Notice: This opinion is subject to correction before publication in the PACIFIC REPORTER. 

Readers are requested to bring errors to the attention of the Clerk of the Appellate Courts, 

303 K Street, Anchorage, Alaska 99501, phone (907) 264-0608, fax (907) 264-0878, email 

corrections@akcourts.gov. 

THE SUPREME COURT OF THE STATE OF ALASKA 

In the Matter of the Necessity for the 

Hospitalization of 

TONJA P. 

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) Supreme Court No. S-18077 

Superior Court No. 3AN-21-00530 PR 

O P I N I O N 

No. 7642 – February 17, 2023 

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Appeal from the Superior Court of the State of Alaska, Third 

Judicial District, Anchorage, Jennifer Henderson, Judge. 

Appearances: Julia Bedell, Assistant Public Defender, and 

Samantha Cherot, Public Defender, Anchorage, for Tonja P. 

Laura Fox, Senior Assistant Attorney General, Anchorage, 

and Treg R. Taylor, Attorney General, Juneau, for State of 

Alaska. 

Before: Winfree, Chief Justice, Maassen, Carney, and 

Borghesan, Justices. [Henderson, Justice, not participating.] 

CARNEY, Justice. 

I. INTRODUCTION 

Awomanappealscourt orders authorizing her involuntarycommitmentand 

administration of psychotropic medication. She argues the superior court erred by 

relying on a cursory report from the court visitor and by failing to make specific findings 

that involuntary medication was in her best interests. She also contends that it was error 

to commit her to a psychiatric hospital instead of to a less restrictive facility. We affirm 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the superior court’s orders. 

II. FACTS AND PROCEEDINGS 

A. Facts 

Tonja P.1 suffers from schizophrenia; before March 2021 she had 

previously been committed to the Alaska Psychiatric Institute (API) six times. Between 

2016 and 2021 Tonja lived with her parents and was able to manage her illness with 

outpatient treatment. In March 2021 her health deteriorated after she stopped taking 

medication. She became unable to care for her hygiene and other needs and became 

aggressive with her parents. Tonja went to API voluntarily but after she was admitted 

she declined medication. API petitioned for an order authorizing Tonja’s hospitalization 

for evaluation. Tonja’s father, who is her legal guardian, supported API’s request. The 

superior court granted the evaluation order. 

A day later API filed a petition to commit Tonja for 30 days for treatment2 

and a petition to authorize the involuntary administration of psychotropic medication.3 

The commitment petition alleged Tonja was mentally ill and was “[c]urrently psychotic, 

responding to internal stimulation (hallucinations) and unable to communicate 

effectively.” It also alleged she was gravely disabled because she was unable to make 

an informed decision or to communicate her needs. The petition asserted that Tonja 

would not be safe and would be unable to obtain shelter or food outside of API. The 

involuntary medication petition sought authorization to treat Tonja with two 

psychotropic medications. 

1 We use a pseudonym to protect her identity. 

2 See AS 47.30.730-.735 (setting out 30-day commitment procedure). 

3 See AS 47.30.839 (describing procedures for seeking court order to 

administer psychotropic medication). 

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B. Proceedings 

1. 30-day commitment and medication petitions 

A combined hearing on both petitions was held before a master on March 

11. API presented Tonja’s treating psychiatrist, Dr. Laura Swogger, as an expert witness 

in psychiatry. Dr. Swogger testified that Tonja initially had been aggressive at API and 

had bitten one of the officers who brought her in. She testified that Tonja had since 

become withdrawn and isolated, and was not able to organize her thoughts or 

communicate in a coherent manner. She acknowledged that Tonja was taking care of her 

basic needs but required “a lot of supervision and prompting.” Dr. Swogger testified that 

Tonja had voluntarily taken medication when she first arrived at API, but that she began 

refusing medication shortly after her admission. Dr. Swogger testified that she spoke 

with Tonja’s father, who stated he and her mother wanted her to return home but not 

until her condition improved. 

Dr. Swogger also testified that Tonja would not be able to function if 

released to a homeless shelter because she would be unable to care for her basic needs 

andwouldeasily bevictimized becauseofher “confused”and “disoriented” mental state. 

Dr. Swogger explained that API offered a variety of types of therapy but that Tonja 

would not benefit from them until her psychosis improved, which required medication. 

She testified that a similar treatment plan had worked for Tonja in the past. Dr. Swogger 

also stated that she was unaware of any outpatient provider that would accept someone 

with Tonja’s level of need. 

Tonja was provided with an opportunity to testify, but she was unable to 

speak coherently and eventually declined to speak. Because Tonja was unable to 

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communicate her wishes, her attorney took no position on the commitment petition4 

except to emphasize API’s high burden. 

The superior court accepted the master’s recommendation and granted the 

commitment petition. It found that Tonja was mentally ill because she “has a longstanding, professional diagnosis of schizophrenia”; that Tonja was gravely disabled 

because “[h]er mental illness precludes her from safely taking care of her physical 

needs”; and that she “w[ould] suffer increasingly severe mental distress” if untreated. 

The court also relied on Dr. Swogger’s testimony that no other “outpatient treatment or 

program would be effective and safe at this time.” 

The superior court next addressed the medication petition. The courtappointed visitor5 testified that Tonja could not follow a conversation; was confused 

about her name, what year it was, and where she was located; and denied having a 

mental illness. The court visitor described Tonja as “confused and disorganized” and 

“actively delusional.” She stated that Tonja had not expressed any reasonable objections 

to medication or identified any side effects that concerned her. The court visitor 

concluded that Tonja did not have the capacity to give consent, to assimilate information 

regarding her diagnosis and treatment, to make treatment decisions or participate in 

treatment, and lacked insight or the ability to rationally engage in treatment decisions. 

She testified that she attempted to reach Tonja’s father but was unsuccessful, and that 

Tonja “does not appear to have an advance[] health care directive.” 

4 See Alaska R. Prof. Conduct 1.2(a) and comment (describing lawyer’s 

general obligation to consult with client); Alaska R. Prof. Conduct 1.14 and comment 

(describing lawyer’s duties to clients with impaired capacity). 

5 See AS 47.30.839(d) (providing for court appointment of visitor “to assist 

the court in investigating the issue of whether the patient has the capacity to give or 

withhold informed consent to the administration of psychotropic medication.”). 

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Dr. Swogger was called again. She agreed with the court visitor’s 

conclusions. Dr. Swogger testified that she planned to administer the antipsychotic 

medication risperidone to Tonja, but to have a second medication, haloperidol, as a 

backup in case Tonja did not tolerate risperidone. She testified that the medication plan 

was within the standard of care for schizophrenia, that Tonja had successfully been 

treated with both medications in the past without negative effects, and that her risk for 

side effects was low. Dr. Swogger also testified that API took the potential for side 

effects very seriously, and she detailed measures to monitor and address potential side 

effects. Finally, Dr. Swogger testified that medication was in Tonja’s best interest 

because her condition would “probably stay the same or . . . potentially worsen” without 

it. Tonja’s attorney again took no position on the petition except to reiterate API’s high 

burden and emphasize that granting the petition would be a “serious intrusion.” 

The court granted the medication petition. It found that Tonja lacked the 

capacity to give informed consent, that the court visitor could not locate an advance 

health care directive for Tonja, that medication was in Tonja’s best interest, and that 

there were no other reasonable and less restrictive alternatives to medication. The court 

concluded that “the benefits of these medications clearly outweigh the minimally 

anticipated risks[,]” and that “Dr. Swogger ha[d] articulated a plan of treatment that 

includes close monitoring” for side effects. 

2. 90-day commitment and medication petitions 

Several weeks later API petitioned for a 90-day commitment order6 and for 

continued authorization to administer medication. Ahearing was held on April 8 on both 

petitions. Dr. Swogger again testified. She stated that Tonja had improved and was able 

to communicate but did not make much sense. She testified that Tonja continued to 

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6 See AS 47.30.740-.745 (setting out 90-day commitment procedure). 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

exhibit “symptoms of a thought disorder,” including hallucinations and minor delusions. 

She also testified that Tonja still needed prompting to take care of her basic needs and 

that she was “not in any way able to procure her own food.” She reported that Tonja’s 

parents still wanted her to return home but wanted her to be more stable before she came 

home. She opined that returning Tonja to her family was “the strongest discharge plan” 

for her. 

Dr. Swogger explained that Tonja’s current treatment planwasto transition 

Tonja from oral medication to long-lasting injectable medication. Dr. Swogger testified 

that outpatient facilities or assisted living facilities were not viable alternatives because 

they were not able to involuntarily administer the injectable medication that Tonja 

needed and could not prevent Tonja from leaving. 

The superior court granted the petition for a 90-day commitment. Based 

on Tonja’s continued hallucinations and delusions and her inability to meet her needs, 

the court concluded that she remained gravely disabled as a result of her mental illness. 

The master then considered the medication petition. The same court visitor 

testified. She reported that Tonja was “oriented in all spheres,” but that she still 

struggled to identify her exact location, continued to be confused and disorganized, 

denied having a mental illness or need for medication, and was still unable to articulate 

reasonable objections to medication or identify any concerning side effects. The court 

visitor concluded Tonja still did not have capacity to give consent nor the ability to 

engage rationally in treatment. The visitor also testified that she again attempted to 

contact Tonja’s father and was again unsuccessful, but this time the court visitor 

informed the court that Tonja “does not have an advance health care directive.” 

Dr. Swogger was called to testify about Tonja’s need for medication. She 

agreed with the court visitor’s testimony and added that Tonja’s next treatment step was 

to transition her from daily pills to one injection every 14 days. She testified that Tonja 

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would benefit from continued medications and that Tonja had not experienced any side 

effects so far. She explained that Tonja would be unable to benefit from other therapies 

without further medication and that she “would go back to the way that she presented” 

without medication. She acknowledged that Tonja was at risk for weight gain and 

diabetes as a result of the medication but detailed measures API would take to counteract 

those side effects. 

The court granted the petition authorizing continued administration of 

medication for the 90-day period. It found that Tonja did not have the capacity to give 

informed consent. 

3. Appeal 

Tonja appeals both her 90-day commitment and the administration of 

psychotropic medication. She argues that the superior court erred by finding that 

commitment to API was the least restrictive means for treating her. She also argues that 

the court visitor’s report was cursory and it was error for the superior court to rely on it 

when ordering the administration of medication. She acknowledges that because she did 

not object to the visitor’s report in superior court, she must show that this reliance was 

plain error. And she argues that the superior court failed to make specific findings that 

medication was in her best interests. 

III. STANDARD OF REVIEW 

“Wereviewthesuperiorcourt’sfactualfindings in involuntarycommitment 

or medication proceedings for clear error and reverse those findings only if we have a 

‘definite and firm conviction that a mistake has been made.’ ”7 Whether “findings meet 

thestatutory requirements for involuntarycommitment or medication is aquestion oflaw 

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7 In re Hospitalization of Naomi B., 435 P.3d 918, 923 (Alaska 2019) 

(quoting In re Hospitalization of Jacob S., 384 P.3d 758, 763-64 (Alaska 2016)). 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

to which we apply our independent judgment.”8 

“We review issues raised for the first time on appeal for plain error.”9 “A 

plain error involves an ‘obvious mistake’ that is ‘obviously prejudicial.’ ”10 

IV.	 DISCUSSION 

A.	 The Superior Court Did Not Err By Finding That Commitment To 

API Was The Least Restrictive Alternative. 

Tonja argues that the court erred by finding that commitment was the least 

restrictive alternative “because assisted living facilities were available to treat Tonja’s 

mental health.” The civil commitment statutes are guided in part by the principle “that 

persons be treated in the least restrictive alternative environment consistent with their 

treatment needs.”11 But “[a] proposed alternative ‘must actually be available, meaning 

that it is feasible and would actually satisfy the compelling state interests that justify the 

proposed state action.’ ”12 The superior court found in this case that “[a]ssisted living 

facilit[ies] would not be able to provide security of locked doors to prevent [Tonja] from 

eloping. They are also not geared to administering injectable medication with a 

noncompliant person.” Dr. Swogger further testifiedthatassistedlivingfacilities usually 

would not accept “clients who are not compliant with their medication” and such 

facilities were not capable of administering Tonja’s medication. 

8 Id. at 923-24. 

9 In re Hospitalization of Connor J., 440 P.3d 159, 163 (Alaska 2019). 

10 Id. (quoting In re Hospitalization of Gabriel C., 324 P.3d 835, 838 (Alaska 

2014)). 

11 AS 47.30.655 (describing “purpose and principles” of revision to civil 

commitment statutes). 

12 Naomi B., 435 P.3d at 933 (quoting Bigley v. Alaska Psychiatric Inst., 208 

P.3d 168, 185 (Alaska 2009)). 

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Tonja challenges the superior court’s reasoning because she had no history 

of eloping and did not need medication. But the court found that even though Tonja did 

not have a history of leaving treatment, her hallucinations and delusions might cause her 

to “wander[] off out the door,” as the master had noted. And Dr. Swogger’s 

uncontradicted testimony was that Tonja continued to need medication in order to 

improve. 

The superior court did not err by finding that there was no less restrictive 

alternative to commitment at API. 

B.	 The Superior Court’s Reliance On The Court Visitor’s Cursory 

Report Was Not Obviously Prejudicial. 

Tonja argues that the court visitor failed to adequately investigate whether 

she had previously refused psychotropic medication while competent. “When the state 

files its petition to authorize psychotropic medication, the law requires a ‘visitor’ to be 

appointed to assist the court when it considers the petition.”13 “One of the two core 

duties assigned to the visitor under AS 47.30.839(d) is to investigate, document, and 

report any prior statements — oral or written — that the patient might have made while 

competent that expressed wishes regarding medication.”14 The purpose of the visitor’s 

report is to assist the court in making “an informed decision” on whether API has met 

its burden to “prove by clear and convincing evidence that . . . the patient never 

previously made a statement while competent that reliably expressed a desire to refuse 

13 Myers v. Alaska Psychiatric Inst., 138 P.3d 238, 243 (Alaska 2006); see 

also AS 47.30.839(d). 

14 Myers, 138 P.3d at 253. The visitor’s other responsibility is to report “the 

patient’s responses to a capacity assessment instrument.” AS 47.30.839(d)(1). 

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future treatment with psychotropic medication.”15 Tonja contends that it was plain error 

for the superior court to rely on the court visitor’s cursory report. 

The court visitor testified that she “attempted to contact” Tonja’s father but 

was unsuccessful. At the first hearing the court visitor testified that Tonja “does not 

appear to have an advance[] health care directive,” but at the second hearing the visitor 

testified that Tonja “does not have an advance health care directive.” The court visitor 

did not explain how she determined there was no directive and was not questioned 

further about her investigation. 

Alaska Statute 47.30.839(d) requires the court visitor “to assist the court 

in investigating” and documenting “any expressed wishes of the patient regarding 

medication . . . that may have been expressed in a [legal document], or . . . conversations 

with relatives and friends that are significant persons in the patient’s life . . . when 

possible.” While the visitor’s testimony implies that she investigated and determined 

that Tonja “does not” have an advance health care directive, there is no evidence that the 

courtvisitor did anythingbeyond her two unsuccessful attempts to reach Tonja’s father.16 

We have explained that “the court visitor’s report is no mere technical 

requirement”;17 rather, it “is an essential component of the statutory scheme.”18 “[I]n the 

absence of an emergency, there is no reason why the statutory protections should be 

15 Wetherhorn v. Alaska Psychiatric Inst., 156 P.3d 371, 382 (Alaska 2007), 

overruled on other grounds by Naomi B., 435 P.3d 918. 

16 AS 47.30.839(d)(2) (outlining court visitor’s responsibility to investigate 

patient’s wishes regarding medication). The touchstone for assessing a court visitor’s 

report is whether it permits “the court [to] make an informed decision.” Wetherhorn, 156 

P.3d at 382. 

17 Wetherhorn, 156 P.3d at 382. 

18 Id. 

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neglected in the interests of speed.”19 Accepting a court visitor’s report based only on 

unsuccessful attempts to reach a single relative risks turning the report into a mere 

technical requirement. To ensure that the report assists the court in making a decision, 

a visitor should provide evidence of the efforts taken. Without this evidence, the court 

may struggle to make “an informed decision” whether API has met its burden to “prove 

by clear and convincing evidence that . . . the patient never previously made a statement 

while competent that reliably expressed a desire to refuse future treatment with 

psychotropic medication.”20 

Nonetheless the superior court did not plainly err in this case because the 

visitor’s cursory report was not “obviously prejudicial.”21 The visitor’s testimony 

implies that she did investigate further before the second hearing and determined that 

Tonja “does not have an advance health care directive.” In addition to the visitor’s two 

failed attempts to contact Tonja’s father, Dr. Swogger testified that she had been in 

contact with the parents. And given Tonja’s inability to communicate, she was unable 

to provide the court visitor with information.22 In light of these circumstances, the 

superior court did not plainly err by accepting the court visitor’s report. 

C.	 The Superior Court Did Not Err By Finding That Medication Was In 

Tonja’s Best Interests. 

Tonja argues that the superior court erred by failing to make specific 

19 Id. at 381. 

20 Id. at 382. 

21 In re Hospitalization of Connor J., 440 P.3d 159, 163 (Alaska 2019) 

(quoting In re Hospitalization of Gabriel C., 324 P.3d 835, 838 (Alaska 2014)). 

22 Because Tonja had previously been committed to API six times, it is 

possible that API records would have contained any advance directives she had made, 

if she had made any. 

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findings about whether the use of psychotropic medication was in her best interest. 

“[C]ourts must make specific findings on relevant, contested mandatory Myers factors 

before ordering involuntary medication . . . .”23 Among those factors is “information 

about alternative treatments and their risks, side effects, and benefits, including the risks 

of nontreatment.”24 Tonja contends that the court failed to adequately evaluate the risk 

of side effects and did not make specific findings about alternatives. 

But the superior court did hear and make findings about side effects. It 

found that the potential “side effects noted in the petition [for medication] have not been 

observed in [Tonja], who is . . . young and generally healthy.” It based this finding on 

testimony from Dr. Swogger, who described the measures API takes to monitor and treat 

side effects and expressed an opinion that Tonja’s risk for side effects was low in relation 

to the benefits of medication. The court also heard testimony that Tonja had a history 

of successful treatment with the requested medication, was currently improving on the 

medication, hadno history ofsideeffects,and was presently experiencing no sideeffects. 

The court reasonably credited that testimony.25 

The superior court also properly considered and rejected alternative 

treatments. During the 30-day commitment hearing, Tonja raised no potential 

alternatives. Dr. Swogger testified that she was “not aware [of] any outpatient provider 

23 In re Hospitalization of Lucy G., 448 P.3d 868, 879 (Alaska 2019). The 

Myers factors mirror the statutory factors for informed consent found in 

AS 47.30.837(d)(2). See Myers v. Alaska Psychiatric Inst., 138 P.3d 238, 252 (Alaska 

2006). 

24 Myers, 138 P.3d at 252. 

25 “We grant ‘especially great deference’ when the [superior court’s] 

‘findings require weighing the credibility of witnesses . . . .’ ” In re Hospitalization of 

Danielle B., 453 P.3d 200, 202-03 (Alaska 2019) (quoting In re Hospitalization of Tracy 

C., 249 P.3d 1085, 1089 (Alaska 2011)). 

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or outpatient program that would take someone that has the level of need . . . that [Tonja] 

has right now.” During the 90-day commitment hearing, Dr. Swogger was again asked 

about discharging Tonja to an outpatient treatment program, but she indicated that “no 

[suitable] program exists in the state of Alaska.” Despite this testimony the only 

alternative that Tonja raised was the possibility of release to an assisted living facility. 

The court considered and rejected this alternative, finding that no “less restrictive 

available facilities” existed and that an assisted living facility would not adequately 

protect Tonja.26 

V. CONCLUSION 

We AFFIRMthe superior court’s involuntary commitment and medication 

orders. 

26 Tonja also argues that the superior court erred in not making findings about 

alternative medications like mood stabilizers. She also did not raise this before the 

superior court, but even if she had, we would conclude there was no error. We have 

described the involuntary administration of any psychotropic drug as “highly intrusive.” 

Myers, 138 P.3d at 241-42. We also observe that such medications may have more than 

one effect, including stabilizing mood. See, e.g., Martha Sajatovic et al., Risperidone in 

the treatment of bipolar mania, 2 NEUROPSYCHIATRY DISEASE AND TREATMENT 127, 

128 (2006); Konstantinos N. Fountaoulakis et al., Report of three cases that received 

maintenance treatment with risperidone as a mood stabilizer, 3 ANNALS OF GEN. HOSP. 

PSYCHIATRY no. 10, 2004, at 3. 

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