COURT OF APPEALS

DECISION

DATED AND FILED

October 29, 2020

Sheila T. Reiff

Clerk of Court of Appeals

NOTICE

This opinion is subject to further editing. If 

published, the official version will appear in 

the bound volume of the Official Reports. 

A party may file with the Supreme Court a 

petition to review an adverse decision by the 

Court of Appeals. See WIS. STAT. § 808.10 

and RULE 809.62. 

Appeal No. 20AP1239-FT Cir. Ct. No. 94ME28D

STATE OF WISCONSIN IN COURT OF APPEALS

DISTRICT IV

IN THE MATTER OF THE MENTAL COMMITMENT OF L. E.:

PORTAGE COUNTY,

 PETITIONER-RESPONDENT,

 V.

L. E.,

 RESPONDENT-APPELLANT.

APPEAL from orders of the circuit court for Portage County: 

ROBERT J. SHANNON, Judge. Affirmed. 
No. 20AP1239-FT

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¶1 KLOPPENBURG, J.1 L.E. appeals orders from the Portage County 

Circuit Court extending her involuntary commitment and ordering involuntary 

medication and treatment as requested by Portage County pursuant to WIS. STAT.

ch. 51. L.E. contends that the County failed to prove that she is dangerous or that 

she is incompetent to refuse medical treatment. I affirm the court’s orders. 

BACKGROUND

¶2 L.E. was first subject to WIS. STAT. ch. 51 orders for involuntary 

commitment and involuntary medication and treatment in 1994. These orders 

have been extended multiple times. In January 2020, the County filed a petition

requesting orders granting a 12-month extension of the most recent commitment

and authorizing involuntary medication and treatment. The circuit court held a 

recommitment hearing, at which it determined that L.E. met the statutory 

requirements for recommitment because she is mentally ill, is treatable, and would 

be a proper subject for commitment if her treatment were withdrawn. The court 

further determined that L.E. is incompetent to refuse medication and treatment. 

The court entered orders extending L.E.’s involuntary commitment for a period of 

12 months and authorizing involuntary medication and treatment during the period 

of commitment. This appeal follows. 

 

1

 This appeal is decided by one judge pursuant to WIS. STAT. § 752.31(2)(d) (2017-18). 

In an August 31, 2020 order, the court placed this case on the expedited appeals calendar, and the 

parties have submitted memo briefs. See WIS. STAT. RULE 809.17(1). The court issues this 

opinion approximately 98 days after the notice of appeal was filed and approximately 24 days 

after the reply brief was filed.

All references to the Wisconsin Statutes are to the 2017-18 version unless otherwise 

stated.
No. 20AP1239-FT

3

¶3 Additional material facts are provided as pertinent in the discussion 

below.

DISCUSSION

¶4 I first explain the standard of review and general legal principles 

governing orders that extend involuntary commitment and authorize involuntary 

medical treatment. I next analyze L.E.’s argument and conclude that the evidence 

was sufficient to support the circuit court’s orders extending L.E.’s involuntary 

commitment and authorizing involuntary medication and treatment. 

I. Standard of Review and General Legal Principles.

¶5 Review of WIS. STAT. ch. 51 orders for involuntary commitment and 

for involuntary medication and treatment presents a mixed question of fact and 

law. This court upholds a circuit court’s findings of fact unless they are clearly 

erroneous. Waukesha Cnty. v. J.W.J., 2017 WI 57, ¶15, 375 Wis. 2d 542, 895 

N.W.2d 783 (involuntary commitment); Outagamie Cnty. v. Melanie L., 2013 WI 

67, ¶¶37-38, 349 Wis. 2d 148, 833 N.W.2d 607 (involuntary medication and 

treatment). Whether those facts fulfill the statutory requirements for an 

involuntary commitment presents a question of law that this court reviews de 

novo. J.W.J., 375 Wis. 2d 542, ¶15; Melanie L., 349 Wis. 2d 148, ¶¶38-39. 

¶6 The criteria for extending an involuntary commitment are governed 

by WIS. STAT. § 51.20(13)(g). That paragraph is read together with the criteria set 

forth in § 51.20(1)(a). Under § 51.20(1)(a), a circuit court may order the initial 

commitment of an individual if the petitioner shows, by clear and convincing 

evidence, that the individual is:
No. 20AP1239-FT

4

(1) mentally ill; 

(2) a proper subject for treatment; and 

(3) currently dangerous under one of five alternative dangerousness 

standards.

See § 51.20(1)(a)1. and 2.a.-e. and (13)(e); Portage Cnty. v. J.W.K., 2019 WI 54, 

¶¶17, 24, 386 Wis. 2d 672, 927 N.W.2d 509; see also WIS JI—CIVIL 7050. With 

regard to the third prong noted above, § 51.20(1)(a)2.a.-e. identifies five separate 

dangerousness standards, each of which includes a requirement of recent acts or 

omissions demonstrating that the individual is a danger to herself or others. See 

Sec. 51.20(1)(a)2.a.-e.; J.W.K., 386 Wis. 2d 672, ¶17.

¶7 Once an individual is subject to a WIS. STAT. ch. 51 commitment 

order, the petitioner (in this case, Portage County) may, before the expiration of 

the initial commitment, petition for the extension of that commitment under WIS.

STAT. § 51.20(13)(g)3. See J.W.K., 386 Wis. 2d 672, ¶18. In order for the 

extension to be granted, the petitioner must prove by clear and convincing 

evidence that the individual is: (1) mentally ill, (2) a proper subject for treatment,

and (3) dangerous. See Sec. 51.20(1)(a) and (am), and (13)(e) and (g)3.; J.W.K., 

386 Wis. 2d 672, ¶¶18, 24. Proof of the third prong (dangerousness) is the point at 

which an initial commitment and a recommitment may materially differ. On a 

petition for recommitment, the petitioner may show that the individual is 

dangerous under § 51.20(1)(am). See J.W.K., 386 Wis. 2d 672, ¶19 (stating that 

§ 51.20(1)(am) “provides a different avenue for proving dangerousness”). 

¶8 WISCONSIN STAT. § 51.20(1)(am) provides in pertinent part:
No. 20AP1239-FT

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If the individual has been the subject of inpatient 

treatment for mental illness ... immediately prior to 

commencement of the proceedings as a result of ... a 

commitment or protective placement ordered by a court 

under this section ... the requirements of a recent overt act, 

attempt or threat to act under par. (a)2.a. or b., pattern of 

recent acts or omissions under par. (a)2.c. or e., or recent 

behavior under par. (a)2.d. may be satisfied by a showing 

that there is a substantial likelihood, based on the subject 

individual’s treatment record, that the individual would be 

a proper subject for commitment if treatment were 

withdrawn. 

Our supreme court has held that § 51.20(1)(am) “recognizes that an individual 

receiving treatment may not have exhibited any recent overt acts or omissions 

demonstrating dangerousness because the treatment ameliorated such behavior, 

but if treatment were withdrawn, there may be a substantial likelihood such 

behavior would recur.” J.W.K., 386 Wis. 2d 672, ¶19. Thus, § 51.20(1)(am) 

“functions as an alternative evidentiary path” for showing dangerousness, 

“reflecting a change in circumstances occasioned by an individual’s commitment 

and treatment” and “acknowledg[ing] that an individual may still be dangerous 

despite the absence of recent acts, omissions, or behaviors exhibiting 

dangerousness outlined in § 51.20(1)(a)2.a.-e.” Id., ¶¶19, 24. 

¶9 However, dangerousness remains an element to be proven to support 

the extension of an involuntary commitment, with reference to the specific 

dangerousness standards set forth in WIS. STAT. § 51.20(1)(a)2.a.-e. Id., ¶19; see 

also Langlade Cnty. v. D.J.W., 2020 WI 41, ¶34, 391 Wis. 2d 231, 942 N.W.2d 

277. Two of those standards are pertinent here. A person is dangerous within the 

meaning of WIS. STAT. § 51.20(1)(a)2.c. (the third standard) if the individual has 

“such impaired judgment ... that there is a substantial probability of physical 

impairment or injury to himself or herself.” Sec. 51.20(1)(a)2.c. A person is 

dangerous within the meaning of § 51.20(1)(a)2.d. (the fourth standard) if the 
No. 20AP1239-FT

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individual is unable to satisfy basic needs for nourishment, medical care, shelter, 

or safety, causing substantial probability of imminent death or harm. Sec. 

51.20(1)(a)2.d. 

¶10 The criteria for ordering involuntary medication and treatment are 

governed by WIS. STAT. § 51.61(1)(g)4., as follows:

[A]n individual is not competent to refuse medication or 

treatment if, because of mental illness, developmental 

disability, alcoholism or drug dependence, and after the 

advantages and disadvantages of and alternatives to 

accepting the particular medication or treatment have been 

explained to the individual, one of the following is true:

a. The individual is incapable of expressing an 

understanding of the advantages and disadvantages of 

accepting medication or treatment and the alternatives.

b. The individual is substantially incapable of 

applying an understanding of the advantages, disadvantages 

and alternatives to his or her mental illness, developmental 

disability, alcoholism or drug dependence in order to make 

an informed choice as to whether to accept or refuse 

medication or treatment.

WIS. STAT. § 51.61(1)(g)4.a.-b. The petitioner bears the burden of proving that 

one of the above conditions is met by clear and convincing evidence. Melanie L., 

349 Wis. 2d 148, ¶55. 

II. Analysis.

¶11 L.E. contends that the County failed to establish by clear and 

convincing evidence that she is dangerous and that she is incompetent to refuse 

medical treatment.

2

 I first summarize the pertinent testimony and the circuit 

 

2

 L.E. does not contend that the County failed to meet its burden of showing that she is 

mentally ill or that she is a proper subject for treatment. See WIS. STAT. § 51.20(1)(a)1. 
No. 20AP1239-FT

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court’s findings, and then explain why I conclude that the evidence was sufficient 

to support the circuit court’s orders.

A. Testimony.

¶12 Dr. Wagdy Khalil, a clinical psychiatrist employed by the Portage 

County Department of Health and Human Services, was the only witness at the 

evidentiary hearing. The circuit court found his testimony credible. He testified 

in pertinent part as follows.

3

 

¶13 Khalil had been treating L.E. for about four months. L.E. was in an 

acute, continuous manic state until very recently but is currently stabilized. L.E. 

has a diagnosis of Bipolar I and she suffers paranoid delusions, mania, depression,

and psychosis. She has suffered from mental illness for over thirty years. 

¶14 L.E. is currently improved under her current commitment and 

treatment, which involves living in a group home and taking oral antipsychotic 

medication. Without medication, L.E. suffers from “severe paranoid delusions” 

and “acute psychosis” and faces an “extreme risk” of not surviving. L.E. has

flooded her house multiple times because of delusion and has no idea why she did

so. Without medication, L.E. will become very impulsive and cause harm to 

herself and others surrounding her. She cannot function on her own. 

 

3

 Khalil also submitted an examination report. The report comprises five pages, detailing 

L.E.’s treatment history, and contains additional support for Khalil’s conclusions. As L.E. 

properly indicates, and the County does not dispute, the County failed to move Khalil’s report 

into evidence. Therefore, I review only Khalil’s testimony, despite the inclusion of the report in 

the record on appeal. Langlade Cnty. v. D.J.W., 2020 WI 41, ¶7 n.4, 391 Wis. 2d 231, 942 

N.W.2d 277; Winnebago Cnty. v. S.H., 2020 WI App 46, ¶2 n.3, 393 Wis. 2d 511, 947 N.W.2d 

761. 
No. 20AP1239-FT

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¶15 L.E. has refused her medication and will not take her medication 

voluntarily. “She is really delusional, paranoid delusion[al] regarding the 

medication, regarding the people around her. So she will stop taking the 

medication.” 

¶16 L.E. would be a proper subject for commitment if treatment were 

withdrawn because “she [would] crash” based on her history of noncompliance. If 

treatment were withdrawn, L.E. would be a danger to herself and unable to care 

for herself, based on both her noncompliance history and her experiencing of 

extreme delusions that would lead to impulsive and endangering behavior, such as 

when she flooded her house and had no idea why she did so. “She would [cause] 

more danger than that. She is not compliant and she becomes more psychotic. 

And I have real[] concerns that she is able to take of herself or even to cause harm 

to herself and others surrounding her.” 

¶17 An order to treat is “very essential.” When Khalil examined L.E. 

she “wasn’t competent” to discuss medication and she now has only a very basic 

competence level: enough to express, for example, that she does not want to take 

medication by injection or that she likes or does not like other antipsychotics she 

has been prescribed in the past. 

¶18 No other testimony was offered, and Khalil was not cross-examined. 

B. Circuit Court’s Findings.

¶19 The circuit court determined that, based on Khalil’s testimony, the 

County clearly and convincingly proved that L.E. is mentally ill and a proper 

subject for treatment, would be substantially likely to harm herself if her current 

treatment were withdrawn, and is not competent to refuse treatment. The court 
No. 20AP1239-FT

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made the following pertinent findings. L.E. has a history of noncompliance, and 

she is at a “very high potential risk for decompensation of her illness if she is not 

required to take the medication and supervised while doing so” which would “be 

directly contrary to her health.” “[W]hen she is not taking the medication, she has 

paranoid delusions which prevent her from functioning[;] while taking the 

medication[] those symptoms are significantly reduced.” The medication she is 

taking is “indicated” and “therapeutic” in the treatment of her specific condition. 

Khalil advised L.E. of the advantages, disadvantages, and alternatives to the 

medication prescribed but L.E. is unable to understand or appreciate that 

information due to her mental illness. 

C. Sufficient Evidence.

¶20 L.E. argues that the evidence was not sufficient to support the circuit 

court’s determinations that she is dangerous and not competent to refuse 

medication and treatment. I address and reject each specific argument in turn.

¶21 L.E. argues that Khalil’s testimony about the flooding and risk of not 

surviving is too vague and equivocal to prove that there is a substantial probability 

of physical harm (the third dangerousness standard) if L.E.’s treatment were 

withdrawn. Similarly, L.E. argues that Khalil’s testimony that without medication 

she would be unable to care for herself (the fourth dangerousness standard) lacks 

any factual foundation. However, as shown above, Khalil’s testimony was not so 

vague, equivocal, or lacking. He testified that she flooded her house multiple 

times without knowing why, and, more significantly, that she is at extreme risk of 

not surviving without her medication and that “she [would] crash” because she 

suffers severe delusions and acts impulsively to such a degree as to risk her health 

and life. Such details as whether L.E. was at home during the flooding or the 
No. 20AP1239-FT

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extent of the flooding are not necessary to prove a substantial risk of physical 

harm to L.E. from her conduct or to prove her inability to satisfy her basic needs if 

her treatment were withdrawn, given Khalil’s description of the severity of the 

“decompensation” that would result from L.E.’s failure to follow her treatment.

¶22 L.E. argues that this case is like D.J.W., in which our supreme court 

reversed an involuntary commitment extension order because the evidence was not 

sufficient to show dangerousness. D.J.W., 391 Wis. 2d 231, ¶3. To the contrary, 

this case is easily distinguished from D.J.W.. In that case, the only testimony as to 

dangerousness was that D.J.W. would be unable to care for himself if untreated as 

indicated by the facts that he was living with his parents, he quit his job because of 

his delusion that he is the Messiah, and he was on disability. Id. at ¶¶10-16. 

D.J.W. also testified, confirming that he believes he is the Messiah, received help 

from his family, had a job on a farm, and received disability benefits. Id. at ¶17. 

The court concluded that the testimony showed only that without treatment D.J.W. 

would experience delusions to a greater degree such that he would be unable to 

maintain a job, would have to rely on disability for income, and would have to 

continue living with family, but that such consequences do not constitute the 

substantial probability of death or serious physical injury or impairment that is 

required under the second and fourth dangerousness standards in the statute. Id., 

at ¶¶51-57. Here, in contrast, Kahlil did testify that L.E.’s delusions would 

prevent her from functioning (that “she [would] “crash”) and prevent her from

dealing with others, and that the delusions combined with her impulsivity would 

cause her engage in more dangerous conduct than the flooding, which would harm 

herself (“extreme risk” of not surviving) and others. 

¶23 L.E. argues that Khalil’s testimony that she “has just the basic 

competent level” and is doing well now regarding taking her medication shows 
No. 20AP1239-FT

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that she is competent to make her own treatment decisions. However, Khalil’s 

reference to basic competence was in terms of L.E.’s not wanting an injection, and 

his reference to her doing well was in terms of her present compliance under 

supervision, but Khalil was repeatedly specific about L.E. not being able to 

understand her need to be subject to the medication and treatment prescribed and 

her resulting history of noncompliance and he explicitly stated that L.E. was not 

competent when he examined her. L.E. also argues that Khalil provided no factual 

basis for his testimony as to what he explained to her about her treatment and what 

she was capable of understanding. However, L.E. points to no legal authority 

supporting the proposition that a doctor must repeat the specifics of the 

advantages, disadvantages, and alternatives that he credibly testified he explained.

¶24 Finally, L.E. argues that this case is akin to Melanie L., in which our 

supreme court reversed an involuntary medication and treatment order. In that 

case, the doctor failed to testify about the person’s noncompliance and show why 

that noncompliance demonstrated the person’s incapability of understanding the 

treatment, and the doctor failed to apply the statutory standards but instead 

articulated a seemingly different standard. Melanie L., 349 Wis. 2d 148, ¶¶9, 90-

91. L.E. does not explain how that case supports her position here, and this court 

will not make an argument for her. See Industrial Risk Insurers v. American 

Eng’g Testing, Inc., 2009 WI App 62, ¶25, 318 Wis. 2d 148, 769 N.W.2d 82 (“we 

will not abandon our neutrality to develop arguments.”); State v. Pettit, 171 

Wis. 2d 627, 647, 492 N.W.2d 633 (Ct. App. 1992) (“We cannot serve as both 

advocate and judge.”).

¶25 In sum, L.E. fails to show that the evidence was insufficient to show 

dangerousness and incompetence to refuse medication and treatment.
No. 20AP1239-FT

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CONCLUSION

¶26 For the foregoing reasons, the orders of the circuit court are

affirmed.

By the Court.—Orders affirmed.

This opinion will not be published. See WIS. STAT. RULE

809.23(1)(b)4.