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 

KARA K.

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Supreme Court No. S-18050 

Superior Court No. 3AN-21-00657 PR 

O P I N I O N 

No. 7715 – August 30, 2024 

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

Judicial District, Anchorage, Dani Crosby, Judge. 

Appearances: Rachel Cella, Assistant Public Defender, and 

Samantha Cherot, Public Defender, Anchorage, for Kara K. 

Laura Wolff, Assistant Attorney General, Anchorage, and 

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

Alaska. 

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

Henderson, and Pate, Justices. 

PATE, Justice. 

INTRODUCTION 

A woman experiencing psychotic delusions was admitted to the Alaska 

Psychiatric Institute (API) for a mental health evaluation. The woman’s treating 

psychiatrist identified three possible causes of the woman’s delusions, one of which 

was psychosis secondary to lupus. The superior court ordered a 30-day involuntary 
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commitment, concluding there was clear and convincing evidence that the woman was

gravely disabled as a result of mental illness.

On appeal the woman urges us to vacate the 30-day commitment order 

because the court failed to “rule out” the possibility that her psychosis was caused by 

lupus. Based on this premise the woman argues that her involuntary commitment to 

API was not the least restrictive alternative treatment. We disagree and affirm the

commitment order.

FACTS AND PROCEEDINGS

A. First And Second Admissions To API

In March 2021 Kara K.1 was admitted to API. The treating psychiatrist at

API did not believe Kara met the criteria for involuntary commitment at that time

because she showed signs of improvement while taking prescribed antipsychotic 

medication. Although the psychiatrist strongly recommended that Kara stay at API for 

further treatment, Kara declined and was discharged against medical advice.

Five days later Kara was taken into emergency detention at a hospital.2 

The next day a hospital social worker filed a petition for evaluation, which the superior 

1 We use a pseudonym to protect Kara’s privacy.

2 See AS 47.30.705(a) (providing that authorized individual “who has 

probable cause to believe that a person is gravely disabled or is suffering from mental 

illness and is likely to cause serious harm to self or others of such immediate nature that 

considerations of safety do not allow initiation of involuntary commitment 

procedures . . . may cause the person to be taken into custody . . . and delivered to the 

nearest crisis stabilization center, crisis residential center, evaluation facility, or 

treatment facility”).
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court granted.3 Kara was transported to API where the same treating psychiatrist

evaluated her for a second time.4

B. 30-Day Commitment Proceedings

API staff subsequently petitioned the superior court for a 30-day

involuntary commitment order.

5 A standing master held a commitment hearing in April 

2021.

6

 The treating psychiatrist was the only witness. Kara was present, but declined 

to testify. 

1. Testimony by the treating psychiatrist

After being qualified as an expert in psychiatry, the psychiatrist testified 

that he had come to a “provisional” diagnosis of “bipolar I disorder . . . mixed with 

psychotic features.” The psychiatrist explained his diagnosis was “provisional” 

because Kara had not displayed “a psychotic illness long enough to be certain that [it 

was] not schizophrenia . . . or schizoaffective disorder.”

3 See AS 47.30.700(a) (providing that “[u]pon petition of any adult, a judge 

shall immediately conduct a screening investigation or direct a local mental health 

professional . . . to conduct a screening investigation of the person alleged to be 

mentally ill and, as a result of that condition, alleged to be gravely disabled or to present 

a likelihood of serious harm to self or others”); see also AS 47.30.710(a) (providing 

that “[a] respondent who is delivered under AS 47.30.700–47.30.705 to an evaluation

facility for emergency examination and treatment shall be examined and evaluated as 

to mental and physical condition by a mental health professional and by a physician 

within 24 hours after arrival at the facility”).

4 See AS 47.30.715 (providing that “[w]hen an evaluation facility receives 

a proper order for evaluation, it shall accept the order and the respondent for an 

evaluation period not to exceed 72 hours” and also requiring court to schedule 30-day 

commitment hearing if needed).

5 See AS 47.30.730 (providing that commitment petition “must be signed 

by two mental health professionals who have examined the respondent, one of whom 

is a physician”).

6 See AS 47.30.735 (describing procedures applicable to 30-day 

commitment hearing and providing respondent specified rights).
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As to symptoms of psychosis, the psychiatrist explained that Kara was 

presenting “grandiose and paranoid and somatic delusional beliefs.” He testified that 

Kara believed she had “psychic powers” and could “read other people’s minds”; she 

thought she was “the subject of a documentary television series” about her life, which 

was being “made without her consent and . . . broadcast on national television”; she 

believed she was pregnant, but she had tested negative on multiple pregnancy tests since 

being admitted to API; and she said she had been raped by an API staff member the 

night before the commitment hearing, although API’s security camera showed that no 

one had entered her hospital room that night.

The psychiatrist described the events leading up to Kara’s second 

admission. He testified that she had “wandered out of her home in clothing that was 

not adequate for the subfreezing temperature” and stood in front of a school for five 

hours “ostensibly because she was waiting for her children to come out.” But he 

explained Kara did not have any school-aged children. He stated that she had initially 

left her home because she had been frightened by “hundreds of spirits” that she believed 

were in her backyard. Since returning to API, Kara had told him that the spirits were 

also in her hospital room.

The psychiatrist testified that Kara’s vital signs were stable, but that she

was not eating or drinking because she believed her food was “tainted and poisoned.” 

He estimated that she was given a 2,000-calorie diet while at API, but that she was 

currently consuming “under 200 calories a day.” He testified that Kara was also 

consuming “under 600 milliliters of fluid,” which was “a medical concern” because she 

was not consuming enough food and drink “to sustain life over the long term.” 

The psychiatrist related Kara’s allegation that she had been sexually 

harassed at work by a supervisor. He thought Kara’s allegations of workplace 

harassment were plausible.
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The psychiatrist identified three possible causes of Kara’s delusional 

beliefs.7 First, assuming the truth of her allegations that she had been sexually harassed 

at work, he explained that these circumstances could have been “sufficient to produce 

a psychotic break.” Second, he testified that Kara had a “long history of depression.” 

He explained that depression can occur in bipolar disorder and that Kara, at 38 years 

old, was in the age range that bipolar disorder “often declares itself in . . . women.”

Third, he testified that Kara had reported a family history of lupus, an 

autoimmune disease. He noted that Kara had presented two physical indicators of the 

disease, including a distinctive “malar rash or a butterfly rash” on both cheeks and 

“significantly impaired kidney function” during her first admission. He testified that 

“lupus is a rare but known cause of bipolar and psychotic symptoms” which “might 

explain [Kara’s] very rapid descent into . . . profound psychosis.” He testified it was 

important for Kara to receive “a medical workup for lupus,” but that she had refused to 

do one. He stated that Kara had also refused to sign a medical release, which prevented 

him from accessing her outpatient medical records or contacting her family or friends.

When asked if his treatment recommendation would be different if he had 

been able to confirm a diagnosis of lupus, the psychiatrist answered that he would have 

still recommended the same course of treatment for Kara’s psychosis. He also opined 

that Kara would need additional testing and, possibly, treatment for lupus. He

concluded that a lupus diagnosis would not have altered his decision to petition for 

Kara’s 30-day involuntary commitment.

7 The psychiatrist dismissed a fourth cause as unlikely. He testified that 

Kara claimed to have post-traumatic stress disorder (PTSD). He testified to his belief 

that PTSD was not causing Kara’s delusional beliefs because “psychosis in PTSD is 

very rare” and because when psychosis does occur, it manifests as “an absolutely 

lifelike re-living of a traumatic experience . . . . [I]t does not branch out into a series of 

unrelated delusions.”
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2. Commitment order and appeal

At the close of evidence, the master found there was clear and convincing 

evidence that Kara was mentally ill.

8

 The master credited the psychiatrist’s testimony 

describing the extent of Kara’s delusional beliefs. Regarding lupus, the master

explained that “although there may be an organic cause [to the mental illness] . . . the 

symptoms, the manifestation right now demonstrates a mental illness currently with the 

psychotic features.”

The master also found, by clear and convincing evidence, that Kara was 

gravely disabled.9 The master acknowledged that “a month ago [Kara] was functioning 

very well and apparently has functioned very highly for a long time and clearly is bright 

and articulate and intelligent.” But the master found that “at this point” Kara could not 

take care of her basic needs because she was not eating or drinking. The master also 

found that Kara could not provide herself with shelter because she had left her home 

based on a delusional belief that there were spirits in her backyard and she had then 

“stood outside of the school for five hours which may have [resulted] in hypothermia.” 

The master recommended that the superior court approve proposed findings and commit 

Kara to API for 30 days.

Kara objected to the master’s recommended findings, arguing API had 

failed to prove, by clear and convincing evidence, that she was mentally ill under

8 See AS 47.30.735(c) (“At the conclusion of the hearing the court may 

commit the respondent to a treatment facility for not more than 30 days if it finds, by 

clear and convincing evidence, that the respondent is mentally ill and as a result is likely 

to cause harm to the respondent or others or is gravely disabled.”).

9 See AS 47.30.915(11) (“ ‘[G]ravely disabled’ means a condition in which 

a person as a result of mental illness (A) is in danger of physical harm arising from such 

complete neglect of basic needs for food, clothing, shelter, or personal safety as to 

render serious accident, illness, or death highly probable if care by another is not taken; 

or (B) is so incapacitated that the person is incapable of surviving safely in 

freedom . . . .”).
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AS 47.30.915(17). Although the psychiatrist had testified that lupus was one potential 

cause of Kara’s delusions, Kara argued he had issued a “provisional diagnosis of 

Bipolar with psychotic features.” Kara argued that “it is just as likely” that she was

“suffering from a medical condition and not a mental health crisis.” Kara thus 

contended that the psychiatrist’s testimony was “equivocal” and did not constitute clear 

and convincing evidence of a mental illness.

API opposed Kara’s objections, arguing that the psychiatrist had “testified 

without contradiction that bipolar often shows up for the first time in women of the 

respondent’s age.” Citing E.P. v. Alaska Psychiatric Institute,

10 API also argued that 

“to the extent [Kara] is arguing that she has lupus, and her lupus is causing her 

psychosis . . . the source of the mental illness does not matter.” API argued that in our 

decision in E.P. we distinguished between “the cause of the ‘mental illness’ and the 

‘mental illness’ itself.”

The superior court adopted the master’s recommended findings and 

ordered Kara’s 30-day involuntary commitment to API. In a handwritten note, the 

superior court explained:

(1) [E]ven if lupus is causing the psychosis, per E.P. v. 

API, . . . the evidence, by the [clear and convincing] 

standard, establishes that she is currently experiencing a 

mental illness — the source does not matter, and (2) while 

[Kara]’s situation is unusual, the evidence nonetheless 

establishes that, at present, she suffers from a mental 

illness[.] [N]otably, [the psychiatrist] did not have a release 

that would have allowed him to review [Kara]’s records [or] 

speak [with] her providers[.]

Kara appeals.

10 205 P.3d 1101 (Alaska 2009).
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STANDARD OF REVIEW

“We apply our independent judgment to the interpretation of the Alaska 

Constitution and the mental health commitment statutes.”11 Independent judgment 

review also applies to “whether the superior court’s ‘findings meet the involuntary 

commitment . . . statutory requirements.’ ”

12

 When applying our independent 

judgment, we adopt “the rule of law that is most persuasive in light of reason, precedent, 

and policy.”13

DISCUSSION

On appeal Kara contends the superior court’s finding of mental illness was 

constitutionally infirm because API failed to “rule out” the possibility that her psychosis 

was caused by lupus. Kara argues that under these circumstances she should have been 

referred to a hospital for treatment for lupus, and that API is therefore unable to show 

that her involuntary commitment was the least restrictive alternative. Kara’s arguments 

are not persuasive, and we affirm the court’s order for her involuntary commitment.

A. There Was Clear And Convincing Evidence That Kara Suffered 

From A Mental Illness.

Kara suggests that we must construe the term “mental illness” to exclude 

mental or emotional impairments that may result from an underlying physical medical 

condition, such as lupus. Alternatively, she argues that due process requires courts to 

first “rule out” a physical condition as the cause of the respondent’s organic, mental, or 

emotional impairment. We consider each argument in turn. 

11 In re Hospitalization of Mabel B., 485 P.3d 1018, 1024 (Alaska 2021) 

(quoting In re Hospitalization of Gabriel C., 324 P.3d 835, 837 (Alaska 2014)).

12 In re Hospitalization of Mark V., 501 P.3d 228, 234 (Alaska 2021) 

(quoting In re Hospitalization of Jacob S., 384 P.3d 758, 764 (Alaska 2016)).

13 In re Mabel B., 485 P.3d at 1024 (quoting In re Hospitalization of 

Naomi B., 435 P.3d 918, 924 (Alaska 2019)).
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We conclude that the statutory definition of “mental illness” does not 

exclude mental or emotional impairments that result from a physical condition, and that 

due process does not obligate courts to “rule out” physical medical conditions as the 

cause of a mental illness. Kara reads the statute to require courts to rule out physical 

medical conditions like lupus as the cause of a person’s psychosis because a mental 

illness must be “an organic, mental . . . impairment,” and “[t]he ‘mental illness’ 

definition excludes certain conditions that might otherwise appear to qualify.” But 

illness arising from lupus is not one of the conditions listed in the statute and nothing 

in the legislative history suggests that the legislature intended that it should be excluded. 

We therefore decline to hold that the statute requires courts to rule out such conditions. 

Further, due process does not require us to adopt Kara’s reading because the civil 

commitment statutes contain adequate protection against erroneous confinement based 

on physical medical conditions. 

1. Statutory definition of mental illness

“When interpreting a statute ‘we begin with the plain meaning of the 

statutory text.’ ”

14

 We then apply “a sliding scale approach to statutory interpretation, 

in which ‘[t]he plainer the statutory language is, the more convincing the evidence of 

contrary legislative purpose or intent must be.’ ”

15

14 State Dep’t of Pub. Safety v. Doe, 425 P.3d 115, 119 (Alaska 2018) 

(quoting Hendricks-Pearce v. State, Dep’t of Corr., 323 P.3d 30, 35 (Alaska 2014)).

15 In re Hospitalization of Jacob S., 384 P.3d 758, 771 (Alaska 2016) 

(quoting Huit v. Ashwater Burns, Inc., 372 P.3d 904, 912 (Alaska 2016) (alteration in 

original)).
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a. Text

In an involuntary commitment proceeding, in addition to other 

prerequisites, the State bears the burden of proving the respondent has a mental illness.16 

AS 47.30.915(17) defines “mental illness”:

“[M]ental illness” means an organic, mental, or emotional impairment that 

has substantial adverse effects on an individual’s ability to exercise 

conscious control of the individual’s actions or ability to perceive reality 

or to reason or understand; intellectual disability, developmental 

disability, or both, epilepsy, drug addiction, and alcoholism do not per se 

constitute mental illness, although persons suffering from these conditions 

may also be suffering from mental illness.

[17]

This definition lists five excluded conditions that “do not per se constitute 

mental illness”: intellectual disability, developmental disability, epilepsy, drug 

addiction, and alcoholism.18 Kara argues that this list of conditions suggests the 

legislature intended to exclude mental illness resulting from an underlying physical 

condition, and that psychosis secondary to lupus must therefore fall outside the 

definition of “mental illness.” We cannot agree.

Beginning with the text, lupus is not listed as an excluded condition under 

AS 47.30.915(17). The semantic canon expressio unius est exclusio alterius suggests 

16 AS 47.30.735(c). Before a court can order involuntary commitment, the 

State must also prove that “as a result” of the respondent’s mental illness, the person 

“is likely to cause harm to the respondent or others or is gravely disabled.” Id. A 

respondent is “gravely disabled” if the person “(A) is in danger of physical harm arising 

from such complete neglect of basic needs for food, clothing, shelter, or personal safety 

as to render serious accident, illness, or death highly probable if care by another is not 

taken; or (B) is so incapacitated that the person is incapable of surviving safely in 

freedom.” AS 47.30.915(11). Finally, the State must prove no “feasible less restrictive 

alternative treatment is available.” In re Naomi B., 435 P.3d at 932 (citing 

AS 47.30.735(d)).

17 AS 47.30.915(17).

18 Id.
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that an item omitted from a list of exclusions is presumed not to be excluded.

19

 The 

definition of mental illness also internally refers back to “these conditions,” which 

reinforces an inference that the list should be considered exhaustive.20

Kara posits that “a person with epilepsy or a typical 

intellectual/developmental disability generally has, by definition, an immutable 

condition that impairs their capacity.” People with these excluded conditions, Kara 

argues, “will almost always be considered mentally ill” under AS 47.30 if a court can 

find someone mentally ill based on an impaired capacity or a lack of volition – unless 

the court rules out an excluded condition as the cause of those symptoms. She argues 

it necessarily follows that a court must rule out excluded conditions like epilepsy or 

intellectual/developmental disability as the cause of psychiatric symptoms to avoid 

committing someone because of an excluded condition. 

But even assuming arguendo that courts must rule out excluded conditions 

as the cause of a respondent’s psychiatric symptoms, the statute does not direct courts 

to do the same with conditionslike lupus. Kara’s reading would impose an extra-textual 

requirement on involuntary commitment proceedings. We decline to adopt such a 

reading. The statute does not list lupus as an excluded condition, and nothing in the

plain text indicates that the legislature intended to exclude any condition other than 

those listed. 

19 Croft v. Pan Alaska Trucking, Inc., 820 P.2d 1064, 1066 (Alaska 1991) 

(“The maxim establishes the inference that, where certain things are designated in a 

statute, ‘all omissions should be understood as exclusions.’ The maxim is one of 

longstanding application, and it is essentially an application of common sense and 

logic.” (quoting Puller v. Municipality of Anchorage, 574 P.2d 1285, 1287 (Alaska 

1978))).

20 See AS 47.30.915(17).
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b. Legislative history

Kara has not identified any legislative history suggesting that the 

legislature intended to treat lupus as an excluded condition. If “a statute’s meaning 

appears clear and unambiguous, . . . the party asserting a different meaning bears a 

correspondingly heavy burden of demonstrating contrary legislative intent.”21 The 

statutory definition of “mental illness” is clear and unambiguous. In contrast, the 

legislative history relied upon by Kara does not show any clear intent to define “mental 

illness” in a manner inconsistent with the plain language of the statute.

The current statutory definition of “mental illness” was adopted with the 

passage of Senate Bill 100 (S.B. 100) in 1981.22 S.B. 100 also added a requirement that 

a physician and a mental health professional examine the respondent’s “mental and 

physical condition . . . within 24 hours after arrival at the facility.”23 In testimony 

before the Senate Health, Education, and Social Services Committee, the Director of 

the Division of Mental Health explained it was a “positive addition” that S.B. 100 

required consideration of whether a respondent’s delusional behavior had a “physical 

basis” like “delirium coming from a fever state, pneumonia for instance,” 

“hyperthyroidism,” or “being overmedicated on multiple drugs in the case of senior 

21 Phillips v. Bremner-Phillips, 477 P.3d 626, 632 (Alaska 2020) (quoting 

State v. Fyfe, 370 P.3d 1092, 1095 (Alaska 2016)); see also In re Protective Proc. of 

Nora D., 485 P.3d 1058, 1064 (Alaska 2021) (explaining that we use “a sliding scale 

approach: ‘[T]he plainer the language of the statute, the more convincing contrary 

legislative history must be.’ ” (quoting Marathon Oil Co. v. State, Dep’t of Nat. Res., 

254 P.3d 1078, 1082 (Alaska 2011))).

22 Ch. 84, § 1, SLA 1981 (codified at AS 47.30.915(17)).

23 Ch. 84, § 1, SLA 1981 (codified at AS 47.30.710(a)).
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citizens.”24 He noted that instead of “demon possession being the number one cause of 

mental illness, . . . many of them are caused by physical conditions.”25

A former Director of the Division of Mental Health also testified before 

the Senate Judiciary Committee. He explained that the examination requirement was 

important to prevent “a loophole where a person with a physical illness could just go 

without the attention of a physician too long and that could result in a tragic death.”26 

He identified one case where a patient with a blood infection was “dead within a matter 

of hours,”

27 and expressed concern that “physically ill people will be transported 

hundreds of miles needlessly. These persons will be at risk of dying themselves and of 

exposing other people to serious illnesses.”28 He later submitted a letter to the 

committee identifying lupus as one such physical condition sometimes causing 

psychotic symptoms.29

This legislative history shows that the requirement for a physician to 

conduct a physical examination during commitment was a precaution intended to

identify serious medical conditions that, if left untreated, could result in death, medical 

complications, or contagion. Contrary to Kara’s argument, the legislative history does 

not show that the definition of “mental illness” was intended to exclude psychiatric 

impairments resulting from physical medical conditions.

24 Testimony of Verner Stillner, Director, Division of Mental Health at 

40:50-51:23, Hearing on S.B. 100 Before the S. Health, Educ. & Soc. Servs. Comm., 

12th Leg., 1st Sess. (Feb. 25, 1981).

25 Id.

26 Testimony of Jerry Schrader, Former Director, Division of Mental Health 

at 29:28-29:45, Hearing on S.B. 100 Before the S. Jud. Comm., 12th Leg., 1st Sess. 

(Apr. 22, 1981).

27 Id. at 31:00-31:21.

28 Letter from Jerry Schrader to Sen. William Ray, 1 (Apr. 28, 1981).

29 Id. at 3.
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Kara has not met her heavy burden to demonstrate contrary legislative 

intent. We thus conclude that lupus is not excluded from the definition of “mental 

illness” in AS 47.30.915(17).

2. Due process

Using Wetherhorn v. Alaska Psychiatric Institute30 as a benchmark, Kara 

challenges the statutory definition of “mental illness” provided in AS 47.30.915(17) as 

an impingement on her constitutional rights. We have recognized that “involuntary 

commitment for a mental illness is a ‘massive curtailment of liberty’ that demands due 

process of law.”31 We evaluate what process is due in light of the fundamental rights 

secured under both the United States Constitution32 and the Alaska Constitution’s 

“more protective” guarantees of individual liberty33 and privacy.34

30 156 P.3d 371 (Alaska 2007), abrogated on other grounds by In re 

Hospitalization of Naomi B., 435 P.3d 918, 929 (Alaska 2019).

31 In re Naomi B., 435 P.3d at 931 (quoting Wetherhorn, 156 P.3d at 375-

76); see also id. (explaining “that constitutional rights ‘extend “equally to mentally ill 

persons” so that the mentally ill are not treated “as persons of lesser status or dignity 

because of their illness” ’ ” (quoting Myers v. Alaska Psychiatric Inst., 138 P.3d 238, 

248 (Alaska 2006))).

32 U.S. Const. amend. XIV, § 1.

33 See Alaska Const. art. I, § 7 (“No person shall be deprived of life, liberty, 

or property, without due process of law.”); Alaska Const. art. I, § 1 (“This constitution 

is dedicated to the principles that all persons have a natural right to life, liberty, the 

pursuit of happiness, and the enjoyment of the rewards of their own industry.”); Myers, 

138 P.3d at 245 (noting “Alaska’s constitutional guarantee of individual liberty” is 

“more protective” than its federal counterpart).

34 See Alaska Const. art. I, § 22 (“The right of the people to privacy is 

recognized and shall not be infringed.”); see also Myers, 138 P.3d at 245 (explaining 

that Alaska’s guarantee of privacy is broader than U.S. Constitution’s because Alaska 

Constitution “expressly provid[es] for a right to privacy” (quoting Anchorage Police 

Dep’t Emps. Ass’n v. Mun. of Anchorage, 24 P.3d 547, 550 (Alaska 2001))).
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Unlike the respondent in Wetherhorn, Kara has not shown that a 

narrowing construction or extra-statutory requirement is necessary to protect against a 

“massive curtailment of liberty” without due process.35 The definition of “mental 

illness” under AS 47.30.915(17) does not create an unacceptable risk that a person will 

be confined for impermissible reasons. The civil commitment statutes guard against 

erroneous confinement because they focus the commitment inquiry on whether the 

respondent’s dangerousness or grave disability is caused by an “organic, mental, or 

emotional impairment” with “substantial adverse effects” on volition.36 The statutory 

requirement that a physical evaluation be conducted contemporaneously with a mental 

health evaluation guards against the risk that the respondent will languish without 

appropriate treatment for physical conditions or disease.37

3. Kara’s commitment hearing

At the commitment hearing the psychiatrist testified that Kara’s psychotic 

symptoms were consistent with bipolar I disorder and that “lupus is a rare but known 

cause of bipolar and psychotic symptoms.” He also testified that his treatment 

recommendation would have remained the same even if he had been able to confirm 

that Kara actually had lupus. We conclude that the psychiatrist’s uncontradicted 

testimony regarding Kara’s psychotic condition supports the superior court’s finding of 

mental illness by clear and convincing evidence. This conclusion fits comfortably 

within the bounds of our prior decisions.38

35 Wetherhorn, 156 P.3d at 375 abrogated on other grounds by In re Naomi 

B., 435 P.3d at 929 (quoting Humphrey v. Cady, 405 U.S. 504, 509 (1972)).

36 See AS 47.30.915(17) (defining “mental illness”); AS 47.30.735(c) 

(stating criteria for 30-day commitment).

37 See AS 47.30.710(a).

38 See, e.g., In re Hospitalization of Naomi B., 435 P.3d 918, 921 (Alaska 

2019) (describing respondent’s reports of “being repeatedly raped, hit, and assaulted” 
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The superior court did not err in concluding there was clear and 

convincing evidence that Kara suffered from a mental illness within the meaning of 

AS 47.30.915(17).

B. The Superior Court’s Application Of Our Reasoning In E.P. Was Not 

Erroneous.

Kara also challenges the superior court’s reliance on E.P.39 The court 

found that because the evidence showed Kara was “currently experiencing a mental 

illness,” the “source does not matter.” Kara argues that the court’s interpretation of 

E.P. is problematic, “namely, that any organic impairment — essentially any illness —

that manifests in psychiatric symptoms constitutes a ‘mental illness,’ regardless of the 

cause.”40 To avoid the commitment of an individual who has an underlying medical 

cause for her psychiatric symptoms, Kara argues that we should limit E.P.’s holding to

circumstances involving drugs and alcohol.

In E.P. we described the petitioner’s organic brain damage, which resulted 

in “greatly impaired ability to exercise judgment, loss of perception of reality, and 

while at API were “delusions caused by mental illness” from “schizoaffective disorder, 

bipolarsubtype”); id. at 922 (describing respondent’s schizophrenia diagnosis as mental 

illness substantiated by paranoid and delusions thoughts, including that “members of a 

drug cartel had attempted to poison her”); In re Hospitalization of Tracy C., 249 P.3d 

1085, 1087 (Alaska, 2011) (describing bipolar I disorder diagnosis and physician’s 

testimony describing respondent’s agitation, rambling speech, inappropriate laughing, 

and paranoid delusions about her family and employer as mental illness).

39 205 P.3d 1101 (Alaska 2009).

40 Kara also claims that E.P. did not raise the issue of whether he had a 

mental illness, so the court’s decision was not “necessary to the resolution of the issues 

before it.” But API quotes a portion of E.P.’s briefing, which argued that “E.P.’s 

addiction to alcohol and gasoline . . . do not meet the statutory definition of mental 

illness.” Opening Brief of Appellant, E.P. v. Alaska Psychiatric Inst., S-12853, S12934, S-13004, 2008 WL 11519508, at *3, *19-22 (Apr. 9, 2008). Given the 

arguments made in E.P., we see no reason why the superior court could not conclude 

that E.P. provided persuasive authority.
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impaired ability to communicate,” as a condition both “apart from, and more than, his 

drug addiction.”41 We explained that E.P.’s continuing desire to huff gas arose “not 

only from addiction, but also from his cognitive inability to understand his situation.”42 

And we affirmed the commitment because E.P.’s intent to continue huffing gas if 

released was “something more than an addiction.”43

A careful reading of E.P. shows we did not hold that evidence of a mental 

illness must be both “apart from, and more than” an excluded condition to establish the 

respondent has a mental illness that justifies civil commitment. Although our 

imprecision in E.P. may have suggested otherwise, we now disavow any such 

implication.44 Under the statutory definition of “mental illness,” excluded conditions 

“do not per se constitute mental illness.”45 In this context, the plain meaning of “per 

se” is that “the excluded conditions do not by themselves, standing alone, constitute 

mental illness.”46 The petitioner must therefore present evidence that the respondent 

suffers from “an organic, mental, or emotional impairment”47 that is either apart from 

or more than an excluded condition.48 A requirement that a mental illness be both “apart 

41 205 P.3d at 1109.

42 Id.

43 Id. at 1110.

44 We also disavow the statement in our unpublished decision in In re 

Hospitalization of Duane M. that a mental illness that justifies involuntary commitment 

must be “apart from, and more than,” a respondent’s excluded condition. See No. 

S-16885, 2020 WL 1165853, at *5 (Alaska Mar. 11, 2020) (emphasis added).

45 AS 47.30.915(17).

46 In re Necessity for the Hospitalization of Dominic N., 548 P.3d 630, 635

(Alaska 2024) (emphasis in original) (citing Per se, BLACK’S LAW DICTIONARY (11th 

ed. 2019)).

47 AS 47.30.915(17).

48 See In re Dominic N., 548 P.3d at 635 (explaining “we did not require that 

addiction or intellectual disability be entirely separate from mental illness in E.P.”).
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from, and more than” an excluded condition would go beyond the plain meaning of the 

statutory text.

Kara’s arguments are inconsistent with our reasoning in E.P. Specifically, 

a mental or emotional impairment that is apart from or more than an excluded condition 

can qualify as a mental illness even if that mental impairment was originally caused by 

an excluded condition. Contrary to Kara’s assertion, the superior court’s application of 

E.P. did not read excluded conditions entirely out of the definition because lupus is not 

an excluded condition, and we decline to treat it as one. And whether or not Kara had 

lupus, her delusional thoughts and behavior were consistent with a mental or emotional 

impairment that had diminished her ability to perceive reality.

49

 Kara does not provide 

a persuasive reason to limit E.P.’s holding to circumstances involving drugs or alcohol. 

The superior court’s dismissal of the relevance of lupus as the potential 

cause of Kara’s delusional beliefs was premised on clear and convincing evidence that 

Kara was experiencing a mental illness. We see no error with the court’s reasoning or 

application of our holding in E.P.

C. It Was Not Error To Find That API Was The Least Restrictive 

Alternative.

Kara maintains that because API failed to “rule out” the possibility that 

her psychosis was caused by lupus, API is unable to show that her involuntary 

hospitalization was the least restrictive alternative treatment. In other words, Kara 

argues she should have been taken to a medical hospital to be evaluated for lupus instead 

of being committed involuntarily for mental health treatment at API.

49 See AS 47.30.915(17) (“ ‘[M]ental illness’ means an organic, mental, or 

emotional impairment that has substantial adverse effects on an individual’s ability to 

exercise conscious control of the individual’s actions or ability to perceive reality or to 

reason or understand.”).
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In an involuntary commitment proceeding, the State bears the burden of 

proving there are no less restrictive alternatives to institutional treatment.50 The absence 

of a less restrictive alternative must be substantiated by clear and convincing evidence.51

At oral argument Kara acknowledged that her arguments regarding the 

least restrictive alternative inquiry were encompassed by her proposed construction of 

the definition of “mental illness.” We have rejected Kara’s proposed construction and 

arguments that API was required to “rule out” the possibility that her psychosis was 

caused by lupus. Thus, we also reject Kara’s argument that the court erred regarding 

the least restrictive alternative inquiry.

The record supports the conclusion that involuntary commitment was the 

least restrictive alternative in this case. The psychiatrist stated he would recommend 

commitment to treat Kara’s psychosis based on her psychotic symptoms even if he 

could confirm Kara had lupus. Although the psychiatrist testified that Kara had some 

“physical signs” of lupus, no testimony indicated that these symptoms were significant 

enough to warrant her being taken to a medical hospital for treatment. Kara had 

“significantly impaired kidney function” during her first admission, but she did not have 

such an impairment during her second admission. The psychiatrist testified that Kara’s 

kidneys might become a medical concern, but that was only because she was not 

consuming enough fluids, which was an issue caused by her psychotic beliefs that 

someone was poisoning her food and drink. Thus, to the extent the psychiatrist was 

worried that Kara might suffer from any medical issues, that concern was premised on 

50 AS 47.30.735(d); In re Hospitalization of Sergio F., 529 P.3d 74, 78-79 

(Alaska 2023) (citing In re Naomi B., 435 P.3d at 934).

51 In re Sergio F., 529 P.3d at 78-79 (“A less restrictive alternative must be 

feasible, available, and provide ‘adequate treatment’ for a respondent.” (quoting In re 

Hospitalization of Danielle B., 453 P.3d 200, 204 (Alaska 2019))).
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complications caused primarily by her mental illness, which the psychiatrist described 

as a “rapid descent into . . . profound psychosis.”

Based on the psychiatrist’s testimony we cannot say the superior court 

erred by concluding there was clear and convincing evidence that treatment for Kara’s 

mental illness at API was the least restrictive available alternative.

CONCLUSION

We AFFIRM the 30-day commitment order.