Opinion ID: 1703516
Heading Depth: 3
Heading Rank: 2

Heading: Facial Challenge: AD-11-97 on Procedural Due Process Grounds

Text: ¶ 60 We begin by looking at the relevant provisions contained within AD-11-97. The directive provides that administrative review of the order must occur six months after the order to treat was issued (regardless of whether staff actually began administering the medication). [17] After that initial review, reviews are to occur annually. [18] The treatment team conducts those reviews, during which the team must conclude that all four criteria are met, thus justifying the patient's involuntary medication. [19] ¶ 61 The directive also sets forth patient appeal rights. If a court issues an order to treat a patient involuntarily and the four criteria are clearly established in the order, the patient has a right to judicial review, not administrative review, for the first six months after the order is issued. [20] Thereafter, when the treatment team holds administrative reviews of the order  as we noted previously, initially six months after the court issues the order and annually thereafter  the patient may appeal the treatment team's determination at those reviews to an independent review panel. [21] The directive requires that panel to be made up of: at least [three] members consisting of a combination of the following facility staff, none of whom are members of the patient's treatment team: a physician; a psychologist; and, the facility Director or designee. [22] At that hearing, the treatment team has the burden to show by a preponderance of the evidence that all four criteria required either to begin or to continue administration of psychotropic medication have been satisfied. The panel may further ask questions of the patient and of a member of the treatment team. The panel then issues its decision within five days. If it concludes by a majority that includes the physician member that all four criteria have been met, the panel will uphold the order to medicate. Otherwise, it will reverse or modify the decision to medicate the patient involuntarily. [23] ¶ 62 Wood asserts that AD-11-97 does not comport with procedural due process requirements facially in two respects. First, in his view, the directive fails because the treatment team, which is made up of staff involved with the patient's day-to-day care, conducts the initial determination and administrative review. He argues that due process requires an independent decisionmaker to review the order. He cites for support Harper, 494 U.S. at 233, 110 S.Ct. 1028, in which the United States Supreme Court observed that the policy in question adequately addressed the independence of the decisionmaker.... None of the hearing committee members may be involved in the inmate's current treatment or diagnosis. He also invokes Anthony D.B., 237 Wis.2d 1, ¶¶ 30-31, 614 N.W.2d 435, in which we emphasized the importance of an independent review of the medical order. ¶ 63 Second, Wood asserts that the frequency of the review is inadequate to safeguard procedural due process protections. He compares the reviews required here (at six months and then annually thereafter) with those mandated by the policy in Harper (initial review within 14 days and then every six months thereafter, with the administering physician submitting biweekly reports) to support his proposition that the reviews here do not occur with sufficient frequency to satisfy procedural due process. ¶ 64 As to the first argument related to independent review, we disagree that due process requires the type of independent decisionmaker that Wood advocates. As the State points out, reading on from that portion of Harper that Wood quotes, the Supreme Court expressly explains that it did not require an independent decisionmaker to review the decision to medicate. In the absence of record evidence to the contrary, we are not willing to presume that members of the staff lack the necessary independence to provide an inmate with a full and fair hearing.... In previous cases involving medical decisions implicating similar liberty interests, we have approved use of similar internal decisionmakers.... [I]t is only by permitting persons connected with the institution to make these decisions that courts are able to avoid unnecessary intrusion into either medical or correctional judgments. Harper, 494 U.S. at 233-35, 110 S.Ct. 1028 (quoting Vitek v. Jones, 445 U.S. 480, 496, 100 S.Ct. 1254, 63 L.Ed.2d 552 (1980)) (citations omitted). Moreover, even if an independent decisionmaker is required, we are satisfied that that requirement is addressed by the directive's provision for further review of the treatment team's decisions by an independent panel, none of whom are members of the patient's treatment team. ¶ 65 As to the alleged infrequency of review, we also reject that argument. The fact that the reviews required by the policy in Harper occur more frequently than they do under the policy here does not necessarily compel the conclusion that less frequent reviews violate procedural due process. Indeed, we have held that periodic annual review of orders to compel medication on persons committed under Wis. Stat. chap. 980 sufficiently satisfies due process. See Anthony D.B., 237 Wis.2d 1, ¶ 31, 614 N.W.2d 435. We are persuaded that the review protocol required by the directive occurs with sufficient frequency. ¶ 66 In sum, we are satisfied that AD-11-97 is not facially invalid on procedural due process grounds. Here, the directive requires that the treatment team members agree that the patient is not competent to refuse medication, that medication is in his or her best interest to medicate voluntarily, that without it he or she presents a current risk of harm to self or others, and that there are not acceptable alternative means to address the dangerousness. More significantly, once the order is in place, the team implements it only after again being satisfied that those four criteria have been met. Administrative review occurs six months after the issuance of the order, regardless of whether the patient has been administered the medication, and annually thereafter. Further, the patient has the right to appeal the initial order to a circuit court and to appeal the administrative reviews to an independent panel. In our view, those requirements adequately provide procedural due process protections to a patient who is subject to an order for involuntarily medication. [24]