which will satisfy the proposed patient's right to 
treatment or, in the alternative, that a plan of treatment be developed by the 
State Hospital which will meet the right to treatment standard as interpreted 
and enforced by the District Court. The Order is recommended to include a time 
limit of twenty (20) days within which to develop either alternative. [State's 
attorney] shall prepare the recommended Order.

 
 

[¶4.]     Except as to the place 
of hospitalization, the recommendations of the commissioner for the involuntary 
hospitalization of K.C. were approved by order of the district court. The 
district court specifically rejected any alternative placement or search for 
alternative care and held "[t]hat the proposed patient be hospitalized and 
transported forthwith to the WyomingStateHospital at or near Evanston, Wyoming." The district court's order further 
provided:

 
 
     2. That, in conformity 
with W.S. § 25-10-113, the patient, within 15 days of admittance, shall be 
examined, the patient's record shall be reviewed and a plan of treatment for the 
patient shall be developed.

 
 
     3. That, within 20 
days of admittance, a copy of the Patient's plan of treatment shall be forwarded 
to this Court and an additional copy shall be forwarded to the patient's 
attorney, * * *.

 
 

[¶5.]     With alternative 
medical care placement denied, K.C. initially pursued two courses of action. 
K.C. appealed the involuntary commitment order and simultaneously filed a 
petition with this court to secure a writ of prohibition denying placement of 
her at the StateHospital. This court 
declined to issue the writ of prohibition which would have resulted in the 
immediate delay of hospitalization at the StateHospital, and K.C. has been institutionalized at the 
StateHospital since mid-April; 
unless recently released, which is not a matter of record 
here.

 
 

[¶6.]     This court will 
consider the direct appeal and the writ conjunctively as a single case now 
presented, essentially testing the propriety of the action of the district court 
in denying the finding of the commissioner that alternative mental institutional 
care should be required for this mentally ill person. K.C. phrases, as submitted 
questions:

 
 
     1. Whether an 
involuntarily civilly committed individual is entitled to 
habilitation?

 
 
     2. Whether the 
involuntary commitment statutes rise to the level of a state-created liberty 
interest in habilitation necessary to effect a right to live in the least 
restrictive, most therapeutic setting possible?

 
 
     3. Whether an 
involuntarily civilly committed individual is entitled to either a 
constitutional or statutory right to treatment necessary to effectuate his/her 
right to live in the least restrictive, most therapeutic setting 
possible?

 
 
     4. Whether it is a 
violation of procedural due process under both the federal and state 
constitutions, as well as, the involuntary commitment statutes, to transfer a 
patient to the WyomingStateHospital without a 
pre-deprivation hearing concerning the proposed plan of treatment at that 
facility?

 
 
     5. Whether it is a 
violation of procedural due process under both the federal and state 
constitutions, as well as the involuntary commitment statutes, to fail to hold a 
hearing on an objection to a post-deprivation proposed individual plan of 
treatment?

 
 
     6. Whether a 
post-commitment individualized plan of treatment lacking an assessment of the 
patient's problems and needs; the description of the services and treatment to 
be administered in the future and their possible side effects and feasible 
alternatives; the identity of specific individuals who will provide future 
services and treatment; the settings in which the services will be provided; a 
timetable for obtaining long-term goals or benefits from treatment or care; and 
a statement of the criteria for the patient's transition from the inpatient 
facility to a less restrictive, more therapeutic environment violates 
substantive due process under both the federal and state constitutions, as well 
as the involuntary commitment statutes?

 
 

[¶7.]     Alternatively, the 
State responds with the following issues:

 
 
I. Does the 
appellate standard applied by this court to decisions of trial courts apply to 
district court "review" of actions of district court commissioners; has 
appellant shown that the decision of the district court was not supported by 
substantial evidence and was clearly erroneous?

 
 
II. Do the 
involuntarily civilly committed have a Fourteenth Amendment due process right to 
treatment in the least restrictive, most therapeutic 
environment?

 
 
III. Does 
Section 25-10-110(j) of the Wyoming statutes create an individual right to 
treatment in the least restrictive, most therapeutic environment for the 
involuntarily civilly committed?

 
 
IV. Did the 
court below err in committing K.C. to the WyomingStateHospital?

 
 
V. Do the 
Wyoming 
statutes provide adequate procedural due process for a post-commitment review of 
the continuing need for hospitalization?

 
 
VI. Do the 
Wyoming 
statutes provide adequate procedural and substantive due process for a 
pre-commitment determination of the need for involuntary 
hospitalization?

 
 
VII. Has 
appellant shown a constitutional or statutory violation by the proposed 
individual treatment plan formulated in her case?

 
 

[¶8.]     Initially, we point out 
that this appeal is confined to the issues presented which involve the validity 
of the commitment order and not subsequent status of care which might be tested 
by habeas corpus or further order of the district court, where continuing 
jurisdiction remains, to consider whether the patient should remain in the State 
Hospital. See Tribby v. Cameron, 379 F.2d 104 (D.C. Cir. 1967); Rouse v. 
Cameron, 373 F.2d 451 (D.C. Cir. 1966); National Center for State Courts, 
Guidelines for Involuntary Civil Commitment 86 (1986); 2 A. Freedman, H. Kaplan, 
& B. Sadock, Comprehensive Textbook of Psychiatry-II § 50.1 at 2429 (2d ed. 
1975); and 3 B. Ennis & P. Friedman, Legal Rights of the Mentally 
Handicapped 1153 (1973). Secondly, there is no dispute, issue, or absence of 
evidence but that involuntary commitment and hospitalization were both 
appropriate and required for K.C. The dispute centers on the place of care for 
K.C. Fundamental in concept and concern in this anguished case is the belief, 
not only of the counsel for K.C. but also the court commissioner, that the 
StateHospital, where prior 
hospitalization had occurred, was not adequate to provide treatment for 
K.C.

 
 
DISCUSSION

 
 

[¶9.]     We surmise from the 
carefully prepared and extended briefing of counsel as mutually evidenced that 
two intrinsic dispositive issues are presented by these combined 
proceedings:

 
 

[¶10.]  (1) Relationship of the district court to 
the court commissioner in ultimate authority and decision; 
and

 
 

[¶11.]  (2) Power or requirement of the district 
court to commit the mentally ill to a habilitation institution outside of the 
state in the face of evidence that the StateHospital may fail in sufficiency of either 
capacity or performance in curative hospitalization for 
K.C.

 
 
1. 
Relationship of the district judge to the 
court commissioner.

 
 

[¶12.]  The designated court commissioner, under 
W.S. 25-10-110(k)3 and Wyo. Const. art. 5, § 14, 4 has no more extended function than 
initial fact finding and entry of preliminary orders. The recommendations - 
conclusions based upon fact as well as law which are distilled into judgment 
orders - cannot be blindly accepted by the district court. The district court 
cannot delegate the power to hear, try, or determine a case to a court 
commissioner. Foster v. Foster, 768 P.2d 1038 (Wyo. 1989); Huhn v. Quinn, 21 Wyo. 51, 128 P. 514 
(1912).

 
 

[¶13.]  This court recently discussed in Foster, 
768 P.2d 1038 the court commissioner's role in relation to domestic relations 
matters. This court found that the district court's cursory review and 
acceptance of the court commissioner's findings leading to an increase in child 
support which was substantiated only by the district court's reading and signing 
of the prepared order were insufficient. Id. at 1042.

 
 
[W]e do 
perceive that the Wyoming Constitution and applicable statutes contemplate that 
the district court shall conduct an independent review of the court 
commissioner's actions beyond that afforded in this case. The court commissioner 
may take evidence, make findings, and submit a recommendation to the district 
court. The district court, however, must 
review the evidence and findings and make its decision upon the basis of that 
review.

 
 

Id. at 1041 
(emphasis added). This court further elucidated that the record should clearly 
indicate that the district court independently reviewed the evidence and 
findings to reach its informed decision. Id. at 1041. In the instant case, the district 
court's rejection of the alternative placement recommendation and imposition of 
the state hospitalization plan shows that the required independent review of the 
case was undertaken. Simply put, "[g]eneral court commissioner responsibilities 
as a hearing examiner cannot be outspread, absent expansion of constitutional 
authorization, to include power of decisional finality within present 
constitutional terms. The differentiation is between adjunct fact finding and 
plenary judicial responsibility." Id. at 1042, Urbigkit, J., specially 
concurring. See also Northern Pipeline Const. Co. v. Marathon Pipe Line Co., 458 U.S. 50, 102 S. Ct. 2858, 73 L. Ed. 2d 598 (1982).

 
 

[¶14.]  While the sociologically well-founded 
intent of the commissioner and the medical examiner5 concerning the sufficiency of the 
state institution may be well-founded, it is not determinative and binding upon 
the district court in its exercise of application of state statutes and funding 
opportunities to its decision. Consequently, the real issue does not encompass 
an abuse of discretion analysis for the district court to disregard part of the 
commissioner's recommendation as it did, but rather a sufficiency of fact to 
sustain the district court's exercise of discretion in institutional selection. 
It is to that subject that we next address attention.

 
 
2. The power of the district court to commit 
mentally ill persons outside this state.

 
 

[¶15.]  The statutory involuntary commitment 
process,6 as invoked by application of W.S. 
25-10-110, has provisions for emergency detention, W.S. 25-10-109; preliminary 
hearing, W.S. 25-10-109(h); and general commitment hearing, W.S. 25-10-110(f). 
In addition to dismissal, disposition options statutorily available in W.S. 
25-10-110(j) to the district judge include:

 
 
(i) Order 
his hospitalization;

 
 
(ii) Assign 
him to a hospital;

 
 
(iii) Send 
to the hospital, with the patient a certified copy of the findings of fact and 
order and a copy of the examiner's report;

 
 
(iv) 
Specify where he will be detained pending transportation to the hospital. Only 
during an extreme emergency shall a person be detained in a nonmedical facility 
used for detention of persons charged with or convicted of penal 
offenses.

 
 
As defined 
in W.S. 25-10-101(a)(v), "`Hospital' means a facility designated pursuant to 
W.S. 25-10-104 or the state hospital;" with further definition of 
"StateHospital" afforded in W.S. 25-10-101(a)(xi) which 
"means the Wyoming state hospital at Evanston, Wyoming." W.S. 25-10-104 outlines D-PASS's 
duties to hospitals other than the StateHospital.7 At present, Wyoming has no 
psychiatric halfway houses, and there is no other domiciliary care facility 
approved in accord with W.S. 25-10-104.

 
 

[¶16.]  The county is responsible for initial 
detention and maintenance expenses, W.S. 25-10-112, with hospitalization 
financial responsibility thereafter assigned to either the State Board of 
Charities and Reform for care provided in the StateHospital or D-PASS if care is provided 
elsewhere. It is in this source of responsibility for providing medical care and 
the availability and expense of costs to be required that the practical 
legislative-administrative agency responsibilities become entangled. 
Realistically, the difference between the district court and the commissioner in 
this case was whether the more conservative budgetary approach was justified, 
appropriate or permitted. Clearly, nothing statutorily stated confines the 
district court to accept the out-of-state institution alternative with the 
probable singularly higher cost involvement. The real issue, lacking mandatory 
statute, is whether the state constitution, the Fourteenth Amendment to the 
United States Constitution, or other federally preemptive criteria require the 
district court to provide a standard of care allegedly not available within the 
StateHospital.8

 
 

[¶17.]  Essentially, K.C. is advocating that she 
is denied her right to treatment9 because she is not receiving the 
best treatment for her illness since she is not being treated in a psychiatric 
halfway house.10 We disagree with K.C.'s broad 
characterization of the right to treatment and her implications. Even Judge 
Bazelon in Rouse, 373 F.2d  at 456-57, while first enunciating such a right, 
recognized the limits of it:

 
 
The 
hospital need not show that the treatment will cure or improve him but only that 
there is a bona fide effort to do so. 
This requires the hospital to show that initial and periodic inquiries are made 
into the needs and conditions of the patient with a view to providing suitable 
treatment for him, and that the program provided is suited to his particular 
needs. * * *

 
 
     The effort should be 
to provide treatment which is adequate in light of present knowledge. * * * 
[T]he possibility of better treatment does not necessarily prove that the one 
provided is unsuitable or inadequate. [Emphasis added & footnotes 
omitted.]

 
 
The Circuit 
Court of Appeals for the District of 
Columbia further clarified and honed this right in 
Tribby, 379 F.2d at 105:

 
 
     We do not suggest that the court should or can 
decide what particular treatment this patient requires. The court's function 
here resembles ours when we review agency action. We do not decide whether the 
agency has made the best decision, but 
only make sure that it has made a permissible and reasonable decision in view of 
the relevant information and within a broad range of discretion. [Emphasis 
added.]

 
 

[¶18.]  Consequently, our review of the dilemma 
faced by the district court in placement decision11 centers simply on whether the 
district court abused its discretion by disregarding either statutory or 
constitutional law in not requiring a more preferable level of care. We find no 
abuse of the district court's discretion in choosing placement at the StateHospital.

 
 

[¶19.]  This resolution is confined to our 
statutory system as provided by our legislature. As Dr. Birnbaum has astutely 
recognized:

 
 
[T]he state 
legislature rather than the judiciary, seems the proper instrumentality to take 
the lead in establishing and enforcing a right to adequate treatment. Only the 
legislature has the means to set up a comprehensive scheme and to coordinate it 
with necessary legislative appropriations; the judiciary is limited to a 
case-by-case development.

 
 
Birnbaum, A 
Rationale for the Right, 57 Geo.L.J. 752, 765 (1969). See also Bazelon, 
Implementing the Right to Treatment, 36 U. of Chi.L.Rev. 742, 745 
(1969).

 
 

[¶20.]  With neither the Wyoming Constitution nor 
the United States Constitution mandating a greater degree of care than what the 
legislative branch has funded and the executive branch has provided through 
facilities within this state, we find no abuse of discretion in the district 
court's placement of K.C. at the StateHospital.

 
 

[¶21.]  Affirmed.

 
 
FOOTNOTES

 
 

1 W.S. 
25-10-101(a)(viii) provides:

 
 
"Mentally ill person" 
means a person who presents an imminent threat of physical harm to himself or 
others as a result of a physical, emotional, mental or behavioral disorder which 
grossly impairs his ability to function socially, vocationally or 
interpersonally and who needs treatment and who cannot comprehend the need for 
or purposes of treatment and with respect to whom the potential risk and 
benefits are such that a reasonable person would consent to 
treatment.

 
 

[¶22.]    This definition section of 
the commitment statute W.S. 25-10-101 has been rewritten by Wyo. Sess. Laws ch. 
147 (1989), effective July 1, 1989. After that date, a designation of a mentally 
ill person is removed from the code to be replaced by W.S. 25-10-101(a)(ii), 
which states:

 
 
"Dangerous to himself 
or others" means that, as a result of mental illness, a 
person:

 
 
     (A) Evidences a 
substantial probability of physical harm to himself as manifested by evidence of 
recent threats of or attempts at suicide or serious bodily harm; 
or

 
 
      (B) Evidences a 
substantial probability of physical harm to other individuals as manifested by a 
recent overt homicidal act, attempt or threat or other violent act, attempt or 
threat which places others in reasonable fear of serious physical harm to them; 
or

 
 
     (C) Evidences behavior 
manifested by recent acts or omissions that, due to mental illness, he is unable 
to satisfy basic needs for nourishment, essential medical care, shelter or 
safety so that a substantial probability exists that death, serious physical 
injury, serious physical debilitation or serious physical disease will 
imminently ensue, unless the individual receives prompt and adequate treatment 
for this mental illness. No person, however, shall be deemed to be unable to 
satisfy his need for nourishment, essential medical care, shelter or safety if 
he is able to satisfy those needs with the supervision and assistance of others 
who are willing and available.

 
 

2 This section is also 
rephrased in 1989 enactment.

 
 

3 W.S. 25-10-110(k) 
provides:

 
 
The court is 
authorized to appoint a special commissioner to assist in the conduct of 
hospitalization proceedings. In proceedings under this act [§§ 25-10-101 through 
25-10-305], regularly appointed court commissioners may exercise the authority 
granted by W.S. 5-3-307. In any case in which the court refers an application to 
the commissioner, the commissioner shall conduct the involuntary hospitalization 
proceedings under this section and on the basis thereof shall either recommend 
dismissal of the application or hold a hearing as provided in this section and 
make recommendations to the court regarding the hospitalization of the proposed 
patient.

 
 

4 Wyo. Const. art. 5, § 14 
provides:

 
 
     The legislature shall 
provide by law for the appointment by the several district courts of one or more 
district court commissioners (who shall be persons learned in the law) in each 
organized county in which a district court is holden, such commissioners shall 
have authority to perform such chamber business in the absence of the district 
judge from the county or upon his written statement filed with the papers, that 
it is improper for him to act, as may be prescribed by law, to take depositions 
and perform such other duties, and receive such compensation as shall be 
prescribed by law.

 
 

5

We must be aware of 
the dangers which lie in our most generous wishes. Some paradox of our nature 
leads us, when once we have made our fellow men the objects of our enlightened 
interests, to go on to make them the object of our pity, then of our wisdom, 
ultimately of our coercion.

 
 
J. Robitscher, The 
Powers of Psychiatry 1 (1980) (quoting L. Trilling, The Liberal 
Imagination).

 
 

6 See 1 P. Friedman, 
Legal Rights of Mentally Disabled Persons 235 (1979) for an overview of other 
states' laws on civil commitment and Stromberg & Stone, Statute-A Model 
State Law on Civil Commitment of the Mentally Ill, 20 Harv.J. on Legis. 275 
(1983).

 
 

7 W.S. 25-10-104 
provides:

 
 
     (a) The department, 
with respect to hospitals other than the state hospital, 
shall:

 
 
(i) Adopt standards 
for the designation of hospitals as qualified to provide treatment under this 
act [§§ 25-10-101 through 25-10-305];

 
 
(ii) Designate 
hospitals which qualify under the standards adopted pursuant to paragraph (i) of 
this subsection;

 
 
(iii) Enter into 
cooperative contracts with hospitals for the treatment of mentally ill persons 
and other services incident to the hospitalization of 
patients;

 
 
(iv) Require reports 
from hospitals concerning the services rendered to patients under the provisions 
of this act;

 
 
(v) Visit each 
hospital at least once a year to review methods of treatment for all mentally 
ill patients; and

 
 
(vi) Investigate 
complaints made by or on behalf of mentally ill patients.

 
 
This section is 
restated in the 1989 enactment without substantive change.

 
 

8 The record does not 
reflect what the relative cost factors might be nor the comparison of degree of 
care that might be obtained. Essentially, the prior hospitalization at the 
StateHospital seems to have been 
minimally beneficial and a further effort in that direction was not considered 
by the medical examiner to be justified.

 
 

9 The "right to 
treatment" is initially credited to Dr. Morton Birnbaum, both a physician and 
attorney, who, in 1960, first defined the concept in Birnbaum, The Right to 
Treatment, 46 A.B.A.J. 499 (1960). See J. Robitscher, supra n. 5, at 103; A. 
Brooks, Law, Psychiatry and the Mental Health System 870 (1974); 1 B. Ennis and 
P. Friedman, Legal Rights of the Mentally Handicapped 275 (1973); and 1 L. 
Irvine & T. Brelje, Law, Psychiatry and the Mentally Disordered Offender 51 
(1972). For historical perspectives on the evolution of this right, see: 
Robitscher, The Right to Psychiatric Treatment: A Social-Legal Approach to the 
Plight of the State Hospital Patient, 18 Vill.L.Rev. 11 (1972); 1 B. Ennis & 
P. Friedman, supra n. 9, at 275; S. Brakel & R. Rock, The Mentally Disabled 
and the Law 34 (1971); and R. Allen, E. Ferster, & H. Weihofen, Mental 
Impairment and Legal Incompetency 2 (1968).

 
 
     The rubric "right to 
treatment" is somewhat misleading in that it suggests that there is such a right 
explicitly recognized in the Constitution. In fact, the right to treatment is a 
shorthand way of describing that package of rights which the involuntarily 
confined mental patient is guaranteed by the due process and equal protection 
clauses, and the cruel and unusual punishment prohibition. In some states, there 
is also an explicit statutory recognition of a right to treatment which may also 
serve as a basis for suit.

 
 
1 B. Ennis & P. 
Friedman, supra, at 280.

 
 

10 It is unfortunate 
that many, including K.C., try to link the right to treatment to the physical 
placement of the care forgetting about the other intangible ingredients in 
successful therapy.

 
 
Optimal patient-staff 
ratios, access to a wide variety of therapeutic modalities, and establishment of 
a human environment, all of which are sorely lacking in most institutions for 
the mentally ill, are prerequisites for treatment which society can provide. 
They must not be equated with the therapeutic endeavor itself. The right to 
treatment, if it is to have meaning, requires in addition a person who can 
exercise such a right or if treatment is imposed, can benefit from it. * * * 
Yet, in linking the right to treatment with adequate staff and a "bona fide 
effort" to treat, there is the danger that once such conditions are met and 
proof to that effect is submitted, the right to treatment will be construed to 
rest on the existence of facilities and not on the person's willingness or 
ability to utilize them.

 
 
G. Morris, The 
Mentally Ill and The Right to Treatment 13-14 (1970) (footnotes omitted and 
emphasis added).

 
 

11 We are cognizant that 
a case of this kind intertwines and requires a balance of serious 
constitutional, legislative, and budgetary problems. See Nason v. Superintendent 
of BridgewaterStateHospital, 353 Mass. 604, 233 N.E.2d 908, 913 (1968). The 
issues presented here have a stark similarity to the concerns for education of 
the handicapped addressed by this court in Natrona County School Dist. No. 1 v. 
Ryan, 764 P.2d 1019 (Wyo. 1988); Natrona County School Dist. No. 1 v. McKnight, 
764 P.2d 1039 (Wyo. 1988); and by the United States Supreme Court in Board of 
Educ. of Hendrick Hudson Central School Dist. Bd. of Ed., Westchester County v. 
Rowley, 458 U.S. 176, 102 S. Ct. 3034, 73 L. Ed. 2d 690 (1982) and Pennhurst State 
School and Hospital v. Halderman, 451 U.S. 1, 101 S. Ct. 1531, 67 L. Ed. 2d 694 
(1981).