Title: Fond du Lac County v. Helen E. F.
Citation: 2012 WI 50
Docket Number: 2010AP002061
State: Wisconsin
Issuer: Wisconsin Supreme Court
Date: May 18, 2012

2012 WI 50 
 
SUPREME COURT OF WISCONSIN 
 
 
 
 
 
CASE NO.: 
2010AP2061 
COMPLETE TITLE: 
 
In the matter of the mental commitment of Helen 
E. F.: 
 
Fond du Lac County, 
          Petitioner-Respondent-Petitioner, 
     v. 
Helen E. F., 
          Respondent-Appellant. 
 
 
 
 
REVIEW OF A DECISION OF THE COURT OF APPEALS 
Reported at: 333 Wis. 2d 740, 798 N.W. 2d 707 
(Ct. App 2011 – Published) 
PDC No: 2011 WI App 72 
 
 
OPINION FILED: 
May 18, 2012   
SUBMITTED ON BRIEFS: 
        
ORAL ARGUMENT: 
December 2, 2011 
 
 
SOURCE OF APPEAL: 
 
 
COURT: 
Circuit   
 
COUNTY: 
Fond Du Lac 
 
JUDGE: 
Richard J. Nuss 
 
 
 
JUSTICES: 
 
 
CONCURRED: 
ABRAHAMSON, C.J., concurs (Opinion filed).  
BRADLEY, J., joins concurrence.    
 
DISSENTED: 
        
 
NOT PARTICIPATING: PROSSER, J., did not participate.    
 
 
 
ATTORNEYS: 
 
For the petitioner-respondent-petitioner there were briefs 
filed and oral argument by William J. Bendt, corporation 
counsel. 
For the respondent-appellant, there was a brief and oral 
argument by Donald T. Lang, assistant state public defender. 
An amicus curiae brief was filed by Dawn N. Klockow, 
Chilton and Ryan O’Rourke, Manitowoc, for the Wisconsin 
Association of County Corporation Counsels; Maren Beermann, 
Madison, for the Coalition of Wisconsin Aging Groups and Tom 
Hlavacek, Milwaukee, for the Alzheimer’s Association of 
 
 
2
Southeastern Wisconsin; Kristin M. Kerschensteiner, Madison, for 
Disability Rights Wisconsin; Carol J. Wessels and Nelson, 
Irvings & Waeffler, S.C., Wauwatosa, and Peter E. Grosskopf and 
Grosskopf & Black LLC, Eau Claire, for the Elder Law Section of 
the State Bar of Wisconsin and the Wisconsin Chapter of the 
National Academy of Elder Law Attorneys; and Andrew T. Phillips, 
Daniel J. Borowski, Patrick C. Henneger and Phillips Borowski, 
S.C., Mequon, for the Wisconsin Counties Association. 
 
 
2012 WI 50
NOTICE 
This opinion is subject to further 
editing and modification.  The final 
version will appear in the bound 
volume of the official reports.   
No.   2010AP2061 
(L.C. No. 
2010ME146) 
STATE OF WISCONSIN  
 
 
   : 
IN SUPREME COURT 
 
 
In the matter of the mental commitment of Helen 
E. F.: 
 
 
 
Fond du Lac County, 
 
          Petitioner-Respondent-Petitioner, 
 
     v. 
 
Helen E. F., 
 
          Respondent-Appellant. 
 
 
 
FILED 
 
MAY 18, 2012 
 
Diane M. Fremgen 
Clerk of Supreme Court 
 
 
 
 
 
REVIEW of a decision of the Court of Appeals.  Affirmed.   
 
¶1 
MICHAEL J. GABLEMAN, J.   We review a published 
decision of the court of appeals1 reversing an order of the 
circuit court for Fond du Lac County, Richard J. Nuss, Judge. 
¶2 
We are asked to decide whether Helen E.F. ("Helen") 
may be involuntarily committed under Wis. Stat. ch. 51 (2009-
                                                 
1 Fond du Lac County v. Helen E.F., 2011 WI App 72, 333 
Wis. 2d 740, 798 N.W.2d 707. 
No. 
2010AP2061   
 
2 
 
10).2  After reviewing chs. 51 and 55, we hold that Helen is more 
appropriately treated under the provisions provided in ch. 55 
rather than those in ch. 51.  Because Helen's disability is 
likely to be permanent, she is a proper subject for protective 
placement and services under ch. 55, which allows for her care 
in a facility more narrowly tailored to her needs, and which 
provides her necessary additional process and protections.  We 
conclude that Helen is not a proper subject for treatment 
because while her Alzheimer's Disease may be managed, she is not 
medically capable of rehabilitation, as required by the chapter.  
For these reasons, we agree with the court of appeals that Helen 
was improperly committed under ch. 51 and we therefore affirm. 
I. 
FACTS AND PROCEDURAL HISTORY 
¶3 
The facts of this case are undisputed.  Helen E.F. 
(“Helen”) is an 85-year-old woman who resided in a Fond du Lac, 
Wisconsin nursing home for six years prior to the commencement 
of this action.  She suffers from Alzheimer's Disease,3 and her 
symptoms 
include 
progressive 
dementia, 
memory 
loss, 
the 
                                                 
2 All subsequent references to the Wisconsin Statutes are to 
the 2009-10 version unless otherwise indicated. 
3 Alzheimer's Disease is a "neurodegenerative disorder 
characterized by . . . neuropathologic changes."  Edward T. Bope 
& Rick D. Kellerman, Conn’s Current Therapy 901 (2011).  In 
other words, the disease is a "progressive, irreversible brain 
disorder that robs those who have it of memory and overall 
mental and physical function, and eventually leads to death."  
Christopher I. Wright, et al., Massachusetts General Hospital 
Comprehensive Clinical Psychiatry 234 (Theodore A. Stern, et 
al., ed. 2008).  
No. 
2010AP2061   
 
3 
 
inability 
to 
learn 
new 
information, 
and 
limited 
verbal 
communication.   
¶4 
Helen began exhibiting aggressive behavior in early 
April 2010.  This behavior included agitation and aggression 
manifested by striking out at caregivers while toileting, 
dressing, and bathing, and refusing both meals and medication.  
On April 12, 2010, Helen was transported to the St. Agnes 
Hospital emergency room in the city of Fond du Lac for medical 
treatment.  While receiving treatment at the emergency room, 
Helen continued to exhibit the same behaviors that she had 
exhibited in the nursing home——agitation and aggression. 
¶5 
Due to Helen’s behavior, a Fond du Lac police officer 
placed her in the hospital’s behavioral health unit under 
emergency detention pursuant to Wis. Stat. § 51.15, and Fond du 
Lac 
County 
("County") 
initiated 
a 
ch. 51 
proceeding 
to 
involuntarily commit her for treatment.  At the statutorily 
required probable cause hearing 72 hours4 later, on April 15, 
2010, a court commissioner concluded that no probable cause 
existed to proceed under ch. 51.  The court commissioner then 
converted the ch. 51 petition to a ch. 55 protective placement 
action and issued an order for a 30-day protective placement.5 
¶6 
On May 15, 2010, the day the 30-day time period to 
proceed with a Wis. Stat. ch. 55 placement expired, the County 
filed a second ch. 51 petition.  At the preliminary (probable 
                                                 
4 See Wis. Stat. § 51.20(7)(a).  
5 See Wis. Stat. § 51.20(7)(d).  
No. 
2010AP2061   
 
4 
 
cause) hearing for this second ch. 51 petition, the circuit 
court heard testimony from Dr. Brian Christenson, who treated 
Helen during her 30-day ch. 55 emergency placement at the St. 
Agnes Behavioral Health Unit.  In the course of testifying about 
Helen's condition, Dr. Christenson stated that he believed that 
Helen suffered from "senile dementia of the Alzheimer’s type," 
more commonly known as Alzheimer's Disease.  Additionally, Dr. 
Christenson testified that Helen's "cognitive deterioration is 
not treatable . . . ." 
¶7 
At the final commitment hearing6 on the second Wis. 
Stat. ch. 51 petition, the circuit court heard testimony from 
Dr. Robert Rawski, one of two physicians who had been appointed 
by the circuit court to examine Helen.7  Dr. Rawski testified 
that although Helen suffered from Alzheimer's Disease, which "is 
not considered to be a treatable mental disorder," he believed 
Helen was a proper subject for treatment because her behavioral 
disturbances were controllable through medications. 
¶8 
Based on Dr. Rawski's uncontroverted testimony, the 
circuit court found that Helen was a proper subject for 
involuntary commitment under Wis. Stat. ch. 51, and granted the 
petition for Helen’s involuntary commitment for up to six months 
in a locked psychiatric unit. 
                                                 
6 See generally Wis. Stat. § 51.20(10). 
7 See Wis. Stat. § 51.20(9)(a).  Pursuant to § 51.20(9)(a), 
the circuit court appointed Dr. Rawski and Dr. Sangita Patel.  
Although Dr. Patel provided a written report, she did not 
provide testimony at the final commitment hearing. 
No. 
2010AP2061   
 
5 
 
¶9 
Helen appealed, and the court of appeals reversed and 
remanded the cause to the circuit court.  Fond du Lac County v. 
Helen 
E.F., 2011 
WI App 72, ¶34, 333 Wis. 2d 740, 798 
N.W.2d 707.  The court of appeals determined, inter alia, that 
the primary purpose of Wis. Stat. ch. 51 is to provide 
treatment, and because Alzheimer's Disease does not respond to 
treatment, 
involuntary 
commitment 
under 
ch. 51 
was 
inappropriate.  Id., ¶27.  Accordingly, the court of appeals 
determined that Helen was not a proper subject for treatment 
under ch. 51.  Id., ¶1.  The County petitioned this court for 
review, which we granted on August 31, 2011. 
II. 
STANDARD OF REVIEW 
¶10 This case requires us to construe specific provisions 
of Wis. Stat. ch. 51.  The interpretation of a statute is a 
question of law that we review de novo.  Hocking v. City of 
Dodgeville, 2010 WI 59, ¶17, 326 Wis. 2d 155, 785 N.W.2d 398.  
We interpret statutes independently, but benefit from both our 
prior analyses and those of prior courts.  State v. Henley, 2010 
WI 97, ¶29, 328 Wis. 2d 544, 787 N.W.2d 350. 
III. 
DISCUSSION 
¶11 The legislature has consistently demonstrated its 
concern for the protection of individuals suffering from mental 
infirmities.  This is the announced legislative purpose of two 
chapters of the Wisconsin statutes: Chapter 51, the "Mental 
Health Act," and Chapter 55, the "Protective Service System."  
See Wis. Stat. § 51.001(1) ("It is the policy of the state to 
assure the provision of a full range of treatment and 
No. 
2010AP2061   
 
6 
 
rehabilitation services . . . ."); § 55.001 ("This chapter is 
designed to establish . . . protective services and protective 
placements, 
[and] 
to 
assure 
their 
availability 
to 
all 
individuals when in need of them . . . .").  The existence of 
these two different chapters demonstrates that the legislature 
has created two separate and distinct avenues by which counties 
may provide medical placement and services to those persons who, 
because of some disability, are "impaired" in their daily lives 
and unable obtain such services for themselves. 
¶12 In constructing these two avenues, the legislature 
also established strict rules and boundaries for the provision 
of care to disabled individuals, demonstrating its commitment 
"to plac[ing] the least possible restriction on personal liberty 
and [on the] exercise of constitutional rights consistent with 
due process."  Wis. Stat. § 55.001; see also § 51.001(2) 
(voicing concern for the personal liberties of those committed 
under ch. 51).  These rules, set forth in chs. 55 and 51, 
require that counties must commit or place individuals in 
institutions in accordance with the individual's specific 
situation, rather than choosing which chapter to apply in a 
given case.  Accordingly, we begin our analysis by reviewing 
both chs. 55 and 51 to determine which contains the mechanisms 
most suited to Helen's condition.   
A. CHAPTERS 55 AND 51 
¶13 Wis. Stat. ch. 55 provides Helen with the best means 
of care.  This is so because ch. 55 was specifically tailored by 
the legislature to provide for long-term care of individuals 
No. 
2010AP2061   
 
7 
 
with 
incurable 
disorders, 
while 
ch. 51 
was 
designed 
to 
facilitate the treatment of mental illnesses suffered by those 
capable of rehabilitation.  To demonstrate why ch. 55 provides 
the 
most 
appropriate 
statutory 
framework 
for 
treating 
individuals such as Helen, we begin with an overview of its 
procedures, which provide for both protective placement and 
services.   
¶14 Beginning 
with 
protective 
placement, 
Wis. 
Stat. 
§ 55.08 requires that a circuit court determine that four 
elements are met before ordering a protective placement under 
ch. 55.  The individual to be protected must: 1) have "a primary 
need for residential care and custody"; 2) be "an adult who has 
been determined to be incompetent by a circuit court"; 3) be "so 
totally incapable of providing for . . . her own care or custody 
as to create a substantial risk of serious harm to . . . 
herself" because of "a developmental disability, degenerative 
brain disorder, serious and persistent mental illness, or other 
like incapacit[y]"; and 4) have "a disability that is permanent 
or likely to be permanent."  § 55.08(1)(a-d). 
¶15 Similarly, in order to be eligible for protective 
services, a circuit court must determine that the following 
elements are met.  First, the individual must be "determined to 
be incompetent by a circuit court."  Wis. Stat. § 55.08(2)(a).  
Second, the circuit court must determine that "[a]s a result of 
developmental disability, degenerative brain disorder, serious 
and persistent mental illness, or other like incapacities, the 
individual will incur a substantial risk of physical harm or 
No. 
2010AP2061   
 
8 
 
deterioration or will present a substantial risk of physical 
harm to others if protective services are not provided."  
§ 55.08(2)(b). 
¶16 These elements must be stated in a petition for 
protective services or protective placement filed by the county 
with the circuit court.  See Wis. Stat. § 55.075.  Upon filing, 
the petitioner must provide notice to the individual to be 
protected, as well as to that individual's guardian, if one 
exists.  § 55.09(1-2).  If the individual has no guardian, the 
court must appoint a guardian ad litem ("GAL") on behalf of the 
individual.8  § 55.10(4)(b). 
¶17 Except in the case of emergency services, the circuit 
court must hold a hearing to determine whether the four elements 
for protective placement and two elements for protective 
services are met by clear and convincing evidence.  Wis. Stat. 
§ 55.10(4)(d); see also § 55.08.  At this hearing, the circuit 
court may take testimony from the individual or individuals 
assigned to conduct the required comprehensive analysis of the 
individual to be protected.  See § 55.11.  At the conclusion of 
the hearing, the court may order a protective placement and 
                                                 
8 Because one of the required elements for both protective 
placement and services under Wis. Stat. § 55.08(1) is a finding 
by the circuit court that the individual in need of protective 
services is incompetent, the requirements of §§ 54.01(16) and 
54.10(3) apply.  Therefore, it is impossible under the current 
statutory scheme for an individual to be subject to protective 
placement or services under ch. 55 without the benefit of a 
guardian ad litem.  See § 55.10(4)(b); see also §§ 54.10(3); 
54.40(1). 
No. 
2010AP2061   
 
9 
 
services at a "nursing home[], public medical institution[] 
. . . or [at] [an]other appropriate facilit[y]," but may not 
order placement at "units for the acutely mentally ill."  
§ 55.12(2).  The circuit court may, however, order protective 
placement in a "locked unit" if the court makes a specific 
finding determining that such placement is necessary.  Id. 
¶18 While protective services are ongoing, the protected 
individual may be subject to the involuntary administration of 
psychotropic 
medication 
if 
"the 
individual 
will 
incur 
a 
substantial probability of physical harm, impairment, injury, or 
debilitation or will present a substantial probability of 
physical harm to others."  Wis. Stat. § 55.14(3)(e).9  By 
allowing for administration of psychotropic medication in a 
process closely monitored by the circuit court, ch. 55 permits 
full treatment of individuals with disorders like Alzheimer's 
                                                 
9 A person exhibits "substantial probability of physical 
harm, impairment, injury, or debilitation" if one of the 
following is true:  
[A] history of at least 2 episodes, one of which has 
occurred within the previous 24 months, that indicate 
a pattern of overt activity, attempts, threats to act, 
or omissions that resulted from the individual's 
failure 
to 
participate 
in 
treatment, 
including 
psychotropic medication, and that resulted in a 
finding of probable cause for commitment . . . ." 
Evidence 
that 
the 
individual 
meets 
one 
of 
the 
dangerousness criteria set forth in s. 51.20(1)(a)2. 
a. to e. 
Wis. Stat. § 55.14(3)(e)1.-2. 
No. 
2010AP2061   
 
10 
 
Disease while restricting the liberty of the person only insofar 
as is strictly necessary.  See § 55.14(3)(a-e). 
¶19 In addition to the protective placement and services 
procedures outlined above, Wis. Stat. ch. 55 also provides for 
emergency services, if needed.  See § 55.13.  Upon filing of a 
petition 
for 
emergency 
services, 
the 
court 
must 
hold 
a 
preliminary hearing to determine whether probable cause exists 
to believe that the individual is a proper subject for 
protective 
placement 
or 
services 
under 
§ 55.08.10 
 
See 
§ 55.13(2).  If the court determines that probable cause exists, 
it may order emergency protective services for up to 60 days, 
pending a final hearing pursuant to § 55.10, and may order the 
involuntary administration of psychotropic medication.  See 
§ 55.13(3); § 55.14(10). 
¶20 Turning to Wis. Stat. ch. 51, that chapter, unlike 
ch. 55, has the principal purpose of "assur[ing] the provision 
of a full range of treatment and rehabilitation services . . . 
for all mental disorders and developmental disabilities and for 
mental illness, alcoholism and other drug abuse."  § 51.001(1); 
see also Rolo v. Goers, 174 Wis. 2d 709, 721-22, 497 N.W.2d 724 
(1993).  Although the procedures for commitment in ch. 51 are 
similar to those contained in ch. 55, there are important 
differences in the elements the state must prove for each.  In 
                                                 
10 At 
this 
probable 
cause 
hearing, 
a 
petition 
for 
guardianship must accompany the petition for protective services 
if the individual does not already have a guardian.  Wis. Stat. 
§ 55.13(2). 
No. 
2010AP2061   
 
11 
 
order to be subject to a ch. 51 involuntary commitment, a 
subject individual must meet three criteria: the subject 
individual must be 1) "mentally ill"; 2) "a proper subject for 
treatment"; and 3) "dangerous" to themselves or to others.  
§ 51.20(1)(a)1.-2.; cf. Steven Erickson, et al., Beyond Overt 
Violence: Wisconsin's Progressive Civil Commitment Statute as a 
Marker of a New Era in Health Law, 89 Marq. L. Rev. 359, 368-71 
(2005).  A subject individual may be involuntarily committed 
under ch. 51 only when the county proves each of the elements 
above; therefore, if the circuit court determines that even one 
of the elements is not met, the subject individual may not be 
committed under ch. 51.  See §§ 51.20(1)(a), (7)(c), (10)(c).11 
B. CHAPTER 55, NOT CHAPTER 51, IS THE APPROPRIATE MECHANISM 
FOR PROVIDING CARE FOR HELEN 
¶21 While 
Wis. 
Stat. 
chs. 55 
and 
51 
have 
similar 
procedures, 
they 
serve 
substantially 
different 
purposes.  
Chapter 51 is designed to accommodate short-term commitment and 
treatment of mentally ill individuals, while ch. 55 provides for 
long-term care for individuals with disabilities that are 
permanent or likely to be permanent.  See § 51.20(13)(g) 
(stating that a commitment under ch. 51 is not to exceed six 
months); § 51.20(1)(a) (stating that the individual subject to 
commitment 
must 
be 
a 
proper 
subject 
for 
treatment); 
§ 55.08(1)(d) (stating that ch. 55 placement is allowed only 
                                                 
11 Chapter 51 requires similar procedures for involuntary 
commitment, so we do not review the totality of those procedures 
here. 
No. 
2010AP2061   
 
12 
 
where the individual to be protected suffers from "a disability 
that is permanent or likely to be permanent").  To that end, we 
turn to three specific differences between the chapters, 
ultimately holding that the procedures and protections provided 
by ch. 55 are a better fit for Helen and her particular 
disorder. 
1. PLACEMENT 
¶22 First, if care were provided to Helen pursuant to Wis. 
Stat. ch. 55, rather than ch. 51, she could be attended to with 
the fewest possible constraints on her freedom consistent with 
her own protection and the safety of the public.  The balancing 
of those interests is required by both chapters, see Wis. Stat. 
§ 55.001 
(requiring 
placement 
with 
"the 
least 
possible 
restriction on personal liberty . . . ."); § 51.001 (stating 
that it is the purpose of the chapter to provide "the least 
restrictive 
treatment 
alternative 
appropriate 
to 
[the 
individual's] needs"), as well as by general principles of 
mental health law and constitutional jurisprudence.  Youngberg 
v. Romeo, 457 U.S. 307, 321 (1982) (emphasizing "the proper 
balance between the legitimate interests of the State and the 
rights of the involuntarily committed to reasonable conditions 
of safety and freedom from unreasonable restraints.").   
¶23 In the case of Helen, Wis. Stat. ch. 55 allows for a 
more appropriate balancing of these important interests than 
does ch. 51.  For an individual committed under ch. 51 may be 
placed in any mental health unit without an additional finding 
by the circuit court, while under ch. 55, an individual may not 
No. 
2010AP2061   
 
13 
 
be placed in units for the acutely mentally ill.  This is an 
important distinction, because under the language of ch. 51, 
Helen, an 85 year-old Alzheimer's Disease patient, could be 
committed to a facility that tends to acutely mentally ill 
patients.  See § 51.01(19) ("'Treatment facility' means any 
publicly 
or 
privately 
operated 
facility 
or 
unit 
thereof 
providing treatment of alcoholic, drug dependent, mentally ill 
or developmentally disabled persons . . . .").  Thus, ch. 55 
excludes certain facilities that Helen might otherwise be placed 
in pursuant to ch. 51.  Because it is more narrowly tailored to 
her specific condition, and because it affords her additional 
process designed to ensure the appropriateness of her facility, 
we conclude that ch. 55 better balances Helen's interest in 
liberty with the County's interest in protecting the public and 
in affording her the care she requires.      
2. GUARDIAN AD LITEM 
¶24 Second, while Wis. Stat. ch. 51 does not provide for 
the appointment of a GAL, ch. 55 requires it.  This is an 
important protection of the individual's interests that confirms 
our 
conclusion 
that 
ch. 55 
is 
better 
suited 
to 
Helen's 
circumstances.  § 51.10(4)(b) ("The court shall in all cases 
require the appointment of an attorney as guardian ad litem 
. . . .").  The appointment of a GAL ensures that individuals 
like Helen are provided adequate and specialized care, thus 
bolstering our determination that ch. 55 is the most appropriate 
means of providing care for Helen. 
No. 
2010AP2061   
 
14 
 
¶25 The legislature provided for the appointment of a GAL 
in Wis. Stat. ch. 55 proceedings because it recognized that 
individuals subject to the chapter need an additional advocate 
for their best interests, given that ch. 55 is focused on the 
provision of long-term care to individuals with incurable 
conditions.  See § 55.195(1-9) (explaining the duties of the 
GAL); see Jennifer M. v. Maurer, 2010 WI App 8, ¶7, 323 
Wis. 2d 126, 779 N.W.2d 436 (stating that a GAL provides "an 
advocate for the best interest of the ward.")  A GAL is 
necessary because, in the context of Helen's Alzheimer's 
Disease, a ch. 55 protective placement is likely to extend for a 
much longer term than treatment in the ch. 51 context.  See 
§ 55.195(4) (stating that one of the GAL's duties under ch. 55 
is to "[r]eview the annual report and relevant reports on the 
ward's condition and protective services.").  Conversely, the 
goal of ch. 51 is to treat and rehabilitate the subject 
individual, which ideally ends by returning her to society.  By 
contrast, ch. 55 is designed for long-term management of 
disorders that cannot be treated, and therefore are unlikely to 
subside, meaning that the individual in need of protection is 
unlikely to return to society.  Thus, periodic assessments by a 
GAL of the individual's situation are essential to the continual 
provision of appropriate care.   
¶26 In Helen's case, the appointment of a GAL would have 
served two purposes.  Most importantly, a GAL would have been 
helpful in providing a recommendation to the court regarding 
Helen's 
need 
for 
protective 
services. 
 
Although 
Helen's 
No. 
2010AP2061   
 
15 
 
appointed counsel also had Helen's best interests in mind, a GAL 
would have provided a second set of watchful eyes sensitive to 
Helen's needs at each step of the commitment process and on a 
regular basis after the issuance of a protective order.  See 
Wis. Stat. §§ 55.10(b); 55.195(1-9). 
¶27 Additionally, a GAL would have provided the court with 
an individualized report regarding the provision of psychotropic 
medication, which the record reflects was a central component of 
Helen's care.  Under Wis. Stat. ch. 55, a GAL must advise the 
court before he or she may order the involuntary administration 
of psychotropic medication whether that administration is in the 
best interest of the patient.  See § 55.14(5).  Further, the GAL 
must file periodic reports with the court outlining the need for 
continued protective placement and services, see § 55.18(2), and 
the 
need 
for 
continued 
involuntary 
administration 
of 
psychotropic medication, see § 55.19(2).  In short, the GAL 
would have provided the court with advice as to Helen's best 
interest 
regarding 
psychotropic 
medication 
throughout 
the 
pendency——and continuance——of the protective placement under 
ch. 55.  Such advice would have given the court valuable 
assistance 
in 
overseeing 
Helen's 
care 
with 
particular 
sensitivity to her unique needs.  Because the County utilized 
ch. 51, however, the court was forced to act without that 
helpful assistance.   
¶28 Accordingly, the GAL requirement in Wis. Stat. ch. 55, 
and its absence from ch. 51, supports our conclusion that Helen 
should receive care pursuant to ch. 55. 
No. 
2010AP2061   
 
16 
 
3. REHABILITATION VERSUS LONG-TERM CARE 
¶29 Finally, as we have already stated, the legislature 
designed Wis. Stat. ch. 55 to be used for long-term care, see 
§ 55.08(1)(d) 
(stating 
that 
one 
of 
the 
requirements 
for 
protective placement is that "[t]he individual has a disability 
that is permanent or likely to be permanent."), while ch. 51 is 
used for short term treatment and rehabilitation intended to 
culminate with re-integration of the committed individual into 
society, 
see 
§ 51.20(1)(a)1. 
(stating 
that 
the 
subject 
individual must be a proper subject for treatment).   
¶30 In order to be a proper subject for treatment pursuant 
to an involuntary commitment under Wis. Stat. ch. 51, an 
individual 
must 
be 
capable 
of 
"rehabilitation." 
 
See 
§ 51.01(17).  We conclude that Helen is not a proper subject for 
treatment because while her Alzheimer's Disease may be managed, 
she is medically incapable of rehabilitation. 
¶31 In reaching this conclusion, we are assisted by two 
decisions from the Wisconsin court of appeals.  In one, the 
court decided that the subject individuals could not be 
rehabilitated, see Milwaukee Cnty. Combined Cmty. Servs. Bd. v. 
Athans, 107 Wis. 2d 331, 337, 320 N.W.2d. 30 (Ct. App. 1982), 
and 
in the other 
that the subject individual could be 
rehabilitated, 
see 
C.J. 
v. 
State, 
120 
Wis. 2d 355, 
354 
N.W.2d 219 (Ct. App. 1984).  These cases are instructive to our 
analysis of whether Helen is a proper subject for treatment 
under Wis. Stat. ch. 51, and whether ch. 55 or 51 is a more 
appropriate avenue for Helen's care.  As with the statutory 
No. 
2010AP2061   
 
17 
 
analysis above, this precedent confirms that ch. 55 better 
accommodates Helen's needs and those of the County. 
a. ATHANS 
¶32 In Athans, the court of appeals found that Theodora 
Athans, a chronic paranoid schizophrenic, "was not a proper 
subject for treatment because rehabilitation in her case was not 
possible."12  107 Wis. 2d at 333.  The physician who examined 
Athans, Dr. Kennedy, stated that he believed that she could be 
treated, but only in the sense that treatment involved long-term 
stabilization, or management of the disease.  Brief for 
Respondents at 10, Athans, 107 Wis. 2d 331 (Nos. 81-1288, 81-
1290).  However, Dr. Kennedy further testified that attempted 
treatment of her underlying condition (or rehabilitation, as the 
court viewed it) would "have as much effect on her as water on a 
duck's back."  Id. at 10.   
¶33 Therefore, the court of appeals determined that Athans 
could not be rehabilitated, because it understood from the 
testimony of Dr. Kennedy that Athans "would not change her 
delusional scheme no matter what the treatment attempted, 
including sedation."  Athans, 107 Wis. 2d at 333.  As a result, 
in the absence of any possibility of rehabilitation, the court 
                                                 
12 The 
Athans 
case 
actually 
involved 
two 
subject 
individuals: 
Athans, 
who 
suffered 
from 
chronic 
paranoid 
schizophrenia, and Haskins, who suffered from the compulsive 
disorder of pyromania.  Milwaukee Cnty. Combined Cmty. Servs. 
Bd. v. Athans, 107 Wis. 2d 331, 333-34, 320 N.W.2d. 30 (Ct. App. 
1982).  The analysis in Athans of the second individual, Gerald 
Haskins, is not relevant to our discussion of the case. 
No. 
2010AP2061   
 
18 
 
concluded that Athans was not a proper subject for treatment.  
See id. at 333, 337. 
b. C.J. 
¶34 Two years later, in C.J., the court of appeals found 
that another individual also suffering from chronic paranoid 
schizophrenia was a proper subject for treatment because, unlike 
with Athans, rehabilitation was possible.  120 Wis. 2d at 356.  
In drawing this conclusion, the court of appeals relied upon the 
fact that treatment could help C.J., the subject individual, by 
effecting a change in his underlying disorder.  See id. at 362.   
¶35 In defending its conclusion, the court of appeals 
distinguished C.J. from Athans on several bases.  It reasoned: 
The experts in Athans testified that neither of the 
persons named in the petitions was [a] proper subject 
for treatment.  Furthermore, there was testimony in 
the case of the schizophrenic that her delusional 
scheme would not change no matter what treatment was 
tried and that hospitalization might actually be 
harmful.  There can be little question that the expert 
testimony in Athans led to the trial court's finding 
that the two individuals, Athans and Haskins, were not 
proper subjects for treatment because these disorders 
could not be helped in any way. 
Id. at 361 (internal citations omitted).  The C.J. court went on 
to juxtapose the facts of Athans with the facts before it: 
We are satisfied that the Athans case involved two 
people who might be helped in terms of maximizing 
their individual functioning and maintenance, even 
though they could not be helped in controlling or 
improving their disorders. In this case, we have 
evidence that C.J. will benefit from treatment that 
will go beyond controlling his activity——it will go to 
controlling his disorder and its symptoms. As such, 
Athans is inapposite to this case. 
No. 
2010AP2061   
 
19 
 
Id. at 362 (emphasis added).  Accordingly, the court of appeals 
held that C.J. was capable of rehabilitation because proper 
treatment had the potential to "control[] his disorder."  Id. 
¶36 In so holding, the court of appeals provided a useful 
and well-constructed fact-based test for determining whether a 
subject individual is capable of rehabilitation, and therefore 
treatable under Wis. Stat. § 51.01(17).  If treatment will 
"maximize[e] the[] individual functioning and maintenance" of 
the subject, but not "help[] in controlling or improving their 
disorder[]," 
then 
the 
subject 
individual 
does 
not 
have 
rehabilitative potential, and is not a proper subject for 
treatment.  C.J., 120 Wis. 2d at 362.  However, if treatment 
will "go beyond controlling . . . activity" and will "go to 
controlling [the] disorder and its symptoms," then the subject 
individual has rehabilitative potential, and is a proper subject 
for treatment.  Id.  We believe the court of appeals' test 
accurately reflects the interests embodied in chs. 51 and 55, 
and we therefore bring it to bear in the case at bar.  
¶37 Applying that test here, we conclude that while the 
medical techniques employed in Helen's case "maximiz[e] [her] 
. . . functioning and maintenance," as was the case in Athans, 
those techniques are unfortunately unlikely to rehabilitate her. 
Viewed in this light, it is apparent that Helen's situation more 
closely mirrors Athans' than it does C.J.'s.  This is so 
because, given the current state of medical science, Helen's 
Alzheimer's Disease is incurable and untreatable; the only 
available medical remedy is maintenance——not treatment——of the 
No. 
2010AP2061   
 
20 
 
disease as it progresses.  See Jinny Tavee & Patrick Sweeney, 
The Cleveland Clinic Foundation, Current Clinical Medicine 893 
(William D. Carey, ed., 2d ed. 2010).  Because Helen's 
Alzheimer's Disease is not treatable and medical techniques can 
only "maximiz[e] the[] . . . functioning and maintenance" of an 
individual, C.J., 120 Wis. 2d at 362, we conclude that Helen 
cannot be rehabilitated within the meaning of Wis. Stat. ch. 51.  
By the plain terms of § 51.01(17) (requiring the subject 
individual to be capable of rehabilitation), therefore, Helen 
cannot be cared for pursuant to ch. 51. 
¶38 There is, to be sure, some evidence that certain 
symptoms 
(anxiety 
and aggression) associated with Helen's 
Alzheimer's 
Disease 
may 
be 
ameliorated 
by 
psychotropic 
medication.  Nevertheless, that fact does not alter the result, 
as there is uncontroverted evidence that Helen's underlying 
disorder, Alzheimer's Disease, as well as the vast majority of 
its symptoms, do not respond to treatment techniques designed to 
bring about rehabilitation.  See Jinny Tavee & Patrick Sweeney, 
The Cleveland Clinic Foundation, Current Clinical Medicine 893 
(William D. Carey, ed., 2d ed. 2010) (stating that temporary 
improvements may occur with medication, but no known cure for 
Alzheimer's Disease currently exists).  In order for Helen to be 
a proper subject for treatment, the record would have to 
reflect, as it did in C.J., "evidence that [the subject 
individual] will benefit from treatment that will go beyond 
controlling [her] activity——it will go to controlling [her] 
disorder and its symptoms."  C.J., 120 Wis. 2d at 362.  In 
No. 
2010AP2061   
 
21 
 
Helen's case, the only evidence on the point contained in the 
record is the testimony of Drs. Christenson and Rawski, who 
testified that while her activity may be managed, her disorder 
cannot be controlled.  Therefore, C.J. is inapposite here, and 
Helen's condition must be considered untreatable and incurable.  
Accordingly, Wis. Stat. ch. 51, with its requirement that the 
individual be a proper subject for treatment, is ill-suited to 
her situation. 
¶39 By contrast, Wis. Stat. ch. 55 contains no such 
requirement and thus imposes no such bar on Helen's care.  
Indeed, ch. 55 has the exact opposite objective: long-term care 
of people who will likely never be cured.  Explaining that 
objective, 
the 
legislature 
noted 
in 
§ 55.08(1)(d) 
that 
individuals in need of protective services are those who have "a 
disability that is permanent or likely to be permanent."  
Therefore, because Helen's disability is consistent with this 
purpose, in that it is not treatable given the current state of 
medical science, and therefore likely to be permanent, we 
believe 
that 
the 
procedures 
in 
ch. 55, 
not 
ch. 51, 
are 
appropriate. 
¶40 We do not address whether an individual who has 
Alzheimer's Disease as well as a Wis. Stat. ch. 51 qualifying 
illness may be involuntarily committed under ch. 51.  Instead, 
like the court of appeals, we "leave for another day the 
question of what is proper under the law when a person has a 
duel diagnosis of Alzheimer's and a Wis. Stat. ch. 51 qualifying 
illness."  Helen E.F., 333 Wis. 2d 740, ¶34 n.6.  We trust the 
No. 
2010AP2061   
 
22 
 
circuit court judges of our state to exercise their sound 
discretion in employing the powers assigned to them by ch. 51. 
¶41 In sum, Wis. Stat. ch. 55, unlike ch. 51, is better 
suited for Helen's situation because her Alzheimer's Disease is 
not treatable.  Because ch. 55 provides additional processes and 
protections for Helen, it is better suited to her needs and 
those of the County.  Accordingly, the circuit court was in 
error to proceed under ch. 51 and the court of appeals was 
correct to reverse and remand.  We therefore must affirm. 
IV. 
CONCLUSION 
¶42 We are asked to decide whether Helen E.F. ("Helen") 
may be involuntarily committed under Wis. Stat. ch. 51.  After 
reviewing 
chs. 51 
and 
55, 
we 
hold 
that 
Helen 
is 
more 
appropriately treated under the provisions provided in ch. 55 
rather than those in ch. 51.  Because Helen's disability is 
likely to be permanent, she is a proper subject for protective 
placement and services under ch. 55, which allows for her care 
in a facility more narrowly tailored to her needs, and which 
provides her necessary additional process and protections.  We 
conclude that Helen is not a proper subject for treatment 
because while her Alzheimer's Disease may be managed, she is not 
medically capable of rehabilitation, as required by the chapter.  
For these reasons, we agree with the court of appeals that Helen 
was improperly committed under ch. 51 and we therefore affirm. 
By the Court.—The decision of the court of appeals is 
affirmed. 
¶43 DAVID T. PROSSER, J., did not participate. 
No. 
2010AP2061   
 
23 
 
 
No.  2010AP2061.ssa 
 
1 
 
¶44 SHIRLEY S. ABRAHAMSON, C.J.   (concurring).  I agree 
that Chapter 55 of the Wisconsin Statutes appears to provide the 
proper procedural avenue for Helen E.F.  Chapter 55 is geared 
toward long-term care and protection, which is suitable for 
Helen E.F.  Chapter 55 also features procedural mechanisms 
allowing for emergency detention and involuntary administration 
of psychotropic medication when either is necessary in specific 
circumstances.  See Wis. Stat. §§ 55.12, 55.14.   
¶45 I write separately for two reasons.  First, I write to 
note some of the difficulties in interpreting Chapters 51 and 
55.  Despite the fact that the chapters ostensibly serve 
different purposes, there is substantial overlap and similarity 
between some aspects of the two chapters.  It is a challenge, at 
times, to determine whether Chapter 51, 55, or both are 
available in a particular case.   
¶46 Second, I write to highlight what I see as possible 
implications of the majority opinion.  A wide and heterogeneous 
group of people is subject to Chapter 51, 55, or both.  
Throughout the chapters, the legislature seemingly attempted to 
categorize people, providing different procedures for different 
categories, such as people with "degenerative brain disorders," 
people 
with 
"developmental 
disabilities," 
people 
who 
are 
"mentally ill," and people who are "drug dependent."  But the 
legislature also considers which procedural mechanisms are to be 
used based on the person's behavior, which does not necessarily 
hinge on the statutory category into which the person falls.   
No.  2010AP2061.ssa 
 
2 
 
¶47 A tension exists in the texts of the statutes (and the 
application of the statutes) between on the one hand lumping 
together all people with a certain condition and on the other 
hand considering the symptoms and conduct of the individual.  
The tension between the more rigid categories of people with a 
certain condition and the more flexible behavioral standards is 
palpable in the majority opinion.  Does this opinion govern all 
Alzheimer's patients or only Helen E.F.? 
¶48 The requirements for involuntary commitment under Wis. 
Stat. § 51.20 present an example of the tension and difficulty 
of interpreting Chapters 51 and 55.  One requirement is that the 
individual 
be 
"mentally 
ill," 
"drug 
dependent," 
or 
"developmentally disabled."  Wis. Stat. § 51.20(1)(a)1.  The 
enumeration of specific categories suggests that the legislature 
intended to limit the reach of a provision and exclude certain 
categories of people.  Yet, as Disability Rights Wisconsin 
argued in its non-party brief, the statute then furnishes a 
definition of mental illness for the purposes of involuntary 
commitment that "is so broad it can't be said to categorically 
rule out much of anything."1   
                                                 
1 See Wis. Stat. § 51.01(13)(b) ("'Mental illness', for 
purposes of involuntary commitment, means a substantial disorder 
of thought, mood, perception, orientation, or memory which 
grossly impairs judgment, behavior, capacity to recognize 
reality, or ability to meet the ordinary demands of life, but 
does not include alcoholism.").   
See also Wis. Stat. § 55.01(4m) ("'Mental illness' means 
mental disease to the extent that an afflicted person requires 
care, treatment or custody for his or her own welfare or the 
welfare of others or of the community."). 
No.  2010AP2061.ssa 
 
3 
 
¶49 Another requirement for involuntary commitment under 
Wis. Stat. § 51.20 is that the individual be "a proper subject 
for treatment," Wis. Stat. § 51.20(1)(a)1., which is defined to 
mean that "rehabilitation" must be possible for the individual.  
See Wis. Stat. § 51.01(17).   
¶50 The two cases discussed by the majority opinion, 
Athans and C.J., are illustrative of the malleability of the 
statutory definition of treatment and the tension inherent in 
the statutes between a defined category or condition and an 
individual's behavior.2   
¶51 The individuals in the two cases suffered from the 
same condition——chronic paranoid schizophrenia——yet the two 
courts 
reached 
opposite 
results 
on 
the 
possibility 
of 
"rehabilitation."  The results appear driven by the words chosen 
by expert medical witnesses describing the impact various 
medications would have on the individual.   
¶52 The court of appeals in Athans concluded that the 
individual could not be rehabilitated; the court of appeals in 
C.J. determined that rehabilitation was possible for the 
individual involved.  The court of appeals in C.J. saw a clear 
distinction 
between 
(a) 
a 
program 
capable 
of 
"maximizing . . . individual 
functioning 
and 
maintenance . . . [and] 
controlling . . . activity" 
(as 
described for the individual in Athans); and (b) a program 
                                                 
2 See majority op., ¶¶32-36 (discussing Milwaukee County 
Combined Cmty. Servs. Bd. v. Athans, 107 Wis. 2d 331, 320 
N.W.2d 30 (Ct. App. 1982), and C.J. v. State, 120 Wis. 2d 355, 
354 N.W.2d 219 (Ct. App. 1983)).  
No.  2010AP2061.ssa 
 
4 
 
capable of "controlling [a] disorder and its symptoms" (as 
described for the individual in C.J.).3  In the court of appeals 
opinion, the former did not constitute rehabilitation, and the 
latter did.  The line between the two does not seem so bright 
and clear to me.  The difference may very well lie in the 
experts' framing of the effects of a treatment program. 
¶53 These 
are 
just 
examples 
of 
the 
interpretive 
difficulties that arise in determining whether a person is 
subject to Chapter 51, 55, or both.  
¶54 Today's 
majority 
opinion 
provides 
a 
potentially 
powerful tool for an individual seeking to avoid involuntary 
commitment under Chapter 51.  The broadest reading of the 
opinion would be that any person with an "incurable" condition 
may not be involuntarily committed under Wis. Stat. § 51.20.  
See majority op., ¶37.  Individuals with conditions that might 
otherwise appear to qualify for involuntary commitment under the 
category "developmental disability"4 may now argue that they are 
not proper subjects for "treatment" because their condition is 
incurable.   
¶55 Although I agree with the result reached in the 
majority opinion, I am concerned that the opinion may have 
                                                 
3 C.J., 120 Wis. 2d at 362.  
4 See Wis. Stat. § 51.20(1)(a)1. (establishing that a person 
with a developmental disability is potentially subject to 
involuntary commitment).  See also Wis. Stat. § 51.01(5)(a) 
(defining "developmental disability" to include disabilities 
such as cerebral palsy, epilepsy, autism, Prader-Willi syndrome, 
and mental retardation); Wis. Stat. § 51.01(5)(b) (defining 
"developmental 
disability 
for 
purposes 
of 
involuntary 
commitment" to exclude cerebral palsy and epilepsy).  
No.  2010AP2061.ssa 
 
5 
 
broad, unforeseen implications for many people who fall within 
the scope of Chapters 51 and 55 and for local governments.5  
¶56 Because of the difficulties that arise in determining 
whether a person with a certain condition or a certain behaviors 
may be subject to Chapter 51, 55, or both, I suggest it may be 
time for the legislature to reassess the goals and intended 
scope of the two chapters.  See Wis. Stat. §§ 13.83(1)(c)1., 
13.92(2)(j).6 
¶57 For the reasons set forth, I write separately. 
¶58 I am authorized to state that Justice ANN WALSH 
BRADLEY joins this opinion. 
 
 
                                                 
5 The court received five non-party briefs in this case, 
which suggests that the case may have particularly broad impact.  
In favor of Helen E.F.'s position, we received briefs from 
Disability Rights Wisconsin, the Elder Law Section of the State 
Bar of Wisconsin and the Wisconsin Chapter of the National 
Academy of Elder Law Attorneys, and the Coalition of Wisconsin 
Aging 
Groups 
and 
Alzheimer's 
Association 
of 
Southeastern 
Wisconsin.  In favor of the County, we received briefs from the 
Wisconsin Counties Association and the Wisconsin Association of 
County Corporation Counsels.  
6 The Joint Legislative Council has established a Special 
Committee on Legal Interventions for Persons with Alzheimer's 
Disease and Related Dementias.  "The Special Committee is 
directed to review and develop legislation to clarify the 
statutes 
regarding 
guardianship, 
protective 
placement, 
involuntary commitment, and involuntary treatment as they apply 
to vulnerable adults with a dementia diagnosis who may or may 
not have a co-occurring psychiatric diagnosis."  Summary of 
April 24, 2012 Joint Legislative Council Mail Ballot, available 
at 
http://legis.wisconsin.gov/lc/committees/jointcouncil/files/2012
/april24_summary_jlc_web.pdf (last visited May 14, 2012).