IN THE

ARIZONA COURT OF APPEALS

DIVISION ONE

IN RE MH2015-002490

MH2015-004896

________________________

ARIZONA DEPARTMENT OF HEALTH SERVICES, ARIZONA STATE 

HOSPITAL, Intervenor/Appellant

and

MARICOPA COUNTY SPECIAL HEALTHCARE DISTRICT d/b/a 

MARICOPA INTEGRATED HEALTH SYSTEM, Intervenor. 

No. 1 CA-MH 15-0107, 1 CA-MH 16-0021 (Consolidated)

Appeal from the Superior Court in Maricopa County

No. MH2015-002490, MH2015-004896

The Honorable Andrew G. Klein, Judge

The Honorable Barbara L. Spencer, Judge Pro Tempore

AFFIRMED

COUNSEL

Arizona Attorney General’s Office, Phoenix

By Aubrey Joy Corcoran, Louis Frank Caputo, III

Counsel for Intervenor/Appellant 

Dickinson Wright, PLLC, Phoenix

By David J. Ouimette, Vail C. Cloar

Counsel for Intervenor 

FILED 5-1-2018
IN RE MH2015-002490

Opinion of the Court

2

OPINION

Judge Kenton D. Jones delivered the Opinion of the Court, in which 

Presiding Judge Randall M. Howe and Judge James B. Morse Jr. joined.

J O N E S, Judge:

¶1 In this consolidated appeal, Intervenor Arizona State Hospital

(ASH)1 challenges orders involuntarily committing Edgar T. and Juan A. 

(the Patients) for inpatient psychiatric treatment. Both Patients were 

deemed incompetent to stand trial for violent crimes, but upon 

commitment were unable to provide documentation establishing their 

lawful presence in the United States. ASH argues it cannot comply with the 

commitment orders without violating state and federal law governing the 

provision of state and local public benefits to unauthorized aliens.

¶2 As a matter of first impression, we consider whether courtordered psychiatric treatment is a “state and local public benefit,” as 

defined within 8 U.S.C. § 1621(c)2 and A.R.S. § 1-502(I). Because individuals 

subject to court-ordered psychiatric treatment do not “apply” for the 

services, the treatment is not a “benefit” within the meaning of those 

statutes. Accordingly, we affirm the superior court’s orders.

FACTS AND PROCEDURAL HISTORY

¶3 In 2013, Edgar was charged with one count of aggravated 

assault and one count of assault by a prisoner with bodily fluids. Edgar 

spat upon an officer who tried to end a fight between Edgar and another 

inmate in the medical area of the Durango Jail. In 2015, Juan was charged 

with aggravated assault and criminal trespass after attacking officers who 

tried to remove him from a dumpster in which he had been living for four 

 

1 ASH is a “state hospital . . . maintained for the care and treatment of 

persons with mental disorders and persons with other personality 

disorders or emotional conditions” under the “charge and control” of the 

Arizona Department of Health Services (AZDHS). See Ariz. Rev. Stat. 

(A.R.S.) § 36-202(A), (D) (2018). For simplicity, we refer to AZDHS and the 

state mental hospital, collectively, as ASH.

2 Absent material changes from the relevant date, we cite a statute’s 

current version.
IN RE MH2015-002490

Opinion of the Court

3

days. When the officers tried to move Juan, he refused to obey orders and 

swung a board at one of them. Ultimately, the officers resorted to the use

of pepper spray to subdue him.

¶4 In March 2014 and July 2015, the criminal court found the 

Patients incompetent to stand trial and dismissed the charges pending 

against them without prejudice. The court ordered the Maricopa County 

Attorney’s Office (MCAO) to file a petition for court-ordered psychiatric 

evaluation. See A.R.S. §§ 13-4517(A)(1) (authorizing the court to “[r]emand 

the defendant to an evaluating agency for the institution of civil 

commitment proceedings” if it finds he is “incompetent to stand trial and 

that there is no substantial probability that the defendant will regain 

competency within twenty-one months”); 36-521(F) (authorizing the 

county attorney to file the petition for evaluation if court-ordered). Both 

Patients were evaluated, and their evaluators filed petitions for courtordered treatment pursuant to A.R.S. § 36-531(B) (stating that, upon a 

determination that a patient is disabled or dangerous, the appropriate 

person “shall prepare, sign and file a petition for court-ordered treatment”). 

After considering the petitions, the superior court in both cases found the

Patients to be “persistently and acutely disabled.” The court also found 

Juan to be “a danger to others.” Both Patients were ordered to submit to 

inpatient psychiatric treatment at ASH.

¶5 ASH moved to intervene in both cases, asking the superior 

court to reconsider the commitment orders — not because its findings were 

incorrect, but because the Patients were unable to provide documents 

establishing their lawful presence in the United States, and therefore were 

ineligible to receive public benefits. The court granted the motion to 

intervene but declined to reconsider its orders, and ASH timely appealed. 

We have jurisdiction pursuant to A.R.S. §§ 12-120.21(A)(1) and -2101(A)(2).3

¶6 On appeal, this Court granted the Maricopa County Special 

Healthcare District (the District) leave to intervene as well. The District 

operates Desert Vista Behavioral Health Center (Desert Vista), a facility that 

provides short-term court-ordered evaluation and treatment for 

 

3 Both treatment orders have expired, but the Patients remain 

persistently and acutely disabled and are still committed to ASH. Although 

the orders themselves are moot, we consider the merits of the appeal 

“because the issue presented is of statewide importance and capable of

evading review.” In re MH-2008-000867, 225 Ariz. 178, 179, ¶ 1 (2010)

(citing Coconino Cty. No. MH 1425, 181 Ariz. 290, 292 (1995)).
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Opinion of the Court

4

individuals with mental disabilities, and therefore has an interest in the 

outcome of our decision.

DISCUSSION

¶7 The parties dispute whether court-ordered psychiatric 

treatment is a “state and local public benefit” subject to immigration 

verification. We review issues of statutory interpretation de novo. In re 

MH2010-002637, 228 Ariz. 74, 78, ¶ 13 (App. 2011) (citation omitted). 

“When interpreting a statute, our primary purpose is to give effect to the 

intent of the legislature.” Pinal Cty. No. MH-201000029, 225 Ariz. 500, 502, 

¶ 6 (App. 2010) (citing Maricopa Cty. No. MH 2001-001139, 203 Ariz. 351, 353, 

¶ 12 (App. 2002)). “The best indicator of that intent is the statute’s plain 

language, and, if that language is clear and unambiguous, we apply it as 

written.” State ex rel. Brnovich v. Maricopa Cty. Cmty. Coll. Dist. Bd.

(MCCCDB), 242 Ariz. 325, 338, ¶ 39 (App. 2017) (quoting State v. Liwski, 238 

Ariz. 184, 186, ¶ 5 (App. 2015)).

I. Court-Ordered Psychiatric Treatment Is Not a “Public Benefit” as 

Defined by 8 U.S.C. § 1621(c).

¶8 In 1996, Congress enacted the Personal Responsibility and 

Work Opportunity Reconciliation Act (PRWORA), which restricts welfare 

and public benefits for aliens. See generally Pub. L. No. 104-193, tit. IV, 

§§ 400-51, 110 Stat. 2105, 2260-77 (1996) (partially codified as amended at 

8 U.S.C. §§ 1601 to 1646). PRWORA defines which groups of non-citizens 

qualify to receive state and local public benefits. Under PRWORA, “state 

and local public benefits,” include:

any retirement, welfare, health, disability, public or assisted 

housing, postsecondary education, food assistance, 

unemployment benefit, or any other similar benefit for which 

payments or assistance are provided to an individual . . . by 

an agency of a State or local government or by appropriated 

funds of a State or local government.

8 U.S.C. § 1621(c)(1)(B).

¶9 ASH argues the phrase “any health benefit” in the federal 

statute includes the involuntary civil commitment that occurred in these 

cases. This takes § 1621(c) out of context, however. The meaning of this 

language is clear when considered within the context of the statutory 

scheme as a whole. See Robinson v. Shell Oil Co., 519 U.S. 337, 341 (1997)

(“The plainness or ambiguity of statutory language is determined by 
IN RE MH2015-002490

Opinion of the Court

5

reference to the language itself, the specific context in which that language 

is used, and the broader context of the statute as a whole.”) (citations 

omitted); J.D. v. Hegyi, 236 Ariz. 39, 41, ¶ 6 (2014) (explaining that, when 

interpreting a statute, the words “cannot be read in isolation from the 

context in which they are used”) (citing Adams v. Comm’n on Appellate Court 

Appointments, 227 Ariz. 128, 135, ¶ 34 (2011)). When read as a whole, the 

unambiguous language in PRWORA limits the definition of public benefits 

to those benefits for which an individual applies. By its terms, PRWORA is 

intended to address concerns regarding the “self-sufficiency” of 

immigrants, given that “aliens have been applying for and receiving public 

benefits . . . at increasing rates.” 8 U.S.C. § 1601(1), (3) (emphasis added). 

Thus, PRWORA authorizes individual states “to require an applicant for 

State and local public benefits . . . to provide proof of eligibility.” 8 U.S.C. 

§ 1625 (emphasis added). In contrast, PRWORA confers no rights or 

responsibilities upon individual states with regard to services imposed 

upon a person by court order. Because “state and local public benefits,”

within the context of PRWORA, unambiguously refers to benefits for which 

an individual voluntarily applies, we hold court-ordered psychiatric 

treatment is not a public benefit as defined by 8 U.S.C. § 1621(c)(1).4

¶10 Even if the statutory language of PRWORA were ambiguous, 

this Court would reject ASH’s interpretation of “state and local public 

benefits” because it would lead to absurd results. See Compassionate Care 

Dispensary, Inc. v. AZDHS, 782 Ariz. Adv. Rep. 12, *5, ¶ 23 (App. Jan. 16,

2018) (refusing to “advance an interpretation that leads to . . . an absurd 

result” when resolving statutory ambiguities) (citing AEA Fed. Credit Union 

v. Yuma Funding, Inc., 237 Ariz. 105, 109, ¶ 13 (App. 2015)). If statutory 

language is ambiguous, we determine legislative intent by “considering the 

statute’s context, subject matter, historical background, effects and 

consequences, and spirit and purpose.” MCCCDB, 242 Ariz. at 338, ¶ 39 

(quoting Calik v. Kongable, 195 Ariz. 496, 500, ¶ 16 (1999)).

¶11 ASH maintains “the method used to provide [mental health 

services] — voluntary admission or involuntary commitment — does not 

 

4 At oral argument, ASH conceded that a public benefit must be 

applied for but argued the State and the evaluators effectively applied for 

mental health treatment on the Patients’ behalf through the petitions for 

court-ordered evaluation and treatment. We disagree. MCAO did not 

apply to a treatment provider for mental health services; it petitioned the 

superior court for an order requiring the Patients to be evaluated, and then 

the evaluators petitioned the court for an order finding involuntary 

psychiatric treatment was necessary.
IN RE MH2015-002490

Opinion of the Court

6

change their classification as public benefits.” Instead, ASH argues, “the 

provision of free mental health services and treatment, together with other 

benefits associated with inpatient treatment — room, board, and physical 

medical examinations and treatment” — is the public benefit provided to 

the Patients. However, if voluntariness were truly irrelevant in defining 

“public benefit,” the incarceration of persons unable to prove their lawful 

presence would likewise violate PRWORA because the State is required by 

law to provide prisoners the same “benefits” ASH argues should be denied 

the Patients — room, board, and physical and mental health examinations 

and treatment. See A.R.S. §§ 31-121(A) (“The sheriff shall receive all persons 

who are committed to jail by competent authority and provide them with 

necessary food, clothing and bedding, the cost of which shall be a county 

charge.”); -201.01(B), (D) (“[T]he director may, in cooperation with

[AZDHS], provide to prisoners psychiatric care and treatment . . . [and]

shall provide medical and health services for the prisoners.”). Even ASH 

concedes incarceration, and its incidentals, do not constitute a “benefit,”

arguing the provisions are imposed upon the prisoner as a punishment.

5

¶12 Additionally, ASH tacitly acknowledged within the 

commitment proceedings below that its interpretation would increase the 

risk to public safety. In its motion for reconsideration, ASH stated it was 

“left with a Hobson’s choice: break the law and indefinitely commit a 

person or potentially increase the risk to public safety.” Indeed, 

interpreting court-ordered psychiatric treatment as a “state or local public 

benefit” subject to immigration verification would allow the Patients —

who have already been determined to be a danger to themselves and others 

— to be released back into the general public because no viable alternative 

exists. The State is unable to prosecute and incarcerate the Patients because 

they are incompetent to stand trial for the violent crimes they allegedly

committed. See Cooper v. Oklahoma, 517 U.S. 348, 354 (1996) (recognizing 

 

5 ASH argues this Court should not compare involuntary civil 

commitment to incarceration, citing MH-2008-000867, in which our 

supreme court held the confrontation clause did not apply to civil 

commitment proceedings and stated, “a civil commitment proceeding

should not be constitutionally ‘equated to a criminal prosecution’ because 

the state is not acting in a punitive manner.” 225 Ariz. at 180-81, ¶ 8 

(quoting Addington v. Texas, 441 U.S. 418, 428 (1979)). However, the narrow 

issue there — whether the admission of evidence in a particular manner 

comported with the patient’s due process rights, id. at 179, 182, ¶¶ 1, 14 —

does not foreclose all future comparisons, particularly here, where we 

consider the interplay between federal immigration law and state statutes 

authorizing courts to order psychiatric treatment.
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Opinion of the Court

7

“the criminal trial of an incompetent defendant violates due process”) 

(citations omitted). Moreover, the District’s facility, Desert Vista, is not 

equipped for long-term psychiatric care, and, unlike ASH, does not offer

“maximum security.” See A.R.S. § 36-212 (requiring the state mental 

hospital to designate and operate a “maximum security area”). Although 

ASH suggests undocumented patients could be committed to a private 

hospital, a private hospital must first agree to take them. See A.R.S. § 36-

540(A)(3) (authorizing the court to order “[i]npatient treatment in . . . a 

private hospital,” but only “if the private hospital agrees”). Moreover, it is 

unclear how ASH perceives the expenditure of state monies applied to the 

commitment of individuals to ASH is a violation of PRWORA, but the 

expenditure of state monies to pay for the commitment of individuals to

Desert Vista or a private hospital is not.

¶13 The statutory language is clear and unambiguous when read 

within the context of the statutory scheme as a whole. And, as noted above, 

even if it were ambiguous, we would not advance an interpretation that 

lead to absurd results. Accordingly, we hold that court-ordered psychiatric 

treatment is not a public benefit as defined by 8 U.S.C. § 1621(c).6

II. Court-Ordered Psychiatric Treatment Is Not a “Public Benefit” as 

Defined by State Law.

¶14 ASH separately asserts that involuntary civil commitment is 

a “public benefit” not available, under state law, to a person who cannot 

prove his lawful presence. The Arizona State Legislature has adopted 

PRWORA’s general definition of “state or local public benefits.” See A.R.S. 

§ 1-502(I). And like PRWORA, the statute’s unambiguous purpose is to 

restrict the availability of public benefits for which an individual must 

apply. Section 1-502(A) states:

 

6 ASH relies heavily upon 8 U.S.C. § 1621(b)(4) (granting the U.S. 

Attorney General sole discretion to exempt certain state or local public 

benefits from PRWORA’s restrictions), and U.S. Attorney General Order 

No. 2353-2001, 66 Fed. Reg. 3613 (Jan. 16, 2001) (specifying “the types of 

community programs, services, or assistance for which all aliens remain 

eligible”), to argue ASH’s treatment was not an exempt state or local public 

benefit. This argument is only relevant if one begins with the assumption 

that court-ordered psychiatric treatment is a public benefit. Because we 

hold otherwise, we need not address this argument further.
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Opinion of the Court

8

[A]ny agency of this state or a political subdivision of this 

state that administers any state or local public benefit shall 

require each natural person who applies for the state or local 

public benefit to submit at least one of the following 

documents . . . demonstrating lawful presence in the United 

States.

(Emphasis added). Thus, the state statute also applies only to benefits for 

which a person voluntarily applies.

¶15 We find further support in A.R.S. § 13-4517(B), which, as 

amended in 2017, explicitly distinguishes court-ordered psychiatric 

treatment from “public benefits.” That statute authorizes the superior

court, after determining a defendant incompetent to stand trial, to order “an 

assessment of the defendant’s eligibility for private insurance or public 

benefits that may be applied to the expenses of the defendant’s medically 

necessary maintenance and treatment.” A.R.S. § 13-4517(B). Although the 

relevant language was added after the Patients were deemed incompetent, 

it demonstrates that the Legislature does not consider court-ordered 

psychiatric treatment to be a public benefit in and of itself, but rather, as a 

circumstance whose expense might be mitigated through the use of public 

benefits, when available. Indeed, the Legislature specifically identified 

public benefits that could be used to offset the costs of court-ordered 

psychiatric treatment, including: “[the Arizona Health Care Cost 

Containment System], state-only behavioral health services, [Social 

Security] services and [M]edicare part D prescription drug benefits, 

supplemental security income and supplemental security disability 

income.” A.R.S. § 13-4517(B).

¶16 In a final public policy argument, ASH contends that because 

it “is not required to provide civil commitment treatment that exceeds the 

funded capacity,” A.R.S. § 36-503.03, a U.S. citizen may be denied access to 

necessary services if its beds are filled by individuals not lawfully present 

in the United States. This argument is unpersuasive given that the 

maximum capacity of ASH is recalculated each year after collecting census 

data, see A.R.S. §§ 36-206(D), -503.03, and that the state maintains a 

contingency plan for the placement of patients in times of emergency and 

other unforeseen circumstances, see A.R.S. § 36-206(D). Thus, the 

Legislature has provided avenues for ASH to avoid potential capacity 

problems.
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Opinion of the Court

9

CONCLUSION

¶17 Court-ordered psychiatric treatment is not a public benefit as 

defined by 8 U.S.C. § 1621(c) and A.R.S. § 1-502(I). Accordingly, we affirm 

the superior court orders.