Title: K.C. v. State
Citation: 1989 WY 74, 771 P.2d 774
Docket Number: 
State: Wyoming
Issuer: Wyoming Supreme Court
Date: March 20, 1989

K.C. v. State Annotate this Case K.C. v. State 1989 WY 74 771 P.2d 774 Case Number: C-88-9 Decided: 03/20/1989 Supreme Court of Wyoming K.C., APPELLANT (RESPONDENT), v. THE STATE OF WYOMING, APPELLEE (PETITIONER). No. C-88-9 Appeal from the District Court, LaramieCounty, Edward L. Grant, J. Robert G. Pickering of Bailey, Pickering, Stock & Welch, Cheyenne, for appellant. Joseph B. Meyer, Atty. Gen., John W. Renneisen, Deputy Atty. Gen., for appellee. Before CARDINE, C.J., and THOMAS, URBIGKIT, MACY and GOLDEN, JJ. URBIGKIT, Justice. [¶1.] Presented by this appeal is the difficult and socially pervasive concern of government responsibility - administrative, judicial and legislative - for the adequacy of care to be provided the mentally ill. Sufficiency of care and treatment was directly contested in the involuntary civil commitment of this admittedly mentally ill and severely disturbed adult to the Wyoming State Hospital (State Hospital) in Evanston, Wyoming, the state's only domiciliary institution. Consequently, alternative arrangements were requested, and the discretionary authority of the district court was questioned in this direct appeal of the involuntary commitment order as well as through a petition for extraordinary writ of prohibition. With the petition phrased in the contours of constitutional deprivation and functional denial, the writ was not granted at initial request. This court, with this combined appeal, affirms the district court's actions. FACTS [¶2.] On March 22, 1988, an application for involuntary hospitalization was filed in the First Judicial District Court of Laramie County, Wyoming following a suicide attempt by K.C., an individual with a history of medical problems and prior institutionalization at the StateHospital. K.C., with this history, had been under the local supervision of the Department of Public Assistance and Social Services (D-PASS) as a person with a recognized mental disturbance. In LaramieCounty, commitment cases are initially handled by a designated court commissioner who immediately appoints a medical examiner and establishes a detention hearing with present counsel appointed to represent the individual. Collaterally involved in factual overlay was a pending divorce and the previous loss of custody of her two children. [¶3.] Hospitalized by emergency detention ordered as a result of the commitment petition, a hearing was held on March 22, 1988, eventuating a continuing order for further examination with a designated medical examiner and hearing on March 28, 1988. It is from the March 28, 1988 hearing which produced the findings of the commissioner and subsequent order of the district court that this proceeding results. The commissioner found K.C. to be a mentally ill person within the criteria of W.S. 25-10-101(a)(viii)1 and recommended hospitalization in finding "that the proposed patient is mentally ill and recommends that she be involuntarily hospitalized." The commissioner then further said: With regard to the appropriate location of the proposed patient's involuntary hospitalization, however, I do not feel that the WyomingStateHospital is the appropriate site for involuntary hospitalization. Counsel for the proposed patient argued, and submitted a trial brief in support, that treatment at the Wyoming State Hospital would violate the proposed patient's right to treatment under the doctrine established in Clark v. Cohen, 794 F.2d 1979[79] Third Circuit (1988) and Wyatt v. Stickney[,] 325 F. Supp. 781 , N.D.[M.D.]Ala. (1971). The proposed patient has previously been hospitalized, during April and May of 1987, at the WyomingStateHospital. Her testimony at the hearing indicated that she did not receive treatment adequate, in the opinion of your Commissioner, to meet the constitutional right to treatment. Dr. Merrell testified that the proposed patient needs inpatient care for a period of at least six (6) months and perhaps as long as a year, depending upon the availability of programs transitional from the institution to the community. Dr. Merrell testified that to his knowledge, there are no community halfway house programs available in the State for psychiatric patients and that in his opinion, no hospital in Wyoming other than the StateHospital, is qualified to accept long-term patients (that is, patients whose condition requires a stay of greater than eight to ten weeks). Your Commissioner finds that counsel for the proposed patient has demonstrated a substantial likelihood that adequate treatment will not be received at the State Hospital and that other instate alternatives are not available. Pursuant to the provisions of W.S. section 25-10-110(j),[2] consideration of the "least restrictive and most therapeutic alternatives" available for involuntary hospitalization and the proposed patient's right to treatment, for the reasons set out above, I cannot recommend that the proposed patient be hospitalized at the Wyoming State Hospital, unless enforceable assurances are made that the constitutionally requisite treatment will be received. Therefore, it is your Commissioner's further recommendation that the Court enter an Order requiring the Department of Health and Social Services to locate and fund a placement either in or out of state which will satisfy the proposed patient's right to treatment or, in the alternative, that a plan of treatment be developed by the State Hospital which will meet the right to treatment standard as interpreted and enforced by the District Court. The Order is recommended to include a time limit of twenty (20) days within which to develop either alternative. [State's attorney] shall prepare the recommended Order. [¶4.] Except as to the place of hospitalization, the recommendations of the commissioner for the involuntary hospitalization of K.C. were approved by order of the district court. The district court specifically rejected any alternative placement or search for alternative care and held "[t]hat the proposed patient be hospitalized and transported forthwith to the WyomingStateHospital at or near Evanston, Wyoming." The district court's order further provided: 2. That, in conformity with W.S. § 25-10-113, the patient, within 15 days of admittance, shall be examined, the patient's record shall be reviewed and a plan of treatment for the patient shall be developed. 3. That, within 20 days of admittance, a copy of the Patient's plan of treatment shall be forwarded to this Court and an additional copy shall be forwarded to the patient's attorney, * * *. [¶5.] With alternative medical care placement denied, K.C. initially pursued two courses of action. K.C. appealed the involuntary commitment order and simultaneously filed a petition with this court to secure a writ of prohibition denying placement of her at the StateHospital. This court declined to issue the writ of prohibition which would have resulted in the immediate delay of hospitalization at the StateHospital, and K.C. has been institutionalized at the StateHospital since mid-April; unless recently released, which is not a matter of record here. [¶6.] This court will consider the direct appeal and the writ conjunctively as a single case now presented, essentially testing the propriety of the action of the district court in denying the finding of the commissioner that alternative mental institutional care should be required for this mentally ill person. K.C. phrases, as submitted questions: 1. Whether an involuntarily civilly committed individual is entitled to habilitation? 2. Whether the involuntary commitment statutes rise to the level of a state-created liberty interest in habilitation necessary to effect a right to live in the least restrictive, most therapeutic setting possible? 3. Whether an involuntarily civilly committed individual is entitled to either a constitutional or statutory right to treatment necessary to effectuate his/her right to live in the least restrictive, most therapeutic setting possible? 4. Whether it is a violation of procedural due process under both the federal and state constitutions, as well as, the involuntary commitment statutes, to transfer a patient to the WyomingStateHospital without a pre-deprivation hearing concerning the proposed plan of treatment at that facility? 5. Whether it is a violation of procedural due process under both the federal and state constitutions, as well as the involuntary commitment statutes, to fail to hold a hearing on an objection to a post-deprivation proposed individual plan of treatment? 6. Whether a post-commitment individualized plan of treatment lacking an assessment of the patient's problems and needs; the description of the services and treatment to be administered in the future and their possible side effects and feasible alternatives; the identity of specific individuals who will provide future services and treatment; the settings in which the services will be provided; a timetable for obtaining long-term goals or benefits from treatment or care; and a statement of the criteria for the patient's transition from the inpatient facility to a less restrictive, more therapeutic environment violates substantive due process under both the federal and state constitutions, as well as the involuntary commitment statutes? [¶7.] Alternatively, the State responds with the following issues: I. Does the appellate standard applied by this court to decisions of trial courts apply to district court "review" of actions of district court commissioners; has appellant shown that the decision of the district court was not supported by substantial evidence and was clearly erroneous? II. Do the involuntarily civilly committed have a Fourteenth Amendment due process right to treatment in the least restrictive, most therapeutic environment? III. Does Section 25-10-110(j) of the Wyoming statutes create an individual right to treatment in the least restrictive, most therapeutic environment for the involuntarily civilly committed? IV. Did the court below err in committing K.C. to the WyomingStateHospital? V. Do the Wyoming statutes provide adequate procedural due process for a post-commitment review of the continuing need for hospitalization? VI. Do the Wyoming statutes provide adequate procedural and substantive due process for a pre-commitment determination of the need for involuntary hospitalization? VII. Has appellant shown a constitutional or statutory violation by the proposed individual treatment plan formulated in her case? [¶8.] Initially, we point out that this appeal is confined to the issues presented which involve the validity of the commitment order and not subsequent status of care which might be tested by habeas corpus or further order of the district court, where continuing jurisdiction remains, to consider whether the patient should remain in the State Hospital. See Tribby v. Cameron, 379 F.2d 104 (D.C. Cir. 1967); Rouse v. Cameron, 373 F.2d 451 (D.C. Cir. 1966); National Center for State Courts, Guidelines for Involuntary Civil Commitment 86 (1986); 2 A. Freedman, H. Kaplan, & B. Sadock, Comprehensive Textbook of Psychiatry-II § 50.1 at 2429 (2d ed. 1975); and 3 B. Ennis & P. Friedman, Legal Rights of the Mentally Handicapped 1153 (1973). Secondly, there is no dispute, issue, or absence of evidence but that involuntary commitment and hospitalization were both appropriate and required for K.C. The dispute centers on the place of care for K.C. Fundamental in concept and concern in this anguished case is the belief, not only of the counsel for K.C. but also the court commissioner, that the StateHospital, where prior hospitalization had occurred, was not adequate to provide treatment for K.C. DISCUSSION [¶9.] We surmise from the carefully prepared and extended briefing of counsel as mutually evidenced that two intrinsic dispositive issues are presented by these combined proceedings: [¶10.] (1) Relationship of the district court to the court commissioner in ultimate authority and decision; and [¶11.] (2) Power or requirement of the district court to commit the mentally ill to a habilitation institution outside of the state in the face of evidence that the StateHospital may fail in sufficiency of either capacity or performance in curative hospitalization for K.C. 1. Relationship of the district judge to the court commissioner. [¶12.] The designated court commissioner, under W.S. 25-10-110(k)3 and Wyo. Const. art. 5, § 14, 4 has no more extended function than initial fact finding and entry of preliminary orders. The recommendations - conclusions based upon fact as well as law which are distilled into judgment orders - cannot be blindly accepted by the district court. The district court cannot delegate the power to hear, try, or determine a case to a court commissioner. Foster v. Foster, 768 P.2d 1038 (Wyo. 1989); Huhn v. Quinn, 21 Wyo. 51, 128 P. 514 (1912). [¶13.] This court recently discussed in Foster, 768 P.2d 1038 the court commissioner's role in relation to domestic relations matters. This court found that the district court's cursory review and acceptance of the court commissioner's findings leading to an increase in child support which was substantiated only by the district court's reading and signing of the prepared order were insufficient. Id. at 1042. [W]e do perceive that the Wyoming Constitution and applicable statutes contemplate that the district court shall conduct an independent review of the court commissioner's actions beyond that afforded in this case. The court commissioner may take evidence, make findings, and submit a recommendation to the district court. The district court, however, must review the evidence and findings and make its decision upon the basis of that review. Id. at 1041 (emphasis added). This court further elucidated that the record should clearly indicate that the district court independently reviewed the evidence and findings to reach its informed decision. Id. at 1041. In the instant case, the district court's rejection of the alternative placement recommendation and imposition of the state hospitalization plan shows that the required independent review of the case was undertaken. Simply put, "[g]eneral court commissioner responsibilities as a hearing examiner cannot be outspread, absent expansion of constitutional authorization, to include power of decisional finality within present constitutional terms. The differentiation is between adjunct fact finding and plenary judicial responsibility." Id. at 1042, Urbigkit, J., specially concurring. See also Northern Pipeline Const. Co. v. Marathon Pipe Line Co., 458 U.S. 50 , 102 S. Ct. 2858, 73 L. Ed. 2d 598 (1982). [¶14.] While the sociologically well-founded intent of the commissioner and the medical examiner5 concerning the sufficiency of the state institution may be well-founded, it is not determinative and binding upon the district court in its exercise of application of state statutes and funding opportunities to its decision. Consequently, the real issue does not encompass an abuse of discretion analysis for the district court to disregard part of the commissioner's recommendation as it did, but rather a sufficiency of fact to sustain the district court's exercise of discretion in institutional selection. It is to that subject that we next address attention. 2. The power of the district court to commit mentally ill persons outside this state. [¶15.] The statutory involuntary commitment process,6 as invoked by application of W.S. 25-10-110, has provisions for emergency detention, W.S. 25-10-109; preliminary hearing, W.S. 25-10-109(h); and general commitment hearing, W.S. 25-10-110(f). In addition to dismissal, disposition options statutorily available in W.S. 25-10-110(j) to the district judge include: (i) Order his hospitalization; (ii) Assign him to a hospital; (iii) Send to the hospital, with the patient a certified copy of the findings of fact and order and a copy of the examiner's report; (iv) Specify where he will be detained pending transportation to the hospital. Only during an extreme emergency shall a person be detained in a nonmedical facility used for detention of persons charged with or convicted of penal offenses. As defined in W.S. 25-10-101(a)(v), "`Hospital' means a facility designated pursuant to W.S. 25-10-104 or the state hospital;" with further definition of "StateHospital" afforded in W.S. 25-10-101(a)(xi) which "means the Wyoming state hospital at Evanston, Wyoming." W.S. 25-10-104 outlines D-PASS's duties to hospitals other than the StateHospital.7 At present, Wyoming has no psychiatric halfway houses, and there is no other domiciliary care facility approved in accord with W.S. 25-10-104. [¶16.] The county is responsible for initial detention and maintenance expenses, W.S. 25-10-112, with hospitalization financial responsibility thereafter assigned to either the State Board of Charities and Reform for care provided in the StateHospital or D-PASS if care is provided elsewhere. It is in this source of responsibility for providing medical care and the availability and expense of costs to be required that the practical legislative-administrative agency responsibilities become entangled. Realistically, the difference between the district court and the commissioner in this case was whether the more conservative budgetary approach was justified, appropriate or permitted. Clearly, nothing statutorily stated confines the district court to accept the out-of-state institution alternative with the probable singularly higher cost involvement. The real issue, lacking mandatory statute, is whether the state constitution, the Fourteenth Amendment to the United States Constitution, or other federally preemptive criteria require the district court to provide a standard of care allegedly not available within the StateHospital.8 [¶17.] Essentially, K.C. is advocating that she is denied her right to treatment9 because she is not receiving the best treatment for her illness since she is not being treated in a psychiatric halfway house.10 We disagree with K.C.'s broad characterization of the right to treatment and her implications. Even Judge Bazelon in Rouse, 373 F.2d at 456-57, while first enunciating such a right, recognized the limits of it: The hospital need not show that the treatment will cure or improve him but only that there is a bona fide effort to do so. This requires the hospital to show that initial and periodic inquiries are made into the needs and conditions of the patient with a view to providing suitable treatment for him, and that the program provided is suited to his particular needs. * * * The effort should be to provide treatment which is adequate in light of present knowledge. * * * [T]he possibility of better treatment does not necessarily prove that the one provided is unsuitable or inadequate. [Emphasis added & footnotes omitted.] The Circuit Court of Appeals for the District of Columbia further clarified and honed this right in Tribby, 379 F.2d at 105: We do not suggest that the court should or can decide what particular treatment this patient requires. The court's function here resembles ours when we review agency action. We do not decide whether the agency has made the best decision, but only make sure that it has made a permissible and reasonable decision in view of the relevant information and within a broad range of discretion. [Emphasis added.] [¶18.] Consequently, our review of the dilemma faced by the district court in placement decision11 centers simply on whether the district court abused its discretion by disregarding either statutory or constitutional law in not requiring a more preferable level of care. We find no abuse of the district court's discretion in choosing placement at the StateHospital. [¶19.] This resolution is confined to our statutory system as provided by our legislature. As Dr. Birnbaum has astutely recognized: [T]he state legislature rather than the judiciary, seems the proper instrumentality to take the lead in establishing and enforcing a right to adequate treatment. Only the legislature has the means to set up a comprehensive scheme and to coordinate it with necessary legislative appropriations; the judiciary is limited to a case-by-case development. Birnbaum, A Rationale for the Right, 57 Geo.L.J. 752, 765 (1969). See also Bazelon, Implementing the Right to Treatment, 36 U. of Chi.L.Rev. 742, 745 (1969). [¶20.] With neither the Wyoming Constitution nor the United States Constitution mandating a greater degree of care than what the legislative branch has funded and the executive branch has provided through facilities within this state, we find no abuse of discretion in the district court's placement of K.C. at the StateHospital. [¶21.] Affirmed. FOOT