Opinion ID: 2185395
Heading Depth: 1
Heading Rank: 4

Heading: past procedural deprivations

Text: Dismissal of the appeals from the Stutsman County court's denials of T.H.'s discharge does not end our inquiry about past procedural deprivations. While we do not directly review those orders, T.H.'s present involuntary treatment is based on those prior continuations extending his initial commitment. His present treatment order, however less restricted, stems from multiple and repeated procedural deprivations going back eight years. For those years, the treatment order under review has been in effect without an evidentiary hearing. Meanwhile, T.H. has petitioned for discharge at least five times, although deprived of procedural protections guaranteed by law each time. Although no evidentiary hearing may have been statutorily mandated for each of those periodic reviews, the procedural safeguard of assistance of counsel was mandated but omitted each time. The superintendent of the Hospital failed to notify T.H.'s attorney of the results of the periodic review each year from 1984 until 1990. That notice is clearly directed by NDCC 25-03.1-31. See note 1. While we are told that, recently, the Hospital has begun notifying the attorney of record for other involuntary patients, that belated effort does nothing to redress past deprivations of T.H.'s procedural rights. Moreover, T.H. correctly argues that the mental-health court is required to appoint legal counsel to assist him for each periodic review, for a hearing, if any, and for an appeal, if necessary. NDCC 25-03.1-13, 25-03.1-29, and 25-03.1-31. This was not done for T.H. until 1990. We agree that the Mental Health Act contemplates that counsel be made available to advise and assist an involuntary patient during a periodic review if the patient desires. According to NDCC 25-03.1-31, the superintendent of the treating facility must notify the involuntary patient's attorney of the results of the review. NDCC 25-03.1-13(1) states: Every respondent under this chapter is entitled to legal counsel. NDCC 25-03.1-13(4) directs that, [i]f the respondent is indigent, the court shall order that appointed counsel be compensated from county funds of the county which is the respondent's place of residence in a reasonable amount based upon time and expenses. See also In Interest of J.B., 410 N.W.2d 530 (N.D.1987). (In accord with the fourteenth amendment of the federal Constitution, North Dakota law provides the right to counsel, at state expense if necessary, in any judicial proceeding concerning a patient's commitment.) Burleigh County took these steps for the periodic review in 1991, but the Stutsman County court completely failed to safeguard T.H.'s right to counsel from 1984 until 1990. Without the assistance of counsel, even a competent patient would be handicapped in understanding the legal labyrinth of involuntary mental-health procedures. Professor Thomas Lockney spoke to this factor in 1975 in his predicate article for the 1977 Mental Health Act: Underlying this increase in strict due process scrutiny is an emerging focus on the worth of individuals and of procedures designed for their protection. In 1972 Judge Joseph Schneider observed that the allegedly mentally ill person who is caught up in the nonvoluntary hospitalization process usually possesses neither the money, the knowledge, nor the initiative to assert his rights unless the state develops the resources to assist him. If the rights guaranteed all citizens under the constitution are different or watered down for allegedly mentally ill persons, that necessarily implies that they are somehow less worthy as human beings to exercise the constitutional rights to which we all assume we are entitled. Viewed in this way, it is incongruous to argue that increasing legal protections for mental patients would make criminals out of them. Surely they are entitled, at the very least, to the same legal protection as criminals. Lockney, Constitutional Problems with Civil Commitment of the Mentally Ill in North Dakota, 52 North Dakota L.R. 83, 86 (1975). Availability of assistance of counsel to an involuntary patient is an important safeguard during a periodic review. Without this safeguard, a periodic review may not be meaningful for the involuntary patient, as this lame record of periodic reviews of T.H.'s continuing treatment order implies. Therefore, we conclude that the repeated deprivations of the right to counsel, during past periodic reviews of T.H.'s continuations, compel an evidentiary hearing under NDCC 25-03.1-31, to dispel any doubt about his continued need for treatment. Even if T.H. is unable to develop independent evidence that he is not in need of continued treatment, he may be able to contest the existing evidence under the statutory standards for involuntary treatment. Even though the initial order for treatment was proper, the State cannot constitutionally continue the confinement of a nondangerous individual who is capable of surviving safely in freedom by himself, or with the help of willing and responsible family members or friends. O'Connor v. Donaldson, 422 U.S. 563, 95 S.Ct. 2486, 45 L.Ed.2d 396 (1975). A periodic review requires the same judicial scrutiny as commencement of involuntary treatment. The standards for continuation are the same as for an involuntary treatment to commence. More than mere benefit to the patient from continued treatment must be shown. See In Interest of R.N., 450 N.W.2d 758 (N.D.1990). The experts' explanations must show why continuation is the least restrictive condition necessary for the treatment. See In Interest of Goodwin, 366 N.W.2d 809 (N.D.1985). The explanations must show that no less restrictive alternative is appropriate. See In Interest of R.R., 479 N.W.2d 138 (N.D.1992). Conclusive reports, particularly ones with preprinted conclusions checked or underlined without satisfactory explanations, are unacceptable. See In Interest of Riedel, 353 N.W.2d 773 (N.D.1984), See also O'Callaghan v. L.B., 447 N.W.2d 326 (N.D.1989). In sum, proof that the patient requires continued treatment is necessary. A person requiring treatment is one who, without treatment, may be reasonably expected to suffer a serious risk of harm, or to pose a serious risk of harm to self, others, or property. NDCC 25-03.1-02(10). Serious risk of harm means a substantial likelihood of suicide, serious bodily harm to another, or substantial deterioration in [the patient's] physical health, in mental health, or by substantial injury, disease, or death to the patient. Id. See In Interest of M.B., 467 N.W.2d 902 (N.D.1991). The risk of harm to the patient, to others, or to property must be serious and substantial. At a periodic review hearing, the burden of proof is the same as in an involuntary treatment hearing. NDCC 25-03.1-31. Clear and convincing proof is necessary. NDCC 25-03.1-19. Here, an evidentiary hearing will ensure that T.H. is properly continued as an involuntary patient if he needs it, despite past procedural deprivations. To redress past deprivations of T.H.'s procedural right to counsel, we direct an evidentiary hearing under NDCC 25-03.1-31 within fourteen days after remand. ERICKSTAD, C.J., LEVINE and VANDE WALLE, JJ., and JAMES K. O'KEEFE, District Judge, concur. The Honorable JAMES H. O'KEEFE, District Judge, sitting as a member of the Court to fill the vacancy created by the resignation of Justice H.F. GIERKE III. Justice JOHNSON not being a member of this Court at the time this case was heard did not participate in this decision.