Opinion ID: 2178267
Heading Depth: 1
Heading Rank: 2

Heading: ms. walker's appeal

Text: On appeal, Ms. Walker contends, as she did in the trial court, that the involuntary administration to her of Haldol in 1997 violated the CMHS policy in several respects. Specifically, she complains that she was forcibly injected with Haldol despite the failure of the treating psychiatrist 1. to make a referral to the medical director; 2. to present the medical director with supporting documentation; and 3. to enter a clinical note in Ms. Walker's record with detailed information regarding her medical history and the reasons for the issuance of an involuntary medication order. According to Ms. Walker, this noncompliance with the policy also deprived her of liberty interests secured by the Due Process Clause of the Fifth Amendment. Ms. Walker further claims that the physicians at Saint Elizabeths failed to consider whether the involuntary administration of Haldol posed a risk to her health, especially in light of her prior history of adverse reactions to such medications. In the trial court, CMHS did not challenge Ms. Walker's position that the CMHS policy created enforceable rights, but argued instead that Respondent was medicated in accordance with [the] CMHS Policy while she was in the Hospital. On appeal, however, CMHS has abruptly changed direction and effectively has acknowledged the Hospital's failure to follow the precise letter of the policy. In its brief CMHS concedes that the Bureau Medical Director was notified of the plan to medicate by the Patient Advocate and not by the treating psychiatrist, [that] the considerations required to be presented to the Bureau Medical Director were contained in a series of progress notes authored by several treating doctors rather than in a single note, and [that] the note of the Bureau Medical Director did not contain each of the considerations described in the CMHS policy. CMHS argues, however, that [t]he Policy here creates no legally recognized right, because, according to CMHS, the policy does not have the force of law. CMHS asserts that the procedures utilized at Saint Elizabeths are in conformity with due process, that the policy adds no enforceable protections beyond those secured to Ms. Walker by the Fifth Amendment, and that Ms. Walker is therefore entitled to no relief. The position taken by CMHS on appeal brings a completely new issue into the case. In the trial court, the litigation centered on whether CMHS had complied with its own policy. The dispositive character of this argument was not challenged by any party. Indeed, this was the only question addressed by the trial judge. Thus, in effect, CMHS is asking us to affirm the trial judge's order on a ground i.e., that the policy conferred no rights on Ms. Walker and is not enforceable which is different from the ground relied upon by the judge herself. Further, the position that CMHS is urging on appeal was never presented to the trial court at all. The kind of barristerial about-face which characterizes [CMHS' position in] this case finds little favor in the courts. B.J.P. v. R.W.P., 637 A.2d 74, 78 (D.C.1994). As Judge Spottswood Robinson wrote so eloquently for the court in Miller v. Avirom, 127 U.S.App. D.C. 367, 369-370, 384 F.2d 319, 321-322 (1967): In our jurisprudential system, trial and appellate processes are synchronized in contemplation that review will normally be confined to matters appropriately submitted for determination in the court of first resort. Questions not properly raised and preserved during the proceedings under examination, and points not asserted with sufficient precision to indicate distinctly the party's thesis, will normally be spurned on appeal. Canons of this tenor reflect, not obeisance to ritual, but considerations of fairness to the court and the parties and of the public interest in bringing litigation to an end after fair opportunity has been afforded to present all issues of law and fact. [Footnotes and internal quotation marks omitted.] In the present case, the claim on which CMHS is attempting to focus the appeal, namely, that its policy is nothing more than an internal handbook or set of guidelines and is therefore not enforceable, bears no significant relation to the question litigated and decided in the Superior Court. To be sure, we may affirm a judgment on any valid ground, even if that ground was not relied upon by the trial judge or raised or considered in the trial court. See, e.g., In re O.L., 584 A.2d 1230, 1232 (D.C.1990). Our authority to do so presupposes, however, that the appellant has suffered no procedural unfairnessthat is, that she has had notice of the ground upon which affirmance is proposed, as well as an opportunity to make an appropriate factual and legal presentation with respect thereto. Sheetz v. District of Columbia, 629 A.2d 515, 519 n. 5 (D.C.1993). Here, Ms. Walker had no notice in the trial court of CMHS' subsequently improvised position that the policy was not enforceable. Had she received such notice, she could have adjusted her strategy to meet this contention, and would doubtless have focused, in her preparation for trial and in her factual and legal presentation, on the status of the policy. We are therefore of the opinion that considerations of procedural fairness preclude us from affirming on the ground now being asserted by CMHS. Moreover, though we do not decide the issue, it is less than clear that even if CMHS had asserted its current theory in timely fashion, its position would be legally sound. It is true that we have held, in a variety of factual settings, that internal policy manuals and similar documents generally do not give rise to judicially enforceable rights, for they are not statutes or regulations and have no legal force or effect. See, e.g., Clark v. District of Columbia, 708 A.2d 632, 636 (D.C.1997) (suicide prevention plan for juvenile detention facility); Morgan v. District of Columbia, 468 A.2d 1306, 1317-18 (D.C.1983) (en banc) (police department general orders). But the policy at issue here must be considered in its constitutional context. In the District of Columbia, as in all jurisdictions, the courts have long recognized and upheld the right of every person to bodily integrity .... In re A.C., 573 A.2d 1235, 1243 (D.C.1990) (en banc). This right embraces a significant liberty interest in avoiding the unwanted administration of antipsychotic drugs under the Due Process Clause of the [Constitution], Washington v. Harper, 494 U.S. 210, 221-222, 110 S.Ct. 1028, 108 L.Ed.2d 178 (1990), for [t]he forcible injection of medication into a nonconsenting person's body represents a substantial interference with that person's liberty. Id. at 229, 110 S.Ct. 1028 (citations omitted); accord, Riggins v. Nevada, 504 U.S. 127, 135, 112 S.Ct. 1810, 118 L.Ed.2d 479 (1992). Thus [t]he government cannot intrude upon [a person's] bodily integrity without a showing of overriding justification and medical appropriateness. Khiem v. United States, 612 A.2d 160, 165-166 (D.C.1992), cert. denied, 507 U.S. 924, 113 S.Ct. 1293, 122 L.Ed.2d 684 (1993) (citing Riggins ). The policy on which Ms. Walker relies was adopted as a result of the District's recognition of its obligation to provide adequate protection for the significant liberty interest in avoiding the involuntary administration of antipsychotic drugs. The Supreme Court has explained that the administration of such drugs cannot withstand challenge if there are no procedural safeguards to ensure [that] the [patient's] interests are taken into account. Harper, 494 U.S. at 233, 110 S.Ct. 1028; see also Kulas v. Valdez, 159 F.3d 453, 456 (9th Cir.1998). CMHS itself has recognized the need for such procedural safeguards and has identified the policy as the procedure which satisfies this constitutional requirement. Indeed, in this very case, CMHS represented to the trial court, correctly, that the procedures for involuntary administration of medication are governed by CMHS Policy 50000.430.2B, and have been upheld by the D.C. Court of Appeals in [ Khiem ]. Ms. Walker argues, not without some force, that [i]t is quite an about-face for the CMHS now to contend that its policy has no legal force. If this is truly the case, the entire process for forcibly medicating patients at St. Elizabeths would be thrown into question, as the procedural safeguards required by Harper seem to be, on the government's theory, nonexistent. In any event, CMHS has effectively conceded that the decision of the trial court cannot be sustained on the theory that there was no material violation of the CMHS policy, for there has in fact been significant noncompliance with the policy. [3] CMHS' alternative theorythat the policy provides no enforceable rightswas not presented to the trial court and, for the reasons stated, we are not prepared to affirm the decision on that ground. Accordingly, the trial court's decision must be reversed, and Ms. Walker's hospital records must be corrected to reflect that the involuntary medication order which led to the administration to her of Haldol was not authorized by law. [4]