Opinion ID: 883216
Heading Depth: 1
Heading Rank: 2

Heading: issues

Text: Were G.P.'s procedural and constitutional rights otherwise violated, mandating reversal of his commitment? G.P. groups a number of claims under this issue. We first address his argument that Phillip Oliver did not have the requisite direct knowledge of the facts to make a request for commitment with the county attorney pursuant to § 53-21-121, MCA. Oliver admitted on cross-examination that he did not have personal knowledge of any present threats or suicidal gestures on the part of G.P. However, in his petition for commitment, he stated he had personal knowledge that G.P. was of the same frame of mind today and has the same attitude and exhibits the same characteristics as during those times [in the past] when I heard him say that he was going to do himself in. Oliver's overall knowledge of the facts concerning G.P.'s history and illness was demonstrated in his testimony and request for involuntary commitment. We conclude he had sufficient personal knowledge of the facts to make a joint request for commitment, along with Dr. Carlson, to the county attorney. G.P. next claims his evaluation by Dr. Carlson pursuant to § 53-21-129(2), MCA, improperly occurred prior to his initial appearance before the District Court, instead of after the hearing and after he was advised of his rights. He states the evaluation was completed prior to the court granting Dr. Carlson the authority to conduct the evaluation. Citing § 53-21-141(1), MCA, he also complains that Dr. Carlson did not advise him that the interview was to be used for the evaluation and not for treatment. The court accepted into evidence two letters written by Dr. Carlson. The first was written on August 12, the day before G.P.'s initial hearing. This is the letter of which G.P. here complains. However, G.P. has identified nothing in Dr. Carlson's August 12 letter which refers to privileged communication with G.P. Dr. Carlson testified on August 18 that he tried to talk with G.P. on at least five different occasions during G.P.'s hospitalization, but that G.P. was either too aggressive or not rousable from sleep on most of those occasions. We really felt that there was very little accomplished by a subsequent interview, and we would just let him sleep so we would not have to medicate him further, put him in restraints. Dr. Carlson's letter of August 17, 1993, which was the second letter introduced into evidence, is germane to many of G.P.'s other complaints concerning his treatment. This letter was written after G.P.'s initial hearing and after G.P. was fully advised of his rights. G.P. claims he was continually detained in seclusion and in isolation as well as maintained in restraints in violation of § 53-21-146, MCA. He alleges that he was denied medical care for broken ribs in violation of § 53-21-142(11), MCA; denied the right of telephone communication in violation of § 53-21-142(3), MCA; and administered medication within twenty-four hours before the hearing, despite his objection, in violation of § 53-21-115, MCA. In his August 17 letter, Dr. Carlson stated: [G.P.] has continued to demonstrate extremely severe symptoms of mental illness. In fact, if anything, [G.P.]'s illness has worsened considerably over the last few days. [G.P.] has remained on the closed unit at the Psychiatric Center. He has spent the majority of his time being secluded to his room because of his severely manic behaviors... . [G.P.] has been extremely destructive of hospital property. This includes an episode shortly after admission where he wrote at great lengths with magic marker filling one of the walls of his hospital room with rambling, grandiose and delusional content... . On the morning of 8/12 he had a noose hanging from an air screen in his hospital room. He, the following day, hung a bed sheet from this noose claiming that it was an effigy but did not identify who this was supposed to be... . We have had to limit his telephone calls because of complaints of acquaintances about the inappropriateness of his calls, both in terms of time of day as well as duration and content. On 8/14 [G.P.] became very agitated on the telephone. He began banging the telephone on a counter and then began indiscriminately waving the telephone around[.] ... When staff attempted to intervene, he managed to get one of the nurses in a head lock, injuring his neck. He then proceeded to kick at and kick another employee. He has attempted to bite employees. He has spit on employees and thrown urine in urinals at employees. [G.P.] is well aware of his HIV status[.] ... [G.P.] has essentially been in restraints about 90% of the time since last Saturday's incident. During attempts to take him out of restraints, although he is initially agreeable and calm, he rapidly becomes very agitated and assaultive again to staff. [G.P.] has removed himself from restraints on three occasions including an episode today where he cut himself out of restraints using a piece of metal again obtained by tearing up his mattress. [G.P.] has completely refused treatment at our hospital... . He has been ordered medication against his will because of his obviously dangerous behaviors. This medication has had to be administered intramuscularly in almost every occasion. [G.P.] shows no insight into his illness. He is unwilling to take Lithium... . When he is not sedated, he is almost unmanageable at its occlusion. ..... [G.P.] is truly a very ill individual. He has severe characterologic symptoms, but at this time he is obviously very manic and quite unable to care for himself and his affairs... . He has made it almost impossible to provide him with care in this setting. To that end, I think [G.P]'s prognosis is generally very poor, but he is deserving of the effort to provide him with treatment. The right to be free from physical restraint and isolation under § 53-21-146, MCA, is not absolute. It exists except for emergency situations. Dr. Carlson's letter explains generally the use of isolation and restraints to control G.P.'s violent and aggressive behavior toward hospital staff and patients. In his allegations, G.P. has not identified any specific instance in which he was restrained or isolated in violation of his rights. Dr. Carlson testified that G.P. was not amenable to being transported to the X-ray room of the hospital to have his ribs X-rayed. Dr. Carlson further testified that the hospital does not provide medical treatment for broken ribs other than X-raying them to determine whether they are indeed broken. Patients admitted to a mental health facility have the right to reasonable access to telephone communications. Section 53-21-142(3), MCA. G.P. has not established that he was denied this right. Dr. Carlson testified that G.P. was not denied all telephone access. He was limited as to time and number of phone calls, so that he could make no calls after midnight and other patients could also use the phone. Patients involuntarily detained for serious mental illness have a right to be free from any but lifesaving medication for up to twenty-four hours prior to a hearing. Section 53-21-115, MCA. Dr. Carlson testified that he determined G.P.'s behavior was so agitated that he was a risk to himself and a threat to the safety of others. The District Court found that the medication given to G.P. prior to the hearing was lifesaving. We conclude that finding is supported by substantial credible evidence. None of the rights claimed by G.P. are absolute. G.P. has not demonstrated any restrictions on his rights other than those necessary for his treatment, evaluation, and care. Further, G.P. has not established that reversal of his commitment would be a proper remedy for any such denial or restriction of his rights. After reviewing the record, we conclude that G.P. has not established that his commitment should be reversed due to violations of his procedural and constitutional rights.